Oral and esophageal pathology

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Answer 1

Aphthous ulcer. Single ulceration with an erythematous halo surrounding a yellowish fibrinopurulent membrane (arrow).

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Answer 2

, fibroma.

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pyogenic granuloma

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geographic tongue

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Fordyce granules, characterized by heterotopic sebaceous glands (arrows).

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Oral hairy leukoplakia characterized by the presence of demarcated white plaques to raised, white lesions with vertical corrugations on the lateral aspect of the tongue in a patient with HIV infection

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Answer 7

. Microscopic image showing irregular epithelial hyperplasia with filiform or hair-like keratin projections, associated parakeratosis, and acanthosis

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Squamous papillomas of the tonsil and uvula (above, left and right, arrows)

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Answer 9

Squamous papillomas

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Answer 10

leukoplakia

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leukoplakia

The histologic features associated with a clinical leukoplakic lesion include hyperkeratosis with or without parakeratosis, often with irregular epithelial hyperplasia with or without dysplasia; in this example there is parakeratosis and absent dysplasia

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Answer 12

Diffuse erythroplakia of the palate and uvula

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erythroplakic lesion is associated with histologic evidence of dysplasia and/or carcinoma that may include severe dysplasia

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carcinoma in situ (vertical arrow), and microinvasive carcinoma (horizontal arrow). from erythroplakia

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Actinic cheilitis: Leukoplakic lesion of the lower lip with loss of the distinct demarcation between the lower lip vermilion border and the skin of the lip

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actinic chellitis. histologic findings include disordered maturation of the epithelium with cytologic atypia, increased mitotic activity, orthokeratosis, and connective tissue solar changes

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Squamous cell carcinoma of the lower lip (above left), lateral tongue (above right)

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Squamous cell carcinoma of tonsil

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Keratinizing invasive squamous cell carcinoma.

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Answer 20

non-keratinizing (right) invasive squamous cell carcinoma.

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Answer 21

Schneiderian papilloma, exophytic (septal) type.

the tumor has a papillary growth protruding from the surface respiratory epithelium composed of a thickened non-keratinized squamous (epidermoid) epithelium;

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Answer 22

Schneiderian papilloma

magnification the epithelium shows cytomorphologic uniformity, retention of cellular polarity, absence of cytologic atypia, and the presence of scattered mucin microcysts and intraepithelial inflammatory cells.

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Answer 23

Schneiderian papilloma, inverted type. Endophytic or ‘inverted’ growth pattern consisting of thickened epithelial nests arising from the surface and growing down into the stroma; the surface epithelium has undergone squamous metaplasia and the stroma is composed of a myxomatous to fibrous tissue with admixed chronic inflammatory cells.

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, nasopharyngeal carcinoma, undifferentiated type. The syncytium-like nests of epithelium (arrow) are surrounded by lymphocytes

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nasopharyngeal carcinoma in-situ hybridization for EBV (EBER) is positive in the neoplastic cells.

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Answer 26

laryngeal carcinoma. Note the large, ulcerated, fungating lesion involving the vocal cord and pyriform sinus.

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obstructive sialadenitis

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Answer 28

obstructive sialadenitis parenchymal changes include marked inflammation and acinar atrophy; ducts are dilated and filled with mucopurulent material

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Answer 29

Lymphoepithelial sialadenitis (LESA) LESA presenting as a markedly enlarged left parotid gland along the mandible and lateral neck region.

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Answer 30

Lymphoepithelial sialadenitis (LESA) parotid gland parenchyma is replaced by a mature lymphocytic infiltrate in association with multiple germinal centers (arrows), as well as acinar atrophy and formation of lymphoepithelial lesions; this process is well demarcated from the adjacent salivary gland parenchyma, seen along the left side of this illustration

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Answer 31

Lymphoepithelial sialadenitis (LESA) characteristic appearance of a lymphoepithelial lesion represented by lymphocytic infiltration of proliferating ductal epithelium and obliteration of ductal lumina surrounded by a severe mixed chronic inflammatory cell infiltrate.

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Answer 32

Mucocele: Fluctuant fluid-filled lesion on the lower lip subsequent to trauma

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Mucocele On the right, cystlike cavity filled with mucinous material (star) and lined by organizing granulation tissue, arrow).

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Pleomorphic adenomas submucosal painless palatal swelling

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pleomorphic adenoma

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Pleomorphic adenoma, fine needle aspiration

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Warthin Tumor

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Answer 38

Warthin Tumor

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Answer 39

Mucoepidermoid carcinoma growing in nests composed of squamous cells as well as clear vacuolated cells containing mucin

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Answer 40

Mucoepidermoid carcinoma Mucicarmine stains the mucin reddish pink

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Answer 41

Adenoid cystic carcinoma The tumor cells have created a cribriform pattern enclosing secretions.

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Adenoid cystic carcinoma perineural invasion by tumor cells.

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Answer 43

Zenker's diverticulum

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Hiatal hernia (type 1)

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Viral esophagitis multiple herpetic ulcers in the distal esophagus

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Answer 46

Viral esophagitis Multinucleate squamous cells containing Herpesvirus nuclear inclusions

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Viral esophagitis Cytomegalovirus-infected endothelial cells with nuclear and cytoplasmic inclusions

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primary eosinophilic esophagitis marked reactive squamous hyperplasia, numerous intraepithelial eosinophils (measuring \>20 per high-power field), and accumulation of eosinophils in the superficial portions of the epithelium.

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primary eosinophilic esophagitis The esophageal mucosa shows burrows, concentric rings, and is studded with whitish-gray nodular plaques and exudates.

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Answer 50

B, Barrett’s esophagus. Note the small islands of paler squamous mucosa within the Barrett’s mucosa

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Answer 51

Barrett’s esophagus transition between esophageal squamous mucosa (left) and Barrett metaplasia, with abundant metaplastic goblet cells

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barret's esophagus

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Esophageal adenocarcinoma

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Esophageal squamous cell carcinoma

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Answer 56

squamous cell carcinoma (squamous nodules)

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Answer 57

adenocarcinoma (forms glands)

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Answer 58

Squamous papilloma