Oral Path Flashcards
What is an epidermoid cyst?
A non-cancerous small bump beneath the skin. They present as painless swellings, often following trauma or surgery
What are the two types of osteomas histopathologically?
Compact and cancellous
The compact type will present with a mass of dense lamellar bone with few marrow spaces. The cancellous type will have interconnecting trabeculae enclosing fatty or fibrous marrow.
Name a developmental white lesion
Fordyce granules
What does the affected bone look like in Paget’s disease?
The affected bones are thickened but weaker than normal bone and pathological fractures can occur
What is the aetiology of Lateral periodontal cysts?
Odontogenic developmental
What is acanthosis?
Increased thickness of the prickle cell layer
Name this lesion from its histopathology:
- Large numbers of multi-nucleate (more than one nuclei) osteoclast-like giant cells
- The lesion will be set in a vascular fibrous stroma
- Areas of haemorrhage and haemosiderin
It can be either:
- Central giant cell granuloma
- Cherubism
- Brown tumour of hyperparathyroidism
- Giant-cell tumours
- Aneurysmal bone cysts
What are all these types of?
● Ameloblastic carcinomas
● Primary intraosseous squamous cell carcinoma
● Sclerosing odontogenic carcinoma
● Clear cell odontogenic carcinoma
● Ghost cell odontogenic carcinoma
Odontogenic carcinomas
What is the treatment for eruption cysts?
No treatment or expose the erupting tooth
What is the treatment for lipomas?
Excision
What is an osteoma?
A benign slow-growing tumours consisting of well-differentiated mature bone. They occur mostly in the mandible of adults
Which demographic is lichen planus most common in?
Women ages 30-65 years
Name two red patches that are associated with dermatological disorders
- erosive lichen planus
- Discoid lupus erythematosus
Name three infective white lesions
- Candidiasis
- Syphilitic leukoplakia
- Oral hairy leukoplakia
What is osteogenesis imperfecta?
A hereditary disease (autosomal dominant, recessive and sporadic) that is characterised by the impairment of collagen maturation
What does mucous membrane pemphigoid look like histopathologically?
- Separation of the full thickness epithelium from connective tissue - producing a subepithelial bullae with a thick roof
- Infiltration of neutrophils and eosinophils around and within the bulla
- The base of the bulla will be inflamed connective tissue.
What is the characteristic radiographic feature of metastatic tumours affecting the bone?
Moth-eaten appearance
What is a cemento-ossifying fibroma?
A rare non cancerous (benign) tumour made of bone tissue that forms within connective tissue occurring exclusively in tooth bearing areas (usually the mandible)
What is the treatment for haemangiomas?
Removal by cryosurgery (freeze)
Where do fibroepithelial polyps normally present orally?
Lips, buccal mucosa, tongue
What is the treatment of rhabdomyosarcomas?
Radical excision
Name the periapical lesion based on its histopathology:
- vascular dilation
- neutrophils (type of white blood cell)
- oedema (build-up of fluid)
Acute periradicular periodontitis
What are all these a type of?
● Sclerosing polycystic adenosis
● Nodular oncocytic hyperplasia
● Lymphoepithelial sialadenitis
● Intercalated duct hyperplasia
Non-neoplastic epithelial salivary gland lesions
Name this white lesion from its histopathological findings:
- Thickened hyperparakeratotic epithelium.
- Band of ‘ballooned’ pale cells in the upper prickle cell layer
Oral hairy leukoplakia
What are these all types of?
● Cherubism
● Aneurysmal bone cyst
● Simple (solitary) bone cyst
Bone cysts
What are these all types of?
● Pleomorphic adenoma
● Warthin tumour
● Canalicular adenoma
Benign salivary gland tumours
What is syphilitic leukoplakia?
A white lesion associated with syphilis, specifically in the tertiary stage of infection
What is usually the cause of soft tissue hyperplastic lesions?
Chronic trauma/inflammation
How do bisphosphonates cause MRONJ?
They are anti-angiogenic drugs which target the processes by which new blood vessels are formed
What is the treatment for papillary hyperplasia of the palate?
Good denture hygiene, antifungals if indicated
What is the treatment for mucous membrane pemphigoid?
Steroids
What are the different forms of osteomyelitis?
acute, chronic suppurative, non-suppurative and sclerotic
What infection is associated with Kaposi’s sarcoma?
HHV-8
What is the treatment for cemento-osseous dysplasia?
Surgery but only if it is symptomatic
What is an odontogenic sarcoma?
A gnathic malignant connective tissue tumour containing epithelium similar to that seen in an ameloblastoma or ameloblastic fibroma
What is immunohistochemistry?
When antibodies are used as stains to look for specific cells
What is a mucosal melanoma?
A malignant neoplasm of melanocytes
What is the most common primary epithelial salivary gland malignant tumour?
Mucoepidermoid carcinoma
What is a sialolipoma?
A proliferation of mature adipose tissue, surrounded by a thin fibrous capsule
Name this lesion
Odontogenic keratocyst
What are these all types of?
● Ameloblastoma
● Squamous odontogenic tumour
● Calcifying epithelial odontogenic tumour (Pindborg tumour)
● Adenomatoid odontogenic tumour
Benign Epithelial Odontogenic tumours
What are Bohn’s nodules?
Gingival cysts in infants
Gingival cysts are superficial keratin-filled cysts, presenting as white nodules on the gingiva
Name this lesion from its histopathology:
- Collections of lots of multinucleated osteoclast-like giant cells in rich vascular and cellular stroma
- A narrow zone of fibrous tissue with dilated blood vessels separates the lesion from the overlying epithelium
Peripheral Giant Cell Granuloma/Giant Cell Epulis
Name this soft tissue lesion based on its histopathology (hint - its often found on the palate):
- Hyperplastic fibrous connective tissue
- Hyperplasia of the overlying epithelium
- May also be focal ulceration
- Inflammation will vary - often acute and chronic
Denture irritation hyperplasia
What are these all types of?
● Chondrosarcoma
● Mesenchymal Chondrosarcoma
● Osteosarcoma
Malignant maxillofacial bone and cartilage tumours
What thickness are tissues cut to for slide prep and why?
4 micrometres because this is usually around the thickness of one single cell
What is the treatment for Warthin tumours?
Excision
Name this lesion based on its histopathology:
- Very cellular endothelial proliferation
- Capillary (lots of small blood vessels) and/or cavernous (large blood-filled spaces) depending on the size of the vascular spaces
- The spaces are endothelium lined and contain red blood cells
Haemangiomas
What is Stafne’s defect?
A rare symptomatic, unilateral oval shaped radiolucent defect in the posterior region of the mandible below the inferior alveolar canal. It looks like a cyst and may be mistaken as one
Which type of lichen planus has Wickham’s striae?
Reticular lichen planus
What age do ameloblastomas usually present?
30-60 years
What is the characteristic radiographic feature of Paget’s disease?
Cotton wool lesion
What infections are associated with oral hairy leukoplakia?
EBV infection and HIV infections
- also seen in immunosuppressed patients
What is a Warthin Tumour?
A relatively frequent and benign neoplasm of the major salivary glands - almost exclusively in the parotid
What is the most common salivary gland tumour?
Pleomorphic adenoma (60% of all parotid tumous)
What are the two types of odontoma?
Compound (bag of teeth) and complex (mishmash of dental tissues)
What is the aetiology of eruption cysts?
Odontogenic developmental
What does MRONJ look like histologically?
There will be fragments of non-vital bone - often with prominent bacterial colonization
What does a melanotic macule look like histologically?
Increased melanin pigment in basal keratinocytes but not an increased number of melanocytes. There will be a melanin pigmentary incontinence in the underlying connective tissue.
What does it mean when it says that odontogenic sarcomas are mixed odontogenic tumours?
The epithelial component is benign and the proliferative mesenchymal (connective tissue) component is malignant
Name this soft tissue lesion based on its histopathology (hint - its often found on the palate):
- Papillary/nodular projections
- Underlying hyperplastic, chronically inflamed vascular fibrous tissue
- Overlying epithelium will be hyperplastic
- May also be fungal organisms with acute inflammation
Papillary hyperplasia of the palate
Where are adenomatoid odontogenic tumours most commonly found?
Maxilla in the canine region and often associated with an unerupted permanent tooth
What is hyperparathyroidism?
The overproduction of parathormone (PTH) which mobilises calcium and raises the plasma calcium level
What does pericoronitis look like histologically?
Acute and chronic inflammatory changes including:
- Oedema
- Inflammatory cells
- Vascular dilation
- and/or fibrotic connective tissue
Where are radicular cysts usually located?
The anterior of the maxilla
What are all of these types of?
● Neurofibroma
● Neurilemmoma
● ‘Traumatic neuroma’
● Malignant peripheral nerve sheath tumours (MPNST)
Tumours of the peripheral nerves
What group of people is osteoporosis common in?
Post-menopausal women
What are exostoses?
Benign localised bony protuberances e.g. torus palatinus (midline of palate) and torus mandibularis (premolar regoin)
What is the histopathology of rhadbomyomas?
lobules of closely packed more mature muscle cells and it can be multifocal (more than one site)
What percentage of major salivary gland tumours occur in the parotid?
90%
What are the two types of non-epithelialised primary bone cyst?
● Simple (or solitary) bone cyst
● Aneurysmal bone cyst
Where are Peripheral Giant Cell Granuloma/Giant Cell Epulis usually located?
Gums of teeth anterior to the molars
What is the treatment for Peripheral Giant Cell Granuloma/Giant Cell Epulis?
Excision then curettage of the underlying bone
Name this lesion from its histopathological features:
- Increased melanin pigment in basal keratinocytes
- NOT an increased number of melanocytes
- Melanin pigmentary incontinence in the underlying connective tissue
Melanotic macule
Where do simple (solitary) bone cysts most commonly occur?
The pre-molar region of the mandible
Name two idiopathic red patches
- Geographic tongue
- Erythroplakia
What is the aetiology of odontogenic keratocysts?
Odontogenic developmental
What is hyperplasia?
The abnormal multiplication or increase in the number of normal cells in a normal arrangement in tissue
What are pyogenic granulomas?
A harmless overgrowth of tiny blood vessels on the skin
Name two dermatological white lesions
- Lichen planus
- Lupus erythematosus
What is osteopetrosis?
Rare genetic diseases in which there is an increase in bone density
Name this lesion
Denture irritation hyperplasia
Name this lesion from its histopathology:
- There will be irregularly shaped slender trabeculae of woven (immature) bone lying in a very cellular fibrous tissue
- The lesion fuses directly to the normal bone at the edges of the lesion
Fibrous dysplasia
What are the two variants of inflammatory collateral cysts?
Paradental and mandibular bifurcation cysts
What is the treatment for cementoblastomas?
Complete excision and removal of the tooth
What is this most likely to be?
Cementoblastoma
What are all of these types of?
● Ameloblastic fibroma
● Primordial odontogenic tumour
● Odontoma (compound, complex type)
● Dentinogenic ghost cell tumour
Benign mixed epithelial and mesenchymal odontogenic tumours
What is orthokeratosis?
The formation of a nuclear keratin layer, as in normal keratinised stratified squamous cell epithelium
How are dentigerous cysts formed?
The accumulation of fluid between the reduced enamel epithelium of the dental follicle and the crown of the unerupted tooth
What are all of these types of?
● Epulides
● Pyogenic granuloma
● Fibroepithelial polyp (giant cell fibroma)
● Denture irritation hyperplasia
● Papillary hyperplasia of the palate
Soft tissue hyperplastic lesions
What dental anomalies are associated with cleidocranial dysplasia?
- Delayed eruption of permanent dentition
- Supernumerary teeth (often numerous)
- Narrow, arched palate
When is marsupialisation used in cyst management?
Large or recurrent cysts
How long does a specimen have to be “fixed” before dissection?
24 hours for high risk specimens and 4-5 days in larger resections
What is the aetiology of Gingival cysts?
Odontogenic developmental
What do ameloblastomas usually arise from?
Ameloblasts (who would have guessed) and rarely gingival mucosa
What are these types of?
● Leiomyoma (benign)
● Leiomyosarcoma (malignant)
Tumours of smooth muscle
Name this lesion
Fordyce granules
What does non-acantholytic mean?
Non-acantholytic is the death and rupture of cells caused by viral infections such as herpes simplex virus. The virus targets and replicates within the epithelial cells, leading to cell lysis
Name two neoplastic white lesions
- Dysplastic keratosis
- Squamous cell carcinoma
What mutations have been linked with fibrous dysplasia?
GNAS1
What is apoptosis?
Programmed cell death
What is the treatment for granular cell tumours?
Excision
What type of lichen planus is this?
Erosive lichen planus
What is a periapical granuloma?
A mass of inflamed granulation tissue at the apex of a non-vital tooth - it is not a true granuloma
Where do ameloblastomas usually present?
Posterior of the mandible
Name this soft tissue cyst from its histopathology:
- Surrounded by a thin cyst wall
- Keratinising stratified squamous epithelium lining
- Abundant keratin debris in the lumen (centre/canal of salivary duct)
- Skin appendages in the cyst wall (hair, nails, sweat glands etc)
Dermoid cyst
What are these types of?
● Lipoma (benign)
● Liposarcoma (malignant)
Tumours of adipose tissue
What is ulceration?
A mucosal/skin defect with complete loss of surface epithelium
Name the periapical lesion based on its histopathology:
- Central collection of pus - neutrophils, bacteria, cellular and debris
- Adjacent zone of preserved neutrophils
- Surrounding membrane will have sprouting capillaries, vascular dilation and occasional fibroblasts (granulation tissue)
Periapical abscess
Where are fibrous epulis usually located?
Between two teeth
Why are melanotic macules often excised?
To confirm diagnosis and rule out melanoma
What is the treatment for Paget’s disease?
Calcitonin and bisphosphonates
At what age does cherubism generally progress until?
7 Years old
What is the difference between a vesicle and a bullae?
A vesicle is a small blister and a bullae is a blister larger than 10mm
Name this lesion based on its clinical features:
- Numerous, small, tightly packed, nodular lesions in the area of the mouth where the dentures are worn constantly
- The roof of the mouth may have a ‘pebbled’ appearance
Papillary hyperplasia of the palate
Name this lesion of the bone
Fibrous dysplasia
How soon should an URGENT referral to max-fax be seen?
Within 2 weeks
Name this lesion based on its histopathological presentation:
- Submucosal deposition of dense collagenous tissue
- Decreased vascularity
- Variable rates of dysplasia (abnormal cells within the tissue)
- Marked with atrophic epithelium
Oral submucous fibrosis
What syndrome features multiple lesions of osteomas?
Gardner Syndrome
What are oral haematolymphoid tumours?
Solitary plasmacytomas of bone (means a tumour consisting of abnormal plasma cells that grow within the soft tissue or bony skeleton)
What advice would you give a patient with lichen planus?(5)
● Maintain oral hygiene
● Soft toothbrush
● Mild flavour/SLS-free toothpaste
● Regular dental check-ups every 6 months
● Avoid spicy, acidic and salty foods
What is pericoronitis?
Inflammation of soft tissues around partially erupted teeth (most frequently lower 8s)
What is a haemangioma?
A bright red birthmark that shows up at birth or in the first or second week of life made up of extra blood vessels in the skin
Name this salivary gland tumour from its histopathology:
- Un-encapsulated
- Displays an infiltrative pattern of growth
- Variable proportions of three types of tumour cell: mucous-secreting cells, epidermoid (squamoid) cells and intermediate cells
Mucoepidermoid carcinoma
Name this pigmented lesion based on its clinical presentation:
- Dark brown or black lesion (sometimes be unpigmented - in which case it will appear red)
- At first asymptomatic
- Regional lymph nodes and blood borne metastases are common
Mucosal melanoma
What are the non-specific histopathological features of most ulcers?
- Loss of surface epithelium
- Inflamed fibrinoid exudate
- Inflamed granulation tissue
Name this lesion from its clinical features:
- rubber, dark red/purple bump
- blanch (turns white) under pressure
Haemangioma
What is the treatment for frictional keratosis?
It should resolve itself once the source of the friction has been removed
Name this lesion based on its histopathological features:
- Highly pleomorphic neoplasms
- Cells appear epithelioid or spindle shaped
- Amount of melanin pigment is variable (sometimes completely absent)
Mucosal melanoma
Name this pigmented lesion
Mucosal melanoma
When do vesiculobullous lesions present as oral ulceration?
Following rupture of the vesicles/bullae
What is the treatment for ameloblastomas?
Complete excision with a margin of uninvolved tissue and long term follow-up
Name this lesion from its histopathology:
- a peripheral (outer layer) single layer of tall, columnar, pre-ameloblast-like cells, which have nuclei at the opposite pole to the basement membrane (reversed polarity).
- a core of loosely arranged cells resembling stellate reticulum. The cells will be organised into two patterns: follicular (islands of epithelial cells) and plexiform (long strands of epithelial cells
Ameloblastoma
Name this lesion based on its histopathology:
- a thin non-keratinized stratified squamous epithelial lining that is 2-5 cells thick
- no inflammation present unless there is a secondary infection
- may be odontogenic epithelium remnants, calcification and/or Rushton Bodies
Dentigerous cyst
What is the name for a soft tissue hyperplastic lesion that occurs on the gingiva?
Epulis
Name this salivary gland tumour from its histopathology:
- Well-circumscribed with a thin capsule
- Comprised of both epithelial and lymphoid elements
- Papillary (finger-like) processes of tumour tissue project into irregular cystic spaces containing mucoid material
- Double-layer of epithelial cells covers projections (basal cuboidal cells below columnar cells)
- The stroma contains a variable amount of lymphoid tissue
- Often germinal centres evident
Warthin tumour
When should you review a high risk MRONJ patient after extraction?
8 weeks
What is there a strong link with for Warthin tumours?
Smoking and radiation
Name the most likely diagnosis for this lesion
Dentigerous cyst
Name this lesion
Mucous membrane pemphigoid - desquamative gingivitis
Name this potentially malignant lesion
Epithelial dysplasia
What are all of these a type of?
● Haemangioma
● Lipoma/sialolipoma
● Nodular fasciitis
Benign soft tissue lesions of salivary glands
What is an ossifying fibroma?
A rare non cancerous (benign) tumour made of bone tissue that forms within connective tissue
Name this cyst from its histopathology:
- Lined by either stratified squamous epithelium, ciliated columnar epithelium or nonciliated columnar epithelium
- Fibrous wall of the cysts typically contains thyroid tissue
Thyroglossal duct cyst
What are the treatment options for chronic periradicular periodontitis?
- Extraction
- Endodontic surgery/retreatment
- Periradicular surgery
What are the six different types of lichen planus?
● Reticular
● Atrophic
● Papular
● Erosive
● Bullous
● Plaque-like
What is alveolar osteitis?
Dry socket - inflammation due to infection from exposure of bone post extraction (no blood clot formed)
Where are dentigerous cysts attached?
Amelocemental junction and encloses all or part of a crown of an unerupted tooth
What are Fibro-Osseous and Osteochondromatous lesions characterised by?
The replacement of bone by cellular fibrous tissue within which islands and trabeculae of metaplastic bone develop
What type of cyst may arise from pericoronitis?
Dentigerous cyst
What is hyperkeratosis?
A thickening of the outer layer of the skin (stratum corneum), which is made of keratin (a tough protective protein)
What does chronic periradicular periodontitis look like histopathologically?(6)
Chronic inflammatory changes, including the presence of:
● Lymphocytes
● Plasma Cells
● Macrophages
● Granulation tissue progressing to fibrosis
● Resorption of bone
● Minimal, if any, tooth resorption
What is Paget’s disease of bone?
A form of osteodystrophy characterised by disorganised formation and remodelling of bone unrelated to functional requirements
Name two idiopathic white lesions
- Leukoplakia
- Proliferative verrucous leukoplakia
What type of lichen planus is this?
Reticular lichen planus
What is metaplasia?
A reversible change in which one adult cell type is replaced by another adult cell type
What is marsupialisation?
When the cyst is first opened with a cut and the fluid is drained out. The edges of the skin are then stitched to create a small “kangaroo pouch”, which allows any further fluid to drain out
What is a “fixed” specimen?
A specimen that has been placed in 10% neutral buffered formalin to stop the tissues breaking down and to preserve tissue histology
What is the treatment for periapical granulomas?
- Extraction
- Endodontic treatment/retreatment
- Periradicular surgery
Are the following changes associated with a chronic or acute inflammatory lesion?
- vascular dilation
- neutrophils (type of white blood cell)
- oedema (build-up of fluid)
Acute
Name this lesion from its histopathological features:
● Hyper keratinised epithelium
● Basal cell destruction
● Dense, band-like infiltrate of T-lymphocytes in superficial connective tissue
Lichen planus
What are the most common cyst of the jaw?
Radicular
Where do rhabdomyomas commonly occur?
Mouth, tongue and/or soft palate
Name three infective red patches
- Periodontal disease
- Median rhomboid glossitis
- HIV gingivitis
What is the treatment for candidiasis?
Anti-fungals
Name this soft tissue lesion from its histopathology:
- Look like polypoid lesions with a core of dense scar-like fibrous tissue
- Overlying stratified squamous epithelium may be hyperplastic
- Very little inflammation associated
Fibroepithelial polyp (giant cell fibroma)
What is medication-related osteonecrosis of the jaw?
A severe adverse drug reaction, consisting of progressive bone destruction in the maxillofacial region of patients
What are odontogenic myxomas most commonly associated with?
An unerupted tooth
What is the treatment for osteomas?
Removal of symptomatic lesions
Name this lesion
Fibroepithelial polyp
Name this bone disease from its histological features:
- Irregular pattern of reversal lines
- Many osteoblasts and osteoclasts
- Fibrosis of marrow spaces
- Increased vascularity
Paget’s disease
What is the treatment for pericoronitis?
- Irrigation
- Consider extraction of the opposing tooth (if traumatic)
- Antibiotics (only is systemic involvement)
- Extraction (after 3 cases)
Where are the highest risk sites for oral cancer?
- Lateral/ventral tongue
- FOM
- Retromolar trigone (tonsils and soft palate)
Name this lesion based on its histopathological findings:
● Nuclear and cellular pleomorphism
● Alteration in nuclear/cytoplasmic ratio (invariably an increase)
● Nuclear hyperchromatism
● Prominent nucleoli
● Increased and abnormal mitoses
● Loss of polarity of basal cells
● Basal cell hyperplasia
● Drop-shaped rete pegs ie wider at their deepest part
● Irregular epithelial stratification or disturbed maturation
● Abnormal keratinisation ‘Dyskeratosis’- cell starts to keratinise before the surface is reached
● Loss/ reduction of intercellular adhesion
Epithelial dysplasia (potentially malignant)
What is this
Cementoblastoma
What are these all types of?
● Fibrous epulis
● Pyogenic granuloma/pregnancy epulis
● Giant cell epulis/peripheral giant cell granuloma
Epulis/Epulides
- soft tissue hyperplastic lesions that occur on the gingivae
What does proliferative verrucous leukoplakia look like histopathologically?
hyperplastic lesion with hyperkeratosis and often with mild dysplasia
Name this idiopathic lesion from its histopathological findings:
- Hyperplastic lesion
- Hyperkeratosis
- Often with mild dysplasia
Proliferative verrucous leukoplakia
What does acromegaly look like dentally?
- The jaw becomes enlarged and protrusive
- Increased spacing between teeth
- May also present with thickening of facial soft tissues
What is chondrosarcoma?
A type of bone cancer that develops in cartilage cells
Name this lesion
Peri radicular periodontitis
What genetic condition are Malignant Peripheral Nerve Sheath Tumours associated with?
Neurofibromatosis type 1 (NF1)
What is the topical treatment for lichen planus?
- Analgesics
- Topical steroids
- Topical tacrolimus (immunosuppressant)
- Triple mouthwash
What are all of these types of?
● Haemangioma
● Lymphangioma
● Kaposi’s Sarcoma
● Angiosarcoma
Tumours of vascular tissue
Name this lesion
Pericoronitis
What type of pemphigoid do we most commonly see in the mouth?
Mucous membrane pemphigoid
What is the most common stain used for histopathology?
Haematoxylin and Eosin (H&E)
What is acantholysis?
The loss of intercellular adhesion between keratinocytes
Name this infective lesion
Oral hairy leukoplakia
This tooth is non-vital. What is the most likely cyst?
Radicular
Where is lichen planus most found?
Buccal and gingival mucosa and the tongue
Name three hereditary white lesions
- White sponge naevus
- Pachyonychia congenita
- Dyskeratosis
Name two neoplastic red lesions
- Dysplastic lesions
- Squamous cell carcinoma
Name this soft tissue lesion
Epulis
What is the treatment of pleomorphic adenomas?
Complete excision
What is osteomyelitis?
Osteomyelitis is an infection in the bone that causes a spectrum of inflammatory and reactive changes in the bone and periosteum
What does lichen planus look like histologically?
● Hyper keratinised epithelium
● Basal cell destruction
● Dense, band-like infiltrate of T-lymphocytes in superficial connective tissue
What is an eruption cyst?
A dentigerous cyst arising from the mucosa shortly before the tooth’s eruption
What is hypertrophy?
The enlargement or overgrowth of an organ or part due to an increase in the size of its constituent cells
What teeth are mandibular bifurcation cysts associated with?
First and second molars
What is fibrous dysplasia?
It is a chronic disorder in which scar-like tissue grows in place of normal bone. Any bone can be affected and it may involve one (monostotic) or several bones (polyostotic)
What does acute periradicular periodontitis look like histopathologically?
Acute inflammatory changes including:
- vascular dilation
- neutrophils (type of white blood cell)
- oedema (build-up of fluid)
Name this lesion based on its histology:
- Epithelium lining stratified squamous, respiratory, cuboidal, or columnar
- Fibrous connective tissue capsule that may contain neurovascular bundles and mucous glands
- Often chronically inflamed
Nasopalatine duct cyst
What do nasopalatine duct cysts originate from?
The remnants of epithelium of the nasopalatine duct in the incisive canal
What are these all types of?
● Mucoepidermoid carcinoma
● Adenoid cystic carcinoma
● Acinic cell carcinoma
Salivary malignant tumours
What does frictional keratosis look like histopathologically?
Hyperkeratosis and prominent scarring fibrosis within the submucosa
Name this lesion from its histopathology:
- Dense masses of acellular cementum-like material on the lesion
- the tumour will blend with root of tooth which helps to distinguish the lesion
Cementoblastoma
What is a cementoblastoma?
A rare odontogenic tumour characterised by the formation of a mass of cementum or cementum-like tissue attached to the roots of a tooth
What is the aetiology of dentigerous cysts?
Odontogenic developmental
What does median rhomboid glossitis look like histopathologically?
- Loss of papillae
- Parakeratosis and acanthosis of the squamous epithelium
- Candidal hyphae in the parakeratin
- Associate neutrophils
What is the main fibrous tissue tumour?
Fibrosarcoma (which is malignant)
What is the treatment for acute periradicular periodontitis?
Extraction or RCT
What is parakeratosis?
The persistence of nuclei in the cells of a keratin layer
What does a periodontal abscess look like histopathologically?
- Central collection of pus - neutrophils, bacteria, cellular and debris
- Adjacent zone of preserved neutrophils
- Surrounding membrane will have sprouting capillaries, vascular dilation and occasional fibroblasts (granulation tissue)
Name this hereditary lesion
White sponge naevus
What is the most common oral giant cell lesion?
Peripheral Giant Cell Granuloma/Giant Cell Epulis
What percentage of head and neck sarcomas do Malignant Peripheral Nerve Sheath Tumour account for?
2-4%
What is the treatment for leukoedema?
No treatment is needed
Name this lesion
Peripheral Giant Cell Granuloma/Giant Cell Epulis
Name this lesion from its histopathology:
- No epithelial lining
- May have a thin fibrovascular tissue lining (with haemosiderin, RBCs or giant cells covering the bony walls)
- Usually, the lesion has no contents
Solitary/simple bone cyst
Give a general clinical description of the clinical findings of lichen planus
- bilateral and symmetrical
- Lesions don’t tend to wipe off
- Not tender to palpate
What is cemento-osseous dysplasia?
The replacement of normal bone by fibrous tissue and subsequently followed by its calcification with osseous and cementum-like material
What is epithelial dysplasia?
Alteration in differentiation, maturation and architecture of adult epithelial cells
Where is the most common site for lipomas?
Buccal mucosa
What is cherubism?
A rare, autosomal dominant disorder characterised by abnormal bone tissue in the jaw. Beginning in early childhood, both the mandible and the maxilla become enlarged as bone is replaced with painless, cyst-like growths
What is Pemphigus?
Pemphigus is a rare skin disorder characterised by blistering of your skin and mucous membranes
What are these all types of?
● Ameloblastic fibrosarcoma
● Ameloblastic fibrodentinosarcoma
● Ameloblastic fibroodontosarcoma
Odontogenic sarcomas
Name this lesion
Papillary hyperplasia of the palate
Name this pigmented lesion
Melanotic macule
What is lichen planus?
An immune-mediated chronic inflammatory condition, with T cell infiltration and destruction of the basal layer with responsive hyperkeratosis
What does a ‘moderate’ grading of epithelial dysplasia mean?
That there are more layers of disorganised basaloid cells, atypia (abnormal cells in tissue) and supra-basal mitosis (cell division - resulting in two daughter cells)
What are all of these types of?
● Alveolar osteitis (dry socket)
● Osteomyelitis
● Radiation injury and osteoradionecrosis
● Medicine-related osteonecrosis of the jaws (MRONJ)
● Paget’s disease of bone (osteitis deformans)
Inflammatory diseases of the bone
What type of lichen planus is this?
Atrophic lichen planus
- Atrophic oral lichen planus appears as diffuse, erythematous patches surrounded by fine, white striae that make the patient symptomatic
What are lipomas?
Benign asymptomatic, soft, smooth swellings that are yellowish or pink in colour
What is the most common soft tissue sarcoma in children?
Rhabdomyosarcoma
What teeth are paradental cysts associated with?
Vital third molars
What are these types of?
● Granular cell tumours
● Congenital epulis
Idiopathic soft tissue neoplasms
What is the aetiology of calcifying odontogenic cysts?
Odontogenic developmental
What is an aneurismal bone cyst?
A benign, blood-filled lesion in the bone that tends to expand or grow. While it is referred to as a cyst, it is a true benign bone tumour surrounded by a thin wall of bone.
What are the two types of odontogenic inflammatory cysts?
Radicular and Inflammatory collateral cysts
What is rickets/osteomalacia?
The deficiency of, or resistance to the action of, vitamin D. This leads to failure of the mineralisation of osteoids and cartilage
Name this periapical lesion from its histopathology:
- Inflamed granulation tissue
- Proliferation of cell rests of Malassez, often in long strands and arcades (which may ultimately lead to inflammatory cyst formation)
- Haemosiderin and cholesterol deposits, from RBC/inflammatory cell breakdown
- Associated multinucleated foreign body giant cells
- Resorption of adjacent bone (and potentially the tooth as well)
Periapical granuloma
Name this lesion based of its histopathological findings:
- Separation of the full thickness epithelium from connective tissue - producing a subepithelial bullae with a thick roof
- Infiltration of neutrophils and eosinophils around and within the bulla
- The base of the bulla will be inflamed connective tissue
Mucous membrane pemphigoid
Name this salivary gland tumour from its histopathology:
- Well-circumscribed, although an incomplete fibrous capsule means than tumour nodules can extend through the capsule
- The lesion may be cystic
Pleomorphic adenomas
What are central giant cell granulomas?
Asymptomatic, localised benign lesions that can be quite aggressive
What is odontogenesis?
The process of tooth development
What is Kaposi’s sarcoma?
A locally aggressive (intermediate grade) tumour of endothelial cells
What are haemangiomas?
A collection of small blood vessels that form a lump under the skin
Name this cyst from its histopathology:
● Chronically inflamed fibrous capsule
● Wholly/partly lined by non-keratinized stratified squamous epithelium of variable thickness
● Hyperplasia of epithelium common, often in arcades
● Mucous metaplasia and ciliated cells may be seen
● Hyaline/Rushton bodies
● Cholesterol clefts and haemosiderin
Radicular cyst or inflammatory collateral cyst
What do nasopalatine duct cysts look like clinically?
Swellings on the midline of the anterior palate
What does leukoedema look like histopathologically?
Hyperkeratotic epithelium with irregular rete pegs. No evidence of malignancy is noted.
What is a lateral radicular cyst?
Although most radicular cysts are found at the apex, some can be found on the lateral of a root due to a lateral root canal branch. This is called a lateral radicular cyst
What is the treatment for dentigerous cysts?
Eneucleation or exposure/extraction of the associated tooth
What are all of these types of?
● Chondroma
● Osteoma
● Melanotic neuroectodermal tumour of infancy
● Chondroblastoma
● Chondromyxoid fibroma
● Osteoid osteoma
● Osteoblastoma
● Desmoplastic fibroma
Benign maxillofacial bone and cartilage tumours
What is MALT lymphoma?
mucosa-associated lymphoid tissue - a slow-growing type of non-Hodgkin lymphoma. A cancer of lymphatic system
Name this red lesion from its histopathological findings:
- Loss of papillae
- Parakeratosis and acanthosis of the squamous epithelium
- Candidal hyphae in the parakeratin
- Associate neutrophils
Median rhomboid glossitis
What disorder is characterised by multiple odontogenic keratocysts?
Gorlin Syndrome (Naevoid Basal Cell Carcinoma)
Name the periapical lesion based on its histopathology:
● Lymphocytes
● Plasma Cells
● Macrophages
● Granulation tissue progressing to fibrosis
● Resorption of bone
● Minimal, if any, tooth resorption
Chronic periradicular periodontitis
What does oral hairy leukoplakia look like histopathologically?
Thickened hyperparakeratotic epithelium. There will be a band of ‘ballooned pale cells in the upper prickle cell layer
What is black hairy tongue?
Papillary hyperplasia and overgrowth of pigment producing bacteria
Name this soft tissue lesion
Epulis
Name this lesion (hint - it disappears when stretched)
Leukoedema
What is a soft tissue neoplasm?
A broad term for cancers that start in the soft tissues
What is a hematolymphoid tumour?
A tumour consisting of abnormal plasma cells that grows within the soft tissue or bony skeleton (in this case it will be bone)
Are the following changes associated with a chronic or acute inflammatory lesion?
● Lymphocytes
● Plasma Cells
● Macrophages
● Granulation tissue progressing to fibrosis
● Resorption of bone
● Minimal, if any, tooth resorption
Chronic
What are all these types of?
● Odontogenic fibroma
● Odontogenic myxoma/myxofibroma
● Cementoblastoma
● Cemento-ossifying fibroma
Benign mesenchymal odontogenic tumours
What is osteoporosis?
When bone loss is excessive or when apposition of bone is reduced - bone is normal quality just less of it
This is a tumour. Name it
Ameloblastoma
What is the histopathology of pleomorphic adenomas?
The tumour is well-circumscribed, although an incomplete fibrous capsule means than tumour nodules can extend through the capsule. The lesion may be cystic
Name this white lesion from its histopathological findings:
- Hyperkeratotic epithelium
- Irregular rete pegs
- No evidence of malignancy noted
Leukoedema
What is the treatment for a periapical abscess?
Drainage and extraction or endodontic treatment
Where do granular cell tumours usually occur?
The tongue, buccal mucosa, floor of mouth or the palate
What is necrosis?
Cell death by injury or disease
What are the treatment options for odontogenic keratocysts?
● Marsupialization
● Enucleation
● Marsupialization + enucleation
● Enucleation + Carnoy’s solution (60% ethanol, 30% chloroform, 10% glacial acetic acid)
● Enucleation + cryotherapy (freezing)
● Resection
What is the histopathological difference between epithelial dysplasia and SSC?
In epithelial dysplasia, the atypical cells are confined to the surface, in SCC, the atypical cells invade the underlying connective tissue
What is the treatment for Kaposi’s sarcoma?
Antiretroviral therapy (HIV medicines) or chemotherapy
What is the aetiology of Orthokeratinised odontogenic cysts?
Odontogenic developmental
Where are Kaposi’s sarcomas commonly found?
Palate and gingivae
What is atrophy?
A decrease in cell size by loss of cell substance
What are the three types of cemento-ossifying fibroma?
- Periapical (apical lower incisors)
- Focal (singular tooth)
- Florid (multiple teeth, multiple quadrants)
What are the treatment options for radicular cysts?
Small cyst = RCT/XLA/periradicular surgery
Large = Enucleation, marsupialisation
What is the treatment for odontomas?
Enucleation
What does acantholytic mean?
Acantholytic is desmosomal breakdown most commonly caused by an autoimmune disease called Pemphigus.
What is the aetiology of radicular cysts?
Odontogenic inflammatory
Name this tumour from its histopathology:
- Epithelium arranged in solid nodules or rosette-like structures
- Duct-like structures in the lesion
Adenomatoid odontogenic tumours
Name this salivary gland tumour based on its histopathology:
- Well-circumscribed
- Two rows of columnar epithelial cells which are alternately closely opposed and widely separated
- Minimal vascular stroma
- Tumour may be cystic
- Sometimes resemble adenoid cystic carcinoma but there will be no evidence of invasion
Canalicular adenomas
Name this soft tissue cyst from its histopathology:
- Surrounded by a thin cyst wall
- Keratinising stratified squamous epithelium lining
- Abundant keratin debris in the lumen (centre/canal of salivary duct)
- No skin appendages in the cyst wall (hair, nails, sweat glands etc)
Epidermoid cyst
What diseases are bisphosphonates used to treat?
- Some cancers
- Paget’s disease
- Osteoporosis
Name this cyst and its treatment
Gingival cyst, excision
How are radicular cysts formed?
Proliferation of the epithelium (Cell Rests of Malassez) in response to inflammation. The cyst then enlarges due to osmotic pressure and causes local bone resorption
What are the histopathological features of oral submucous fibrosis?
- Submucosal deposition of dense collagenous tissue
- Decreased vascularity
- Variable rates of dysplasia (abnormal cells within the tissue)
- Marked with atrophic epithelium
What does a ‘severe’ grading of epithelial dysplasia mean?
A very abnormal lesion that affects the full thickness of epithelium. A severe epithelial dysplasia grading indicates that there is a carcinoma in situ
What bone are exostoses usually made up of?
completely dense cortical bone or cancellous bone with a shell of cortical bone
This is a benign, painless rubbery lump. Name it
Pleomorphic adenoma
What does a nasopalatine duct cyst look like radiographically?
Heart-shaped radiolucency on anterior of the hard palate
What are fibroepithelial polyps (giant cell fibromas)?
Skin tags - very common benign tumours that usually occur in skin folds, such as the maxilla, genital area or neck
What must a radicular cyst always be associated with?
A non-vital tooth
What are the different types of pemphigoid?(4)
- Bullous
- Mucous membrane
- Linear IgA disease
- Drug induced
Name this lesion
Florid cemento-osseous dysplasia
What type of lichen planus is this?
Bullous lichen planus
What are odontogenic carcinomas characterised by histologically?
The presence of agglomerates (formation of mass or group) of cells with eosinophilic cytoplasm (proteins that look bright pink under a microscope)
What is the aetiology of inflammatory collateral cysts?
Odontogenic inflammatory
What is the treatment for inflammatory collateral cysts?
Eneucleation
Name this lesion
Chronic hyperplastic candidiasis
What does a ‘mild’ grading of epithelial dysplasia mean?
Disorganisation and increased proliferation (increased number of cells) and atypia (abnormal cells in tissue) of basal cells
Name this lesion
Papillary hyperplasia of the palate
Name this soft tissue lesion from its histopathology:
- A nodular lesion with ulcerated surface epithelium
- Underlying vascular proliferation - either solid sheets of endothelial cells or small and large vascular spaces
- Variable inflammation (often acute and chronic)
Pyogenic granuloma/ pregnancy epulis
Where will you most commonly find mucosal melanomas?
Hard palate and maxillary gingivae
What is Neurofibromatosis type 1 (NF1)
Neurofibromatosis type 1 (NF1) is a genetic condition that causes tumours to grow along your nerves.
What are fordyce granules?
Enlarged, slightly raised sebaceous (oil) glands that appear on the lip and the buccal mucosa
What are all of these types of?
● Osteogenesis imperfecta
● Osteopetrosis (marble bone disease)
● Cleidocranial dysplasia
● Achondroplasia
Inherited disorders of bone
Name this white lesion from its histopathological findings:
- Hyperkeratosis
- Prominent scarring fibrosis within the submucosa
Frictional keratosis
What is acromegaly?
A renewed growth of the bones of the jaws, hands and feet with soft tissue overgrowth too
What will patients with osteogenesis imperfecta present with clinically?
Bone that is easily fractured. Dentally, patients will often have affected teeth that present with dentinogenesis imperfecta and malocclusion may be an issue
What is the most common type of ameloblastoma?
Solid/multicystic
Name this soft tissue neoplasm based on its histopathology:
- Well-circumscribed
- Thin capsule and lobules of mature fat cells
- Bands (septa) of fibrous tissue
Lipoma
What classification is used when staging the malignancy of salivary gland tumours?
TNM classification
Name this soft tissue neoplasm
Lipoma
What remnants do odontogenic keratocysts derive from?
Dental lamina (glands of serres)
Name a white lesion of normal variation
Leukoedema
What is dyskeratosis?
Premature keratinisation of epithelial cells that have not reached the keratinising surface layer
Name this lesion based off its histopathological features:
● Hyperparakeratosis
● Prominent, irregular acanthosis
● Numerous neutrophils in parakeratin, forming micro-abscesses
● Candidal hyphae in parakeratin
● Acute and chronic inflammation in prickle cell layer
● Mixed chronic inflammatory infiltrate in lamina propria
● Varying degrees of cellular atypia
Chronic hyperplasic candidiasis
What are all of these types of?
● Ossifying fibroma
● Familial gigantiform cementoma
● Fibrous dysplasia
● Cemento-osseous dysplasia
● Osteochondroma
Fibro-Osseous and Osteochondromatous lesions
What are all of these types of?
● Osteoporosis
● Hyperparathyroidism
● Rickets and Osteomalacia
● Acromegaly
Metabolic or endocrine disorders of bone
What is another word for recurrent radicular cysts?
Residual cysts (occur even once the associated tooth is gone)
What is the treatment for mucoepidermoid carcinomas?
Excision
Name this infective lesion
Candidiasis
How does radiation injury cause osteoradionecrosis?
Radiation affects the vascularity of bone by causing proliferation of the intima of the blood vessels (endarteritis obliterans). The bone then becomes non-vital which is sterile and asymptomatic but very susceptible to infection and trauma
Name this soft tissue lesion from its histopathology:
- Nodular lesion with hyperplastic surface epithelium
- Cellular fibroblastic granulation tissue
- Collagen bundles
- Inflammation of the lesion is variable
- Calcification or metaplastic bone formation
Fibrous epulis
Name this lesion from its clinical findings:
- pale coloured mucosa that is firm to palpate
- If left to progress, the patient will present with trismus (limited jaw opening)
- Most common on the buccal mucosa, soft palate and labial mucosa
Oral submucous fibrosis
Name this soft tissue neoplasm from its histopathology:
- Encapsulated and have large eosinophilic cells
- Granular cytoplasm in subepithelial tissue
- Tends to merge with underlying skeletal muscle fibres
- Marked hyperplasia of the overlying epithelium
Granular cell tumours
What is the systemic treatment for severe lichen planus?
● Regular blood tests
● On bone protection (if on long term oral corticosteroids)
● Short course of predisolone
● Azathioprine, mycophenolate mofetil (to further dampen down the immune system so that the dose of corticosteroid can be reduced asap)
What is the treatment for nasopalatine duct cysts?
Enucleation
What is a cyst?
A pathological cavity with a fluid or semi-fluid content that is lined wholly or in part by epithelium
Name this cystic lesion based on its histological findings:
● Keratinized stratified squamous epithelial lining, 5- 10 cells thick
● Corrugated appearance of surface parakeratin layer
● Well-defined, palisaded basal cell layer
● Keratin debris in lumen
● Thin fibrous cyst wall with no inflammation, unless secondary infection
● May be daughter/satellite cysts in wall
Odontogenic keratocyst
Name this lesion
Oral blood blister (angina bullosa haemorrhagica)
What is HIV gingivitis also known as?
Linear gingival erythema (LGE)
What is a canalicular adenoma?
A salivary gland tumour that occurs almost exclusively (80%) in the upper lip
What are these types of?
● Rhabdomyoma (benign)
● Rhabdomyosarcoma (malignant)
Tumours of smooth muscle
What is the aetiology of glandular odontogenic cysts?
Odontogenic developmental
What is the treatment for mucosal melanomas?
Surgical resection and adjuvant radiotherapy although the prognosis is very poor
Name this traumatic lesion
Frictional keratosis
What is a non-epithelialised primary bone cyst?
A benign fluid filled bone cyst that almost exclusively occurs in the mandible. However, these are not true cysts - meaning it is not a closed structure (no lining to separate it from nearby tissue/structures)
What’s the rhyme for the presentation of hyperparathyroidism?
‘stones, bones and abdominal groans’
Stones = renal calculi and other calcifications
Bones = bone lesions such as brown tumour
Abdominal groans = duodenal ulcers
What is the most likely diagnosis for this lesion?
Paradental cyst
What is the treatment for oral hairy leukoplakia?
No treatment is needed
