Oral Pathology Flashcards
Topics covered: An introduction to oral and maxillofacial pathology, white lesions, red lesions, pigmented lesions, ulcerated lesions, non-cystic dental inflammatory lesions, odontogenic cysts, non-odontogenic cysts, odontogenic tumours, soft tissue hyperplastic lesions, soft tissue neoplasms
1
Q
What are the different types of biopsy and when are each of the types used?
A
Excisional - clinical diagnosis usually matches the definitive diagnosis therefore specimen is removed for definitive diagnosis and treatment is given at the same time.
Incisional - small piece of tissue is taken from a representative area of the lesion to obtain diagnosis of the condition
Surgical resection - usually carried out after incisional biopsy if further histopathological assessment is required.
2
Q
When would you send a fresh biopsy sample?
A
In cases where urgent diagnosis is required or for specimens where further investigations are required (immunofluorescent studies).
3
Q
Why are fixed biopsy samples placed in a 10% neutral buffered formalin when sent to the lab?
A
As it stops the tissues from breaking down
And allows cross-linking of proteins which helps to preserve the tissue histology.
4
Q
What should be sent to the lab along with the specimen?
A
- Correct patient details on specimen tube
- Correctly filled out pathology request form (including accurate details that may help with diagnosis)
5
Q
What happens when the pathology lab receives the specimen?
A
The specimen and the form will be checked to ensure the patient details are correct.
Once this has been checked the specimen will be logged into the pathology system and assigned a unique pathology number.
6
Q
How long must a specimen be fixed for before undergoing macroscopic description and dissection by the pathologist?
A
24 hours for small non high risk specimens
4-5 days for larger resections
7
Q
What do larger biopsy specimens often require before significant dissection?
A
They often require to be inked in different colours to mark the surgical margins prior to dissection
8
Q
What happens to the specimens following dissection?
A
Once dissected the specimens are normally photographed to help relay information to the surgeons.
The tissue will then be embedded in hot paraffin wax to form tissue blocks.
4 micrometres thick sections are then cut from the tissue blocks using a microtome.
Sections are then floated in a water bath, mounted on a glass slide, stained using H&E stain and a coverslip is placed.
The slides are then examined by a pathologist - additional stains/investigations may be required.
A pathology report is issued following examination and interpretation of macroscopic and microscopic features.
9
Q
What stain is most commonly used?
A
H&E (haematoxylin and eosin) stain
10
Q
Other than H&E stain, what other special histochemical stains are available?
A
Periodic Acid-Schiff (PAS)
Trichromes
Gram
11
Q
In addition to light microscopy with routine special stains and immunohistochemistry, what other investigations may be used to aid diagnosis?
A
- Immunofluorescence
- In situ hybridisation
- Electron microscopy
- Cytogenetic and molecular genetic analysis
12
Q
What does digital pathology include?
A
Acquisition, management, sharing and interpretation of pathology information including slides and data in a digital environment
13
Q
How are digital slides created?
A
Glass slides are captured with a scanning device to provide a high-resolution image that can be viewed on a computer screen or mobile device.
14
Q
What does hyperplasia mean?
A
The abnormal multiplication or increase in number of normal cells in normal arrangement in a tissue.
15
Q
What does hypertrophy mean?
A
The enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells.
16
Q
What does atrophy mean?
A
A decrease in cell size by loss of cell substance.
17
Q
What is metaplasia?
A
Reversible change in which one adult cell type is replaced by another adult cell type
18
Q
What does hyperkeratosis mean?
A
That there is a thickening of the stratum corneum
19
Q
What is orthokeratosis?
A
The formation of an anuclear keratin layer, as found in normal keratinised stratified squamous epithelium.
20
Q
What is parakeratosis?
A
The persistence of nuclei in the cells of a keratin layer
21
Q
What is dyskeratosis?
A
Premature keratinisation of epithelial cells that have not reached the keratinising surface layer.
22
Q
What is acanthosis?
A
Increased thickness of the prickle cell layer
23
Q
What is acantholysis?
A
The loss of intercellular adhesion between keratinocytes
24
Q
What is epithelial dysplasia?
A
Alteration in differentiation, maturation, and architecture of adult epithelial cells.
25
What is ulceration?
Mucosal/skin defect with complete loss of surface epithelium
26
What is apoptosis?
Programmed cell death
27
What is necrosis?
Cell death by injury or disease
28
List 8 causes of white lesions:
1. Developmental
2. Normal variation
3. Hereditary
4. Traumatic
5. Dermatological
6. Infective
7. Idiopathic
8. Neoplastic
29
Give an example of a developmental white patch seen in the mouth.
Fordyce spots
30
Give an example of a white patch seen in the mouth that is of normal variation?
Leukoedema
31
Give 3 examples of hereditary white lesions seen in the mouth?
1. White sponge naevus
2. Pachyonychia congenita
3. Dyskeratosis congenita
32
List some typical features that may be seen in white sponge naevus:
Ill-defined white patches with shaggy surface
Often bilateral
Any part of oral mucosa, especially buccal mucosa
Can also affect nose, oesophagus, and anogenital region
33
What histopathological features can be seen in white sponge naevus?
1. Hyperparakeratosis of the epithelium
- thickening of the stratum corneum composed of parakeratin
2. Acanthosis of the epithelium
- Increased thickness of the prickle cell layer
3. Marked intracellular oedema of prickle and parakeratinised cells - 'basket weave' appearance
4. No cellular atypia/dysplasia
5. No inflammatory changes in lamina propria
34
Does white sponge naevus require treatment?
No
35
What 3 types of trauma may cause a white lesion to form in the mouth?
1. Mechanical/frictional trauma
2. Chemical trauma
3. Thermal trauma
36
What histopathological features can be seen in a white lesion that has occurred as a result of mechanical/frictional trauma?
1. Hyperkeratosis
2. Prominent scarring fibrosis with submucosa
37
Name 2 dermatological conditions that can present as white patches in the mouth?
1. Lichen planus
2. Lupus erythematosus
38
What is important about oral lichen planus?
Because it is an oral potentially malignant disorder - 0.1-10% (low risk) of developing into an oral squamous cell carcinoma.
39
List some clinical features of oral lichen planus:
1. Violaceous, itchy papule that may present with distinctive white streaks on the surface (Wickham's striae)
2. More chronic than skin lichen planus - sometimes can last several years.
3. Usually bilateral and symmetrical
4. Buccal mucosa is most commonly affected site although tongue, gingiva and lips my be affected.
40
What are the 6 different appearances of lichen planus?
1. Reticular
2. Atrophic
3. Plaque-like
4. Papular
5. Erosive
6. Bullous
41
What can plaque-like lichen planus be mistaken for?
Leukoplakia
42
What does bullous lichen planus look like and how does it get its appearance?
Presence of subepithelial blisters that form as a result of basal cell degradation and oedema.
This is due to lack of cohesion between the epithelium and lamina propria.
43
What 6 histopathological features can be seen in lichenoid inflammation*?
**(this includes lichen planus, lichenoid reactions to drugs/restorative material, lupus erythematosus, graft versus host disease, lichenoid inflammation associated with dysplasia.)
1. Hyperorthokeratosis/hyperparakeratosis of the epithelium which may be acanthotic.
2. Saw-tooth rete ridges
3. Dense band-like lymphocytic infiltrate (mostly T-cell) hugging epithelial/connective tissue junction
4. Lymphocytic exocytosis
5. Liquefaction degeneration of basal cell layer
6. Degenerating cells appear as hyaline, shrunken/condensed bodies known as 'Civatte' bodies and represent basal cells undergoing apoptosis.
44
How can symptomatic lichen planus be treated?
Steroids
45
Which 3 infective conditions can result in white patches?
1. Candidosis
2. Syphilitic Leukoplakia
3. Oral Hairy Leukoplakia
46
List the clinical features associated with Oral Hairy Leukoplakia:
1. White, shaggy appearance on lateral tongue
2. Asymptomatic
3. Can affect other sites - e.g. buccal mucosa
47
Which infections are associated with Oral Hairy Leukoplakia?
EBV
Strong association with HIV
Also seen in immunocompromised patients and in some apparently healthy patients
48
What histopathological features can be seen in oral hairy Leukoplakia?
1. Thickened, hyperparakeratotic epithelium
2. Band of ballooned pale cells in upper prickle cell layer
3. Often superadded candidal infection but without normal inflammatory response
49
What test is carried out to confirm the presence of EBV in oral hairy leukoplakia?
In situ hybridisation (ISH)
50
What treatment is carried out for oral hairy leukoplakia?
No treatment.
51
Name 2 conditions that may present as a white patch in the mouth that have no known cause (idiopathic):
1. Leukoplakia
2. Proliferative Verrucous Leukoplakia
52
What is important about leukoplakia?
It is important as leukoplakia is classified as an oral potentially malignant disorder (although considered low risk).
53
What is proliferative verrucous leukoplakia?
A clinico-pathological variant of oral leukoplakia that is multifocal, persistent, and progressive with a high rate of recurrence
HIGH risk of progression to cancer (SCC or verrucous carcinoma!!)
It begins as normal hyperkeratosis that in time becomes exophytic and wart-like.
54
Where is proliferative verrucous leukoplakia most commonly seen?
Gingiva, alveolar ridge, buccal mucosa, tongue, hard palate.
55
Name 2 neoplastic conditions that can present as a white patch in the mouth:
1. Dysplastic lesions (abnormal cell growth in a tissue)
2. Squamous Cell Carcinoma
56
What histological features can be seen in proliferative verrucous leukoplakia?
1. Hyperplastic lesion (abnormal increase in normal cells)
2. Hyperkeratosis (thickening of the stratum corneum)
3. Often minimal dysplasia
57
List 4 causes of red patches in the mouth:
1. Infective - bacterial, viral, fungal
2. Associated with dermatological disorders
3. Idiopathic
4. Neoplastic
58
List 3 infections (bacterial, fungal or viral) that may result in red patches in the mouth?
1. Periodontal disease
2. Median rhomboid glossitis
3. HIV gingivitis
59
What is median rhomboid glossitis?
An asymptomatic rhomboid shaped red patch on the midline of the posterior aspect of the anterior 2/3 of the dorsal tongue
Can present with a reciprocal lesion on the palate
60
What causes median rhomboid glossitis?
Aetiology is uncertain, but most cases are associated with candida
61
How would you diagnose median rhomboid glossitis?
Usually diagnosed clinically, however some do go on to get biopsied.
62
What histological features can be seen in median rhomboid glossitis?
Loss of lingual papillae
Parakeratosis and acanthosis of the squamous epithelium
Candidal hyphae in parakeratin and associated neutrophils
Chronic inflammatory infiltrate in connective tissue
63
How would you treat median rhomboid glossitis?
Anti-fungals
- even with successful treatment, papillae on the tongue do not grow back.
64
Name 2 dermatological conditions that may present as a red patch in the mouth:
1. Erosive lichen planus
2. Discoid Lupus Erythematosus
65
Name 2 conditions that may present as a red patch in the mouth that have no known cause (idiopathic):
1. Geographic tongue
2. Erythroplakia
66
What is the importance of erythroplakia?
It is an oral potentially malignant disorder that has a HIGH likelihood of malignant transformation
67
What does erythroplakia look like and where is it commonly found?
It has a red velvety appearance, smooth or nodular.
It is most frequently seen on the palate, FOM, and buccal mucosa.
68
What is erythroleukoplakia (speckled leukoplakia) ?
An oral potentially malignant disorder.
Has both leukoplakia (white) and erythroplakia (red) components
On biopsy >90% will show severe dysplasia or carcinoma!!
69
List 5 exogenous (out with the body) causes of oral pigmentation?
1. Superficial staining of mucosa from food, drinks, tobacco
2. Black hairy tongue - papillary hyperplasia and overgrowth of pigment producing bacteria - more common in smokers.
3. Foreign bodies - amalgam tattoo
4. Heavy metal poisoning
5. Some drugs - NSAIDs, antimalarials, chlorhexidine
70
How would you confirm diagnosis of amalgam tattoo?
May be seen on a radiograph.
May excise lesion to confirm diagnosis.
71
List 9 endogenous (within the body) causes of oral pigmentation:
1. Normal variation in pigmentation similar to that seen in skin
2. Melanotic macule
3. Pigmented naevi
4. Peutz-Jeghers Syndrome
5. Smoker's Melanesia
6. HIV infection
7. May be a manifestation of systemic disease (Addison's), malignancy
8. Mucosal melanoma
9. Melanotic neuroectodermal tumour of infancy
72
What is a melanotic macule?
A benign, well-defined small flat brown/black lesion that occurs due to an increased activity of melanocytes.
73
Where would a melanotic macule commonly be found?
Buccal mucosa, palate, gingiva
74
Why would you excise a melanotic macule?
To confirm diagnosis and exclude melanoma
75
What histopathological features would be seen in a melanotic macule?
Increased melanin pigment in basal keratinocytes (NOT an increased number of melanocytes!!)
Melanin pigmentary incontinence in underlying connective tissue
76
What is a mucosal melanoma?
A dark brown, black or red (if not pigmented) malignant neoplasm of mucosal melanocytes.
Typically asymptomatic at first, however can progress and present with pain, ulceration, bleeding, or neck mass
Regional lymph node and blood borne metastases are common
Very invasive lesions that metastasise early
Typically very advanced at presentation - prognosis is poor
77
What are the most common sites for a mucosal melanoma?
Hard palate and maxillary gingiva
78
What causes mucosal melanoma?
Aetiology is unknown
79
What histopathological features can be seen in melanomas?
Cells appear epithelioid or spindle shaped
Amount of melanin pigment varies
80
What diagnostic aid can be useful in the diagnosis of melanomas?
Immunohistochemistry using specific markers for malignant melanocytes.
81
What is the treatment for mucosal melanoma?
Surgical resection is mainstay treatment
Adjuvant radiotherapy
Potential role in immunotherapy
82
What is melanotic neuroectodermal tumour of infancy?
A very rare condition affecting <1yr olds
Locally aggressive, rapidly growing pigmented mass
Arises most frequently in the anterior maxillary alveolus
83
What histopathological features can be seen in neuroectodermal tumour of infancy?
Neuroblastic cells and pigmented epithelial cells
84
How would you treat neuroectodermal tumour of infancy?
Complete local excision (treatment of choice)
Tumour of uncertain malignant potential
Some can recur
Small number do behave in a malignant behaviour and metastasise
85
List 7 causes of oral ulceration:
1. Infective
2. Traumatic
3. Drugs
4. Idiopathic
5. Associated with systemic disease
6. Associated with dermatological disease
7. Neoplastic
86
List some infections that may be responsible for oral ulceration:
1. Bacterial
2. Fungal
3. Viral:
- Herpes Simplex Virus
- Varicella zoster virus
- Cytomegalovirus
- Coxsackie virus
87
What types of trauma can cause oral ulceration?
Mechanical
Chemical
Thermal
Factitious injury
Radiation
88
Which drugs can cause oral ulceration?
Nicorandil
NSAIDs
89
Name a condition that results in oral ulceration that can have no known cause (idiopathic)?
Recurrent aphthous stomatitis
90
Name 3 systemic diseases that may result in oral ulceration:
1. Haematological disease
2. GI disease
3. HIV (immunosuppressed)
91
Name 3 different types of dermatological diseases that can result in oral ulceration:
1. Lichen planus
2. Discoid lupus erythematosus
3. Immunobullous diseases
92
List some neoplastic lesions of the mouth than can result in oral ulceration?
1. Oral squamous cell carcinoma
2. Other malignant neoplasms including salivary gland neoplasms or metastasis
93
What histopathological features may you see in an ulcer?
1. Non-specific features of ulceration with loss of surface epithelium.
2. Inflamed fibrinoid exudate and inflamed fibrinoid exudate and inflamed granulation tissue
** It can be difficult to differentiate between the different causes using histopathology, however, Neoplastic lesions are an exception as they would have an ulcerated tumour
94
What is the difference between a vesicle and a bulla?
Vesicles are small blisters
Whereas bulla are large blisters (>10mm)
95
How do vesiculobullous lesion present?
As oral ulceration following rupture of vesicles/bullae.
96
What are Immunobullous disorders?
Immunobullous disorders are autoimmune diseases in which antibodies against components of the skin and mucosa produce blisters.
These disorders are a subset of vesiculobullous lesions.
97
How are vesicles/bullae classified histologically?
They are classified histologically depending on the location of the bulla.
Different classification categories include:
- Intraepithelial (non-acantholytic or acantholytic)
- Subepithelial
98
How do non-acantholytic intraepithelial vesiculobullous lesions form?
By death and rupture of cells by viral infection (e.g. HSV in primary hermetic stomatitis and herpes labialis).
Groups of infected cells break down to form vesicles within the epithelium - infection can spread infecting nearby normal cells.
Ulcer forms when full thickness epithelium is involved and destroyed.
99
How do acantholytic intraepithelial vesiculobullous lesions form?
By desmodermal breakdown as a result of autoimmune disease
100
Name one autoimmune disease that can result in the formation of an acantholytic intraepithelial vesiculobullous lesion:
Pemphigus
101
What are the different types of pemphigus and identify which type is the most common and most severe?
Types:
- Vulgaris (most common, most severe)
- Foliaceous
- IgA
- Drug-induced
- Paraneoplastic
102
How do you treat pemphigus vulgaris?
Steroids
103
List some histopathological features of pemphigus vulgaris:
1. Intraepithelial bullae produced by acantholysis (desmodermal breakdown)
2. Bullae just above basal cells that form base of the lesion (tombstones)
3. Acantholytic cells (Tzanck) found lying free within the bulla fluid
104
What can be used to aid diagnosis of Pemphigus vulgaris?
Direct immunofluorescence and histopathology to confirm diagnosis - fresh specimen is mandatory for direct immunofluorescence!!
105
List 4 examples of subepithelial vesiculobullous lesions?
1. Pemphigoid
2. Erythema multiforme
3. Dermatitis herpetiform
4. Epidermolysis bullosa
106
What is pemphigoid?
A group of autoimmune diseases including:
- Bullous pemphigoid
- Mucous membrane pemphigoid
- Linear IgA disease
- Drug induced pemphigoid
107
How does mucous membrane pemphigoid present?
Oral mucosa almost always involved and usually first affected site - gingiva, buccal mucosa, tongue, palate
Gingival lesions present as desquamative gingivitis
Eyes, nose, larynx, oesophagus and genitalia may be involved
Bullae tend to be relatively tough as the lid is full thickness epithelium - when they rupture, they tend to heal slowly with scarring
108
How do you treat mucous membrane pemphigoid?
Steroids
109
What histopathological features can be seen in mucous membrane pemphigoid?
Separation of full thickness epithelium from connective tissue producing subepithelial bulla with a thick roof
Infiltration of neutrophils and eosinophils around and within bulla
Base of bulla has inflamed connective tissue
110
What can be used to aid diagnosis of mucous membrane pemphigoid?
Direct Immunofluorescence and histopathology to confirm diagnosis - fresh specimen is mandatory for direct immunofluorescence!!
111
What is the difference between pemphigoid and pemphigus?
Pemphigus:
- Affects outer layer of skin
- Intraepithelial Vesiculobullous lesion
- Fragile shallow blisters - rupture easily
Pemphigoid:
- Affects deeper layer of skin
- Subepithelial Vesiculobullous lesion
- Stronger tense blisters - Hard to burst
Commonly present with red itchy hives
112
What is epidermolysis bullosa acquisita?
A acquired autoimmune condition resulting in subepithelial vesiculobullous lesions.
Presents as blistering dermatosis with subepithelial bulllae.
Oral lesions in approximately 50% cases.
Early stage mimics pemphigoid and later resembles epidermolysis bullosa.
Separation occurs in or beneath lamina densa in basement membrane zone.
113
What is epidermolysis bullosa?
A group of rare genetic conditions
Formation of skin bullae which heal with scarring - variable involvement with oral mucosa
3 variants:
- Simplex (intraepithelial)
- Junctional (subepithelial)
- Dystrophic (subepithelial)
114
Which variant of epidermolysis bullosa is caused by mutations in keratins 5/14?
Simplex
115
Which variant of epidermolysis bullosa is caused by mutation in type VII collagen gene?
Dystrophic
116
What is the scientific name given to oral blood blisters?
Angina Bullosa Haemorrhagica
117
Where do oral blood blisters most commonly occur?
Soft palate
118
What is the most common cause of blood blisters?
Secondary to trauma
(NOT caused by systemic reasons or haematological disease)
119
What is oral submucous fibrosis?
A chronic progressive oral potentially malignant disorder resulting in:
- Pale mucosa that is firm to palpate
- Fibrous bands of tissue affecting the buccal/labial mucosa, and soft palate.
- Marked trismus
120
Name a common cause of submucous fibrosis:
Betel quid/areca nut
121
What histopathological features can be seen in oral submucous fibrosis?
1. Submucosal deposition of dense collagenous tissue
2. Decreased vascularity
3. Marked epithelial atrophy
4. Variable grades of epithelial dysplasia
5. High risk of malignant transformation
122
What is epithelial dysplasia?
Atypical epithelial changes to the surface squamous epithelium
- architectural changes: maturation and differentiation
- cytological changes: change in cells
Risk of developing oral SCC - if the atypical cells invade the underlying connective tissue (not all epithelial dysplasia's progress to cancer - high grade epithelial dysplasia's have a higher risk)
123
Where does epithelial dysplasia commonly affect?
Can affect anywhere in the mouth, however lateral/ventral surfaces of the tongue, retromolar area, and FOM are areas associated with higher risk of malignant change
124
What histological features are associated with Epithelial Dysplasia?
- 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 - i.e. 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 intracellular adhesion
125
How is epithelial dysplasia graded?
1. Using the basic grading system:
Mild - disorganisation, increased proliferation, atypia of basal cells
Moderate - more layers of disorganised basaloid cells, atypia. suprabasal mitoses
Severe - very abnormal, affects full thickness of epithelium
2. Using the binary system:
- Low grade
- High grade
126
How would you manage epithelial dysplasia?
1. Modify risk factors - tobacco, alcohol
2. Manage high risk areas (lateral, ventral, FOM) less conservatively
3. Antifungal treatment - if superadded candidal infection
4. Excision/CO2 laser excision
5. Topical agents - Imiquimod (immunotherapy cream - typically used for dysplasia in the lip)
6. Close clinical review
7. Re-biopsy - pts will likely have multiple sites of dysplasia
127
What is classified as an oral cancer?
Any cancer that is present in the oral cavity and the external lip up to the vermillion border.
128
What % of oral cancers present as SCCs?
>90%
129
What are the risk factors for oral cancer?
Tobacco
Alcohol
Betel quid/pan/areca nut
Previous oral cancer
Exposure to UV light (lip)
Poor diet
Immunosuppression
OPMDs
Genetics - genetic predisposition
FH
Human papilloma virus - more often associated with oropharyngeal cancer
130
Name some high risk sites and some low risk sites of oral cancer:
High risk sites:
- Lateral/ventral tongue
- FOM
- Retromolar region
(tonsils/soft palate - oropharyngeal cancer)
Low risk sites:
- Hard palate
- Dorsal of tongue
131
List some signs and symptoms of oral cancer:
1. Lumps and bumps
2. Ulcers
3. White patches
4. Red patches
5. Speckled patches
6. Non-healing socket
7. Tooth mobility not associated with periodontal disease
8. Induration/fixation of mucosa
9. Dysphasia
10. Pain/paraesthesia
11. Bleeding
132
What should you do if you suspect that your patient has oral cancer?
Refer them to a specialist management team (the local Oral and Maxillofacial surgery department) under the 'Urgent 2-week suspicion of cancer' referral pathway.
133
What exact presentations would elicit the need for referral due to suspected oral cancer?
1. Persistent unexplained head and neck lumps >3 weeks
2. Unexplained ulceration or unexplained swelling/induration of the oral mucosa persisting > 3 weeks
3. All unexplained red or mixed red/white patches in the oral mucosa persisting >3 weeks
4. Persistent (non-intermittent) hoarseness lasting >3weeks
5. Persistent pain in the throat/pain on swallowing lasting for >3 weeks
134
Which tumours require immunohistochemistry to aid diagnosis?
Very poorly differentiated tumours
Immunohistochemistry is not used routinely for diagnosis of all oral cancers - however it is used routinely for all oropharyngeal SCCs.
135
Which staging system is used to stage most cancers (including lip and oral cavity carcinomas)?
TNM Staging
136
How are tumours staged in the TNM staging system?
Staged depending on the anatomical extent of disease
Staged clinically, radiologically and pathologically
137
What are the TNM components of TNM staging?
T - extent of primary tumour
N - absence or presence and extent of regional lymph node metastasis
M - absence or presence of distant metastasis
138
What does the number given to each component in TNM staging of cancer indicate?
The greater the number= the larger the extent of disease
139
What are the most significant prognostic factors for oral cancer?
Tumour size
Depth of invasion
Nodal status
Distant metastasis
140
How are SCCs graded?
By degree of differentiation
- Well-differentiated: very obviously squamous with prickles and keratinisation
- Moderately differentiated
- Poorly differentiated: may be difficult to identify tumour cells as epithelial
**grading alone does not correlate with prognosis
141
How do you treat oral cancer?
Surgery +/- adjuvant therapy - radiochemotherapy
Monoclonal antibodies - can be used in advanced H&N cancers
142
What is the survival rate for oral cancer?
5 year survival rate - early detection is crucial in optimising treatment outcomes
143
What core data items are included in a histopathology report when reporting oral cancers?
1. Clinical data - site and laterality of the tumour, type of specimen
2. Pathological data:
- max diameter of tumour
- max depth of invasion
- type of carcinoma
- grade of tumour
- pattern of invasion
- distance from invasive carcinoma to surgical margins
- vascular invasion
- nerve invasion
- bone invasion
- severe dysplasia
144
List 5 examples of non-cystic dental inflammatory lesions:
1. Acute periradicular periodontitis
2. Acute periapical abscess
3. Chronic periradicular periodontitis
4. Periapical granuloma
5. Pericoronitis
145
What is the most common reason for periradicular/periapical inflammation?
Bacterial infection following pulpal death - this may be due to caries or trauma
146
What can acute and chronic periradicular periodontitis lead to?
Periapical abscess
147
What can chronic periradicular periodontitis lead to?
Periapical granuloma
148
What can periapical granuloma lead to?
Radicular cyst formation
OR
Can become acutely inflamed and develop an acute abscess
149
What can an acute abscess result in?
Chronic abscess formation
OR
Cellulitis
150
What are the clinical features of an acute periradicular periodontitis?
Pain
Grossly carious/heavily restored tooth
Previous trauma
Typically little to see radiographically unless acute exacerbation of chronic lesion
151
What histopathological features might you see in an acute periradicular periodontitis?
Acute inflammatory changes:
- vascular dilation
- neutrophils
- oedema
152
What treatment options are there for an acute periradicular periodontitis?
- Extract
- RCT
153
What are the clinical features of acute periapical abscess?
Pain
Swelling/sinus
154
What histopathological features can be seen with an acute periapical abscess?
Central collection of pus (neutrophils, bacteria, cellular debris)
Adjacent zone of preserved neutrophils
Surrounding membrane of sprouting capillaries, vascular dilation, and occasional fibroblasts (granulation tissue).
155
What are the treatment options for an acute apical abscess?
Drainage of abscess and extraction or RCT of associated tooth
156
What are the clinical features of chronic periradicular periodontitis?
Non-vital tooth (may be previous RCT)
Often minimal symptoms
Apical radiolucent lesion may be evident on radiograph
157
What histopathological features can be seen in chronic periradicular periodontitis?
Chronic inflammatory changes - seen by the presence of:
- Lymphocytes
- Plasma cells
- Macrophages
- Granulation tissue progressing to fibrosis - predominantly by lymphocytes and plasma cells
- Resorption of bone
- Minimal, if any, tooth resorption
158
What are the treatment options for chronic periradicular periodontitis?
Extraction. RCT, endodontic retreatment, periradicular surgery
Does NOT resolve spontaneously
159
What is a periapical granuloma?
A mass of inflamed granulation tissue at the apex of a non-vital tooth, that can arise as a result of chronic periradicular periodontitis or from an acute abscess.
Not a true granuloma - i.e. not a collection of macrophages
Can transform to an abscess
Some may undergo cystic change to become a radicular cyst (odontogenic inflammatory cyst)
160
What are the clinical features of a periapical granuloma?
Same features as chronic periradicular periodontitis, however apical radiolucency is typically evident on radiograph.
161
What histopathological features can be seen in a periapical granuloma?
Inflamed granulation tissue - lymphocytes, plasma cells, macrophages and neutrophils
Proliferation of cell rests of Malassez - often in long strands and arcades (may ultimately lead to inflammatory radicular cyst formation
Hemosiderin and cholesterol deposits from RBC/inflammatory cell breakdown, with multi-nuclear foreign body giant cells
Resorption of adjacent bone +/- tooth
162
What are the treatment options for periapical granuloma?
1. Extraction
2. RCT
3. Endodontic re-treatment
4. Peri-radicular surgery
163
What is pericoronitis?
Inflammation of soft tissues around PE tooth
Frequently lower 8s
Often exacerbated by trauma from opposing tooth
164
What are the clinical features of pericoronitis?
Pain
Swelling/tenderness of operculum
Bad taste
Trismus
165
What histopathological features can be seen in pericoronitis?
Acute and chronic inflammatory changes including oedema, inflammatory cells, vascular dilation, fibrotic connective tissue.
Paradental cyst (type of odontogenic cyst) may arise in chronic pericoronitis.
166
How can you treat pericoronitis?
Irrigation
Consider extraction of opposing tooth
Antibiotics (only if systemically unwell)
167
What is a cyst?
A pathological cavity having fluid or semi-fluid contents
Lined wholly or partly in epithelium
Not due to accumulation of pus
168
What are the 2 different types of cysts that are classified in the WHO 2022 Classification of Cysts of the Jaws?
Odontogenic cysts - derived from epithelial residues of tooth forming organ. Can be inflammatory or developmental
Non-odontogenic cysts - derived from sources other than tooth forming organ
169
What components combine to form a tooth?
Odontogenic epithelium and neural crest derived ectomesenchyme
170
What forms the enamel organ?
The dental lamina buds down from the ectoderm and becomes the enamel organ.
171
What are the 4 layers that make up the enamel organ?
1. Inner enamel epithelium (future ameloblasts)
2. Outer enamel epithelium
3. Stellate reticulum
4. Status intermedium
172
Which types of cells develop into pulpal tissue?
Ectomesenchymal cells
173
How is dentine and the enamel matrix formed?
Signalling causes the outer cells of the pulp (next to ameloblasts) to differentiate into odontoblasts and lay down dentine.
Enamel matrix is then subsequently laid down.
174
What happens after crown formation?
The enamel organ reduces to form the Root Sheath of Hertwig which grows down to map out the root.
175
What remnants can be left behind following odontogenesis?
1. Remnants of odontogenic epithelium
- will remain in PDL and gingiva after tooth development
2. Remnants of dental lamina (known as Glands of Serres)
3. Remnants of Root Sheath of Hertwig (known as cell Rests of Malassez)
176
What are the 2 different types of odontogenic cyst?
1. Inflammatory odontogenic cyst
2. Developmental odontogenic cyst
177
What are the 2 types of inflammatory odontogenic cyst?
1. Radicular cyst (apical, lateral, residual)
2. Inflammatory collateral cyst (paradental cyst or mandibular buccal bifurcation cyst)
178
Where does a lateral radicular cyst arise from?
Lateral root canal branch of a non-vital tooth
179
Where does a residual radicular cyst arise from?
Persists after extraction of the associated non-vital tooth
180
What are the clinical features of a radicular cyst?
Most common type of jaw cyst
Anterior maxilla most frequent location
Can occur over a wide age range
Slow growing swelling
Often asymptomatic unless very large
Must be associated with a non-vital tooth (usually at the apex, although can be on a lateral aspect of root if associated with lateral canal.
Typically well-circumscribed unilocular radiolucent lesion seen at the apex, although can be on lateral aspect of root if associated with lateral canal.
181
What is happening pathologically in the presence of a radicular cyst?
There is proliferation of the epithelium (Cell Rests of Malassez) in response to inflammation.
Cyst enlarges due to osmotic pressure
Local bone resorption
182
What histopathological features can be seen in a radicular cyst?
Chronically inflamed fibrous capsule
Central cystic lumen surrounded by a non-keratinised stratified squamous epithelium lining of variable thickness
Beyond the epithelial lining lies fibrous connective tissue cyst wall - areas of this cyst wall are densely packed with chronic inflammatory infiltrate
May also see hyperplasia of epithelium, mucous metaplasia, ciliated cells, Hyaline/Rushton bodies (secreted by cyst lining - indicates odontogenic origin), cholesterol clefts and hemosiderin
183
How would a radicular cyst be treated?
Small cysts may resolve after RCT/extraction/periradicular surgery.
Larger lesions may require enucleation - entire removal of lesion
Very large lesions may require marsupialisation prior to enucleation - small pouch made into cyst to allow decompression of the lesion prior to enucleation.
184
What is the cause for inflammatory collateral cysts?
Inflammation associated with pericoronitis
May be enamel spur on buccal aspect of involved tooth
Exacerbated by impact action of food
Proliferation of sulcular or junctional epithelium derived from reduced enamel epithelium.
185
What are the 2 different types of inflammatory collateral cyst and which teeth are affected by each of the cysts?
1. Paradental cyst - lower third molars
2. Mandibular buccal bifurcation cyst - lower 1st and 2nd molars
186
Which type of inflammatory collateral cyst can arise from chronic pericoronitis?
Paradental cyst
187
What radiological features are associated with a paradental cyst?
Well-demarcated radiolucency
188
What are the clinical and radiological features associated with a mandibular buccal bifurcation cyst?
- Often painless swelling
- Associated tooth usually tilted buccally with deep perio pocket
- Well demarcated buccal radiolucency
189
What histopathological features can be seen associated with a inflammatory collateral cyst?
Same histopathological features that are associated with radicular cysts.
190
How would you treat mandibular buccal bifurcation cysts?
By enucleation (complete removal)
191
How would you treat paradental cysts?
Removal of 8s and paradental cyst
192
List the 7 different developmental odontogenic cysts:
1. Odontogenic keratocyst
2. Dentigerous cyst/Eruption cyst
3. Lateral periodontal cyst and botryoid odontogenic cyst
4. Glandular odontogenic cyst
5. Gingival cysts
6. Calcifying odontogenic cysts
7. Orthokeratinised odontogenic cyst
193
What are OKCs?
A benign developmental odontogenic cyst that has a high recurrence rate (25%) if incompletely removed.
194
Why was the 2005 term 'Keratocystic Odontogenic tumour' (KCOT) more recently changed to 'Odontogenic Keratocyst' (OKC)?
Because there was insufficient evidence to suggest a neoplastic origin.
195
What are the clinical/radiographic features of an OKC?
3rd most common cyst in the jaw
Occurs over a wide age range
80% arise in the mandible (especially posteriorly)
Symptomless unless infected or when cortical bony expansion is evident (often late as enlarges in anterior-posterior direction) - can reach considerable size before detection.
Well-defined radiolucent uni- or multilocular lesion
196
What is the aetiology of OKC?
Arise from remnants of the dental lamina (Glands of Serres)
Associated with mutation or inactivation of the PTCH1 gene (found in chromosome 9) - this activates SHH signalling pathway resulting in aberrant cell proliferation of epithelium.
OKCs can be sporadic or associated with a particular syndrome
- Naevoid basal cell carcinoma syndrome (Gorlin syndrome) - multiple recurring OKCs, skeletal abnormalities, multiple basal cell carcinomas, associated with autosomal dominant PTCH1 gene mutations
197
What histopathological features can be seen in OKCs?
Cystic lesion
Keratinised 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.
198
What happens to the histopathological features in OKCs if secondary infection in present?
Typical features are lost - in these circumstances it is hard to distinguish OKC from other inflammatory cysts using histology alone.
199
Why do OKCs have a high recurrence rate?
Due to thin capsule/daughter cysts
200
What are the treatment options for OKCs?
- Marsupialisation
- Enucleation
- Marsupialisation and enucleation
- Enucleation and Carnoy's solution (modified Carnoy's) - used to eliminate any remaining cyst/daughter cyst, <10% recurrence rate
- Resection - involves removal of whole lesion and margin of normal bone (2% recurrence rate, has increased morbidity)
201
What is a dentigerous cyst?
Accumulation of fluid between the reduced enamel epithelium of the dental follicle and the crown of the unerupted tooth
202
What are the clinical features of a dentigerous cyst?
2nd most common odontogenic cyst
Encloses all or part of crown of unerupted tooth
Attached to ACJ
Associated with impacted teeth or late to erupt teeth (3, 5, 8s)
Higher occurrence in the mandible, 20-50 years
Symptom-free until significant swelling or if infected
Ballooning expansion
Well-circumscribed unilocular radiolucency associated with crown of unerupted tooth.
203
What histopathological features can be seen in dentigerous cysts?
Thin non-keratinised stratified squamous epithelial lining (2-5 cells thick)
Mucous metaplasia is common
Fibrous capsule
No inflammation, unless secondary infection
May be odontogenic epithelium remnants, calcification, Rushton bodies
204
What happens to the histopathological features in dentigerous cysts if secondary infection in present?
They are lost which makes it difficult to distinguish dentigerous cysts from other inflammatory cysts.
205
What should you include on the pathology request form to aid diagnosis of dentigerous cysts?
The attachment of the lesion to the ACJ of the unerupted tooth.
206
How are dentigerous cysts treated?
By enucleation of the cyst with exposure/transplantation/extraction of associated tooth
207
What is an eruption cyst?
A dentigerous cyst arising in an extra-alveolar location
208
What are the clinical features of an eruption cyst?
Typically seen in children
Deciduous and permanent molars
Presents as a bluish swelling
209
What is the histopathology of an eruption cyst?
Same as dentigerous cyst
210
How would you treat a dentigerous cyst?
1. No treatment - the unerupted tooth should naturally erupt through the cyst
2. Exposure of erupting tooth
211
What are the clinical features of a lateral periodontal cyst?
Uncommon
Arise adjacent to vital tooth
Canine and premolar region of mandible
Wide age range
Usually symptom-free, incidental finding
Well-circumscribed radiolucency in PDL
212
What is the aetiology of a lateral periodontal cyst?
Likely arises from cell rest of Malassez
213
What histopathological features can be seen with lateral periodontal cysts?
Thin non-keratinised squamous or cuboidal epithelium
Focal thickenings/plaques
Uninflamed fibrous wall
214
How would you treat a lateral periodontal cyst?
Enucleation
*Recurrence is RARE.
215
What is a Botryoid Odontogenic Cyst?
Very rare, multi-cystic variant of lateral periodontal cyst - has the same histopathological features as a lateral periodontal cyst.
Botryoid = 'bunch of grapes' - polycystic appearance
Typically multilocular radiolucency
Affects the mandibular premolar to canine region
Frequent in adults
Can recur
216
What are the clinical features of a glandular odontogenic cyst?
Very rare
Occur over wide age range
Anterior mandible
Multilocular radiolucency
Strong tendency to recur
217
What histopathological features can be seen in a glandular odontogenic cyst?
Cystic lumen lined by epithelium of various thickness with mucous cells and glandular structures (crypts/cyst-like spaces)
Focal epithelial plaques/thickenings
**MUST BE DIFFERENTIATED FROM CENTRAL MUCOEPIDERMOID CARCINOMA!
218
How would you treat a glandular odontogenic cyst?
Enucleation but high recurrence rate (up to 50%)
219
What clinical features are associated with gingival cysts in children?
Seen as Bohn's nodules - superficial keratin-filled cysts in the gingivae of newborns
Present as white nodules in gingivae
220
How do you treat gingival cysts in children?
No treatment - usually disappear within a few weeks.
221
What clinical features are associated with gingival cysts in adults?
Very rare
Middle aged adults
Painless dome-shaped swelling in gingiva
Majority in mandibular canine-premolar region
May be superficial erosion of underlying alveolar bone
222
What histopathological features can be seen in gingival cysts in adults?
Cyst just below oral epithelium
Un-inflamed fibrous wall
Lined by thin epithelium, cuboidal to squamous
223
How would you treat gingival cyst in adult?
Simple excision
224
What is the cause of a calcifying odontogenic cyst?
Arises from dental lamina
Currently classified as a benign lesion
225
What are the clinical features of a calcifying odontogenic cyst?
Rare
Wide age range
Painless swelling of jaw
Well-defined radiolucency
Tooth displacement and resorption common
Either jaw, often anterior
Minority can be in soft tissues
226
What histopathological features can be seen in calcifying odontogenic cysts?
Uni-cystic
Lined by epithelium which is ameloblast-like
Palisaded basal cell layer with overlying stellate reticulum-like layer
Focal 'ghost cells' which may calcify
227
How would you treat a calcifying odontogenic cyst?
Enucleation
Recurrence is rare
228
What causes Orthokeratinised odontogenic cysts?
Likely derived from dental lamina
229
What are the clinical features of an orthokeratinised odontogenic cyst?
Rare
Wide age range
90% mandible
Painless swelling of the jaw
Well defined uni-locular radiolucency
230
What histopathological features can be seen in orthokeratinised odontogenic cysts?
Uninflamed fibrous wall
Lined by stratified squamous epithelium
Prominent granular cell layer and orthokeratinised
No basal palisading, no corrugated parakeratin
231
How would you treat orthokeratinised odontogenic cysts?
Enucleation
Recurrence is rare
232
Name 5 types of Non-Odontogenic cysts:
1. Nasopalatine duct cyst
2. Surgical ciliated cyst
3. Nasolabial cyst
4. Soft tissue cyst
5. Non-epithelialised primary bone cyst
233
What are the clinical features of Nasopalatine Duct Cysts?
Uncommon
Originates from the nasopalatine duct in the incisive canal
Swelling in the midline of the anterior palate
Pt may complain of a salty taste
Rounded heart-shaped radiolucency in the midline of the anterior hard palate
Often chronically inflamed
234
List 3 different presentations of Nasopalatine Duct Cyst:
1. Median palatine cyst
2. Incisive canal cyst
3. Median alveolar cyst
235
How would you treat a nasopalatine duct cyst?
Enucleation
Recurrence is unlikely
236
What are the clinical features of a surgical ciliated cyst?
Rare
Most are found in the posterior maxilla
May be asymptomatic or present with pain and swelling
Develop after sinus/nasal mucosa implanted in the jaw following trauma or surgery
237
How are surgical ciliated cysts treated?
Enucleation
Recurrence is rare
238
What is enucleation of a cyst?
Enucleation is a type of excision carried out which involves removing a cyst along with the cyst lining to prevent recurrence.
239
What is marsupilisation of a cyst?
Marsulipilisation is a procedure used to decompress large cystic lesions prior to enucleation.
240
Name the 5 types of soft tissue cysts:
1. Salivary mucocele (extravasation/retention types, ranula)
2. Epidermoid cyst
3. Dermis cyst
4. Lymphoepithelial cyst
5. Thyroglossal cyst
241
Where is an oral dermoid cyst most commonly found?
FOM
242
What distinct/identifiable histopathological feature can be in dermoid cysts?
Skin appendages in the cyst wall - e.g. hair follicle, sebaceous gland etc.
243
How are all soft tissue cysts treated?
By excision
244
What type of procedure would be followed when excising a thyroglossal duct cyst?
A 'Sistrunk' procedure - involves the removal of the mid-third of the hyoid bone as well as the cystic lesion, to prevent the chance of recurrence
245
Are non-epithelialised primary bone cysts true cysts?
No - as they are not lined by epithelium
246
List 2 examples of non-epithelialised primary bone cysts:
1. Simple solitary bone cyst
2. Aneurysmal bone cyst
247
When do simple solitary bone cysts often arise?
Premolar/molar regions of mandible.
248
How do you treat simple solitary bone cysts?
They resolve spontaneously and after opening of cavity
249
Which developmental anomaly appears cyst-like on the radiograph?
Stafne's duct
250
List 4 different odontogenic tumours:
1. Ameloblastoma
2. Ademomatoid odontogenic tumour
3. Odontoma
4. Cementoblastoma
251
Which odontogenic tumour has the following features:
- Usually found in the posterior mandible
- Slow-growing, locally aggressive
Ameloblastoma
252
What is important to note about maxillary ameloblastomas?
- They are rare but readily spread through thin bones and base of the skull
- Difficult to completely excise
- Potentially lethal!!
253
How are ameloblastomas treated?
Complete excision with a margin of uninvolved tissue + long-term follow-up
(if excision is incomplete then it will recur)
254
Which odontogenic tumour has the following features:
- Found most commonly in the maxillary canine region
- Often associated with UE permanent tooth
- Unilocular radiolucency
- Arranged in solid nodules or rosette-like structures
Adenomatoid Odontogenic Tumour
**(i dont know ma toid)
255
How are Adenomatoid odontogenic tumours treated?
Local excision
Recurrence is rare
256
What are the 2 different types of odontoma?
1. Compound type
2. Complex type
257
Out of the 2 types of odontomas (compound and complex) which type is known as the most common odontogenic tumour?
Compound type
258
Where are odontomas (compound type) most frequently found?
Anterior maxilla
259
What does a compound type odontodoma look like?
Lots of tooth-like structures enclosed in a fibrous capsule (bag of teeth)
260
Where are odontomas (complex type) most frequently found?
Posterior mandible
261
How does a complex type odontoma appear radiographically?
Radiopaque mass (irregular mass of hard and soft dental tissues)
Haphazard arrangement with no resemblance to tooth
Often forming a cauliflower-like mass
Cementum is often very scant
262
How are odontomas treated?
Enucleation
Mature lesions completely enucleated - do not recur
Incompletely enucleated lesions may recur
263
Which odontogenic tumour has the following features:
- formation of cementum-like tissue in connection with root of a tooth
- most commonly found in the mandible - especially associated with 6s
- painful swelling
- tooth remains vital
- well defined radiopaque or mixed density lesion
Cementoblastoma
264
How do you distinguish a cementoblastoma from a bone tumour?
As the cementoblastoma blends with the roots of the tooth
265
How do you treat cementoblastoma?
By complete excision and removal of the tooth - common recurrence rate if incompletely excised.
266
What are soft tissue hyperplastic lesions known as if they are found on the gingiva?
An epulis
267
List 5 different types of soft tissue hyperplastic lesion:
1. Epulides
2. Pyogenic granuloma
3. Fibroepithelial polyp
4. Denture irritation hyperplasia
5. Papillary hyperplasia of the palate
268
Name 3 different types of epulides:
1. Fibrous Epulis
2. Pyogenic Granuloma/Pregnancy Epulis
3. Giant Cell Epulis (Peripheral Giant Cell Granuloma)
269
List some clinical features of a fibrous epulis?
Pedunculated or sessile firm mass on the gingiva
Often between 2 teeth
Pink in colour
270
How do you treat a fibrous epulis?
Excision
Remove the source of irritation (e.g. ill-fitting crown, restoration overhang etc.) - if not removed then irritation is likely to recur.
271
List some clinical features of a pyogenic granuloma/pregnancy epulis?
Soft red/purple swelling
Often ulcerated
Can occur in gingiva (epulis) or other places of the mouth
*pregnancy epulis is a pyogenic granuloma in a pregnant woman
272
How would you treat pyogenic granuloma/pregnancy epulis?
Pyogenic granuloma - local excision, remove source of irritation
Pregnancy epulis - Good OH and periodontal treatment (lesion typically regresses post-partum)
273
List some clinical features of a Giant cell epulis (peripheral giant cell granuloma)?
Soft purplish gingival swelling
Mostly on gum of teeth anterior to molars
Caused by local irritation
Must differentiate from central giant cell granuloma, hyperparathyroidism
274
How would you treat a Giant cell epulis (peripheral giant cell granuloma)?
Excision of lesion
Remove source of irritation
Curettage of underlying bone to reduce chance of recurrence
275
Which soft tissue hyperplastic lesion has these features?
- Pink smooth mucosal polyp
- Very common
- Most common sites: buccal mucosa, lip, tongue
- FEP under denture is known as a ‘leaf fibroma’
Fibroepithelial polyp
276
How would you treat a fibroepithelial polyp?
Excision
277
What is a giant cell fibroma?
A variant of fibroepithelial polyp often seen on the gingivae and tongue
In this lesion, there are more conspicuous larger stellate fibroblasts.
278
Which soft tissue hyperplastic lesion has these features?
- Broad-based, leaf-like folds of tissue related to periphery of badly fitting dentures
- Typically pale, fibrous swelling
- May be ulcerated
Denture irritation hyperplasia
279
What is also commonly found in patients that have denture irritation hyperplasia?
Superadded candida infection
280
How would you treat denture irritation hyperplasia?
Excision
New dentures
281
Which soft tissue hyperplastic lesion has these features?
- Numerous, small, tightly packed, nodular lesions
- Involves all or part of denture bearing area of palate
- Typically older patients, ill-fitting dentures
- Can be seen in non-denture wearers
- May be superadded candidal infection (not causative)
Papillary hyperplasia of the palate
282
How do you treat papillary hyperplasia of the palate?
Good denture hygiene
Anti-fungals if indicated
Rarely surgery
283
Name an intraoral soft tissue tumour that:
- is most commonly found on the palate or gingivae
- is purple/red
- becomes increasingly nodular
- frequently bleeds
Kaposis sarcoma
284
Which viral infection is associated with Kaposis sarcoma?
HHV-8 infection
285
How is kaposis sarcoma treated?
By anti-retroviral therapy/chemotherapy
