Patho Ospe Flashcards
What’s this
Hp
Prognosis
Ameloblastoma- Acanthomatous-
small discrete islands of tumor cells
with layers of columnar cells with polarized nucleus
resembling like ameloblasts.
The central masses are squamous like cells with keratin formation.
Areas of follicular pattern also noticed.
Fair
Hp prognosis
hyperkeratosis and acanthosis (increased spinous layer).
Basal cells exhibit increased mitotic activity and are hyperchromatic.
The rete pegs are broad and bulbous.
Underlying fibrovascular connective tissue shows mild infiltration and chronic inflammatory cells
surface epithelium demonstrating dysplastic changes from basal to surface layer.
Increased mitotic figures, increased abnormal mitosis, and irregular extension of lesional epithelium through the basement membrane into the underlying connective tissue are noticed.
Keratin pearls inside the connective tissue are evident.
Infiltrations of chronic inflammatory cells are dispersed.
Hp diagnosis prognosis
Histopathology:
• Edematous granulation tissue
• High vascular proliferation
• Massive Acute & Chronic inflammatory cells infiltration
• Surface- often show ulceration
• New vessels aggregate forming lobules
Good
Leukoplakia
Cause diagnosis prognosis
Carcinoma of lips
UV light and pipe smoking
Favorable lower lip
a chronic non-healing
ulcer or as an exophytic lesion that is occasionally verrucous in nature.
● Tumor is characterized by slow growth rate, crusted, oozing, non-tender,
indurated ulcer
Diagnosis
Scc well differentiate
Diagnosis prognosis treatment
The lesion is composed of sheets or thick trabeculae of mineralized material with irregularly placed lacunae
and prominent basophilic reversal lines.
Multinucleated giant cells are often present.
• This lesion closely resembles the osteoblastoma.
surgical extraction of
the tooth together with the attached mass;
Good
Diagnosis hp prognosis treatment
tumor is composed of loosely
arranged stellate, spindle-shaped
and round cells in an abundant,
loose myxoid stroma with few
collagen bundles.
Good prognosis
Small odontogenic myxomas are treated by curettage,
while larger lesions may require surgical resection.
Compound odontoma
Complex odontoma
Hp diagnosis treatment
The lesion is usually surrounded by a thick, fibrous capsule.
• The tumor is composed of spindle-shaped epithelial cells that form sheets, strands or whorled masses with little connective tissue.
• The epithelial cells may form rosette-like structures, tubular or duct-like structures may be prominent or absent.
• Calcifications may be observed in the tumor mass.
• Treatment- Enucleation is the treatment of choice as
the tumor is easily removed from the bone.
radiopaque material (“snowflake”
calcifications) within the lucency.
Hp treatment prognosis
• This lesion is typically composed of islands, sheets or strands of
polyhedral epithelial cells in a fibrous stroma..
• Cells outlines are distinct and intercellular bridges may be seen.
• Nuclei show considerable variation with giant nuclei and
pleomorphism observed.
• Calcifications may be noted as well as amyloid-like material and
form concentric rings called Liesegang rings.
• After Congo red staining, the amyloid material in CEOT exhibits
apple-green birefringence when viewed with polarized light
• The protein structure and the DNA sequence as odontogenic ameloblast-associated protein (ODAM).
Conservative local resection is the treatment of
choice as these lesions are typically less
aggressive
Good
Luminal: the tumor is confined to the luminal surface of the cyst.
–Intraluminal/plexiform: the tumor projects from the cystic lining;
sometimes resembles the plexiform type of solid/multicystic
ameloblastoma.
–Mural: the tumor infiltrates the fibrous cystic wall.
Hp
Dc
Thin connective tissue wall with a layer of stratified
squamous epithelium lining the lumen
•Thin layer of epithelium, 2 – 3 layers thick with no
rete ridge formation, unless infected
•Presence of Odontogenic epithelium in islands in
the connective tissue wall – which may give rise to
the development of AMELOBLASTOMA.
•The cystic lumen contains thin watery yellow fluid,
occasionally blood stained.
Dc treatment prognosis
Smaller lesions: should be removed entirely-
Enucleation
•Larger lesions: With Bone loss and the cyst
thinning the bone drastically
-Marsupilisation and Surgical drainage
Good if treated adequately
Diagnosis prognosis treatment
• Epithelium: Thin ; Stratified squamous epithelium
1. A parakeratinized surface which is typically corrugated, rippled wrinkled
2. A remarkable uniformity of thickness of the epithelium, usually ranging from 6 to 10 cells thick
3. A prominent palisaded, polarized basal layer of cells
often described as having a “picket fence” appearance
• Connective tissue : small islands of epithelium
• Lumen: Thin straw color fluid or thick creamy material;
May contain cholesterol as well as some hyaline bodies
Small – simple enucleation, complete removal of cyst wall
• Larger – enucleation with/without peripheral ostectomy
Carnoys solution
Diagnosis
Hp
Glandular odontogenic tumor
lined by squamous epithelium of varying thickness
with fibrous connective tissue wall
Mucous material and
glandular structures present within epithelium.
Diagnosis hp
Treatment prognosis
Lining is usually thin about 6 – 8 cell thick, may be thickened
in other areas.
•Lining shows characteristic Odontogenic features with
reversely polarized basal cell layer.
•TYPICALLY – GHOST CELLS may be seen in thicker areas
of lining.
CALCIFYING
ODONTOGENIC CYST
surgical enucleation,
ERUPTION CYST
An Odontogenic cyst with the histological features of
Dentigerous cyst that surrounds a tooth’s crown that has
erupted through bone but not soft tissue and is clinically
visible a s a soft fluctuant mass on the alveolar ridges.
•Radiology : Enlarged follicular space
of blood filled spaces surrounded by
multinucleated giant cells and fibrous connective
tissue
▪ Non-endothelial- lined
spaces filled with blood
▪ Numerous, non- endothelial-lined spaces of varying sizes filled with blood. The spaces are separated by cellular fibrous tissue
➢multinucleated giant cells in the fibrous septa
➢Hemorrhage
– Surgical excision
Dg pg hp
dense irregular collagen bundles arranged in many directions radiating,
circular or haphazard fashion with
minimal lymphocytic infiltration,
and not encapsulated,
• Epithelium over the mass demonstrates
either atrophic changes with loss of rete ridges or hyperkeratosis due to
secondary trauma.
Conservative surgical excision
Good
Hp pg dg
Fibrous stroma with many spindle cells
• Streaming fascicles
• Not encapsulated
• Cells are mature and numerous
Fibromatosis
Wide surgical excision including bone
Dg hp prognosis
Traumatic Neuroma (Amputation Neuroma)
Haphazard proliferation
of mature myelinated
nerve bundles within
fibrous stroma
• Chronic inflammatory
cells
Treatment:
• conservative surgical excision-with small part of
affected nerve
• May lead to paresthesia and pain
Linea alba
Frictional keratosis
Chronic rubbing
Rough restoration
Oral habits
benign reactive phenomenon that
occurs when the mucous membranes are repeatedly irritated
over a prolonged period of time.
Excess keratin that builds up on an epithelial surface is
known as hyperkeratosis.
Snuff dipperkeratosis
Direct contact of smokeless tobacco product
Retrocuspid papilla
Small fibrous gingival nodule
• More frequent in children (25%), 6% of adults
• Behind mandible cuspid, Often bilateral
• HP-Giant fibroblasts similar to the giant cell fibroma
Large, stellate, subepithelialnfibroblasts
• Sometimes multiple nuclei are present
• Remains indefinitely
• Treatment- conservative surgical
excision, recurrence is rare
Epulis Fissuratum
Similar to irritation fibroma
• More chronic inflammatory
cells
• The epithelial lining may
show acanthosis or atrophy
• Surface may show
ulceration (traumatic ulcer)
• May be associated with
surface inflammatory
papillary hyperplasia
Papillary
hyperplasia
• There might be Pseudoepitheliomatous Hyperplasia-
these are islands of epithelium if cut tangentially or
in cross section might resemble SCC
Surgical excision
• Denture replacement or
repair (relining, etc)
• Low recurrence if treated
properly
Gingival fibrous hyperplasia
Several causes:
• Drugs
• Plaque induced
• Hormones
• Related to diseases, such as sarcoidosis, Crohn’s
disease, or Wegener’s granulomatosis, leukaemia, etc
• Treatment:
• Treat the cause
• Surgery
Peripheral Ossifying Fibroma
(Peripheral Cementifying Fibroma
Primitive spindle cells in
fibrous stroma
• Immature bone
formation (often with
active osteoblasts)
• There might be
cementoid globules
• Few cementoblasts
• Almost no
cementocytes
Aphthous ulcers
SystemicConditionsAssociated
– Hematinic deficiency (up to 20%)- iron, folic acid
– Hormonal influence
– Genetic predisposition
– Systemic lupus erythematosus
Break in epithelium
Inflammatory cells in floor
Numerous dilated vessels
The cause is a mutation in the mucosal keratin genes
Hyperparakeratosis of the epithelium
•Intact Basal layer
•Acanthosis- Cells of spinous layer show Intracellular edema with pyknotic nuclei •Submucosa- inflammatory cell infiltrate
•Vacuolated and dyskeratotic keratinocytes are present that demonstrate perinuclear eosinophilic condensations.
concentric ring like appearance of the lesions , resulting from the varying shades of Erythema , occurs in the some cases and hasgiveriseto TARGETorIRISorBULL’SEYEdescribingthem.
• Appears rapidly within a day or two and persist from several days to a few weeks , gradually fading and eventually clearing
Intraepithelialvesicleorbullaejustabovebasallayer producing distinctive suprabasilar split
• Prevesicularedemaappearswhichweakensthe intercellular bridges and junctions
• Lossofcohesiveness{ACANTHOLYSIS}becauseof which clumps of epithelium are often found lying free in the vesicular space { TZANCK CELLS }
• Fluidinthevesicles:variablenumbersofPMN leukocytes and lymphocytes
• SCARCITYofinflammatorycellinfiltrateinCTand vesicular fluid differentiate Pemphigus from other Bullous lesions
The epidermis is hyperkeratotic with irregular acanthosis and focal thickening in the granular layer. (wedge-shaped hypergranulosis)
•The upper dermis has a band like infiltrate of lymphocytic (primarily helper T) and histiocytic cells with many Langerhans cells at the dermal-epidermal junction.
•The lymphocytes are intimately associated with basal keratinocytes , which shows degeneration and necrosis.
•As a consequence to this destructive infiltration ,results in redefining of normal smoothly of dermo-epidermal junction or epithelial-connective tissue junctions, to more angulated zigzag contour (“saw-tooth” appearance of the rete pegs).
•Pigment incontinence manifest in the skin due to damage of basal keratinocytes and melanocytes.(this leads to hyperpigmentation of lesion)
The epidermis is hyperkeratotic with irregular acanthosis and focal thickening in the granular layer. (wedge-shaped hypergranulosis)
•The upper dermis has a band like infiltrate of lymphocytic (primarily helper T) and histiocytic cells with many Langerhans cells at the dermal-epidermal junction.
•The lymphocytes are intimately associated with basal keratinocytes , which shows degeneration and necrosis.
•As a consequence to this destructive infiltration ,results in redefining of normal smoothly of dermo-epidermal junction or epithelial-connective tissue junctions, to more angulated zigzag contour (“saw-tooth” appearance of the rete pegs).
•Pigment incontinence manifest in the skin due to damage of basal keratinocytes and melanocytes.(this leads to hyperpigmentation of lesion)
STEVEN-JOHNSON SYNDROME
• A severe Bullous form of Erythema multiforme
• It commences with the abrupt occurrence of fever, malaise, photophobia and eruptions of the oral mucosa, genital and skin
• Patients usually recover unless they give way to a secondary infection
ANA – screening test (95% sensitivity)
Systemic lupus erythematosus
• Auto-immunedisorder
• Multisystemmicrovascularinflammation
• Formationofautoantibodies
• Chronicwithrelapsingandremittingcourse
Geographic Tongue/ Migratory Glossitis
hyper keratinization at the periphery of the epithelium with loss of filiform papillary projections in the erythematous centre areas .
Mild inflammatory cell infiltration in CT. inter cellular edema may be present in epithelium.
• No treatment required. Vitamins aid the healing.
Sub epidermal vesicle or bullae
• No acantholysis
• Non specific Chronic inflammatory infiltrate in connective tissue chiefly lymphocytes and plasma cells
Mucous membrane pemphigoid
Sub epidermal vesicle or bullae
• No acantholysis
• Non specific Chronic inflammatory infiltrate in connective tissue chiefly lymphocytes and plasma cells
Mucous membrane pemphigoid
Epithelium lacks keratin and atrophic , may be
hyperplastic, Lack of keratin when combined with
epithelial thinness , allows the underlying
microvasculature causes red color. Presence of
chronic inflammatory cells
• Differential diagnosis : Erythematous candidiasis,
lichen planus, discoid lupus erythematous.
• Treatment : Removal of cause, surgical stripping.
CF- adult male with sun exposed areas, firm, non
tender, well demarcated, dome-shaped nodule. The
growth shows three phases-1. growth phase, 2.
stationary phase and 3. involution phase. About 6
months to one year the involution occurs leaving just a
scar.
• HP- Dyskeratosis, individual cell keratinization and
keratin pearls are typically seen in a nodular area but
not inside the connective tissue bellow the sweat gland
area and also immense inflammatory cell infiltration is
noticed in the CT
• Prognosis is very good
Atypical melanocytes (larger than normal)proliferate
inside epithelium (radical growth)as well as in
connective tissue (vertical growth), some lesions may
present with no melanin production called amelanotic
melanoma, but they are positive with
immunohistochemical analysis for melanocytes.
HP- fascicles of anaplastic spindle cells with surface
epithelium exhibiting dysplastic changes like
carcinoma in situ
• Superficial tumors with better prognosis
benign in microscopic features, wide, elongated rete ridges with
relatively normal maturation process, less cellular atypia and mostly
with intense inflammatory cell infiltration.
• Prognosis- relatively good
Fig. 20.21 Verrucous carcinoma. An extensive lesion
