Added Notes on Lab 1

7/28/2019 Added Notes on Lab 1

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Hyperplastic, Neoplasticand Related Disorders of

Oral MucosaLAB

Dr. Rima Safadi


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Leaf Fibroma

It is hyperplasia of fibrous tissue lesion , have another namewhich is irritation fibroma the most common lesion.

Case 1


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Giant cell fibroma

Multinucleated fibroblasts

Tongue dorsum

Case 2


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Denture irritation hyperplasia

Hyperplastic epithelium

Hyperplastic fibrous tissue

Case 3

Traumatized by the flange of acomplete denture


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Papillary palatal hyperplasia

Psuedoepitheiomatous hyperplasia

Case 4

Traumatized by the fitting

surface of a complete denture


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13 year old female

This 13 year-oldfemale is referred forevaluation of anasymptomatic, 1 x 1.5mm mass in the right

buccal mucosa in thepremolar area at thelevel of the occlusalplane. The patientwears full orthodontic

appliances. Shebelieves that thelesion was presentbefore she started theorthodontic treatmentone year ago.

Courtesy of Dr. Hellstein, UIowa

Case 5


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Differential Diagnosis

List 1- irritation fibroma

2- mucocele

3- lipoma 4-

5-

When we know that the lesion is firm not soft so we consider it irritation fibroma


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The lesion has been

excised, and make slides to

look at it under the

microscope.


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Granular cells

Hyperplasticepithelium


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Diagnosis??

We have granular cytoplasm's cells ,, so we diagnose it as

Granular cell tumor


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Granular Cell Tumor

Microscopic features Pseudoepitheliomatou

s hyperplasia of

overlying stratifiedsquamous epithelium

Large cells withgranular, eosinophiliccytoplasmGranules: lysosomes

Cells will be stained with S100 stain, because it become

positive in Granular cells and schwan cells.


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Pseudo Epitheliomatous

Hyperplasia


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PEH


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Patient: 17 year old female

Chief Complaint:Non-tenderswelling of the

left posteriorbuccal mucosaof 2 months

duration.

Case 6


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What is your ClinicalDiagnosis and

Management?

This lesion could be : or the differential diagnosis are :

1- lipoma2-irritation fibroma

3- neurofibroma

4- granular cell tumor (usually on areas of skeletal mussels)


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Clinical Differential Diagnosis ofLocalized Soft Tissue Enlargementswith a normal mucosa:

Benign mesenchymal tumors(irritation fibroma, schwannoma,neurofibroma, lipoma)

Benign salivary gland tumorsLow grade salivary adenocarcinomas


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Management in thiscase: Excisionalbiopsy.


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Irritation fibroma

Histopathology

Hypocellular fibrous tissue and obvious

amount of collagen fibers

** Treatment isconservative surgicalexcision because its notagrissive.


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C 7


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Case 7

This lesion is Irritation fibroma

Because its pale in color so its not pyogenicgranuloma which is usually red or blue incolor

C 8


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Patient:19-year-old male

Chief Complaint:Referred byInternal Medicine

to evaluate forpossibleodontogenic causeof right

submandibularswelling.

Case 8

In This area the submandibular salivary gland and thesubmandibular lymph nodes located , we take biopsy from

the lymph nodes.


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Hodgkins lymphoma

Reed Sternberg cell

lymphocytes

We got this histopathology pic. Which shows the malignantReed Sternberg cell.


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Histopathologic Findings

Hodgkins lymphoma

Case 9


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26 year old woman

Case 9


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26 year old woman

Clinical Findings: Adiffuse,compressible, non-

tender, purplesurface lesion ispresent on the leftsoft palate.


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What is your Clinical

Diagnosis and

Management?

On the next slide


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Differential Diagnosisof IntravascularBlood Lesions

Surface Lesions:

1- Hemangioma

2- Varix3- Kaposis sarcoma


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ClinicalDiagnosis:Hemangioma

Management:No treatment

If we have multiple Hemangioma we will consider thepatient have Strurge-Weber Syndrome


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Hemangioma classification :

1-Capillary Hemangioma2- cavernous Hemangioma3- mixed Hemangioma

Blanching test is used to examinehemangioma, if its not workingthat because of:1- thrombus2- classification3- increased size of the lesion

Case 10


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Kaposi Sarcoma

Case 10


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Cellular hemangioma

Endothelial cells


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AVM

Thin walled vein

Thick walled arte

Case 11


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Sublingual varicosities

Case 11

Multiple small

tortuous veins

They are nottumor but theyare not normalalso

Case 12
http://www.usc.edu/hsc/dental/opfs/QL/32big.html


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Sturge Weber Syndrome

Case 12

He have changed skin and intra oral

mucosa color following thetrigeminal nerve branches, due tomultiple hemangiomas.We could see hemangioma in themeningi also.

Case 13


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Hereditary hemorrhagic

telangiectasia Autosomal Dominant

Multiple dilatedmalformed capillaries Skin and mucous

membranes and organs

Nose bleeding

Case 13

Case 14


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Patient: 10 year old male

Chief Complaint:History of a tonguelesion since the

patient was 6months of age.The lesion iscurrently

asymptomatic andslowly enlarging.

Case 14

Small numerous papillary projections, so itd not

hemangioma


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A diffuse,compressible,nontenderenlargement is

present in theanterior dorsum ofthe tongue. Nothrill or bruit

evident.


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Lymphangioma

Lymphatic fluid

Or lymph


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Cystic Hygroma

Early indevelopment oflymphatic changes

Large fluctuantswelling

10 cm in diameter

May extend tobase of the tongueand floor of the

mouth

Case 15


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HemangiomaA tongue mass whichshows a smooth surface,with the histopathologicpic ??Hemangioma

Case 16


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Patient: 18 year old female

Third recurrenceof non tendergingival swelling.


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What is your Clinical

Diagnosis and

Management?1- Hemangioma

2- hamartoma when itsthere for more that 10years


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Epulides

Types: Fibrous epulis, chronic hyperplastic

gingivitis

pyogenic granuloma Peripheral giant cell granuloma

Peripheral ossifying fibroma

Peripheral odontogenic fibromaManagement: Excisional biopsy.


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Peripheral giant cell granuloma

Multinuclatedgiant cells


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Peripheral ossifying fibromaBone formation

Cellular fibrous stroma


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Pyogenic granulomaVascular spaces*If it occurs in pregnancy we

should leave it because itsrecurrent

Case 17


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Clinical findings

Area is firm butmovable, somewhat

pedunculated and

located about 5mmfrom Stensons duct.

It is of unknown

duration and non-

painful to palpation.


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Capsule

Schwannoma


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Schwannoma


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Schwannoma

Microscopic features:

Rows of cells with palisading nuclei

S-100 stain is positive (neural origin)

No neurites (nerve fibers) passingthrough

Tissue of origin is neural

The lumen is filled with schwan cells

Case 17


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Neurofibroma

Firm lesion is 1 year duration ,, so weshould think about :1- neurofibroma

2- irritation fibroma

But its not irritation fibroma after lookingto the histopathologic pic. Of the waveyschwan cells neuclei.Not lymphangioma : pale color and one

lobule and its short duration!


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Neurofibroma


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Neurofibroma

Wavy spindelecells

N fib t iCase 17


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Neurofibromatosis(multiple neurofibroma)

Caf-au lait spots

Other findings:axillary freckeling

Malignanttransformation

In 5-15% of cases

Case 18


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Traumatic neuroma

Nerve bundels

Surrounded by fibroustissue and schwancells (haphazardorganization)

Without capsule


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Nervebundels

Surroundedby fibroustissue andschwan cells(haphazardorganization)

Withoutcapsule

Case 19


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Lipoma


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liposarcoma

Lipoblasts with pleomorphic nuclei

Ulcerative enlargement of the hard


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Ulcerative enlargement of the hard

palate


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Non-Hodgkin's lymphoma

Because we see The same type oflymphocytes all over the area (Bcells)

Starry Sky pattern


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Starry Sky pattern

in Burkitt`s lymphoma

Macrophages are not neoplastic theyare pale in color engulfing lymphocytes

Small closely packed malignant cells

Aggressive fibromatosis


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Aggressive fibromatosis

Firm mass on the gingiva , highly

cellular histologically , so we willnot consider irritation fibromain this case.And because we do not see anymalignant features so its

Fibromatosis. But nxt slide


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FibrosarcomaBut in this case it showsmalignant features ,polymorphism, mitotic figures andhyperchromatism ,, we will cal it

Fibrosarcoma

Lethal midline granuloma


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gTcell lymphoma or natural killer lymphoma

perforating the palate


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Some Additional notes from dr. Rima written by : Baraah Alsalamat

Added Notes on Lab 1

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