Lab 1 ch 8
Transcript of Lab 1 ch 8
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Written and designed by Oral Pathology Scripting Team 2010.
Jordan University of Science and Technology, Faculty of
Dentistry, Irbid, Jordan.
Doctor Rima Al-Safadis Lectures.1
Chapter 8 :Hyperplastic,neoplastic, andrelated disorders of
oral mucosa.
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Chapter 8Hyperplastic, neoplastic, and related disorders of
oral mucosa
Lab 1
Connective tissue neoplasms and allied
conditions
Hyperplasias of oral mucosa
Tumours of fibrous tissue Tumours of adipose tissue
Tumours of vascular tissue
Tumours of peripheral nerves
The granular cell tumour
Tumours of muscle
Malignant lymphomas
Epulides
Pyogenic granuloma
Fibroepithelial polyp
Denture irritation hyperplasia papillary hyperplasia of the palate
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Hyperplasias of oral mucosa Fibrous Epulis
It should be inflamed
because the etiology ofthis lesion is chronic
inflammation.
Pale lesion which does not
bleed easily, the color issimilar to the surroundings.
The commonest location
between the teeth,
because plaque presentsmore there and its the
stimulation of the
inflammation.
Wide base (sessile)
Maxilla > Mandible
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Hyperplasias of oral mucosa
Buccal growth of the gingiva anterior
to the first molar.
Pedunculated, have a constricted
neck can be raised.
Fibrous Epulis
Fib E li
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Hyperplasias of oral mucosa
Reactive bone formation
less cellular and less vascular
Fibrous Epulis
Fib E li
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Reactive bone
formation or
some mineralized
tissue
Hyperplasias of oral mucosa
Granulation tissue
High cellularity
YOU DO NOT HAVE TO DEFRENTIATE BETWEEN THEM HISTOLOGUCALLY
Fibrous Epulis
Fib E li
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Hyperplasias of oral mucosa
Well-formed
Bundles of
fibroblasts and
collagen fibers
YOU DO NOT HAVE TO DEFRENTIATE BETWEEN THEM HISTOLOGUCALLY
Fibrous Epulis
V l E li
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Hyperplasias of oral mucosa Vascular Epulis
Pyogenic granuloma : can be located any where in the oral cavity but most of the time (75%)
on gingiva .
Located only on the gingiva.
lobulated
Soft and Red-purple in colorbecause its highly vascular .
Bleeding is common
Pyogenic granuloma
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Hyperplasias of oral mucosa
Located on :
LipDorsum of the tongue
gingiva.
Pyogenic granuloma
l i f l Pyogenic granuloma or vascular epulis
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Hyperplasias of oral mucosa
Highly vascular , small
capillary sizes blood
vessels
So its also called lobular
capillary hemangioma
Pyogenic granuloma or vascular epulis
H l i f l Peripheral giant cell granuloma
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Hyperplasias of oral mucosa Peripheral giant cell granuloma
Dark-red in color , havehigh vascular
components may bleed
easily.
Located only on the
gingiva or alveolar
mucosa.
H l i f l Peripheral giant cell granuloma
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Hyperplasias of oral mucosa Peripheral giant cell granuloma
May be squeezed
between teeth to give
hourglass appearance
H l i f l Peripheral giant cell granuloma
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Hyperplasias of oral mucosa
The same histology as the central giant
cell granuloma
Multinucleated giant cells
Peripheral giant cell granuloma
Highly vascular
H l i f l Peripheral giant cell granuloma
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Hyperplasias of oral mucosa
Multinucleated giant cell
Blood vessel
Hemosiderin
Stromal cells:Macrophage or fibroblasts or
endothelial cells
Peripheral giant cell granuloma
Hyperplasias of oral mucosa Peripheral giant cell granuloma
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Hyperplasias of oral mucosa Peripheral giant cell granuloma
If its multible and central lesion we
should think about :
HYPERPARATHYROIDISMand rarly Neurofibromatosis
Peripheral giant cell granuloma, could be
continuous to reach the outsild to the
oral cavity
Hyperplasias of oral mucosa Fibroepithelial polyp
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Hyperplasias of oral mucosa
Irritation fibroma)
The most common exophytic
mass in the oral cavity.
Pale color because its highly
fibrous and not highly
vascular.
Buccally erupted 8
caused the fibroeithelial
polyp.
Fibroepithelial polyp
Hyperplasias of oral mucosa Fibroepithelial polyp
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Hyperplasias of oral mucosa Fibroepithelial polyp
Atrophic epithelium because it is pushed
by the underling fibrous tissue.
But all over its fibrous, Collagen fibers
are the promenant.
Relatively avascular acellular , cells are
lymphocytes and fibroblasts.
Hyperplasias of oral mucosa Fibroepithelial polyp
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Hyperplasias of oral mucosa Fibroepithelial polyp
Treatment is surgical
excision.
Hyperplasias of oral mucosa Giant cell fibroma
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Hyperplasias of oral mucosa Giant cell fibroma
Giant cell fibroblasts having
stellate appearance and sometime its multinucleated
Fibers
Best location on the keratinized
mucosa : dorsum of the tongue
and gingiva. But it could appeare
any where also
Hyperplasias of oral mucosa Giant cell fibroma
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Hyperplasias of oral mucosa G ce b o
The same histopathologyof giant cell fibroma ,
appears specifically
lingual to the lower
canines , usually bilateral.
Hyperplasias of oral mucosa Denture irritation hyperplasia
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Hyperplasias of oral mucosa yp p
Fissures , the denture flange
sets and cause ulcers.
Folds
Hyperplasias of oral mucosa Denture irritation hyperplasia
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Hyperplasias of oral mucosa yp p
Caused by palatal ill-fitting
denture.
Hyperplasias of oral mucosa Denture irritation hyperplasia
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Hyperplasias of oral mucosa yp p
Fissure which is not
ulcerated because we
still see the epithelium.
Pale fibrous underling
tissue.
Hyperplasias of oral mucosa Papillary Hyperplasia of the Palate
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ype p s s o o ucos
Small numerous papillary
projections near to each other
on the papte.
Hyperplasias of oral mucosa Papillary Hyperplasia of the Palate
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yp p
papillary projections
Hyper plastic fibrous
tissue under these
projections
Hyperplasias of oral mucosa Papillary Hyperplasia of the Palate
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yp p
papillary projections,
they appeared asthey are in air when
we cut the lesion in
the lab.
Hyper plastic fibrous
tissue under these
projections
Hyperplasias of oral mucosa Not neoplasms
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yp p
We differentiate it from fibroma that there is no
malignant features histologicaly.
We differentiate it from Irritation fibroma that its
highly cellular.
Hyperplasias of oral mucosa Tumours of fibrous tissue
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yp p
Mitotic figure
Pleomorphism
hyperchromatism
It is hyper cellular and
also have malignant
features :
Hyperplasias of oral mucosa Tumours of adipose tissue
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Circumscribedmass of
mature tissue , may be
herniation of the buccalpad due to trauma.
Yellowish colored swellingmost commonly in buccalmucosa and tongue
Mature adipocyts becausethey have nuclei pushed tothe periphery
Hyperplasias of oral mucosa Tumours of adipose tissue
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fibrolipoma
Mature adipocytsbecause they havenuclei pushed to theperiphery
Collagen fibers
Hyperplasias of oral mucosa Tumours of adipose tissue
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Mitotic figurePleomorphism hyperchromatism
Hyperplasias of oral mucosa Tumours of vascular tissue
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Located any where in
the oral cavity:Mucosa, muscles,
bone, major salivary
gland
If its multible we will
think ofsturge-webersyndrome.
Blue to purple in color
, its not red because
the blood vessels are
deep in the tissue.
Can be smooth,
lobulated, soft or hard.
Multi lobulated
Hyperplasias of oral mucosa Tumours of vascular tissue
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small blood vessels lined by
epithelium.
Hyperplasias of oral mucosa Tumours of vascular tissue
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Dilated blood vessels lined by
epithelium, located superfacialand also deep in the tissue.
Hyperplasias of oral mucosa Tumours of vascular tissue
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Sheets of Endothelialcells forming few
capillary sized vessels.
Sheets of Endothelial
cells can bedifferentiated from
other cell types by
stained positive to
CD 34 stain .
More common inchildren.
Hyperplasias of oral mucosa Tumours of vascular tissue
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Thick walled artery
next to a thin walledvein without passing
through the capillary
stage, we could feel
pulsation.
Hyperplasias of oral mucosa Tumours of vascular tissue
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Hyperplasias of oral mucosa Tumours of vascular tissue
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Sinosoidal vascular spaces
lined by pleomophicendothelial cells
Malignant features:
Mitotic figures
Pleomorphism
Hyperchromatism
Hyperplasias of oral mucosa Tumours of vascular tissue
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Multiple hemangioma followingthe five branches of the
trigeminal nerve intra and extra
orally.
Hyperplasias of oral mucosa Tumours of vascular tissue
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Small numerous lobulescaused by the superficial
located lymphatic channels.
Hyperplasias of oral mucosa Tumours of vascular tissue
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A lymphatic channel located immediately bellow the lining epithelium, we
can differentiate it from a blood vessel by S100 stain , its location
superficially and its content is lymph.
Hyperplasias of oral mucosa Tumours of vascular tissue
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Hyperplasias of oral mucosa Tumours of vascular tissue
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Swilling extra orally submandibular orsublingual.
Hyperplasias of oral mucosa Tumours of nervous tissue
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A firm mass containing
shwan cells and fibroblasts,most of the time has
defused bordered.
Hyperplasias of oral mucosa Tumours of nervous tissue
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Wavy shaped shwan cells nucleus Collagen fibers Fibroblasts
Hyperplasias of oral mucosa Tumours of nervous tissue
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Wavy shaped shwan cells nucleus
Hyperplasias of oral mucosa Tumours of nervous tissue
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Multiple neurofibromas of cutanous
nerves , mutation in NF1 gene.
Hyperplasias of oral mucosa Tumours of nervous tissue
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Contain only schwan cells , arise
adjacent to the nerve, nerve
fibers do not pass through
theschwannoma.
Arranged in a manner that thecytoplasm of the cells on the
periphery. So there is areas
named :
Cellular areas
Acellular areas
If we applied S100 it will be
almost 100% positive +
Hyperplasias of oral mucosa Tumours of nervous tissue
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Schwann cells and scar
tissue
nerve fibers
Painful, firm, reactive
not neoplastic
Hyperplasias of oral mucosa Tumours of nervous tissue
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Oreginated from schwan
cells (give + with S100
stain)
Firm , located any where
in the oral cavity, notwell circumscribed
Granular cells filled withabundant cytoplasm
with granules.
Hyperplasias of oral mucosa Tumours of nervous tissue
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Hyperplasias of oral mucosa Tumours of nervous tissue
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Hyper plastic lesion
have an ultimateattach with the
surface and underling
tissues , so it give a
wrong impression that
its malignant.
Hyperplasias of oral mucosa Tunmors of muscles
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Hyperplasias of oral mucosa Malignant lymphoma
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Starts on an intra nodal location,
usually on the cervical lymphnodes.
Reed- Sternberg cell , The
malignant component inhodgkins lymphoma, have the
pop-corn appearance.
Firm or rubbery
Normal Lymphocytes, their
prominence is better to have a
good prognosis to the patient
situation.
Hyperplasias of oral mucosa Malignant lymphoma
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Aggressive mass , loosening the
teeth, ulcerated, ugly rapidly
growing,,, its malignant.
Sheets of small B lymphocytes
which have malignant features:hyperchromatism, Mitosis using
CD 20 stain positively.
Hyperplasias of oral mucosa Malignant lymphoma
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Hyperplasias of oral mucosa Malignant lymphoma
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Starry appearance cells,
Macrophages with lymphocytes
engulfed in their cytoplasm.
Malignant cells, B cells
Hyperplasias of oral mucosa Malignant lymphoma
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Malignant cells, T cells
and natural killer cells
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Done By : Baraah Al-Salamat
Oral PathoLogy Laboratory Team 2010