Hyperplastic, Neoplastic and Related Disorders of Oral Mucosa

LAB Dr. Rima Safadi

Case 1

Leaf Fibroma

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

Case 2

Giant cell fibroma

Multinucleated fibroblasts Tongue dorsum

Case 3

Denture irritation hyperplasia

Traumatized by the flange of a complete denture Hyperplastic epithelium Hyperplastic fibrous tissue

Case 4

Papillary palatal hyperplasia

Traumatized by the fitting surface of a complete denture

Psuedoepitheiomatous hyperplasia

Case 5

13 year old female

This 13 year-old female is referred for evaluation of an asymptomatic, 1 x 1.5 mm mass in the right buccal mucosa in the premolar area at the level of the occlusal plane. The patient wears full orthodontic appliances. She believes that the lesion was present before she started the orthodontic treatment one year ago.

Courtesy of Dr. Hellstein, UIowa

Differential Diagnosis

List
1- irritation fibroma 2- mucocele 3- lipoma 45-

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

The lesion has been excised, and make slides to look at it under the microscope.

Hyperplastic epithelium

Granular cells

Diagnosis??

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

Granular cell tumor

Granular Cell Tumor

Microscopic features
Pseudoepitheliomatou s hyperplasia of overlying stratified squamous epithelium Large cells with granular, eosinophilic cytoplasm
Granules:

lysosomes

Cells will be stained with S100 stain, because it become positive in Granular cells and schwan cells.

Pseudo Epitheliomatous Hyperplasia

PEH

Case 6

Patient: 17 year old female

Chief Complaint: Non-tender swelling of the left posterior buccal mucosa of 2 months duration.

What is your Clinical Diagnosis and Management?

This lesion could be : or the differential diagnosis are : 1- lipoma 2-irritation fibroma 3- neurofibroma 4- granular cell tumor (usually on areas of skeletal mussels)

Clinical Differential Diagnosis of Localized Soft Tissue Enlargements with a normal mucosa: Benign mesenchymal tumors (irritation fibroma, schwannoma, neurofibroma, lipoma) Benign salivary gland tumors Low grade salivary adenocarcinomas

Management in this case: Excisional biopsy.

Irritation fibroma
Histopathology

** Treatment is conservative surgical excision because its not agrissive.

Hypocellular fibrous tissue and obvious amount of collagen fibers

Case 7

This lesion is Irritation fibroma

Because its pale in color so its not pyogenic granuloma which is usually red or blue in color

Case 8

Patient:19-year-old male
Chief Complaint: Referred by Internal Medicine to evaluate for possible odontogenic cause of right submandibular swelling.
In This area the submandibular salivary gland and the submandibular lymph nodes located , we take biopsy from the lymph nodes.

Hodgkins lymphoma
We got this histopathology pic. Which shows the malignant Reed Sternberg cell.

lymphocytes

Reed Sternberg cell

Histopathologic Findings Hodgkins lymphoma

Case 9

26 year old woman

26 year old woman

Clinical Findings: A diffuse, compressible, nontender, purple surface lesion is present on the left soft palate.

What is your Clinical Diagnosis and Management?

On the next slide

Differential Diagnosis of Intravascular Blood Lesions Surface Lesions: 1- Hemangioma 2- Varix 3- Kaposis sarcoma

Clinical Diagnosis: Hemangioma

Management: No treatment

If we have multiple Hemangioma we will consider the patient have Strurge-Weber Syndrome

Hemangioma classification : 1-Capillary Hemangioma 2- cavernous Hemangioma 3- mixed Hemangioma Blanching test is used to examine hemangioma, if its not working that because of: 1- thrombus 2- classification 3- increased size of the lesion

Case 10

Kaposi Sarcoma

Cellular hemangioma

Endothelial cells

AVM

Thick walled arter

Thin walled vein

Case 11

Sublingual varicosities
Multiple small tortuous veins They are not tumor but they are not normal also

Case 12

Sturge Weber Syndrome

He have changed skin and intra oral mucosa color following the trigeminal nerve branches, due to multiple hemangiomas. We could see hemangioma in the meningi also.

Case 13

Hereditary hemorrhagic telangiectasia

Autosomal Dominant Multiple dilated malformed capillaries

Skin and mucous membranes and organs

Nose bleeding

Case 14

Patient: 10 year old male

Chief Complaint: History of a tongue lesion since the patient was 6 months of age. The lesion is currently asymptomatic and slowly enlarging.
Small numerous papillary projections, so itd not hemangioma

A diffuse,

compressible, nontender enlargement is present in the anterior dorsum of the tongue. No thrill or bruit evident.

Lymphangioma

Lymphatic fluid Or lymph

Cystic Hygroma

Early in development of lymphatic changes

Large fluctuant swelling 10 cm in diameter May extend to base of the tongue and floor of the mouth

Case 15

Hemangioma
A tongue mass which shows a smooth surface, with the histopathologic pic ?? Hemangioma

Case 16

Patient: 18 year old female

Third recurrence of non tender gingival swelling.

What is your Clinical Diagnosis and Management?

1- Hemangioma 2- hamartoma when its there for more that 10 years

Epulides
Types:

Fibrous epulis, chronic hyperplastic gingivitis pyogenic granuloma Peripheral giant cell granuloma Peripheral ossifying fibroma Peripheral odontogenic fibroma

Management: Excisional biopsy.

Peripheral giant cell granuloma

Multinuclated giant cells

Peripheral ossifying fibroma

Bone formation

Cellular fibrous stroma

Pyogenic granuloma
*If it occurs in pregnancy we should leave it because its recurrent Vascular spaces

Case 17

Clinical findings
Area is firm but movable, somewhat pedunculated and located about 5mm from Stensons duct. It is of unknown duration and nonpainful to palpation.

Schwannoma

Capsule

Schwannoma

Schwannoma
Microscopic

features:

Rows of cells with palisading nuclei S-100 stain is positive (neural origin) No neurites (nerve fibers) passing through Tissue of origin is neural The lumen is filled with schwan cells

Case 17

Neurofibroma

Firm lesion is 1 year duration ,, so we should think about : 1- neurofibroma 2- irritation fibroma But its not irritation fibroma after looking to the histopathologic pic. Of the wavey schwan cells neuclei. Not lymphangioma : pale color and one lobule and its short duration!

Neurofibroma

Neurofibroma

Wavy spindeled cells

Case 17

Neurofibromatosis
(multiple neurofibroma)

Caf-au lait spots Other findings: axillary freckeling Malignant transformation In 5-15% of cases

Case 18

Traumatic neuroma

Nerve bundels Surrounded by fibrous tissue and schwan cells (haphazard organization) Without capsule

Nerve bundels Surrounded by fibrous tissue and schwan cells (haphazard organization) Without capsule

Case 19

Lipoma

liposarcoma

Lipoblasts with pleomorphic nuclei

Ulcerative enlargement of the hard palate

Non-Hodgkin's lymphoma
Because

we see The same type of lymphocytes all over the area (B cells)

Starry Sky pattern in Burkitt`s lymphoma

Macrophages

are not neoplastic they are pale in color engulfing lymphocytes Small closely packed malignant cells

Aggressive fibromatosis
Firm mass on the gingiva , highly cellular histologically , so we will not consider irritation fibroma in this case. And because we do not see any malignant features so its Fibromatosis. But nxt slide

Fibrosarcoma
But in this case it shows malignant features , polymorphism, mitotic figures and hyperchromatism ,, we will cal it

Fibrosarcoma

Lethal midline granuloma

Tcell lymphoma or natural killer lymphoma perforating the palate

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