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Chapter 8Written : and designed by Oral Pathology Scripting Team 2010. Hyperplastic, Doctor Rima Al-Safadis Lectures. neoplastic, and related disorders of Jordan University of Science and Technology, Faculty of oral mucosa. Dentistry, Irbid, Jordan.
Lab 1
Fibrous Epulis
Pale lesion which does not bleed easily, the color is similar to the surroundings. Wide base (sessile) It should be inflamed because the etiology of this lesion is chronic inflammation. The commonest location between the teeth, because plaque presents more there and its the stimulation of the inflammation. Maxilla > Mandible
Fibrous Epulis
Fibrous Epulis
Fibrous Epulis
Granulation tissue
High cellularity
Fibrous Epulis
Vascular Epulis
Located only on the gingiva. lobulated Soft and Red-purple in color because its highly vascular . Bleeding is common
Pyogenic granuloma : can be located any where in the oral cavity but most of the time (75%) on gingiva .
Pyogenic granuloma
Highly vascular , small capillary sizes blood vessels So its also called lobular capillary hemangioma
Located only on the gingiva or alveolar mucosa. Dark-red in color , have high vascular components may bleed easily.
The same histology as the central giant cell granuloma Multinucleated giant cells
Highly vascular
Multinucleated giant cell Blood vessel Hemosiderin Stromal cells: Macrophage or fibroblasts or endothelial cells
If its multible and central lesion we should think about : HYPERPARATHYROIDISM and rarly Neurofibromatosis
Peripheral giant cell granuloma, could be continuous to reach the outsild to the oral cavity
Fibroepithelial polyp
Irritation fibroma)
The most common exophytic mass in the oral cavity. Pale color because its highly fibrous and not highly vascular.
Fibroepithelial polyp
Atrophic epithelium because it is pushed by the underling fibrous tissue. Relatively avascular acellular , cells are lymphocytes and fibroblasts. But all over its fibrous, Collagen fibers are the promenant.
Fibroepithelial polyp
Giant cell fibroblasts having stellate appearance and some time its multinucleated
Fibers
Best location on the keratinized mucosa : dorsum of the tongue and gingiva. But it could appeare any where also
The same histopathology of giant cell fibroma , appears specifically lingual to the lower canines , usually bilateral.
papillary projections
papillary projections, they appeared as they are in air when we cut the lesion in the lab. Hyper plastic fibrous tissue under these projections
Not neoplasms
It is hyper cellular and also have malignant features : hyperchromatism Mitotic figure Pleomorphism
Circumscribed mass of mature tissue , may be herniation of the buccal pad due to trauma. Yellowish colored swelling most commonly in buccal mucosa and tongue Mature adipocyts because they have nuclei pushed to the periphery
fibrolipoma
Collagen fibers
Pleomorphism
Mitotic figure
hyperchromatism
Multi lobulated
Located any where in the oral cavity: Mucosa, muscles, bone, major salivary gland If its multible we will think of sturge-weber syndrome. Blue to purple in color , its not red because the blood vessels are deep in the tissue. Can be smooth, lobulated, soft or hard.
Dilated blood vessels lined by epithelium, located superfacial and also deep in the tissue.
Sheets of Endothelial cells forming few capillary sized vessels. Sheets of Endothelial cells can be differentiated from other cell types by stained positive to CD 34 stain . More common in children.
Thick walled artery next to a thin walled vein without passing through the capillary stage, we could feel pulsation.
Multiple hemangioma following the five branches of the trigeminal nerve intra and extra orally.
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.
A firm mass containing shwan cells and fibroblasts, most of the time has defused bordered.
Collagen fibers
Fibroblasts
Contain only schwan cells , arise adjacent to the nerve, nerve fibers do not pass through theschwannoma. Arranged in a manner that the cytoplasm 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 +
nerve fibers
Oreginated from schwan cells (give + with S100 stain) Firm , located any where in the oral cavity, not well circumscribed
Hyper plastic lesion have an ultimate attach with the surface and underling tissues , so it give a wrong impression that its malignant.
Tunmors of muscles
Malignant lymphoma
Starts on an intra nodal location, usually on the cervical lymph nodes. Firm or rubbery Reed- Sternberg cell , The malignant component in hodgkins lymphoma, have the pop-corn appearance. Normal Lymphocytes, their prominence is better to have a good prognosis to the patient situation.
Malignant lymphoma
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.
Malignant lymphoma
Malignant lymphoma
Starry appearance cells, Macrophages with lymphocytes engulfed in their cytoplasm. Malignant cells, B cells
Malignant lymphoma