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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.

Chapter 8 Hyperplastic, neoplastic, and related disorders of oral mucosa


Hyperplasias of oral mucosa
Epulides Pyogenic granuloma Fibroepithelial polyp Denture irritation hyperplasia papillary hyperplasia of the palate

Lab 1

Connective tissue neoplasms and allied conditions


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

Hyperplasias of oral mucosa

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

Hyperplasias of oral mucosa

Fibrous Epulis

Buccal growth of the gingiva anterior to the first molar.

Pedunculated, have a constricted neck can be raised.

Hyperplasias of oral mucosa

Fibrous Epulis

Reactive bone formation

less cellular and less vascular

Hyperplasias of oral mucosa

Fibrous Epulis

Reactive bone formation or some mineralized tissue

Granulation tissue

High cellularity

YOU DO NOT HAVE TO DEFRENTIATE BETWEEN THEM HISTOLOGUCALLY

Hyperplasias of oral mucosa

Fibrous Epulis

Well-formed Bundles of fibroblasts and collagen fibers

YOU DO NOT HAVE TO DEFRENTIATE BETWEEN THEM HISTOLOGUCALLY

Hyperplasias of oral mucosa

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 .

Hyperplasias of oral mucosa

Pyogenic granuloma

Located on : Lip Dorsum of the tongue gingiva.

Hyperplasias of oral mucosa

Pyogenic granuloma or vascular epulis

Highly vascular , small capillary sizes blood vessels So its also called lobular capillary hemangioma

Hyperplasias of oral mucosa

Peripheral giant cell granuloma

Located only on the gingiva or alveolar mucosa. Dark-red in color , have high vascular components may bleed easily.

Hyperplasias of oral mucosa

Peripheral giant cell granuloma

May be squeezed between teeth to give hourglass appearance

Hyperplasias of oral mucosa

Peripheral giant cell granuloma

The same histology as the central giant cell granuloma Multinucleated giant cells

Highly vascular

Hyperplasias of oral mucosa

Peripheral giant cell granuloma

Multinucleated giant cell Blood vessel Hemosiderin Stromal cells: Macrophage or fibroblasts or endothelial cells

Hyperplasias of oral mucosa

Peripheral giant cell granuloma

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

Hyperplasias of oral mucosa

Fibroepithelial polyp

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.

Hyperplasias of oral mucosa

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.

Hyperplasias of oral mucosa

Fibroepithelial polyp

Treatment is surgical excision.

Hyperplasias of oral mucosa

Giant cell fibroma

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

Hyperplasias of oral mucosa

Giant cell fibroma

The same histopathology of giant cell fibroma , appears specifically lingual to the lower canines , usually bilateral.

Hyperplasias of oral mucosa

Denture irritation hyperplasia

Folds Fissures , the denture flange sets and cause ulcers.

Hyperplasias of oral mucosa

Denture irritation hyperplasia

Caused by palatal ill-fitting denture.

Hyperplasias of oral mucosa

Denture irritation hyperplasia

Fissure which is not ulcerated because we still see the epithelium.

Pale fibrous underling tissue.

Hyperplasias of oral mucosa

Papillary Hyperplasia of the Palate

Small numerous papillary projections near to each other on the papte.

Hyperplasias of oral mucosa

Papillary Hyperplasia of the Palate

papillary projections

Hyper plastic fibrous tissue under these projections

Hyperplasias of oral mucosa

Papillary Hyperplasia of the Palate

papillary projections, they appeared as they are in air when we cut the lesion in the lab. Hyper plastic fibrous tissue under these projections

Hyperplasias of oral mucosa

Not neoplasms

We differentiate it from Irritation fibroma that its highly cellular.

We differentiate it from fibroma that there is no malignant features histologicaly.

Hyperplasias of oral mucosa

Tumours of fibrous tissue

It is hyper cellular and also have malignant features : hyperchromatism Mitotic figure Pleomorphism

Hyperplasias of oral mucosa

Tumours of adipose tissue

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

Hyperplasias of oral mucosa

Tumours of adipose tissue

fibrolipoma

Collagen fibers

Mature adipocyts because they have nuclei pushed to the periphery

Hyperplasias of oral mucosa

Tumours of adipose tissue

Pleomorphism

Mitotic figure

hyperchromatism

Hyperplasias of oral mucosa

Tumours of vascular tissue

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.

Hyperplasias of oral mucosa

Tumours of vascular tissue

small blood vessels lined by epithelium.

Hyperplasias of oral mucosa

Tumours of vascular tissue

Dilated blood vessels lined by epithelium, located superfacial and also deep in the tissue.

Hyperplasias of oral mucosa

Tumours of vascular 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.

Hyperplasias of oral mucosa

Tumours of vascular tissue

Thick walled artery next to a thin walled vein without passing through the capillary stage, we could feel pulsation.

Hyperplasias of oral mucosa

Tumours of vascular tissue

Hyperplasias of oral mucosa

Tumours of vascular tissue

Sinosoidal vascular spaces lined by pleomophic endothelial cells

Malignant features: Mitotic figures Pleomorphism Hyperchromatism

Hyperplasias of oral mucosa

Tumours of vascular tissue

Multiple hemangioma following the five branches of the trigeminal nerve intra and extra orally.

Hyperplasias of oral mucosa

Tumours of vascular tissue

Small numerous lobules caused by the superficial located lymphatic channels.

Hyperplasias of oral mucosa

Tumours of vascular tissue

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

Hyperplasias of oral mucosa

Tumours of vascular tissue

Swilling extra orally submandibular or sublingual.

Hyperplasias of oral mucosa

Tumours of nervous tissue

A firm mass containing shwan cells and fibroblasts, most of the time has defused bordered.

Hyperplasias of oral mucosa

Tumours of nervous tissue

Wavy shaped shwan cells nucleus

Collagen fibers

Fibroblasts

Hyperplasias of oral mucosa

Tumours of nervous tissue

Wavy shaped shwan cells nucleus

Hyperplasias of oral mucosa

Tumours of nervous tissue

Multiple neurofibromas of cutanous nerves , mutation in NF1 gene.

Hyperplasias of oral mucosa

Tumours of nervous tissue

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 +

Hyperplasias of oral mucosa

Tumours of nervous tissue

Painful, firm, reactive not neoplastic

Schwann cells and scar tissue

nerve fibers

Hyperplasias of oral mucosa

Tumours of nervous tissue

Oreginated from schwan cells (give + with S100 stain) Firm , located any where in the oral cavity, not well circumscribed

Granular cells filled with abundant cytoplasm with granules.

Hyperplasias of oral mucosa

Tumours of nervous tissue

Hyperplasias of oral mucosa

Tumours of nervous tissue

Hyper plastic lesion have an ultimate attach with the surface and underling tissues , so it give a wrong impression that its malignant.

Hyperplasias of oral mucosa

Tunmors of muscles

Hyperplasias of oral mucosa

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.

Hyperplasias of oral mucosa

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.

Hyperplasias of oral mucosa

Malignant lymphoma

Hyperplasias of oral mucosa

Malignant lymphoma

Starry appearance cells, Macrophages with lymphocytes engulfed in their cytoplasm. Malignant cells, B cells

Hyperplasias of oral mucosa

Malignant lymphoma

Malignant cells, T cells and natural killer cells

Oral PathoLogy Laboratory Team 2010

Done By : Baraah Al-Salamat