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Hyperplasia of oral mucosa

Localized hyper plastic lesions of oral mucosa Cause: chronic inflammation

Inflammation and repair together Production of granulation tissue Range: richly cellular and vascular Non inflamed, avascular, dense collagen avascular,

Hyperplasia of oral mucosa

Localized hyperplastic lesions of oral mucosa Location:

Any where in the mouth Gingiva: epulis

Hyperplasias of Oral Mucosa

Localized hyperplastic lesions of oral mucosa Pyogenic granuloma Peripheral giant cell granuloma *Peripheral ossifying fibroma *Irritation fibroma (focal fibrous hyperplasia) Giant cell fibroma Retrocuspid papilla *In your text book these are considered as fibrous epulius

Hyperplasia of Oral Mucosa

Fibroepithelial polyp Epulis Fissuratum, inflammatory fibrous Fissuratum, hyperplasia, denture irritation hyperplasia Inflammatory papillary hyperplasia (papillary hyperplasia of the palate)

hyperplastic, hyperplastic, not neoplastic
Mostly from interdental tissue Irritation from dental plaque and calculus Types:
Fibrous epulis (ossifying fibroma, hyperplastic gingivitis)

Pyogenic granuloma Peripheral giant cell granuloma

More common in females More in anterior to molar region Maxilla>mandible Recur if causative factor persists Or if incompletely excised as in PGCG

Fibrous epulis
Clinically: Pedunculated or sessile Firm Similar in color to adjacent gingiva Ulceration ++-

Fibrous epulis
Histopathology: Cellularity variable Mature collagen Inflammatory infiltrate

Mainly plasma cells

Bone formation Could be less cellular and less vascular

Fibrous epulis
Chronic hyperplastic gingivitis Or Peripheral ossifying fibroma

Peripheral ossifying fibroma

Histopathology: Fibrous proliferation Formation of mineralized product, cementum like High cellularity

Vascular epulis: Pyogenic granuloma

Origin of the name: Clinically: Soft, lobulated RedRed-purple often ulcerated Bleeding is common Rapid growth History of trauma

On gingiva 75% of the time or any other mucosal site 75%

Pyogenic granuloma
Pregnancy epulis: pyogenic granuloma in a pregnant female


Gradually increasing in size Regress after delivery Recur if excised in pregnancy and bleed

Pyogenic granuloma
Histopathology:  Highly vascular proliferation


Lobular organization (lobular capillary hemangioma) hemangioma) _+ Ulcerated surface Older lesions: more fibrous

Pyogenic granuloma
Treatment and prognosis


Conservative surgical excision down to periosteum Occasionally it may recur Pregnancy tumor: delay treatment, may resolve spontaneously

Peripheral giant cell granuloma

Exclusively on the gingiva or alveolar ridge Anterior to molar teeth Slightly More in mandible Dark red in color Commonly ulcerated Present interdentally

Buccal and palatal parts: hourhour- glass appearance

Peripheral giant cell granuloma

Need a radiograph to rule out central giant cell granuloma May reveal superficial bone erosions Pathogenesis: Most likely arise from periosteum Giant cells origin: Macrophages or osteoclasts

Peripheral giant cell granuloma

Histopathology: Giant cells variation in size and number of nuclei Richly vascular and cellular stroma

Peripheral giant cell granuloma

Histopathology: Extravasated RBCs and haemosiderin Stromal cells: Spindled or ovoid Macrophage or fibroblasts or endothelial cells Occasional bone formation

Peripheral giant cell granuloma

If multiple: Hyperparathyroidism OR RARELY Neurofibromatosis I

Peripheral giant cell granuloma


Local surgical excison to underlying bone Scaling and polishing Recurrence rate 10% 10%



Fibroepithelial polyp (irritation fibroma)

The commonest lesion of the oral cavity A true tumor?

Doesnt increase significantly in size with time

Most common site is the buccal mucosa Labial mucosa tongue and gingiva Chronic minor trauma appears to be the cause Under denture: Leaf fibroma

Irritation fibroma

Giant cell fibroma and retrocuspid papilla

Distinctive histopathologic finding

Multinucleated fibroblasts

On keratinized mucosa: gingiva, gingiva, tongue and hard palate

Giant cell fibroma

Retrocuspid papilla
Same histopathology as giant cell fibroma Developmental lesion, lingual to mandibular canine on the interdental papilla 25-99% 25-99% of young adults and children

Denture irritation hyperplasia Epulis Fissuratum

Related to the flange of ill fitting denture

Denture irritation hyperplasia

Clinically: Multiple folds of tissue in the vestibule Firm and fibrous Commonly on the facial aspect of the flange

Leaf fibroma on the hard palate

Denture irritation hyperplasia


year old woman


nts this palate. routine Denture .

Papillary Hyperplasia of the Palate

Ill fitting denture Continuous denture wearing Candida associated denture mucositis Histopathology

Connective tissue neoplasms

Swellings Resemble their counterparts in other sites in the body Tissue of origin

Tumors of fibrous tissue

Benign tumors (true fibroma) are rare Peripheral odontogenic fibroma Fibrous histiocytoma Nodular fasciitis (neoplastic like lesion) Fibromatosis

Gingival fibromatosis
This is not neoplastic

Aggressive fibromatosis

Tumors of fibrous tissue

Fibrosarcoma Rare in the oral cavity Relatively good prognosis 5 year survival rate is 70% 70%



Tumors of adipose tissue LIPOMA

Yellowish colored swelling most commonly in buccal mucosa and tongue Circumscribed mass of mature tissue:

Variable proportions of stroma and mature fat tissue: fibrolipoma, angiolipoma, myxolipoma fibrolipoma, angiolipoma, myxolipoma

Floats in formalin ** traumatic herniation of the buccal pad of fat in infants and young children




Lipoblasts with pleomorphic nuclei

Tumors of vascular tissues

May be hamartoma Common especially in oral cavity Mucosa, muscles, bone, major salivary gland Infants and childrenjuvenile hemangioma in parotid gland If multiple . think of syndromes???

Dark red-purple redElevation: smooth, lobulated, lobulated, soft or hard Blanching on pressure May increase in size:


hemorrhage thrombosis inflammation





Capillary, cavernous and mixed Arteriovenous malformation (AVM)

Other Malformations:

Other vascular anomalies: sublingual varicosities Malignant vascular lesions: Kaposi lesions: sarcoma and angiosarcoma Angiomatous syndromes: syndromes:

Capillary and cavernous hemangioma

Cellular hemangioma


Kaposi sarcoma


Sinosoidal vascular spaces lined by pleomophic endothelial cells

Angiomatous syndromes
StrurgeStrurge-Weber Syndrome



Hemangiomatous lesions of one or more of the branches of the trigeminal nerve Ipsilateral hemangiomas and calcifications in the meninges over cerebral cortex Convulsions affecting the limbs on the opposite side

..Angiomatous syndromes:

Hereditary hemorrhagic telangiectasia

Multiple dilated capillaries Nose bleeding

Tumors of vascular tissues

Hamartomatous Predilection for the children and especially tongue Increase in size due to: inflammation, calcification, or sudden increase in size



Cystic hygroma
Early in development of lymphatic changes Detected at birth Up to 10 cm in diameter

Tumors of peripheral nerves

Nerve sheath tumors:
1. 2.

Neurofibroma, solitary and multiple Neurilemmoma (Schwannoma)

Traumatic neuroma: non neoplastic

Multiple mucosal nueroma

Soliotary or Multiple/ associated with:

Neurofibromatosis, von Recklinghaisens disease of nerves

Cutaneous nerves Mutation in tumor suppressor gene: NF1 NF1



Histologically: Considerable variation Schwann cells and fibroblasts Varying amount of collagen and mucoid tissue A few nerve fibers run through the lesion May be circumscribed or diffuse



Neurofibromatosis I
NF1 NF1 mutation (tumor suppressor gene) Familial, AD or sporadic mutation Multiple neurofibromas of cutanous nerves
Intraoraly: mucosal swellings and bone involvement (mental and ID nerve)

CafCaf-au lait spots Other findings: axillary freckeling Malignant transformationin 5-15% of all 15% cases

Types I (skin) and II (central nervous system)

Plexiform neurofibromas are characterstic of Neurofibromatosis

Arise within or around nerve trunks A mass of nerves surrounded by Schwann cells and fibroblasts

Schwannoma (Neurilemmoma)
Encapsulated Nerve fibers dont pass through the lesion

May be over the capsule

Spindled cells with parallel nuclei

Traumatic neuroma
Non neoplastic disorganized overgrowth of nerve fibers, Schwann cells and scar tissue severed end of nerves Exaggerated regeneration of nerve tissue Clinical features  Slowly growing  Firm, fixed to surrounding structures  Painful to palpation  large nerves, such as mental foramen

MEN (multiple endocrine neoplasia)

Type IIb  Multiple mucosal neuromas  Phaecromocytoma  Medullary thyroid carcinoma

RET oncogene mutation

Can be used for screening

Granular cell tumor

Previously called : granular cell myoblastoma Arise from Schwann cells Etiology: benign neoplasm, probably of Schwann cells

Clinical features
Slowly growing. Most common in tongue. Firm, fixed to overlying mucosa and deep structures Multiple tumors may occur

Non encapsulated Feeling of invasion/but it is benign Granular cells: contain lysosomes

PsuedoPsuedo-epitheliomatous hyperplasia

Tunmors of muscles
Leiomyoma, leiomyomatous hamartoma, leiomyosarcoma Rhabdomyoma, rhabdomyosarcoma



Hodgkins lymphoma NonNon-Hodgkins lymphoma

Hodgkins lymphoma
30% 30% of all lymphomas Young age group Cervical lymph nodes in 75% 75% ReedReed- Sternberg cell is the diagnostic cell: large cell with 2 nuclei or bilobed nucleus (mirror image) Genetic factors and viral infection (EBV) Prognosis: clinical staging and histologic grading Distribution: mainly nodal

Hodgkins lymphoma
Histopathologic types: Lymphocyte predominant Mixed cellularity Nodular sclerosis Lymphocyte depletion

NonNon-Hodgkins lymphoma
B cell: majority T cell/ NK

extra nodal  MALT lymphoma better prognosis than lymphoma nodal, remian localized for long periods  Salivary gland.Sjogren Syndrome and gland.Sjogren myoepithelial sialadentitis  Bone  AIDS

Burkits Lymphoma
Endemic and sporadic Endemic: Africa: EBV and Malaria Children 2-14 yrs

Starts in the jaws, maxillary and posterior Rapidly growing, multifocal Starts in the abdomen

Sporadic: no viral association

Chromosomal translocation 8,14. c-myc 14. cactivation

Starry Sky pattern

B cell type Dark small malignant lymphoid cells Pale stained macrophages Macrophages are not neoplastic

NK/T cell lymphoma

Angiocentric T cell lymphoma, lethal midline granuloma Extensive destruction of midline structures EBV in neoplastic cells

Lethal midline granuloma Tcell lymphoma