Download Pathology of the Oral Cavity

Pathology
of the
Oral Cavity
Diseases of the Oral Cavity
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To learn:
Disorders of the Oral Mucosa and Gingiva
Disorders of the Salivary glands
Disorders of the Teeth and Jaw bones
Disorders due to the Systemic Diseases
Disorders of the Oral Mucosa and
Gingiva
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Ulcerative and inflammatory lesions
Aphtous ulcers
 Herpes virus infections
 Fungal infections
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Hyperkeratotic lesions
Leukoplakia
 Erythroplakia
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Tumors
Benign tumors
 Malignant tumors
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Ulcerative and inflammatory lesions
Aphtous ulcers
 Extremely common superficial ulcerations
(erosions) of the oral mucosa
 Painful
 Single
or multiple
 Shallow
 Hyperemic (erythematous) or yellowish-gray
 Less than 5 mm in diameter
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Covered by a thin exudate and rimmed by a
narrow zone of erythema
 Location:
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Soft palate
Buccolabial mucosa
Floor of the mouth
Lateral borders of the tongue
 Triggers
or Etiology:
Inflammatory bowel diseases
 Behçet’s disease
 Hypersensitivity reactions
 Emotional stress
 Endocrine influences (pregnancy, menstruation)
 Autoimmune reactions (involving both cellular and
humoral mechanisms)
 Infectious diseases
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Herpes virus infections
Orofacial herpetic infections are caused by
HSV type 1 (HHV-1)
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HHV-2 most often involves the genital tract
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Most primary oral infections with HSV-1 are
trivial “cold sores”
Adults harbor latent HHV-1:
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upper respiratory tract infections
excessive exposure to cold, wind, or sunlight
allergic reactions
Herpetic gingivostomatitis
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Generally acute
Common in AIDS patients
In severe cases 
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keratoconjunctivitis
encephalitis
Lesions:
1.
2.
3.
the oral and pharyngeal mucosa
the tongue
the gingivae
Herpes simplex Herpetic gingivostomatitis (HIV-positive
patient)
Fungal infections
Candida albicans
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Superficial, curdy, gray to white inflammatory membrane
Fibrinosuppurative exudate + C.albicans with an underlying
erythematous inflammatory base
Risk factors:
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diabetes mellitus
neutropenia
immune deficiency syndromes
AIDS
antibiotic therapy
Oral trush
Candida albicans
Hyperkeratotic lesions
Leukoplakia (white plaque)
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White plaque on the oral mucous membranes that cannot be removed by
scraping
Precancerous lesion
Range from completely benign epithelial thickenings to highly atypical
lesions with dysplastic changes that merge with carcinoma in situ (CIS)
Etiology:
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Tobacco
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smoking (cigar, cigarette, pipe)
Chewing tobaco
Alcohol
Chronic irritations (i.e. cheek bite)
Leukoplakia
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Erythroplakia (dysplastic leukoplakia)
Red, velvety, possibly eroded area
Higher risk of malignant transformation
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more than 50%
Etiology:
Tobacco (cigarettes, pipes, cigars, and particularly
chewing tobacco )
 alcohol
 Chronic exposure to persistent irritants
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ill-fitting dentures
 hot meals
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HPV
Erythroplakia
Tumors
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Benign tumors and tumor-like conditions
Tumors
Papilloma (HPV serotypes 6 and 11)
 Angioma (hemangioma & lymphangioma)
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Tumor-like conditions
Fordyce spots (ectopic sebaceous glands)
 Mucocele (minor salivary glands – destruction of
ductus)
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Malignant tumors
Squamous cell carcinoma:
95% of cancers of the oral cavity and the tongue
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The small residual includes
adenocarcinoma (of salivary gland origin)
 melanoma
 various carcinomas
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Squamous cell carcinoma (Epidermoid carcinoma)
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Location (most predicted):
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Lower lip
Floor of the mouth
Tongue (lateral borders)
Etiology:
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Leukoplakia and erythroplakia
Tobacco : alcohol&smoking, tobacco chewing
Ill-fitting dentures
Jagged teeth
HPV
Sunlight (lower lip)
Chronic infections
Morphology
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In the early stage:
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Raised, firm, pearly plaques
irregular - roughened
 verrucose areas of mucosal thickening
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Differential diagnosis : leukoplakia & erythroplakia
As these lesions enlarge:
protruding masses
 undergo central necrosis
 irregular, shaggy ulcer rimmed by elevated, firm,
rolled borders
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Microscopy
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with leukoplakia and erythroplakia
well-differentiated keratinizing neoplasms
or anaplastic
 or sometimes undifferentiated (sarcomatoid) tumors
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Metastases:
regional and mediastinal lymph nodes
 lungs
 liver
 bones
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Squamous cell carcinoma
Disorders of the Salivary glands
Inflammatory disorders
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Tumors
Benign tumors
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Sialadenitis
Sjögren syndrome
Mikulicz syndrome
Plemorphic adenoma
Warthin tumor
Malignant tumors
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Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Inflammatory Disorders of the Salivary glands
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Viral (mumps)
Bacterial (complication of sialolithiasis)
Autoimmune origin
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Sjögren’s syndrome:
involvement of the salivary glands  xerostomia (dry mouth)
 involvement lacrimal glands  keratoconjunctivitis sicca (dry eyes)
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Sarcoidosis :
bilateral sarcoidosis of the parotid, submaxillary, and
sublingual glands
 uvea involvement
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Mikulicz syndrome
Sjögren’s syndrome
Tumors of the Salivary glands
Benign tumors
Plemorphic adenoma
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Mostly parotid gland
Painless swelling at the angle of the jaw
Excision; may recur (10%)
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Microscopy
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Composed of epithelial elements and myoepithelial
cells dispersed throughout a matrix of
mucoid,
 myxoid,
 chondroid tissue
 a mixed tumor
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Warthin Tumor (Papillary Cystadenoma Lymphomatosum)
Almost always in the parotid gland
Small, round to oval, encapsulated mass
Excision; may recur (10%)
Microscopy:
(1) spaces are lined by a double layer of epithelial cells
 (2) dense lymphoid stroma sometimes forming germinal
centers
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Malignant tumors
Mucoepidermoid carcinoma
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Particularly the minor salivary glands
Radiation-induced neoplasm
Mixture of squamous cells, mucus-secreting cells
May recur ( 30%)
Disseminate to distant sites (30%)
Adenoid cystic carcinoma
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Particularly the minor salivary glands
Frank pain due to neural invasion
Microscopy: round-cystic spaces filled by mucus
Tumors of the Salivary glands
Disorders of the Teeth and Jaw bones
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Teeth
Caries
 Inflammation (pulpitis, apical granuloma & cyst)
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Jaw bones
Fractures
 Inflammation (osteomyelitis)
 Cysts (odontogenic; non-odontogenic)
 Tumors
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Soft tissues
 Bone & Cartilage
 Odontogenic
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Odontogeic cysts & tumors
Disorders due to the Systemic Diseases
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INFECTIOUS DISEASES
Measles: Koplik’s spots
Infectious mononucleosis: acute
tonsillitis/pharyngitis, cervical lymphadenopathy
Diphtheria: pseudomembrane (tonsils/retropharynx)
AIDS: Herpesvirus infection (gingivostomatitis),
Candida albicans, Kaposi sarcoma
DERMATOLOGIC DISORDERS
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Lichen planus: reticulate, white (keratotic) lesions
Pemphigus: vesicles and erosions
Bullous pemphigoid: bullae and erosions
Erythema multiforme (Stevens-Johnson syndrome):
maculopapular-vesiculobullous lesions
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follows an infection
drug
cancer
auto-immune disorder
Pemphigus vulgaris
HEMATOLOGIC DISORDERS
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Pancytopenia and/or Leukemia
gingivitis
 pharyngitis
 tonsillitis
 neck cellulitis (Ludwig’s angina)
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Monocytic leukemia
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gingival infiltration
MISCELLANEOUS
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Melanotic pigmentation:
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Albright’s syndrome
Peutz-Jegher’s syndrome
Dilantin (phenytoin): gingival hyperplasia
Pregnancy: granuloma gravidarum
Other Syndromes: oral manifestations can be found in
the hereditary or acquired syndromes
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Teeth anomalies
Macroglossia
Bifid palate/tongue/lip
Hemangiomas, ect.
Peutz-Jegher’s syndrome; Gingival hyperplasia