Download Diseases of the oral cavity

6/5/2014
pathology – sheet 23
Fidaa' AL-masaeid & Mais abdallah
Diseases of the oral cavity
Ulcerative and inflammatory lesions :
*Aphthous Ulcers:
 The most common ulcer in oral cavity affects almost everybody in his life.
 Another name Canker sore.
 Small size (<5mm) , painful, shallow round.(in order to differentiate it from oral cavity
squamous cell carcinoma which is larger, painful or painless ,deep because it is malignant ).
 Covered by gray-white exudate with red rim.
 Can be single or multiple , location >>any where in the oral cavity except for the posterior
(dorsum) part of the tongue and hard palate.
 Most common in the first 2 decades of life.
 Pathophysiology >>there is nothing exactly ….but it has an Autoimmune base (destruction of
epithelium cells).
 Invoked by stress ( physical ,chemical, emotional) ,fever ,cold exposure, gastric infection,
certain food ,menstrual cycle.
 It is self limited lesion.
*Aphthous ulcers can occur systemic disease:
1- inflammatory bowel disease (crohn’s disease >>it is different from usual aphthous ulcers >>it is
larger >>but in the same category ).
2-celiac disease .
3-AIDS
4-Behcet disease (‫ ( بهجت‬:autoimmune disease affect joints ,oral cavity and genital area (multiple
ulcers ).
5-SLE ulcers (painless & large ).
*Herpes stomatitis :
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Very common .
Caused by herpes simple virus(1) (herpes labialis).
Herpes genitalis can cause genital ulcer and can cause oral ulcers.
Transmitted from person to person.
Primary infection is silent .
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6/5/2014
pathology – sheet 23
Fidaa' AL-masaeid & Mais abdallah
 Virus stays dormant within the nerve ganglia in the oral cavity.
 Reactivation of virus in stress conditions ,causing solitary or multiple vesicles ( ‫تبدأ على شكل‬
‫( فقاعات صغيرة وليس قرحة‬containing clear fluid , which rupture into painful ulcers.
 Often on lips ,nasal orifices.
*slide6: under the microscope we see separation of outer area …in the nucleus there is clear
particles (virus inside the nuclei).
*Oral candidiasis:
 Candida albicans is a fungal organism,,, it can be a normal flora in half people ( in slides
40% of people) ,,,in normal flora there is a balance between bacteria and fungus and they
counterpart each other ,,,,,,if candida proliferate more >>cause the disease.
 The other name of disease is oral thrush ( thrush means ‫( قشرة لونها ابيض‬,,,,other
description pseudomembranous candidiasis ( pseudo>>it is not normal
tissue…membrane>>>loosely attach layer )
 Candida is increase in :1-immune suppression (AIDS, steroids >>patient with asthma take
steroids in oral cavity >> oral candidiasis >>tend to spread to eosophagus)
2-antibiotics like erythromycin and third generation of cephalosporin ( it kills all the normal
flora in mouth so candida proliferate and expand ).
3-Diabetis mallets >>immune system is not normally functioning because of hyperglycemia
>>multiple infection ,,one of them candida.
 Appears white circumscribed plaque .
 Not adherent ,,can be scrapped off ( ‫(ممكن ازالتها بسهولة‬, showing inflammatory base .
 Under the microscope : sheets of fungi.
*AIDS:
 Infection is common in mouth in patient with aids by numerous microorganisms(
candida, herpes).
َ ‫ ) ُم‬so it look like
 Hairy leukoplakia: when surface of tongue become corrugated) ْ‫ط ْع َوج‬
hair >>> IT IS NOT ATRUE HAIR…….it appears white irregular patches ( adherent CAN NOT
be scrapped of ) ……under the microscope proliferation of squamous epithelium non
keratinized with irregular border.
 Caused by EBV infection ( this patient has 2 viruses HIV&EBV).
 EBV is oncogene virus ,,it affect lymphocyte and can affect squamous epithelium in oral
cavity causing proliferation.
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6/5/2014
pathology – sheet 23
Fidaa' AL-masaeid & Mais abdallah
*slide10: oral thrush white circumscribed and can be scrapped off .
*slide11:hairy leukoplakia …it is more diffused and have corrugated surface ( hairy).
*Kaposi sarcoma:
**Sarcom: non-epithelial cancer, looks like spindle**.
It’s a malignant neoplasm of the endothelial cells, ~even though it’s endothelial which is a type
of the epithelial cells, this tumot is still named SARCOMA and it’s the only epithelial derived
sarcoma~.
They appear as proliferating spindle cells and that’s why it’s called sarcoma.
Commonly seen in HIV+ patients and AIDS patients, they acquire another virus; Herpes Simplex
8, it’s an oncogenic virus, which causes Kaposi Sarcoma.
It appears as red submucosal masses.
Slide3, Kaposi Sarcoma appears as red vascular tumor.
Kaposi Sarcoma doesn’t necessary to be with AIDS patients, it can be with immunocompetent
people as well.
*Leukoplakia:
It’s different from Hairy Leukoplakia (HIV+).
It comes with smoking, NOT immunosuppression (HIV+).
It’s well-defined, where Hairy Leukoplakia is ill-defined, Leukoplakia looks like oral thrush but its
adherent.
Well-defined white mucosal patch caused by epidermal thickening and hyperkeratosis.
^^Normally, the oral cavity is non-keratinized, but this is a pathologic condition, we have
chronic irritation, so the epithelial cells proliferate and produce keratin to protect
themselves^^.
More common on the vermilion border of the lower lip and more common in elderly people.
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6/5/2014
pathology – sheet 23
Fidaa' AL-masaeid & Mais abdallah
Caused by tobacco, pipe smoking, alcohol and irritant ingestion, any irritant can cause
Leukoplakia.
25% progress to squamous cell carcinoma.
Microscopically, Leukoplkia and Hairy Leukoplakai look similar, proliferation of the squamous
epithelium. Marked thickening, <<under normal histology, this epidermis layer is much more
small>>, there’s also keratin that’s not presented in normal oral cavity.
Sometimes it progresses to dysplasia, all cells will be the same, <> normally, basal cell layer
differs from granulosal layer, differs from Spinozal layer<>, but in dysplasia they all look same.
*Erythroplakia:
It differs from Leukoplakia in colour, it’s red, like an alarm meaning here the dysplasia is more,
the cells are advancely dysplastic.
It appears as red, velvety ‫ مخمل‬often granular, well circumscribed area in the oral cavity that
may be elevated or not, having poorly defined borders,
Histologically, epidermal thickening, hyperkeratosis and always dysplastic, while Leukoplkia
there’s just thickening can progress to dysplasia or stay as it.
50% progress to cancer, more chance.
*Squamous cell carcinoma:
It’s the most common cancer in the oral cavity, over all human body cancer it’s rare, only 3%.
It’s bad disease, 50% die within 5 years
Elderly disease, it needs more time to make irritation in the squamous epithelium to progress
to cancer.
*Risk factors:
 In oral cavity tobacco #1 , the most important
Other cancers secondary to smoking : lung cancer ,oral cavity cancer, urinary bladder
,pancreatic and gastric .
 Other causing (predisposing factor ) leukoplakia and erythroplakia.
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6/5/2014
pathology – sheet 23
Fidaa' AL-masaeid & Mais abdallah
 Alcohol abuse ( comes with smoking….these patient smoke and drink alcohol together ).
 Human papilloma virus 16,18 >>most potent oncogene virus in HPV.
Common in cervix ( genital area ) >> cause cancer >>goes to oral cavity and cause cancer
(squamous cell carcinoma )
Squamous cell carcinoma : present as NON healing ulcer .
Aphthous : ‫قرحة بتيجي اسبوع زمن وبتروح‬
*slide 19: under the microscope squamous epithelium epidermis ….it is invasive >>SO it is
cancer.
Today a reader, tomorrow, a LEADER
GOOD LUCK
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