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7/28/2019 Added Notes on Lab 1
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Hyperplastic, Neoplasticand Related Disorders of
Oral MucosaLAB
Dr. Rima Safadi
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Leaf Fibroma
It is hyperplasia of fibrous tissue lesion , have another namewhich is irritation fibroma the most common lesion.
Case 1
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Giant cell fibroma
Multinucleated fibroblasts
Tongue dorsum
Case 2
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Denture irritation hyperplasia
Hyperplastic epithelium
Hyperplastic fibrous tissue
Case 3
Traumatized by the flange of acomplete denture
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Papillary palatal hyperplasia
Psuedoepitheiomatous hyperplasia
Case 4
Traumatized by the fitting
surface of a complete denture
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13 year old female
This 13 year-oldfemale is referred forevaluation of anasymptomatic, 1 x 1.5mm mass in the right
buccal mucosa in thepremolar area at thelevel of the occlusalplane. The patientwears full orthodontic
appliances. Shebelieves that thelesion was presentbefore she started theorthodontic treatmentone year ago.
Courtesy of Dr. Hellstein, UIowa
Case 5
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Differential Diagnosis
List 1- irritation fibroma
2- mucocele
3- lipoma 4-
5-
When we know that the lesion is firm not soft so we consider it irritation fibroma
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The lesion has been
excised, and make slides to
look at it under the
microscope.
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Granular cells
Hyperplasticepithelium
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Diagnosis??
We have granular cytoplasm's cells ,, so we diagnose it as
Granular cell tumor
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Granular Cell Tumor
Microscopic features Pseudoepitheliomatou
s hyperplasia of
overlying stratifiedsquamous epithelium
Large cells withgranular, eosinophiliccytoplasmGranules: lysosomes
Cells will be stained with S100 stain, because it become
positive in Granular cells and schwan cells.
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Pseudo Epitheliomatous
Hyperplasia
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PEH
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Patient: 17 year old female
Chief Complaint:Non-tenderswelling of the
left posteriorbuccal mucosaof 2 months
duration.
Case 6
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What is your ClinicalDiagnosis and
Management?
This lesion could be : or the differential diagnosis are :
1- lipoma2-irritation fibroma
3- neurofibroma
4- granular cell tumor (usually on areas of skeletal mussels)
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Clinical Differential Diagnosis ofLocalized Soft Tissue Enlargementswith a normal mucosa:
Benign mesenchymal tumors(irritation fibroma, schwannoma,neurofibroma, lipoma)
Benign salivary gland tumorsLow grade salivary adenocarcinomas
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Management in thiscase: Excisionalbiopsy.
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Irritation fibroma
Histopathology
Hypocellular fibrous tissue and obvious
amount of collagen fibers
** Treatment isconservative surgicalexcision because its notagrissive.
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C 7
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Case 7
This lesion is Irritation fibroma
Because its pale in color so its not pyogenicgranuloma which is usually red or blue incolor
C 8
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Patient:19-year-old male
Chief Complaint:Referred byInternal Medicine
to evaluate forpossibleodontogenic causeof right
submandibularswelling.
Case 8
In This area the submandibular salivary gland and thesubmandibular lymph nodes located , we take biopsy from
the lymph nodes.
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Hodgkins lymphoma
Reed Sternberg cell
lymphocytes
We got this histopathology pic. Which shows the malignantReed Sternberg cell.
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Histopathologic Findings
Hodgkins lymphoma
Case 9
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26 year old woman
Case 9
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26 year old woman
Clinical Findings: Adiffuse,compressible, non-
tender, purplesurface lesion ispresent on the leftsoft palate.
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What is your Clinical
Diagnosis and
Management?
On the next slide
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Differential Diagnosisof IntravascularBlood Lesions
Surface Lesions:
1- Hemangioma
2- Varix3- Kaposis sarcoma
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ClinicalDiagnosis:Hemangioma
Management:No treatment
If we have multiple Hemangioma we will consider thepatient have Strurge-Weber Syndrome
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Hemangioma classification :
1-Capillary Hemangioma2- cavernous Hemangioma3- mixed Hemangioma
Blanching test is used to examinehemangioma, if its not workingthat because of:1- thrombus2- classification3- increased size of the lesion
Case 10
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Kaposi Sarcoma
Case 10
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Cellular hemangioma
Endothelial cells
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AVM
Thin walled vein
Thick walled arte
Case 11
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Sublingual varicosities
Case 11
Multiple small
tortuous veins
They are nottumor but theyare not normalalso
Case 12
http://www.usc.edu/hsc/dental/opfs/QL/32big.html7/28/2019 Added Notes on Lab 1
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Sturge Weber Syndrome
Case 12
He have changed skin and intra oral
mucosa color following thetrigeminal nerve branches, due tomultiple hemangiomas.We could see hemangioma in themeningi also.
Case 13
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Hereditary hemorrhagic
telangiectasia Autosomal Dominant
Multiple dilatedmalformed capillaries Skin and mucous
membranes and organs
Nose bleeding
Case 13
Case 14
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Patient: 10 year old male
Chief Complaint:History of a tonguelesion since the
patient was 6months of age.The lesion iscurrently
asymptomatic andslowly enlarging.
Case 14
Small numerous papillary projections, so itd not
hemangioma
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A diffuse,compressible,nontenderenlargement is
present in theanterior dorsum ofthe tongue. Nothrill or bruit
evident.
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Lymphangioma
Lymphatic fluid
Or lymph
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Cystic Hygroma
Early indevelopment oflymphatic changes
Large fluctuantswelling
10 cm in diameter
May extend tobase of the tongueand floor of the
mouth
Case 15
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HemangiomaA tongue mass whichshows a smooth surface,with the histopathologicpic ??Hemangioma
Case 16
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Patient: 18 year old female
Third recurrenceof non tendergingival swelling.
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What is your Clinical
Diagnosis and
Management?1- Hemangioma
2- hamartoma when itsthere for more that 10years
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Epulides
Types: Fibrous epulis, chronic hyperplastic
gingivitis
pyogenic granuloma Peripheral giant cell granuloma
Peripheral ossifying fibroma
Peripheral odontogenic fibromaManagement: Excisional biopsy.
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Peripheral giant cell granuloma
Multinuclatedgiant cells
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Peripheral ossifying fibromaBone formation
Cellular fibrous stroma
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Pyogenic granulomaVascular spaces*If it occurs in pregnancy we
should leave it because itsrecurrent
Case 17
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Clinical findings
Area is firm butmovable, somewhat
pedunculated and
located about 5mmfrom Stensons duct.
It is of unknown
duration and non-
painful to palpation.
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Capsule
Schwannoma
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Schwannoma
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Schwannoma
Microscopic features:
Rows of cells with palisading nuclei
S-100 stain is positive (neural origin)
No neurites (nerve fibers) passingthrough
Tissue of origin is neural
The lumen is filled with schwan cells
Case 17
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Neurofibroma
Firm lesion is 1 year duration ,, so weshould think about :1- neurofibroma
2- irritation fibroma
But its not irritation fibroma after lookingto the histopathologic pic. Of the waveyschwan cells neuclei.Not lymphangioma : pale color and one
lobule and its short duration!
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Neurofibroma
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Neurofibroma
Wavy spindelecells
N fib t iCase 17
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Neurofibromatosis(multiple neurofibroma)
Caf-au lait spots
Other findings:axillary freckeling
Malignanttransformation
In 5-15% of cases
Case 18
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Traumatic neuroma
Nerve bundels
Surrounded by fibroustissue and schwancells (haphazardorganization)
Without capsule
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Nervebundels
Surroundedby fibroustissue andschwan cells(haphazardorganization)
Withoutcapsule
Case 19
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Lipoma
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liposarcoma
Lipoblasts with pleomorphic nuclei
Ulcerative enlargement of the hard
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Ulcerative enlargement of the hard
palate
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Non-Hodgkin's lymphoma
Because we see The same type oflymphocytes all over the area (Bcells)
Starry Sky pattern
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Starry Sky pattern
in Burkitt`s lymphoma
Macrophages are not neoplastic theyare pale in color engulfing lymphocytes
Small closely packed malignant cells
Aggressive fibromatosis
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Aggressive fibromatosis
Firm mass on the gingiva , highly
cellular histologically , so we willnot consider irritation fibromain this case.And because we do not see anymalignant features so its
Fibromatosis. But nxt slide
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FibrosarcomaBut in this case it showsmalignant features ,polymorphism, mitotic figures andhyperchromatism ,, we will cal it
Fibrosarcoma
Lethal midline granuloma
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gTcell lymphoma or natural killer lymphoma
perforating the palate
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Some Additional notes from dr. Rima written by : Baraah Alsalamat