Alimentary System Pathology (Part 1)

7/23/2019 Alimentary System Pathology (Part 1)

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Alimentary system pathology (part 1)

Pyogenic Granuloma (12st)

Highly vascular pedunculated lesion,

usually in children, young adults,

and pregnant women (pregnancy

tumor).

Over 60% of between and !0

years of age

painless, e"ophytic nodular mass

usually pedunculated or sessile

#levated. $oft

deep redpurple color

#rythematous, hemorrhagic

&enign polypoid nodule primarily

occurring on mucous membranes

'ingiva 0 *%, followed by the

tongue, lips, and buccal mucosa

+omposed of lobules of dense,

proliferating capillaries (capillary

hemangioma), often with edema

and inflammatory infiltrate

ilated, irregular vascular spaces

surrounded by granulation tissue

with chronic inflammatory

infiltrate

'rows rapidly. $i-e from a few

millimeters to several centimeters

&udding of the capillaries taes place

around the small, thinwalled blood

vessels, which are often considerably

e"panded. /hus comes the anotheratin name 1granuloma

teleangiectaticum2

$lide3

'ranulation tissue 4 proliferative

connective tissue (fibroblasts and

fibrocytes) and newly formed

capillary channels, with interspersed

chronic inflammatory cells.

5umerous thinwalled capillariescontaining erythrocytes

eratini-ed, s7uamous

epithelium.

8ascular space


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Giant cell epulis (Epulis gigantocellularis) (13st)

9eripheral giant cell granuloma (giant

cell epulis) is a relatively uncommon

reactive tumor of the oral cavity

:ll age groups. ;ore common in

females. 9redominant in white

persons. Often < =0 years of age. ;a"illa and mandible are affected

with e7ual fre7uency

: softtofirm mass forms in the

gingiva

9ushes the teeth aside, may erode

the underlying bone

&enign and probably of reactive

nature

/ypically wellcircumscribed sessile

or pedunculated mass, dar red incolor, which hemorrhages easily and

may or may not be ulcerated.

/he lesion is relatively elastic on

palpation, and the si-e ranges from

0.* cm to = cm in diameter.

#tiology

ocal irritation or trauma. >n?ury

to soft tissues. /he trauma may be

caused by tooth e"traction

+hronic infection

>t seems to originate from either

periodental ligament or

mucoperiosteum

/he lesion occurs e"clusively on the

gingiva or edentulous alveolar ridge

/reatment 4 e"cision with borders of

normal tissue with entire base of

lesion, so that recurrence is avoided. 1:ctive2 stroma with numerous3

osteoclastlie giant cells

blood vessels

@ibroangiomatous stroma

$7uamous epithelium of the

gingiva is seen on the surface

@ibroblasts between the giant

cells produce the stroma


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Keratosis of the epithelium of the oral cavity (Leukoplakia) (23st)

euoplaia (from 'ree, leuos, 1white2 and pal", 1pla7ue2) is an asymptomatic white patch on

oral mucosa that cannot be scraped off. $ome of these lesions undergo transformation to

s7uamous cell carcinoma (premalignant lesion)A

:lways biopsy these lesions because of the high ris to progress to oral cancer

*=*% of cases are premalignant.

>s a clinical term used to describe patches of eratosis. >t is visible as adherent white patches onthe mucous membranes of the oral cavity. /he clinical appearance is highly variable3

$olitary or multiple

$mall lesions to large patches

Bsually well defined borders

+linical appearance of leuoplaias can range from3

a) smooth and thin with well demarcated borders

b) diffuse and thic

c) irregular with a granular surface

d) diffuse and corrugated

ocations3 leuoplaia occurs most often on the buccal mucosa, tongue, and floor of the mouth eoplaia of the tongue with invasive s7uamous cell carcinoma. iscrete raised white patches

are evident on both sides of the tongue.

/he disorders occur with e7ual fre7ue?cy in both se"es, mostly after the third decade of life

#tiology the causes of leuoplaia are diverse3

a) chronic local irritation (e.g. dentures)

b) all forms of tobacco use 4 ma?or ris factor (associated with smoingA)

c) alcohol abuse

d) human papilloma virus (H98)

/reatment3 complete removal (surgical e"cision, cryosurgery, +O=laser surgery). 9reservespecimen for histological e"amA

: variety of diseases appear clinically as leuoplaia.

+andidiasis, lichen planus, psoriasis, syphilis, various erotoses, hypererotosis, s7uamous

carcinoma in situ, chemical in?ury (aspirin burn)

;ust distinguish from diseases that may cause similar white lesions. /he lesions of leuoplaia

cannot be scraped off easily

/he typical clinical progression of oral cancer3

euoplaia may show a spectrum of histopathologic changes, from increased surfaceeratini-ation without dysplasia to invasive eratini-ing s7uamous carcinoma. /he fre7uency

of malignant transformation in leuoplaia is about 0C0%

/he histologic progression of s7uamous epithelium3

Hypereratosis D mildmoderate dysplasia D to severe dysplasia D carcinoma in situ

(+>$) D s7uamous cell carcinoma ($++)

Histopathological features3 presence or absence of epithelial dysplasia, epithelial hyperplasia,

surface hypereratosis, mared atypia, and paraeratosis.


4/10

Keratosis of the epithelium of the oral cavity (Leukoplakia) (23st)

Leukoplakia

#pithelial changes can range from hypereratosis overlying a thicened, acanthotic but orderly

mucosal epithelium to lesions with maredly dysplastic changes sometimes merging into

carcinoma in situ.

/he more dysplastic or anaplastic, the more liely inflammatory infiltrate is present.

#pithelium

;ucous gland

amina propria

(underlies epithelium)

$ubmucosa

eratin


5/10

Suamous papilloma (1!st)

/he papilloma (s7uamous papilloma) is a benign, e"ophytic proliferation of stratified s7uamous

epithelium arranged in fingerlie pro?ections

evelops in all age groups but is most often seen in the third to fifth decade of life

#tiology3 presumably human piapillomavirus (H98)

/reatment is conservative surgical e"cision, including a small amount of normal epithelim at the

base. Eecurrance is rare !%.

;ost commonly seen on the hard and soft palateuvula comple", but is often seen on the ventral

and dorsal tongue, the gingiva, and the buccal mucosa.

9in, pedunculated and papaillary lesion attached to the lingual frenum.

+linically, this configuration may appear cauliflowerlie

/he base may be either pedunculated or sessile

+olor ranges from that of normal mucosa to white or red

$oft, painless

papillomas are generally less than cm in diameter, but they have grown as large as = to C cm

(*% are less than cm) >n most situations, the lesion is solitaryF however, an occasional patient may have multiple

papillomas. >n addition, multiple papillomalie epithelial proliferations may develop in

immunocompromised persons

/he covering s7uamous epithelium shows a normal maturation pattern, although occasional

papillomas demonstrate basilar hyperplasia an mild mitotoc activity which could be mistaen for

mild epithelial dysplasia

;icro3 delicate fibrovascular cores surrounded by s7uamous epitheliumF hypereratosis in G=%,

paraeratosis in =%F variable hyperplasia of basilar cell, individual cell eratini-ation, abnormal

mitotic figuresF often no oilocytotic changesF no pushing growth into lamina propria.


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Suamous papilloma (1!st)

Histology3

papillary configuration

@ingerlie pro?ections of

thicened (acanthotic) epidermis

overlying a fibrovascular core variable inflammation

Hypereratosis and paraeratosis

often present.

&ranching fronds of

s7uamous epithelium

with fibrovascular cores

eratini-ed, stratified

s7uamous epithelium

@ibrovascular

connective tissue


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Granular cell tumor ("myo#lastoma$) (1%st)

/his granular cell tumor is relatively

uncommon neoplasm that shows a

predilection to the oral cavity,

especially the tongue

@ormerly called the granular cell

myoblastoma because of its suspectedseletal muscle origin.

;ost investigators now believe it

arises from either the $chwann

cell or an undifferentiated

mesenchymal cell.

>t is most common in young and

middleaged adults and is twice as

common in women.

/he typical presentation3

: sessile swelling on the tongue

covered by normal appearing

epithelium

$lowgrowing, nonulcerated

nodular mass that is usually pin

but sometimes may appear yellow

;ultiple granular cell tumors

occasionally may occur

&enign

/reatment3 ocal surgical e"cisionF

recurrence uncommon

;icro3 associated with

pseudoepitheliomatous hyperplasia of

the overlying epithelium. >t is

important that the pathologist not

mistae it for s7uamous cell

carcinoma.

arge polygonal oval or bipolar

cells with eosinophilic cytoplasm.

: small nuclei acentrically locatedin the cell.

;inimal or no bacground

stroma.

arge cells with abundant granular

cytoplasm and nuclei

arge cells with no

bacground stroma.

$mall nuclei.


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&melo#lastoma ('st)

:meloblastomas are slowgrowing,

locally invasive tumors that generally

follow a benign course

/he most common tumor of

odontogenic epithelial origin that

primarily affects ?aws

#tiology3

:meloblastoma probably arises

from dental lamina rests or from

basal epithelial cells

EememberA :meloblastoma is

characteri-ed by infiltrative

growth and tendency to recur.

Earely, it may metastasi-e.

Bsually present as painless, slow

growing, nonulcerated, sessile red

mass

si-e between and = cm ;andible 4 most arise in mandibular

ramus or molar area

;icro3

+ells tend to move the nucleus

away from basement membrane.

/his process is called 1reverse

polari-ation2

inner -one composed of cells

resembling stellate reticulum

9eripheral cells form bands that

separate the tumor from the

stroma. /he outermost cells

resemble the ameloblastic layer of

developing tooth follicle.

+onfluent islands of

odontogenic epithelium.

>rregular cords of epithelial cells

form ple"iform pattern.

Odontogenic epithelium cells withpalisading and polari-ing nuclei

oriented vertically to the basement

membrane.

@ibrous connective

tissue stroma

+entral portion of epithelial cord is

composed of loose networ of

triangular shaped cells resembling

stellate reticulum

&asement membrane


9/10

hronic sialaenitis ('1*)

: form of mild lymphocytic

infiltration of ma?or salivary gland

$ome cases are focal obstructive,

accompanied by various degree of

parenchymal atrophy and fibrosis.

Other, more common in females, areage related, have high statical

association with rheumatoid arthritis,

and probably immune related.

$ialolithiasis is the most common

cause in clinically apparent cases.

;ainly involves submandibular gland

/reatment 4 depends on position of

stone. >f the stone is in the duct, it can

be removed with the duct. &ut if

inside gland, the entire gland will

have to be removed.

$lide3

Hyperplastic lymphoid infiltrates

with loss of salivary gland aciniF

ducts are surrounded and infiltrated

by lymphoid cells

@ibrosis and parenchymal atrophy

>nflammatory infiltrate everywhere

;any glands (mi"ed glands) &ands of fibrous connective tissue,

divide salivary gland into nodules

(septa)

ense inflammatory

infiltrate (lymphocytes)

surrounding acinar glands

$alivary gland (acini)

uct

$epta


10/10

Pleomorphic aenoma of the salivary glan ('1')

&enign mi"ed tumor (pleomorphic

adenoma of parotid gland)

#pithelial and mesenchymal part

in are mi"ed together

9leomorphic adenomas3

#pidemiology3 60% of tumors ofparotid gland are pleomorphic

adenomas.

Eare in minor salivary glands.

/he most common neoplasm of

the salivary gland.

Eadiation e"posure

@emale dominant

;icro3 5ests of epithelial and

myoepithelial cells forming ducts,trabeculae or solid sheets.

oose my"oid and chondroid

tissue (differentiation of a part of

the stroma into cartilage)

;yoepithelial cells undergoing

cartilaginous metaplasia

uctal cells, myoepithelial cells,

matri" (my"oid, hyaline,

chondroid).

Bsually no epithelial dysplasia or

mitotic activity.

$low growing, painless, movable

mass at the angle of ?aw

/umor with stromal metaplasia

/he capsule tends to be thicer and

less liely to be penetrated by the

tumor when the lesions are located in

the deeper lobes.

&enign tumor, but may recur whenremoved from capsule without the

surrounding tissue.

'ross3 welldemarcated, rarely

e"ceed 6 cm. /he consistency

depends on the relative amount of

epithelial cells and stroma. +ut

surface is yellowwhite with my"oid.

>sland of cartilage can be recogni-ed

by their translucent appearance.

+hondroid matri" uct formation

+apsule

;y"oid

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Alimentary System Pathology (Part 1)