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___________________ There is an exophytic, nodular mass of dense fibrous Connective Tissue that is NOT encapsulated, connective tissue is dense and collagenized as well as covered by stratified squamous epithelium.
___________________ Highly vascular proliferation that resembles granulation tissue. There are endothelium-lined channels that are engorged with RBCs. Vessels are sometimes organized in lobular aggregates.
___________________ Streaming fasclicles of spindle-shaped Schwann cells that form a palasaded arrangement around the central, acellular eosinophilc areas known as Verocay bodies. Tumor cells have a positive reaction to S100 protein. Antoni A and B are seen in the histology as well.
___________________The patient presents with a marfanoid body build. Blood tests prove increased catecholamine levels and VMA. This patient must be closely monitored due to the risk of medullary thyroid carcinoma.
Multiple Endocrine Neoplasia (Type 2B)
___________________The histology shows hyperplastic stratified squamous epithelium. In this advanced case, you see that the hyperplasia is pseudoepitheliomatous in appearance and sort of resembles a carcinoma. However, the CT varies from loose and edmatous to densely collagenized.
Inflammatory Papillary Hyperplasia (Denture Papillomatosis)
___________________ This is derived from Schwann cells or neuroendocrine cells. It is NOT encapsulated, is positive for S100 protein and shows presence of acanthosis and pseudoepitheliomatous hyperplasia. It is mostly seen on the tongue.
Granular Cell Tumor
___________________The histology shows a circumscribed cellular mass of vascular endothelial cells arranged in lobular aggregates. These are typically seen at within the first few weeks after birth.
___________________The histology shows excessive numbers of dilated blood vessels in the middle and deep dermis. There is vascular dilation. In addition, the brain reveals gyriform “tramline” calcifications and the patient presents with glaucoma.
___________________Tumor-like growth of microscopically normal tissue in an abnormal location.
___________________The histology shows a mass of vascular fibrous CT that is loosely arranged and covered by stratified squamous epithelium. There are numerous larger multi-nucleated stellate fibrolasts within the superficial CT. Rete ridges are narrow and elongated.
Giant Cell Fibroma
___________________The histology shows a nodular proliferation of multi-nucleated giant cells within the gingiva. They are within a hemorrhagic background of ovoid and spindle-shaped mesenchymal cells. This red-blue lesion occurs on the gingiva or edentulous alveolar ridge.
Peripheral Giant Cell Granuloma (Giant Cell Epulis)
___________________This soft, smooth-surfaced, yellow nodular mass is pedunculated and composed of mature fat cells. The tumor is well-circumscribed and may have a thin fibrous capsule. There is distinct lobular arrangement of the cells.
___________________This lesion’s histology shows haphazard proliferation of mature, myelinated and unmyelinated nerve bundles. These are within a fibrous CT stroma that ranges from densely collagenized to myxomatous in nature.
Traumatic Neuroma (Amputation Neuroma)
___________________A polyp, leaf-like lesion is very obvious on your patient’s hard palate. It is pedunculated and hyperkeratoti with overlying epithelium and irregular hyperplasitc rete ridges. Your patient’s chief complaint is “my dentures make my mouth hurt.”
Name five diagnostic criteria for Neurofibromatosis:
- 6 or more Café au lait macules
- 2 or more neurofibromas of any type OR 1 plexiform neurofibroma
- 2 or more lisch nodules
- Axial or inguinal freckling
- Optic glioma
- Sphenoid dysplaisa or thinning of the long bone cortex
- First degree relative with NF1
___________________Masson Trichome stain shows bundles of smooth muscle with adjacent normal collagen.
___________________Uniform tumor composed of rounded and polygonal cells with focal vaculolization (spider web appearance). Cells exhibit abundant granular, eosinophilic cytoplasm. Evidence of skeletal muscle on the histology as well.
- __________(50%)Malignant Peripheral Nerve Sheath Tumor
List three lesions that do NOT change color in the sun:
- Lengito Simplex
- Actinic Lentigo
- Oral Melanotic Macule
___________________The histology shows considerable acanthosis, surface hyperkatosis and numerous pseudocysts. The epidermal proliferation extends upward, above the normal epidermal surface. The pseudocysts are actually keratin-filled invaginations.
___________________These lesions are common on the dorsa of the hands and result from chronic exposure to UV light. They are uniformly pigmented brown to tan macules with well-demarcated but irregular borders.
Actinic Lentigo (Liver Spots)
___________________Characterized by increased melanin deposition within an otherwise unremarkable epidermis. Bilateral light to dark brown cutaneous macules primarily on the forehead, upper lip and chin.
Melasma (Mask of Pregnancy)
___________________Neural Crest derived cells can be found at the junction between the epithelium and the connective tissue. As the cells proliferate, groups of cells begin to drop into the underlying dermis or lamina propria. When cells are present within the underlying connective tissue AND the junctional area, the name changes to ___________.
Junctional Melanotic NevusCompound Melanotic Nevus
___________________is the intraoral counterpart where melanocytes are found ONLY within the underlying connective tissue. This usually occurs at later stages in the disease process.
___________________The radial growth phase is characterized by the spread of atypical melanocytes along the basilar portion of the epidermis. Individual melanocytes are invading the higher levels of the epithelium singly or in nests. This microscopic pattern is referred to as “pagetoid.”
Superficial Spreading Melanoma
___________________The histology of this hypopigmented lesion shows short, cigar-butt hyphae. KOH findings show spores with short mycelium that resembles “spaghetti and meatballs.”
Pityriasis (Tinea) Versicolor
___________________This hyperpigmented palatal lesion shows numerous atypical melanocytes in the basilar portion of the epithelium. These cells spread along the basal layer in a lateral manner. The cells also show significant dendritic processes. Invasion into the superficial lamina propria is visible as well.
Acral Lentiginous Melanoma
___________________Abundant melanin is seen within spindle-shaped melanocytes. These melanocytes are deep within the lamina propria, parallel to the surface epithelium and have significant branching dendritic extensions.
Blue Nevus (Compound Nevus)
___________________This circumscribed tan to brown macule on the lower lip shows an increase in melanin in the basal and parabasal layers. It also shows Melanin Incontinence. It is NOT dependent upon sun exposure and is usually less than 0.5cm in diameter.
Oral Melanotic Macule
___________________Your patient presents with freckle-like lesions on their hands, perioral skin, and oral mucosa. Their Jejunum and Ileum are affected by intestinal polyps and they have a significant chance of developing a GI adenocarcinoma.
___________________Your patient presents with a mucin-filled cyst-like cavity beneath the mucosal surface on the floor of their mouth. There is a granulation response due to the spilled mucin and it typically contains foamy histiocytes.
___________________Accumulation of PMNs is observed within the ductal system and acini. Scattered or patchy infiltration of the salivary parenchyma by lymphocytes and plasma cells is also observed. There is associated fibrosis with the lesion.
Chronic Sclerosing Sialadenitis
Episodic hypersecretion of saliva is called ________ _________ and is associated with ______________.
Water Brash; Sialorrhea
___________________The histology of this lesion shows lyphocytic infiltrate of the parotid gland with an associated epimyoepithelial island. Mikulicz disease is associated with this lesion and may produce bilateral salivary and lacrimal enlargement.
Benign Lymphoepithelial Lesion
___________________An excessive accumulation of secretory granules with marked enlargement of acinar cells (2-3x larger) is seen histologically. This is most commonly seen in the parotid glands and is a result of dysregulation of autonomic innervations of the salivary acini.
___________________Acinar necrosis is seen in early lesions followed by associated squamous metaplasia of the salivary ducts. However, overall lobular architecture of the involved gland is maintained. There is also pseudoepitheliomatous hyperplasia present.
___________________This patient presents with Sicca Syndrome and elevated levels of erythrocyte sedimentation rate and IgG. There is evidence of lymphocytic infiltration of the salivary glands and destruction of the acinar units. There is a significant number of focal chronic inflammatory aggregates.
___________________A cystic cavity lined by thin cuboidal epithelium with an adjacent duct lined by columnar epithelium is seen on the histology.
Salivary Duct Cyst
___________________A radiopaque mass is visible on the Pano near the middle of the manidble. The histology shows an intraductal calcified mass with concentric laminations surrounding a nidus of amorphous debris. The duct exhibits squamous metaplasia.
___________________Your patient presents with a small nodule on the upper lip. You take a biopsy and the results show a single layered cords of columnar or cuboidal epithelial cells with deeply basophilic nuclei. It has a uniform histolopathological pattern throughout the lesion and is only found in minor salivary glands.
___________________A well-circumscribed encapsulated tumor with a variable microscopic pattern composed of a mixture of glandular epithelium and myoepithelium cells within a mesenchyme-like background.
___________________This well-circumscribed tumor is composed of sheets of large polyhedral epithelial cells. The abundant granular and eosinophilic cytoplasm is due to the excessive accumulation of mitochondria.
Papillary Cystadenoma Lymphomatosum
___________________This tumor has a variable microscopic appearance. There are areas of typical benign pleomorphic adenoma while other areas have cellular pleomorphism and abnormal mitiotic activity. The nuclei are often pleomorphic in the malignant portion of the tumor.
Malignant Mixed Tumors (Carcinoma Ex Pleomorphic Adenoma)
___________________This lesion is associated with odontogenic cysts or impacted teeth (most often dentigerous cysts) within the jaw. It has prominent cyst formation, minimal cellular atypia and a relatively high proportion of mucous cells. Intermediate cells are also present.
Intraosseous Mucoepidermoid Carcinoma
___________________This lesion shows a mixture of ductal epithelium and a lymphoid stroma. There are two layers of cells: An inner luminal layer with tall columnar cells with centrally placed, palasading and slightly hyperchormatic nuclei and a second layer of cuboidal or polygonal cells with more vesicular nuclei. There are multiple papillary infoldings that protrude into the cystic spaces.
Papillary Cystadenoma Lymphomatosum (Warthin’s Tumor)
What are the four Monomorphic Adenomas?
OncocytomaCanalicular AdenomaWarthin’s Tumor (Papillary Cystadenoma Lymphomatosum)Basal Cell Adenoma
___________________This lesion is usually encapsulated and well-circumscribed. There are cords of basaloid cells arranged in a trabecular pattern and is usually seen in the parotid gland. There is a homogenous appearance of this lesion.
Basal Cell Adenoma
___________________This lesion is composed of a mixture of mucous-producing cells and squamous epidermoid cells. It has solid islands of squamous and intermediate cells and can demonstrate considerable pleomorphism and abnormal mitotic activity.
Mucoepidermoid Carcinoma (High-Grade)
A patient presents to your office with a soft, painless, pedunculated, exophytic nodule on their soft palate. It has a cauliflower appearance. Histology shows fingerlike projections with fibrovascular connective tissue cores and koilocytes in the prickle cell layer. You learn that it is induced by HPV 6 and 11. What lesion is this?
Histology shows hyperkeratosis and acanthosis of the palatal epithelium, along with squamous metaplasia of minor salivary gland ducts. This lesion is reversible. What is it?
A patient presents to your office with a malignant tumor in the nasopharynx. He also has EBV infection. What is this tumor?
Describe the spectrum of Epithelial Dysplasia (5 things)
- Mild= basal and parabasal layers only
- Moderate= basal layer to mid-spinous layer
- Severe= basal layer to above mid-epithelial layer
- Carcinoma in situ= involves the entire thickness of the epithelium
- Ductal dysplasia= extends down duct of a minor salivary gland
Histology shows submucosal deposition of dense and hypovascular collagenous connective tissue. There is also hyperkeratosis, basilar hyperplasia and fibrosis in the lamina dura. It is associated with betal quid use and the chief complaint associated is trismus. What lesion is this?
Oral Submucous Fibrosis
A patient presents with irregular scaly plaques on the dorsum of their right hand, exhibiting a cutaneous horn. Histology shows hyperparakeratosis and acanthosis. There are also tear-drop shaped rete ridges and hyperchromatism and pleomorphism of epidermal cells. What lesion does this patient have?
List 6 alterations of dysplastic epithelial cells.
- Enlarged nuclei and cells
- Increased nucleus to cytoplasm ratio
- Large and prominent nucleolus
- Hyperchromatic nuclei
- Pleomorphic nuclei and cells
- Dyskeratosis (premature keratinization)
- Increased mitotic activity
- Abnormal mitotic figures (tripolar)
- Bulbous or tear-drop shaped rete ridges
- Loss of polarity (lack of progressive maturation toward the surface)
- Keratin or epithelial pearls
List 4 factors that increase the risk of cancer in leukoplakic lesions.
- Persistence over many years
- Occurring on oral floor or ventral tongue
This rare variant of squamous cell carcinoma shows dysplastic surface epithelium and an invasive spindle cell element. What is it?
Spindle Cell Carcinoma
Histology shows an epithelium exhibiting acanthosis, hyperkeraotis and chevron formation. There is no induration, ulceration or pain associated with this lesion. What is it?
Chronic smokeless tobacco user
This lesion exhibits virus-induced epithelial hyperplasia from a DNA poxvirus. Oral involvement is not common, but rather shows a predilection for warm areas and sites of recent injury. It will show spontaneous regression. What is this lesion?
A patient presents to your office with a firm papule that has a central depression and umbilicated appearance. Telangiectatic blood vessels can be seen and a pearly opalecent quality is discerned upon pressure. Fearing formation of a Rodent ulcer if left untreated, you take a biopsy. Histology shows uniform, ovoid, dark-staining basaloid cells. Cells are arranged into well-demarcated islands that demonstrate palisading of peripheral cells. Solar elastosis is seen in the adjacent stroma. What does your patient have?
Basal Cell Carcinoma
List 5 local oral alterations in chronic smokeless tobacco users.
- Gingival recession (most common!)
- Destruction of facial surface of alveolar bone
- Dental caries
- Smokeless tobacco keratosis
- Teeth staining
- Localized or generalized wear of occlusal and incisal surfaces
- Soft, velvety feel to mucosa
- Fissured, rippled mucosa
- Lesion is thick and appears leathery
Histology shows a very thin epithelium with a lack of keratin production. It is a red macule with a soft, velvety texture. Biopsy is required to distinguish between other things like candidiasis or psoriasis. What is this lesion?
A patient presents to your office with an umbilicated lesion with a small central depression. Compression of the lesion causes expression of an oily substance. What is this lesion?
This lesion is firm, nontender, and sessile with a central plug of keratin. It is self-limiting and can be associated with syndromes. What is it?
Describe 6 variables included in tumor grading systems
- Pattern of invasion
- Tumor thickness
- Degree of keratinization
- Nuclear polymorphism
- Lymphocytic response
- Mitotic rate
This lesion is a white patch or plaque resulting from a thickened surface keratin layer or thickened spinous layer. Histology shows hyperkeratosis with or without acanthosis, and chronic inflammatory cells within the subjacent connective tissue. The keratin layer may have parakeratin, orthokeratin, or both. What is it?
This lesion arises from dysplastic surface epithelium. Histology shows invasive islands and cords of malignant squamous epithelial cells that invade into the lamina propria. Other noticeable characteristics are angiogenesis, fibrosis, eosinophilic cytoplasm, and keratin pearls
Squamous Cell Carcinoma
List 5 signs and symptoms of Oral Submucous Fibrosis
This lesion shows localized proliferation of oral squamous epithelium. It is induced by HPV 13 and 32 and is associated with the HLA-DR4 allele. No treatment is needed because it exhibits spontaneous regression. What is it?
Multifocal Epithelial Hyperplasia (Heck’s Disease)
A patient presents to your office with the chief complaint of “a funny change at the edge of my lip.” You notice a blurring of the margin between the vermillion zone and the cutaneous portion of the lip. Histology shows hyperkeratosis, epithelial atrophy and solar elastosis of the underlying CT. What does this patient have?
Histology shows acanthotic stratified squamous epithelium forming a blunted projection. Prickle cells demonstrate crinkled nuclei surrounded by koilocytes. This lesion also accounts for 20% of all STDs. What is it?
Condyloma Acuminatum (Venereal Wart)
Histology shows numerous papillary projections that are covered by hyperkeratotic stratified squamous epithelium, elongated rete ridges, and koilocytes in the upper epithelial layers. A characteristic clinical feature is a cutaneous horn. What lesion is this? (clinical and common terms)
Verruca Vulgaris (common wart)
List 4 factors that increase the risk of malignant transformation.
- 1.Loss of Heterozygosity (LOH)
- 2.Microsatellite instability
- 3.Increased telomerase activity
- 4.Changes in expression of various
- molecular biomarkers (p53, p16, etc)
This low-grade variant of oral squamous cell carcinoma shows wide, elongated rete ridges that appear to push into the underlying connective tissue. There are also parakeratin plugs between its many surface projections. What is it?
Verrucous Carcinoma (Snuff Dipper’s Cancer)