Oral Pathology

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Oral Pathology
2013-11-24 22:38:24

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  1. Neoplasm, Neoplasia
    New growth of tissue
  2. Tumor
    Neoplasm, also a swelling or enlargement
  3. Benign Tumor
    A tumor that is favorable for treatment and recovery
  4. Malignant Tumor
    A tumor that is resistant to treatment and may cause death
  5. Carcinoma
    Malignant tumor of epithelium
  6. Sarcoma
    Malignant tumor of connective tissue
  7. Dysplasia
    Disordered growth, alteration in size, shape, and organization of cells
  8. Hyperplasia
    Increase in the number of cells
  9. (5) Characteristics of Benign Tumors
    1.Usually well-differentiated

    2.Usually slow growth

    3.Mitotic figures are rare

    4.Usually encapsulated

    5.No metastasis
  10. (5) Characteristics of Malignant Tumors
    1.Well-differentiated to anaplastic

    2.Slow to rapid growth

    3.Mitotic figures may be numerous

    4.Invasive and unencapsulated

    5.Metastasis likely
  11. (5) Types of Tumors of Squamous Cell Epithelium

    2.Premalignant Lesions

    3.Squamous Cell Carcinoma

    4.Verrucous Carcinoma

    5.Basal Cell Carcinoma
  12. Papilloma
    •Benign tumor of squamous epithelium

    • •Small,
    • •exophytic,
    • •pedunculated or sessile growth
    • •Composed
    • of numerous papillary projections; either white or color of mucosa
    • •Cauliflower-like
    • •Usually solitaire lesions. 

    •Caused by HPV virus

    •The color of the lesion depends upon the amount of keratin present

    •Similar clinical presentation to verruca vulgaris and condyloma
  13. What type of Treatment is required of a Papilloma?
    • •Treatment includes:
    • surgical excision with the base of the lesion; does not recur
  14. What are the most common sites of a papilloma in the oral cavity?
    • 1. Tongue
    • 2. Palate
  15. What are the (3) types of Premalignant Lesions?
    • 1.Leukoplakia
    • 2.Erythroplakia
    • 3.Epithelial Dysplasia
  16. (5) Characteristics of Leukoplakia
    1.White plaque-like lesion

    2.Cannot be wiped off, cannot be diagnosed as a specific disease

    3.Biopsy is necessary to establish a definite diagnosis

    • 4.Biopsy may show epithelial dysplasia, a premalignant condition, or squamous cell
    • carcinoma

    5.Would consider this a premalignant lesion, or could already be a malignant lesion.
  17. Leukoplakia Continued:
    •If you see a white lesion clinically:

    –Identify the cause

    –Remove the associated irritant

    • •If the lesion does not resolve,
    • biopsy must be performed
  18. Erythroplakia
    1.Smooth, red patch

    2.Most cases occur on the floor of the mouth, tongue and soft palate

    3.Less common than leukoplakia

    • 4.Biopsy reveal epithelial dysplasia or squamous cell carcinoma (present in about 40% of
    • these lesions)

  19. True or False: An erythroplakia is usually less common, but usually more malignant than a leukoplakia.
  20. Epithelial Dysplasia
    1.Disordered growth

    2.Premalignant condition; frequently precedes squamous cell carcinoma

    3.Cellular changes in epithelial dysplasia may return to normal if the stimulus is removed
  21. Epithelial Dysplasia continued...
    • •Clinically may appear as an
    • erythematous lesion, white lesion or a mixed lesion (speckled leukoplakia)

    •Usually found on the floor of the mouth or tongue

    • •All dysplastic lesions should be
    • excised surgically and closely followed
  22. Squamous Cell Carcinoma
    Malignant tumor of sqamous cell carcinoma
  23. Squamous Cell Carcinoma
    • •Most common primary malignancy of the
    • oral cavity

    • •Usually metastasizes to:
    • • lymph nodes of the neck,
    • •lungs,
    • •liver

    • •Clinically can appear as an exophytic
    • ulcerative mass
  24. Squamous Cell Carcinoma
    • •Early tumors may be erythematous,
    • white or a mixture of both

    •Be suspicious of induration!

    • •In persons with fair skin, may see
    • SCC in association with actinic cheilitis
    • and actinic keratosis

    •Seen in persons > age 40
  25. Squamous Cell Carcinoma is commonly seen on:
    • –floor of the mouth,
    • –lateral and ventral surface of tongue,
    • –soft palate,
    • –tonsillarpillar
    • –retromolar areas
  26. •Risk factors for Squamous Cell Carcinoma  include:
    • -all tobacco products,
    • -alcohol consumption
  27. Treatment of Squamous Cell Carcinoma is:
    •surgical excision, followed by radiation or chemotherapy
  28. (7) Signs and Symptoms of Oral Cancer
    • 1. Mouth sore that does not heal
    • 2. Mouth sore that bleeds spontaneously
    • 3. Velvety, white, red, or speckeled (red and white) patch in the mouth that is persistent
    • 4. Hard red lesion (lump) crusts, eroded areas on the lips, gums, or other areas inside the mouth.
    • 5. Unexplained bleeding in the mouth
    • 6. Persistent pain in the mouth
    • 7. Difficulty chewing, swallowing, speaking, or moving the tongue.
  29. Verrucous Carcinoma
    • 1. Type of SCC, with a better prognosis
    • 2.Slow-growing,exophytic tumor with a pebbly white and red surface
    • 3.Men > age 55
    • 4.Vestibule and buccal mucosa
    • 5.Seen most often in persons who use smokeless tobacco products
    • 6.Surgical excision, with long term follow-up
  30. Basal Cell Carcinoma
    •Malignant skin tumor associated with excessive sun exposure

    •Does not occur inside the oral cavity

    • •Areas of the skin of the face show
    • non-healing ulcers with characteristic rolled borders

    •Caucasion adults

    •Locally invasive tumor that can become large if left untreated

    •Surgical excision may need to be followed up with radiation therapy

    •BCC rarely metastasize

    –But does need to be treated.  Can disfigure.
  31. (4) Types of Tumors of Salivary Glands
    1.Pleomorphic Adenoma

    2.Monomorphic Adenoma

    3.Adenoid Cystic Carcinoma

    4.Mucoepidermoid Carcinoma
  32. Pleomorphic Adenoma
    (Benign Mixed Tumor)
    • •Benign salivary gland tumor;
    • --most common salivary gland neoplasm

    •Most common extraoral location:  parotid gland

    •Most common intraoral location:  palate

    • •Slowly enlarging, non-ulcerated,
    • painless, dome-shaped mass

    •Up to several centimeters in size

    •Persons > age 40; females

    • •Surgical excision; may be difficult
    • to remove
  33. Monomorphic Adenoma
    • •Benign, encapsulated salivary gland
    • tumor
    • •Occurs less frequently than pleomorphic adenoma
    • •Adult females; upper lip and buccal mucosa
    • •Surgical excision
    • •Recurrence is rare
  34. Adenoid Cystic Carcinoma
    • •Malignant tumor of salivary gland
    • origin, from either major or minor salivary gland tissue
    • •Unencapsulated; infiltrates surrounding tissue; slow growing
    • •Most common sites:  parotid gland and palate
    • •May exhibit surface ulceration
    • •Pain is often noted due to the
    • tendency of these tumors to surround nerves
    • •Surgical excision; recurrence is
    • common
  35. Mucoepidermoid Carcinoma
    • •Malignant salivary gland tumor
    • •Unencapsulated, infiltrating tumor
    • •Occur most often in the parotid
    • gland and palate
    • •Slowly enlarging masses
    • •Occasionally may arise within bone,
    • usually in the mandibular posterior region
    • •See a uni-or multilocular radiolucency
    • •Occurs over a wide age range; most
    • common malignant salivary gland tumor in children
    • •Surgical excision
    • •Most commonly seen in women, but
    • also seen in kids.