Sandbox:Affan: Difference between revisions

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{| class="wikitable"
{| class="wikitable"
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! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Soft tissue oral lesions
! colspan="6" style="background:#4479BA; color: #FFFFFF;" align="center" + |Soft tissue oral lesions
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! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |Reactive lesions
! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |Reactive lesions
! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
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! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |Characterstic features
! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |Characterstic features
! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |Associated conditions
! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |Associated conditions
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| rowspan="1" style="background: #DCDCDC; padding: 5px; text-align: center;" |
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* Leukoedema
* Leukoedema
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* Fordyce granules
* Fordyce granules
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* Hairy tongue
* Hairy tongue
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* Hairy leukoplakia
* Hairy leukoplakia
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* White sponge nevus
* White sponge nevus
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* Lichen planus
* Lichen planus
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* Focal keratosis
* Focal keratosis
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! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Tumors
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Tumors
! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |etiology
! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |etiology
! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |location
! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |location
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! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |Image
! rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |Image
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| rowspan="5" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tumors|Benign tumors]]
| rowspan="3" |Epithelial tumors
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* Epithelial tumors
* Squamous cell carcinoma
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* Oral epithelial dysplasia
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* Proliferative verrucous leukoplakia
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| rowspan="3" |Papillomas
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* Condyloma acuminatum
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* Verrucous vulgaris
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* Multifocal epithelial hyperplasia
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| rowspan="2" |Salivary type tumors
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* Mucoepidermoid carcinoma
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* Pleomorphic adenoma
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| rowspan="8" |Soft tissue and Neural tumors
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* Granular cell tumor
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* Rhabdomyoma
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* Lymphangioma
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* Papilloma
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* Verruca Vulgaris
* Hemangioma
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* Condylomata acuminatum
* Schwannoma
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* Mesenchymal tumors
* Neurofibroma
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* Kaposi sarcoma
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* Myofibroblastic sarcoma
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| rowspan="4" |Hematolymphoid tumors
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* CD-30 positive lymphoproliferative disorder
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* Salivary gland tumors
* Plasmablastic lymphoma
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| rowspan="4" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tumors|Malignant tumors]]
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* Langerhan cell histiocytosis
*  
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* Extramedullary myeloid sarcoma
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| rowspan="2" |Tumors of uncertain histiogenesis
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* Congenital granular cell epulis
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* Ectomesenchymal chondromyxoid tumor
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* Gingival cyst
* Gingival cyst
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* Lymphoepithelial cyst
* Lymphoepithelial cyst
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* Epidermoid cyst
* Epidermoid cyst
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* Thyroglossal tract cyst
* Thyroglossal tract cyst
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* Nasolabial cyst
* Nasolabial cyst
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Revision as of 21:52, 11 February 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Muhammad Affan M.D.[2]

Surface oral lesions
Oral lesions Appearance Associated conditions Location Microscopic Image
White Lesions Leukoedema
  • White or whitish grey edematous lesion
  • Diffuse or patchy
  • Variant of normal oral mucosa
  • Buccal and labial oral mucosa
  • Intracellular edema or vacuolization of Malpighian cells.
Fordyce granules
  • White or yellow discrete papules
  • Symmetrically distributed
  • Variant of normal oral mucosa
  • Buccal mucosa
  • Vermillion border of the lips
  • Similar to normal sebaceous glands of skin
  • Lacks hair follicles and almost always lack ductal communication with surface.
Benign migratoy glossitis
  • Red patches with white distinct border
  • Map like appearance
  • Psoriasis
  • Diabetes
  • Reiter's syndrome
  • Medications such as Oral contraceptive pills and lithium carbonate
  • Dorsal/Lateral surface of the tongue
  • Acanthosis with neutrophils throughout epithelium and surface
  • Microabscesses, plus inflammatory infiltrate in lamina propria
  • Resembles psoriasis
Hairy tongue
  • Elongated filliform lingual papillae
  • Carpet like appearance
  • Xerostomia
  • Medications such as anti-psychotics
  • HIV
  • Amyotropic lateral sclerosis
  • Dorsum of the tongue
  • Marked elongation and hyperparakeratosis of the filiform papillae
Hairy leukoplakia

White patches

  • Corrugated in appearance
  • Hairy, hair-like growths
  • Permanent
  • Buccal mucosa
  • Lateral surface of the tongue
  • Floor of the mouth
  • Palate
  • Hyperkeratotic oral mucosa due to piling of keratotic squamous epithelium
  • Cowdry type A intranuclear inclusions
  • Balloon cells with margination of chromatin
White sponge nevus
  • White patches of tissue (nevi)
  • Singular or multiple
  • Thickened, velvety, sponge-like appearance
  • Heriditarary
  • Buccal mucosa
  • Parakeratosis, acanthosis
  • Extensive vacuolation
  • Dyskeratotic cells exhibit dense peri and paranuclear eosinophilic condensations
  • Abundant Odland bodies
Lichen Planus
  • Reticular or papular lace like white lesions
  • Multiple, Painful
  • Autoimmune disorders disorders
  • Posterior buccal mucosa
  • Gingival margin
  • Hyperkeratosis and acanthosis
  • Granular cell layer, sawtoothing of rete pegs, bandlike chronic inflammatory infiltrate
  • Civatte bodies
  • Artifactual cleft formation
  • No atypia
Frictional hyperkeratosis
  • White shaggy plaques
  • Could be easily peeled without any pain leaving normal mucosa
  • Bite trauma
  • Grinding of the teeth
  • Buccal mucosa
  • Limited to line of dental occlusion
  • Hyperkeratinization and acanthosis
  • Smooth, corrugated, or ragged, epthelial surfac with multiple keratin projections
Leukoplakia
  • White or grayish in patches that can't be wiped away
  • Irregular or flat-textured
  • Thickened or hardened in areas
  • Along with raised, red lesions (speckled leukoplakia or erythroplakia), which are more likely to show precancerous changes
  • Smoking
  • Soft palate
  • Floor of mouth
  • Ventral surface of tongue and the retromolar area
  • Varies histologically from acanthosis, hyperkeratosis, dysplasia or carcinoma in situ
  • Carcinoma in situ is associated with lymphocytes and macrophages
Erythroplakia
  • Fiery red patch
    • Smooth, velvety, granular or nodular lesions
  • Highest risk of malignant transformation
  • Soft palate
  • Floor of mouth
  • Ventral surface of tongue and the retromolar area
  • Thin atrophic epithelium with prominent subepithelial vascularity and inflammation.
  • Almost all erythroplakic lesions contain dysplastic cells
Oral lesions Characterestic features Associated conditions Location Microscopic Image
Pigmented lesions
  • Ephelis
  • Flat red or light brown spots
  • 3–10 mm in diameter
  • Poorly defined and may merge into large patches
  • Sun exposed skin
  • Predominant in outer lips
  • Mild hyperpigmentation of basal keratinocytes, normal architecture
  • Oral melanocytic macule
  • Focal pigmented brown lesions similar to ephelides
  • Flat and mostly smaller than 1 cm
  • Characterised by a focal increase in melanin production
  • Idiopathic
  • Gingiva, with the buccal mucosa and palate
  • No atypia.
  • Melanin pigmentation tends to be present in significant amounts in the basal-cell layer.
  • Oral melanoacanthoma
  • Proliferation of benign dendritic melanocytes scattered throughout the epithelium, acanthosis and spongiosis
  • Smoker's melanosis
  • Increased melanin pigmentation is noted in the basal cell layer of the epithelium.
  • Melanin incontinence may also be noted in the underlying lamina propria
  • Melanoma
  • Varies from dark brown to blue-black
  • Mucosa-colored and white lesions are occasionally noted
  • Erythema is observed when the lesions are inflamed.
  • Idiopathic
  • 80% cases involve palate and maxillary gingiva
  • Buccal mucosa, mandibular gingiva, and tongue lesions
  • Acral lentiginous
  • Malignant cells often nest or cluster in groups in an organoid fashion
  • Kaposi sarcoma
  • HIV and HHV-8.
  • Hard palate is most frequently affected, followed by the gums
  • Addison's disease
  • Hyperparakeratinized areas showing acanthosis, spongiosis, exocytosis, vacuolar degeneration,
  • Substantial deposition of melanin in all epithelial layers
  • Melanocytic hyperplasia
  • Dendritic melanocytes in all epithelial layers.
  • Peutz jeghers syndrome

Perioral

  • Freckling of the skin around lips and vermillionzone of the lips.

Intraorally

  • Neurofibromatosis
  • Proliferation of all elements of peripheral nerves
  • Schwann cells with wire like collagen fibrils,fibroblasts and collagen
  • Perineurial cells in plexiform types, mitotic figures are rare
  • Polyostotic fibrous dysplasia
  • Orofacial deformity
  • Dental disorders
  • Bone pains
  • Compromised oral health
  • Predominantly involves musculo-skeletal defects of oral cavity
  • Gingiva
  • Curvilinear trabeculae of metaplastic woven bone in hypocellular, fibroblastic stroma
  • Amalgam tattoo
  • Pigmented fragments of metal within connective tissue
  • A scattered arrangement of black or dark brown granules
  • Large particles may be surrounded by chronically inflamed fibrous tissue
Oral lesions Characteristic features Associated conditions Location Microscopic Image
Vesicular/

Ulcerative

Infections Herpes simplex virusinfections

Herpetic gingivostomatitis

  • Painful ulcers covered by a yellowish pseudomembrane
  • Ulcers that may coalesce to form bigger lesions
  • Self limiting after 7 days
  • HSV 1 Infection
  • Keratinized and non-keratinized mucosa.
  • Intra and intercellular edema (acantholysis)
  • Intranuclear inclusions
  • Multinucleate polykaryons (giant cells)
Herpes zoster
  • Clustered small ulcers with characteristic unilateral pattern
  • Keratinocytes are multinucleated, acantholytic with distinct nuclear inclusions, found initially in follicular epithelium
  • Late epidermal necrosis or full-thickness acantholysis
  • Dermal nerve twigs may exhibit a perineural infiltrate of lymphocytes and neutrophils, sometimes associated with intraneural involvement
  • Schwann cell hypertrophy and frank neural necrosis are occasionally encountered
Hand foot mouth disease
  • Irregularly shaped shallow ulcers with yellow-grey base and hyperemic margin.
Infectious mononucliosis
Erosive lichen planus
Pseudomembranous candidiasis
  • Known as thrush.
  • Usually asymptomatic.
  • Confluent white wipeable plaques resembling curdled milk
  • Superficially the plaques can be wiped off and the underlying mucosa often exhibits an erythematous appearance.
Histoplasmosis
  • Ohio and Mississippi river valleys
Blastomycosis
  • Mississippi, Missouri and Ohio River valleys and the Great lakes region.
Coccidiodomycosis
Autoimmune conditions Pemphigus vulgaris
Mucous membrane pemphigoid (Cicatricial pemphigoid)
Aphthous ulcer
  • Shallow, round to oval ulcer with white or yellow pseudomembrane surrounded by halo
  • In chronic ulcer grey membrane may replace the yellow pseudomembrane
Erythema multiforme
Sjogren's Syndrome

Affects salivary and lacrimal glands

Bullous pemphigoid
Idiopathic conditions Allergic contact stomatitis
Irritant contact stomatitis
Soft tissue oral lesions
Reactive lesions Symptoms Characterstic features Associated conditions Location Image
  • Leukoedema
  • Fordyce granules
  • Hairy tongue
  • Hairy leukoplakia
  • White sponge nevus
  • Lichen planus
  • Focal keratosis
Tumors etiology location Clinical appearance Gold standard/Diagnosis Image
Epithelial tumors
  • Squamous cell carcinoma
  • Oral epithelial dysplasia
  • Proliferative verrucous leukoplakia
Papillomas
  • Condyloma acuminatum
  • Verrucous vulgaris
  • Multifocal epithelial hyperplasia
Salivary type tumors
  • Mucoepidermoid carcinoma
  • Pleomorphic adenoma
Soft tissue and Neural tumors
  • Granular cell tumor
  • Rhabdomyoma
  • Lymphangioma
  • Hemangioma
  • Schwannoma
  • Neurofibroma
  • Kaposi sarcoma
  • Myofibroblastic sarcoma
Hematolymphoid tumors
  • CD-30 positive lymphoproliferative disorder
  • Plasmablastic lymphoma
  • Langerhan cell histiocytosis
  • Extramedullary myeloid sarcoma
Tumors of uncertain histiogenesis
  • Congenital granular cell epulis
  • Ectomesenchymal chondromyxoid tumor
Cysts
  • Gingival cyst
  • Lymphoepithelial cyst
  • Epidermoid cyst
  • Thyroglossal tract cyst
  • Nasolabial cyst

References