Sandbox leucocytosis: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 543: Line 543:
*Papillary squamous cell carcinoma
*Papillary squamous cell carcinoma
*Spindle cell carcinoma
*Spindle cell carcinoma
*Acantholytic squamous cell carcinoma
*Acantholytic squamous cell carcinoma
*Acantholytic squamous cell carcinoma
*[[Adenosquamous carcinoma]]
*[[Adenosquamous carcinoma]]

Revision as of 15:37, 18 January 2019


Disease Presentation Risk Factors Diagnosis Affected Organ Systems Important features Picture
Diseases predominantly affecting the oral cavity
Oral Candidiasis
  • Denture users
  • As a side effect of medication, most commonly having taken antibiotics. Inhaled corticosteroids for the treatment of lung conditions (e.g, asthma or COPD) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication.
  • Clinical diagnosis
  • Confirmatory tests rarely needed
Localized candidiasis

Invasive candidasis

Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg
Herpes simplex oral lesions
  • Stress
  • Recent URTI
  • Female sex
  • The symptoms of primary HSV infection generally resolve within two weeks
Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg
Aphthous ulcers
  • Painful, red spot or bump that develops into an open ulcer
  • Physical examination
  • Diagnosis of exclusion
  • Oral cavity
  • Self-limiting , Pain decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358
Squamous cell carcinoma
Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632
Leukoplakia
  • Vulvar lesions occur independent of oral lesions
Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087
Melanoma
Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811
Fordyce spots
Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899
Burning mouth syndrome
Torus palatinus
Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591
Diseases involving oral cavity and other organ systems
Behcet's disease
Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021
Crohn's disease
Agranulocytosis
Syphilis[3]
oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349
Coxsackie virus
  • Symptomatic treatment
Hand-foot-and-mouth disease - adapted from atlasdermatologico.com[4]
Chicken pox
Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565
Measles
  • Unvaccinated individuals[5][6]
  • Crowded and/or unsanitary conditions
  • Traveling to less developed and developing countries
  • Immunocompromized
  • Winter and spring seasons
  • Born after 1956 and never fully vaccinated
  • Health care workers
Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483
Pathophysiology Prevelance Descriptions Diagnosis Treatment
Normal Variants Leukoedema
  • Benign mucosal variant
  • Results due to accumulation of the fluid within the epithelial cells
  • >50%
  • Black men.
Asymptomatic

Bilateral

Grayish-white

Semitransparent

  • Clinical diagnosis
  • Disappears on mucosal strech
Topical application of tretinoin
Fordyce granules
Type of cancer Subtype Epidemiology Localization Clinical features Diagnostic procedures
Squamous cell carcinoma
  • Basaloid squamous cell carcinoma
  • Papillary squamous cell carcinoma
  • Spindle cell carcinoma
  • Acantholytic squamous cell carcinoma
  • Adenosquamous carcinoma
Verrucous carcinoma
  • Older males
  • 5th and 6th decades of life
  • Males are affected more often than females
  • Hard palate
  • Anterior two-thirds of the tongue, including dorsal, ventral and lateral surfaces, and the floor of mouth
  • Often asymptomatic or may present with vague symptoms and minimal physical finding
Biopsy shows:

Thickened club-shaped

papillae and blunt stromal invaginations

of well-differentiated squamous epithelium with marked keratinization

Lymphoepithelial carcinoma 0.8-2% of all oral or oropharyngeal cancers
  • Some tumors can be bilateral
Biopsy chows:
Epithelial precursor lesions --- --- Seen in the entire digestive tract Biopsy shows:
Proliferative verrucous leukoplakia and precancerous conditions ---
  • Average age at diagnosis is 62 years
  • Women are more commonly afflicted (ratio, 4:1)
An aggressive form of oral leukoplakia with considerable morbidity and

strong predilection to malignant transformation

Biopsy shows:
Papillomas Squamous cell papilloma and

verruca vulgaris

  • Common in children and in adults in the 3rd to 5th decades
  • Almost equal sex incidence with a slight male predominance
Any oral site may be affected mostly: Soft, pedunculated lesions formed by a cluster of finger-like fronds or a sessile, dome-shaped lesion with a nodular, papillary or verrucous surface Biopsy shows:
Condyloma acuminatum 2nd and 5th decade with a peak in teenagers and young adults
  • Painless, rounded, dome-shaped exophytic nodules
  • 15 mm in diameter
  • Have a broad base and a nodular or mulberry-like surface that is slightly red, pink or of normal mucosal color.
  • Lesions may be multiple and are then usually clustered
Biopsy shows:

Several sessile, cauliflower-like swellings forming a cluster

Focal epithelial hyperplasia Disease of children, adolescents and young adults
  • Soft rounded or flat plaque-like sessile swelling.
  • Usually pink or white in color
  • 2-10mm in diameter
Biopsy shows:
  • Rounded sessile swelling formed by a sharply demarcated zone of epithelial acanthosis
  • Koilocytes similar to those of squamous papilloma are usually present
Granular cell tumor ---
  • Arise in all age groups, with a peak between 40 and 60 years
  • Females are affected more often than males with an M/F ratio of 2:1
  • The overlying epithelium is of normal color or may be slightly pale
Biopsy shows:
Keratoacanthoma ---
  • Occurs more often in

whites

  • Twice as frequent in

men as in women

Biopsy shows:
Papillary hyperplasia --- Affects all age groups Palate Asymptomatic nodular or papillary mucosal lesion Biopsy shows:
  • Parakeratinisation or less frequently orthokeratinisation
Median rhomboid glossitis --- --- Dorsum of the tongue at the junction of the anterior two thirds

and posterior third

Forms a patch of papillary atrophy in the region of the

embryological foramen caecum

Biopsy shows:
Salivary gland tumors Acinic cell carcinoma
  • 2-6.5% of all intraoral salivary gland tumors
  • Age range from 11-77 years, with a mean of 45 years
  • Male to female ratio of 1.5:1
Tumors usually

form non-descript swellings

Biopsy shows:
  • Solid sheets of epithelium with secretory material
  • Ductal differentiation in tumors
Mucoepidermoid carcinoma
  • 9.5-23% of all minor gland tumors
Low power microscopy shows low-grade tumor with both cystic and solid areas and an inflamed, fibrous stroma
Adenoid cystic carcinoma
  • 42.5% of minor gland tumors
Predominantly solid variant shows peri- and intraneural invasion
Epithelial-myoepithelial

carcinoma

--- --- --- ---
Clear cell carcinoma,

NOS

--- --- ---
Basal cell

adenocarcinoma

Rare in minor glands Asymptomatic, smooth or lobulated sub-mucosal masses Microscopically similar to basal

cell adenocarcinomas of the major gland

Cystadenocarcinoma 32% developed in the minor glands Slow growing and painless but

some palatal tumors may erode the

underlying bone causing sinonasal complex

---
Salivary duct carcinoma
  • Rare in minor salivary glands
  • Age range was 23-80 years (mean 56 years)
Tumors formed painless swellings but many in the palate can be painful and ulcerated or fungated with metastases to regional lymph nodes The range of

microscopical appearances is similar

to that seen in the major glands

Salivary gland adenomas Pleomorphic adenoma 40-70% of minor gland tumors Painless, slow growing, submucosal masses, but when

traumatized may bleed or ulcerate

Biopsy shows cellular, and hyaline or plasmacytoid cell
Myoepithelioma 42% of minor gland tumors --- ---
Basal cell adenoma 20% of minor gland tumors --- They are histologically

similar to those in major glands.

Cystadenoma 7% of benign minor gland tumors --- ---
Kaposi sarcoma --- Biopsy of all 4 types show:
Lymphangioma ---
  • Appear mostly in the head and neck area but may be found in any other part of the body
Tongue
  • Circumscribed painless swelling
  • Soft and fluctuant on palpation
  • Irregular nodularity of the dorsum of the tongue
Biopsy shows:
Ectomesenchymal chondromyxoid

tumour of the anterior tongue

---
  • Age range varies from 9-78 years
  • No distinct sex predilection.
--- Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue Biopsy shows:
Focal oral mucinosis (FOM) ---
  • The lesion affects all ages
  • Rare in children
  • There is no distinct sex predilection.
Asymptomatic fibrous or cystic-like lesion Histopathology is characterized by:
  • Mucinous material shows alcianophilia at pH 2.5
Congenital granular cell epuli ---
  • Affects newborns
  • Females are affected ten times more often than males
Solitary, somewhat pedunculated fibroma-like lesion attached to the alveolar

ridge near the midline

Hematolymphoid tumors Non-Hodgkin lymphoma Second most common cancer of the oral cavity NHL of the lip presents with: Biopsy shows:
  • Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.
  • Predominantly medium-sized cells with abundant pale cytoplasm.
  • Large cells with round or multilobated nuclei
Langerhans cell histiocytosis ---
  • Jaw bone
  • Intraoral soft tissues
  • Gingiva

and

Common oral symptoms

include:

Biopsy shows ovoid Langerhans cells

with deeply grooved nuclei, thin nuclear membranes and abundant eosinophilic cytoplasm

Hodgkin lymphoma --- Most patients present with localized disease (stage I/II), with ---
Extramedullary myeloid

sarcoma

--- Isolated tumor-forming intraoral mass Biopsy shows an Indian-file pattern of infiltration
Follicular dendritic cell

sarcoma / tumour

  • Tumor of adulthood
  • Affects wide age range
The patients usually

present with a painless mass

Biopsy usually exhibits

borders and comprises:

  • Storiform arrays or
  • Diffuse sheets of spindly to ovoid tumor cells sprinkled with small lymphocytes
Mucosal malignant melanoma ---
  • 0.5% of oral malignancies
  • Incidence 0.02 per 100,000
80% arise:

Others:

  • Floor of mouth
  • Biopsy:
  • S100 positive
  • Negative for cytokeratins
  • More specific markers include:
  • HMB45,
  • Melan-A or anti-tyrosinase
  1. Ann M. Gillenwater, Nadarajah Vigneswaran, Hanadi Fatani, Pierre Saintigny & Adel K. El-Naggar (2013). "Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!". Advances in anatomic pathology. 20 (6): 416–423. doi:10.1097/PAP.0b013e3182a92df1. PMID 24113312. Unknown parameter |month= ignored (help)
  2. Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. (2006). "Idiosyncratic drug-induced agranulocytosis: Update of an old disorder". Eur J Intern Med. 17 (8): 529–35. Text "pmid 17142169" ignored (help)
  3. title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"
  4. "Dermatology Atlas".
  5. Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE (2000). "Individual and community risks of measles and pertussis associated with personal exemptions to immunization". JAMA. 284 (24): 3145–50. PMID 11135778.
  6. Ratnam S, West R, Gadag V, Williams B, Oates E (1996). "Immunity against measles in school-aged children: implications for measles revaccination strategies". Can J Public Health. 87 (6): 407–10. PMID 9009400.