Sandbox leucocytosis

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Oral lesion Differentiating feature Location Associated condition
White lesions
Benign migratory glossitis
  • Red patches with white distinct border
  • Map like appearance
Dorsal/Lateral surface of the tongue
  • Psoriasis
  • Diabetes
  • Reiter's syndrome
  • Medications such as oral contraceptive pills and lithium carbonate
  • Pregnancy
Hairy tongue
  • Elongated filiform lingual papillae
  • Carpet-like appearance
Dorsum of the tongue. 25152586
  • Xerostomia
Leukoedema
  • White or whitish-gray edematous lesion
  • Diffuse or patchy
Buccal and labial oral mucosa7406518
White sponge nevus
  • White patches of tissue (nevi)
  • Singular or multiple
  • Thickened, velvety, sponge-like appearance
The moist lining of the oral mucosa buccal mucosa23230487
Hairy leukoplakia
  • White patches
    • Corrugated in appearance
    • Hairy, hair-like growths
    • Permanent
  • Lateral portions of the tongue
  • Floor of the mouth
  • Palate
  • Buccal mucosa
  • EBV virus infection
  • Immunosupression
Oral lichen planus
  • Lace-like, white patches
  • Erossios
  • Posterior buccal mucosa
  • Gingival margin
Nicotinic stomatitis
  • Reddened area and slowly progresses to a white, thickened, and fissured
  • White cobblestone appearance
  • Red dot in the center
  • Cannot be wiped off
  • Painful
  • Palatal mucosa
  • Posterior hard palate
Smokers
Oral frictional hyperkeratosis
  • White shaggy plaques
  • Could be easily peeled without any pain leaving normal mucosa
  • Bilateral buccal mucosa
  • Limited to the line of dental occlusion
Fordyce granules
  • White to yellow discrete papules,
  • 1 to 2 mm
  • Symmetrically distributed
    • Buccal mucosa
    • Vermilion border of the lips
Malignant
Epithelial dysplasia
Carcinoma in-situ
Squamous cell carcinoma


Pigmented lesions
Oral lesion Differentiating feature Location Associated Condition
Physiologic
  • Multifocal, symmetric, persistent and race inherited.
  • Dark-brown band
  • Marginal gingiva
Intravascular Hemangioma
  • Red or bluish-red, slightly raised lesion
  • Rapidly during infancy and regress slowly during childhood
  • Lip
  • Dorsum of the tongue
  • Gingiva
  • Buccal mucosa
  • Rendu-Osler-Weber syndrome
  • Sturge-Weber-Dimitri syndrome
  • Kasabach-Merritt syndrome
  • Maffucci syndrome
  • Klippel-Trenaunay-Weber syndrome
  • PHACE(S)
Kaposi sarcoma
  • Predominantly skin lesions
  • Oral/ mucosal lesions are less common
  • Skin
Extra-vascular Hematoma
Ecchymosis
  • Non-palpable purpuric spots
  • Palate
  • Tongue
  • Lips
  • Aging
  • Chronic usage of
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Corticosteroids
    • Anticoagulants
  • Deficiency of zinc
  • Liver disorders
Petechiae
Melanocytic Oral melanocytic macule
  • Focal pigmented brown lesions similar to epheledes
  • Flat and mostly smaller than 1 cm
  • Characterised by a focal increase in melanin production
  • Vermilion of the lips
Melanoma
Ephelis
Diffuse
Addison's disease
  • Mucosal hyperpigmentatation

Brown patches of

  • Gingival
  • Vermillion border of the lips
  • Buccal mucosa, palate and tongue
Peutz-Jeghers syndrome
Neurofibromatosis
  • Nodular neuro-fibromas
  • Macrogloassia
  • Enlargement of filiform pappillae
  • Tongue
  • Lips
  • Palate
  • Buccal mucosa
  • Gingiva
  • Floor of the mouth or the pharynx
Other manifestations
  • Cafe au lait macules
  • Freckling in the axillary or inguinal regions (Crowe´s sign)
  • Optic glioma
  • Lisch nodules (iris harmartomas)
  • Sphenoid dysplasia
  • A first-degree relative
Polyostotic fibrous dysplasia
Smoker's melanosis
  • Irregular macular hyperpigmentation of the oral mucosa.
  • Brown patches
  • Mandibular anterior gingiva in cigarette smokers
  • Buccal mucosa in pipe smokers.
  • Hard palate in those who engage in reverse smoking
  • Smoking

Vesicular/Ulcerative/Erythematous lesions
Oral lesion Differentiating feature Location Associated Condition
Hereditary Epidermolysis bullosa
  • Epidermolysis bullosa simplex
  • Autosomal dominant
  • Intradermal blistering
  • Skin lesions usually disappear without scarring
  • Pyloric atresia
  • Other congenital abnormalities of the gastrointestinal and genitourinary tract
Junctional epidermolysis bullosa
  • Autsomal recessive
  • Separation of lamina lucida at the dermo-epidermal junction
  • Involvement of oral mucosa, Alopecia and annonychia are frequent
Dystrophic epidermolysis bullosa
  • Autosomal dominant or recessive
  • Defective anchoring fibrils resulting in separation of sub-basal lamina
  • Blisters results in dystrophic lesions
  • Millium formation due to damaged hair follicles
Infections Herpes simplex virus infections
Herpes zoster
Varicella zoster
Hand foot mouth disease
Herpangina
Infectious mononuceliosis
Erosive lichen planus
Mucus membrane pemphigoid
Candidiosis
Autoimmune Pemphigus vulgaris
Bullous pemphigoid
Lupus erythmatosus
Aphthous ulcer
Erythema multiforme
Idiopathic Erythroplakia
Contact stomatitis
Medication induced stomatitis
Surface Lesions of Oral Mucosa Description Location Associated conditions Image
White lesions
  • White
  • Epithelial
  • Geographic tongue/Benign migratory glossitis
  • Unknown etiology
  • Mostly asymptomatic but rarely burning sensation
  • Decreased papillae
  • Red patches with white distinct border giving it a map like appearance
  • Diagnosis is clinical but a biopsy may be indicated
  • No treatment for asymptomatic cnditions
  • Anesthetics/antihistamines/Steroids for pain
  • Dorsal/Lateral surface of the tongue
  • Psoriasis
  • Diabetes
  • Reiter's syndrome
  • Down's syndrome
  • Pregnancy
  • Medicine such as Oral contraceptive pills, lithium carbonate
  • Asthma
  • Hairy tongue
  • Elongated filiform lingual papillae
  • Carpet-like appearance
  • Dorsum of the tongue. 25152586
  • Leukoedema
  • White sponge nevus
  • Hairy leukoplakia
  • Lichen planus
  • Nicotinic stomatitis
  • Hyperkeratosis
  • Epithelial dysplasia
  • Carcinoma in-situ
  • Squamous cell carcinoma
  • Surface debris
  • Candidiosis
  • Burn
  • Subepithelial
  • Congenital keratotic cyst
  • Scar
  • Fordyce granules
  • Pigmented
  • Localized
  • Intravascular
  • Hemangioma
  • Varix
  • Kaposi sarcoma
  • Extravasated blood
  • Hematoma
  • Ecchymosis
  • Petechiae
  • Melanocytic
  • Oral melanocytic macule
  • Nevus
  • Melanoma
  • Ephelis
  • Diffuse
  • Hereditary
  • Addison's disease
  • Heavy metal ingestion
  • Peutz-Jeghers syndrome
  • Neurofibromatosis
  • Polyostotic fibrous dysplasia
  • Pregnancy
  • Medication
  • Smoker's melanosis
Vesicular/Ulcerative/Erythematous
  • Hereditary
  • Epidermolysis bullosa
  • Viral
  • Herpes simplex
  • Herpangina
  • Hand foot and mouth disease
  • Herpes zoster
  • Infectious mononucleosis
  • Varicella
  • Autoimmune
  • Erosive lichen planus
  • Mucous memrane pemphigoid
  • Pemphigous vulgaris
  • Bullous pemphigoid
  • Lupus erythmatosus
  • Idiopathic
  • Aphthous ulcer
  • Erythema multiforme
  • Erythroplakia
  • Medication induced mucositis
  • Contact stomatitis
  • Mycotic
  • Candidiosis
Soft Tissue Lesion Description Location Asssociated conditions Treatment Image
  • Tumor/Neoplasms
  • Benign
  • Epithelial
  • Papilloma
  • Verruca vulgaris
  • Condyloma acuminatum
  • Mesenchymal
  • Fibroma
  • Peripheral ossifying fibroma
  • Leiomyoma
  • Rhabdomyoma
  • Peripheral giant cell granuloma
  • Hemangioma
  • Lymphangioma
  • Pyogenic granuloma
  • Lipoma
  • Neuroma
  • Neurofibroma
  • Schwannoma
  • Granular cell tumor
  • Congenital epulis
  • Salivary gland
  • Pleomorphic adenoma
  • Papillary cystadenoma lymphomatosum
  • Adenoid cystic carcinoma
  • Acinic cell adenocarcinoma
  • Mucoepidermoid carcinoma low grade
  • Polymorphous low grade adenocarcinoma
  • Acinic cell adenocarcinoma
  • Cyst
  • Gingival cyst of adult
  • Lymphoepithelial cyst
  • Epidermoid/dermoid cyst
  • Thyroglossal tract cyst
  • Malignant
  • Squamous cell carcinoma
  • Verrucous carcinoma
  • Lymphoma
  • Melanoma
  • Sarcoma
  • Salivary gland adenocarcinoma
  • Adenoid cystic carcinoma
  • Mucoepidermoid carcinoma
  • Polymorphous low grade adenocarcinoma
  • Acinic cell adenocarcinoma
  • Metastatic carcinoma
  • Reactive
  • Sinus track
  • Periodontal abscess
  • Mucocele
  • Fibrous hyperplasia
  • Inflammatory papillary hyperplasia
  • Necrotizing sialometaplasia
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