Sandbox leucocytosis

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Oral lesion Differentiating feature Location Associated condition
White lesions
Benign migratory glossitis[1][2][3]
  • Red patches with white distinct border
  • Map like appearance
Dorsal/Lateral surface of the tongue
Hairy tongue[4][5][6][7]
  • Elongated filliform lingual papilae
  • Carpet-like appearance
Dorsum of the tongue
Leukoedema[8][9]
  • White or whitish-gray edematous lesion
  • Diffuse or patchy
Buccal and labial oral mucosa
White sponge nevus[10][11]
  • White patches of tissue (nevi)
  • Singular or multiple
  • Thickened, velvety, sponge-like appearance
The moist lining of the oral mucosa buccal mucosa
Hairy leukoplakia[12][13]
  • White patches
    • Corrugated in appearance
    • Hairy, hair-like growths
    • Permanent
Oral lichen planus[14][15]
  • Reticular or papular lace like white lesions
  • Multiple, Painful
Nicotinic stomatitis[16][17]
  • Reddened area and slowly progresses to a white, thickened, and fissured
  • White cobblestone appearance
  • Red dot in the center
  • Cannot be wiped off
  • Painful
Smokers
Oral frictional hyperkeratosis[18][19]
  • White shaggy plaques
  • Could be easily peeled without any pain leaving normal mucosa
Fordyce granules[20][21][22][23]
  • White to yellow discrete papules,
  • 1 to 2 mm
  • Hereditary non-polyposis colorectal cancer
  • Muir-torre syndrome
Infectious oral Lesions
Disease Differentiating feautures Location Image
Herpes simplex virus infections[24][25][26] Herpetic gingivostomatitis
  • Painful ulcers covered by a yellowish pseudomembrane
  • Ulcers that may coalesce to form bigger lesions
  • Self limiting after 7 days
Keratinized and non-keratinized mucosa. Commonly seen on:
Herpes zoster[27][28][29]
  • Prodromal unilateral pain
  • Clustered small ulcers with characteristic unilateral pattern
  • Self limiting, heal within 10-14 days
Hand foot mouth disease[30][31][32]
  • Oval-shaped, pale papules with a rim of erythema
  • Small aphthae
Lesions spare the lips and gingiva, in contrast to HSV
Infectious mononucliosis[33][34] Pharyngitis
Erosive lichen planus[35][36][37]
Pseudomembranous candidiasis[38][39][40]
  • 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[41][42][43][44][45] Ohio and Mississippi river valleys
Blastomycosis[46][47][48] Mississippi, Missouri and Ohio River valleys and the Great lakes region.
Coccidiodomycosis[49][50][51][52] No specific location


Pigmented lesions
Oral lesion Differentiating feature Location Associated Condition
Physiologic[53][54]
Intravascular Hemangioma[55][56][57]
  • Red or bluish-red, slightly raised lesions
  • Rapidly during infancy and regress slowly during childhood
Kaposi sarcoma[58][59]
Extra-vascular Hematoma
Ecchymosis
Petechiae
Melanocytic Oral melanocytic macule[60][61]
  • Focal pigmented brown lesions similar to ephelides
  • Flat and mostly smaller than 1 cm
  • Characterised by a focal increase in melanin production
Oral melanoacanthoma[62][63][64]
Ephelis
  • Flat red or light brown spots
  • 3–10 mm in diameter
  • Poorly defined and may merge into large patches
Diffuse
Addison's disease[65][66]

Brown patches of

Peutz-Jeghers syndrome[67][68] Perioral
  • Freckling of the skin around lips and vermillion zone of the lips.

Intraorally

Neurofibromatosis[69][70]
Polyostotic fibrous dysplasia[71]
  • Orofacial deformity
  • Dental disorders
  • Bone pains
  • Compromised oral health
Smoker's melanosis[72][73][74]
Amalgam Tattoo[75][76]

Vesicular/Ulcerative/Erythematous lesions
Oral lesion Differentiating feature Location Associated Condition
Hereditary Epidermolysis bullosa[77][78][79][80]
  • Epidermolysis bullosa simplex
Junctional epidermolysis bullosa
Dystrophic epidermolysis bullosa
Autoimmune Pemphigus vulgaris[81][82][83]
Mucous membrane pemphigoid (Cicatricial pemphigoid)[84][85][86][84]
Lupus erythematosus[87][88][89] Classical clinical manifestation is represented by a regular:
Aphthous ulcer[90][91][92]
  • Shallow, round to oval ulcer with white or yellow pseudomembrane surrounded by erythematous halo
  • In chronic ulcer grey membrane may replace the yellow pseudomembrane
Erythema multiforme[93][94]
Sjogren's Syndrome Affects salivary and lacrimal glands
Bullous pemphigoid
Idiopathic Erythroplakia
Contact stomatitis Irritant contact stomatitis Microscopic features:

Clinical manifestations may incude

Allergic contact stomatitis
Medication induced stomatitis
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
Hypopharyngeal Cancer
  • Tobacco use.
  • Abuse of alcohol consumption
  • 7% of all cancers of head and neck
  • 1 per 100,000 individuals
  • Males are commonly affected with a hypopharyngeal cancer compared to females.
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