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2024-03-28T08:21:18Z
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https://www.wikidoc.org/index.php?title=User:Tarek_Nafee&diff=1703815
User:Tarek Nafee
2021-06-12T16:47:07Z
<p>Tarek Nafee: /* Education */</p>
<hr />
<div>__NOTOC__<br />
[[Image:Tarek.jpg|right|200px]]<br />
==Tarek Nafee, MD, MMSc.==<br />
Contact: +1-312-504-4498 <br /><br />
Email: [mailto:tarekomarnafee@gmail.com tarekomarnafee@gmail.com]<br /><br />
<br />
==Current Positions==<br />
Associate Editor-in-Chief, WikiDoc.org<br><br />
Postdoctoral Research Fellow, PERFUSE Study Group, Beth Israel Deaconess Medical Center, Harvard Medical School<br><br />
Visiting Lecturer, PPCR Program, Harvard T.H. Chan School of Public Health<br><br />
<br />
==Professional Background==<br />
Dr. Tarek Nafee is a postdoctoral research fellow of cardiovascular medicine at the PERFUSE Study Group at Beth Israel Deaconess Medical Center. He received his BSc. in Biomedical Sciences from the University of Waterloo, Canada after which he worked for four years in the CRO industry on Phase I and Phase II multinational clinical trials. Dr. Nafee received his M.D. in 2016 from the ASU College of Medicine in St. Vincent & The Grenadines. Dr. Nafee is currently a Resident Physician at Roger Williams medical center and an Associate editor-in-chief at ''Wikidoc.org.''<br />
<br />
==Education==<br />
Present - Resident Physician, Roger Williams Medical Center, Providence, RI<br />
<br />
2019 - MMSc., Clinical Investigation, Harvard Medical School, Boston, MA<br><br />
2016 -M.D., All Saints University College of Medicine, Saint Vincent & The Grenadines<br><br />
2008 - BSc., Honors Biomedical Sciences, Minor in Chemistry - University of Waterloo, Canada<br />
<br />
==Pages Authored==<br />
{{MultiCol}}<br />
*[[Orbital cellulitis]]<br />
*[[Uveitis]]<br />
*[[Sexually transmitted diseases]]<br />
*[[Syphilis]]<br />
*[[HIV]]<br />
*[[Zika virus infection]]<br />
*[[Stroke]]<br />
*[[Cholera]]<br />
*[[Diphtheria]]<br />
*[[Lipoprotein disorders]]<br />
*[[Hyperlipoproteinemia]]<br />
*[[Hypolipoproteinemia]]<br />
*[[Acute coronary syndrome]]<br />
*[[Dual antiplatelet therapy]]<br />
*[[Intervention in left main coronary artery disease]]<br />
*[[Endophthalmitis]]<br />
*[[Blebitis]]<br />
{{ColBreak}}<br />
*[[Acute retinal necrosis]]<br />
*[[Progressive outer retinal necrosis]]<br />
*[[Seborrheic dermatitis]]<br />
*[[Otitis externa]]<br />
*[[Sinusitis]]<br />
*[[Human papillomavirus]]<br />
*[[Percutaneous coronary intervention]]<br />
*[[Coronary artery bypass surgery]]<br />
*[[ST elevation myocardial infarction]]<br />
*[[Unstable angina]]<br />
*[[Acute pancreatitis]]<br />
*[[Valvular heart disease]]<br />
*[[Diabetes mellitus]]<br />
*[[Transcatheter aortic valve replacement]]<br />
*[[Complement mediated glomerular disorders]]<br />
*[[C4 glomerulopathy]]<br />
*[[FSGS]]<br />
{{ColBreak}}<br />
*[[PAN]]<br />
*[[Granulomatosis with polyangiitis]]<br />
*[[Breast pump]]<br />
*[[Ulcerative colitis]]<br />
*[[Crohn's disease]]<br />
*[[Botulism]]<br />
*[[Ebola]]<br />
{{EndMultiCol}}</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Coronary_heart_disease_risk_factors&diff=1554761
Coronary heart disease risk factors
2019-02-27T17:44:40Z
<p>Tarek Nafee: /* Complete List of Cardiac Risk Factors */</p>
<hr />
<div>__NOTOC__<br />
{{Coronary heart disease}}<br />
{{CMG}}<br />
<br />
{{SK}} CAD risk factors; risk factors for CAD<br />
<br />
==Overview==<br />
There are many risk factors and risk equivalents associated with coronary heart disease. Risk factors include [[cigarette smoking]], [[hypertension]], a family history of premature coronary artery disease, high [[LDL]] cholesterol, low [[HDL]] cholesterol, and older age. Some of these risk factors are modifiable, and are good targets for primary prevention in the health care setting.<br />
==Risk Factors==<br />
<br />
===Proposed Risk Factor Categories based on the 27th Bethesda Conference<ref name="pmid8609364">Pasternak RC, Grundy SM, Levy D, Thompson PD (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8609364 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 3. Spectrum of risk factors for coronary heart disease.] ''J Am Coll Cardiol'' 27 (5):978-90. PMID: [http://pubmed.gov/8609364 8609364]</ref>===<br />
{{cquote|<br />
'''Category I:''' Risk factors for which interventions have '''proved''' to reduce the incidence of [[coronary artery disease]] events such as [[Chronic stable angina treatment smoking cessation|cigarette smoking]], [[Chronic stable angina treatment lipid management|LDL cholesterol]], dietary modification, [[Chronic stable angina treatment blood pressure control|hypertension]] and thrombogenic factors.<br />
<br />
'''Category II:''' Risk factors for which interventions are '''likely''', based on our current pathophysiologic understanding and on epidemiologic and clinical trial evidence, to reduce the incidence of [[coronary artery disease]] events such as [[Chronic stable angina treatment diabetes control|diabetes]], [[Chronic stable angina treatment physical activity|physical inactivity]], [[Chronic stable angina treatment lipid management|HDL cholesterol]], [[Chronic stable angina treatment weight management|obesity]] and postmenopausal status.<br />
<br />
'''Category III:''' Risk factors clearly associated with an increase in [[coronary artery disease]] risk and which, if modified, '''might lower''' the incidence of [[coronary artery disease]] events such as psychosocial factors, [[Chronic stable angina treatment lipid management|triglycerides]], Lp(a), [[homocysteine]], oxidative stress and alcohol consumption.<br />
<br />
'''Category IV:''' Risk factors associated with increased risk but which cannot be modified or whose modification would be '''unlikely''' to change the incidence of [[coronary artery disease]] events such as age, gender, family history and many others.}}<br />
<br />
==Risk Equivalents in Primary Prevention==<br />
You are essentially considered to have the equivalent of coronary heart disease if you have any of the following:<br />
*[[Aortic aneurysm]]<br />
*[[Diabetes]]<br />
*[[Framingham Risk Score]] ([[FRS]]) of > 20%<br />
*[[Peripheral vascular disease]] ([[PVD]]) (defined as [[claudication]], an [[Ankle Brachial Index]] ([[ABI]]) of < 0.9)<br />
*Symptomatic [[carotid artery disease]] (defined as prior [[stroke]] or [[TIA]])<br />
<br />
<br />
==Cardiovascular Risk Factors in the Setting of Primary Prevention==<br />
* [[Cigarette smoking]]<br />
* Family history of premature [[coronary artery disease]] ([[CAD]])<br />
* High [[LDL]] (defined as LDL > 130 mg /dl)<br />
* [[Hypertension]] ( defined as a BP ≥140/90 mm Hg or if the patient is on antihypertensive drugs)<br />
* Low [[HDL]] (defined as HDL < 40 mg/dL males, < 50 mg/dL in females)<br />
* Older Age (men ≥45 years old; women ≥55 years old)<br />
<br />
==European Systematic Coronary Risk Evaluation (SCORE) system <ref name="pmid12788299">Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12788299 Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.] ''Eur Heart J'' 24 (11):987-1003. PMID: [http://pubmed.gov/12788299 12788299]</ref>==<br />
<br />
* The '''SCORE''' project, assembled a pool of datasets from 12 European cohort studies, representing 2.7 million person years of follow-up to predict any kind of fatal cardiovascular event over a ten-year period.<br />
* This system includes both non-modifiable and modifiable coronary risk factors such as:<br />
:*Age<br />
:*Gender<br />
:*[[Chronic stable angina treatment blood pressure control|Systolic blood pressure]]<br />
:*[[Chronic stable angina treatment smoking cessation|Smoking]]<br />
:*[[Chronic stable angina treatment lipid management|Total cholesterol and/or cholesterol:HDL ratio]]<br />
:to estimate a person’s total ten-year risk of cardiovascular death.<br />
* Patients with established [[coronary artery disease]], [[diabetics]] with [[microalbuminuria]], asymptomatic patients with multiple risk factors are considered high-risk for the development of fatal coronary event.<br />
:* The threshold for being at high-risk according to the SCORE system is defined as greater than or equal to 5% since it estimates the fatal events and not the composite primary end-point. This system is shown to be most helpful in the decision-making process to intensify secondary prevention strategies. Hence, the SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.<br />
<br />
== Complete List of Cardiac Risk Factors ==<br />
<br />
In alphabetical order: <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref><br />
<br />
* [[ACE]] DD genotype<br />
* Age<br />
*:* Men > 45<br />
*:* Women > 45 (early [[menopause]])<br />
*:* Women > 55 (normal onset [[menopause]])<br />
* [[Chronic Renal Failure]]<br />
* [[Cigarette smoking]]<br />
* Decreased [[apolipoprotein A1]]<br />
* Decreased serum [[folate]]<br />
* [[Diabetes Mellitus]]<br />
* [[Family history]] of premature [[coronary artery disease]]<br />
* [[HDL cholesterol]] < 40 mg/dl<br />
* [[Hyperhomocysteinemia]]<br />
* [[Hypertension]]<br />
* [[Hypertriglyceridemia]]<br />
* [[Immunosuppressive posttransplant]]<br />
* Increased [[apolipoprotein B]]<br />
* Increased [[C-reactive protein]]<br />
* Increased [[Fibrinogen|fibrinogen]]<br />
* [[Infection]]s<br />
* [[Insulin resistance]] syndrome<br />
* Lack of supportive primary relationship<br />
* [[LDL cholesterol]] > 130 mg/dl <br />
* [[Low birth weight]]<br />
* [[Metabolic syndrome]]<br />
* [[Obesity]]<br />
* [[Oral contraceptive]] use<br />
* [[Sedentary living]]<br />
* [[Syndrome X]]<br />
* Type A personality<br />
<br />
==2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non -ST-Elevation Myocardial Infarction (DO NOT EDIT)<ref name="pmid21444888">{{cite journal| author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE et al.| title=2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 123 | issue= 18 | pages= e426-579 | pmid=21444888 | doi=10.1161/CIR.0b013e318212bb8b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21444888 }} </ref>==<br />
===Identification of Patients at Risk (DO NOT EDIT)<ref name="pmid21444888">{{cite journal| author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE et al.| title=2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 123 | issue= 18 | pages= e426-579 | pmid=21444888 | doi=10.1161/CIR.0b013e318212bb8b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21444888 }} </ref>===<br />
{|class="wikitable"<br />
|-<br />
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]<br />
|-<br />
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Primary care providers should evaluate the presence and status of control of major risk factors for [[CHD]] for all patients at regular intervals (approximately every 3 to 5 years). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki><br />
|-<br />
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Ten-year risk (National Cholesterol Education Program [NCEP] global risk) of developing symptomatic [[CHD]] should be calculated for all patients who have 2 or more major risk factors to assess the need for primary prevention strategies.<ref name="pmid15249516">{{cite journal| author=Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB et al.| title=Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. | journal=Circulation | year= 2004 | volume= 110 | issue= 2 | pages= 227-39 | pmid=15249516 | doi=10.1161/01.CIR.0000133317.49796.0E | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15249516 }} </ref><ref name="pmid12485966">{{cite journal| author=National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)| title=Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. | journal=Circulation | year= 2002 | volume= 106 | issue= 25 | pages= 3143-421 | pmid=12485966 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12485966 }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki><br />
|-<br />
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Patients with established [[CHD]] should be identified for secondary prevention efforts, and patients with a CHD risk equivalent (e.g., [[atherosclerosis]] in other [[vascular bed]]s, [[diabetes mellitus]], [[chronic kidney disease]], or 10-year risk greater than 20% as calculated by Framingham equations) should receive equally intensive risk factor intervention as those with clinically apparent CHD. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki><br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
[[Category:Disease]]<br />
[[Category:Cardiology]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1547102
Oral cancer differential diagnosis
2019-02-07T16:26:09Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Oral_cancer]]<br />
{{CMG}};{{AE}}{{DAMI}} <br />
<br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1547100
Oral cancer differential diagnosis
2019-02-07T16:25:21Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
[[Image:Home_logo1.png|align=right|100px|link=https://www.wikidoc.org/index.php/Oral_cancer]]<br />
{{CMG}};{{AE}}{{DAMI}} <br />
<br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1547099
Oral cancer differential diagnosis
2019-02-07T16:24:33Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
[[Image:Home_logo1.png|align=left|link=https://www.wikidoc.org/index.php/Oral_cancer]]<br />
{{CMG}};{{AE}}{{DAMI}} <br />
<br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=File:Home_logo1.png&diff=1547096
File:Home logo1.png
2019-02-07T16:24:02Z
<p>Tarek Nafee: </p>
<hr />
<div></div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1547089
Oral cancer differential diagnosis
2019-02-07T16:16:31Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| class="infobox bordered" style="width: 15em; text-align: center; font-size: 90%; background:AliceBlue"<br />
|-<br />
| colspan="1" style="text-align:center; background:DarkGray" |<br />
|- bgcolor="LightSkyBlue"<br />
! align="center" style="color: #FFFFFF;" + |[[Image:Home logo.png|50px|link=https://www.wikidoc.org/index.php/Oral_cancer]]<br><big><big>[[Oral cancer|Return to Homepage]]</big></big><br />
|- <br />
|}<br />
{{CMG}};{{AE}}{{DAMI}} <br />
<br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1547086
Oral cancer differential diagnosis
2019-02-07T16:15:50Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| class="infobox bordered" style="width: 15em; text-align: center; font-size: 90%; background:AliceBlue"<br />
|-<br />
| colspan="1" style="text-align:center; background:DarkGray" |<br />
|- bgcolor="LightSkyBlue"<br />
! align="center" style="color: #FFFFFF;" + |[[Image:Home logo.png|50px|link=https://www.wikidoc.org/index.php/Oral_cancer]]<big><big>[[Oral cancer|Return to Homepage]]</big></big><br />
|- <br />
|}<br />
{{CMG}};{{AE}}{{DAMI}} <br />
<br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1547083
Oral cancer differential diagnosis
2019-02-07T16:14:17Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| class="infobox bordered" style="width: 15em; text-align: center; font-size: 90%; background:AliceBlue"<br />
|-<br />
| colspan="1" style="text-align:center; background:DarkGray" |<br />
|- bgcolor="LightSkyBlue"<br />
! align="center" style="color: #FFFFFF;" + |[[Image:Home logo.png|20px]]<big><big>[[Oral cancer|Return to Homepage]]</big></big><br />
|- <br />
|}<br />
{{CMG}};{{AE}}{{DAMI}} <br />
<br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1547082
Oral cancer differential diagnosis
2019-02-07T16:13:41Z
<p>Tarek Nafee: </p>
<hr />
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{{CMG}};{{AE}}{{DAMI}} <br />
<br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1547080
Oral cancer differential diagnosis
2019-02-07T16:12:47Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
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|- bgcolor="LightSkyBlue"<br />
! align="center" style="color: #FFFFFF;" + |[[Image:Home logo.png]]<big><big><br />
[[Oral cancer|Return to Homepage]]</big></big><br />
|- <br />
|}<br />
{{CMG}};{{AE}}{{DAMI}} <br />
<br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=File:Home_logo.png&diff=1547077
File:Home logo.png
2019-02-07T16:11:29Z
<p>Tarek Nafee: Tarek Nafee uploaded a new version of File:Home logo.png</p>
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Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1546658
Oral cancer differential diagnosis
2019-02-06T21:17:47Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| class="infobox bordered" style="width: 15em; text-align: center; font-size: 90%; background:AliceBlue"<br />
|-<br />
| colspan="1" style="text-align:center; background:DarkGray" |<br />
|- bgcolor="LightSkyBlue"<br />
! align="center" style="color: #FFFFFF;" + |<big><big><br />
[[Oral cancer|Return to Homepage]]</big></big><br />
|- <br />
|}<br />
{{CMG}};{{AE}}{{DAMI}} <br />
<br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1546656
Oral cancer differential diagnosis
2019-02-06T21:17:15Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{{CMG}};{{AE}}{{DAMI}} <br />
<br />
{| class="infobox bordered" style="width: 15em; text-align: center; font-size: 90%; background:AliceBlue"<br />
|-<br />
| colspan="1" style="text-align:center; background:DarkGray" |<br />
|- bgcolor="LightSkyBlue"<br />
! align="center" style="color: #FFFFFF;" + |<big><big><br />
[[Oral cancer|Return to Homepage]]</big></big><br />
|- <br />
|}<br />
<br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1546654
Oral cancer differential diagnosis
2019-02-06T21:16:37Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
<br />
{| class="infobox bordered" style="width: 15em; text-align: center; font-size: 90%; background:AliceBlue"<br />
|-<br />
| colspan="1" style="text-align:center; background:DarkGray" |<br />
|- bgcolor="LightSkyBlue"<br />
! align="center" style="color: #FFFFFF;" + |<big><big><br />
[[Oral cancer|Return to Homepage]]</big></big><br />
|- <br />
|}<br />
<br />
{{CMG}};{{AE}}{{DAMI}} <br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1546648
Oral cancer differential diagnosis
2019-02-06T21:12:05Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
<br />
{| class="infobox bordered" style="width: 15em; text-align: center; font-size: 90%; background:AliceBlue"<br />
|-<br />
| colspan="1" style="text-align:center; background:DarkGray" |<br />
|- bgcolor="LightSkyBlue"<br />
! align="center" style="color: #FFFFFF;" + |<big><big><br />
[[Oral cancer|Return to Homepage]]</big></big><br />
|- <br />
!<br />
|}<br />
<br />
{{CMG}};{{AE}}{{DAMI}} <br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1546646
Oral cancer differential diagnosis
2019-02-06T21:10:43Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
<br />
{| class="infobox bordered" style="width: 15em; text-align: left; font-size: 90%; background:AliceBlue"<br />
|-<br />
| colspan="1" style="text-align:center; background:DarkGray" |<br />
|- bgcolor="LightSkyBlue"<br />
! align="center" style="color: #FFFFFF;" + |<big><big><br />
[[Oral cancer|Return to Homepage]]</big></big><br />
|- <br />
!<br />
|}<br />
<br />
{{Home|Oral cancer}}<br />
<br />
{{CMG}};{{AE}}{{DAMI}} <br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1546645
Oral cancer differential diagnosis
2019-02-06T21:10:01Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
<br />
{| class="infobox bordered" style="width: 15em; text-align: left; font-size: 90%; background:AliceBlue"<br />
|-<br />
| colspan="1" style="text-align:center; background:DarkGray" |<br />
|- bgcolor="LightSkyBlue"<br />
! align="center" style="color: #FFFFFF;" + |<big><br />
[[Oral cancer|Return to Homepage]]</big><br />
|- <br />
!<br />
|}<br />
<br />
{{Home|Oral cancer}}<br />
<br />
{{CMG}};{{AE}}{{DAMI}} <br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Template:Neck_of_femur_fracture&diff=1546453
Template:Neck of femur fracture
2019-02-06T18:32:15Z
<p>Tarek Nafee: Created page with "{| class="infobox bordered" style="width: 15em; text-align: left; font-size: 90%; background:AliceBlue" |- | colspan="1" style="text-align:center; background:DarkGray" | '''N..."</p>
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Tarek Nafee
https://www.wikidoc.org/index.php?title=Neck_of_femur_fracture&diff=1546449
Neck of femur fracture
2019-02-06T18:30:10Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| align="right"<br />
|<br />
[[File:Xray tibial plateau.gif|300px|thumb|X ray of Knee showing Schatzker type VI tibial plateau fracture. Source: Case courtesy by: [[User:Rohan Bhimani|Dr. Rohan A. Bhimani]]]]<br />
|}<br />
<br />
{{Oral cancer}}<br />
<br />
'''For patient information, click [[Tibial plateau fracture (patient information)|here]]'''<br />
<br />
{{CMG}}; {{AE}} {{Rohan}}<br />
<br />
{{SK}} Femoral neck fracture, Intracapsular femoral neck fracture<br />
<br />
==[[Neck of femur fracture overview|Overview]]==<br />
<br />
==[[Neck of femur fracture historical perspective|Historical Perspective]]==<br />
<br />
==[[Neck of femur fracture classification|Classification]]==<br />
<br />
==[[Neck of femur fracture pathophysiology|Pathophysiology]]==<br />
<br />
==[[Neck of femur fracture causes|Causes]]==<br />
<br />
==[[Neck of femur fracture differential diagnosis|Differentiating Tibial plateau fracture from other Diseases]]==<br />
<br />
==[[Neck of femur fracture epidemiology and demographics|Epidemiology and Demographics]]==<br />
<br />
==[[Neck of femur fracture risk factors|Risk Factors]]==<br />
<br />
==[[Neck of femur fracture screening|Screening]]==<br />
<br />
==[[Neck of femur fracture natural history, complications and prognosis|Natural History, Complications and Prognosis]]==<br />
<br />
==Diagnosis==<br />
[[Neck of femur fracture diagnostic study of choice|Diagnostic study of choice]] | [[Neck of femur fracture history and symptoms|History and Symptoms]] | [[Neck of femur fracture physical examination|Physical Examination]] | [[Neck of femur fracture laboratory findings|Laboratory Findings]] | [[Neck of femur fracture electrocardiogram|Electrocardiogram]] | [[Neck of femur fracture x ray|X-Ray Findings]] | [[Neck of femur fracture echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Neck of femur fracture CT scan|CT-Scan Findings]] | [[Neck of femur fracture MRI|MRI Findings]] | [[Neck of femur fracture other imaging findings|Other Imaging Findings]] | [[Neck of femur fracture other diagnostic studies|Other Diagnostic Studies]]<br />
<br />
==Treatment==<br />
[[Neck of femur fracture medical therapy|Medical Therapy]] | [[Neck of femur fracture interventions|Interventions]] | [[Neck of femur fracture surgery|Surgery]] | [[Neck of femur fracture primary prevention|Primary Prevention]] | [[Neck of femur fracture secondary prevention|Secondary Prevention]] | [[Neck of femur fracture cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Neck of femur fracture future or investigational therapies|Future or Investigational Therapies]]<br />
<br />
==Case Studies==<br />
[[Neck of femur fracture case study one|Case #1]]<br />
<br />
[[Category: Orthopedics]]<br />
[[Category: Bone Fractures]]<br />
[[Category: Fractures]]<br />
[[Category: Emergency Medicine]]<br />
[[Category: Up-To-Date]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1546445
Oral cancer differential diagnosis
2019-02-06T18:26:07Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
<br />
{| class="infobox bordered" style="width: 15em; text-align: left; font-size: 90%; background:AliceBlue"<br />
|-<br />
| colspan="1" style="text-align:center; background:DarkGray" |<br />
|- bgcolor="LightSkyBlue"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |<br />
[[Oral cancer|Return to Homepage]]<br />
|- <br />
!<br />
|}<br />
<br />
{{Home|Oral cancer}}<br />
<br />
{{CMG}};{{AE}}{{DAMI}} <br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Oral_cancer_differential_diagnosis&diff=1546442
Oral cancer differential diagnosis
2019-02-06T18:24:25Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
<br />
{| class="infobox bordered" style="width: 15em; text-align: left; font-size: 90%; background:AliceBlue"<br />
|-<br />
| colspan="1" style="text-align:center; background:DarkGray" |<br />
|- bgcolor="LightSkyBlue"<br />
!<br />
[[Home|Oral cancer]]<br />
|- <br />
!<br />
|}<br />
<br />
{{Home|Oral cancer}}<br />
<br />
{{CMG}};{{AE}}{{DAMI}} <br />
==Overview==<br />
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another. <br />
==Oral cancer differential diagnosis==<br />
The table below outlines the different types of tumors/cancers present in the oral cavity and oropharynx and how they can be differentiated from one another.<br />
{| class="wikitable"<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization<br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features <br />
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures<br />
|-<br />
|[[Squamous cell carcinoma]]<br />
* Basaloid squamous cell carcinoma<br />
* Papillary squamous cell carcinoma<br />
* Spindle cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* Acantholytic squamous cell carcinoma<br />
* [[Adenosquamous carcinoma]]<br />
<br />
|[[Verrucous carcinoma]]<br />
|8051/3<br />
|<br />
* Older males<br />
* 5th and 6th decades of life<br />
* Males are affected more often than females<br />
|<br />
* [[Tobacco smoking]] and [[alcohol]]<br />
* Chronic smokeless tobacco<br />
* [[HPV|HPV 16]] and 18<br />
|<br />
* Lip SCC arise almost exclusively on the lower lip<br />
* [[Buccal mucosa]]<br />
* Upper and lower [[gingiva]]<br />
<br />
* [[Hard palate]]<br />
* Anterior two-thirds of the [[tongue]], including dorsal, ventral and lateral surfaces, and the floor of mouth<br />
|<br />
* Often asymptomatic or may present with vague symptoms and minimal physical finding<br />
|Biopsy shows:<br />
Thickened club-shaped<br />
<br />
[[papillae]] and blunt stromal invaginations<br />
<br />
of well-differentiated [[squamous epithelium]] with marked [[keratinization]]<br />
|-<br />
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]<br />
|<br />
|8082/3<br />
|0.8-2% of all oral or oropharyngeal cancers<br />
|[[EBV]]<br />
|<br />
* [[Tonsil]] and [[tongue]](90%)<br />
* [[Palate]] and [[buccal mucosa]](others)<br />
|<br />
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. <br />
<br />
* Some tumors can be bilateral<br />
|Biopsy chows:<br />
* Syncytial sheets and clusters of [[Carcinoma|carcinoma cells]] with [[Vesicular|vesicular nuclei]]<br />
<br />
* Prominent [[nucleoli]] and ill-defined cell borders<br />
* A rich [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present<br />
|-<br />
|[[Epithelial cells|Epithelial precursor]] lesions<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|[[Smoking]]<br />
|Seen in the entire [[digestive tract]]<br />
|<br />
* White patches ([[leukoplakia]])<br />
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]]) <br />
* Mixed red and white lesions<br />
|Biopsy shows:<br />
* [[Hyperplasia]]<br />
* [[Dysplasia]], / squamous intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]<br />
* [[Carcinoma in situ|Carcinoma in-situ]]<br />
|-<br />
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Average age at diagnosis is 62 years <br />
* Women are more commonly afflicted (ratio, 4:1)<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]] in women<br />
* [[Tongue]] in men.<br />
|An aggressive form of [[oral leukoplakia]] with considerable morbidity and<br />
<br />
strong predilection to [[malignant transformation]]<br />
|Biopsy shows:<br />
* Extensive, thick, white plaques<br />
* [[Hyperplasia]] and dense [[hyperkeratosis]]<br />
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]<br />
|-<br />
| rowspan="3" |[[Papillomas]]<br />
|[[Squamous cell papilloma]] and<br />
[[verruca vulgaris]]<br />
|<br />
|<br />
* Common in children and in adults in the 3rd to 5th decades<br />
<br />
* Almost equal sex incidence with a slight male predominance<br />
|[[HPV]] subtype<br />
2,4,6,7,10,40.<br />
|Any oral site may be affected mostly:<br />
* [[Hard palate|Hard]] and [[soft palate]]<br />
<br />
* [[Labial]] [[Mucous membrane|mucosa]]<br />
* [[Tongue]]<br />
* [[Gingiva]]<br />
|Soft, [[Pedunculated|pedunculated lesions]] formed by a cluster of finger-like fronds or a [[sessile]], dome-shaped lesion with a [[nodular]], [[papillary]] or [[Verrucous carcinoma|verrucous]] surface<br />
|Biopsy shows:<br />
* Exophytic and comprise folds of [[hyperplastic]] [[stratified epithelium]] <br />
* Cluster of finger-like projections <br />
|-<br />
|[[Condyloma acuminatum]]<br />
|<br />
|2nd and 5th decade with a peak in teenagers and young adults<br />
|<br />
* [[HPV]], most commonly types 6,11,16 and 18<br />
|<br />
* [[Labial]] [[mucosa]]<br />
* [[Tongue]] <br />
* [[Palate]]<br />
|<br />
* Painless, rounded, dome-shaped exophytic [[nodules]] <br />
<br />
* 15 mm in diameter<br />
<br />
* Have a broad base and a [[nodular]] or mulberry-like surface that is slightly red, pink or of normal [[Mucous membrane|mucosal]] color.<br />
<br />
* Lesions may be multiple and are then usually clustered<br />
|Biopsy shows:<br />
<br />
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster<br />
|-<br />
|[[Focal epithelial hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|[[Disease]] of children, adolescents and young adults<br />
|[[HPV]]<br />
<br />
13 and 32<br />
|<br />
* All areas of the [[oral cavity]]<br />
* [[Labia]] <br />
* [[Buccal mucosa]]<br />
* [[Tongue]]<br />
|<br />
* Multiple asymptomatic [[lesions]]<br />
<br />
* Soft rounded or flat plaque-like [[sessile]] swelling. <br />
* Usually pink or white in color<br />
* 2-10mm in diameter<br />
|Biopsy shows:<br />
* Rounded [[sessile]] swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis<br />
<br />
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually present <br />
<br />
* “Mitosoid bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure<br />
|-<br />
|[[Granular cell tumor]]<br />
|<nowiki>---</nowiki><br />
|9580/0<br />
|<br />
* Arise in all age groups, with a peak between 40 and 60 years<br />
* Females are affected more often than males with an M/F ratio of 2:1<br />
|No etiological factors are known<br />
|<br />
* [[Tongue]] is the most common single site<br />
* [[Buccal mucosa]] <br />
* Floor of oral cavity<br />
* [[Palate]]<br />
* [[Salivary gland]]<br />
|<br />
* Lesion presents as a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]] <br />
* 1-2 cm in diameter with a firm texture. <br />
<br />
* The overlying [[epithelium]] is of normal color or may be slightly pale<br />
|Biopsy shows:<br />
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]<br />
|-<br />
|[[Keratoacanthoma]]<br />
|<nowiki>---</nowiki><br />
|8071/1<br />
|<br />
* Occurs more often in<br />
whites<br />
* Twice as frequent in<br />
men as in women<br />
|Associated with uptake of [[carcinogens]](e.g. via particular [[smoking]] habits)<br />
|<br />
* [[Skin]] of the face,including the [[lips]]<br />
* [[Mucocutaneous|Mucocutaneous linings]] may also be involved<br />
|<br />
* [[Verrucous carcinoma|Verrucous]], speckled or [[Ulcerated lesion|ulcerated lesions]]<br />
<br />
* Deep projections, which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone<br />
|Biopsy shows:<br />
* [[Verrucous carcinoma|Verrucous]] surface, [[keratinized]] clefts and penetrating squamous [[Rete pegs|rete processes]]<br />
* Minimal [[atypia]] seen<br />
|-<br />
|[[Papillary|Papillary hyperplasia]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Affects all age groups<br />
|Associated with:<br />
* Wearing ill-fitting [[dentures]]<br />
* [[Xerostomia]]<br />
* Individuals with a [[high arched palate]]<br />
* [[HIV AIDS|HIV infection]]<br />
|[[Palate]]<br />
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]<br />
|Biopsy shows:<br />
* Parakeratinisation or less frequently orthokeratinisation<br />
|-<br />
|Median rhomboid glossitis<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|Associated with chronic [[Candidal|candidal infection]]<br />
|Dorsum of the tongue at the junction of the anterior two thirds<br />
and posterior third<br />
|Forms a patch of papillary atrophy in the region of the<br />
embryological [[Foramen cecum|foramen caecum]]<br />
|Biopsy shows:<br />
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]<br />
<br />
* Areas of pseudoepitheliomatous [[hyperplasia]]<br />
* [[Atypia]] may be present<br />
|-<br />
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]<br />
|[[Acinic cell carcinoma]]<br />
|8550/3<br />
|<br />
* 2-6.5% of all intraoral [[Salivary gland tumor|salivary gland tumors]]<br />
* Age range from 11-77 years, with a mean of 45 years<br />
* Male to female ratio of 1.5:1<br />
|Unknown<br />
|<br />
* [[Buccal mucosa]]<br />
* [[Upper lip]] and <br />
* [[Palate]]<br />
|[[Tumors]] usually<br />
<br />
form non-descript swellings<br />
|Biopsy shows:<br />
* Solid sheets of [[epithelium]] with secretory material<br />
* Ductal differentiation in [[tumors]]<br />
|-<br />
|[[Mucoepidermoid carcinoma]]<br />
|8430/3<br />
|<br />
* 9.5-23% of all minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] (most common site) <br />
* [[Buccal mucosa]]<br />
* [[Lips]]: upper>lower<br />
* Floor of [[oral cavity]]<br />
* Retromolar pad<br />
|<br />
* Asymptomatic<br />
* Bluish, domed swellings that resemble mucoceles or [[Hemangioma|haemangiomas]]<br />
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]<br />
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma<br />
|-<br />
|Adenoid cystic carcinoma<br />
|8200/3<br />
|<br />
* 42.5% of minor gland tumors<br />
* <br />
|Unknown<br />
|<br />
* [[Tongue]]<br />
* [[Tonsil]] <br />
* [[Oropharynx]]<br />
* [[Cheek]]<br />
* [[Lips]]<br />
* Retromolar pad and [[gingiva]]<br />
|<br />
* Slow growing [[Submucosa|submucosal]] masses and [[ulceration]] may be seen, particularly in the [[palate]]<br />
* [[Pain]], or evidence of [[Nerve|nerve involvement,]] is usually only present in advanced tumors<br />
|<br />
Predominantly solid variant shows peri- and intraneural invasion<br />
<br />
|-<br />
|Epithelial-myoepithelial<br />
carcinoma <br />
|8562/3<br />
|<nowiki>---</nowiki><br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Clear cell tumor|Clear cell carcinoma,]]<br />
NOS<br />
|8310/3<br />
|<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Basal cell carcinoma|Basal cell]]<br />
[[Basal cell carcinoma|adenocarcinoma]]<br />
|8147/3<br />
|Rare in minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Buccal mucosa]]<br />
* [[Lip]]<br />
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal masses]]<br />
|Microscopically similar to [[Basal cell carcinoma|basal]]<br />
<br />
[[Basal cell carcinoma|cell adenocarcinomas]] of the major gland<br />
|-<br />
|[[Cystadenocarcinoma]] <br />
|8450/3<br />
|32% developed in the minor glands<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]]<br />
* [[Buccal mucosa]]<br />
* [[Tongue]] and retromolar regions<br />
|Slow growing and painless but<br />
<br />
some [[palatal]] [[tumors]] may erode the<br />
<br />
underlying bone causing sinonasal complex<br />
|<nowiki>---</nowiki><br />
|-<br />
|Salivary duct carcinoma<br />
|8500/3<br />
|<br />
* Rare in minor salivary glands<br />
* Age range was 23-80 years (mean 56 years)<br />
|Unknown<br />
|<br />
* [[Palate]] (65%)<br />
* [[Buccal mucosa]] and [[vestibule]] (19%)<br />
<br />
* [[Tongue]] (8%)<br />
* Retromolar pad (4%) and [[upper lip]] (4%)<br />
|[[Tumor|Tumors]] formed painless swellings but many in the [[palate]] can be painful and [[Ulcerated lesion|ulcerated]] or fungated with [[Metastasis|metastases]] to [[Lymph nodes|regional lymph nodes]]<br />
|The range of<br />
<br />
microscopical appearances is similar<br />
<br />
to that seen in the major glands<br />
|-<br />
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]<br />
|[[Pleomorphic adenoma]]<br />
|8940/0<br />
|40-70% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]]<br />
* [[Lips]] and<br />
* [[Buccal mucosa]]<br />
|Painless, slow growing, [[Submucosa|submucosal]] masses, but when<br />
<br />
traumatized may [[bleed]] or [[Ulcer|ulcerate]]<br />
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell<br />
|-<br />
|Myoepithelioma<br />
|8982/0<br />
|42% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Palate]] of younger individuals<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|Basal cell adenoma<br />
|8147/0<br />
|20% of minor gland tumors<br />
|Unknown<br />
|<br />
* [[Upper lip]]<br />
* [[Buccal mucosa]]<br />
|<nowiki>---</nowiki><br />
|They are histologically<br />
<br />
similar to those in major glands.<br />
|-<br />
|[[Cystadenoma]]<br />
|8149/0<br />
|7% of benign minor gland tumors<br />
|Uknown<br />
|<br />
* [[Lips]]<br />
* [[Cheek]]<br />
* [[Palate]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|-<br />
|[[Kaposi's sarcoma|Kaposi sarcoma]]<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Classic (elderly men of Mediterranean/EastEuropean descent)<br />
* [[Endemic]] ( middle-aged adults and children in Equatorial Africa who are not [[HIV infected adolescents|HIV infected]])<br />
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)<br />
* [[AIDS associated Kaposi sarcoma|AIDS associated]] ([[HIV-1 protease|HIV-1]] infected individuals)<br />
|<br />
* [[HHV-8]]<br />
* [[Immunology|Immunologic]], [[genetic]], and environmental factors<br />
|<br />
* [[Skin]] ( most common)<br />
* [[Mucous membrane|Mucosal membranes]] such as [[oral mucosa]], [[lymph nodes]] and [[Visceral organ|visceral organs]]<br />
|<br />
* Purplish, reddish blue or dark brown [[macules]]<br />
* [[Plaques]] and [[nodules]] that may [[Ulcerated lesion|ulcerate]]<br />
|Biopsy of all 4 types show:<br />
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]<br />
|-<br />
|[[Lymphangioma]]<br />
|<nowiki>---</nowiki><br />
|9170/0<br />
|<br />
* [[Pediatric Oncology Group|Pediatric lesions]]<br />
* Present at birth or during the first years of life<br />
<br />
* Appear mostly in the head and neck area but may be found in any other part of the body<br />
|<br />
* [[Developmental abnormality|Developmental malformation]]<br />
* [[Genetic disorder|Genetic abnormalities]]<br />
* [[Turner's syndrome]]<br />
|[[Tongue]]<br />
|<br />
* Circumscribed painless swelling<br />
* Soft and fluctuant on palpation<br />
* Irregular nodularity of the dorsum of the [[tongue]]<br />
|Biopsy shows:<br />
* Thin-walled, dilated [[lymphatic vessels]] of different size, which are lined by a flattened [[endothelium]]<br />
|-<br />
|Ectomesenchymal chondromyxoid<br />
tumour of the anterior tongue<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Age range varies from 9-78 years <br />
* No distinct sex predilection.<br />
|Unknown<br />
|<nowiki>---</nowiki><br />
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue<br />
|Biopsy shows:<br />
* Round, cup-shaped, [[fusiform]], or polygonal cells with uniform small [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]<br />
* Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation <br />
|-<br />
|Focal oral mucinosis (FOM)<br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* The lesion affects all ages<br />
* Rare in children <br />
* There is no distinct sex predilection.<br />
|Unknown<br />
|<br />
* [[Gingiva]]( most common site)<br />
* [[Palate]]<br />
* Cheek [[mucosa]] and<br />
* [[Tongue]]<br />
|Asymptomatic fibrous or cystic-like lesion<br />
|Histopathology is characterized by:<br />
* Well-circumscribed area of [[myxomatous]] tissue<br />
<br />
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]<br />
<br />
* Absent or sparse [[reticular fibers]]<br />
<br />
* [[Mucinous]] material shows alcianophilia at pH 2.5<br />
|-<br />
|Congenital granular cell epuli <br />
|<nowiki>---</nowiki><br />
|<nowiki>---</nowiki><br />
|<br />
* Affects newborns<br />
* Females are affected ten times more often than males<br />
|Etiology uncertain<br />
|<br />
* [[Maxilla]]<br />
<br />
* [[Mandible]]<br />
|[[Solitary]], somewhat [[pedunculated]] fibroma-like lesion attached to the alveolar<br />
ridge near the midline<br />
|<br />
* Ultrasound for prenatal diagnosis<br />
* Immuno histochemically, the tumor cells are positive for [[vimentin]] and neuron specific [[enolase]]<br />
* No reactivity with [[cytokeratin]], [[CEA]], [[desmin]], hormone receptors or [[S-100]]<br />
|-<br />
| rowspan="5" |Hematolymphoid tumors<br />
|[[Non-Hodgkin lymphoma]]<br />
|<nowiki>---</nowiki><br />
|Second most common cancer of the [[oral cavity]]<br />
<br />
|<br />
* There is no known etiology in most patients<br />
<br />
* Underlying [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]]) <br />
* Strong association with [[Epstein Barr virus|EBV]]<br />
|<br />
* [[Palate]]<br />
<br />
* [[Tongue]]<br />
<br />
* Floor of mouth<br />
* [[Gingiva]]<br />
* [[Buccal mucosa]]<br />
* [[Lips]]<br />
* [[Palatine tonsils]]<br />
* [[Lingual tonsils]] or<br />
* [[Oropharynx]]<br />
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:<br />
* [[Ulcer]]<br />
* [[Swelling]]<br />
* [[Discolored tongue|Discoloration]]<br />
* [[Pain]]<br />
* [[Paresthesia|Paraesthesia]]<br />
* [[Anesthesia|Anaesthesia]], or<br />
* Loose teeth<br />
|<br />
Biopsy shows:<br />
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.<br />
<br />
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].<br />
* Large cells with round or multilobated nuclei<br />
|-<br />
|[[Langerhans cell histiocytosis]]<br />
|9751/1<br />
|<nowiki>---</nowiki><br />
|Associated with:<br />
* [[Eosinophilic granuloma|Eosinophilic granulomas]]<br />
* Multifocal multisystem disease<br />
|<br />
* Jaw bone<br />
* Intraoral soft tissues <br />
* [[Gingiva]]<br />
<br />
* [[Palate]]<br />
* Floor of mouth<br />
* [[Buccal mucosa]]<br />
and <br />
* [[Tonsil cancer|Tonsil]] <br />
|Common oral symptoms<br />
<br />
include:<br />
* [[Swelling]]<br />
* [[Pain]]<br />
* [[Gingivitis]]<br />
* Loose teeth and<br />
* [[Ulceration]]<br />
|Biopsy shows ovoid [[Langerhans cells]]<br />
<br />
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]<br />
|-<br />
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]<br />
|<br />
|<nowiki>---</nowiki><br />
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]<br />
|<br />
* [[Waldeyer's ring|Waldeyer ring,]] particularly the [[palatine tonsil]]<br />
* [[Oropharynx]] <br />
* Alveolar crest of [[mandible]]<br />
* [[Maxillary bone|Maxillary gingiva]]<br />
|Most patients present with localized disease (stage I/II), with <br />
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without enlarged [[cervical lymph nodes]]<br />
|<nowiki>---</nowiki><br />
|-<br />
|Extramedullary myeloid<br />
sarcoma<br />
|9930/3<br />
|<nowiki>---</nowiki><br />
|History of [[Acute myeloid leukemia|acute myeloid leukaemia]],<br />
<br />
predominantly in the [[Monocyte|monocytic]] or myelomonocytic subtypes<br />
|<br />
* [[Palate]]<br />
<br />
* [[Gingiva]]<br />
|Isolated tumor-forming intraoral mass<br />
|Biopsy shows an Indian-file pattern of infiltration<br />
|-<br />
|[[Follicular dendritic cell]]<br />
sarcoma / tumour<br />
|9758/3<br />
|<br />
* Tumor of adulthood<br />
<br />
* Affects wide age range<br />
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]<br />
|<br />
* [[Tonsil]]<br />
* [[Palate]] or <br />
* [[Oropharynx]].<br />
|The patients usually<br />
<br />
present with a painless mass<br />
|Biopsy usually exhibits <br />
<br />
borders and comprises:<br />
* [[Fascicles]]<br />
* Whorls<br />
<br />
* [[Nodules]] <br />
<br />
* Storiform arrays or <br />
* Diffuse sheets of spindly to ovoid tumor cells sprinkled with small [[lymphocytes]]<br />
|-<br />
|Mucosal malignant melanoma<br />
|<nowiki>---</nowiki><br />
|8720/3<br />
|<br />
* 0.5% of oral malignancies<br />
* Incidence 0.02 per 100,000<br />
|No known etiological factors associated with oral melanoma<br />
|80% arise:<br />
* [[Palate]]<br />
* Maxillary alveolus or [[Gingiva|gingivae]]<br />
* Mandibular gingiva<br />
Others:<br />
* [[Buccal mucosa]]<br />
<br />
* Floor of mouth<br />
<br />
* [[Tongue]]<br />
|<br />
* Asymmetric with irregular outlines<br />
* Macular pigmentation<br />
* Nodular growth<br />
* [[Ulceration]] <br />
* [[Melanosis]]<br />
|<br />
* Biopsy:<br />
* S100 positive<br />
* Negative for cytokeratins <br />
<br />
* More specific markers include:<br />
* HMB45,<br />
<br />
* Melan-A or anti-tyrosinase<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Oral and maxillofacial surgery]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Types of cancer]]<br />
[[Category:Disease]]<br />
[[Category:Mature chapter]]<br />
<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category:Up-To-Date]]<br />
[[Category:Oncology]]<br />
[[Category:Medicine]]<br />
[[Category:Otolaryngology]]<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Differential diagnosis]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Neck_of_femur_fracture&diff=1546435
Neck of femur fracture
2019-02-06T18:18:09Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| align="right"<br />
|<br />
[[File:Xray tibial plateau.gif|300px|thumb|X ray of Knee showing Schatzker type VI tibial plateau fracture. Source: Case courtesy by: [[User:Rohan Bhimani|Dr. Rohan A. Bhimani]]]]<br />
|}<br />
<br />
{{Neck of femur fracture}}<br />
<br />
'''For patient information, click [[Tibial plateau fracture (patient information)|here]]'''<br />
<br />
{{CMG}}; {{AE}} {{Rohan}}<br />
<br />
{{SK}} Femoral neck fracture, Intracapsular femoral neck fracture<br />
<br />
==[[Neck of femur fracture overview|Overview]]==<br />
<br />
==[[Neck of femur fracture historical perspective|Historical Perspective]]==<br />
<br />
==[[Neck of femur fracture classification|Classification]]==<br />
<br />
==[[Neck of femur fracture pathophysiology|Pathophysiology]]==<br />
<br />
==[[Neck of femur fracture causes|Causes]]==<br />
<br />
==[[Neck of femur fracture differential diagnosis|Differentiating Tibial plateau fracture from other Diseases]]==<br />
<br />
==[[Neck of femur fracture epidemiology and demographics|Epidemiology and Demographics]]==<br />
<br />
==[[Neck of femur fracture risk factors|Risk Factors]]==<br />
<br />
==[[Neck of femur fracture screening|Screening]]==<br />
<br />
==[[Neck of femur fracture natural history, complications and prognosis|Natural History, Complications and Prognosis]]==<br />
<br />
==Diagnosis==<br />
[[Neck of femur fracture diagnostic study of choice|Diagnostic study of choice]] | [[Neck of femur fracture history and symptoms|History and Symptoms]] | [[Neck of femur fracture physical examination|Physical Examination]] | [[Neck of femur fracture laboratory findings|Laboratory Findings]] | [[Neck of femur fracture electrocardiogram|Electrocardiogram]] | [[Neck of femur fracture x ray|X-Ray Findings]] | [[Neck of femur fracture echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Neck of femur fracture CT scan|CT-Scan Findings]] | [[Neck of femur fracture MRI|MRI Findings]] | [[Neck of femur fracture other imaging findings|Other Imaging Findings]] | [[Neck of femur fracture other diagnostic studies|Other Diagnostic Studies]]<br />
<br />
==Treatment==<br />
[[Neck of femur fracture medical therapy|Medical Therapy]] | [[Neck of femur fracture interventions|Interventions]] | [[Neck of femur fracture surgery|Surgery]] | [[Neck of femur fracture primary prevention|Primary Prevention]] | [[Neck of femur fracture secondary prevention|Secondary Prevention]] | [[Neck of femur fracture cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Neck of femur fracture future or investigational therapies|Future or Investigational Therapies]]<br />
<br />
==Case Studies==<br />
[[Neck of femur fracture case study one|Case #1]]<br />
<br />
[[Category: Orthopedics]]<br />
[[Category: Bone Fractures]]<br />
[[Category: Fractures]]<br />
[[Category: Emergency Medicine]]<br />
[[Category: Up-To-Date]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Neck_of_femur_fracture&diff=1546431
Neck of femur fracture
2019-02-06T18:15:10Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| align="right"<br />
|<br />
[[File:Xray tibial plateau.gif|300px|thumb|X ray of Knee showing Schatzker type VI tibial plateau fracture. Source: Case courtesy by: [[User:Rohan Bhimani|Dr. Rohan A. Bhimani]]]]<br />
|}<br />
<br />
{{neck of femur fracture}}<br />
<br />
'''For patient information, click [[Tibial plateau fracture (patient information)|here]]'''<br />
<br />
{{CMG}}; {{AE}} {{Rohan}}<br />
<br />
{{SK}} Femoral neck fracture, Intracapsular femoral neck fracture<br />
<br />
==[[Neck of femur fracture overview|Overview]]==<br />
<br />
==[[Neck of femur fracture historical perspective|Historical Perspective]]==<br />
<br />
==[[Neck of femur fracture classification|Classification]]==<br />
<br />
==[[Neck of femur fracture pathophysiology|Pathophysiology]]==<br />
<br />
==[[Neck of femur fracture causes|Causes]]==<br />
<br />
==[[Neck of femur fracture differential diagnosis|Differentiating Tibial plateau fracture from other Diseases]]==<br />
<br />
==[[Neck of femur fracture epidemiology and demographics|Epidemiology and Demographics]]==<br />
<br />
==[[Neck of femur fracture risk factors|Risk Factors]]==<br />
<br />
==[[Neck of femur fracture screening|Screening]]==<br />
<br />
==[[Neck of femur fracture natural history, complications and prognosis|Natural History, Complications and Prognosis]]==<br />
<br />
==Diagnosis==<br />
[[Neck of femur fracture diagnostic study of choice|Diagnostic study of choice]] | [[Neck of femur fracture history and symptoms|History and Symptoms]] | [[Neck of femur fracture physical examination|Physical Examination]] | [[Neck of femur fracture laboratory findings|Laboratory Findings]] | [[Neck of femur fracture electrocardiogram|Electrocardiogram]] | [[Neck of femur fracture x ray|X-Ray Findings]] | [[Neck of femur fracture echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Neck of femur fracture CT scan|CT-Scan Findings]] | [[Neck of femur fracture MRI|MRI Findings]] | [[Neck of femur fracture other imaging findings|Other Imaging Findings]] | [[Neck of femur fracture other diagnostic studies|Other Diagnostic Studies]]<br />
<br />
==Treatment==<br />
[[Neck of femur fracture medical therapy|Medical Therapy]] | [[Neck of femur fracture interventions|Interventions]] | [[Neck of femur fracture surgery|Surgery]] | [[Neck of femur fracture primary prevention|Primary Prevention]] | [[Neck of femur fracture secondary prevention|Secondary Prevention]] | [[Neck of femur fracture cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Neck of femur fracture future or investigational therapies|Future or Investigational Therapies]]<br />
<br />
==Case Studies==<br />
[[Neck of femur fracture case study one|Case #1]]<br />
<br />
[[Category: Orthopedics]]<br />
[[Category: Bone Fractures]]<br />
[[Category: Fractures]]<br />
[[Category: Emergency Medicine]]<br />
[[Category: Up-To-Date]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Neck_of_femur_fracture&diff=1546429
Neck of femur fracture
2019-02-06T18:14:22Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| align="right"<br />
|<br />
[[File:Xray tibial plateau.gif|300px|thumb|X ray of Knee showing Schatzker type VI tibial plateau fracture. Source: Case courtesy by: [[User:Rohan Bhimani|Dr. Rohan A. Bhimani]]]]<br />
|}<br />
<br />
{{Neck Of Femur Fracture}}<br />
<br />
'''For patient information, click [[Tibial plateau fracture (patient information)|here]]'''<br />
<br />
{{CMG}}; {{AE}} {{Rohan}}<br />
<br />
{{SK}} Femoral neck fracture, Intracapsular femoral neck fracture<br />
<br />
==[[Neck of femur fracture overview|Overview]]==<br />
<br />
==[[Neck of femur fracture historical perspective|Historical Perspective]]==<br />
<br />
==[[Neck of femur fracture classification|Classification]]==<br />
<br />
==[[Neck of femur fracture pathophysiology|Pathophysiology]]==<br />
<br />
==[[Neck of femur fracture causes|Causes]]==<br />
<br />
==[[Neck of femur fracture differential diagnosis|Differentiating Tibial plateau fracture from other Diseases]]==<br />
<br />
==[[Neck of femur fracture epidemiology and demographics|Epidemiology and Demographics]]==<br />
<br />
==[[Neck of femur fracture risk factors|Risk Factors]]==<br />
<br />
==[[Neck of femur fracture screening|Screening]]==<br />
<br />
==[[Neck of femur fracture natural history, complications and prognosis|Natural History, Complications and Prognosis]]==<br />
<br />
==Diagnosis==<br />
[[Neck of femur fracture diagnostic study of choice|Diagnostic study of choice]] | [[Neck of femur fracture history and symptoms|History and Symptoms]] | [[Neck of femur fracture physical examination|Physical Examination]] | [[Neck of femur fracture laboratory findings|Laboratory Findings]] | [[Neck of femur fracture electrocardiogram|Electrocardiogram]] | [[Neck of femur fracture x ray|X-Ray Findings]] | [[Neck of femur fracture echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Neck of femur fracture CT scan|CT-Scan Findings]] | [[Neck of femur fracture MRI|MRI Findings]] | [[Neck of femur fracture other imaging findings|Other Imaging Findings]] | [[Neck of femur fracture other diagnostic studies|Other Diagnostic Studies]]<br />
<br />
==Treatment==<br />
[[Neck of femur fracture medical therapy|Medical Therapy]] | [[Neck of femur fracture interventions|Interventions]] | [[Neck of femur fracture surgery|Surgery]] | [[Neck of femur fracture primary prevention|Primary Prevention]] | [[Neck of femur fracture secondary prevention|Secondary Prevention]] | [[Neck of femur fracture cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Neck of femur fracture future or investigational therapies|Future or Investigational Therapies]]<br />
<br />
==Case Studies==<br />
[[Neck of femur fracture case study one|Case #1]]<br />
<br />
[[Category: Orthopedics]]<br />
[[Category: Bone Fractures]]<br />
[[Category: Fractures]]<br />
[[Category: Emergency Medicine]]<br />
[[Category: Up-To-Date]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Neck_of_femur_fracture&diff=1546427
Neck of femur fracture
2019-02-06T18:13:55Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| align="right"<br />
|<br />
[[File:Xray tibial plateau.gif|300px|thumb|X ray of Knee showing Schatzker type VI tibial plateau fracture. Source: Case courtesy by: [[User:Rohan Bhimani|Dr. Rohan A. Bhimani]]]]<br />
|}<br />
<br />
{{Neck of Femur Fracture}}<br />
<br />
'''For patient information, click [[Tibial plateau fracture (patient information)|here]]'''<br />
<br />
{{CMG}}; {{AE}} {{Rohan}}<br />
<br />
{{SK}} Femoral neck fracture, Intracapsular femoral neck fracture<br />
<br />
==[[Neck of femur fracture overview|Overview]]==<br />
<br />
==[[Neck of femur fracture historical perspective|Historical Perspective]]==<br />
<br />
==[[Neck of femur fracture classification|Classification]]==<br />
<br />
==[[Neck of femur fracture pathophysiology|Pathophysiology]]==<br />
<br />
==[[Neck of femur fracture causes|Causes]]==<br />
<br />
==[[Neck of femur fracture differential diagnosis|Differentiating Tibial plateau fracture from other Diseases]]==<br />
<br />
==[[Neck of femur fracture epidemiology and demographics|Epidemiology and Demographics]]==<br />
<br />
==[[Neck of femur fracture risk factors|Risk Factors]]==<br />
<br />
==[[Neck of femur fracture screening|Screening]]==<br />
<br />
==[[Neck of femur fracture natural history, complications and prognosis|Natural History, Complications and Prognosis]]==<br />
<br />
==Diagnosis==<br />
[[Neck of femur fracture diagnostic study of choice|Diagnostic study of choice]] | [[Neck of femur fracture history and symptoms|History and Symptoms]] | [[Neck of femur fracture physical examination|Physical Examination]] | [[Neck of femur fracture laboratory findings|Laboratory Findings]] | [[Neck of femur fracture electrocardiogram|Electrocardiogram]] | [[Neck of femur fracture x ray|X-Ray Findings]] | [[Neck of femur fracture echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Neck of femur fracture CT scan|CT-Scan Findings]] | [[Neck of femur fracture MRI|MRI Findings]] | [[Neck of femur fracture other imaging findings|Other Imaging Findings]] | [[Neck of femur fracture other diagnostic studies|Other Diagnostic Studies]]<br />
<br />
==Treatment==<br />
[[Neck of femur fracture medical therapy|Medical Therapy]] | [[Neck of femur fracture interventions|Interventions]] | [[Neck of femur fracture surgery|Surgery]] | [[Neck of femur fracture primary prevention|Primary Prevention]] | [[Neck of femur fracture secondary prevention|Secondary Prevention]] | [[Neck of femur fracture cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Neck of femur fracture future or investigational therapies|Future or Investigational Therapies]]<br />
<br />
==Case Studies==<br />
[[Neck of femur fracture case study one|Case #1]]<br />
<br />
[[Category: Orthopedics]]<br />
[[Category: Bone Fractures]]<br />
[[Category: Fractures]]<br />
[[Category: Emergency Medicine]]<br />
[[Category: Up-To-Date]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Neck_of_femur_fracture&diff=1546426
Neck of femur fracture
2019-02-06T18:12:54Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| align="right"<br />
|<br />
[[File:Xray tibial plateau.gif|300px|thumb|X ray of Knee showing Schatzker type VI tibial plateau fracture. Source: Case courtesy by: [[User:Rohan Bhimani|Dr. Rohan A. Bhimani]]]]<br />
|}<br />
<br />
{{neck of femur fracture}}<br />
<br />
'''For patient information, click [[Tibial plateau fracture (patient information)|here]]'''<br />
<br />
{{CMG}}; {{AE}} {{Rohan}}<br />
<br />
{{SK}} Femoral neck fracture, Intracapsular femoral neck fracture<br />
<br />
==[[Neck of femur fracture overview|Overview]]==<br />
<br />
==[[Neck of femur fracture historical perspective|Historical Perspective]]==<br />
<br />
==[[Neck of femur fracture classification|Classification]]==<br />
<br />
==[[Neck of femur fracture pathophysiology|Pathophysiology]]==<br />
<br />
==[[Neck of femur fracture causes|Causes]]==<br />
<br />
==[[Neck of femur fracture differential diagnosis|Differentiating Tibial plateau fracture from other Diseases]]==<br />
<br />
==[[Neck of femur fracture epidemiology and demographics|Epidemiology and Demographics]]==<br />
<br />
==[[Neck of femur fracture risk factors|Risk Factors]]==<br />
<br />
==[[Neck of femur fracture screening|Screening]]==<br />
<br />
==[[Neck of femur fracture natural history, complications and prognosis|Natural History, Complications and Prognosis]]==<br />
<br />
==Diagnosis==<br />
[[Neck of femur fracture diagnostic study of choice|Diagnostic study of choice]] | [[Neck of femur fracture history and symptoms|History and Symptoms]] | [[Neck of femur fracture physical examination|Physical Examination]] | [[Neck of femur fracture laboratory findings|Laboratory Findings]] | [[Neck of femur fracture electrocardiogram|Electrocardiogram]] | [[Neck of femur fracture x ray|X-Ray Findings]] | [[Neck of femur fracture echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Neck of femur fracture CT scan|CT-Scan Findings]] | [[Neck of femur fracture MRI|MRI Findings]] | [[Neck of femur fracture other imaging findings|Other Imaging Findings]] | [[Neck of femur fracture other diagnostic studies|Other Diagnostic Studies]]<br />
<br />
==Treatment==<br />
[[Neck of femur fracture medical therapy|Medical Therapy]] | [[Neck of femur fracture interventions|Interventions]] | [[Neck of femur fracture surgery|Surgery]] | [[Neck of femur fracture primary prevention|Primary Prevention]] | [[Neck of femur fracture secondary prevention|Secondary Prevention]] | [[Neck of femur fracture cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Neck of femur fracture future or investigational therapies|Future or Investigational Therapies]]<br />
<br />
==Case Studies==<br />
[[Neck of femur fracture case study one|Case #1]]<br />
<br />
[[Category: Orthopedics]]<br />
[[Category: Bone Fractures]]<br />
[[Category: Fractures]]<br />
[[Category: Emergency Medicine]]<br />
[[Category: Up-To-Date]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Neck_of_femur_fracture&diff=1546425
Neck of femur fracture
2019-02-06T18:12:23Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| align="right"<br />
|<br />
[[File:Xray tibial plateau.gif|300px|thumb|X ray of Knee showing Schatzker type VI tibial plateau fracture. Source: Case courtesy by: [[User:Rohan Bhimani|Dr. Rohan A. Bhimani]]]]<br />
|}<br />
{{neck of femur fracture}}<br />
'''For patient information, click [[Tibial plateau fracture (patient information)|here]]'''<br />
<br />
{{CMG}}; {{AE}} {{Rohan}}<br />
<br />
{{SK}} Femoral neck fracture, Intracapsular femoral neck fracture<br />
<br />
==[[Neck of femur fracture overview|Overview]]==<br />
<br />
==[[Neck of femur fracture historical perspective|Historical Perspective]]==<br />
<br />
==[[Neck of femur fracture classification|Classification]]==<br />
<br />
==[[Neck of femur fracture pathophysiology|Pathophysiology]]==<br />
<br />
==[[Neck of femur fracture causes|Causes]]==<br />
<br />
==[[Neck of femur fracture differential diagnosis|Differentiating Tibial plateau fracture from other Diseases]]==<br />
<br />
==[[Neck of femur fracture epidemiology and demographics|Epidemiology and Demographics]]==<br />
<br />
==[[Neck of femur fracture risk factors|Risk Factors]]==<br />
<br />
==[[Neck of femur fracture screening|Screening]]==<br />
<br />
==[[Neck of femur fracture natural history, complications and prognosis|Natural History, Complications and Prognosis]]==<br />
<br />
==Diagnosis==<br />
[[Neck of femur fracture diagnostic study of choice|Diagnostic study of choice]] | [[Neck of femur fracture history and symptoms|History and Symptoms]] | [[Neck of femur fracture physical examination|Physical Examination]] | [[Neck of femur fracture laboratory findings|Laboratory Findings]] | [[Neck of femur fracture electrocardiogram|Electrocardiogram]] | [[Neck of femur fracture x ray|X-Ray Findings]] | [[Neck of femur fracture echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Neck of femur fracture CT scan|CT-Scan Findings]] | [[Neck of femur fracture MRI|MRI Findings]] | [[Neck of femur fracture other imaging findings|Other Imaging Findings]] | [[Neck of femur fracture other diagnostic studies|Other Diagnostic Studies]]<br />
<br />
==Treatment==<br />
[[Neck of femur fracture medical therapy|Medical Therapy]] | [[Neck of femur fracture interventions|Interventions]] | [[Neck of femur fracture surgery|Surgery]] | [[Neck of femur fracture primary prevention|Primary Prevention]] | [[Neck of femur fracture secondary prevention|Secondary Prevention]] | [[Neck of femur fracture cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Neck of femur fracture future or investigational therapies|Future or Investigational Therapies]]<br />
<br />
==Case Studies==<br />
[[Neck of femur fracture case study one|Case #1]]<br />
<br />
[[Category: Orthopedics]]<br />
[[Category: Bone Fractures]]<br />
[[Category: Fractures]]<br />
[[Category: Emergency Medicine]]<br />
[[Category: Up-To-Date]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=User_talk:Hamad&diff=1545767
User talk:Hamad
2019-02-05T17:12:17Z
<p>Tarek Nafee: Welcome!</p>
<hr />
<div>'''Welcome to ''wikidoc''!'''<br />
We hope you will contribute much and well.<br />
You will probably want to read the [https://www.mediawiki.org/wiki/Special:MyLanguage/Help:Contents help pages].<br />
Again, welcome and have fun! [[User:Tarek Nafee|Tarek Nafee]] ([[User talk:Tarek Nafee|talk]]) 17:12, 5 February 2019 (UTC)</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=User:Hamad&diff=1545766
User:Hamad
2019-02-05T17:12:17Z
<p>Tarek Nafee: Creating user page for new user.</p>
<hr />
<div>My name is Hamad Hussain and I am currently a first year medical student with special interests in Anesthesiology, Ophthalmology, and Cardiology. I completed by Bachelor of Science degree from Loyola University Chicago in 2017 as Biology/Pre-med with a Health Systems Management minor. I will be conducting ophthalmology research over the summer and look forward to it. The medical school that I attend is Rosalind Franklin University - Chicago Medical School. <br />
Class of 2022 MD Candidate</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=User_talk:Umschejh&diff=1545751
User talk:Umschejh
2019-02-05T17:03:24Z
<p>Tarek Nafee: Welcome!</p>
<hr />
<div>'''Welcome to ''wikidoc''!'''<br />
We hope you will contribute much and well.<br />
You will probably want to read the [https://www.mediawiki.org/wiki/Special:MyLanguage/Help:Contents help pages].<br />
Again, welcome and have fun! [[User:Tarek Nafee|Tarek Nafee]] ([[User talk:Tarek Nafee|talk]]) 17:03, 5 February 2019 (UTC)</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=User:Umschejh&diff=1545750
User:Umschejh
2019-02-05T17:03:24Z
<p>Tarek Nafee: Creating user page for new user.</p>
<hr />
<div>4th year medical student working from the University of Kansas School of Medicine in Wichita, KS. We worked on smoking cessation for a public health project in Wichita, KS where we gathered information from the American College of Cardiology, United States Preventative Services Task Force and CDC for the most up to date recommendations for appropriate smoking cessation counseling guidelines.</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=User_talk:Almahabib&diff=1545747
User talk:Almahabib
2019-02-05T17:02:18Z
<p>Tarek Nafee: Welcome!</p>
<hr />
<div>'''Welcome to ''wikidoc''!'''<br />
We hope you will contribute much and well.<br />
You will probably want to read the [https://www.mediawiki.org/wiki/Special:MyLanguage/Help:Contents help pages].<br />
Again, welcome and have fun! [[User:Tarek Nafee|Tarek Nafee]] ([[User talk:Tarek Nafee|talk]]) 17:02, 5 February 2019 (UTC)</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=User:Almahabib&diff=1545746
User:Almahabib
2019-02-05T17:02:18Z
<p>Tarek Nafee: Creating user page for new user.</p>
<hr />
<div>I am a current medical student at University of Kansas-Wichita School of Medicine (graduation year: 2019). I am working on a QI project and literature review with my group in my Population Health in Practice course. <br />
Previously, I received a BSN degree from University of Saint Mary in 2013 and worked as a registered nurse.</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=User_talk:Cdthacker&diff=1545744
User talk:Cdthacker
2019-02-05T17:01:11Z
<p>Tarek Nafee: Welcome!</p>
<hr />
<div>'''Welcome to ''wikidoc''!'''<br />
We hope you will contribute much and well.<br />
You will probably want to read the [https://www.mediawiki.org/wiki/Special:MyLanguage/Help:Contents help pages].<br />
Again, welcome and have fun! [[User:Tarek Nafee|Tarek Nafee]] ([[User talk:Tarek Nafee|talk]]) 17:01, 5 February 2019 (UTC)</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=User:Cdthacker&diff=1545743
User:Cdthacker
2019-02-05T17:01:11Z
<p>Tarek Nafee: Creating user page for new user.</p>
<hr />
<div>I am a senior medical student at the University of Kansas School of Medicine-Wichita. As part of our required senior course in Population Health in Practice (http://wichita.kumc.edu/php), we implement a quality improvement project at a local clinical site. To ensure that the intervention in the project is based on best available clinical knowledge, we execute a literature search and assessment and then summarize the assessment online at WikiDoc. Our literature search is based on the 6S strategy (PMID 19755349). Our study assessment uses the IOM Trustworthy scale for practice guidelines, AMSTAR framework for systematic reviews, Cochrane Risk of Bias tool for randomized controlled trials, and the QUADAS-2 tool for diagnostic tests assessment. We strive to use numeracy in our edits when able and link back to sources at PubMed.</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=User_talk:Nyssa84&diff=1545738
User talk:Nyssa84
2019-02-05T16:59:33Z
<p>Tarek Nafee: Welcome!</p>
<hr />
<div>'''Welcome to ''wikidoc''!'''<br />
We hope you will contribute much and well.<br />
You will probably want to read the [https://www.mediawiki.org/wiki/Special:MyLanguage/Help:Contents help pages].<br />
Again, welcome and have fun! [[User:Tarek Nafee|Tarek Nafee]] ([[User talk:Tarek Nafee|talk]]) 16:59, 5 February 2019 (UTC)</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=User:Nyssa84&diff=1545737
User:Nyssa84
2019-02-05T16:59:33Z
<p>Tarek Nafee: Creating user page for new user.</p>
<hr />
<div>I am a senior medical student at the University of Kansas School of Medicine-Wichita. As part of our required senior course in Population Health in Practice (http://wichita.kumc.edu/php), we implement a quality improvement project at a local clinical site. To ensure that the intervention in the project is based on best available clinical knowledge, we execute a literature search and assessment and then summarize the assessment online at WikiDoc. Our literature search is based on the 6S strategy (PMID 19755349). Our study assessment uses the IOM Trustworthy scale for practice guidelines, AMSTAR framework for systematic reviews, Cochrane Risk of Bias tool for randomized controlled trials, and the QUADAS-2 tool for diagnostic tests assessment. We strive to use numeracy in our edits when able and link back to sources at PubMed using http://sumsearch.org/cite.</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Widget:VisitSchedulerRedux&diff=1538217
Widget:VisitSchedulerRedux
2019-01-21T19:15:31Z
<p>Tarek Nafee: </p>
<hr />
<div><includeonly><br />
<link rel="stylesheet" href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css"><br />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script><br />
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script><br />
<script><br />
$.noConflict();<br />
jQuery( document ).ready(function( $ ) {<br />
<br />
$( "#patientID, #assigned, #indexEvent, #indexEventTime").css({"display":"flex","flex-direction":"column","align-items":"flex-end"});<br />
$( "#indexEvent, #indexEventTime, #visit-1, #visitTime-1" ).val("");<br />
$( "#indexEvent" ).datepicker({minDate: new Date()});<br />
$( "#visit-1" ).datepicker({minDate: new Date()});<br />
$( "#visit-1" ).change(function(){<br />
<br />
var schedule = visitSchedule($("patientID").val(),$("#assigned").val(),new Date($( "#indexEvent" ).val()));<br />
});<br />
function visitSchedule(patient, assigned, index){<br />
$("#print, #save").css("visibility","visible");<br />
var timeConstraints = {<br />
// VisitNum : [Days from Infusion 1, Window + Days, Window - Days, Window + Hours, Window - Hours, Visit, Visit Description, Short Visit Description]<br />
1 : [1, 4, 1, 12, 0, "Visit 2", "Infusion 1 of investigational product should occur <b>no earlier than 12 h after IV contrast or first medical contact</b> and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.", "Infusion 1"],<br />
2 : [7, 1, 2, 0, 0, "Visit 3", "Infusion 2 should occur approximately 7 (-2/+1) days after the 1st infusion (Visit 2) with a minimum window between infusions of at least 5 days.", "Infusion 2"],<br />
3 : [7, 1, 2, 0, 0, "Visit 4", "Infusion 3 should occur approximately 7 (-2/+1) days after the 2nd infusion (Visit 3) with a minimum window between infusions of at least 5 days.", "Infusion 3"],<br />
4 : [7, 1, 2, 0, 0, "Visit 5", "Infusion 4 should occur approximately 7 (-2/+1) days after the 3rd infusion (Visit 4) with a minimum window between infusions of at least 5 days. This infusion must be given within 30 days of the 1st infusion.", "Infusion 4"],<br />
5 : [8, 3, 1, 0, 0, "Visit 6", "This follow-up visit should occur approximately on day 29 (&plusmn;2) after the 1st infusion (Visit 5).", "1st Follow-Up After Infusion 4"],<br />
6 : [31, 10, 10, 0, 0, "Visit 7", "This follow-up visit should occur approximately on day 60 (&plusmn;10) after the 1st infusion (Visit 2).", "2nd Follow-Up After Infusion 4"],<br />
7 : [30, 10, 10, 0, 0, "Visit 8", "This follow-up visit should occur approximately on day 90 (&plusmn;10) after the 1st infusion (Visit 2).", "3rd Follow-Up After Infusion 4"],<br />
8 : [90, 10, 10, 0, 0, "Visit 9", "This follow-up visit should occur approximately on day 180 (&plusmn;10) after the 1st infusion (Visit 2).", "4th Follow-Up After Infusion 4"],<br />
9 : [90, 10, 10, 0, 0, "Visit 10", "This follow-up visit should occur approximately on day 270 (&plusmn;10) after the 1st infusion (Visit 2).", "5th Follow-Up After Infusion 4"],<br />
10 : [95, 14, 14, 0, 0, "Visit 11", "This follow-up visit should occur approximately on day 365 (&plusmn;14) after the 1st infusion (Visit 2).", "End Of Study Visit"],<br />
};<br />
this.patientID = patient;<br />
this.assigned = assigned;<br />
if(!$("#visit-2").length){<br />
$.each(timeConstraints, function(key, value){<br />
if(key == 1){<br />
currentAppointment = new Date($("#visit-1").val());<br />
} else {<br />
currentAppointment = new Date($("#visit-"+(key-1)).val());<br />
}<br />
currentAppointment = new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[0]);<br />
if(key ==1 ){<br />
$("#visit-1").val(new Date($("#visit-1").val()).toDateString());<br />
}<br />
else if(key <= 4){<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' class='appointment' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='time' id='visitTime-"+key+"' value='"+$("#indexEventTime").val()+"'></td><td><input type='checkbox' class='delayedInfusion' value='"+key+"' /></td><td>"+value[6]+"</td></tr>");<br />
} else {<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='time' id='visitTime-"+key+"' value='"+$("#indexEventTime").val()+"'></td><td></td><td>"+value[6]+"</td></tr>");<br />
}<br />
$("#visit-"+key).datepicker({minDate: new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()-value[2]), maxDate:new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[1])});<br />
})};<br />
validateConstraints();<br />
$(".appointment").change(function(){<br />
var modId = $(this).attr("id").split("-")[1];<br />
var updatedAppointment = new Date($(this).val());<br />
$(this).val(updatedAppointment);<br />
$.each(timeConstraints, function(key, value){<br />
$("#visit-"+key).css("border", "1px solid black");<br />
if(key > modId && key <= 4){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment.toDateString());<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()-value[2]), maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
} else if(key == modId){<br />
$("#visit-"+key).val(updatedAppointment.toDateString());<br />
}<br />
});<br />
<br />
validateConstraints();<br />
});<br />
$( "#indexEventTime" ).change(function(){<br />
$.each(timeConstraints, function(key, value){<br />
$("#visitTime-"+key).val($("#indexEventTime").val());<br />
});<br />
});<br />
$(".delayedInfusion").change(function(){<br />
if($(this).prop('checked')){<br />
$("#visit-"+$(this).val()).datepicker('destroy');<br />
var prevAppointment = new Date($("#visit-"+($(this).val()-1)).val());<br />
$("#visit-"+$(this).val()).datepicker({minDate: new Date(prevAppointment.getFullYear(), prevAppointment.getMonth(), prevAppointment.getDate()+5)});<br />
} else {<br />
fixDateRanges();<br />
}<br />
});<br />
$("#visitTime-1").change(function(){validateConstraints();});<br />
$( "#indexEventTime" ).change(function(){validateConstraints();});<br />
function fixDateRanges(){<br />
$.each(timeConstraints, function(key, value){<br />
var updatedAppointment = new Date($("#visit-"+(key-1)).val());<br />
$("#visit-"+key).css("border", "1px solid black");<br />
if(key > 1 && key <= 4){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment.toDateString());<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()-value[2]), maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
}<br />
});<br />
}<br />
function validateConstraints(){<br />
var errorFlag = false;<br />
<br />
var splitTime = $( "#indexEventTime" ).val().split(":");<br />
var hours = splitTime[0]*60*60*1000;<br />
var minutes = splitTime[1]*60*1000;<br />
var visit1 = $( "#visitTime-1" ).val().split(":");<br />
var visit1hours = visit1[0]*60*60*1000;<br />
var visit1minutes = visit1[1]*60*1000;<br />
if(((new Date($("#visit-1").val()).getTime()+visit1hours+visit1minutes) - (new Date($("#indexEvent").val()).getTime()+hours+minutes)) < (12*60*60*1000)){<br />
errorFlag = true;<br />
$("#visit-1").css("border", "1px solid red");<br />
$("#visit-1").addClass("invalid");<br />
}<br />
if((new Date($("#visit-2").val()).getTime() - new Date($("#visit-1").val()).getTime()) > (24*60*60*1000*30)){<br />
errorFlag = true;<br />
$("#visit-2").css("border", "1px solid red");<br />
$("#visit-2").addClass("invalid");<br />
}<br />
if((new Date($("#visit-3").val()).getTime() - new Date($("#visit-1").val()).getTime()) > (24*60*60*1000*30)){<br />
errorFlag = true;<br />
$("#visit-3").css("border", "1px solid red");<br />
$("#visit-3").addClass("invalid");<br />
}<br />
if((new Date($("#visit-4").val()).getTime() - new Date($("#visit-1").val()).getTime()) > (24*60*60*1000*30)){<br />
errorFlag = true;<br />
$("#visit-4").css("border", "1px solid red");<br />
$("#visit-4").addClass("invalid");<br />
}<br />
<br />
if(errorFlag){alert("Visits in red fall out of the 30 day window and infusions may not be scheduled on those dates. For help with this matter, call the AEGIS II Hotline");}<br />
};<br />
$("#print").click(function(){<br />
var newWin = window.open("");<br />
newWin.document.write($("#appointments").prop('outerHTML'));<br />
newWin.print();<br />
newWin.close();<br />
});<br />
};<br />
<br />
<br />
});<br />
</script><br />
<div id="visitScheduler" style="position:relative; float:left; width:100%;><br />
Welcome to the AEGIS II Trial Visit Scheduler! <br />
<br />
Enter the date and time of First Medical Contact AND the date and time of the First Infusion (Visit 2) to get a full suggested schedule. Click the "Print" button to print the schedule for each patient OR Click "Save to Outlook" to save to your electronic calendar, if you use Microsoft Outlook email service.<br /><br /><br />
<br />
<b>Please Note: Clicking the "Delayed infusion" button for Visits 3, 4, and 5 will allow you to select more date options for those visits.</b><br /><br /><br />
<br />
If you have any specific questions about patient scheduling criteria according to the protocol, feel free to contact the AEGIS II Hotline <a href="https://aegis2.bidmc.org/index.php/Hotline_Contact">here</a><br /><br /><br />
<div style="position:relative; float:left; width:20%;"><br />
<form action="http://www.wikidoc.org/calendar.php" method="post" id="visitForm"><br />
<label for="patientID">Patient ID</label><br />
<input type="text" name="patientID" id="patientID" /><br /><br />
<label for="assigned"> Enrolling Staff Member</label><br />
<input type="text" name="assigned" id="assigned" /><br /><br />
<label for="indexEvent">First Medical Contact Date</label><br />
<input type="text" id="indexEvent" name="indexEvent" /><br /><br />
<label for="indexEventTime">First Medical Contact Time</label><br />
<input type="time" id="indexEventTime" name="indexEvent" /><br /><br />
<img src="https://files.constantcontact.com/68305626001/e6428b6e-8655-4dfe-acc8-b16c80037cdc.png" style="width:100%;" /><br />
</div><br />
<div style="position:relative; float:right; width:80%;"><br />
<table id="appointments"><br />
<tr><th>Visit Number</th><th>Visit Date</th><th>Visit Time</th><th>Delayed Infusion?</th><th>Visit Description</th></tr><br />
<tr><td>Visit 2</td><td><input type="text" class="appointment" id="visit-1" value=""></td><td><input type="time" id="visitTime-1" value=""></td><td></td><td>Infusion 1 of investigational product should occur <b>no earlier than 12 h after IV contrast or first medical contact</b> and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.</td></tr><br />
</table><br />
<br />
<input type="hidden" id="outlookJSON" /><br />
<input type="button" id="print" value="Print" style="visibility:hidden"/><br />
<input type="submit" id="save" value="Save to Outlook" style="visibility:hidden" /><br />
</form><br />
</div><br />
</div><br />
</includeonly></div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Widget:VisitSchedulerRedux&diff=1538214
Widget:VisitSchedulerRedux
2019-01-21T19:10:41Z
<p>Tarek Nafee: </p>
<hr />
<div><includeonly><br />
<link rel="stylesheet" href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css"><br />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script><br />
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script><br />
<script><br />
$.noConflict();<br />
jQuery( document ).ready(function( $ ) {<br />
<br />
$( "#patientID, #assigned, #indexEvent, #indexEventTime").css({"display":"flex","flex-direction":"column","align-items":"flex-end"});<br />
$( "#indexEvent, #indexEventTime, #visit-1, #visitTime-1" ).val("");<br />
$( "#indexEvent" ).datepicker({minDate: new Date()});<br />
$( "#visit-1" ).datepicker({minDate: new Date()});<br />
$( "#visit-1" ).change(function(){<br />
<br />
var schedule = visitSchedule($("patientID").val(),$("#assigned").val(),new Date($( "#indexEvent" ).val()));<br />
});<br />
function visitSchedule(patient, assigned, index){<br />
$("#print, #save").css("visibility","visible");<br />
var timeConstraints = {<br />
// VisitNum : [Days from Infusion 1, Window + Days, Window - Days, Window + Hours, Window - Hours, Visit, Visit Description, Short Visit Description]<br />
1 : [1, 4, 1, 12, 0, "Visit 2", "Infusion 1 of investigational product should occur <b>no earlier than 12 h after IV contrast or first medical contact</b> and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.", "Infusion 1"],<br />
2 : [7, 1, 2, 0, 0, "Visit 3", "Infusion 2 should occur approximately 7 (-2/+1) days after the 1st infusion (Visit 2) with a minimum window between infusions of at least 5 days.", "Infusion 2"],<br />
3 : [7, 1, 2, 0, 0, "Visit 4", "Infusion 3 should occur approximately 7 (-2/+1) days after the 2nd infusion (Visit 3) with a minimum window between infusions of at least 5 days.", "Infusion 3"],<br />
4 : [7, 1, 2, 0, 0, "Visit 5", "Infusion 4 should occur approximately 7 (-2/+1) days after the 3rd infusion (Visit 4) with a minimum window between infusions of at least 5 days. This infusion must be given within 30 days of the 1st infusion.", "Infusion 4"],<br />
5 : [8, 3, 1, 0, 0, "Visit 6", "This follow-up visit should occur approximately on day 29 (&plusmn;2) after the 1st infusion (Visit 5).", "1st Follow-Up After Infusion 4"],<br />
6 : [31, 10, 10, 0, 0, "Visit 7", "This follow-up visit should occur approximately on day 60 (&plusmn;10) after the 1st infusion (Visit 2).", "2nd Follow-Up After Infusion 4"],<br />
7 : [30, 10, 10, 0, 0, "Visit 8", "This follow-up visit should occur approximately on day 90 (&plusmn;10) after the 1st infusion (Visit 2).", "3rd Follow-Up After Infusion 4"],<br />
8 : [90, 10, 10, 0, 0, "Visit 9", "This follow-up visit should occur approximately on day 180 (&plusmn;10) after the 1st infusion (Visit 2).", "4th Follow-Up After Infusion 4"],<br />
9 : [90, 10, 10, 0, 0, "Visit 10", "This follow-up visit should occur approximately on day 270 (&plusmn;10) after the 1st infusion (Visit 2).", "5th Follow-Up After Infusion 4"],<br />
10 : [95, 14, 14, 0, 0, "Visit 11", "This follow-up visit should occur approximately on day 365 (&plusmn;14) after the 1st infusion (Visit 2).", "End Of Study Visit"],<br />
};<br />
this.patientID = patient;<br />
this.assigned = assigned;<br />
if(!$("#visit-2").length){<br />
$.each(timeConstraints, function(key, value){<br />
if(key == 1){<br />
currentAppointment = new Date($("#visit-1").val());<br />
} else {<br />
currentAppointment = new Date($("#visit-"+(key-1)).val());<br />
}<br />
currentAppointment = new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[0]);<br />
if(key ==1 ){<br />
$("#visit-1").val(new Date($("#visit-1").val()).toDateString());<br />
}<br />
else if(key <= 4){<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' class='appointment' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='time' id='visitTime-"+key+"' value='"+$("#indexEventTime").val()+"'></td><td><input type='checkbox' class='delayedInfusion' value='"+key+"' /></td><td>"+value[6]+"</td></tr>");<br />
} else {<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='time' id='visitTime-"+key+"' value='"+$("#indexEventTime").val()+"'></td><td></td><td>"+value[6]+"</td></tr>");<br />
}<br />
$("#visit-"+key).datepicker({minDate: new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()-value[2]), maxDate:new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[1])});<br />
})};<br />
validateConstraints();<br />
$(".appointment").change(function(){<br />
var modId = $(this).attr("id").split("-")[1];<br />
var updatedAppointment = new Date($(this).val());<br />
$(this).val(updatedAppointment);<br />
$.each(timeConstraints, function(key, value){<br />
$("#visit-"+key).css("border", "1px solid black");<br />
if(key > modId && key <= 4){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment.toDateString());<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()-value[2]), maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
} else if(key == modId){<br />
$("#visit-"+key).val(updatedAppointment.toDateString());<br />
}<br />
});<br />
<br />
validateConstraints();<br />
});<br />
$( "#indexEventTime" ).change(function(){<br />
$.each(timeConstraints, function(key, value){<br />
$("#visitTime-"+key).val($("#indexEventTime").val());<br />
});<br />
});<br />
$(".delayedInfusion").change(function(){<br />
if($(this).prop('checked')){<br />
$("#visit-"+$(this).val()).datepicker('destroy');<br />
var prevAppointment = new Date($("#visit-"+($(this).val()-1)).val());<br />
$("#visit-"+$(this).val()).datepicker({minDate: new Date(prevAppointment.getFullYear(), prevAppointment.getMonth(), prevAppointment.getDate()+5)});<br />
} else {<br />
fixDateRanges();<br />
}<br />
});<br />
$("#visitTime-1").change(function(){validateConstraints();});<br />
$( "#indexEventTime" ).change(function(){validateConstraints();});<br />
function fixDateRanges(){<br />
$.each(timeConstraints, function(key, value){<br />
var updatedAppointment = new Date($("#visit-"+(key-1)).val());<br />
$("#visit-"+key).css("border", "1px solid black");<br />
if(key > 1 && key <= 4){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment.toDateString());<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()-value[2]), maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
}<br />
});<br />
}<br />
function validateConstraints(){<br />
var errorFlag = false;<br />
<br />
var splitTime = $( "#indexEventTime" ).val().split(":");<br />
var hours = splitTime[0]*60*60*1000;<br />
var minutes = splitTime[1]*60*1000;<br />
var visit1 = $( "#visitTime-1" ).val().split(":");<br />
var visit1hours = visit1[0]*60*60*1000;<br />
var visit1minutes = visit1[1]*60*1000;<br />
if(((new Date($("#visit-1").val()).getTime()+visit1hours+visit1minutes) - (new Date($("#indexEvent").val()).getTime()+hours+minutes)) < (12*60*60*1000)){<br />
errorFlag = true;<br />
$("#visit-1").css("border", "1px solid red");<br />
$("#visit-1").addClass("invalid");<br />
}<br />
if((new Date($("#visit-2").val()).getTime() - new Date($("#visit-1").val()).getTime()) > (24*60*60*1000*30)){<br />
errorFlag = true;<br />
$("#visit-2").css("border", "1px solid red");<br />
$("#visit-2").addClass("invalid");<br />
}<br />
if((new Date($("#visit-3").val()).getTime() - new Date($("#visit-1").val()).getTime()) > (24*60*60*1000*30)){<br />
errorFlag = true;<br />
$("#visit-3").css("border", "1px solid red");<br />
$("#visit-3").addClass("invalid");<br />
}<br />
if((new Date($("#visit-4").val()).getTime() - new Date($("#visit-1").val()).getTime()) > (24*60*60*1000*30)){<br />
errorFlag = true;<br />
$("#visit-4").css("border", "1px solid red");<br />
$("#visit-4").addClass("invalid");<br />
}<br />
<br />
if(errorFlag){alert("Visits in red fall out of the 30 day window and infusions may not be scheduled on those dates. For help with this matter, call the AEGIS II Hotline");}<br />
};<br />
$("#print").click(function(){<br />
var newWin = window.open("");<br />
newWin.document.write($("#appointments").prop('outerHTML'));<br />
newWin.print();<br />
newWin.close();<br />
});<br />
};<br />
<br />
<br />
});<br />
</script><br />
<div id="visitScheduler" style="position:relative; float:left; width:100%;><br />
Welcome to the AEGIS II Trial Visit Scheduler! <br />
<br />
Enter the date and time of First Medical Contact AND the date and time of the First Infusion (Visit 2) to get a full suggested schedule. Click the "Print" button to print the schedule for each patient OR Click "Save to Outlook" to save to your electronic calendar, if you use Microsoft Outlook email service.<br /><br /><br />
<br />
<b>Please Note: Clicking the "Delayed infusion" button for Visits 3, 4, and 5 will allow you to select more date options for those visits.</b><br /><br /><br />
<br />
If you have any specific questions about patient scheduling criteria according to the protocol, feel free to contact the AEGIS II Hotline <a href="https://aegis2.bidmc.org/index.php/Hotline_Contact">here</a><br /><br /><br />
<div style="position:relative; float:left; width:20%;"><br />
<form action="http://www.wikidoc.org/calendar.php" method="post" id="visitForm"><br />
<label for="patientID">Patient ID</label><br />
<input type="text" name="patientID" id="patientID" /><br /><br />
<label for="assigned"> Enrolling Staff Member</label><br />
<input type="text" name="assigned" id="assigned" /><br /><br />
<label for="indexEvent">First Medical Contact</label><br />
<input type="text" id="indexEvent" name="indexEvent" /><br /><br />
<label for="indexEventTime">First Medical Contact Time</label><br />
<input type="time" id="indexEventTime" name="indexEvent" /><br /><br />
<img src="https://files.constantcontact.com/68305626001/e6428b6e-8655-4dfe-acc8-b16c80037cdc.png" style="width:100%;" /><br />
</div><br />
<div style="position:relative; float:right; width:80%;"><br />
<table id="appointments"><br />
<tr><th>Visit Number</th><th>Visit Date</th><th>Visit Time</th><th>Delayed Infusion?</th><th>Visit Description</th></tr><br />
<tr><td>Visit 2</td><td><input type="text" class="appointment" id="visit-1" value=""></td><td><input type="time" id="visitTime-1" value=""></td><td></td><td>Infusion 1 of investigational product should occur <b>no earlier than 12 h after IV contrast or first medical contact</b> and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.</td></tr><br />
</table><br />
<br />
<input type="hidden" id="outlookJSON" /><br />
<input type="button" id="print" value="Print" style="visibility:hidden"/><br />
<input type="submit" id="save" value="Save to Outlook" style="visibility:hidden" /><br />
</form><br />
</div><br />
</div><br />
</includeonly></div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Acute_pancreatitis&diff=1510874
Acute pancreatitis
2018-12-19T20:15:15Z
<p>Tarek Nafee: </p>
<hr />
<div>__NOTOC__<br />
{| class="infobox" style="float:right;"<br />
|-<br />
| [[File:Siren.gif|30px|link=Acute pancreatitis resident survival guide]]|| <br> || <br><br />
| [[Acute pancreatitis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]<br />
|}<br />
'''For patient information, click [[Acute pancreatitis (patient information)|here]]'''<br />
<br />
{{Infobox_Disease<br />
| Name = Acute pancreatitis<br />
| Image = Blausen 0699 PancreasAnatomy2.png<br />
| Caption = Pancreas<ref><https://en.wikipedia.org/wiki/Pancreas#/media/File:Blausen_0699_PancreasAnatomy2.png></ref><br />
}}<br />
{{Acute pancreatitis}}<br />
<br />
{{CMG}}; {{AE}} {{TarekNafee}}; {{IQ}}; {{CZ}}; {{RT}}; <br />
{{SK}} Pancreatitis, acute; acute inflammation of pancreas; acute soreness of pancreas<br />
<br />
==[[Acute pancreatitis overview|Overview]]==<br />
<br />
==[[Acute pancreatitis historical perspective|Historical Perspective]]==<br />
<br />
==[[Acute pancreatitis classification|Classification]]==<br />
<br />
==[[Acute pancreatitis pathophysiology|Pathophysiology]]==<br />
<br />
==[[Acute pancreatitis causes|Causes]]==<br />
<br />
==[[Acute pancreatitis differential diagnosis| Differentiating Acute Pancreatitis from other Diseases]]==<br />
<br />
==[[Acute pancreatitis epidemiology and demographics|Epidemiology and Demographics]]==<br />
<br />
==[[Acute pancreatitis risk factors|Risk Factors]]==<br />
<br />
==[[Acute pancreatitis screening|Screening]]==<br />
<br />
==[[Acute pancreatitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==<br />
<br />
==Diagnosis==<br />
<br />
[[Acute pancreatitis history and symptoms|History and Symptoms ]] | [[ Acute pancreatitis physical examination|Physical Examination]] | [[Acute pancreatitis laboratory findings|Laboratory Findings]] | [[Acute pancreatitis abdominal x ray| Abdominal X ray]] | [[Acute pancreatitis CT|CT ]] | [[Acute pancreatitis MRI|MRI]] | [[Acute pancreatitis ultrasound|Ultrasound]] | [[Acute pancreatitis other imaging findings|Other Imaging Findings]] | [[Acute pancreatitis other diagnostic studies|Other Diagnostic Studies]]<br />
<br />
==Treatment==<br />
[[Acute pancreatitis medical therapy|Medical Therapy]] | [[Acute pancreatitis surgery|Surgery]] | [[Acute pancreatitis primary prevention|Primary Prevention]] | [[Acute pancreatitis secondary prevention|Secondary Prevention]] | [[Acute pancreatitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Acute pancreatitis future or investigational therapies|Future or Investigational Therapies]]<br />
<br />
==Case Studies==<br />
[[Acute pancreatitis case study one|Case #1]]<br />
<br />
==Related Chapters==<br />
*[[Chronic pancreatitis|Chronic Pancreatitis]]<br />
<br />
{{Gastroenterology}}<br />
[[de:Akute Pankreatitis]]<br />
[[fr:Pancréatite aiguë]]<br />
[[it:Pancreatite acuta]]<br />
[[no:Akutt pankreatitt]]<br />
[[pl:Ostre zapalenie trzustki]]<br />
[[ru:Острый панкреатит]]<br />
[[sl:Akutni pankreatitis]]<br />
[[tr:Akut pankreatit]]<br />
<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
<br />
[[Category:Gastroenterology]]<br />
[[Category:Surgery]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Disease]]</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=AEGIS_II_Visit_Scheduler_(test_mode)&diff=1510267
AEGIS II Visit Scheduler (test mode)
2018-12-17T22:04:27Z
<p>Tarek Nafee: Created page with "{{#Widget:VisitSchedulerRedux}}"</p>
<hr />
<div>{{#Widget:VisitSchedulerRedux}}</div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Widget:VisitSchedulerRedux&diff=1504911
Widget:VisitSchedulerRedux
2018-11-27T22:28:03Z
<p>Tarek Nafee: </p>
<hr />
<div><includeonly><br />
<link rel="stylesheet" href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css"><br />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script><br />
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script><br />
<script><br />
$.noConflict();<br />
jQuery( document ).ready(function( $ ) {<br />
<br />
$( "#indexEvent" ).datepicker();<br />
$( "#indexEvent" ).change(function(){<br />
var schedule = visitSchedule($("patientID").val(),$("#assigned").val(),new Date($( "#indexEvent" ).val()));<br />
});<br />
function visitSchedule(patient, assigned, index){<br />
var timeConstraints = {<br />
// VisitNum : [Days from Infusion 1, Window + Days, Window - Days, Window + Hours, Window - Hours, Visit, Visit Description, Short Visit Description]<br />
1 : [0, 5, 0, 12, 0, "Visit 2", "Infusion 1 of investigational product should occur no earlier than 12 h after IV contrast and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.", "Infusion 1"],<br />
2 : [7, 1, 2, 0, 0, "Visit 3", "Infusion 2 should occur approximately 7 (-2/+1) days after the 1st infusion (Visit 2) with a minimum window between infusions of at least 5 days.", "Infusion 2"],<br />
3 : [7, 1, 2, 0, 0, "Visit 4", "Infusion 3 should occur approximately 7 (-2/+1) days after the 2nd infusion (Visit 3) with a minimum window between infusions of at least 5 days.", "Infusion 3"],<br />
4 : [7, 1, 2, 0, 0, "Visit 5", "Infusion 4 should occur approximately 7 (-2/+1) days after the 3rd infusion (Visit 4) with a minimum window between infusions of at least 5 days. This infusion must be given within 30 days of the 1st infusion.", "Infusion 4"],<br />
5 : [7, 2, 2, 0, 0, "Visit 6", "This follow-up visit should occur approximately on day 29 (ą2) after the 1st infusion (Visit 5).", "1st Follow-Up After Infusion 4"],<br />
6 : [31, 10, 10, 0, 0, "Visit 7", "This follow-up visit should occur approximately on day 60 (ą10) after the 1st infusion (Visit 2).", "2nd Follow-Up After Infusion 4"],<br />
7 : [30, 10, 10, 0, 0, "Visit 8", "This follow-up visit should occur approximately on day 90 (ą10) after the 1st infusion (Visit 2).", "3rd Follow-Up After Infusion 4"],<br />
8 : [90, 10, 10, 0, 0, "Visit 9", "This follow-up visit should occur approximately on day 180 (ą10) after the 1st infusion (Visit 2).", "4th Follow-Up After Infusion 4"],<br />
9 : [90, 10, 10, 0, 0, "Visit 10", "This follow-up visit should occur approximately on day 270 (ą10) after the 1st infusion (Visit 2).", "5th Follow-Up After Infusion 4"],<br />
10 : [95, 14, 14, 0, 0, "Visit 11", "This follow-up visit should occur approximately on day 365 (ą14) after the 1st infusion (Visit 2).", "End Of Study Visit"],<br />
};<br />
this.patientID = patient;<br />
this.assigned = assigned;<br />
$.each(timeConstraints, function(key, value){<br />
if(key == 1){<br />
currentAppointment = new Date($( "#indexEvent" ).val());<br />
} else {<br />
currentAppointment = new Date($("#visit-"+(key-1)).val());<br />
}<br />
currentAppointment = new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[0]);<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' class='appointment' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='checkbox' class='delayedInfusion' value='"+key+"' /></td><td>"+value[6]+"</td></tr>");<br />
$("#visit-"+key).datepicker({minDate: currentAppointment, maxDate:new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[1])});<br />
});<br />
$(".appointment").change(function(){<br />
var modId = $(this).attr("id").split("-")[1];<br />
var updatedAppointment = new Date($(this).val());<br />
$(this).val(updatedAppointment);<br />
$.each(timeConstraints, function(key, value){<br />
if(key > modId){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment);<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: updatedAppointment, maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
} else if(key == modId){<br />
$("#visit-"+key).val(updatedAppointment);<br />
}<br />
});<br />
});<br />
$(".delayedInfusion").change(function(){<br />
$("#visit-"+$(this).val()).datepicker('destroy');<br />
$("#visit-"+$(this).val()).datepicker();<br />
});<br />
};<br />
<br />
<br />
});<br />
</script><br />
<br />
<form><br />
<label for="patientID">Patient ID</label><br />
<input type="text" name="patientID" id="patientID" /><br /><br />
<label for="assigned"> Enrolling Staff Member</label><br />
<input type="text" name="assigned" id="assigned" /><br /><br />
<label for="indexEvent">Index Event</label><br />
<input type="text" id="indexEvent" name="indexEvent" /><br /><br />
<table id="appointments"><br />
<tr><th>Visit Number</th><th>Visit Date</th><th>Delayed Infusion?</th><th>Visit Description</th></tr><br />
</table><br />
</form><br />
<br />
</includeonly></div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Widget:VisitSchedulerRedux&diff=1504905
Widget:VisitSchedulerRedux
2018-11-27T21:52:03Z
<p>Tarek Nafee: </p>
<hr />
<div><includeonly><br />
<link rel="stylesheet" href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css"><br />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script><br />
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script><br />
<script><br />
$.noConflict();<br />
jQuery( document ).ready(function( $ ) {<br />
<br />
$( "#indexEvent" ).datepicker();<br />
$( "#indexEvent" ).change(function(){<br />
var schedule = visitSchedule($("patientID").val(),$("#assigned").val(),new Date($( "#indexEvent" ).val()));<br />
});<br />
function visitSchedule(patient, assigned, index){<br />
var timeConstraints = {<br />
// VisitNum : [Days from Infusion 1, Window + Days, Window - Days, Window + Hours, Window - Hours, Visit, Visit Description, Short Visit Description]<br />
1 : [0, 5, 0, 12, 0, "Visit 2", "Infusion 1 of investigational product should occur no earlier than 12 h after IV contrast and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.", "Infusion 1"],<br />
2 : [7, 1, (2), 0, 0, "Visit 3", "Infusion 2 should occur approximately 7 (-2/+1) days after the 1st infusion (Visit 2) with a minimum window between infusions of at least 5 days.", "Infusion 2"],<br />
3 : [14, 1, -2, 0, 0, "Visit 4", "Infusion 3 should occur approximately 7 (-2/+1) days after the 2nd infusion (Visit 3) with a minimum window between infusions of at least 5 days.", "Infusion 3"],<br />
4 : [21, 1, -2, 0, 0, "Visit 5", "Infusion 4 should occur approximately 7 (-2/+1) days after the 3rd infusion (Visit 4) with a minimum window between infusions of at least 5 days. This infusion must be given within 30 days of the 1st infusion.", "Infusion 4"],<br />
5 : [28, 2, -2, 0, 0, "Visit 6", "This follow-up visit should occur approximately on day 29 (ą2) after the 1st infusion (Visit 5).", "1st Follow-Up After Infusion 4"],<br />
6 : [59, 10, -10, 0, 0, "Visit 7", "This follow-up visit should occur approximately on day 60 (ą10) after the 1st infusion (Visit 2).", "2nd Follow-Up After Infusion 4"],<br />
7 : [89, 10, -10, 0, 0, "Visit 8", "This follow-up visit should occur approximately on day 90 (ą10) after the 1st infusion (Visit 2).", "3rd Follow-Up After Infusion 4"],<br />
8 : [179, 10, -10, 0, 0, "Visit 9", "This follow-up visit should occur approximately on day 180 (ą10) after the 1st infusion (Visit 2).", "4th Follow-Up After Infusion 4"],<br />
9 : [269, 10, -10, 0, 0, "Visit 10", "This follow-up visit should occur approximately on day 270 (ą10) after the 1st infusion (Visit 2).", "5th Follow-Up After Infusion 4"],<br />
10 : [364, 14, -14, 0, 0, "Visit 11", "This follow-up visit should occur approximately on day 365 (ą14) after the 1st infusion (Visit 2).", "End Of Study Visit"],<br />
};<br />
this.patientID = patient;<br />
this.assigned = assigned;<br />
$.each(timeConstraints, function(key, value){<br />
if(key == 1){<br />
currentAppointment = new Date($( "#indexEvent" ).val());<br />
} else {<br />
currentAppointment = new Date($("#visit-"+(key-1)).val());<br />
}<br />
currentAppointment = new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[0]);<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' class='appointment' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='checkbox' class='delayedInfusion' value='"+key+"' /></td><td>"+value[6]+"</td></tr>");<br />
$("#visit-"+key).datepicker({minDate: currentAppointment, maxDate:new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[1])});<br />
});<br />
$(".appointment").change(function(){<br />
var modId = $(this).attr("id").split("-")[1];<br />
var updatedAppointment = new Date($(this).val());<br />
$(this).val(updatedAppointment);<br />
$.each(timeConstraints, function(key, value){<br />
if(key > modId){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment);<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: updatedAppointment, maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
} else if(key == modId){<br />
$("#visit-"+key).val(updatedAppointment);<br />
}<br />
});<br />
});<br />
$(".delayedInfusion").change(function(){<br />
$("#visit-"+$(this).val()).datepicker('destroy');<br />
$("#visit-"+$(this).val()).datepicker();<br />
});<br />
};<br />
<br />
<br />
});<br />
</script><br />
<br />
<form><br />
<label for="patientID">Patient ID</label><br />
<input type="text" name="patientID" id="patientID" /><br /><br />
<label for="assigned"> Enrolling Staff Member</label><br />
<input type="text" name="assigned" id="assigned" /><br /><br />
<label for="indexEvent">Index Event</label><br />
<input type="text" id="indexEvent" name="indexEvent" /><br /><br />
<table id="appointments"><br />
<tr><th>Visit Number</th><th>Visit Date</th><th>Delayed Infusion?</th><th>Visit Description</th></tr><br />
</table><br />
</form><br />
<br />
</includeonly></div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Widget:VisitSchedulerRedux&diff=1504899
Widget:VisitSchedulerRedux
2018-11-27T21:45:02Z
<p>Tarek Nafee: </p>
<hr />
<div><includeonly><br />
<link rel="stylesheet" href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css"><br />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script><br />
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script><br />
<script><br />
$.noConflict();<br />
jQuery( document ).ready(function( $ ) {<br />
<br />
$( "#indexEvent" ).datepicker();<br />
$( "#indexEvent" ).change(function(){<br />
var schedule = visitSchedule($("patientID").val(),$("#assigned").val(),new Date($( "#indexEvent" ).val()));<br />
});<br />
function visitSchedule(patient, assigned, index){<br />
var timeConstraints = {<br />
// VisitNum : [Days from Infusion 1, Window + Days, Window - Days, Window + Hours, Window - Hours, Visit, Visit Description, Short Visit Description]<br />
1 : [0, 5, 0, 12, 0, "Visit 2", "Infusion 1 of investigational product should occur no earlier than 12 h after IV contrast and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.", "Infusion 1"],<br />
2 : [7, 4, -2, 0, 0, "Visit 3", "Infusion 2 should occur approximately 7 (-2/+1) days after the 1st infusion (Visit 2) with a minimum window between infusions of at least 5 days.", "Infusion 2"],<br />
3 : [14, 1, -2, 0, 0, "Visit 4", "Infusion 3 should occur approximately 7 (-2/+1) days after the 2nd infusion (Visit 3) with a minimum window between infusions of at least 5 days.", "Infusion 3"],<br />
4 : [21, 1, -2, 0, 0, "Visit 5", "Infusion 4 should occur approximately 7 (-2/+1) days after the 3rd infusion (Visit 4) with a minimum window between infusions of at least 5 days. This infusion must be given within 30 days of the 1st infusion.", "Infusion 4"],<br />
5 : [28, 2, -2, 0, 0, "Visit 6", "This follow-up visit should occur approximately on day 29 (ą2) after the 1st infusion (Visit 5).", "1st Follow-Up After Infusion 4"],<br />
6 : [59, 10, -10, 0, 0, "Visit 7", "This follow-up visit should occur approximately on day 60 (ą10) after the 1st infusion (Visit 2).", "2nd Follow-Up After Infusion 4"],<br />
7 : [89, 10, -10, 0, 0, "Visit 8", "This follow-up visit should occur approximately on day 90 (ą10) after the 1st infusion (Visit 2).", "3rd Follow-Up After Infusion 4"],<br />
8 : [179, 10, -10, 0, 0, "Visit 9", "This follow-up visit should occur approximately on day 180 (ą10) after the 1st infusion (Visit 2).", "4th Follow-Up After Infusion 4"],<br />
9 : [269, 10, -10, 0, 0, "Visit 10", "This follow-up visit should occur approximately on day 270 (ą10) after the 1st infusion (Visit 2).", "5th Follow-Up After Infusion 4"],<br />
10 : [364, 14, -14, 0, 0, "Visit 11", "This follow-up visit should occur approximately on day 365 (ą14) after the 1st infusion (Visit 2).", "End Of Study Visit"],<br />
};<br />
this.patientID = patient;<br />
this.assigned = assigned;<br />
$.each(timeConstraints, function(key, value){<br />
if(key == 1){<br />
currentAppointment = new Date($( "#indexEvent" ).val());<br />
} else {<br />
currentAppointment = new Date($("#visit-"+(key-1)).val());<br />
}<br />
currentAppointment = new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[0]);<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' class='appointment' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='checkbox' class='delayedInfusion' value='"+key+"' /></td><td>"+value[6]+"</td></tr>");<br />
$("#visit-"+key).datepicker({minDate: currentAppointment, maxDate:new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[1])});<br />
});<br />
$(".appointment").change(function(){<br />
var modId = $(this).attr("id").split("-")[1];<br />
var updatedAppointment = new Date($(this).val());<br />
$(this).val(updatedAppointment);<br />
$.each(timeConstraints, function(key, value){<br />
if(key > modId){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment);<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: updatedAppointment, maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
} else if(key == modId){<br />
$("#visit-"+key).val(updatedAppointment);<br />
}<br />
});<br />
});<br />
$(".delayedInfusion").change(function(){<br />
$("#visit-"+$(this).val()).datepicker('destroy');<br />
$("#visit-"+$(this).val()).datepicker();<br />
});<br />
};<br />
<br />
<br />
});<br />
</script><br />
<br />
<form><br />
<label for="patientID">Patient ID</label><br />
<input type="text" name="patientID" id="patientID" /><br /><br />
<label for="assigned"> Enrolling Staff Member</label><br />
<input type="text" name="assigned" id="assigned" /><br /><br />
<label for="indexEvent">Index Event</label><br />
<input type="text" id="indexEvent" name="indexEvent" /><br /><br />
<table id="appointments"><br />
<tr><th>Visit Number</th><th>Visit Date</th><th>Delayed Infusion?</th><th>Visit Description</th></tr><br />
</table><br />
</form><br />
<br />
</includeonly></div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Widget:VisitSchedulerRedux&diff=1504898
Widget:VisitSchedulerRedux
2018-11-27T21:43:50Z
<p>Tarek Nafee: </p>
<hr />
<div><includeonly><br />
<link rel="stylesheet" href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css"><br />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script><br />
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script><br />
<script><br />
$.noConflict();<br />
jQuery( document ).ready(function( $ ) {<br />
<br />
$( "#indexEvent" ).datepicker();<br />
$( "#indexEvent" ).change(function(){<br />
var schedule = visitSchedule($("patientID").val(),$("#assigned").val(),new Date($( "#indexEvent" ).val()));<br />
});<br />
function visitSchedule(patient, assigned, index){<br />
var timeConstraints = {<br />
// VisitNum : [Days from Infusion 1, Window + Days, Window - Days, Window + Hours, Window - Hours, Visit, Visit Description, Short Visit Description]<br />
1 : [0, 5, 0, 12, 0, "Visit 2", "Infusion 1 of investigational product should occur no earlier than 12 h after IV contrast and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.", "Infusion 1"],<br />
2 : [7, 1, -2, 0, 0, "Visit 3", "Infusion 2 should occur approximately 7 (-2/+1) days after the 1st infusion (Visit 2) with a minimum window between infusions of at least 5 days.", "Infusion 2"],<br />
3 : [14, 1, -2, 0, 0, "Visit 4", "Infusion 3 should occur approximately 7 (-2/+1) days after the 2nd infusion (Visit 3) with a minimum window between infusions of at least 5 days.", "Infusion 3"],<br />
4 : [21, 1, -2, 0, 0, "Visit 5", "Infusion 4 should occur approximately 7 (-2/+1) days after the 3rd infusion (Visit 4) with a minimum window between infusions of at least 5 days. This infusion must be given within 30 days of the 1st infusion.", "Infusion 4"],<br />
5 : [28, 2, -2, 0, 0, "Visit 6", "This follow-up visit should occur approximately on day 29 (ą2) after the 1st infusion (Visit 5).", "1st Follow-Up After Infusion 4"],<br />
6 : [59, 10, -10, 0, 0, "Visit 7", "This follow-up visit should occur approximately on day 60 (ą10) after the 1st infusion (Visit 2).", "2nd Follow-Up After Infusion 4"],<br />
7 : [89, 10, -10, 0, 0, "Visit 8", "This follow-up visit should occur approximately on day 90 (ą10) after the 1st infusion (Visit 2).", "3rd Follow-Up After Infusion 4"],<br />
8 : [179, 10, -10, 0, 0, "Visit 9", "This follow-up visit should occur approximately on day 180 (ą10) after the 1st infusion (Visit 2).", "4th Follow-Up After Infusion 4"],<br />
9 : [269, 10, -10, 0, 0, "Visit 10", "This follow-up visit should occur approximately on day 270 (ą10) after the 1st infusion (Visit 2).", "5th Follow-Up After Infusion 4"],<br />
10 : [364, 14, -14, 0, 0, "Visit 11", "This follow-up visit should occur approximately on day 365 (ą14) after the 1st infusion (Visit 2).", "End Of Study Visit"],<br />
};<br />
this.patientID = patient;<br />
this.assigned = assigned;<br />
$.each(timeConstraints, function(key, value){<br />
if(key == 1){<br />
currentAppointment = new Date($( "#indexEvent" ).val());<br />
} else {<br />
currentAppointment = new Date($("#visit-"+(key-1)).val());<br />
}<br />
currentAppointment = new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[0]);<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' class='appointment' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='checkbox' class='delayedInfusion' value='"+key+"' /></td><td>"+value[6]+"</td></tr>");<br />
$("#visit-"+key).datepicker({minDate: currentAppointment, maxDate:new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[1])});<br />
});<br />
$(".appointment").change(function(){<br />
var modId = $(this).attr("id").split("-")[1];<br />
var updatedAppointment = new Date($(this).val());<br />
$(this).val(updatedAppointment);<br />
$.each(timeConstraints, function(key, value){<br />
if(key > modId){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment);<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: updatedAppointment, maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
} else if(key == modId){<br />
$("#visit-"+key).val(updatedAppointment);<br />
}<br />
});<br />
});<br />
$(".delayedInfusion").change(function(){<br />
$("#visit-"+$(this).val()).datepicker('destroy');<br />
$("#visit-"+$(this).val()).datepicker();<br />
});<br />
};<br />
<br />
<br />
});<br />
</script><br />
<br />
<form><br />
<label for="patientID">Patient ID</label><br />
<input type="text" name="patientID" id="patientID" /><br /><br />
<label for="assigned"> Enrolling Staff Member</label><br />
<input type="text" name="assigned" id="assigned" /><br /><br />
<label for="indexEvent">Index Event</label><br />
<input type="text" id="indexEvent" name="indexEvent" /><br /><br />
<table id="appointments"><br />
<tr><th>Visit Number</th><th>Visit Date</th><th>Delayed Infusion?</th><th>Visit Description</th></tr><br />
</table><br />
</form><br />
<br />
</includeonly></div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Widget:VisitSchedulerRedux&diff=1504896
Widget:VisitSchedulerRedux
2018-11-27T21:37:28Z
<p>Tarek Nafee: </p>
<hr />
<div><includeonly><br />
<link rel="stylesheet" href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css"><br />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script><br />
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script><br />
<script><br />
$.noConflict();<br />
jQuery( document ).ready(function( $ ) {<br />
<br />
$( "#indexEvent" ).datepicker();<br />
$( "#indexEvent" ).change(function(){<br />
var schedule = visitSchedule($("patientID").val(),$("#assigned").val(),new Date($( "#indexEvent" ).val()));<br />
});<br />
function visitSchedule(patient, assigned, index){<br />
var timeConstraints = {<br />
// VisitNum : [Days from Infusion 1, Window + Days, Window - Days, Window + Hours, Window - Hours, Visit, Visit Description, Short Visit Description]<br />
1 : [0, 5, 0, 12, 0, "Visit 2", "Infusion 1 of investigational product should occur no earlier than 12 h after IV contrast and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.", "Infusion 1"],<br />
2 : [7, 4, -2, 0, 0, "Visit 3", "Infusion 2 should occur approximately 7 (-2/+1) days after the 1st infusion (Visit 2) with a minimum window between infusions of at least 5 days.", "Infusion 2"],<br />
3 : [14, 1, -2, 0, 0, "Visit 4", "Infusion 3 should occur approximately 7 (-2/+1) days after the 2nd infusion (Visit 3) with a minimum window between infusions of at least 5 days.", "Infusion 3"],<br />
4 : [21, 1, -2, 0, 0, "Visit 5", "Infusion 4 should occur approximately 7 (-2/+1) days after the 3rd infusion (Visit 4) with a minimum window between infusions of at least 5 days. This infusion must be given within 30 days of the 1st infusion.", "Infusion 4"],<br />
5 : [28, 2, -2, 0, 0, "Visit 6", "This follow-up visit should occur approximately on day 29 (ą2) after the 1st infusion (Visit 5).", "1st Follow-Up After Infusion 4"],<br />
6 : [59, 10, -10, 0, 0, "Visit 7", "This follow-up visit should occur approximately on day 60 (ą10) after the 1st infusion (Visit 2).", "2nd Follow-Up After Infusion 4"],<br />
7 : [89, 10, -10, 0, 0, "Visit 8", "This follow-up visit should occur approximately on day 90 (ą10) after the 1st infusion (Visit 2).", "3rd Follow-Up After Infusion 4"],<br />
8 : [179, 10, -10, 0, 0, "Visit 9", "This follow-up visit should occur approximately on day 180 (ą10) after the 1st infusion (Visit 2).", "4th Follow-Up After Infusion 4"],<br />
9 : [269, 10, -10, 0, 0, "Visit 10", "This follow-up visit should occur approximately on day 270 (ą10) after the 1st infusion (Visit 2).", "5th Follow-Up After Infusion 4"],<br />
10 : [364, 14, -14, 0, 0, "Visit 11", "This follow-up visit should occur approximately on day 365 (ą14) after the 1st infusion (Visit 2).", "End Of Study Visit"],<br />
};<br />
this.patientID = patient;<br />
this.assigned = assigned;<br />
$.each(timeConstraints, function(key, value){<br />
if(key == 1){<br />
currentAppointment = new Date($( "#indexEvent" ).val());<br />
} else {<br />
currentAppointment = new Date($("#visit-"+(key-1)).val());<br />
}<br />
currentAppointment = new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[0]);<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' class='appointment' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='checkbox' class='delayedInfusion' value='"+key+"' /></td><td>"+value[6]+"</td></tr>");<br />
$("#visit-"+key).datepicker({minDate: currentAppointment, maxDate:new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[1])});<br />
});<br />
$(".appointment").change(function(){<br />
var modId = $(this).attr("id").split("-")[1];<br />
var updatedAppointment = new Date($(this).val());<br />
$(this).val(updatedAppointment);<br />
$.each(timeConstraints, function(key, value){<br />
if(key > modId){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment);<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: updatedAppointment, maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
} else if(key == modId){<br />
$("#visit-"+key).val(updatedAppointment);<br />
}<br />
});<br />
});<br />
$(".delayedInfusion").change(function(){<br />
$("#visit-"+$(this).val()).datepicker('destroy');<br />
$("#visit-"+$(this).val()).datepicker();<br />
});<br />
};<br />
<br />
<br />
});<br />
</script><br />
<br />
<form><br />
<label for="patientID">Patient ID</label><br />
<input type="text" name="patientID" id="patientID" /><br /><br />
<label for="assigned"> Enrolling Staff Member</label><br />
<input type="text" name="assigned" id="assigned" /><br /><br />
<label for="indexEvent">Index Event</label><br />
<input type="text" id="indexEvent" name="indexEvent" /><br /><br />
<table id="appointments"><br />
<tr><th>Visit Number</th><th>Visit Date</th><th>Delayed Infusion?</th><th>Visit Description</th></tr><br />
</table><br />
</form><br />
<br />
</includeonly></div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Widget:VisitSchedulerRedux&diff=1504895
Widget:VisitSchedulerRedux
2018-11-27T21:33:19Z
<p>Tarek Nafee: </p>
<hr />
<div><includeonly><br />
<link rel="stylesheet" href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css"><br />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script><br />
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script><br />
<script><br />
$.noConflict();<br />
jQuery( document ).ready(function( $ ) {<br />
<br />
$( "#indexEvent" ).datepicker();<br />
$( "#indexEvent" ).change(function(){<br />
var schedule = visitSchedule($("patientID").val(),$("#assigned").val(),new Date($( "#indexEvent" ).val()));<br />
});<br />
function visitSchedule(patient, assigned, index){<br />
var timeConstraints = {<br />
// VisitNum : [Days from Infusion 1, Window + Days, Window - Days, Window + Hours, Window - Hours, Visit, Visit Description, Short Visit Description]<br />
1 : [0, 5, 0, 12, 0, "Visit 2", "Infusion 1 of investigational product should occur no earlier than 12 h after IV contrast and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.", "Infusion 1"],<br />
2 : [7, 4, -2, 0, 0, "Visit 3", "Infusion 2 should occur approximately 7 (-2/+1) days after the 1st infusion (Visit 2) with a minimum window between infusions of at least 5 days.", "Infusion 2"],<br />
3 : [14, 1, -2, 0, 0, "Visit 4", "Infusion 3 should occur approximately 7 (-2/+1) days after the 2nd infusion (Visit 3) with a minimum window between infusions of at least 5 days.", "Infusion 3"],<br />
4 : [21, 1, -2, 0, 0, "Visit 5", "Infusion 4 should occur approximately 7 (-2/+1) days after the 3rd infusion (Visit 4) with a minimum window between infusions of at least 5 days. This infusion must be given within 30 days of the 1st infusion.", "Infusion 4"],<br />
5 : [28, 2, -2, 0, 0, "Visit 6", "This follow-up visit should occur approximately on day 29 (ą2) after the 1st infusion (Visit 5).", "1st Follow-Up After Infusion 4"],<br />
6 : [59, 10, -10, 0, 0, "Visit 7", "This follow-up visit should occur approximately on day 60 (ą10) after the 1st infusion (Visit 2).", "2nd Follow-Up After Infusion 4"],<br />
7 : [89, 10, -10, 0, 0, "Visit 8", "This follow-up visit should occur approximately on day 90 (ą10) after the 1st infusion (Visit 2).", "3rd Follow-Up After Infusion 4"],<br />
8 : [179, 10, -10, 0, 0, "Visit 9", "This follow-up visit should occur approximately on day 180 (ą10) after the 1st infusion (Visit 2).", "4th Follow-Up After Infusion 4"],<br />
9 : [269, 10, -10, 0, 0, "Visit 10", "This follow-up visit should occur approximately on day 270 (ą10) after the 1st infusion (Visit 2).", "5th Follow-Up After Infusion 4"],<br />
10 : [364, 14, -14, 0, 0, "Visit 11", "This follow-up visit should occur approximately on day 365 (ą14) after the 1st infusion (Visit 2).", "End Of Study Visit"],<br />
};<br />
this.patientID = patient;<br />
this.assigned = assigned;<br />
$.each(timeConstraints, function(key, value){<br />
if(key == 1){<br />
currentAppointment = new Date($( "#indexEvent" ).val());<br />
} else {<br />
currentAppointment = new Date($("#visit-"+(key-1)).val());<br />
}<br />
currentAppointment = new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[0]);<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' class='appointment' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='checkbox' class='delayedInfusion' value='"+key+"' /></td><td>"+value[6]+"</td></tr>");<br />
$("#visit-"+key).datepicker({minDate: currentAppointment, maxDate:new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[1])});<br />
});<br />
$(".appointment").change(function(){<br />
var modId = $(this).attr("id").split("-")[1];<br />
var updatedAppointment = new Date($(this).val());<br />
$(this).val(updatedAppointment);<br />
$.each(timeConstraints, function(key, value){<br />
if(key > modId){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment);<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: updatedAppointment, maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
} else if(key == modId){<br />
$("#visit-"+key).val(updatedAppointment);<br />
}<br />
});<br />
});<br />
$(".delayedInfusion").change(function(){<br />
$("#visit-"+$(this).val()).datepicker('destroy');<br />
$("#visit-"+$(this).val()).datepicker();<br />
});<br />
};<br />
<br />
<br />
});<br />
</script><br />
<br />
<form><br />
<label for="patientID">Patient ID</label><br />
<input type="text" name="patientID" id="patientID" /><br /><br />
<label for="assigned"> Doctor Assigned</label><br />
<input type="text" name="assigned" id="assigned" /><br /><br />
<label for="indexEvent">Index Event</label><br />
<input type="text" id="indexEvent" name="indexEvent" /><br /><br />
<table id="appointments"><br />
<tr><th>Visit Number</th><th>Visit Date</th><th>Delayed Infusion?</th><th>Visit Description</th></tr><br />
</table><br />
</form><br />
<br />
</includeonly></div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Widget:VisitSchedulerRedux&diff=1504894
Widget:VisitSchedulerRedux
2018-11-27T21:32:09Z
<p>Tarek Nafee: </p>
<hr />
<div><includeonly><br />
<link rel="stylesheet" href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css"><br />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script><br />
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script><br />
<script><br />
$.noConflict();<br />
jQuery( document ).ready(function( $ ) {<br />
<br />
$( "#indexEvent" ).datepicker();<br />
$( "#indexEvent" ).change(function(){<br />
var schedule = visitSchedule($("patientID").val(),$("#assigned").val(),new Date($( "#indexEvent" ).val()));<br />
});<br />
function visitSchedule(patient, assigned, index){<br />
var timeConstraints = {<br />
// VisitNum : [Days from Infusion 1, Window + Days, Window - Days, Window + Hours, Window - Hours, Visit, Visit Description, Short Visit Description]<br />
1 : [0, 5, 0, 12, 0, "Visit 2", "Infusion 1 of investigational product should occur no earlier than 12 h after IV contrast and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.", "Infusion 1"],<br />
2 : [7, -2, 1, 0, 0, "Visit 3", "Infusion 2 should occur approximately 7 (-2/+1) days after the 1st infusion (Visit 2) with a minimum window between infusions of at least 5 days.", "Infusion 2"],<br />
3 : [14, 1, -2, 0, 0, "Visit 4", "Infusion 3 should occur approximately 7 (-2/+1) days after the 2nd infusion (Visit 3) with a minimum window between infusions of at least 5 days.", "Infusion 3"],<br />
4 : [21, 1, -2, 0, 0, "Visit 5", "Infusion 4 should occur approximately 7 (-2/+1) days after the 3rd infusion (Visit 4) with a minimum window between infusions of at least 5 days. This infusion must be given within 30 days of the 1st infusion.", "Infusion 4"],<br />
5 : [28, 2, -2, 0, 0, "Visit 6", "This follow-up visit should occur approximately on day 29 (ą2) after the 1st infusion (Visit 5).", "1st Follow-Up After Infusion 4"],<br />
6 : [59, 10, -10, 0, 0, "Visit 7", "This follow-up visit should occur approximately on day 60 (ą10) after the 1st infusion (Visit 2).", "2nd Follow-Up After Infusion 4"],<br />
7 : [89, 10, -10, 0, 0, "Visit 8", "This follow-up visit should occur approximately on day 90 (ą10) after the 1st infusion (Visit 2).", "3rd Follow-Up After Infusion 4"],<br />
8 : [179, 10, -10, 0, 0, "Visit 9", "This follow-up visit should occur approximately on day 180 (ą10) after the 1st infusion (Visit 2).", "4th Follow-Up After Infusion 4"],<br />
9 : [269, 10, -10, 0, 0, "Visit 10", "This follow-up visit should occur approximately on day 270 (ą10) after the 1st infusion (Visit 2).", "5th Follow-Up After Infusion 4"],<br />
10 : [364, 14, -14, 0, 0, "Visit 11", "This follow-up visit should occur approximately on day 365 (ą14) after the 1st infusion (Visit 2).", "End Of Study Visit"],<br />
};<br />
this.patientID = patient;<br />
this.assigned = assigned;<br />
$.each(timeConstraints, function(key, value){<br />
if(key == 1){<br />
currentAppointment = new Date($( "#indexEvent" ).val());<br />
} else {<br />
currentAppointment = new Date($("#visit-"+(key-1)).val());<br />
}<br />
currentAppointment = new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[0]);<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' class='appointment' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='checkbox' class='delayedInfusion' value='"+key+"' /></td><td>"+value[6]+"</td></tr>");<br />
$("#visit-"+key).datepicker({minDate: currentAppointment, maxDate:new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[1])});<br />
});<br />
$(".appointment").change(function(){<br />
var modId = $(this).attr("id").split("-")[1];<br />
var updatedAppointment = new Date($(this).val());<br />
$(this).val(updatedAppointment);<br />
$.each(timeConstraints, function(key, value){<br />
if(key > modId){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment);<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: updatedAppointment, maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
} else if(key == modId){<br />
$("#visit-"+key).val(updatedAppointment);<br />
}<br />
});<br />
});<br />
$(".delayedInfusion").change(function(){<br />
$("#visit-"+$(this).val()).datepicker('destroy');<br />
$("#visit-"+$(this).val()).datepicker();<br />
});<br />
};<br />
<br />
<br />
});<br />
</script><br />
<br />
<form><br />
<label for="patientID">Patient ID</label><br />
<input type="text" name="patientID" id="patientID" /><br /><br />
<label for="assigned"> Doctor Assigned</label><br />
<input type="text" name="assigned" id="assigned" /><br /><br />
<label for="indexEvent">Index Event</label><br />
<input type="text" id="indexEvent" name="indexEvent" /><br /><br />
<table id="appointments"><br />
<tr><th>Visit Number</th><th>Visit Date</th><th>Delayed Infusion?</th><th>Visit Description</th></tr><br />
</table><br />
</form><br />
<br />
</includeonly></div>
Tarek Nafee
https://www.wikidoc.org/index.php?title=Widget:VisitSchedulerRedux&diff=1504893
Widget:VisitSchedulerRedux
2018-11-27T21:29:59Z
<p>Tarek Nafee: </p>
<hr />
<div><includeonly><br />
<link rel="stylesheet" href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css"><br />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script><br />
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script><br />
<script><br />
$.noConflict();<br />
jQuery( document ).ready(function( $ ) {<br />
<br />
$( "#indexEvent" ).datepicker();<br />
$( "#indexEvent" ).change(function(){<br />
var schedule = visitSchedule($("patientID").val(),$("#assigned").val(),new Date($( "#indexEvent" ).val()));<br />
});<br />
function visitSchedule(patient, assigned, index){<br />
var timeConstraints = {<br />
// VisitNum : [Days from Infusion 1, Window + Days, Window - Days, Window + Hours, Window - Hours, Visit, Visit Description, Short Visit Description]<br />
1 : [0, 5, 0, 12, 0, "Visit 2", "Infusion 1 of investigational product should occur no earlier than 12 h after IV contrast and be dosed within 5 days of First Medical Contact. Subjects who are to undergo angiography and, therefore, receive IV contrast agent must have stable renal function.", "Infusion 1"],<br />
2 : [7, 1, -2, 0, 0, "Visit 3", "Infusion 2 should occur approximately 7 (-2/+1) days after the 1st infusion (Visit 2) with a minimum window between infusions of at least 5 days.", "Infusion 2"],<br />
3 : [14, 1, -2, 0, 0, "Visit 4", "Infusion 3 should occur approximately 7 (-2/+1) days after the 2nd infusion (Visit 3) with a minimum window between infusions of at least 5 days.", "Infusion 3"],<br />
4 : [21, 1, -2, 0, 0, "Visit 5", "Infusion 4 should occur approximately 7 (-2/+1) days after the 3rd infusion (Visit 4) with a minimum window between infusions of at least 5 days. This infusion must be given within 30 days of the 1st infusion.", "Infusion 4"],<br />
5 : [28, 2, -2, 0, 0, "Visit 6", "This follow-up visit should occur approximately on day 29 (ą2) after the 1st infusion (Visit 5).", "1st Follow-Up After Infusion 4"],<br />
6 : [59, 10, -10, 0, 0, "Visit 7", "This follow-up visit should occur approximately on day 60 (ą10) after the 1st infusion (Visit 2).", "2nd Follow-Up After Infusion 4"],<br />
7 : [89, 10, -10, 0, 0, "Visit 8", "This follow-up visit should occur approximately on day 90 (ą10) after the 1st infusion (Visit 2).", "3rd Follow-Up After Infusion 4"],<br />
8 : [179, 10, -10, 0, 0, "Visit 9", "This follow-up visit should occur approximately on day 180 (ą10) after the 1st infusion (Visit 2).", "4th Follow-Up After Infusion 4"],<br />
9 : [269, 10, -10, 0, 0, "Visit 10", "This follow-up visit should occur approximately on day 270 (ą10) after the 1st infusion (Visit 2).", "5th Follow-Up After Infusion 4"],<br />
10 : [364, 14, -14, 0, 0, "Visit 11", "This follow-up visit should occur approximately on day 365 (ą14) after the 1st infusion (Visit 2).", "End Of Study Visit"],<br />
};<br />
this.patientID = patient;<br />
this.assigned = assigned;<br />
$.each(timeConstraints, function(key, value){<br />
if(key == 1){<br />
currentAppointment = new Date($( "#indexEvent" ).val());<br />
} else {<br />
currentAppointment = new Date($("#visit-"+(key-1)).val());<br />
}<br />
currentAppointment = new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[0]);<br />
$("#appointments").append("<tr><td>"+value[5]+"</td><td><input type='text' class='appointment' id='visit-"+key+"' value='"+currentAppointment.toDateString()+"' /></td><td><input type='checkbox' class='delayedInfusion' value='"+key+"' /></td><td>"+value[6]+"</td></tr>");<br />
$("#visit-"+key).datepicker({minDate: currentAppointment, maxDate:new Date(currentAppointment.getFullYear(), currentAppointment.getMonth(), currentAppointment.getDate()+value[1])});<br />
});<br />
$(".appointment").change(function(){<br />
var modId = $(this).attr("id").split("-")[1];<br />
var updatedAppointment = new Date($(this).val());<br />
$(this).val(updatedAppointment);<br />
$.each(timeConstraints, function(key, value){<br />
if(key > modId){<br />
updatedAppointment = new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[0]);<br />
$("#visit-"+key).val(updatedAppointment);<br />
$("#visit-"+key).datepicker('destroy');<br />
$("#visit-"+key).datepicker({minDate: updatedAppointment, maxDate:new Date(updatedAppointment.getFullYear(), updatedAppointment.getMonth(), updatedAppointment.getDate()+value[1])});<br />
} else if(key == modId){<br />
$("#visit-"+key).val(updatedAppointment);<br />
}<br />
});<br />
});<br />
$(".delayedInfusion").change(function(){<br />
$("#visit-"+$(this).val()).datepicker('destroy');<br />
$("#visit-"+$(this).val()).datepicker();<br />
});<br />
};<br />
<br />
<br />
});<br />
</script><br />
<br />
<form><br />
<label for="patientID">Patient ID</label><br />
<input type="text" name="patientID" id="patientID" /><br /><br />
<label for="assigned"> Doctor Assigned</label><br />
<input type="text" name="assigned" id="assigned" /><br /><br />
<label for="indexEvent">Index Event</label><br />
<input type="text" id="indexEvent" name="indexEvent" /><br /><br />
<table id="appointments"><br />
<tr><th>Visit Number</th><th>Visit Date</th><th>Delayed Infusion?</th><th>Visit Description</th></tr><br />
</table><br />
</form><br />
<br />
</includeonly></div>
Tarek Nafee