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{{Oral cancer}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Oral_cancer]]
{{CMG}};{{AE}}{{Simrat}}
{{CMG}}; {{AE}} {{DAMI}}; {{GRR}} {{Nat}}  
 
==Overview==
==Overview==
Oral cancer must be differentiated from actinic keratosis, Dermatologic Manifestations of Oral Leukoplakia, Erythroplasia and [differential dx3].
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another.
==Oral cancer differential diagnosis==
==Oral cancer differential diagnosis==
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.
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures
|-
|[[Squamous cell carcinoma]]
* Basaloid squamous cell carcinoma
* Papillary squamous cell carcinoma
* Spindle cell carcinoma
* Acantholytic squamous cell carcinoma
* Acantholytic squamous cell carcinoma
* [[Adenosquamous carcinoma]]
|[[Verrucous carcinoma]]
|8051/3
|
* Older males
* 5th and 6th decades of life
* Males are affected more often than females
|
* [[Tobacco smoking]] and [[alcohol]]
* Chronic smokeless tobacco
* [[HPV|HPV 16]] and 18
|
* Lip SCC arise  almost exclusively on the lower lip
* [[Buccal  mucosa]]
* Upper and lower  [[gingiva]]
* [[Hard  palate]]
* Anterior two-thirds  of the [[tongue]],  including dorsal, ventral and lateral surfaces, and the floor of mouth
|
* Often asymptomatic or may present with  vague symptoms and minimal physical finding
|Biopsy shows:
Thickened club-shaped
[[papillae]] and blunt stromal  invaginations
of well-differentiated [[squamous  epithelium]] with marked [[keratinization]]
|-
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]
|
|8082/3
|0.8-2% of all oral or oropharyngeal cancers
|[[EBV]]
|
* [[Tonsil]] and [[tongue]](90%)
* [[Palate]] and [[buccal  mucosa]] (others)
|
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]]. 
* Some tumors can  be bilateral
|Biopsy chows:
* Syncytial sheets and  clusters of  [[Carcinoma|carcinoma  cells]] with [[Vesicular|vesicular  nuclei]]
* Prominent [[nucleoli]]  and ill-defined cell  borders
* A rich  [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present
|-
|[[Epithelial cells|Epithelial precursor]] lesions
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|[[Smoking]]
|Seen in the entire [[digestive tract]]
|
* White patches ([[leukoplakia]])
* Red patches ([[Erythroplasia of Queyrat|erythroplasia]]/[[erythroplakia]])
* Mixed red and white lesions
|Biopsy shows:
* [[Hyperplasia]]
* [[Dysplasia]] / squamous  intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]
* [[Carcinoma in situ|Carcinoma in-situ]]
|-
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|
* Average age at diagnosis is 62 years
* Women are more commonly  affected (ratio, 4:1)
|Unknown
|
* [[Buccal  mucosa]] in women
* [[Tongue]]  in  men.
|An aggressive form of  [[oral  leukoplakia]] with considerable morbidity  and strong predilection  to [[malignant  transformation]]
|Biopsy shows:
* Extensive, thick, white plaques
* [[Hyperplasia]] and dense [[hyperkeratosis]]
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]
|-
| rowspan="3" |[[Papillomas]]
|[[Squamous cell papilloma]] and
[[verruca vulgaris]]
|
|
* Common in children and in  adults in the 3rd to 5th decades
* Almost equal sex incidence with a slight male predominance
|[[HPV]] sub-types
2, 4, 6, 7,10, and 40
|Any oral site may be affected mostly:
* [[Hard palate|Hard]] and [[soft  palate]]
* [[Labial]] [[Mucous membrane|mucosa]]
* [[Tongue]]
* [[Gingiva]]
|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
|Biopsy shows:
* Exophytic and  comprise folds of [[hyperplastic]] [[stratified epithelium]]
* Cluster of finger-like  projections 
|-
|[[Condyloma acuminatum]]
|
|2nd and 5th decade with a peak in teenagers and young adults
|
* [[HPV]]-  most  common sub-types: 6, 11, 16 and 18
|
* [[Labial]] [[mucosa]]
* [[Tongue]]
* [[Palate]]
|
* Painless, rounded, dome-shaped exophytic  [[nodules]]
* 15 mm  in  diameter
* Have a broad base and a [[nodular]] or mulberry-like surface that  is slightly red, pink or  of normal [[Mucous membrane|mucosal]]  color.
* Lesions may be multiple and are then usually clustered
|Biopsy shows:
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster
|-
|[[Focal epithelial hyperplasia]]
|<nowiki>---</nowiki>
|[[Disease]] of children, adolescents and young adults
|[[HPV]] sub types:
13 and 32
|
* All areas of the [[oral cavity]]
* [[Labia]]
* [[Buccal  mucosa]]
* [[Tongue]]
|
* Multiple asymptomatic [[lesions]]
* Soft rounded or flat plaque-like [[sessile]] swelling.
* Usually pink or white in color
* 2-10 mm  in  diameter
|Biopsy shows:
* Rounded [[sessile]]  swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually  present
* “Mitosoid  bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure
|-
|[[Granular cell tumor]]
|<nowiki>---</nowiki>
|9580/0
|
* Arise in all age groups, with a peak between 40 and 60 years
* Females are affected more  often than males with an M/F ratio of 2:1
|No etiological factors  are known
|
* [[Tongue]] is the most common single site
* [[Buccal mucosa]]
* Floor of oral cavity
* [[Palate]]
* [[Salivary gland]]
|
* Lesion presents as  a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]]
* 1-2 cm in diameter with a firm texture
* The overlying [[epithelium]] is of normal color or may  be slightly pale
|Biopsy shows:
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]
|-
|[[Keratoacanthoma]]
|<nowiki>---</nowiki>
|8071/1
|
* Occurs more often in
whites
* Twice as frequent in
men as in women
|Associated with uptake of  [[carcinogens]] (e.g. via  particular [[smoking]] habits)
|
* [[Skin]] of the face, including the [[lips]]
* [[Mucocutaneous|Mucocutaneous linings]]  may also  be involved
|
* [[Verrucous carcinoma|Verrucous]],  speckled or [[Ulcerated lesion|ulcerated lesions]]
* Deep projections,  which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone
|Biopsy shows:
* [[Verrucous carcinoma|Verrucous]] surface,  [[keratinized]] clefts and  penetrating squamous  [[Rete pegs|rete processes]]
* Minimal [[atypia]] seen
|-
|[[Papillary|Papillary hyperplasia]]
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|Affects all age groups
|Associated with:
* Wearing ill-fitting [[dentures]]
* [[Xerostomia]]
* Individuals with a [[high arched palate|high-arched palate]]
* [[HIV AIDS|HIV infection]]
|[[Palate]]
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]
|Biopsy shows:
* Parakeratinisation or  less frequently orthokeratinisation
|-
|Median rhomboid glossitis
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|Associated with chronic [[Candidal|candidal infection]]
|Dorsum of the tongue at the junction of the anterior two-thirds
and posterior third
|Forms a patch of papillary atrophy in the  region of the
embryological [[Foramen cecum|foramen  caecum]]
|Biopsy shows:
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]
* Areas of  pseudoepitheliomatous  [[hyperplasia]]
* [[Atypia]] may be present
|-
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]
|[[Acinic cell carcinoma]]
|8550/3
|
* 2-6.5% of all intra-oral  [[Salivary gland tumor|salivary gland tumors]]
* Age range from 11-77 years, with a mean of 45 years
* Male to female ratio of 1.5:1
|Unknown
|
* [[Buccal  mucosa]]
* [[Upper  lip]]
* [[Palate]]
|[[Tumors]] usually
form non-descript swellings
|Biopsy shows:
* Solid sheets of  [[epithelium]] with secretory material
* Ductal differentiation in [[tumors]]
|-
|[[Mucoepidermoid carcinoma]]
|8430/3
|
* 9.5-23% of all minor gland tumors
|Unknown
|
* [[Palate]] (most common site)
* [[Buccal mucosa]]
* [[Lips]]: upper>lower
* Floor of [[oral  cavity]]
* Retromolar pad
|
* Asymptomatic
* Bluish, domed  swellings that  resemble mucoceles  or [[Hemangioma|haemangiomas]]
* High-grade tumors result in [[ulceration]], loosening of teeth, [[Paresthesia|paraesthesia]] or [[Anesthesia|anaesthesia]]
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma
|-
|Adenoid cystic carcinoma
|8200/3
|
* 42.5% of minor gland tumors
*
|Unknown
|
* [[Tongue]]
* [[Tonsil]] 
* [[Oropharynx]]
* [[Cheek]]
* [[Lips]]
* Retromolar  pad  and  [[gingiva]]
|
* Slow growing [[Submucosa|sub-mucosal]] masses and [[ulceration]] may  be seen, particularly  in the [[palate]]
* [[Pain]], or evidence  of [[Nerve|nerve involvement,]] is usually only present  in advanced tumors
|
Predominantly solid variant shows peri- and intraneural invasion
|-
|Epithelial-myoepithelial
carcinoma                         
|8562/3
|<nowiki>---</nowiki>
|Unknown
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|-
|[[Clear cell tumor|Clear cell carcinoma,]]
NOS
|8310/3
|
|Unknown
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|-
|[[Basal cell carcinoma|Basal cell]]
[[Basal cell carcinoma|adenocarcinoma]]
|8147/3
|Rare in minor glands
|Unknown
|
* [[Palate]]
* [[Buccal  mucosa]]
* [[Lip]]
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal  masses]]
|Microscopically similar to [[Basal cell carcinoma|basal]] [[Basal cell carcinoma|cell adenocarcinomas]] of the major gland
|-
|[[Cystadenocarcinoma]]       
|8450/3
|32% developed in the minor glands
|Unknown
|
* [[Palate]]
* [[Lips]]
* [[Buccal  mucosa]]
* [[Tongue]] and  retromolar  regions
|Slow growing and painless but some[[palatal]] [[tumors]] may erode the underlying bone-causing sinonasal  complex
|<nowiki>---</nowiki>
|-
|Salivary duct carcinoma
|8500/3
|
* Rare in minor salivary glands
* Age range is 23-80 years  (mean is 56 years)
|Unknown
|
* [[Palate]] (65%)
* [[Buccal  mucosa]] and [[vestibule]]  (19%)
* [[Tongue]] (8%)
* Retromolar pad  (4%) and [[upper  lip]]  (4%)
|[[Tumor|Tumors]] form 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]]
|The range of
microscopical appearances is similar
to that seen in the major glands
|-
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]
|[[Pleomorphic adenoma]]
|8940/0
|40-70% of minor gland tumors
|Unknown
|
* [[Palate]]
* [[Lips]]
* [[Buccal  mucosa]]
|Painless, slow-growing,  [[Submucosa|submucosal]] masses,  but when traumatized  may [[bleed]] or [[Ulcer|ulcerate]]
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell
|-
|Myoepithelioma
|8982/0
|42% of minor gland tumors
|Unknown
|
* [[Palate]] of younger individuals
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|-
|Basal cell adenoma
|8147/0
|20% of minor gland tumors
|Unknown
|
* [[Upper  lip]]
* [[Buccal  mucosa]]
|<nowiki>---</nowiki>
|They are histologically
similar to those in major glands.
|-
|[[Cystadenoma]]
|8149/0
|7% of benign minor gland tumors
|Uknown
|
* [[Lips]]
* [[Cheek]]
* [[Palate]]
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|-
|[[Kaposi's sarcoma|Kaposi sarcoma]]
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|
* Classic (elderly men of Mediterranean/East European descent)
* [[Endemic]] (middle-aged adults and children in Equatorial Africa, who are not [[HIV infected adolescents|HIV  infected]])
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)
* [[AIDS associated Kaposi sarcoma|AIDS-associated]] ([[HIV-1 protease|HIV-1]] infected individuals)
|
* [[HHV-8]]
* [[Immunology|Immunologic]], [[genetic]], and environmental factors
|
* [[Skin]] (most common)
* [[Mucous membrane|Mucosal membranes]], such  as [[oral  mucosa]],  [[lymph nodes]] and  [[Visceral organ|visceral organs]]
|
* Purplish, reddish-blue or dark brown [[macules]]
* [[Plaques]] and [[nodules]] that  may [[Ulcerated lesion|ulcerate]]
|Biopsy of all 4 types show:
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]
|-
|[[Lymphangioma]]
|<nowiki>---</nowiki>
|9170/0
|
* [[Pediatric Oncology Group|Pediatric lesions]]
* Present at birth or    during the first years of  life
* Appear mostly in  the head and neck area but may be found in any other part of the body
|
* [[Developmental abnormality|Developmental  malformation]]
* [[Genetic disorder|Genetic  abnormalities]]
* [[Turner's syndrome]]
|[[Tongue]]
|
* Circumscribed painless  swelling
* Soft and fluctuant on palpation
* Irregular nodularity of the  dorsum of the [[tongue]]
|Biopsy shows:
* Thin-walled, dilated  [[lymphatic  vessels]]  of different size, which are  lined by a flattened [[endothelium]]
|-
|Ectomesenchymal chondromyxoid
tumour of the anterior tongue
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|
* Age range varies  from 9-78 years 
* No distinct sex predilection.
|Unknown
|<nowiki>---</nowiki>
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue
|Biopsy shows:
* Round, cup-shaped, [[fusiform]], or polygonal  cells with uniform small  [[nuclei]] and moderate amounts of [[Basophilic|faintly basophilic cytoplasm]]
* Some tumors may show  nuclear pleomorphism,  hyperchromatism, and multinucleation
|-
|Focal oral mucinosis (FOM)
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|
* The lesion affects  all ages
* Rare in children
* There is no distinct sex predilection.
|Unknown
|
* [[Gingiva]] (most common site)
* [[Palate]]
* Cheek [[mucosa]]
* [[Tongue]]
|Asymptomatic fibrous or cystic-like lesion
|Histopathology is characterized by:
* Well-circumscribed area  of [[myxomatous]] tissue
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]
* Absent or sparse [[reticular  fibers]]
* [[Mucinous]] material  shows alcianophilia at  pH  2.5
|-
|Congenital granular cell epuli
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|
* Affects newborns
* Females are affected ten times more often than males
|Etiology uncertain
|
* [[Maxilla]]
* [[Mandible]]
|[[Solitary]], somewhat [[pedunculated|edunculated]]  fibroma-like lesion, attached to the alveolar ridge near the mid-line
|
* Ultrasound for prenatal diagnosis
* Immuno-histochemically,  the tumor cells are positive for [[vimentin]] and  neuron specific [[enolase]]
* No reactivity with  [[cytokeratin]], [[CEA]],  [[desmin]], hormone receptors or [[S-100]]
|-
| rowspan="5" |Hematolymphoid tumors
|[[Non-Hodgkin lymphoma]]
|<nowiki>---</nowiki>
|Second most common  cancer of the [[oral  cavity]]
|
* There is no known  etiology in most patients
* Underlying  [[immunodeficiency]]  state (e.g. [[HIV AIDS classification|HIV Infection]])
* Strong association with [[Epstein Barr virus|EBV]]
|
* [[Palate]]
* [[Tongue]]
* Floor of mouth
* [[Gingiva]]
* [[Buccal mucosa]]
* [[Lips]]
* [[Palatine tonsils]]
* [[Lingual tonsils]]
* [[Oropharynx]]
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:
* [[Ulcer]]
* [[Swelling]]
* [[Discolored tongue|Discoloration]]
* [[Pain]]
* [[Paresthesia|Paresthesia]]
* [[Anesthesia|Anesthesia]]
* Loose teeth
|
Biopsy shows:
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].
* Large cells with round or multilobated nuclei
|-
|[[Langerhans cell histiocytosis]]
|9751/1
|<nowiki>---</nowiki>
|Associated with:
* [[Eosinophilic granuloma|Eosinophilic  granulomas]]
* Multifocal  multisystem  disease
|
* Jaw bone
* Intra-oral soft tissues
* [[Gingiva]]
* [[Palate]]
* Floor of mouth
* [[Buccal  mucosa]]
* [[Tonsil cancer|Tonsil]]
|Common oral symptoms
include:
* [[Swelling]]
* [[Pain]]
* [[Gingivitis]]
* Loose teeth
* [[Ulceration]]
|Biopsy shows ovoid [[Langerhans  cells]]
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]
|-
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]
|
|<nowiki>---</nowiki>
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]
|
* [[Waldeyer's ring|Waldeyer ring,]]  particularly the  [[palatine tonsil]]
* [[Oropharynx]] 
* Alveolar crest of  [[mandible]]
* [[Maxillary bone|Maxillary gingiva]]
|Most patients present with localized disease (stage I/II), with
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without  enlarged [[cervical  lymph nodes]]
|<nowiki>---</nowiki>
|-
|Extramedullary myeloid
sarcoma
|9930/3
|<nowiki>---</nowiki>
|History of [[Acute myeloid leukemia|acute  myeloid  leukaemia]],
predominantly in the  [[Monocyte|monocytic]] or myelomonocytic      sub-types
|
* [[Palate]]
* [[Gingiva]]
|Isolated tumor-forming intra-oral mass
|Biopsy shows an Indian-file pattern of infiltration
|-
|[[Follicular dendritic cell]]
sarcoma / tumour
|9758/3
|
* Tumor of adulthood
* Affects wide age range
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]
|
* [[Tonsil]]
* [[Palate]]
* [[Oropharynx]]
|The patients usually present  with a painless mass
|Biopsy usually exhibits
borders and comprises:
* [[Fascicles]]
* Whorls
* [[Nodules]] 
* Storiform arrays 
* Diffused sheets of  spindle to ovoid tumor  cells sprinkled with small  [[lymphocytes]]
|-
|Mucosal malignant melanoma
|<nowiki>---</nowiki>
|8720/3
|
* 0.5% of oral malignancies
* Incidence 0.02 per 100,000
|No known etiological  factors associated with oral melanoma
|80% arise:
* [[Palate]]
* Maxillary alveolus or [[Gingiva|gingivae]]
* Mandibular gingiva
Others:
* [[Buccal mucosa]]
* Floor of mouth
* [[Tongue]]
|
* Asymmetric with irregular  outlines
* Macular pigmentation
* Nodular growth
* [[Ulceration]] 
* [[Melanosis]]
|
* Biopsy:
* S100 positive
* Negative for  cytokeratins 
* More specific markers  include:
* HMB45
* Melan-A or anti-tyrosinase
|-
|
|
|
|
|
|
|
|
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
[[Category:Needs content]]
 


{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Otolaryngology]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Differential diagnosis]]

Latest revision as of 12:49, 11 April 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]; Grammar Reviewer: Natalie Harpenau, B.S.[3]

Overview

There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another.

Oral cancer differential diagnosis

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.

Type of cancer Subtype ICD-O Code Epidemiology Etiology Localization Clinical features Diagnostic procedures
Squamous cell carcinoma
  • Basaloid squamous cell carcinoma
  • Papillary squamous cell carcinoma
  • Spindle cell carcinoma
  • Acantholytic squamous cell carcinoma
  • Acantholytic squamous cell carcinoma
  • Adenosquamous carcinoma
Verrucous carcinoma 8051/3
  • Older males
  • 5th and 6th decades of life
  • Males are affected more often than females
  • Hard palate
  • Anterior two-thirds of the tongue, including dorsal, ventral and lateral surfaces, and the floor of mouth
  • Often asymptomatic or may present with vague symptoms and minimal physical finding
Biopsy shows:

Thickened club-shaped

papillae and blunt stromal invaginations

of well-differentiated squamous epithelium with marked keratinization

Lymphoepithelial carcinoma 8082/3 0.8-2% of all oral or oropharyngeal cancers EBV
  • Some tumors can be bilateral
Biopsy chows:
Epithelial precursor lesions --- --- --- Smoking Seen in the entire digestive tract Biopsy shows:
Proliferative verrucous leukoplakia and precancerous conditions --- ---
  • Average age at diagnosis is 62 years
  • Women are more commonly affected (ratio, 4:1)
Unknown An aggressive form of oral leukoplakia with considerable morbidity and strong predilection to malignant transformation Biopsy shows:
Papillomas Squamous cell papilloma and

verruca vulgaris

  • Common in children and in adults in the 3rd to 5th decades
  • Almost equal sex incidence with a slight male predominance
HPV sub-types

2, 4, 6, 7,10, and 40

Any oral site may be affected mostly: Soft, pedunculated lesions formed by a cluster of finger-like fronds or a sessile, dome-shaped lesion with a nodular, papillary or verrucous surface Biopsy shows:
Condyloma acuminatum 2nd and 5th decade with a peak in teenagers and young adults
  • HPV- most common sub-types: 6, 11, 16 and 18
  • Painless, rounded, dome-shaped exophytic nodules
  • 15 mm in diameter
  • Have a broad base and a nodular or mulberry-like surface that is slightly red, pink or of normal mucosal color.
  • Lesions may be multiple and are then usually clustered
Biopsy shows:

Several sessile, cauliflower-like swellings forming a cluster

Focal epithelial hyperplasia --- Disease of children, adolescents and young adults HPV sub types:

13 and 32

  • Soft rounded or flat plaque-like sessile swelling.
  • Usually pink or white in color
  • 2-10 mm in diameter
Biopsy shows:
  • Rounded sessile swelling formed by a sharply demarcated zone of epithelial acanthosis
  • Koilocytes similar to those of squamous papilloma are usually present
Granular cell tumor --- 9580/0
  • Arise in all age groups, with a peak between 40 and 60 years
  • Females are affected more often than males with an M/F ratio of 2:1
No etiological factors are known
  • The overlying epithelium is of normal color or may be slightly pale
Biopsy shows:
Keratoacanthoma --- 8071/1
  • Occurs more often in

whites

  • Twice as frequent in

men as in women

Associated with uptake of carcinogens (e.g. via particular smoking habits) Biopsy shows:
Papillary hyperplasia --- --- Affects all age groups Associated with: Palate Asymptomatic nodular or papillary mucosal lesion Biopsy shows:
  • Parakeratinisation or less frequently orthokeratinisation
Median rhomboid glossitis --- --- --- Associated with chronic candidal infection Dorsum of the tongue at the junction of the anterior two-thirds

and posterior third

Forms a patch of papillary atrophy in the region of the

embryological foramen caecum

Biopsy shows:
Salivary gland tumors Acinic cell carcinoma 8550/3
  • 2-6.5% of all intra-oral salivary gland tumors
  • Age range from 11-77 years, with a mean of 45 years
  • Male to female ratio of 1.5:1
Unknown Tumors usually

form non-descript swellings

Biopsy shows:
  • Solid sheets of epithelium with secretory material
  • Ductal differentiation in tumors
Mucoepidermoid carcinoma 8430/3
  • 9.5-23% of all minor gland tumors
Unknown Low power microscopy shows low-grade tumor with both cystic and solid areas and an inflamed, fibrous stroma
Adenoid cystic carcinoma 8200/3
  • 42.5% of minor gland tumors
Unknown

Predominantly solid variant shows peri- and intraneural invasion

Epithelial-myoepithelial

carcinoma

8562/3 --- Unknown --- --- ---
Clear cell carcinoma,

NOS

8310/3 Unknown --- --- ---
Basal cell

adenocarcinoma

8147/3 Rare in minor glands Unknown Asymptomatic, smooth or lobulated sub-mucosal masses Microscopically similar to basal cell adenocarcinomas of the major gland
Cystadenocarcinoma 8450/3 32% developed in the minor glands Unknown Slow growing and painless but somepalatal tumors may erode the underlying bone-causing sinonasal complex ---
Salivary duct carcinoma 8500/3
  • Rare in minor salivary glands
  • Age range is 23-80 years (mean is 56 years)
Unknown Tumors form painless swellings but many in the palate can be painful and ulcerated or fungated withmetastases to regional lymph nodes The range of

microscopical appearances is similar

to that seen in the major glands

Salivary gland adenomas Pleomorphic adenoma 8940/0 40-70% of minor gland tumors Unknown Painless, slow-growing, submucosal masses, but when traumatized may bleed or ulcerate Biopsy shows cellular, and hyaline or plasmacytoid cell
Myoepithelioma 8982/0 42% of minor gland tumors Unknown --- ---
Basal cell adenoma 8147/0 20% of minor gland tumors Unknown --- They are histologically

similar to those in major glands.

Cystadenoma 8149/0 7% of benign minor gland tumors Uknown --- ---
Kaposi sarcoma --- --- Biopsy of all 4 types show:
Lymphangioma --- 9170/0
  • Appear mostly in the head and neck area but may be found in any other part of the body
Tongue
  • Circumscribed painless swelling
  • Soft and fluctuant on palpation
  • Irregular nodularity of the dorsum of the tongue
Biopsy shows:
Ectomesenchymal chondromyxoid

tumour of the anterior tongue

--- ---
  • Age range varies from 9-78 years
  • No distinct sex predilection.
Unknown --- Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue Biopsy shows:
Focal oral mucinosis (FOM) --- ---
  • The lesion affects all ages
  • Rare in children
  • There is no distinct sex predilection.
Unknown Asymptomatic fibrous or cystic-like lesion Histopathology is characterized by:
  • Mucinous material shows alcianophilia at pH 2.5
Congenital granular cell epuli --- ---
  • Affects newborns
  • Females are affected ten times more often than males
Etiology uncertain Solitary, somewhat edunculated fibroma-like lesion, attached to the alveolar ridge near the mid-line
Hematolymphoid tumors Non-Hodgkin lymphoma --- Second most common cancer of the oral cavity
  • There is no known etiology in most patients
NHL of the lip presents with:

Biopsy shows:

  • Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.
  • Predominantly medium-sized cells with abundant pale cytoplasm.
  • Large cells with round or multilobated nuclei
Langerhans cell histiocytosis 9751/1 --- Associated with:
  • Jaw bone
  • Intra-oral soft tissues
  • Gingiva
Common oral symptoms

include:

Biopsy shows ovoid Langerhans cells

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

Hodgkin lymphoma --- Strongly associated with Epstein- Barr Virus Most patients present with localized disease (stage I/II), with ---
Extramedullary myeloid

sarcoma

9930/3 --- History of acute myeloid leukaemia,

predominantly in the monocytic or myelomonocytic sub-types

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

sarcoma / tumour

9758/3
  • Tumor of adulthood
  • Affects wide age range
History of underlying hyaline-vascular Castleman disease The patients usually present with a painless mass Biopsy usually exhibits

borders and comprises:

  • Storiform arrays
  • Diffused sheets of spindle to ovoid tumor cells sprinkled with small lymphocytes
Mucosal malignant melanoma --- 8720/3
  • 0.5% of oral malignancies
  • Incidence 0.02 per 100,000
No known etiological factors associated with oral melanoma 80% arise:

Others:

  • Floor of mouth
  • Biopsy:
  • S100 positive
  • Negative for cytokeratins
  • More specific markers include:
  • HMB45
  • Melan-A or anti-tyrosinase

References


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