Oral cancer differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{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==
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another.   
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another.   
Line 7: Line 8:
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.
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"
{| class="wikitable"
!Type of cancer
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type of cancer
!Subtype
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Subtype
!ICD-O Code
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ICD-O Code
!Epidemiology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Epidemiology
!Etiology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology
!Localization
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Localization
!Clinical features  
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical features  
!Diagnostic procedures
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic procedures
|-
|-
|[[Squamous cell carcinoma]]
|[[Squamous cell carcinoma]]
Line 29: Line 30:
* Older males
* Older males
* 5th and 6th decades of life
* 5th and 6th decades of life
* Males are affected more often than females
* Males are affected more often than females
|
|
* [[Tobacco smoking]] and [[alcohol]]
* [[Tobacco smoking]] and [[alcohol]]
* Chronic smokeless tobacco
* Chronic smokeless tobacco
* HPV 16 and 18
* [[HPV|HPV 16]] and 18
|
|
* Lip SCC arise  almost exclusively on the lower lip
* Lip SCC arise  almost exclusively on the lower lip
* Buccal  mucosa
* [[Buccal  mucosa]]
* Upper   and lower  gingiva
* Upper and lower  [[gingiva]]


* Hard  palate
* [[Hard  palate]]
* Anterior two-thirds  of the tongue,  including dorsal, ventral and lateral surfaces, and the floor of mouth
* 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 mini- mal  physical finding
* Often asymptomatic or may present with  vague symptoms and minimal physical finding
|Biopsy shows:
|Biopsy shows:
Thickened club-shaped
Thickened club-shaped


papillae and blunt stromal  invaginations
[[papillae]] and blunt stromal  invaginations


of well-differentiated squamous  epitheli-
of well-differentiated [[squamous  epithelium]] with marked [[keratinization]]
um with marked keratinization
|-
|-
|Lymphoepithelial carcinoma
|[[Lymphoepithelioma|Lymphoepithelial carcinoma]]
|
|
|8082/3
|8082/3
|0.8-2% of all oral or oropharyngeal cancers
|0.8-2% of all oral or oropharyngeal cancers
|EBV
|[[EBV]]
|
|
* Tonsil and tongue(90%)
* [[Tonsil]] and [[tongue]](90%)
* Palate and buccal  mucosa(others)
* [[Palate]] and [[buccal  mucosa]] (others)
|
|
* Intra-oral mass, which may be ulcerated.   
* Intraoral mass, which may be [[Ulcerated lesion|ulcerated]].   


* Some tumors can  be bilateral
* Some tumors can  be bilateral
|Biopsy chows:
|Biopsy chows:
* Syncytial sheets and  clusters of  carcinoma  cells with vesicular  nuclei
* Syncytial sheets and  clusters of  [[Carcinoma|carcinoma  cells]] with [[Vesicular|vesicular  nuclei]]


* Prominent nucleoli  and ill-defined cell  borders
* Prominent [[nucleoli]] and ill-defined cell  borders
* A rich  lymphoplasmacytic infiltrate is present
* A rich  [[Lymphoplasmacytic lymphoma|lymphoplasmacytic]] infiltrate is present
|-
|-
|Epithelial precursor lesions
|[[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]])  
|Smoking
|Seen in the entire digestive tract
|
* White patches (leukoplakia)
* Red patches (erythroplasia/erythroplakia)  
* Mixed red and white lesions
* Mixed red and white lesions
|Biopsy shows:
|Biopsy shows:
* Hyperplasia
* [[Hyperplasia]]
* Dysplasia/ squamous  intraepithelial neoplasia / atypical hyperplasia
* [[Dysplasia]] / squamous  intraepithelial neoplasia / [[Hyperplasia|atypical hyperplasia]]
* Carcinoma in-situ
* [[Carcinoma in situ|Carcinoma in-situ]]
|-
|-
|Proliferative verrucous leukoplakia and precancerous conditions
|Proliferative verrucous leukoplakia and [[Premalignant condition|precancerous conditions]]
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|
|
* Average age at diagnosis is 62 years  
* Average age at diagnosis is 62 years  
* Women are more commonly  afflicted  (ratio, 4:1)
* Women are more commonly  affected (ratio, 4:1)
|Unknown
|Unknown
|
|
* Buccal  mucosa in women
* [[Buccal  mucosa]] in women
* Tongue  in  men.
* [[Tongue]] in  men.
|An aggressive form of  oral  leukoplakia with considerable morbidity  and
|An aggressive form of  [[oral  leukoplakia]] with considerable morbidity  and strong predilection  to [[malignant  transformation]]
 
strong predilection  to malignant  transformation
|Biopsy shows:
|Biopsy shows:
* Extensive, thick, white plaques
* Extensive, thick, white plaques
* Hyperplasia and dense hyperkeratosis
* [[Hyperplasia]] and dense [[hyperkeratosis]]
* Verrucous surface with hyperkeratosis, hypergranulosis and a dense inflammatory infiltrate in the corium
* [[Verrucous carcinoma|Verrucous]] surface with [[hyperkeratosis]], [[hypergranulosis]] and a dense inflammatory infiltrate in the [[corium]]
|-
|-
| rowspan="3" |Papillomas
| rowspan="3" |[[Papillomas]]
|Squamous cell papilloma and
|[[Squamous cell papilloma]] and
verruca vulgaris
[[verruca vulgaris]]
|
|
|
|
* Common in children and in  adults in the 3rd to 5th decades
* Common in children and in  adults in the 3rd to 5th decades


* Almost equal sex incidence with a slight male predominance
* Almost equal sex incidence with a slight male predominance
|HPV subtype
|[[HPV]] sub-types
2,4,6,7,10,40.
2, 4, 6, 7,10, and 40
|Any oral site may be affected mostly:
|Any oral site may be affected mostly:
* Hard and soft  palate
* [[Hard palate|Hard]] and [[soft  palate]]
 
* Labial mucosa
* Tongue
* Gingiva
|
* Soft, peduncu-
lated  lesions  formed  by  a  cluster  of  finger-like  fronds  or  a  sessile,  dome-


shaped lesion with a nodular, papillary or
* [[Labial]] [[Mucous membrane|mucosa]]
verrucous surface
* [[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:
|Biopsy shows:
* Exophytic and  comprise folds of hyperplastic stratified epithelium  
* Exophytic and  comprise folds of [[hyperplastic]] [[stratified epithelium]]
* Cluster of finger-like  projections   
* Cluster of finger-like  projections   
|-
|-
|Condyloma acuminatum
|[[Condyloma acuminatum]]
|
|
|2nd and 5th decade with a peak in teenagers and young adults
|2nd and 5th decade with a peak in teenagers and young adults
|
|
* HPV, most  commonly types 6,11,16 and 18
* [[HPV]]- most  common sub-types: 6, 11, 16 and 18
|
|
* Labial mucosa
* [[Labial]] [[mucosa]]
* Tongue  
* [[Tongue]]
* Palate
* [[Palate]]
|
|
* Painless, rounded, dome-shaped exophytic  nodules  
* Painless, rounded, dome-shaped exophytic  [[nodules]]


* 15mm in  diameter
* 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.
* 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
* Lesions may be multiple and are then usually clustered
|Biopsy shows:
|Biopsy shows:


Several sessile, cauliflower-like swellings forming a cluster
Several [[sessile]], [[Cauliflower ear|cauliflower]]-like swellings forming a cluster
|-
|-
|Focal epithelial hyperplasia
|[[Focal epithelial hyperplasia]]
|
|<nowiki>---</nowiki>
|Disease of children,adolescents and young adults
|[[Disease]] of children, adolescents and young adults
|HPV
|[[HPV]] sub types:


13 and 32
13 and 32
|
|
* All areas of the oral cavity
* All areas of the [[oral cavity]]
* Labial
* [[Labia]]
* Buccal  mucosa
* [[Buccal  mucosa]]
* Tongue
* [[Tongue]]
|
|
* Multiple asymptomatic lesions
* Multiple asymptomatic [[lesions]]


* Soft rounded or flat plaque-like sessile swelling.  
* Soft rounded or flat plaque-like [[sessile]] swelling.  
* Usually pink or white in color
* Usually pink or white in color
* 2-10mm in  diameter
* 2-10 mm in  diameter
|Biopsy shows:
|Biopsy shows:
* Rounded   sessile  swelling formed by a sharply demarcated zone of epithelial acanthosis
* Rounded [[sessile]]   swelling formed by a sharply demarcated zone of [[epithelial]] acanthosis


* Koilocytes similar to those of squamous papilloma are usually  present  
* [[Koilocyte|Koilocytes]] similar to those of squamous papilloma are usually  present  


* “Mitosoid  bodies”, which are nuclei with coarse clumped heterochromatin resembling a mitotic figure
* “Mitosoid  bodies”, which are [[nuclei]] with coarse clumped [[heterochromatin]] resembling a mitotic figure
|-
|-
|Granular cell tumour
|[[Granular cell tumor]]
|
|<nowiki>---</nowiki>
|9580/0
|9580/0
|
|
* Arise in all age groups, with a peak between 40 and 60 years
* Arise in all age groups, with a peak between 40 and 60 years
* Females are affect-  ed  more  often than males with an M/F ratio of 2:1
* Females are affected more  often than males with an M/F ratio of 2:1
|No etiological factors  are known
|No etiological factors  are known
|
|
* Tongue is the most common single site
* [[Tongue]] is the most common single site
* Buccal mucosa  
* [[Buccal mucosa]]
* Floor of oral cavity
* Floor of oral cavity
* Palate
* [[Palate]]
* Salivary gland
* [[Salivary gland]]
|
|
* Lesion presents   as  a smooth, sessile mucosal swelling  
* Lesion presents as  a smooth, [[sessile]] [[Mucous membrane|mucosal swelling]]
* 1-2 cm in diameter with a firm texture.
* 1-2 cm in diameter with a firm texture  


* The overlying epithelium is of normal color or may  be slightly pale
* The overlying [[epithelium]] is of normal color or may  be slightly pale
|Biopsy shows:
|Biopsy shows:
* Plump eosinophilic cells with central small dark nuclei and abundant granular cytoplasm
* Plump [[eosinophilic]] cells with central small dark nuclei and abundant [[Cytoplasm|granular cytoplasm]]
|-
|-
|Keratoacanthoma
|[[Keratoacanthoma]]
|
|<nowiki>---</nowiki>
|8071/1
|8071/1
|
|
* Occurs more often in
* Occurs more often in
whites
whites
* Twice as frequent in
* Twice as frequent in
men as in women
men as in women
|Associated with uptake of  carcinogens(e.g. via  particular smoking habits)
|Associated with uptake of  [[carcinogens]] (e.g. via  particular [[smoking]] habits)
|
|
* Skin of the face,including the lips
* [[Skin]] of the face, including the [[lips]]
* Mucocutaneous linings  may also  be involved
* [[Mucocutaneous|Mucocutaneous linings]] may also  be involved
|
|
* Verrucous,  speckled or ulcerated lesions
* [[Verrucous carcinoma|Verrucous]],  speckled or [[Ulcerated lesion|ulcerated lesions]]


* Deep projections,  which extend through minor salivary glands and underlying bone
* Deep projections,  which extend through [[Salivary gland tumor|minor salivary glands]] and underlying bone
|Biopsy shows:
|Biopsy shows:
* Verrucous surface,  keratinized clefts and  penetrating squamous  rete processes
* [[Verrucous carcinoma|Verrucous]] surface,  [[keratinized]] clefts and  penetrating squamous  [[Rete pegs|rete processes]]
* Minimal atypia seen
* Minimal [[atypia]] seen
|-
|-
|Papillary hyperplasia
|[[Papillary|Papillary hyperplasia]]
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|Affects all age groups
|Affects all age groups
|Associated with:
|Associated with:
* Wearing ill-fit-  ting dentures
* Wearing ill-fitting [[dentures]]
* Xerostomia
* [[Xerostomia]]
* Individuals with a high arched palate
* Individuals with a [[high arched palate|high-arched palate]]
* HIV infection
* [[HIV AIDS|HIV infection]]
|Palate
|[[Palate]]
|Asymptomatic nodular or papillary mucosal lesion
|Asymptomatic [[nodular]] or [[Papillary|papillary mucosal lesion]]
|Biopsy shows:
|Biopsy shows:
* Parakeratinisation or  less frequently orthokeratinisation
* Parakeratinisation or  less frequently orthokeratinisation
|-
|-
|Median rhomboid glossitis
|Median rhomboid glossitis
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|Associated with chronic candidal infection
|Associated with chronic [[Candidal|candidal infection]]
|Dorsum of the tongue at the junction of the anterior two thirds
|Dorsum of the tongue at the junction of the anterior two-thirds
and posterior third
and posterior third
|Forms a patch of papillary atrophy in the  region of the
|Forms a patch of papillary atrophy in the  region of the
embryological foramen  caecum
embryological [[Foramen cecum|foramen  caecum]]
|Biopsy shows:
|Biopsy shows:
* Psoriasiform hyperplasia
* [[Psoriasis|Psoriasiform]] [[hyperplasia]]


* Areas of  pseudoepitheliomatous  hyperplasia
* Areas of  pseudoepitheliomatous  [[hyperplasia]]
* Atypia may be present
* [[Atypia]] may be present
|-
|-
| rowspan="8" |Salivary gland tumours
| rowspan="8" |[[Salivary gland tumor|Salivary gland tumors]]
|Acinic cell carcinoma
|[[Acinic cell carcinoma]]
|8550/3
|8550/3
|
|
* 2-6.5%   of   all   intraoral salivary   gland tumors
* 2-6.5% of all intra-oral [[Salivary gland tumor|salivary gland tumors]]
* Age range was from 11-77 years, with a mean of 45 years
* Age range from 11-77 years, with a mean of 45 years
* Male to female ratio of 1.5:1
* Male to female ratio of 1.5:1
|Unknown
|Unknown
|
|
* Buccal  mucosa
* [[Buccal  mucosa]]
* Upper  lip and
* [[Upper  lip]]
* Palate
* [[Palate]]
|Tumors usually
|[[Tumors]] usually


form non-descript swellings
form non-descript swellings
|Biopsy shows:
|Biopsy shows:
* Solid sheets of  epithelium with secretory material
* Solid sheets of  [[epithelium]] with secretory material
* Ductal differentiation in tumors
* Ductal differentiation in [[tumors]]
|-
|-
|Mucoepidermoid carcinoma
|[[Mucoepidermoid carcinoma]]
|8430/3
|8430/3
|
|
* 9.5-23% of all minor gland tumors
* 9.5-23% of all minor gland tumors
|Unknown
|Unknown
|
|
* Palate (most common site)  
* [[Palate]] (most common site)  
* Buccal mucosa
* [[Buccal mucosa]]
* Lips: upper>lower
* [[Lips]]: upper>lower
* Floor of oral  cavity
* Floor of [[oral  cavity]]
* Retromolar pad
* Retromolar pad
|
|
* Asymptomatic
* Asymptomatic
* Bluish, domed  swellings that  resemble mucoceles  or haemangiomas
* Bluish, domed  swellings that  resemble mucoceles  or [[Hemangioma|haemangiomas]]
* High-grade tumors result in ulceration, loosening of teeth, paraesthesia or anaesthesia
* 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
|Low power [[microscopy]] shows low-grade tumor with both [[cystic]] and solid areas and an inflamed, fibrous stroma
|-
|-
|Adenoid cystic carcinoma
|Adenoid cystic carcinoma
Line 286: Line 279:
|Unknown
|Unknown
|
|
* Tongue
* [[Tongue]]
* Tonsil   
* [[Tonsil]]    
* Oropharynx
* [[Oropharynx]]
* Cheek
* [[Cheek]]
* Lips
* [[Lips]]
* Retromolar  pad  and  gingiva
* Retromolar  pad  and  [[gingiva]]
|
|
* Slow growing submucosal masses and ulceration may  be seen, particularly  in the palate
* Slow growing [[Submucosa|sub-mucosal]] masses and [[ulceration]] may  be seen, particularly  in the [[palate]]
* Pain,   or   evidence  of   nerve involvement, is usually only present  in advanced tumors
* [[Pain]], or evidence  of [[Nerve|nerve involvement,]] is usually only present  in advanced tumors
|
|
Predominantly solid variant shows peri- and intraneural invasion.
Predominantly solid variant shows peri- and intraneural invasion


|-
|-
Line 302: Line 295:
carcinoma                           
carcinoma                           
|8562/3
|8562/3
|
|<nowiki>---</nowiki>
|Unknown
|Unknown
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|-
|-
|Clear cell carcinoma,
|[[Clear cell tumor|Clear cell carcinoma,]]
NOS
NOS
|8310/3
|8310/3
|
|
|Unknown
|Unknown
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|-
|-
|Basal cell
|[[Basal cell carcinoma|Basal cell]]
adenocarcinoma
[[Basal cell carcinoma|adenocarcinoma]]
|8147/3
|8147/3
|Rare in minor glands
|Rare in minor glands
|Unknown
|Unknown
|
|
* Palate
* [[Palate]]
* Buccal  mucosa
* [[Buccal  mucosa]]
* Lip
* [[Lip]]
|Asymptomatic, smooth or lobulated sub-mucosal  masses
|Asymptomatic, smooth or lobulated [[Submucosa|sub-mucosal  masses]]
|Microscopically similar to basal
|Microscopically similar to [[Basal cell carcinoma|basal]] [[Basal cell carcinoma|cell adenocarcinomas]] of the major gland
 
cell   adenocarcinomas   of   the   major
gland
|-
|-
|Cystadenocarcinoma         
|[[Cystadenocarcinoma]]          
|8450/3
|8450/3
|32% developed in the minor glands
|32% developed in the minor glands
|Unknown
|Unknown
|
|
* Palate
* [[Palate]]
* Lips
* [[Lips]]
* Buccal  mucosa
* [[Buccal  mucosa]]
* Tongue and  retromolar  regions.
* [[Tongue]] and  retromolar  regions
|Slow growing and painless but
|Slow growing and painless but some[[palatal]] [[tumors]] may erode the underlying bone-causing sinonasal  complex
 
|<nowiki>---</nowiki>
some palatal tumors may erode the
 
underlying   bone   causing
sinonasal  complex.
|
|-
|-
|Salivary duct carcinoma
|Salivary duct carcinoma
|8500/3
|8500/3
|
|
* Rare in minor salivary glands
* Rare in minor salivary glands
* Age range was  23-80 years  (mean 56 years)
* Age range is 23-80 years  (mean is 56 years)
|Unknown
|Unknown
|
|
* Palate (65%)
* [[Palate]] (65%)
* Buccal  mucosa and vestibule  (19%)
* [[Buccal  mucosa]] and [[vestibule]] (19%)


* Tongue (8%)
* [[Tongue]] (8%)
* Retromolar pad  (4%) and upper  lip  (4%)
* Retromolar pad  (4%) and [[upper  lip]] (4%)
|Tumours  formed  painless swellings but many in the palate can be painful and ulcerated or fungated with metastases to regional lymph nodes.
|[[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
|The range of


microscopical appearances os  similar
microscopical appearances is similar


to that seen in the major glands.
to that seen in the major glands
|-
|-
| rowspan="4" |Salivary gland adenomas
| rowspan="4" |[[Salivary gland cancer|Salivary gland adenomas]]
|Pleomorphic adenoma
|[[Pleomorphic adenoma]]
|8940/0
|8940/0
|40-70% of minor gland tumors
|40-70% of minor gland tumors
|Unknown
|Unknown
|
|
* Palate
* [[Palate]]
* Lips and
* [[Lips]]
* Buccal  mucosa
* [[Buccal  mucosa]]
|Painless, slow growing,  submucosal masses,  but when
|Painless, slow-growing,  [[Submucosa|submucosal]] masses,  but when traumatized  may [[bleed]] or [[Ulcer|ulcerate]]
 
|Biopsy shows cellular, and [[hyaline]] or [[plasmacytoid]] cell
traumatized  may bleed or ulcerate.
|Biopsy shows cellular, and hyaline or plasmacytoid cell
|-
|-
|Myoepithelioma
|Myoepithelioma
Line 387: Line 370:
|Unknown
|Unknown
|
|
* Palate of younger individuals
* [[Palate]] of younger individuals
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|-
|-
|Basal cell adenoma
|Basal cell adenoma
Line 396: Line 379:
|Unknown
|Unknown
|
|
* Upper  lip
* [[Upper  lip]]
* Buccal  mucosa
* [[Buccal  mucosa]]
|
|<nowiki>---</nowiki>
|They are histologically
|They are histologically


similar to those in major glands.
similar to those in major glands.
|-
|-
|Cystadenoma
|[[Cystadenoma]]
|8149/0
|8149/0
|7% of benign minor gland tumors
|7% of benign minor gland tumors
|Uknown
|Uknown
|
|
* Lips
* [[Lips]]
* Cheek
* [[Cheek]]
* Palate
* [[Palate]]
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|-
|-
|Kaposi sarcoma
|[[Kaposi's sarcoma|Kaposi sarcoma]]
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|
|
* Classic (elderly men of Mediterranean/EastEuropean  descent)
* Classic (elderly men of Mediterranean/East European descent)
* Endemic ( middle-aged adults and children in Equatorial Africa who are not   HIV  infected)
* [[Endemic]] (middle-aged adults and children in Equatorial Africa, who are not [[HIV infected adolescents|HIV  infected]])
* Iatrogenic (Immunosuppressed, post-transplant)
* [[Iatrogenic]] ([[Immunosuppressed]], post-transplant)
* AIDS associated (HIV-1 infected individuals)
* [[AIDS associated Kaposi sarcoma|AIDS-associated]] ([[HIV-1 protease|HIV-1]] infected individuals)
|
|
* HHV-8
* [[HHV-8]]
* Immunologic, genetic, and environmental factors
* [[Immunology|Immunologic]], [[genetic]], and environmental factors
|
|
* Skin ( most common)
* [[Skin]] (most common)
* Mucosal mem-  branes  such  as oral  mucosa,  lymph nodes   and  visceral   organs
* [[Mucous membrane|Mucosal membranes]], such  as [[oral  mucosa]][[lymph nodes]] and  [[Visceral organ|visceral organs]]
|
|
* Purplish, reddish blue or dark brown macules
* Purplish, reddish-blue or dark brown [[macules]]
* Plaques and nodules that  may ulcerate
* [[Plaques]] and [[nodules]] that  may [[Ulcerated lesion|ulcerate]]
|Biopsy of all 4 types show:
|Biopsy of all 4 types show:
* Vascular slits and sparsely distributed lymphocytes.
* [[Vascular|Vascular slits]] and sparsely distributed [[Lymphocyte|lymphocytes]]
|-
|-
|Lymphangioma
|[[Lymphangioma]]
|
|<nowiki>---</nowiki>
|9170/0
|9170/0
|
|
* Pediatric lesions
* [[Pediatric Oncology Group|Pediatric lesions]]
* Present at birth or    during   the   first   years   of   life.
* 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
* Appear mostly in  the head and neck area but may be found in any other part of the body
|
|
* Developmental  malformation
* [[Developmental abnormality|Developmental  malformation]]
* Genetic  abnormalities
* [[Genetic disorder|Genetic  abnormalities]]
* Turner's syndrome
* [[Turner's syndrome]]
|Tongue
|[[Tongue]]
|
|
* Circumscribed painless  swelling
* Circumscribed painless  swelling
* Soft and fluctuant on palpation
* Soft and fluctuant on palpation
* Irregular nodularity of the  dorsum of the tongue
* Irregular nodularity of the  dorsum of the [[tongue]]
|Biopsy shows:
|Biopsy shows:
* Thin-walled, dilated  lymphatic  vessels  of different size, which are  lined by a flattened endothelium
* Thin-walled, dilated  [[lymphatic  vessels]] of different size, which are  lined by a flattened [[endothelium]]
|-
|-
|Ectomesenchymal chondromyxoid
|Ectomesenchymal chondromyxoid
tumour of the anterior tongue
tumour of the anterior tongue
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|
|
|
* Age range varies  from 9-78 years   
|
* Age range varies  from 9-78 years   
* No distinct sex predilection.
* No distinct sex predilection.
|Unknown
|Unknown
|
|<nowiki>---</nowiki>
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue
|Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue
|Biopsy shows:
|Biopsy shows:
* Round, cup-shaped, fusiform, or polygonal  cells with uniform small  nuclei and   moderate   amounts   of   faintly basophilic cytoplasm
* 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  
* Some tumors may show  nuclear pleomorphism,  hyperchromatism, and multinucleation  
|-
|-
|Focal oral mucinosis (FOM)
|Focal oral mucinosis (FOM)
|<nowiki>---</nowiki>
|<nowiki>---</nowiki>
|
|
|
* The lesion affects  all ages
|
* Rare in children  
* The lesion affects  all ages
* Rare in children  
* There is no distinct sex predilection.
* There is no distinct sex predilection.
|Unknown
|Unknown
|
|
* Gingiva( most common site)
* [[Gingiva]] (most common site)
* Palate
* [[Palate]]
* Cheek mucosa and
* Cheek [[mucosa]]
* Tongue
* [[Tongue]]
|Asymptomatic fibrous or cystic-like lesion
|Asymptomatic fibrous or cystic-like lesion
|Histopathology is characterized by:
|Histopathology is characterized by:
* Well-circumscribed area  of myxomatous
* Well-circumscribed area  of [[myxomatous]] tissue
tissue
 
* Fusiform or stellate fibroblasts
* [[Fusiform]] or [[Stellate cell|stellate]] [[fibroblasts]]


* Absent or sparse reticular  fibres
* Absent or sparse [[reticular  fibers]]


* Mucinous material  shows alcianophilia at  pH  2.5
* [[Mucinous]] material  shows alcianophilia at  pH  2.5
|-
|-
|Congenital granular cell epuli  
|Congenital granular cell epuli  
|
|<nowiki>---</nowiki>
|
|<nowiki>---</nowiki>
|
|
* Affects newborns
* Affects newborns
Line 499: Line 482:
|Etiology uncertain
|Etiology uncertain
|
|
* Maxilla
* [[Maxilla]]


* Mandible
* [[Mandible]]
|Solitary, somewhat pedunculated  fibroma-like lesion attached to the alveolar
|[[Solitary]], somewhat [[pedunculated|edunculated]] fibroma-like lesion, attached to the alveolar ridge near the mid-line
ridge near the midline
|
|
* Ultrasound for prenatal diagnosis
* Ultrasound for prenatal diagnosis
* Immuno histochemically,  the tumor cells are positive for vimentin and  neuron specific enolase
* Immuno-histochemically,  the tumor cells are positive for [[vimentin]] and  neuron specific [[enolase]]
* No reactivity with  cytokeratin, CEA,  desmin, hormone   receptors   or   S-100
* No reactivity with  [[cytokeratin]], [[CEA]][[desmin]], hormone receptors or [[S-100]]
|-
|-
| rowspan="5" |Haematolymphoid tumours
| rowspan="5" |Hematolymphoid tumors
|Non-Hodgkin lymphoma
|[[Non-Hodgkin lymphoma]]
|
|<nowiki>---</nowiki>
|Second most com-
|Second most common cancer of the [[oral  cavity]]
mon cancer of the oral  cavity


|
|
* There   is   no   known  etiology   in   most patients.
* There is no known  etiology in most patients


* Underlying  immunodeficiency  state (e.g. HIV Infection)  
* Underlying  [[immunodeficiency]] state (e.g. [[HIV AIDS classification|HIV Infection]])  
* Strong association with EBV
* Strong association with [[Epstein Barr virus|EBV]]
|
|
* Palate,
* [[Palate]]


* Tongue
* [[Tongue]]


* Floor of mouth
* Floor of mouth
* Gingiva
* [[Gingiva]]
* Buccal mucosa
* [[Buccal mucosa]]
* Lips
* [[Lips]]
* Palatine tonsils
* [[Palatine tonsils]]
* Lingual tonsils or
* [[Lingual tonsils]]
* Oropharynx
* [[Oropharynx]]
|NHL of the lip presents with:
|[[Non-Hodgkin lymphoma|NHL]] of the [[lip]] presents with:
* Ulcer
* [[Ulcer]]
* Swelling,
* [[Swelling]]
* Discoloration
* [[Discolored tongue|Discoloration]]
* Pain
* [[Pain]]
* Paraesthesia
* [[Paresthesia|Paresthesia]]
* Anaesthesia,  or
* [[Anesthesia|Anesthesia]]
* Loose teeth
* Loose teeth
|
|
Biopsy shows:
Biopsy shows:
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.
* Large cells with predominantly round nuclei and membrane-bound nucleoli, consistent with centroblastic morphology.


* Predominantly medium-sized cells with abundant pale cytoplasm.
* Predominantly medium-sized cells with abundant pale [[cytoplasm]].
* Large cells with round or multilobated nuclei
* Large cells with round or multilobated nuclei
|-
|-
|Langerhans cell histiocytosis
|[[Langerhans cell histiocytosis]]
|9751/1
|9751/1
|
|<nowiki>---</nowiki>
|Associated with:
|Associated with:
* Eosinophilic  granulomas
* [[Eosinophilic granuloma|Eosinophilic  granulomas]]
* Multifocal  multisystem  disease
* Multifocal  multisystem  disease
|
|
* Jaw bone
* Jaw bone
* Intraoral soft tissues  
* Intra-oral soft tissues  
* Gingiva
* [[Gingiva]]
 
* [[Palate]]
* Floor of mouth
* [[Buccal  mucosa]]


* Palate
* [[Tonsil cancer|Tonsil]]
* Floor  of  mouth
|Common oral symptoms
* Buccal  mucosa
and 
* Tonsil  
|Common oral symptoms


include:
include:
* Swelling
* [[Swelling]]
* Pain
* [[Pain]]
* Gingivitis
* [[Gingivitis]]
* Loose teeth and
* Loose teeth
* Ulceration
* [[Ulceration]]
|Biopsy shows ovoid Langerhans  cells
|Biopsy shows ovoid [[Langerhans  cells]]


with deeply grooved nuclei, thin nuclear membranes and abundant eosinophilic cytoplasm
with deeply grooved nuclei, thin nuclear membranes and abundant [[Eosinophilic|eosinophilic cytoplasm]]
|-
|-
|Hodgkin lymphoma
|[[Hodgkin's lymphoma|Hodgkin lymphoma]]
|
|
|
|Strongly associated with Epstein- Barr Virus
|<nowiki>---</nowiki>
|Strongly associated with [[Epstein-Barr virus|Epstein- Barr Virus]]
|
|
* Waldeyer ring,  particularly the  pala-tine tonsil
* [[Waldeyer's ring|Waldeyer ring,]] particularly the  [[palatine tonsil]]
* Oropharynx   
* [[Oropharynx]]  
* Alveolar crest of  mandible
* Alveolar crest of  [[mandible]]
* Maxillary gingiva
* [[Maxillary bone|Maxillary gingiva]]
|Most patients present with localized disease (stage I/II), with  
|Most patients present with localized disease (stage I/II), with  
* Chronic tonsillitis or tonsillar enlargement with or without  enlarged   cervical  lymph nodes
* [[Chronic tonsillitis]] or [[Tonsillar abscess|tonsillar enlargement]] with or without  enlarged [[cervical  lymph nodes]]
|
|<nowiki>---</nowiki>
|-
|-
|Extramedullary myeloid
|Extramedullary myeloid
sarcoma
sarcoma
|9930/3
|9930/3
|
|<nowiki>---</nowiki>
|History of acute  myeloid  leukaemia,
|History of [[Acute myeloid leukemia|acute  myeloid  leukaemia]],


predominantly   in   the  monocytic   or
predominantly in the  [[Monocyte|monocytic]] or myelomonocytic      sub-types
myelomonocytic      subtypes
|
|
* Palate
* [[Palate]]


* Gingiva
* [[Gingiva]]
|Isolated tumor-forming intraoral mass
|Isolated tumor-forming intra-oral mass
|Biopsy shows an Indian-file pattern of infiltration
|Biopsy shows an Indian-file pattern of infiltration
|-
|-
|Follicular dendritic cell
|[[Follicular dendritic cell]]
sarcoma / tumour
sarcoma / tumour
|9758/3
|9758/3
Line 610: Line 590:


* Affects wide age range
* Affects wide age range
|History of underlying hya-line-vascular Castleman disease
|History of underlying [[Castleman's disease|hyaline-vascular Castleman disease]]
|
|
* Tonsil
* [[Tonsil]]
* Palate or
* [[Palate]]
* Oropharynx.
* [[Oropharynx]]
|The patients usually
|The patients usually present  with a painless mass
 
|Biopsy usually exhibits  
present  with a painless mass
|Biopsy usually exhibits  


borders and comprises:
borders and comprises:
* Fascicles
* [[Fascicles]]
* Whorls
* Whorls


* Nodules,    
* [[Nodules]]    


* Storiform   arrays   or    
* Storiform arrays   
* Diffuse sheets of  spindly  to ovoid tumour cells sprinkled with small  lymphocytes
* Diffused sheets of  spindle to ovoid tumor cells sprinkled with small  [[lymphocytes]]
|-
|-
|Mucosal malignant melanoma
|Mucosal malignant melanoma
|
|<nowiki>---</nowiki>
|8720/3
|8720/3
|
|
* 0.5% of oral malignancies
* 0.5% of oral malignancies
* Incidence 0.02 per 100,000
* Incidence 0.02 per 100,000
|No known etiological  factors associated with oral melanoma
|No known etiological  factors associated with oral melanoma
|80% arise:
|80% arise:
* Palate
* [[Palate]]
* Maxillary alveolus or gingivae
* Maxillary alveolus or [[Gingiva|gingivae]]
* Mandibular
* Mandibular gingiva
gingivae
 
Others:
Others:
* Buccal mucosa
* [[Buccal mucosa]]


* Floor of mouth
* Floor of mouth


* Tongue
* [[Tongue]]
|
|
* Asymmetric with irregular  outlines
* Asymmetric with irregular  outlines
* Macular   pigmentation
* Macular pigmentation
* Nodular growth
* Nodular growth
* Ulceration   
* [[Ulceration]]  
* Melanosis
* [[Melanosis]]
|
|
* Biopsy:
* Biopsy:
* S100 positive
* S100 positive
* Negative   for  cytokeratins   
* Negative for  cytokeratins   


* More specific markers  include:
* More specific markers  include:
* HMB45,
* HMB45


* Melan-A or anti-tyrosinase
* Melan-A or anti-tyrosinase
|-
|
|
|
|
|
|
|
|
|}
|}


Line 683: Line 668:
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[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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