Oral cancer differential diagnosis: Difference between revisions

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| rowspan="13" |Salivary gland tumours
| rowspan="12" |Salivary gland tumours
|Acinic cell carcinoma
|Acinic cell carcinoma
|8550/3
|8550/3
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* Age range was from 11-77 years, with a mean of 45 years
* Age range was 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
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|Unknown
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* Upper  lip and  
* Upper  lip and  
* Palate
* Palate
|
|Tumors  usually
 
form
non-descript  swellings
|Biopsy shows:
|Biopsy shows:
* Solid  sheets  of  epithelium  with secretory material
* Solid  sheets  of  epithelium  with secretory material
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|8430/3
|8430/3
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|
* 9.5-23%  of  all  minor  gland tumors
|Unknown
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* Palate (most common site)
* Buccal mucosa
* Lips: upper>lower
* Floor  of  oral  cavity
* Retromolar pad
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|
|
* Asymptomatic
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* Bluish,  domed  swellings  that  resemble  mucoceles  or haemangiomas
* High-grade  tumors result in  ulceration, loosening of teeth, paraesthesia or anaesthesia
|Low power microscopy shows low-grade tumor with both cystic and solid areas and an inflamed, fibrous stroma
|-
|-
|Adenoid cystic carcinoma
|Adenoid cystic carcinoma
|8200/3
|8200/3
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* 42.5% of minor gland tumors
*
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* Tongue
* Tonsil 
* Oropharynx
* Cheek
* Lips
* Retromolar  pad  and  gingiva
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* Slow growing submucosal masses and ulceration  may  be  seen,  particularly  in  the palate
* Pain,  or  evidence  of  nerve  involvement,  is  usually  only  present  in advanced  tumors
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|Polymorphous low-grade
Predominantly solid variant shows peri- and intraneural invasion.
adenocarcinoma               
 
|8525/3
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|Epithelial-myoepithelial
|Epithelial-myoepithelial
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adenocarcinoma
adenocarcinoma
|8147/3
|8147/3
|Rare in minor glands
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|
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|
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* Palate
|
* Buccal  mucosa
|
* Lip
|Asymptomatic, smooth or lobulated sub-mucosal  masses
|Microscopically similar to basal
 
cell  adenocarcinomas  of  the  major
gland
|-
|-
|Cystadenocarcinoma         
|Cystadenocarcinoma         
|8450/3
|8450/3
|32%  developed  in  the  minor  glands
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* Palate
|
* Lips
* Buccal  mucosa
* Tongue and  retromolar  regions.
|Slow  growing  and  painless  but
 
some  palatal  tumors  may erode  the
 
underlying    bone    causing
sinonasal  complex.
|
|
|-
|-
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|8500/3
|8500/3
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* Rare  in  minor  salivary glands
* Age  range  was  23-80  years  (mean  56 years)
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* Palate  (65%)
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* Buccal  mucosa and  vestibule  (19%)
 
* Tongue  (8%)
* 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.
|The  range  of
 
microscopical  appearances  os  similar
 
to that seen in the major glands.
|-
|-
|Myoepithelial carcinoma
|Myoepithelial carcinoma

Revision as of 16:28, 6 February 2018

Oral cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Oral cancer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Staging

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Other Imaging Findings

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Future or Investigational Therapies

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

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 must be differentiated from actinic keratosis, dermatologic manifestations of oral leukoplakia, erythroplasia, lichen planus and mucosal candidiasis.

Oral cancer differential diagnosis

Type of cancer Subtype ICD-O Code Epidemiology Etiology Second primary tumors Localization Clinical features Diagnostic procedures
Squamous cell carcinoma Verrucous carcinoma 8051/3 Older males
  • Chronic smokeless tobacco
  • HPV 16 and 18
Basaloid squamous cell carcinoma 8083/3
Papillary squamous cell carcinoma 8052/3
Spindle cell carcinoma 8074/3
Acantholytic squamous cell carcinoma 8075/3
Adenosquamous carcinoma 8560/3
Carcinoma cuniculatum

(epithelioma cuniculatum)

8051/3
Lymphoepithelial carcinoma
Epithelial precursor lesions
Proliferative verrucous leukoplakia and precancerous conditions
Papillomas Squamous cell papilloma and

verruca vulgaris

Condyloma acuminatum
Papillomas and papillomatosis

in immunodeficiency

Focal epithelial hyperplasia
Granular cell tumour
Keratoacanthoma
Papillary hyperplasia
Median rhomboid glossitis
Median rhomboid glossitis
Salivary gland tumours Acinic cell carcinoma 8550/3
  • 2-6.5% of all intraoral salivary gland tumors
  • Age range was from 11-77 years, with a mean of 45 years
  • Male to female ratio of 1.5:1
Unknown
  • Buccal mucosa
  • Upper lip and
  • 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 haemangiomas
  • High-grade tumors result in ulceration, loosening of teeth, paraesthesia or 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
  • Tongue
  • Tonsil
  • Oropharynx
  • Cheek
  • Lips
  • Retromolar pad and gingiva
  • Slow growing submucosal masses and ulceration may be seen, particularly in the palate
  • Pain, or evidence of nerve involvement, is usually only present in advanced tumors

Predominantly solid variant shows peri- and intraneural invasion.

Epithelial-myoepithelial

carcinoma

8562/3
Clear cell carcinoma,

NOS

8310/3
Basal cell

adenocarcinoma

8147/3 Rare in minor glands
  • Palate
  • Buccal mucosa
  • Lip
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
  • Palate
  • Lips
  • Buccal mucosa
  • Tongue and retromolar regions.
Slow growing and painless but

some palatal tumors may erode the

underlying bone causing sinonasal complex.

Mucinous adenocarcinoma 8480/3
Oncocytic carcinoma 8290/3
Salivary duct carcinoma 8500/3
  • Rare in minor salivary glands
  • Age range was 23-80 years (mean 56 years)
  • Palate (65%)
  • Buccal mucosa and vestibule (19%)
  • Tongue (8%)
  • 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. The range of

microscopical appearances os similar

to that seen in the major glands.

Myoepithelial carcinoma 8982/3
Carcinoma ex pleomorphic

adenoma

8941/3
Salivary gland adenomas Pleomorphic adenoma 8940/0 40-70% of minor gland tumors
  • Palate
  • Lips and
  • Buccal mucosa
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
  • Palate of younger individuals
Basal cell adenoma 8147/0 20% of minor gland tumors
  • Upper lip
  • Buccal mucosa
They are histologically

similar to those in major glands.

Cystadenoma 8149/0 7% of benign minor gland tumors
  • Lips
  • Cheek
  • Palate
Kaposi sarcoma
  • Classic (elderly men of Mediterranean/EastEuropean descent)
  • Endemic ( middle-aged adults and children in Equatorial Africa who are not HIV infected)
  • Iatrogenic (Immunosuppressed, post-transplant)
  • AIDS associated (HIV-1 infected individuals)
  • HHV-8
  • Immunologic, genetic, and environmental factors
  • Skin ( most common)
  • Mucosal mem- branes such as oral mucosa, lymph nodes and visceral organs
  • Purplish, reddish blue or dark brown macules
  • Plaques and nodules that may ulcerate
Biopsy of all 4 types show:
  • Vascular slits and sparsely distributed lymphocytes.
Lymphangioma 9170/0
  • 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 malformation
  • 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

  • Age range varies from 9-78 years
  • No distinct sex predilection.
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 faintly basophilic cytoplasm
  • Some tumors may show nuclear pleomorphism, hyperchromatism, and multinucleation
Focal oral mucinosis (FOM)
  • The lesion affects all ages
  • Rare in children
  • There is no distinct sex predilection.
  • Gingiva( most common site)
  • Palate
  • Cheek mucosa and
  • Tongue
Asymptomatic fibrous or cystic-like lesion Histopathology is characterized by:
  • Well-circumscribed area of myxomatous

tissue

  • Fusiform or stellate fibroblasts
  • Absent or sparse reticular fibres
  • 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
  • Maxilla
  • Mandible
Solitary, somewhat pedunculated fibroma-like lesion attached to the alveolar

ridge near the midline

  • 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
Haematolymphoid tumours Non-Hodgkin lymphoma Second most com-

mon cancer of the oral cavity

  • There is no known etiology in most patients.
  • Underlying immunodeficiency state (e.g. HIV Infection)
  • Strong association with EBV
  • Palate,
  • Tongue
  • Floor of mouth
  • Gingiva
  • Buccal mucosa
  • Lips
  • Palatine tonsils
  • Lingual tonsils or
  • Oropharynx
NHL of the lip presents with:
  • Ulcer
  • Swelling,
  • Discoloration
  • Pain
  • Paraesthesia
  • Anaesthesia, or
  • 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
Extramedullary plasmacytoma 9734/3
Langerhans cell histiocytosis 9751/1 Associated with:
  • Eosinophilic granulomas
  • Multifocal multisystem disease
  • Jaw bone
  • Intraoral soft tissues
  • Gingiva
  • Palate
  • Floor of mouth
  • Buccal mucosa

and

  • Tonsil
Common oral symptoms

include:

  • Swelling
  • Pain
  • Gingivitis
  • Loose teeth and
  • Ulceration
Biopsy shows ovoid Langerhans cells

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

Hodgkin lymphoma Strongly associated with Epstein- Barr Virus
  • Waldeyer ring, particularly the pala-tine tonsil
  • Oropharynx
  • Alveolar crest of mandible
  • Maxillary gingiva
Most patients present with localized disease (stage I/II), with
  • Chronic tonsillitis or tonsillar enlargement with or without enlarged cervical lymph nodes
Extramedullary myeloid

sarcoma

9930/3 History of acute myeloid leukaemia,

predominantly in the monocytic or myelomonocytic subtypes

  • Palate
  • Gingiva
Isolated tumor-forming intraoral 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 hya-line-vascular Castleman disease
  • Tonsil
  • Palate or
  • Oropharynx.
The patients usually

present with a painless mass

Biopsy usually exhibits

borders and comprises:

  • Fascicles
  • Whorls
  • Nodules,
  • Storiform arrays or
  • Diffuse sheets of spindly to ovoid tumour 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:
  • Palate
  • Maxillary alveolus or gingivae
  • Mandibular

gingivae

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


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