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| rowspan="4" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Cysts'''
| rowspan="4" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Cysts'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Oral Lymphoepithelial cyst ([[Branchial cleft cyst]])
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Oral Lymphoepithelial cyst ([[Branchial cleft cyst]])<ref name="pmid28936296">{{cite journal |vauthors=Sykara M, Ntovas P, Kalogirou EM, Tosios KI, Sklavounou A |title=Oral lymphoepithelial cyst: A clinicopathological study of 26 cases and review of the literature |journal=J Clin Exp Dent |volume=9 |issue=8 |pages=e1035–e1043 |date=August 2017 |pmid=28936296 |pmc=5601105 |doi=10.4317/jced.54072 |url=}}</ref><ref name="pmid22452887">{{cite journal |vauthors=Stramandinoli-Zanicotti RT, de Castro Ávila LF, de Azevedo Izidoro AC, Izidoro FA, Schussel JL |title=Lymphoepithelial cysts of oral mucosa: two cases in different regions |journal=Bull. Tokyo Dent. Coll. |volume=53 |issue=1 |pages=17–22 |date=2012 |pmid=22452887 |doi= |url=}}</ref>
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* Painless
* Painless
* White to yellow
* White to yellow
* Soft to firm
* Soft to firm submucosal nodule
* Less than 1 cm
* Less than 1 cm
|
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Revision as of 02:28, 19 February 2019


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

Surface oral lesions
Oral lesions Appearance Associated conditions Location Microscopic Image
White Lesions Leukoedema[1][2]
  • White or whitish grey edematous lesion
  • Diffuse or patchy
Fordyce granules[3][4][5][6]
  • White or yellow discrete papules
  • Symmetrically distributed
Benign migratory glossitis[7][8][9]
  • Red patches with white distinct border
  • Map like appearance
  • Dorsal/Lateral surface of the tongue
Hairy tongue[10][11][12][13]
Hairy leukoplakia[14][15]

White patches

  • Corrugated in appearance
  • Hairy, hair-like growths
  • Permanent
White sponge nevus[16][17]
  • White patches of tissue (nevi)
  • Singular or multiple
  • Thickened, velvety, sponge-like appearance
  • Parakeratosis, acanthosis
  • Extensive vacuolization
  • Dyskeratotic cells exhibit dense peri and paranuclear eosinophilic condensations
  • Abundant Odland bodies
Lichen Planus[18][19]
  • Reticular or papular lace like white lesions
  • Multiple, Painful
Frictional hyperkeratosis[20][21]
  • White shaggy plaques
  • Could be easily peeled without any pain leaving normal mucosa
  • Bite trauma
  • Grinding of the teeth
Leukoplakia
  • White or grayish in patches that can't be wiped away
  • Irregular or flat-textured
  • Thickened or hardened in areas
  • Along with raised, red lesions (speckled leukoplakia or erythroplakia), which are more likely to show precancerous changes
Erythroplakia
Oral lesions Appearance Associated conditions Location Microscopic Image
Pigmented lesions
  • Ephelis
  • Flat red or light brown spots
  • 3–10 mm in diameter
  • Poorly defined and may merge into large patches
  • Predominant in outer lips
  • Focal pigmented brown lesions similar to ephelides
  • Flat and mostly smaller than 1 cm
  • Characterised by a focal increase in melanin production
  • Laugier Hunziker syndrome
  • Strong female predilection
  • Varies from dark brown to blue-black
  • Mucosa-colored and white lesions are occasionally noted
  • Erythema is observed when the lesions are inflamed.
  • Hyperparakeratinized areas showing acanthosis, spongiosis, exocytosis, vacuolar degeneration,
  • Substantial deposition of melanin in all epithelial layers
  • Melanocytic hyperplasia
  • Dendritic melanocytes in all epithelial layers.

Perioral

  • Freckling of the skin around lips and vermillionzone of the lips.

Intraorally

  • Proliferation of all elements of peripheral nerves
  • Schwann cells with wire like collagen fibrils,fibroblasts and collagen
  • Perineurial cells in plexiform types, mitotic figures are rare
  • Orofacial deformity
  • Dental disorders
  • Bone pains
  • Compromised oral health
  • Predominantly involves musculo-skeletal defects of oral cavity
  • Gingiva
  • Curvilinear trabeculae of metaplastic woven bone in hypocellular, fibroblastic stroma
  • Pigmented fragments of metal within connective tissue
  • A scattered arrangement of black or dark brown granules
  • Large particles may be surrounded by chronically inflamed fibrous tissue
Oral lesions Appearance Associated conditions Location Microscopic Image
Vesicular/Erythematous

Ulcerative lesions

Infections Herpes simplex virusinfections[40][41][42]

Herpetic gingivostomatitis

  • Painful ulcers covered by a yellowish pseudomembrane
  • Ulcers that may coalesce to form bigger lesions
  • Self limiting after 7 days
  • HSV 1 Infection
  • Keratinized and non-keratinized mucosa.
  • Intra and intercellular edema (acantholysis)
  • Intranuclear inclusions
  • Multinucleate polykaryons (giant cells)
Herpes zoster[43][44][45]
  • Clustered small ulcers with characteristic unilateral pattern
  • Keratinocytes are multinucleated, acantholytic with distinct nuclear inclusions, found initially in follicular epithelium
  • Late epidermal necrosis or full-thickness acantholysis
  • Dermal nerve twigs may exhibit a perineural infiltrate of lymphocytes and neutrophils, sometimes associated with intraneural involvement
  • Schwann cell hypertrophy and frank neural necrosis are occasionally encountered
Hand foot mouth disease[46][47][48]
  • Irregularly shaped shallow ulcers with yellow-grey base and hyperemic margin.
  • Coxsackievirus
  • Vesicular lesions will demonstrate loose strands of fibrin, lymphocytes and neutrophils in the vesicular fluid.
  • The presence of acantholysis in the epidermis and perivascular infiltration of leukocytes is seen in hand foot and mouth disease.
  • The absence of intracelluar inclusion bodies differentiates it from the herpes simplex infection.
Infectious mononucliosis[49][50]
  • Epstein-Barr virus infection
  • Kissing's Disease
  • Reactive lymphoid hyperplasia
  • Extensive immunoblastic proliferation in sheets and nodules, marked atypia resembling Reed-Sternberg cells
Erosive lichen planus[51][52][53]
Pseudomembranous candidiasis[54][55][56]
  • Known as thrush.
  • Usually asymptomatic.
  • Confluent white wipeable plaques resembling curdled milk
  • Superficially the plaques can be wiped off and the underlying mucosa often exhibits an erythematous appearance.
  • Chronic medications
  • Immuno-suppressive conditions
  • Wet mount examination with 10% KOH or saline demonstrates hyphae, pseudohyphae, and blastospores.
Histoplasmosis[57][58][59][60][61]
  • Ohio and Mississippi river valleys
Blastomycosis[62][63][64]
  • Mississippi, Missouri and Ohio River valleys and the Great lakes region.
  • Ginguve
  • Mostly Pulmonary Nodules

Classic appearance on modified Wright's stain

Coccidiodomycosis[65][66][67][68]
  • Dust exposure in endemic areas, due to occupational activities agricultural or construction workers
  • Military personnel training in endemic areas
  • Construction work, and model airplane competitions
  • Natural disasters such as earthquakes and windstorms
  • Tongue

It is a dimorphic fungus and on microscopy, the following can be seen

Autoimmune diseases Pemphigus vulgaris[69][70][71]
  • Intraepithelial blister with acantholysis and chronic inflammation
Mucous membrane pemphigoid (Cicatricial pemphigoid)[72][73][74]
  • Subepidermal vesicle contains edema fluid, fibrin and variable inflammatory cells
  • Perivascular lymphohistiocytic infiltrate, plasma cells and neutrophils
  • Fewer eosinophils than generalized bullous pemphigoid
  • Conjunctival squamous metaplasia with foci of hyperkeratosis and parakeratosis, accompanied by goblet cell depletion; conjunctival vesicles or bulla are rare
Aphthous ulcer[75][76][77]
  • Shallow, round to oval ulcer with white or yellow pseudomembrane surrounded by halo
  • In chronic ulcer grey membrane may replace the yellow pseudomembrane
  • Appear on the non-keratinizing epithelial surfaces in the mouth.
  • Except the attached gingiva, the hard palate and the dorsum of the tongue
Erythema multiforme[78][79]
Sjogren's Syndrome

Affects salivary and lacrimal glands

Bullous pemphigoid
  • Psoriasis
  • Parkinson's disease
  • Dementia
  • Certain drugs e.g. spironolactone, loop diuretics and neuroleptics
  • Malignancies e.g. breast cancer
  • Unilocular, subepidermal, nonacantholytic blisters with festooning (suspended in a loop between two points) of dermal papillae, infiltrate including eosinophils located in blister cavity and in the dermis
  • Early erythematous lesion shows upper papillary dermal edema, perivascular lymphohistiocytic infiltrate, accompanied by conspicuous eosinophils
Idiopathic conditions Allergic contact stomatitis
Irritant contact stomatitis
Soft tissue oral lesions
Reactive lesions Appearance Associated conditions Location Microscopic Image
Inflammatory papillary hyperplasia
  • Benign lesion characterized by hyperemic mucosa
  • One or more bulbous or nodular growth measuring less than 2 mm
Fibrous hyperplasia
  • Presents as a yellowish–white or mucosal colored, sessile, smooth-surfaced, asymptomatic, soft nodule.
  • The surface may be hyperkeratotic or ulcerated, owing to repeated trauma.
Mucocele
  • Mucus cyst is a distinct, fluctuant, painless swelling of the mucosa.
  • <1 cm in diameter
  • Superficial lesions take on a bluish to translucent hue
  • Deep lesions have normal mucosal coloration
  • Bleeding into the swelling may impart a bright red and vascular appearance.
Necrotizing sialometaplasia
  • Non-ulcerated swelling that transforms into crater like ulcer
  • 1-5cms
Periodontal abscess
  • Originates in the dental pulp
  • Associated with living tooth
  • Neutrophils are found surrounding a central area of soft tissue debris and destroyed leukocytes.
  • At later stage, a pyogenic membrane is organized macrophages and neutrophils
Periapical abscess
  • Usually attached to tooth root
  • Firm or have deflated capsule
  • Lumen can contain thin serous or straw colored fluid, opaque yellow-white debris, muddy brown fluid from old hemorrhage or frank purulent debris
  • Originates in the dental pulp
  • Associated with dead tooth
Tumors Appearance Associated conditions Locations Microscopic Image
Epithelial tumors Squamous cell carcinoma
  • Initially it may present as a painless, rough white or red lesion with induration
  • In advanced stages it presents as a painful ulcerated lesion with elevated margins and increased nodularity and feels hard on palpation
  • It may also appear as a fixed exophytic lesion with irregular margins, delayed healing after dental extraction or as a cervical lymph node enlargement
  • Hard palate
  • Anterior two-thirds of the tongue, including dorsal, ventral and lateral surfaces, and the floor of mouth
Squamous cell carcinoma may be well, moderately or poorly differentiated.

SCC variants:

Basaloid:

  • Bimorphic i.e. both basaloid and squamous cell component. Solid basaloid appearing dysplastic island with biphasic pattern showing comedo type necrosis and pseudoglandular pattern. Abrupt foci of squamous differentiation with or without keratin pearls.

Verrucous

Papillary

Spindle cell

Adenosquamous

Acantholytic

Cunniculatum

Oral epithelial dysplasia
  • Lesion may appear as a homogeneous white or red patch, mixed white/red speckled area or as an ulcer
Common sites: Histopathologically it may be classified as

Mild:

Moderate:

  • Parakeratosis
  • Disorganization of the strata with basilar hyperplasia
  • Nuclear enlargement and hyperchromaticity
  • Drop shaped rete ridges involving one half of epithelial thickness

Severe:

  • Loss of cellular organization and polarity
  • Basilar hyperplasia
  • nuclear enlargement and hyperchromaticity
  • Drop shaped rete ridges involving two-third of epithelial thickness
Proliferative verrucous leukoplakia
  • Initially it may present as a white hyperkeratotic plaque that ultimately proliferates and becomes multifocal with confluent exophytic mass
  • HPV
  • EBV
  • Candida

The histopathological findings associated with PVL are as under:

Papillomas Condyloma acuminatum
  • 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 usually clustered
HPV, most commonly types 6,11,16 and 18 Several sessile, cauliflower-like swellings forming a cluster
Verrucous vulgaris Soft, pedunculated lesions formed by a cluster of finger-like fronds or a sessile, dome-shaped lesion with a nodular, papillary or verrucous surface HPV subtype

2,4,6,7,10,40.

Any oral site may be affected mostly:

Multifocal epithelial hyperplasia
  • Soft rounded or flat plaque-like sessile swelling.
  • Usually pink or white in color
  • 2-10 mm in diameter
HPV

13 and 32

  • Rounded sessile swelling formed by a sharply demarcated zone of epithelial acanthosis
  • Koilocytes similar to those of squamous papilloma are usually present
Salivary type tumors Mucoepidermoid carcinoma Low power microscopy shows low-grade tumor with both cystic and solid areas and an inflamed, fibrous stroma
Pleomorphic adenoma Painless, slow growing, submucosal masses, but when

traumatized may bleed or ulcerate

Histopathological findings shows cellular, and hyaline or plasmacytoid cell
Soft tissue and Neural tumors Granular cell tumor
  • The overlying epithelium is of normal color or may be slightly pale
Plump eosinophilic cells with central small dark nuclei and abundant granular cytoplasm
Rhabdomyoma
  • It usually presents as a non tender smooth, solitary or rarely multifocal nodule. Or as a confined intramuscular mass in the tongue
  • Floor of the mouth
Lymphangioma
  • Circumscribed painless swelling
  • Soft and fluctuant on palpation
  • Irregular nodularity of the dorsum of the tongue
Thin-walled, dilated lymphatic vessels of different size, which are lined by a flattened endothelium
Hemangioma[80][81][82]
Kaposi sarcoma[83][84] HIV and HHV-8 Spindle cells with minimal nuclear atypia
Myofibroblastic sarcoma
  • Painless swelling or an enlarged mass
Hematolymphoid tumors Plasmablastic lymphoma[85][86][87] It may appear as thickened ulcerative lesion that may invade the adjacent bone Intraoally:
Langerhan cell histiocytosis[88][89][90]

Associated with:

Biopsy shows ovoid langerhans cells

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

Extramedullary myeloid sarcoma[91][92][93] Isolated tumor-forming intraoral mass History of acute myeloid leukemia,

predominantly in the monocytic or myelomonocytic subtypes

Tumors of uncertain histiogenesis Congenital granular cell epulis
  • Congenital
  • Spontaneously regresses over first 8 months of life
Ectomesenchymal chondromyxoid tumor
Cysts Oral Lymphoepithelial cyst (Branchial cleft cyst)[94][95]
  • Painless
  • White to yellow
  • Soft to firm submucosal nodule
  • Less than 1 cm
  • Floor of the mouth
  • Laterla margin of the tongue
Cystic cavity lined with:
Oral Epidermoid cyst[96][97][98]
  • A slow growing nonfluctuating mass
  • Soft and painless

Histopathologically:

Thyroglossal tract cyst
Nasolabial cyst ( Klestadt cyst)[99][100][101]

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