Oral cavity and oropharynx

Last revised 17 April 2008

Last major update June 2004

Copyright (c) 2004-2008, PathologyOutlines.com, Inc.

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Table of contents

Primary references, normal anatomy, normal histology

Congenital anomalies: dermoid/epidermoid cyst, duplication cyst, epithelial nests, epulis, Fordyce’s disease, hairy polyp, heterotopia, lingual thyroid, lingual tonsil, white sponge nevus

Infectious: general, aphthous ulcers, candidiasis, CMV, condyloma acuminatum, diphtheria, gingivitis, hairy leukoplakia, herpes simplex, histoplasmosis, HIV, infectious mononucleosis, measles, periodontitis, scarlet fever, syphilis, tuberculosis

Inflammatory (non-infectious): atypical histiocytic granuloma, Behcet’s disease, Crohn’s disease, fissured tongue, geographic tongue, glossitis, granulomatous inflammation, hyaline ring like structures, Melkersson-Rosenthal syndrome, necrotizing sialometaplasia, oral submucosal fibrosis, papillary hyperplasia, peripheral giant cell granuloma, sarcoidosis, tongue ulceration with eosinophilia, Wegener’s granulomatosis, xerostomia

Dermatologic conditions: erythema multiforme, lichen planus, melanotic pigmentation, pemphigus vulgaris, smokeless tobacco keratosis

Other benign tumors/conditions: amyloidosis, angiolymphoid hyperplasia, chondroma, crystal storing histiocytosis, ectomesenchymal chondromyxoid tumor, ephelis, fibroid epulis, focal dermal hyperplasia, focal epithelial hyperplasia, giant cell angiofibroma, gingival hyperplasia, granular cell tumor, hemangioma, irritation fibroma, keratoacanthoma, leukoedema, lymphangioendothelioma, lymphoid hyperplasia / polyp, mucinosis, mucous cyst, nevus, paraganglioma, peripheral ameloblastoma, plasma cell granuloma, plasmacytosis, post-traumatic spindle cell nodule, pseudoepitheliomatous hyperplasia, pyogenic granuloma, rhabdomyoma, solitary fibrous tumor, Spitz nevus, squamous papilloma, verruca vulgaris, verruciform xanthoma

Premalignant/in situ conditions: carcinoma in situ, dysplasia, leukoplakia, verrucous hyperplasia

Squamous cell carcinoma: general oral cavity, buccal mucosa, floor of mouth, gingiva, lip, oropharynx, palate, tongue, tonsil, Waldeyer’s ring; subtypes-basaloid, papillary, pseudoglandular, spindle cell, verrucous

Other carcinomas (non salivary gland): adenosquamous, basal cell, small cell

Minor salivary gland tumors/lesions: general, acinic cell carcinoma, adenoid cystic carcinoma, adenomatoid hyperplasia, basal cell adenoma, choristoma, clear cell carcinoma, cystadenocarcinoma, intraductal, inverted ductal papilloma, malignant mixed tumor, mucoepidermoid, myoepithelioma, Paget’s disease, pleomorphic adenoma, polymorphous low grade adenocarcinoma, sialadenoma papilliferum, signet ring adenocarcinoma

Other malignancies: angiosarcoma, follicular dendritic cell tumor, hemangioendothelioma, Kaposi’s sarcoma, liposarcoma, lymphoma, melanoma, metastases, plasmacytoma, post-transplant lymphoproliferative disorder, sarcoma-other

Miscellaneous: TNM staging, grossing, features to report

 

 

Primary references

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AJCC Cancer Staging Manual (6th Ed)

American Journal of Surgical Pathology (AJSP), March 1977 to June 2004

Archives of Pathology and Laboratory Medicine (Archives) January 1976 to June 2004

Human Pathology (Hum Path), March 1970 to May 2004

Modern Pathology (Mod Path), January 1988 to May 2004

Rosai, J:  Ackerman’s Surgical Pathology (8th Ed); Mosby-Year Book, Inc., 1996

Sternberg, S: Diagnostic Surgical Pathology (3rd Ed); Lippincott Williams & Wilkins, 1999

Oral Pathology website - Dr. William Crawford (Univ Southern California)

Journal search terms: oral, mouth, tongue, gingiva, tonsil, oropharynx

 

Please refer to these primary references for more detailed discussions and photographs

 

Normal anatomy

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Oral cavity extends from skin-vermilion junction of lips to junction of hard and soft palate above and to line of circumvallate papillae below

Dorsal tongue: villous, normally exposed surface

Ventral tongue: nonvillous undersurface

Anterior 2/3 of tongue (oral tongue): freely mobile portion of tongue that extends anteriorly from line of circumvallate papillae to undersurface of tongue at junction of floor of mouth; composed of four areas - the tip, the lateral borders, the dorsum and the undersurface (nonvillous ventral surface of tongue)

Base of tongue (posterior 1/3 of tongue): bound anteriorly by circumvallate papillae, laterally by glossotonsillar sulci, posteriorly by epiglottis

Buccal mucosa: all of the membrane lining the inner surface of cheeks and lips from line of contact of opposing lips to line of attachment of mucosa of alveolar ridge (upper and lower) and pterygomandibular raphe

Floor of mouth: semilunar space of myelohyoid and hyoglossus muscles, extending from inner surface of lower alveolar ridge to undersurface of tongue; posterior boundary is base of anterior pillar of tonsil; divided into two sides by frenulum of tongue, contains ostia of submaxillary and sublingual salivary glands

Gingiva: soft tissue in area of teeth and palate; extends from labial sulcus and buccal sulcus to a cuff of tissue around each tooth

Hard palate: semilunar surface between upper alveolar ridge and mucous membrane covering palatine process of maxillary palatine bones; extends from inner surface of superior alveolar ridge to posterior edge of palatine bone

Lip: begins at junction of vermilion border (mucocutaneous junction) with skin, includes only the vermilion surface or that portion of lip that comes into contact with opposing lip; upper and lower lip are joined at commissures of mouth; external surface is skin and mucous membrane; internally contains orbicularis oris muscle, blood vessels, nerves, areolar tissue, fat, small labial glands; inner surface of lip is connected to gum in midline by frenulum, a mucous membrane fold

Lower alveolar ridge: mucosa overlying alveolar process of mandible which extends from the line of attachment of mucosa in buccal gutter to line of free mucosa of floor of mouth; posteriorly, it extends to ascending ramus of mandible

Retromolar gingiva (retromolar trigone): mucosa overlying ascending ramus of mandible from level of posterior surface of last molar tooth to apex superiorly, adjacent to tuberosity of maxilla

Tonsillar area: anterior and posterior tonsillar pillars and tonsillar fossa

Upper alveolar ridge: mucosa overlying alveolar process of maxilla which extends from line of attachment of mucosa in upper gingival buccal gutter to junction of hard palate; posterior margin is upper end of pterygopalatine arch

Vermillion border: mucocutaneous junction of lip

Drawings: nose, mouth, pharynx and larynx; tongue surface, tongue and oral cavity, undersurface of tongue, coronal section of tongue

 

Normal histology

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Stratified squamous epithelium with parakeratosis

No hair follicles or sweat glands present

Keratinization in areas most exposed to mastication (gingiva, hard palate, dorsum of tongue)

Lamina propria contains loose connective tissue, mucous glands and serous minor salivary type glands

Submucosa has collagenous, dense, fibrous tissue

Tonsillectomy specimens frequently contain skeletal muscle, Hum Path 2000;31:813

Micro images: lip, soft palate #1, #2, filiform papilla #1, #2, fungiform papilla #1, #2, circumvallate papilla #1, #2, #3, #4, #5, taste buds #1, #2

 

 

Congenital anomalies

Dermoid/epidermoid cyst

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Midline in floor of mouth

Present at birth but asymptomatic until inflamed

Gross images: epidermoid cyst

Micro: lined by squamous epithelium, contains skin adnexae if dermoid cyst

 

Duplication cyst

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Lined by indigenous mucosa of segment it is duplicating

Case reports: congenital duplication cyst of ventral surface of tongue with gastrointestinal and respiratory epithelium in newborn (Archives 1989;113:1301), enteric duplication cyst of floor of mouth and base of tongue in 7 year old (Archives 2000;124:614)

Treatment: excision; may recur if incompletely excised

Gross images: sublingual duplication cyst

Micro images: colonic and gastric mucosa in cyst wall

 

Epithelial nests

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Not actually a congenital anomaly, but normal occurring neuroepithelial structure called organ of Chievitz, Chievitz’s paraparotid organ, or juxtaoral organ

Reported in 56% of adult autopsies without oral mucosal lesions

Occur within intraoral sensory nerve

May undergo nodular hyperplasia

Micro: squamous like epithelium, occasionally with lumen lined by cuboidal cells; associated with small nerves and resembling perineural invasion

References: AJSP 1979;3:147

 

Epulis

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Congenital granular cell tumors that occur exclusively in girls

Sites: anterior alveolar ridge of maxilla and mandible, usually overlying future canine and lateral incisor teeth

Don’t recur, even if incompletely excised

Micro: confluent to nodular submucosal growth of tumors composed of large polygonal cells with eosinophilic granular cytoplasm and small, central nuclei

References: AJSP 1981;5:37

 

Fordyce’s disease

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Common; normal sebaceous glands within oral cavity

May be hyperplastic and nodular

Gross images: multiple small yellow papular lesions, various gross/micro images #1

Hairy polyp

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Rare, arises from oropharynx or nasopharynx

Micro: polypoid lesion of epidermis, hair follicles, sebaceous glands, eccrine sweat glands; variable adipose tissue, smooth muscle, striated muscle and cartilage in core

 

Heterotopia

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Gastric or intestinal epithelium in tongue and floor of mouth that may become cystic, or glial and ependyma-lined clefts in palate and parapharyngeal space

 

Lingual thyroid

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Thyroid tissue at base of tongue due to failure of descent

In 10% of normals; 70% with grossly evident lingual thyroid lack a normal thyroid gland

 

Lingual tonsil

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Fairly common; raised red areas at lateral tongue base containing lymphoid tissue

Gross/micro images: various gross/micro images

 

White sponge nevus

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Autosomal dominant disease

Large white plaques in oral mucosa with striking intracellular edema in malpighian layer

 

 

Infectious conditions

Infections-general

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Oral cavity defenses against infection include competition by organisms of low virulence, secretory IgA (from submucosal lymphocytes and plasma cells), antibacterial effects of saliva, diluting effects of food and drink

 

Aphthous ulcers

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Also called canker sores

Affect 40% in US; more common up to 20 years; painful, recurrent, familial

Treatment: symptomatic

Gross: single or multiple, shallow, hyperemic ulcerations covered by a thin exudate with hyperemic rim

Micro: initially mononuclear infiltrate, then neutrophilic infiltrate from secondary bacterial infection

 

Candidiasis (thrush)

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Normal flora that overgrows due to diabetes, neutropenia, AIDS, immunosuppression, xerostomia, antibiotics

Gross: superficial curdy, gray-white inflammatory membrane

Micro: membrane composed of fungi in a fibrinopurulent exudate resting on an inflammatory base

 

CMV

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Ulcerated lesion

 

Condyloma acuminatum

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Associated with HPV

Case report of HIV- woman who acquired HPV 6/11 in late teens and developed disseminated condylomas of oropharynx, nasopharynx, anogenital region, urethra and bladder, with no known immune defect, AJSP 1998;22:1291

Micro: acanthosis, koilocytotic atypia

 

Diphtheria

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Gross: dirty white, fibrinosuppurative, tough, inflammatory membrane over tonsils, posterior pharynx

 

Gingivitis

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Painless inflammation of gingiva around gingival sulci or cuff surrounding each tooth, due to bacterial plaque

Most commonly due to Streptococcus, Fusobacterium, Actinomyces, Veillonella, Treponema

May be due to scurvy, endocrine alterations (teenagers, pregnancy), disseminated tuberculosis, phenytoin or other drugs

Gross: erythematous and edematous gingiva adjacent to teeth

Micro: initially neutrophils, later T lymphocytes, finally B lymphocytes and plasma cells

 

Acute necrotizing gingivitis

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Also called trench mouth, Vincent’s stomatitis, ulcerative stomatitis

Caused by fusospirochetal complex of microbes

Heals with scarring and blunting of interdental papillae; may recur

Predisposing factors: poor oral hygiene, smoking, emotional anguish, age 12-29 years in US and Northern Europe

Gross: highly inflamed mucosa with enlargement of interdental papillae and presence of gray pseudomembrane with hemorrhagic tissue below; occasional ulceration of papillae

Micro: necrosis of interdental gingival papillae, focal abscess

 

Hairy leukoplakia

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Associated with HIV infection (AIDS may appear within 2-3 years), but actually due to EBV infection

Gross: white, confluent patches of fluffy (hairy) mucosa along lateral tongue

Gross images: hairy leukoplakia #1

Micro: hyperkeratotic oral mucosa due to piling of keratotic squamous epithelium; Cowdry type A intranuclear inclusions; EBV present in clear cells of spinous layer; variable koilocytosis, superimposed Candida infection

EM: herpes type virions

Reference: AJSP 1989;13:114 (intranuclear inclusions)

 

Herpes simplex virus

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Also called cold sore

Usually HSV1

Lasts 3-4 weeks, then virus tracks along regional nerves and becomes dormant in trigeminal or other local ganglia

Most infected adults have latent HSV-1 that is activated by upper respiratory infection, excessive exposure to cold, wind, sun, allergies

Acute herpetic gingivostomatitis: rare, children 2-4 years with diffuse involvement of oral and pharyngeal mucosa, tongue, gingiva; fiery red mucosa and swelling with clusters of vesicles

Recurrent herpetic stomatitis: groups of 1-3 mm vesicles on the lips, nasal orifices, buccal mucosa; milder than acute, lesions dry up in 4-6 days, heal in 7-10 days

Tzanck test: microscopic examination of vesicle fluid shows giant cells, inclusions

Gross: vesicles (mm size) to bullae (cm size) with clear serous fluid, painful shallow ulcers

Gross images: lip lesions, acute herpetic gingivostomatitis (various images)

Micro: intra- and intercellular edema (acantholysis), intranuclear inclusions, multinucleate polykaryons (giant cells)

 

Histoplasmosis

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Ulcers, nodular lesions, verrucous masses

Micro: noncaseating granulomas or nonspecific inflammatory infiltrate

Positive stains: GMS, PAS

DD: squamous cell carcinoma

 

Human immunodeficiency virus (HIV)

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Associated with opportunistic infections, herpes simplex virus, Candida, fungi, Kaposi’s sarcoma, hairy leukoplakia

Lymphoid hyperplasia of Waldeyer’s ring is a frequent symptomatic complication of HIV infection, often with HIV+, EBV- multinucleated giant cells in crypt or surface epithelium, Hum Path 1999;30:1383, Mod Path 2000;13:1293

Micro: adenoids and tonsils - florid follicular hyperplasia, follicle lysis, attenuated mantle zone, multinucleated giant cells adjacent to surface or tonsillar crypt epithelium; may have marked lymphoid depletion with no germinal centers, plasmacytosis and stromal vascular proliferation

Micro images: multinucleated giant cells in Waldeyer’s ring

References: AJSP 1996;20:572

 

Infectious mononucleosis

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Acute pharyngitis and tonsillitis with gray-white exudate, lymphadenopathy in neck

Due to Epstein-Barr virus infection

Micro: tonsil - reactive lymphoid hyperplasia (polymorphous transformed lymphocytes) with extensive immunoblastic proliferation in sheets and nodules, marked atypia resembling Reed-Sternberg cells

Negative stains: CD15, CD30

References: AJSP 1987;11:122

 

Measles

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Koplik spots: ulcerations on buccal mucosa around Stensen duct; spotty enanthema in oral cavity, may precede rash

 

Periodontitis

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Recurrent and continuous gingivitis that affects alveolar bone

Causes bone destruction and pockets around teeth > 3 mm in depth

Plaque within pockets serves as nidus for mineralization (dental calculus), causing progressive disease until gingival scarring and bony erosion lead to loss of teeth

Treatment: scaling and planing of root surfaces to remove focal irritants, surgery, brushing and flossing

 

Scarlet fever

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Fiery red tongue with prominent papillae (raspberry tongue), white coated tongue through which hyperemic papillae project (strawberry tongue)

 

Syphilis

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May produce painless indurated gummatous mass in tongue or palate

Associated with tongue cancer in older studies

Micro: granulomas with giant cells, plasma cells, vascular changes

 

Tuberculosis

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Rare; painful ulcer of tongue or buccal mucosal lesion

Associated with advanced pulmonary disease

Micro: caseating granulomas

 

 

Inflammatory (noninfectious) lesions

Atypical histiocytic granuloma

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Reactive nodule with marked histiocytic infiltration and variable mitotic activity

 

Behcet’s disease

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Affects skin, oral mucosa and eyes

Micro: leukocytoclastic vasculitis

 

Crohn’s disease

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Initial presentation may be in oral cavity and pharynx

6% have oral lesions at some time (lip, gingiva, vestibular sulci, buccal mucosa)

Micro: edema, ulcers, papillary hyperplastic mucosa, dilation of lymphatics, chronic inflammatory infiltrate, giant cells, rarely noncaseating granulomas

 

Fissured tongue

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Also called furrowed tongue

Grooves get deeper and more prominent with age

50% also have geographic tongue

May have true fissure with ulceration

Treatment: brushing tongue

Gross images: fissured tongue, various images

 

Geographic tongue

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Also called benign migratory glossitis, glossitis migrans

1-2% of population, usually adults

Associated with common cold, work/home stresses

Associated with tongue fissures

Gross: erythematous flat zone on tongue dorsum due to loss of filiform papillae

Gross images: geographic tongue #1, #2, various images #1,

Micro: acanthosis with neutrophils throughout epithelium and surface microabscesses, plus inflammatory infiltrate in lamina propria; resembles psoriasis

 

Glossitis

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Inflammation or beefy red tongue associated with deficiency states

Due to atrophy of tongue papillae, thinning of mucosa and exposure of underlying vasculature

Median rhomboid glossitis: red patch in posterior dorsal tongue

Causes: pernicious anemia (Vitamin B12 deficiency), deficiency of riboflavin, niacin or pyridoxine; sprue, iron deficiency anemia; also associated with jagged teeth, ill fitting dentures, rarely syphilis, burns, ingestion of corrosive chemicals

Plummer-Vinson / Patterson-Kelly syndrome: iron deficiency anemia, glossitis, esophageal webs

Gross images: median rhomboid glossitis #1, #2, atrophic tongue #1

 

Granulomatous inflammation

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Associated with chronic recurrent tonsillitis

Usually no specific organism is recovered

Usually benign course

 

Hyaline ring like structures

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Also called pulse granuloma (pulse is edible seed of legumes), oral vegetable granuloma, giant cell hyaline angiopathy

Rarely associated with chronic periostitis, edentulous patients

May be a degenerative change in vessel walls from vasculitis or a reaction to legume cells at various stages of digestion

Treatment: excision or curettage

Micro: hyaline ring like structures, some containing granular necrotic material that surrounds giant cells, vessels and collagen, and is itself surrounded by chronic inflammatory cells

Micro images: pulse granuloma from rectum

 

Melkersson-Rosenthal syndrome

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Orofacial swelling, peripheral facial nerve paralysis and plicated tongue

Cheilitis granulomatosa: may be a variant

Micro: granulomatous inflammation of lip stroma

DD: sarcoidosis, Crohn’s disease

 

Necrotizing sialometaplasia

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Reactive condition of minor or occasionally major salivary glands, probably due to ischemia or vasculitis

Gross: ulcerated lesion of hard palate

Gross/micro images: as part of case history #1

Micro: ulcerated surface mucosa; intraductal proliferation of metaplastic squamous epithelium containing trapped mucous cells in lobular (not infiltrative) pattern; pseudoepitheliomatous hyperplasia common; vascular proliferation with prominent inflammatory infiltrate and partial necrosis of salivary glands, associated with squamous metaplasia of adjacent ducts and acini

DD: squamous cell carcinoma, mucoepidermoid carcinoma, post-radiation changes

 

Oral submucosal fibrosis

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Mainly in residents of India and Pakistan

Reactive, but risk factor for squamous cell carcinoma

Micro: subepithelial fibrosis, chronic inflammation, hyalinization, loss of vascularity; overlying epithelium is atrophic or hyperplastic and hyperkeratotic

 

Papillary hyperplasia (inflammatory papillary hyperplasia)

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Common, usually involves palate or lingual mandibular gingiva

Called palatal papillomatosis in palate

Associated with ill fitting dentures or partial dentures, wearing prostheses at night, poor oral hygiene

Not a premalignant condition

Treatment: complete excision, proper fitting dentures; removal of offending agent

Gross: multiple red polyp-like projections, often under ill-fitting dentures, usually in palate

Gross images: inflammatory papillary hyperplasia #1, #2 (various gross/micro images) Micro: exophytic mucosal epithelial hyperplasia, including pseudoepitheliomatous hyperplasia, submucosal fibrous hyperplasia; islands of hyperplastic squamous mucosa may appear in submucosa; may have chronic inflammation of accessory salivary glands; no dysplasia

 

Peripheral giant cell granuloma

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Also called giant cell epulis

Reactive gingival mass resembling pyogenic granuloma, but pushes teeth aside and may erode alveolar bone or involve periodontal membrane

Usually women, mean age 30 years, although may involve children or elderly patients without teeth

Treatment: excision with curettage of base of lesion extending into adjacent periodontal membrane

Recurs if not completely excised or source of irritation not removed

Gross: inflammatory lesion up to 1.5 cm that protrudes from gingiva at site of chronic inflammation; covered by gingival mucosa or ulcerated

Gross images: various gross/micro images

Micro: nonencapsulated aggregates of foreign body giant cells and fibroangiomatous stroma with hemorrhage, hemosiderin, acute and chronic inflammatory cells; alveolar bone often expanded in edentulous patients leading to superficial bone loss with peripheral cuffing

DD: giant cell granuloma of maxilla/mandible, giant cell “brown tumors” of hyperparathyroidism

 

Central giant cell granuloma

Similar to peripheral giant cell granuloma, but multiloculated

 

Sarcoidosis

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Sites: oral mucosa, gingiva, tongue, hard palate and major salivary glands

Lower lip biopsy is relatively sensitive; 58% demonstrate noncaseating granulomas

 

Tongue ulceration with eosinophilia

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Also called ulcerative eosinophilic granuloma, Riga-Fede disease, traumatic granuloma

Resembles carcinoma clinically

Presumed due to crush injury of tongue muscle

Micro: eosinophils and other inflammatory cells in submucosa, mucosa and salivary glands; dilated vessels often present

 

Wegener’s granulomatosis

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5% of cases present with oral cavity lesion

Gross: red-purple hyperplastic gingiva

Micro: epithelioid histiocytes, giant cells, eosinophils, pseudoepitheliomatous hyperplasia, rarely vasculitis

 

Xerostomia

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Dry mouth

Associated with Sjogren’s syndrome (dry eyes, inflammatory enlargement of salivary glands, xerostomia)

Gross: dry mucosa, atrophy of tongue papillae with fissures, ulcerations

DD: radiation therapy, anticholinergic drugs

 

 

Dermatologic conditions

Erythema multiforme

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Called Stevens-Johnson syndrome if it involves lips and oral mucosa

Maculopapular, vesiculobulbous eruption, due to infection, drugs, cancer, collagen vascular disorder

 

Lichen planus

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Subacute to chronic mucocutaneous disorder of unknown etiology

Involves skin, nails, mucosal surfaces (oral mucosa, pharynx, perineum)

Mucosal disease primarily affects women ages 40-60 years

Treatment: topical steroids or cyclosporine

Gross: reticulate, lacelike, white keratotic lesions; rarely bullous or ulcerated

Gross: buccal mucosa, various gross/micro images #1

Micro: keratosis, subepithelial T cell infiltrate

 

Melanotic pigmentation

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Associated with Addison’s disease, hemochromatosis, fibrous dysplasia of bone (Albright’s syndrome), Peutz-Jegher syndrome

 

Pemphigus vulgaris

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Vesicles and bullae prone to rupture, leaving erosions covered with exudate

Autoimmune disease with antigen-antibody complexes at desmosomes

Treatment: steroids

Micro: intraepithelial blister with acantholysis and chronic inflammation

Micro images: various gross/micro images

 

Smokeless tobacco keratosis

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Occurs in users of smokeless tobacco (snuff) or tobacco chewers

Severity related to length of exposure and tobacco brand

Reversible with cessation of use

Gross: filmy, gray-white opalescence at areas of contact with tobacco

Micro: parakeratosis or hyperorthokeratosis with parakeratin spires (“chevrons”), acanthosis, mild chronic inflammation, PAS+ marked hyalin deposition resembling amyloid

Micro images: hyperorthokeratosis, parakeratosis and acanthosis, diffuse hyalinization of lamina propria, PAS+ hyaline material, lower lip mucosa, buccal mucosa

DD: hyalinosis cutis et mucosae (deposition begins around vessels, eccrine glands and epithelial-stromal interface, then fills entire dermis of all oral mucosa, tongue, pharynx, larynx, vocal cords)

References: Archives 2004;128:e17

 

 

Benign tumors/conditions

Amyloidosis