Contributed by James Guggenheimer, D.D.S.
Blurring of lip vermilion
Contributed by Joshua Seth Goldfaden, D.D.S.
Hyperkeratotic, dysplastic epithelium
Prominent solar elastosis and telangiectasia
Epithelium with dysplastic changes
Arising squamous cell carcinoma
Keratosis and solar elastosis
Epithelial dysplasia and dilated vessels
Contributed by Sarah H. Glass, D.D.S. and Duane Schafer, D.D.S., M.S.
Radiopaque amalgam fragments
Contributed by Sarah H. Glass, D.D.S. and Duane Schafer, D.D.S., M.S.
Buccal mucosa amalgam tattoo
Large maxillary amalgam tattoo
Alveolar ridge amalgam tattoos
Contributed by Sarah H. Glass, D.D.S.
Excisional biopsy specimen
Cross section
Contributed by Sarah H. Glass, D.D.S.
Extensive amalgam deposition
Scattered amalgam granules
Around blood vessels
Large amalgam fragment
Giant cell engulfment
Contributed by Katherine Hulme, M.B.Ch.B.
Oropharynx (frontal view)
Oropharynx (lateral view)
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Aphthous ulcers
26 year old man:
Minor ulcer
Major ulcer
Laser therapy
After one week of laser treatment
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Osseous choristoma
Contributed by Dhiraj B. Nikumbh, M.B.B.S., M.D.
2 day old girl with
difficulty eating and
breathing due to
upper jaw lesion
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Lesion at 3 weeks
Lesion at 16 months
Tumor arising from anterior maxillary alveolus
Contributed by Dhiraj B. Nikumbh, M.B.B.S., M.D.
Congenital granular cell tumor
Contributed by Dhiraj B. Nikumbh, M.B.B.S., M.D. and Kelly Magliocca, D.D.S., M.P.H. (Case #524)
Stratified squamous epithelium
Abundant granular eosinophilic cytoplasm
S100
Scanning magnification
Stroma and overlying surface epithelium
Sheet-like growth
Granular stromal cells
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Polygonal cells
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Submental swelling
Contributed by Dhiraj B. Nikumbh, M.D.
Multiple tonsillar epidermoid cyst
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Sublingual dermoid cyst
Sublingual epidermoid cyst
Contributed by Dhiraj B. Nikumbh, M.D.
Multiple tonsillar epidermoid cyst
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Cyst filled with keratin
Sebaceous gland and hair follicles
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Anterior floor
of the mouth
and base of tongue
Foregut duplication cyst
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Foregut duplication cyst
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Forgut duplication cyst of anterior tongue
Contributed by Katherine Hulme, M.B.Ch.B.
Oral cavity (sagittal view)
Oral cavity (frontal view)
Contributed by Molly Housley Smith, D.M.D.
Floor of mouth leukoplakia
Buccal and labial leukoplakia
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Leukoplakia of buccal mucosa
Contributed by Veronica Cheung, M.Ch.D.
Laser resection oral mucosa
Contributed by Veronica Cheung, M.Ch.D.
Basal cytologic and architectural change
Drop shaped rete
Dysplasia involving > two - thirds of mucosa
Severe cytologic, architectural atypia
Transition from normal to dysplastic mucosa
Floor of mouth dysplasia with skip lesion
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Cystic appearing mass
T1 weighted image, MRI
T2 weighted image, MRI
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Submucosal nodule
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Well circumscribed, tan, hemorrhagic mass
Contributed by Molly Housley Smith, D.M.D.
Prominent hemorrhagic areas
Entrapment within muscle
Focal papillary growth pattern
Chondromyxoid stroma
Hemosiderin breakdown products
Sheets of ovoid cells
Reticular pattern
Chondromyxoid stroma
Ovoid nuclei
GFAP
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FISH rearrangement of RREB1 and MRTFB
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55 year old woman
60 year old man
26 year old woman
37 year old woman
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Keratinocytes (fig d)
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21 year old woman:
irregular lip uclerations and buccal mucosal
23 year old woman:
palatal ulcerations
40 year old man:
hemorrhagic bullae and target lesions
Contributed by Molly Housley Smith, D.M.D.
Yellow, floral papules
1 - 3 mm yellow-white papules
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Yellow-white papules
Contributed by Molly Housley Smith, D.M.D.
Oral mucosa containing sebaceous lobules
Sebaceous lobules adjacent to mucous glands
Sebaceous lobules
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Before and after therapy
Before and after therapy
Geographic tongue
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Psoriform epidermal hypertrophy
Contributed by Sarah H. Glass, D.D.S.
Bosselated gingival mass
Small tongue mass
Contributed by Sarah H. Glass, D.D.S.
Dome shaped mass
White cut surface
Contributed by Sarah H. Glass, D.D.S.
Nodular fibrous proliferation
Elongated rete ridges
Stellate fibroblasts
Multinucleated fibroblasts
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9 year old girl:
Preoperative
1 year follow up
11 year old boy:
Preoperative
Postoperative
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Multiple granulomas
Lip and gingival biopsies
Granulomatous lesion and infiltrates
Contributed by Molly Housley Smith, D.M.D.
Black hairy tongue
Brown hairy tongue
Yellow hairy tongue
Contributed by Molly Housley Smith, D.M.D.
Hyperparakeratosis
Superficial bacterial colonies
Elongated filiform papilla
Contributed by Zahra Maleki, M.D.
Ultrasound
Contributed by Zahra Maleki, M.D. and @AnaPath10 on Twitter
Infiltrating tumor
Basaloid cells
HPV positive oropharynx squamous cell carcinoma
Contributed by Zahra Maleki, M.D.
Atypical squamous cells
Pleomorphism
Focal keratinization
Cohesive fragments
Basaloid features
Cyst aspiration
Cell block
p63
p16
Contributed by Zahra Maleki, M.D.
High risk HPV DNA ISH
HPV16 DNA ISH
HPV RNA ISH
Contributed by Katherine Hulme, M.B.Ch.B.
Oropharynx (frontal view)
Oropharynx (lateral view)
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Preoperative soft palate tumor
Contributed by Ruta Gupta, M.B.B.S., M.D.
Verrucous mucosal lesion
Ulceroproliferative
mucosal lesion
Contributed by Ruta Gupta, M.B.B.S., M.D.
Well differentiated SCC
Moderately differentiated SCC
Poorly differentiated SCC
Verrucous SCC
Papillary SCC
Lymphoepithelial carcinoma
p40 in lymphoepithelial carcinoma
Spindle cell / sarcomatoid carcinoma
CK5/6 in spindle cell SCC
p40 in spindle
cell / sarcomatoid
carcinoma
Adenosquamous carcinoma
Mucicarmine in adenosquamous carcinoma
Contributed by Ruta Gupta, M.B.B.S., M.D.
Keratin and dyskeratotic cells
Clusters of keratin and dyskeratotic cells
Clusters of well differentiated squamous cells
CK5/6 in cell block
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Multiple small nodules on palate
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Inflamed bulbous projection
Contributed by Brandon Stapleton, D.M.D., Molly Housley Smith, D.M.D. and Jimmy Vellis, D.D.S., M.S.
Fibroma of buccal mucosa
Fibroma of the tongue
Ulcerated irritation fibroma
Contributed by Molly Housley Smith, D.M.D.
Tan to gray nodule
Cut surface
Contributed by Molly Housley Smith, D.M.D.
Nodular mass
Hyperkeratotic surface
Scattered chronic inflammatory cells
Contributed by Ivan J. Stojanov, D.M.D., M.M.Sc.
Left posterior maxillary leukoplakia
Right posterior maxillary leukoplakia
Left ventral tongue leukoplakia
Extensive leukoplakia of tongue
Contributed by Ivan J. Stojanov, D.M.D., M.M.Sc.
Undulating / verrucoid surface architecture
Absence of epithelial atypia
Sharply demarcated hyperkeratosis
Verrucous hyperplasia
Leukoplakia periphery
Moderate dysplasia
Leukoplakia with no dysplasia
Parakeratosis and epithelial hyperplasia
Hyperkeratosis and epithelial atrophy
Minimal cytologic dysplastic features
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CGH leukoplakia versus SCC
Genes implicated in malignant transformation
Contributed by Mark Mintline, D.D.S., Sahar Mirfarsi, D.D.S. and Molly Housley Smith, D.M.D.
Reticular oral lichen planus
Erosive lichen planus
Desquamative gingivitis
Ulceration
Cutaneous plaques
Papular lichen planus
Reactive pigmentation
Cutaneous papules
Nail changes
Contributed by Molly Housley Smith, D.M.D.
White striations
Contributed by Mark Mintline, D.D.S. and Molly Housley Smith, D.M.D.
Interface mucositis
Hydropic degeneration
Sawtooth rete ridges
Colloid bodies
Melanin pigmentation
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CT and laryngoscopy
SPECT / CT
CT scan:
Distinct margins
Lingual thyroid
Well defined mass
Aberrant thyroid tissue
48-year-old white female with obstructive lingual thyroid
MRI:
Axial MRI: lingual thyroid
38 year old female
Radionuclide scan:
Scintigraphy with Tc-99m
Tc99m pertechnetate planar image
99mTcO4 radionuclide thyroid scan
Thyroid scintigraphy
Angiography:
External carotid artery angiogram
Ectopic thyroid
Carotid arteriography
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Tongue mass:
Endoscopy:
Flexible and rigid
Swelling
Lingual thyroid in surgery:
Exposed tumor
Intraoperative photograph and surgical specimen
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Excised specimen
Contributed by Andrey Bychkov, M.D., Ph.D. and AFIP
Enlarged thyroid follicles
Resembles malignancy
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With skeletal muscle
Thyroid follicles
Papillary thyroid
carcinoma in
lingual thyroid
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Follicular cells
Ectopic thyroid in a 6 year old child
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Lingual tonsil anatomy
Contributed by Molly Housley Smith, D.M.D.
Sagittal T1 weighted MRI
Contributed by Molly Housley Smith, D.M.D.
Posterior dorsal tongue
Posterior lateral tongue
Numerous enlarged papules
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Inferior view
Superior view
Contributed by Molly Housley Smith, D.M.D.
Germinal center formation
Epithelial crypt formation
Diffuse lymphocytic tissue
Reticular epithelium
Histology of the lingual tonsil
Lingual tonsillectomy for obstructive sleep apnea
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Lymphoepithelial cyst in tonsil
Lymphoepithelial cyst, floor of mouth
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Lymphoepithelial cyst, floor of mouth
Contributed by John Kalmar, D.M.D., Ph.D.
Floor of mouth cyst
Squamous epithelial lining
Lateral tongue cyst
Germinal center in stroma
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Median rhomboid glossitis
Diabetic patient
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Diffuse swelling of lip
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Nonnecrotizing granulomas
Giganto-epithelioid granuloma
Contributed by Nathan Lee, D.M.D.
Oral cavity mucocele
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Intact lesions
Contributed by Vancouver General Hospital
Early mucocele removed intact
Late mucocele removed ruptured
Mucocele mimicking mucoepidermoid carcinoma
Early mucocele removed intact
Late mucocele removed ruptured
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Slightly elevated
Multiple lesions
Lesions on tongue and lip
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Parakeratosis
Typical nuclear changes
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Lateral cephalograph
Raised left ala of nose
Extraoral swelling
Obliteration of labial sulcus
Endoscopic view
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Surgical specimen
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Pseudostratified cylindrical epithelium
Cyst lining
Stratified squamous epithelium
Case #419
Nests and nodules
of tumor cells with
melanin pigments
Tumor cells with
extensive necrosis
and melanin
pigments
PAP
HMB45 (cell block)
Giemsa
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Blanching and fibrosis
With verrucous leukoplakia
38 year old man:
preoperative, after suturing graft and 1 year followup
10 year old boy:
difficulty in mouth opening
12 year old girl:
shrunken uvula, pretreatment and posttreatment
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Dense fibrosis
Advanced
Contributed by Molly Housley Smith, D.M.D.
Periapical radiolucency
Contributed by Molly Housley Smith, D.M.D.
Fluctuant gingival nodules
Yellow gingival nodule
Contributed by Molly Housley Smith, D.M.D.
Exophytic nodule
Loose, inflamed mesenchymal stroma
Dense collections of neutrophils
Etiology and treatment of a dental fistulous tract / parulis
Tracing a dental fistulous tract with gutta percha
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Epidermal / dermal junction
Table 2 MMPDA Index
Contributed by Molly Housley Smith, D.M.D. and Sonal Tuli, M.D.
Diffuse gingival involvement
Localized gingival ulceration
Bullae development
Buccal mucosa involvement
Symblepharon
Contributed by Molly Housley Smith, D.M.D. and @reportesVilla on Twitter
Subepithelial separation
Subepithelial cleft
contains fibrin,
erythrocytes and
inflammatory cells
Subepithelial separation
Minimal inflammation
Pemphigoid
Clinical, histology, laboratory findings with discussion on pathophysiology
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36 year old woman:
Intra oral lesion
After 15 days
52 year old woman:
Erosive lesions
Erythematous gingivae
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36 year old woman
52 year old woman
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Resembes pyogenic granuloma
22 year old woman:
preoperative, excision and postoperative
53 year old man:
pre and postoperative
57 year old woman:
pre and postoperative
81 year old woman:
pre and postoperative
Central giant cell granuloma:
swelling, extended to midline and excisional biopsy
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22 year old woman
Contributed by Tim Bracey, M.B.Ch.B., Ph.D.
28 year old woman with rapidly growing lesion
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22 year old woman
81 year old woman
53 year old man
Central giant cell
granuloma: irregular
giant cells
Contributed by Molly Housley Smith, D.M.D.
Visible ossification
Contributed by Molly Housley Smith, D.M.D.
Nodular mass
Multilobular red growth
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Typical clinical appearance
17 year old boy
21 year old man
25 year old man
26 year old man
31 year old man
Contributed by Molly Housley Smith, D.M.D.
Partially calcified mass
Contributed by Timothy Fielder, M.B.B.S., B.Med.Sci., Ruta Gupta, M.D. and Molly Housley Smith, D.M.D.
Well demarcated mucosal lesion
Ulceration
Metaplastic ossification
Ossification and calcification
Lamellar bone
Collagenous matrix
Woven bone
Peripheral cemento-ossifying fibroma
Cementum-like bone
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Diffuse erythema and edema of the gingiva
Contributed by S. Rajendran, M.B.B.Ch., M.Sc., Ph.D.
Diffuse plasma cell infiltrate
CD138
MUM1
CD56
CD20
Kappa
Lambda
Contributed by Molly Housley Smith, D.M.D., Michael Piepgrass, D.M.D.,
John McGehee, D.M.D., Michael Menis, D.D.S. and Trent Clifton, D.M.D., M.D.
Patchy mandibular leukoplakia
Verrucoid surface texture
Ring around the collar
Diffuse leukoplakia
Buccal mucosa
Tongue lesion
Nonmigrating white lesions
Carcinomatous transformation
Contributed by Molly Housley Smith, D.M.D.
Ring around the collar
Multifocal lesions
Contributed by Molly Housley Smith, D.M.D.
Corrugated hyperorthokeratosis
Skip pattern
Prominent granular cell layer
Skip pattern
Cytologic dysplasia
Dysplastic and elongated epithelium
Bulky hyperkeratotic epithelial proliferation
Suspicion for invasion
Verrucous carcinoma transformation
Deceptively benign
Squamous cell carcinoma transformation
Contributed by Molly Housley Smith, D.M.D.
Median rhomboid glossitis
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Granular cell tumor
Contributed by Molly Housley Smith, D.M.D.
PEH in granular cell tumor
PEH in chronic hyperplastic candidiasis
PEH in median rhomboid glossitis
PEH in blastomycosis
PEH in epulis fissuratum
PEH in necrotizing sialometaplasia
PEH in melanoma in situ
PEH in granulomatosis with polyangiitis
PEH in excision of skin lesion
Definition, causes and histologic appearance of PEH
PEH in granular cell tumor
Contributed by Brittany Camenisch, D.M.D., Nehal Almehmadi, B.D.S., Sana Naheed, B.D.S., Evan Lynch, M.D., Ph.D.,
Justin Kolasa, M.D., D.M.D., Molly Housley Smith, D.M.D. and Susanna Goggin, D.M.D.
Gingival pyogenic granuloma
Reactive pyogenic granuloma
Pedunculated vascular nodule
Red ulcerated pyogenic granuloma
Nodular red pebbly masses
Epulis granulomatosum
Ulcerated gingival pyogenic granuloma
Contributed by Molly Housley Smith, D.M.D.
Lobulated and hyperkeratotic mass
Lobulated and hyperkeratotic mass, sectioned
Deep inflammatory infiltrate
Ulcerated pyogenic granuloma
Ulcerated pyogenic granuloma, sectioned
Contributed by Molly Housley Smith, D.M.D.
Pedunculated mass
Prominent vasculature
Prominent blood vessels
Acute inflammation
Lobular arrangement
Lobular and exophytic architecture
Capillary proliferation
Histopathology of pyogenic granuloma
Clinical and etiologic features
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Nonhomogenous parotid lesion
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Labial mucosal bluish nodule
Parotid salivary gland swelling
Smooth firm labial nodule
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Smooth firm labial nodule
Contributed by Vancouver General Hospital
True cyst removed intact
Squamous metaplasia, ruptured cyst
Contributed by Sarah Glass, D.D.S.
Mandible invasion
Contributed by Sarah Glass, D.D.S.
Exophytic mass lateral tongue
Ulceration ventrolateral tongue
Red-white maxillary gingiva
Contributed by Kathleen Higgins, D.D.S., M.S., Stephen Roth, D.D.S. and Kathleen Schultz, D.M.D.
Glossectomy specimen
Glossectomy specimen cross section
Resection
lateral view
Resection superior view
Resection anterior view
Glossectomy specimen
Contributed by Kathleen Higgins, D.D.S., M.S., Duane Schafer, D.D.S., M.S. and Sarah Glass, D.D.S.
Tumor with margins
Basement membrane breach
Keratin pearl
Muscle invasion
Individual cell keratinization
Impressive pleomorphism
Surrounding nerve
Scattered malignant cells
Basaloid variant
Adenosquamous variant
Verrucous carcinoma
Papillary variant
Acantholytic variant
Spindle variant
Cuniculatum variant
Cytokeratin positive
Contributed by Ivan J. Stojanov, D.M.D., M.M.Sc.
Squamous papilloma of gingiva
Squamous papilloma of tongue
Squamous papilloma of soft palatal mucosa
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Hard palate tumor
Contributed by Ivan J. Stojanov, D.M.D., M.M.Sc.
Pedunculated
Sessile
Irritated
Fibrovascular cores
Tangentially sectioned
Tangentially sectioned
Hyalinization
Irritated
Mitotic activity
With acanthosis
Contributed by Vasiliki Tzelepi, M.D.
Lateral border of tongue
Taste buds
S100
EMA
CK8 / 18
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70 year old woman:
Painful ulcer of tongue
Ill fitting prosthesis
Healing after removal of prosthesis
6 month old boy:
Ulcerative swelling
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Mixed cellular infiltrate
Contributed by Molly Housley Smith, D.M.D.
Sublingual varicosities
Varicosity on lower lip
Thrombosed varicosity of labial mucosa
Contributed by Molly Housley Smith, D.M.D.
Oral varicosity
Contributed by Molly Housley Smith, D.M.D.
Oral varicosity
Compressed oral varicosity
Oral varicosity with organizing thrombus
Phlebolith formation
Contributed by Molly Housley Smith, D.M.D. and Michael Piepgrass, D.M.D., M.S.
Well circumscribed papillary lesion
Prominent keratin horn
Contributed by Molly Housley Smith, D.M.D.
Prominent cupping of rete pegs
Hypergranulosis and koilocytosis
Hyperorthokeratosis
Hypergranulosis
Eosinophilic viral inclusions
Verruca vulgaris versus seborrheic keratosis pathology
Contributed by Louis Beto, D.D.S., M.D., Hal Levine, D.M.D., M.D., Mark Mintline, D.D.S. and Mark Sutor, D.D.S.
Yellow granular mass of oral vestibule
Well circumscribed solitary lesion
Yellow-red pebbly growth
Pink gingival mass
Contributed by Molly Housley Smith, D.M.D. and Kelly Magliocca, D.D.S., M.P.H.
Prominent verrucoid architecture
Inflammatory infiltrate
Well circumscribed mass
Keratin filled clefts
Leukocytic exocytosis
Foamy macrophages
Lipid laden macrophages
Slightly papillary silhouette
Surface parakeratosis and histiocytes
Histiocytes
VX of skin, histology
Clinical description of VX
Contributed by Molly Housley Smith, D.M.D., Thamer Musbah, M.D., Thomas C. Ocheltree, M.D. and Steven Anderson, M.D.
Verrucous carcinoma within PVL
Exophytic white mass
Verrucoid mass of alveolus
Exophytic verrucoid labial mass
Contributed by Molly Housley Smith, D.M.D.
Exophytic and downward growth
Contributed by Molly Housley Smith, D.M.D.
Hyperplastic, bulbous rete ridges
Church spire keratin peaks
Broad, plunging rete ridges
Keratin plugging
Cytologically bland
Verrucous carcinoma
Cutaneous verrucous carcinoma
Contributed by Molly Housley Smith, D.M.D.
Necrotizing sialometaplasia
Oral melanoacanthoma
Squamous papilloma
Oral epithelial dysplasia
Early proliferative verrucous leukoplakia
HPV associated dysplasia
Squamous cell carcinoma
Verrucous carcinoma
Carcinoma cuniculatum
Congenital granular cell epulis
Granular cell tumor
Ectomesenchymal chondromyxoid tumor
Hamartomatous polyp
Franchi: 2020
Gnepp: 2021
IARC: 2024
Neville: 2023
Slootweg: 2016
Stelow: 2020
Thompson: 2022
Wenig: 2017
Wenig: 2024
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