dent 355 rima huda lab keratosis

Dent 355Dent 355Laboratory Session Laboratory Session

Keratoses and Related Keratoses and Related Disorders of Oral MucosaDisorders of Oral Mucosa

Dr. Rima SafadiDr. Rima SafadiModified from Dr. Huda Modified from Dr. Huda

HammadHammad

Normal Oral MucosaNormal Oral Mucosa

Color of normal Color of normal oral mucosaoral mucosa

Normal Oral MucosaNormal Oral Mucosa

Color of normal Color of normal oral mucosa: oral mucosa: vascularity, vascularity, melanin, epithelial melanin, epithelial thickness, thickness, keratinization.keratinization.

Normal Oral MucosaNormal Oral MucosaNon-keratinized partsNon-keratinized parts

Normal Oral MucosaNormal Oral MucosaNon-keratinized partsNon-keratinized parts

Normal Oral MucosaNormal Oral MucosaKKeratinized Partseratinized Parts

White PatchesWhite Patches

DebrisHyperkeratosis

Definition of Histopathological Definition of Histopathological TermsTerms

Pyknotic nuclei: parakeratosis Granular cell layer

orthokeratin

Definition of Histopathological Definition of Histopathological TermsTerms

Acanthosis

Atrophy

Cellular atypia, Cellular atypia, Epithelial dysplasia.Epithelial dysplasia.

Dysplasia

Hereditary Conditions Hereditary Conditions (Genodermatoses): Oral Epithelial (Genodermatoses): Oral Epithelial Nevus (White Sponge Nevus)Nevus (White Sponge Nevus)

Hereditary Conditions Hereditary Conditions (Genodermatoses): Oral Epithelial (Genodermatoses): Oral Epithelial

Nevus (White Sponge Nevus)Nevus (White Sponge Nevus)

-Intracellular edema of prickle and cell layers.Intracellular edema of prickle and cell layers.Hyperkeratosis

Hereditary Conditions Hereditary Conditions (Genodermatoses): Leukoedema(Genodermatoses): Leukoedema

Hereditary Conditions:Hereditary Conditions:LeukoedemaLeukoedema

Intracellular edemaAnd glycogenCells appear vaculated

Thick epithelium with broad rete ridges

Traumatic Keratoses: Traumatic Keratoses: Mechanical Trauma-Frictional Mechanical Trauma-Frictional

KeratosisKeratosis

Trauma-Frictional KeratosisTrauma-Frictional KeratosisHabitual cheek bitingHabitual cheek biting

Traumatic Keratoses: Traumatic Keratoses: Mechanical Trauma-Frictional Mechanical Trauma-Frictional

KeratosisKeratosis Histopathology: Histopathology: - Hyperkeratosis +/- Hyperkeratosis +/-

acanthosis.acanthosis.- There is There is nono dysplasia. dysplasia.

Traumatic Keratoses: Traumatic Keratoses: ChemicalChemical

Aspirin burn.Aspirin burn.

Traumatic Keratoses: Traumatic Keratoses: ChemicalChemical

Snuff dipper’s lesion.Snuff dipper’s lesion.

Similar to chronic friction

Traumatic Keratoses: Thermal Traumatic Keratoses: Thermal Nicotinic Stomatitis Nicotinic Stomatitis

Dilated duct of minor salivary gland

LeukoplakiaLeukoplakia

Homogenous LeukoplakiaHomogenous Leukoplakia

HomogeneousHomogeneous- flat, uniform, - flat, uniform,

predominantly white predominantly white plaquesplaques

- may show shallow - may show shallow cracks/fissurescracks/fissures

Leukoplakia: Clinical Leukoplakia: Clinical FeaturesFeatures

Speckeled

Speckeled

ErythroplakiaErythroplakia

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial DysplasiaDysplasia

2 features are highly 2 features are highly suggestive of smoking as suggestive of smoking as an etiological factor:an etiological factor:

1. presence of chevron peaks 1. presence of chevron peaks in keratin.in keratin.

2. increased melanin 2. increased melanin production in basal production in basal keratinocytes  and leakage keratinocytes  and leakage of melanin into the of melanin into the underlying connective underlying connective tissue (melanin tissue (melanin incontinence).incontinence).

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial DysplasiaDysplasia

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial DysplasiaDysplasia

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial DysplasiaDysplasia

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial Dysplasia- Features of Epithelial Dysplasia- Features of Epithelial

DysplasiaDysplasia

1. Increased and abnormal mitoses.1. Increased and abnormal mitoses.

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial Dysplasia- Features of Epithelial Dysplasia- Features of Epithelial

DysplasiaDysplasia

2. Basal cell hyperplasia.2. Basal cell hyperplasia.

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial Dysplasia- Features of Epithelial Dysplasia- Features of Epithelial

DysplasiaDysplasia

3. Drop-shaped rete ridges.3. Drop-shaped rete ridges.

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial Dysplasia- Features of Epithelial Dysplasia- Features of Epithelial

DysplasiaDysplasia

4. Disturbed polarity of basal cells or loss of 4. Disturbed polarity of basal cells or loss of cellular orientation.cellular orientation.

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial Dysplasia- Features of Epithelial Dysplasia- Features of Epithelial

DysplasiaDysplasia

5. Increase in nuclear/ cytoplasmic ratio.5. Increase in nuclear/ cytoplasmic ratio.

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial Dysplasia- Features of Epithelial Dysplasia- Features of Epithelial

DysplasiaDysplasia

6. Nuclear hyperchromatism.6. Nuclear hyperchromatism.

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial Dysplasia- Features of Epithelial Dysplasia- Features of Epithelial

DysplasiaDysplasia7. Prominent and enlarged nucleoli.7. Prominent and enlarged nucleoli.

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial Dysplasia- Features of Epithelial Dysplasia- Features of Epithelial

DysplasiaDysplasia8. Irregular epithelial stratification or 8. Irregular epithelial stratification or

disturbed maturation.disturbed maturation.

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial Dysplasia- Features of Epithelial Dysplasia- Features of Epithelial

DysplasiaDysplasia

9. Nuclear and cellular pleomorphism.9. Nuclear and cellular pleomorphism.

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial Dysplasia- Features of Epithelial Dysplasia- Features of Epithelial

DysplasiaDysplasia

10. Abnormal keratinization (dyskeratosis).10. Abnormal keratinization (dyskeratosis).

Leukoplakia: Pathology, Epithelial Leukoplakia: Pathology, Epithelial Dysplasia- Features of Epithelial Dysplasia- Features of Epithelial

DysplasiaDysplasia

11. Loss or reduction of intercellular 11. Loss or reduction of intercellular adhesion.adhesion.

Regezi

Lichen Planus: Clinical FeaturesLichen Planus: Clinical Features

Skin lesions:Skin lesions:

Lichen Planus: Clinical FeaturesLichen Planus: Clinical Features

Skin Lesions:Skin Lesions:

Lichen Planus: Clinical FeaturesLichen Planus: Clinical Features

Skin and Nail Skin and Nail Lesions:Lesions:

Lichen Planus: Clinical FeaturesLichen Planus: Clinical Features

Oral Lesions:Oral Lesions:

Reticular pattern

Lichen Planus: Clinical FeaturesLichen Planus: Clinical Features

Oral Lesions:Oral Lesions:

Non-erosive types:Non-erosive types:

- reticular or annular, - reticular or annular, papular, plaque-papular, plaque-like.like.

Lichen Planus: Clinical FeaturesLichen Planus: Clinical Features

Oral Lesions:Oral Lesions:

Erosive/atrophic typesErosive/atrophic types

Lichen Planus: Clinical FeaturesLichen Planus: Clinical Features

Oral Lesions:Oral Lesions:

Lichen planus involving the Lichen planus involving the gingiva often presents as a gingiva often presents as a desquamative gingivitis.desquamative gingivitis.

Lichen Planus: PathologyLichen Planus: Pathology

Histopathologic Features:Histopathologic Features:

Ortho- or parakeratosis.Ortho- or parakeratosis.

Epithelial atrophy or Epithelial atrophy or acanthosis (sawtooth acanthosis (sawtooth pattern of rete ridges).pattern of rete ridges).

Dense, well-defined band Dense, well-defined band of subepithelial of subepithelial mononuclear infiltrate, mononuclear infiltrate, mainly T-cells.mainly T-cells.

Lichen Planus: PathologyLichen Planus: Pathology

Histopathologic Features:Histopathologic Features:

Lichen Planus: PathologyLichen Planus: Pathology

Histopathologic Features:Histopathologic Features:

Liquefactive Liquefactive degeneration of basal degeneration of basal cell layer associated cell layer associated with edema and with edema and lymphocytic infiltration.lymphocytic infiltration.

Civatte bodies: hyaline Civatte bodies: hyaline shrunken bodies shrunken bodies representing apoptotic representing apoptotic cells.cells.

Lichen Planus: PathologyLichen Planus: Pathology

Histopathologic Histopathologic Features:Features:

Basal cell Basal cell degeneration may degeneration may result in subepithelial result in subepithelial bullae formation and bullae formation and ulceration.ulceration.

Lupus Erythematosus: Clinical Lupus Erythematosus: Clinical FeaturesFeatures

Chronic Discoid Chronic Discoid Lupus Lupus Erythematosus Erythematosus (DLE):(DLE):

Lupus Erythematosus: Clinical Lupus Erythematosus: Clinical FeaturesFeatures

Chronic Discoid Lupus Chronic Discoid Lupus Erythematosus (DLE): Oral Erythematosus (DLE): Oral Lesions Lesions

Lupus erythematosus Lupus erythematosus histopathologyhistopathology

Deep perivascular Lymphocytic infiltrate

Lupus Erythematosus: Histopathologic Lupus Erythematosus: Histopathologic FeaturesFeatures

Subepithelial and Subepithelial and deep perivascular deep perivascular lymphocytic infiltrates.lymphocytic infiltrates.

Liquefactive Liquefactive degenerartion of basal degenerartion of basal cells.cells.