oral workshop

8/2/2019 Oral Workshop

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60 yr old male, mass buccal mucosa



Differential diagnosis?????



Solitary fibrous tumor

Leiomyoma

Fibroma



Recent explosion of reports citing SFT at unrecognizedsites.

Region of head and neck is one of the more commonsites.

SFT is not very aggressive in head and neck sites. In the head and neck buccal mucosa is the commonest

site.

Fibroblast like cells with patternless pattern, thin strip-

like bands of collagen and gaping vessels. IHC; CD34, bcl2+ Fibroma CD34-, Leiomyoma ; actin/desmin+

CD34-



40 year female ulcer lip



Differential diagnosis????



Well differentiated squamous cell carcinoma

Granular cell tumor



Benign neoplasms very rarely malignant

Female prdilection.

Can occur in a variety of sites in head and neck

region.Tongue is the commonest site. H/P; border of lesion ; ill defined with tumor

infiltrating in the stroma.

When the tumor arises in the muscle , granular

cells can be difficult to recognize Cytology; bland, distinct cytoplasmic borders,

fine granulations



Closely associated with nerves.

N.B. If a graular cell tumor is present, adiagnosis of squamous cell carcinoma should

not be rendered; no matter how closely thesquamous proliferation resembles squamouscell carcinoma.

IHC; S100+, inhibin+

CD68+, Alpha 1 antitrypsin +



66 yr old man treated with radiation forcarcinoma oral cavity. Polypoid noduleradiation site.



Reactive fibroblastic proliferation

Pseudosarcomatous reaction to an associatedcarcinoma or radiation

True sarcoma Sarcomatoid carcinoma



Rare, diagnostically challenging esp in head andneck region.

May show prominent or exclusively spindle cellcomponent.

Cellular atypia is highly variable. IHC may help but not always relaible. Cytokeratin 50 -75% but absence of CK +vty does

not excludes sarcomatoid SCC

CK +vty does not confirm presence of sarcomatoidSCC. p63 is very useful as its expression is not

encoutered in most sarcomas or benign spindle celllesions.



60 yr old male ,mandible resection for recurrentsquamous cell carcinoma



Silaometaplasia

Squamous cell carcinoma

Jxtaoral organ of chievitz



Vestigial epithelial remnant

Site; medial aspect of mandible along the angle.

May serve some mechanosensory function (

some suggest that it is a neuroendocrinereceptor)

Resemblance to squamous cell carcinoma but

lack cytologic atypia May undergo hyperplasia



68 yr old female, large solid pale yellowswelling soft palate, tumor excision done



Lipomatosis or fatty replacement

Lipomatous pleomorphic adenoma

Lipoadenoma of salivary glands

Hamartoma

Sialopliopma



Slow growing painless mass

Mean age; 51 years. Male predominance

H/P; well circumscribed, may be encapsulated.

Focii of atrophic acini and ducts containedwithin lipomatous proliferation.

Ductal structures may be dilated with fibrosis

of the wall.



40 yr old male , dome shaped nodule softpalate



Traumatic neuroma

Palisaded encapsulated neuroma

Spindle cell melanoma



Nodular neuroma consisting of schwan cells andnumerous axons with a delicate perineuralcapsule.

90% affect lips,face , oral cavity

Usually a solitary nodule May poorly or prtially encapsulate.

Retraction artefact common.

Vague palisading may be present.

Nuclear regimentation into verocay bodiesoccasionally seen.

Mitosis, atypia not seen.



Palisaded encapsulated neuroma schwanoma

Peripheral delicate EMA positivity Completely surrounded by perineuralcapsule

Axons throught the lesion Axons when present are typicallyperipheral, subcapsular

GFAP- GFAP+

No organization into Antoni A & Bareas

common



Traumatic neuroma PEN

H/O trauma, surgery

Can have irregular margins Circumscribed

Numerous well formed small nervetwigs

Random proliferation of schwan cellsand axonsLack collagenous stroma

EMA+ perineurium surroundsindividual nerve twigs

EMA+ perineurium restricted toperphery of entire neuroma



40 yr old man red patch hard palate



Differential diagnosis???



Kaposi sarcoma

Fibrosarcoma



Vascular lesion of low grade malignant potential

May originate from cell type capable ofundergoing lymphatic differentiation based on D240 staining.

Sites; skin , mucus membranes, visceral organs,lymph nodes.

IHC: FL1 (nuclear), VEGFR-3, HHV8,fVIII related

antigen,CD34,CD31 KS represents the most frequent oral malignancy

seen in association with HIV infection.



50 year old male , mass hard palate



Differential diagnosis???




Myoepithelioma

Inflammatory myofibroblastic tumor

Sarcomatoid carcinoma



25 yr female painful swelling buccal aspect ofalveolar ridge. Xray shows radio opaque lesionsurrounded by radiolucent area connected witha tooth



Cementoblastoma

Osteoblastoma



Def; a cementoblastoma is characterized by theformation of cementum like tissue in connectionwith the root of a tooth.

Benign tumor. Male to female ratio 2.1:1

Mostly in permanent dentition Symptomless or pain & swelling Also called true cementoma H/P; formation of sheets of cementum like tissue

cotaining a large number of basophilic reversallines and lack of mineralization at the periphery ofthe mass.

The diagnosis can not be made on the biopsyalone.



35 yr male, painless jaw swelling. Xray showsmottled mixed radio opaque/lucent lesionsuggestive of fibro osseous origin.



Desmoplastic ameloblastoma

Squamous odontogenic tumor

Odontogenic fibroma

Ameloblastic fibroma



Ameloblastoma is the most common odontogenictumor of epithelial tissue origin.

Desmoplastic ameloblastoma is one of its variantswith specific clinical, imaging & histologicalfeatures.

Slowly growing, no gender predilection,wide agerange, locally invasive& high rate of recurrencewith incomplete removal.

Frequency slightly higher in Asian population

Show more aggressive behavior than other typesof ameloblastoma. Common location; maxilla

H/P



H/P;

1) Stromal desmoplsia (moderately cellular

fibrous connective tissue with abundantcollagen)

2)islands of different shapes in the epithelial

component. 3)peripheral layer of cuboidal cells

4)hypercellular central area composed ofspindle shaped or polygonal epithelial cells.

X ray; diffuse ill defined lesion



50 yr old female swelling of jaw, loosening ofteeth. Xray shows ill defined radiolucency



Clear cell lesions of salivary glands Melanoma

Metastatic renal cell carcinoma

Clear cell odontogenic carcinoma



It is characterized by sheets and islands ofvacuolated and clear cells.

Strong female predilection. Older adults

On x ray ill defined radiolucency

H/P; A biphasic pattern often seen Fibrous stroma withislands of epithelial cells

having clear to faintly eosinophilic cytoplasm. Thecells have distint boundries and irregular dark

stainig nucleus. Cords of basaloid cells seen.

Ameloblastomatous islands



PAS +, Mucin -

IHC; CK 13,14,19,8,18, EMA+

Negative stains; vimentin, S100, desmin,SMA,HMB 45

Aggressive behavior, may metastsize.



Tumor histologic type and pattern Tumor size and location Tumor histologic grade Depth of invasion (not used for TNM staging) Pattern of invasion (noncohesive irregular cords, infiltrative single

cells, well defined blunt pushing borders, thick rounded invasivecords)

Tumor extension to adjacent structures Status of resection margins Vascular invasion Perineural invasion

Lymph nodes: for each level, number obtained, number involvedby tumor, size of nodal metastases, presence of extracapsularspread

Dysplasia

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