Oral Pathology Short case 1 - 51 Years Male - Whitish lesion on the lateral border of the tongue for 6 months duration

on


Answer : Keratosis with Severe epithelial dysplasia
Dysplasia definition: Spectrum of architectural and cytological epithelial changes caused by the accumulation of genetic changes, associated with an increased risk of progression to squamous cell carcinoma.

Or

Deviation of normal cell proliferation, differentiation and maturation.

Epithelium may be atrophic, acanthotic, keratinized or non keratinized 

World Health Organization (WHO) criteria for epithelial dysplasia (2005)


Architectural changes

Cellular changes

Irregular epithelial stratification

Abnormal variation in nuclear size (anisonucleosis)

Loss of polarity of basal cells

Abnormal variation in nuclear shape (nuclear pleomorphism)

Basal cell hyperplasia*

Abnormal variation in cell size (anisocytosis)

Drop-shaped rete ridges

Abnormal variation in cell shape (cellular pleomorphism)

Increased number of mitotic figures

Increased nuclear-cytoplasmic ratio

Abnormally superficial mitotic figures

Increase in nuclear size*

Premature keratinization in single cells (dyskeratosis)

Atypical mitotic figures

Keratin pearls within rete ridges

Increased number and size of nucleoli


Hyperchromasia


The cutoff point between low grade and high-grade dysplasia suggested by Omar Kujan is 

  • 4 architectural changes and 

  • 5 cytological changes (Nankivell et al 4 cytological)

  • Irrespective of the level of the epithelium involved 


 Grading scheme for Oral Epithelial Dysplasia – adopted from the WHO classification of head and neck, 2017

WHO dysplasia grade 

Binary System

Mild Dysplasia

Low grade dysplasia


High grade dysplasia

Moderate Dysplasia

Severe dysplasia


Table 1: HPV types

Disease 

HPV type

Squamous cell papilloma

6, 11

Cervical and Oral cancer

16, 18

Heck disease 

13, 32

Warts

2,4,10

Condyloma acumunatum

6, 11

Verruca Vulgaris

2, 4, 10,40,57


Download the Oral Pathology Short cases clicking the following link

Comments

Post a Comment

Popular Posts

Image

Oral Pathology Short Case 4 - 25 Year Male –Radiologically visible lesion in the maxilla

Answer : Cemento osseous dysplasia Non-neoplastic fibro-osseous lesion Most common benign fibro-osseous lesion of the jaws Common in middle-aged black women 3 variants –based on anatomic location Periapical – Periapical –mandibular anterior teeth Focal COD – Single tooth Florid – Multiquadrent involvement  Asymptomatic – Accidental finding Associated with vital tooth Radiolucent, Radiodense or mixed – the periodontal ligament is intact Histopathology  Cellular fibrous stroma with areas of swirling(Spirelling) and loose collagen With mineralizing tissues consisting of osteoid, bone and cementum Osteoblastic rimming is rare Vascularity is pronounced-Blood within biopsied specimens No capsule Treatment: No treatment –Follow up for complication for osteomyelitis  Download the Oral Pathology Short cases clicking the following link Click Here
Image

Oral Pathology Short Case 6 - 60 Years old Male - Lump in the parotid

  Answer : Warthin tumour Second most common tumour of salivary gland 5-15% of all cases 6 th and 7 th decades Male > Female Linked to cigarette smoking Table 6 Histopathology Papillary projections lined by epithelium Lymphoid stroma Papillary cystic structures lined by epithelium Epithelium Inner – Columnar Outher - Cuboidal With germinal centers  After FNAC – necrosis confused with malignancy  Granulomatous reaction with langerhan type giant cells may seen Oncocytes – epithelial cells characterized by excessive number of mitochondria When present in a lower pole metastatic node is a suspicion  May associate with HIV (P 27 positivity in HIV) Technetium 99 may appear as hot lesion Complete surgical excision with adequate margin  Parotid resection nomenclature Anatomical Functional Extracapsular dissection Partical parotidectomy Superficial parotidectomy Deep parotidectomy Conservative Semi conservative Radical Eg : Conservative superficial parotidectomy D...
Image

Oral Pathology Short Case 8 - Swelling of the lip and rough buccal mucosa in a 25 Year old Male

  Answer : Orofacial granulomatosis Lymphoedema  Multiple non caseating giant cell granuloma in peri oral and oral regionSubgroupd of patients previously known as Melkersson Rosenthal syndrome  IF GIT manifestations present – Crohns disease  Histopathology Oedematous corium and perivascular lymphocytic infiltration Non caseating granulomas Treatment  Local or systemic corticosteroids  Immuno modulators Surgical management Download the Oral Pathology Short cases clicking the following link Click Here