Recall... Oral Pathology .. Part (1) Solitary bone cyst occurs in children and adolescents .

. Aneurysmal bone cyst occur in children and young adults Stafne's idiopathic bone lesion occur in 80-90% in men Solitary bone cyst >>molar regions of the mandible Aneurysmal bone cyst >>posterior part of the body or angle of the mandible Stafne's idiopathic bone lesion Most lesions are unilateral and stable in size Extravasation mucoceles (70% in lower lip ) .. then cheek and floor of the mouth ------------------ Retention mucoceles are rare in the lower lip Thyroglossal duct cyst arise in the region of the hyoid bone Dermoid cysts sites in the head and neck including occasionally the floor of the mouth If epidermoid cysts are found in the midline then they are developmental BUT if they are found in other locations they are acquired Lymphoepithelial cysts , occur anterior to Sternocleidomastoid muscle (SCM) at the level of the angle of the mandible

Recall ... Oral Pathology .. Part (2) Solitary bone cyst , resolve spontaneously with time solitary bone cyst trauma produces inter-medullary hemorrhage , Cavitation may occurs by subsequent hemolysis and resorption of the blood clot Aneurysmal bone cyst associated with deformity and pain and paresthesia Aneurysmal bone cyst has ballooned out appearance solitary bone cyst & the Aneurysmal bone cyst reflecting some hemodynamic disturbances in medullary bone Salivary gland tumors are more common in the upper lip than in the lower lip Extravasation mucoceles will have large numbers of macrophages -------------------Ranula = swelling of the floor of the mouth Plunging Ranula: Extension of Ranula through the mylohyoid muscle , Occurs in the

submandibular area or the neck. Lymphoepithelial cysts has unknown pathogenesis and need Surgical excision Differential diagnoses for Ranula (floor of the mouth swelling): 1. Mucous Extravasation cyst 2. Mucous retention cyst 3. Dermoid cyst 4. Epidermoid cyst 5. Lymphoepithelial cyst 6. Thyroglossal duct cyst Recall .. Oral Pathology .. Part3 Hyperplasia: Increase in number of cells (controlled proliferation of cells) In Hyperplasia cells looks normal in the microscope but increased in number . Neoplasia or true tumor : Increase in number of cells (uncontrolled proliferation of cells) and cells look abnormal . Causes of reactive hyperplasia are: 1- Plaque & calculus 2- Lip/cheek biting 3- Ill fitting/over-extended denture 4- Sharp edge of crown or bridge Epulis : localized chronic inflammation on the gingiva Epulides are more common in females & more in maxilla Epulides lesion regress by itself. If not then surgical excision. -------------------------------------------Types of epulides: Fibrous epulis ( Commonest ), Vascular epulis , Giant cell epulis ( uncommon ) . Pyogenic granuloma & pregnancy epulis are clinically & histologically identical but pregnancy epulis occur in Pregnancy women . Vascular epulis occurs in females of child-bearing age pregnancy epulis lesions regress by themselves after delivery Vascular epulis may recur !

Oral Pathology .. Part (4)

 Giant cell epulis: It is slightly more in the mandible in anterior to molar teeth Giant cell epulis in dentate patients will give hour- glass appearance In both PGCG and CGCG we should ask for parathyroid hormone level to exclude brown tumor of hyperparathyroidism Giant cells are thought to originate from macrophages or osteoclasts CGCG & Papillary Hyperplasia of the Palate & Denture irritation hyperplasia & Vascular epulis & Fibrous epulis & Fibroepithelial polyp will regress by itself if not it needs surgical treatment . CGCG are highest recurrence rate among all epulides (Recurrence rate is 10%) Fibroepithelial polyp , is the commonest lesion of the oral cavity Leaf fibroma related to fitting surface of denture on the hard palate Etiology of Papillary Hyperplasia of the Palate: Ill-fitting denture , Continuous denture wearing, Candida-associated denture stomatitis, Poor oral hygiene Papillary Hyperplasia of the Palate: hard palate shows pebbled appearance. Benign tumors of fibrous tissue (true fibromas) in the oral cavity are rare. Malignant tumors (fibrosarcoma) are also rare in the oral cavity and have 5 year survival rate is 70%. Lipoma types : *Fibrolipoma Lipoma and fibrous tissue stroma *Angiolipoma Lipoma and vascular tissue stroma *Myxolipoma Lipoma and connective tissue stroma Malignant tumors (liposarcoma) are uncommon, most arise in cheeks, floor of the mouth or the base of the tongue, Juvenile Hemangioma in parotid gland which is the commonest salivary gland tumor occurring in infants and children Hemangiomas at birth or arise during early childhood Capillary Hemangioma a type of blood vessel malformation that has relatively small blood-filled spaces , starts at birth and ends at 9 years old Cavernous Hemangioma a type of blood vessel malformation that has relatively large blood-filled spaces

Recall .. Oral Pathology .. Part (5 ) Arteriovenous malformation: Abnormal connection between arteries and veins, bypassing the capillary system. Kaposi sarcoma and angiosarcoma are rare but common in AIDS patients

 Lymphangioma , less common than Hemangioma , It can occur anywhere in the oral cavity but are most frequently seen on the tongue. Neurofibroma is usually solitary BUT if it is associated with neurofibromatosis then it is multiple. About 10% of Plexiform neurofibromas undergo transformation into a malignant peripheral nerve sheath tumor. Type I Neurofibromatosis affects the skin while Type II Neurofibromatosis affects the centralnervous system. To differentiate between Types of Neurofibromatosis: If there's multiple giant cell lesions suspect neurofibromatosis type I or primary hyperparathyroidism. Traumatic neuroma: Fixed to surrounding structures & Painful to palpation. Granular cell tumor commonly in tongue . Tumors of muscles: smooth muscles: Leiomyoma (benign), leiomyomatous hamartoma, leiomyosarcoma (malignant) skeletal muscles: Rhabdomyoma (benign) , rhabdomyosarcoma (malignant) -------------- Hodgkins lymphoma: 30% of all malignant lymphomas , Affects young age group Hodgkins lymphoma histological diagnosis depends on identification ofReedSternberg cells Non-Hodgkins lymphoma: Increased incidence reported in AIDS patients Burkitts Lymphoma , endemic cases in Africa and affects mainly children between 214 yrs, while Sporadic cases in non-African countries Odontomes occasionally cause bone expansion The majority of Odontomes are associated with the crowns of unerupted teeth ,occasionally, they take the place of a missing tooth Multiple Odontomes are rare

Recall .. Oral Pathology .. Part (6) Compound odontome It occurs mostly in the anterior maxilla Ameloblastoma, It is rare but one of the commonest odontogenic tumors, more common in black Americans and west Africans, 80% occur in the

mandible Root resorption of involved teeth occur with Ameloblastoma Ameloblastoma may be associated with an unerupted tooth, particularly an impacted 3rd molar Sequamous odontogenic tumor: Rare tumor presenting with tooth mobility Calcifying Epithelial Odontogenic Tumor , In the Mandible mostly in molar and premolar area . Adenomatoid Odontogenic Tumor : 2nd and 3rd decades , In anterior maxilla, especially canine area, It is slowly enlarging swelling. Ameloblastic Fibroma occur in young people with Recurrence rates of ~18%. The dentinogenic ghost cell tumor is histologically similar to calcifying cystic odontogenic tumor except that it is solid Odontogenic Fibroma and Myxoma, different presentations reflect the different mesenchymal tissues. Odontogenic Myxoma (more common ) than odontogenic fibroma Odontogenic Myxoma has soap-bubble, or tennis-racket appearance ----------------- Cementoblastoma identical to Osteoblastoma except for association with tooth roots If the tumor shows features of atypia, it is given the diagnosis of ameloblastic carcinoma Melanotic Neuro ectodermal Tumor of Infancy Maxilla of Infants Congenital Epulis: 10 times more common in females more in anterior maxilla 5% of saliva entering the oral cavity come from Sublingual glands Aplasia = defective development or congenital absence of an organ or tissue Atresia = condition in which an orifice or passage in the body is abnormally closed or absent Accessory parotid tissue : commonly occur within the cheek or Masseter muscle Sialadenitis = inflammation of the salivary gland
Recall ...

Oral Pathology .. Part (7) Only one Left ! Mumps (Epidemic Parotitis) is contagious infection occurs in minor epidemics, it has painful swelling Orchitis (testicular inflammation) is the most common complication affecting 20% of affected adult males Diagnosis of Mumps: confirmed by detection of IgM antibodies Cytomegalic virus (CMV) associated with xerostomia in HIV infection Serous Acini are more sensitive than mucous Acini Heerfordt syndrome : make Sarcoidosis occur in lacrimal gland Salivary Calculi (Sialoliths): (79-90%) of cases involve submandibular gland Necrotizing Sialometaplasia: Presents most commonly as a deep, crater-like ulcer which may mimic a malignant ulcer , on hard palate in middle-aged patients, especially males Rheumatoid arthritis is the most common Connective Tissue disease associated with secondary Sjgren syndrome ------------ Kerato-conjunctivitis sicca manifests as: Dryness of eyes , Conjunctivitis , Burning sensation 55% of minor gland tumors affect palate, 20% upper lip Proportion of malignant tumors in minor glands is higher than benign Proportion of benign tumors in major glands is higher than malignant Basal Cell Adenoma , Peak incidence in 7th decade Canalicular adenoma: > 50 years of age, Almost all cases in upper lip Low grade Mucoepidermoid Carcinoma: Advance on a broad, pushing front (grow in size while remaining in place without invasion or infiltration) Recall ... Oral Pathology .. Part (8)
** PAS stain is a special stain that detects the presence of mucin in tissues and it is used to distinguish Sequamous cell carcinoma from mucoepidermoid carcinoma histologically

Parotid tumors may present with facial palsy

 Polymorphous Low Grade Adenocarcinoma only in Minor Glands Geographic Tongue : heal and then reappear in another location (migratory) Crohns Disease: involving any part of GIT, most commonly terminal ileum Crohns Disease: Intestinal involvement usually causes recurrent episodes of abdominal pain & nutritional deficiencies due to malabsorption Sarcoidosis may leave residual swelling Wegeners Granulomatosis: destructive granulomatous inflammation of respiratory tract , it has (strawberry gingivitis) Wegener's Granulomatosis controlled with corticosteroids & Cytotoxic medications, otherwise is rapidly fatal Oral Submucous Fibrosis: almost exclusively among Asiatic Indians amyloid is positively stained by Congo red stain death in Amyeloidosis results from organ failure Exogenous Pigmentation: Black hairy tongue, Foreign bodies: amalgam tattoo, miscellaneous Endogenous pigments: Blood breakdown products e.g. jaundice Disturbances of iron metabolism e.g. hemochromatosis Age Changes in the Oral Mucosa: Increased prominence of Fordyces granules