1

Normal oral epithelium

Basal cell layer –prickle cell layer- granular cell layer- keratin

2
 Reactive lesions

1- Verruca vulgaris

Hyperkeratosis, papillomatosis, hypergranulosis, koilocytosis and inward bending of

rete ridges at borders of lesion.

Vacuolization of the cells of the upper stratum spinosum and stratum granulosum with
pyknotic raisin-like nuclei.
3
Koilocytes. Notice the raisin-like pyknotic nuclei.

Koilocytes. Notice the raisin-like pyknotic nuclei.

4
 2- Heck’s disease
.

Heck’s disease, acanthosis and irregular elongation and anastomosis of rete ridges.

Classic “mitosoid” cells.

5
 3- Verruciform xanthoma

Verruciform xanthoma, exophytic finger-like proliferation of mature squamous

stratified epithelium that covers thin cores of connective tissue, which shows
superficial chronic inflammatory infiltrate.

Verruciform xanthoma, showing surface parakeratosis and histocytes with connective

tissue papillae.
6
Verruciform xanthoma, showing histocytes with connective tissue papillae.

7
 4- Pyogenic granuloma

Pyogenic granuloma, acanthotic hyperplastic epithelium, rete ridges and

dilated blood vessels in the connective tissue.

Pyogenic granuloma, para-keratinized hyperplastic epithelium, rete ridges and dilated

blood vessels in the connective tissue.
8
 5- Irritational fibroma

Irritational fibroma showing para-keratinized hyperplastic epithelium, rete ridges and

collogen bundles in the connective tissue.

Irritational fibroma, collagen bundles interspersed with fibroblasts, blood vessels and
scattered chronic inflammatory cells.

9
 6- Peripheral giant cell granuloma

Peripheral giant cell granuloma, low magnification. The stratified squamous

epithelium exhibits hyperkeratosis and acanthosis. The subjacent fibrous connective
tissue showed non-capsulated proliferation of cellular mesenchymal tissue with
abundant dispersed multinucleated giant cells.

10
Peripheral giant cell granuloma demonstrating giant cells in fibrous connective tissue
stroma with overlying hyperplastic epithelium.

Microscopic aspect showing multinucleated giant cells.

7- Peripheral ossifying fibroma

Peripheral ossifying fibroma showing calcifying material resembling bone within the
connective tissue.
11
Mineralized tissue within peripheral ossifying fibroma: Lamellar bone.

Mineralized tissue within peripheral ossifying fibroma: Dystrophic calcification.

12
 Benign Lesions

1. Squamous Cell Papilloma

SQUAMOUS CELL PAPILLOMA : PAPILLARY PROJECTIONS LINED

BY KERATINIZED STRATIFIED SQUAMOUS EPITHELIUM WITH
FIBROVASCULAR CONNECTIVE TISSUE CORES .

SQUAMOUS CELL PAPILLOMA : KERATINIZING STRATIFIED

SQUAMOUS EPITHELIUM AROUND FIBROVASCULAR CORES (R ED
ARROWS).
13
SQUAMOUS CELL PAPILLOMA : NUMEROUS FINGER - LIKE
PAPILLARY PROJECTIONS (PEDUNCULATED).

SQUAMOUS CELL PAPILLOMA :FIBROVASCULAR CONNECTIVE

TISSUE CORES (RED ARROWS).

14
SESSILE SQUAMOUS CELL PAPILLOMA .

15
 2. Keratoacanthoma

3.
4.
5.

KERATOACANTHOMA (1); SYMMETRIC, HEMISPHERIC SHAPE WITH

OVERHANGING EDGES AND A KERATIN - FILLED CRATER IN THE
CENTER . A BRUPT TRANSITION OF NORMAL EPITHELIUM (YELLOW
ARROW).

KERATOACANTHOMA (2).
16
KERATOACANTHOMA (3).

IN CENTRAL CRATER OFA KERATOACANTHOMA “PLUGS OF KERATIN

AND NESTS AND CLUSTERS OF PROLIFERATING WELL -
DIFFERENTIATED SQUAMOUS EPITHELIUM ”.
17
 3. Fibroma

NUMEROUS COLLAGEN BUNDLES WITH FIBROBLASTS COVERED BY

STRATIFIED SQUAMOUS EPITHELIUM .

(A) CELLULAR FIBROMA, (B) FIBROUS FIBROMA .

18
 4. Desmoplastic Fibroma

SPINDLE CELL PROLIFERATION , COLLAGEN PRODUCTION , THIN-

WALLED BLOOD VESSELS (RED ARROW ).

SPINDLE CELL PROLIFERATION , PLUMP NUCLEI, NO ATYPIA, AND

MODERATE COLLAGEN PRODUCTION .

19
 5. Myxoma

PROLIFERATING PRIMITIVE MESENCHYMAL CELLS WITH SMALL

CELL BODIES AND ANASTOMOSING PROCESSES IN A LOOSE
CONNECTIVE TISSUE STROMA .

STELLATE TO SPINDLED MESENCHYMAL CELLS

20
STELLATE CELLS (RED ARROWS) IN MYXOID TUMOR TISSUE
(BLACK ASTERIK ).

21
 6. Lipoma

CAPSULATED LESION, LOBULES OF FAT CELLS .

ROUND OR POLYHEDRAL CELLS WITH CLEAR CYTOPLASM EXHIBITING

SIGNET RING APEARENCE .

22
23
 7. Granular Cell Tumor

SHEETS OF GRANULAR CELLS (R ED ARROW ) COVERED BY HYPERPLASTIC

STRATIFIED SQUAMOUS EPITHELIUM .

HYPERPLASTIC STRATIFIED SQUAMOUS EPITHELIUM

SHOWING PSEUDOEPITHELIOMATOUS HYPERPLASIA (R ED
ARROWS).

24
GRANULAR CELLS ; ROUND OR POLYHEDRAL WITH
GRANULAR EOSINOPHILIC CYTOPLASM AND DARKLY
STAINED NUCLEUS .

25
 8. Congenital Epulis of New-born

NESTS OF GRANULAR CELLS COVERED BY THIN STRATIFIED SQUAMOUS EPITHELIUM

WITH FLAT RETE RIDGES .

LARGE POLYHEDRAL CELLS WITH GRANULAR EOSINOPHILIC CYTOPLASM .

26
NUMEROUS , SMALL , THIN-WALLED BLOOD VESSELS UNIFORMLY
DISTRIBUTED THROUGHOUT LESION “VASCULAR CONNECTIVE TISSUE
STROMA” (R ED ARROWS ).

27
 9. Neurofibroma

Neurofibroma composed of a wavy pattern of neoplastic Schwann cells and

fibroblasts within collagenic matrix resembling shredded carrots

28
29
 10.Schwannoma

Antoni type A (palisaded) (black arrow)

Antoni type B (haphazard) (purple arrow)

Verocay bodies are seen within Antoni A areas (A-B, and left side of C and D).
Looser, less cellular Antoni B areas are found immediately adjacent (right side of C
and D).
30
Schwannoma shows the cellular Antoni A pattern with Verocay bodies (arrows) in
the top left, whereas the loosely arranged Antoni B pattern is seen in the bottom
right.

31
 11.Chondroma

The chondrocytes lie in lacunae and have small, round, regular nuclei. They are
arranged singly or in small clusters with intervening blue hyaline matrix

32
Hyaline cartilage: Small uniform cartilage cells in lacunae

12.Osteoma

33
 dense compact or cancellous bone

Lamellar and woven bone patterns with marrow spaces.

34
 Lamellar bone pattern with Haversian-like canals.

Osteoid osteoma: woven bone trabeculae with variable mineralization and

prominent osteoblastic rimming. Scattered giant cells are present within a
fibrovascular stroma. Heavy chronic inflammatory cells

35
Osteoid osteoma: woven bone trabeculae with variable mineralization and
prominent osteoblastic rimming. Scattered giant cells are present within a
fibrovascular stroma. Heavy chronic inflammatory cells

13.Capillary hemangioma

36
Endothelium-lined capillary channels of varying sizes

37
Cavernous hemangioma, large blood filled spaces lined by endothelial lining

38
39
14.Lymphangioma

40
Micro and macro cystic spaces filled with lymph

41
15.Junctional nevus

42
43
16.Compound nevus

44
17.Intradermal nevus

45
 Premalignant Lesions

1. Mild dysplasia

Mild Epithelial Dysplasia: Hyperchromatic and pleomorphic nuclei are noted in the
basal and parabasal cell layers of this stratified squamous epithelium. Intact
basement membrane.

Mild Epithelial Dysplasia: Basilar hyperplasia and hyperchromatic nuclei are noted
in the basal and parabasal cell layers of epithelium. Intact basement membrane.
46
Mild epithelial dysplasia: Basilar hyperplasia, nuclear hyperchromatism and cellular
and nuclear pleomorphism involving less than one third the thickness of epithelium.
Intact basement membrane.

Mild epithelial dysplasia: There is pleomorphism, hyperchromatism, basilar

hyperplasia and abnormal mitotic figures (arrows), but the changes are limited to
the lower third of the epithelium. Intact basement membrane.
47
 2. Moderate dysplasia

Moderate Epithelial Dysplasia: Dysplastic changes extend to the midpoint of the

epithelium and are characterized by basilar hyperplasia, nuclear hyperchromatism
and cellular and nuclear pleomorphism. Intact basement membrane.

Moderate epithelial dysplasia: Bulbous rete ridges, basilar hyperplasia, nuclear

hyperchromatism, cellular and nuclear pleomorphism and mitotic figures (arrows)
extending to the midpoint of the epithelium. Intact basement membrane.

48
 3. Severe dysplasia

Severe epithelial dysplasia: Basilar hyperplasia, nuclear hyperchromatism, cellular

and nuclear pleomorphism and mitotic figures (arrows) involving most of the
epithelial thickness. Intact basement membrane.

Severe Epithelial Dysplasia. Epithelium exhibiting marked cellular and nuclear

pleomorphism, hyperchromatism, large prominent nucleoli, scattered mitotic

49
figures (yellow arrows) and individual cell keratinization (red arrows). Atypical cells
involve most of the epithelial thickness. Intact basement membrane.

4. Carcinoma in situ

Carcinoma in Situ: Dysplastic changes extend throughout the entire thickness of the
epithelium. Intact basement membrane.

Carcinoma in situ: Bulbous rete ridges, dysplastic cells involving full thickness of
epithelium. Basilar hyperplasia marked cellular and nuclear pleomorphism,
hyperchromatism, large prominent nucleoli, scattered mitotic figures (yellow
arrows). Intact basement membrane.

50
Cellular changes in dysplasia: Basilar hyperplasia, marked cellular and nuclear
pleomorphism, hyperchromatism, large prominent nucleoli, scattered mitotic
figures (yellow arrows). Intact basement membrane.

51
 5. Actinic cheilitis

Actinic Cheilitis: Hyperkeratosis and epithelial atrophy. Note the striking underlying
solar elastosis (red brace).

Actinic Cheilitis: Hyperkeratosis and epithelial hyperplasia. Note the striking

underlying solar elastosis (red arrows).

52
Actinic Cheilitis: Hyperkeratosis and epithelial atrophy with moderate dysplasia.
Note the striking underlying solar elastosis (red arrows).

6. Oral submucous fibrosis

Oral Submucous fibrosis: Hyperplastic epithelium showing moderate dysplasia with

basilar hyperplasia and mild pleomorphism involving approximately half the
epithelium. Hyalinized fibrous tissue in the underlying C.T.

53
Oral Submucous fibrosis: Hyalinized fibrous tissue in the underlying C.T.

54
Oral Submucous fibrosis: Hyperplastic epithelium showing mild dysplasia.
Hyalinized fibrous tissue in the underlying C.T.

55
 Malignant Neoplasms

1. Well differentiated SCC

Well differentiated squamous cell carcinoma: showing cell nests (green arrow)
invading the connective tissue. Cells show keratin pearl formation (red arrow),
individual cell keratinization (orange arrow) and hyperchromatism (black arrow).

56
Well differentiated squamous cell carcinoma: showing numerous cell nests (green
arrow) invading the connective tissue. Cells show keratin pearl formation (red arrow)
and individual cell keratinization (orange arrow). Note both rupture of basement
membrane (black arrow) and inflammatory reaction of the connective tissue (yellow
arrow).

57
 2. Moderately differentiated SCC

Moderately differentiated squamous cell carcinoma: showing numerous cell nests

(green arrows) invading the connective tissue that has chronic inflammatory cells
(orange arrow). Cells showed abnormal mitotic figure (red arrow), hyperchromatism
(black arrow). Note absence of keratin pearls.

58
Moderately differentiated squamous cell carcinoma: showing numerous cell nests
(green arrows) invading the connective tissue. Cells showed individual cell
keratinization (orange arrows), abnormal mitotic figure (red arrow) and increased
mitosis (black arrow).

59
Moderately differentiated squamous cell carcinoma: showing numerous cell nests
(green arrows) invading the connective tissue which has inflammatory reaction (red
arrow). Cells showed individual cell keratinization (black arrow).

Moderately differentiated squamous cell carcinoma: showing cell nests invading the
connective tissue which has inflammatory reaction (red arrow). Cells showed
individual cell keratinization (black arrow).
60
 3. Verrucous carcinoma

Verrucous carcinoma: showing exo-endophytic growth (yellow bracket), keratin plug

(black arrow), pushing borders (red arrow), bulldozing effect (elephant legs).

61
Verrucous carcinoma: showing exo-endophytic growth, keratin plug (red arrow),
interpapillary clefts, pushing borders (black arrows) and bulldozing effect (elephant
legs).

62
Verrucous carcinoma: showing exo-endophytic growth, keratin plug (red arrow),
pushing borders (black arrows) and bulldozing effect (elephant legs).

Verrucous carcinoma: showing exo-endophytic growth, keratin plug (red arrow),

pushing borders (black arrows) and bulldozing effect (elephant legs).
63
 4. Mucosal melanoma

Mucosal melanoma: showing invasion of malignant pigmented cells into connective

tissue.

64
Mucosal melanoma: showing malignant melanocytes in both epithelium and
connective tissue. Melanocytes are bizarre in shape (cells are large and different in
shape) (red arrow).

65
 Mucosal melanoma: showing invasion of malignant melanocytes into connective
tissue cells. They are large and bizarre in shape.

Mucosal melanoma: showing invasion of malignant melanocytes into connective

tissue cells. They are large and bizarre in shape.
66
 5. Fibrosarcoma

Fibrosarcoma: showing the characteristic herring bone appearance of the malignant

fibroblast (spindle cells) (red arrow).

A higher magnification of fibrosarcoma photo showing the signs of dysplasia in

malignant spindle cells (fibroblasts): hyperchromatism (red arrow), abnormal mitotic
figure (green arrow), mitosis (eleven shape 11) (black arrow). It also shows little
amount of collagen fibers formation (orange arrow).
67
Fibrosarcoma: showing herring bone appearance (red circle), increased cellularity and
hyperchromatism of most of the cells.
A

Fibrosarcoma: showing herring bone appearance and increased cellularity and

hyperchromatism.
68
 6. Hodgkin lymphoma

Hodgkin lymphoma: the characteristic Reed Sternberg cells (yellow arrows) and the
surrounding reactive inflammatory cells (red arrow).

69
Hodgkin lymphoma: the characteristic Reed Sternberg cell (green arrow) which is a
giant cell with bilobed nuclei, also it has prominent eosinophilic nucleolus as well as
nuclear membrane and the surrounding reactive inflammatory cells (red arrow).

70
 7. Burkitt lymphoma

Burkitt lymphoma: showing the characteristic starry sky appearance, it is formed of

sheets of monotonous lymphocytes (dark) (red arrow) and the pale stained
macrophages in between (star) (yellow arrows).

71
Burkitt lymphoma: showing the characteristic starry sky appearance, it is formed of
sheets of monotonous lymphocytes (dark) (red arrow) and the pale stained
macrophages in between (star) (green arrow). It also contains blood vessels (orange
arrow).

72
 8. Kaposi sarcoma

Kaposi sarcoma: showing many slit-like spaces (yellow arrow), extravasated RBCs
(black arrow) and numerous blood vessels also filled with RBCs (green arrow)

Kaposi sarcoma: a spindle cell lesion (green arrow) with numerous extravasated RBCs
(yellow arrows)

73
A higher magnification showing the components of Kaposi sarcoma: spindle cells
(orange arrow), multiple slit like spaces (black arrow), extravasated RBCs (yellow
arrow) and blood vessels also filled with RBCs (green arrow).

74
 Salivary gland neoplasms
1. Pleomorphic Adenoma

Pleomorphic adenoma: Low-power view showing a well-circumscribed,

encapsulated tumor mass. Even at this power, the variable microscopic pattern of
the tumor is evident.

Pleomorphic adenoma: Chondroid material (top, yellow arrow), with adjacent

ductal epithelium and myoepithelial cells (bottom, green arrow).

75
 Pleomorphic adenoma: Plasmacytoid myoepithelial cells

Pleomorphic adenoma: Ductal structures (yellow arrow) with associated

myxomatous background (blue arrow).

76
Pleomorphic adenoma: classic appearance with an admixture of epithelial (yellow
arrow), myoepithelial (blue arrow), and stromal elements (red arrow)

Pleomorphic adenoma: classic appearance with an admixture of epithelial,

myoepithelial, and stromal elements. The stroma consists of abundant basophilic
myxoid foci as well as eosinophilic hyalinized areas
77
 2. Oncocytoma

Well circumscribed lesion composed of large cells with abundant granular

eosinophilic cytoplasm and central round nuclei.

Typical oncocytoma composed of nests and trabeculae of granular eosinophilic

cells with scattered lumina and separated by a delicate vascular stroma.

78
 3. Warthin tumor

Low-power view showing a papillary cystic tumor with a lymphoid stroma.

High-power view of epithelial lining showing double rows of oncocytes with

adjacent lymphoid stroma. The inner luminal layer consists of tall columnar cells
(yellow arrow), while the outer basal layer is cuboidal (blue arrow)

79
 4. Canalicular adenoma

Canalicular adenoma: bi-layered basaloid epithelial cells forming interconnecting

cords, rows, and tubular structures. The stroma was loose and contained some
capillaries.

Uniform columnar cells forming canal-like ductal structures.

80
Anastomosing, frequently bi-layered cords of tumor cells. The stroma was
edematous and contained some capillaries.

81
 5. Adenoid cystic carcinoma

Adenoid cystic carcinoma: Islands of hyperchromatic cells forming cribriform and

tubular structures. Inset shows a high-power view of a small cribriform island.

Adenoid cystic carcinoma: The tumor cells are surrounded by hyalinized material.
82
 Adenoid cystic carcinoma: Solid pattern: tumor cells forming solid sheets and
nests.

Adenoid cystic carcinoma: Perineural invasion (yellow arrow), a common finding in

adenoid cystic carcinoma.

83
 6. Mucoepidermoid carcinoma

Low grade mucoepidermoid carcinoma: shows numerous large mucous cells

(yellow arrow) surrounding a cystic space.

Low grade mucoepidermoid carcinoma: composed predominantly of mucinous

cells lining cystic (yellow arrow) and glandular spaces. The tumor cells have
abundant, basophilic foamy cytoplasm and small hyperchromatic basally-located
nuclei.

84
 Moderate mucoepidermoid carcinoma: Low-power view of a moderately well-
differentiated tumor showing ductal and cystic spaces surrounded by mucous and
squamous cells.

Moderate mucoepidermoid carcinoma: High-power view showing a sheet of

pleomorphic squamous epithelial cells intermixed with mucous and intermediate
cells.

85
Clear cell mucoepidermoid carcinoma.

86