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Cysts
1. Radicular Cyst

Radicular cyst: Cyst lining with inflammation consists of nonkeratinized stratified squamous
epithelium showing arcades.

Radicular cyst: hyperplastic epithelium with eosinophilic hyaline Rushton bodies and
dystrophic calcifications (yellow arrows) .
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Radicular cyst: hyperplastic epithelium with eosinophilic hyaline Rushton bodies.

Cholesterol crystals
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 2. Odontogenic Keratocyst

Odontogenic keratocyst: Cyst lined by uniformly thin epithelium with abundant keratin in
lumen. Lining is 5 to 15 cells thick with parakeratosis, surface corrugations, and palisading of
basal cell nuclei.

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Odontogenic keratocyst: Cyst lined by uniformly thin epithelium with parakeratosis, surface
corrugations, and palisading of basal cell nuclei. Note the clefting between epithelium & C.T
(red stars).

Odontogenic keratocyst: uniform thin lining with many daughter cysts in the C.T (yellow
arrows).

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OKC: Cyst lined by uniformly thin epithelium showing budding (yellow arrows).

Dentigerous cyst: Cyst lined by thin, nonkeratinized epithelial lining.

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 3. Dentigerous Cyst

Dentigerous cyst: Scattered mucous cells (red arrows) can be seen within the epithelial lining.

Dentigerous cyst: Cyst lined by thin, nonkeratinized epithelial lining.

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 4. Glandular Odontogenic Cyst

Glandular odontogenic cyst: Cyst lined by epithelium of variable thickness showing

intraepithelial microcysts (stars), mucous cells (red arrows), clear cells (yellow arrows) and
hobnail cells (black arrows).

Glandular odontogenic cyst: Cyst lined by epithelium showing intraepithelial microcysts (star),
clear cells (yellow arrows) and hobnail cells (black arrows).

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 5. Calcifying Odontogenic Cyst

Calcifying Odontogenic Cyst: The cyst lining shows ameloblast-like basal cells (yellow arrow)
and loose stellate reticulum like cells (blue arrow). Large eosinophilic ghost cells are present
within the epithelial lining (star).

Calcifying Odontogenic Cyst: The cyst lining shows ameloblast-like basal cells (yellow arrow).
Ghost cells and dystrophic calcifications (red arrows) are present within the epithelial lining.
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Calcifying Odontogenic Cyst: The cyst lining shows ameloblast-like basal cells (yellow arrow).
Ghost cells (red star) are present within the epithelial lining.

Calcifying Odontogenic Cyst: Ghost cells (yellow arrows), dentinoid material (star) and
dystrophic calcifications (blue arrow).
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 6. Nasopalatine Duct Cyst

Nasopalatine Duct Cyst: Upper photo: cyst lined by pseudostratified columnar and ciliated
epithelium. Lower photo: Cyst wall showing blood vessels (1), nerve bundles (2), and minor
salivary glands (3).

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 7. Aneurysmal Bone Cyst

Aneurysmal Bone Cyst: blood-filled space surrounded by fibroblastic connective tissue.

Scattered multinucleated giant cells (yellow arrows) are seen adjacent to the vascular space.

Aneurysmal Bone Cyst: blood-filled spaces surrounded by fibroblastic connective tissue.

Scattered multinucleated giant cells (yellow arrows) are seen adjacent to the vascular space.
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 8. Epidermoid Cyst

Epidermoid Cyst: A: Low-power view showing a keratin-filled cystic cavity. B, High-power view
showing stratified squamous epithelial lining with orthokeratin production.
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 9. Dermoid Cyst

Dermoid Cyst: Lining is orthokeratinized stratified squamous epithelium and with hair follicle
(F), sebaceous glands (S) in the cyst wall.

Dermoid Cyst: Lining is orthokeratinized stratified squamous epithelium and with hair follicle
(F), sebaceous glands (S) in the cyst wall.

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Dermoid Cyst: Squamous epithelial lining (top), with hair follicle (F), sebaceous glands (S) in
the cyst wall.

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 10. Branchial Cleft Cyst

Branchial Cleft Cyst: A cyst lined by stratified squamous epithelium. Note the lymphoid tissue
in the cyst wall.

Branchial Cleft Cyst: A cyst lined by stratified squamous epithelium. Note the lymphoid tissue
in the cyst wall forming germinal centers (yellow star).
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 11. Thyroglossal Duct Cyst

Thyroglossal Duct Cyst: Cyst lined by stratified squamous epithelium (top). Thyroid follicles
can be seen in the cyst wall (bottom).

Thyroglossal Duct Cyst: Cyst lined by respiratory epithelium (left). Thyroid follicles can be seen
in the cyst wall (right).
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 Bone diseases
1. Osteopetrosis (Marble bone disease)

Osteopetrosis: Sclerotic bone with reversal lines and minimal marrow spaces.

Osteopetrosis: H& E-stained section showing thick bone trabeculae (pink) and retained islands of
calcified cartilage within the mature bone
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 2. Cherubism

Cherubism: Osteoclast-like multinucleated giant cells within cellular and fibrous

tissue.

Cherubism: Perivascular eosinophilic cuffing of collagen.

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 3. Fibrous dysplasia

Fibrous dysplasia: Irregularly shaped, curvilinear, thin and disconnected trabeculae of immature
(woven) bone in a cellular fibrous stroma. “Chinese letters-like/ alphabet soup pattern".”

Fibrous dysplasia: Fibrous dysplasia shows blended margins with the adjacent
normal bone.

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Fibrous dysplasia: Bland moderately cellular stroma and slender trabeculae of
woven type bone.

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 4. Paget disease of bone (Late stage)

Paget disease of bone: Coarse thick trabeculae "Mosaic pattern". Note the dark
reversal lines

Paget disease of bone: Numerous blue wavy reversal lines.

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 5. Ossifying fibroma (Calcifying fibroma)

Ossifying fibroma: Cellular fibrous tissue with mineralized product including a variable
admixture of osteoid, bone, and basophilic acellular (or “cementum-like”) spherules.

Ossifying fibroma: Well-defined periphery of the lesion with a rim of reactive

new bone at the edge.

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 6. Chondrosarcoma

Chondrosarcoma: Malignant cartilaginous tissue with marked cellular and

nuclear pleomorphism.

Chondrosarcoma: Large atypical cartilage cells exhibiting nuclear pleomorphism

(red arrow) and cellular pleomorphism (black arrow).

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 Chondrosarcoma: Large atypical cartilage cells exhibiting nuclear pleomorphism
and cellular pleomorphism.

Chondrosarcoma: Mitotic figures are uncommon and are not used in the grading.
The tumor shown in the photomicrograph shows high cellularity and pronounced atypia

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 7. Osteosarcoma

Osteosarcoma: Malignant stromal cells surrounded by delicate strands of

osteoid.

Osteosarcoma: Highly atypical spindle cells + Osteoid formation.

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Osteosarcoma: Malignant stromal cells with abundant production of osteoid

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 8. Ewing sarcoma

Ewing sarcoma: Sheets of uniform small round blue cells in scanty stroma.

Ewing sarcoma: malignant cells with hyperchromatic round to oval

nuclei and scanty pale to vacuolated cytoplasm and ill-defined cell
borders.

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 Odontogenic tumors
1-Follicular ameloblastoma (solid, cystic, acanthomatous, granular)

Photomicrographs of the different types of ameloblastoma. (A, E) Follicular type.

(B, F) Plexiform type. (C, G) Acanthomatous type.

Solid follicular ameloblastoma showing peripheral palisading and central

reticulum stellate pattern (H.E.; orig.magn. x 200).

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Solid follicular Ameloblastoma

Follicular ameloblastoma connective tissue (Ct) contains islands of odontogenic

epithelium (black arrows) outlined by peripheral columnar cells that display
reverse polarization. There are islands of cystic degeneration containing central
loose stellate reticulum-like cells (*).

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Follicular ameloblastoma showing cystic degeneration.

Acanthomatous Follicular ameloblastoma showing squamous metaplasia.

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Acanthomatous follicular ameloblastoma: The cells within the center of this
tumor island shows squamous differentiation with associated keratinization

Granular cell ameloblastoma: granular cells filled with coarse eosinophilic

granules, eccentric nucleus and an inconspicuous cytoplasmic membrane, so that
the adjacent cells seem to be merging with each other

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Granular cell ameloblastoma: Follicular ameloblastoma showing granular cell
change

2- Plexiform ameloblastoma (Solid, cystic, hemangio)

Plexiform ameloblastoma: connective tissue contains long anastomosing cords of

odontogenic epithelium (black arrowheads) outlined by peripheral columnar cells
that display reverse polarization and central loose stellate reticulum-like cells.

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Plexiform ameloblastoma: Anastomosing cords and sheets of odontogenic
epithelium. The peripheral cells are columnar to cuboidal and show reverse
nuclear polarization.

Plexiform ameloblastoma: solid variant, with anastomosing strands and cords of

tumor cells.

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Solid plexiform ameloblastoma: Higher magnification

Cystic plexiform ameloblastoma with anastomosing strands and cords of tumor

cells showing cystic degeneration (arrows).

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Hemangio-ameloblastoma showing typical plexiform ameloblastomatous areas
interspersed with prominent endothelial lined vascular channels.

Histopathological image showing typical plexiform ameloblastomatous

component interspersed with large blood-filled spaces (H.E.; orig.magn. x 200).

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 3- Unicystic ameloblastoma

Unicystic ameloblastoma (luminal type), a cystic cavity lined with odontogenic

epithelium, the basal cells are columnar, hyperchromatic, and palisaded and
shows reversed polarity.

Unicystic ameloblastoma (luminal type), showing ameloblastomatous epithelium

lining the "cyst" wall.

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Representative epithelium of ameloblastoma, unicystic type.

Intraluminal unicystic ameloblastoma: Notice the projection of nodules of

ameloblastoma from the cystic lining into the lumen.
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Intraluminal unicystic ameloblastoma, intraluminal proliferation of ameloblastoma
from the cyst lining (green arrow) into the lumen.

Mural unicystic ameloblastoma, islands of ameloblastic cells in the C.T. (arrows)

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Unicystic ameloblastoma with mural infiltration (arrows)

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 4- Adenomatoid odontogenic tumour

Variable histological features of adenomatoid odontogenic tumor. (A, E) Multiple

epithelial follicles with calcifications (arrows). (B, F) Whirling epithelial cells with
adenomatoid structures. (C, G) Multifocal calcification (arrows) with eosinophilic
coagulum (arrowheads). (D, H) Abortive tooth materials (asterisk) produced by
epithelial tumour cells. (H.E.; orig.magn. x 200).

Adenomatoid odontogenic tumor: Nodules of spindled odontogenic epithelium with

adjacent reticular-appearing epithelium (yellow arrow)
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Adenomatoid odontogenic tumor: Tubular-like structures (green arrows).

Adenomatoid odontogenic tumor: Nodular islands of odontogenic epithelium

consist of spindled and ovoid odontogenic epithelial cells, minimal stroma

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Adenomatoid odontogenic tumor: Duct-like structure with nuclei displaced away
from 'lumen'.

Adenomatoid odontogenic tumor: Thickened fibrous capsule (red star),

calcifications (yellow arrow) & duct-like structure (green arrow head).

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Adenomatoid odontogenic tumor: Calcifications (yellow arrows), nodular islands of
odontogenic epithelium, and rosette-like structure (green arrow) 150x, H&E.

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 5- Pindborg tumour (Calcifying epithelial odontogenic tumor)

Histopathologic findings of calcifying epithelial odontogenic tumor. (A) Sheet of

polyhedral epithelial cells characterizing an epithelium-rich subtype (B) Nuclear
and cellular pleomorphism of the epithelial cells (C) Prominent intercellular
bridges and cellular pleomorphism (D) Homogeneous eosinophilic material
interspersed by some cords of epithelial cells characterizing an amyloid-rich
subtype (E) Extensive presence of calcified material in a calcification-rich subtype
(F) A balanced distribution of epithelial, amyloid, and calcified components in
classic calcifying epithelial odontogenic tumor.

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Pindborg tumor: polygonal, pleomorphic, eosinophilic epithelial nests and cords
(white arrow) in a background of calcification (blue arrow) and amyloid-like
material.

Pindborg tumor: A classic histopathology of CEOT as demonstrated by sheets of

polyhedral epithelial cells with distinct cell borders and intercellular bridges,
among which rounded, eosinophilic homogeneous masses are found. Note the
hyperchromatism and pleomorphism in nuclei.

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Pindborg tumor: epithelial cells in sheets and islands (yellow arrows) dispersed
throughout the connective tissue matrix along with numerous circular ring-like
calcifications (black arrows).

Pindborg tumor: large areas of amyloid or amyloid-like material (yellow arrow

heads) are usually present. Calcifications (white arrow heads) develop within these
amyloid-like areas and can form concentric rings known as Liesegang rings.
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 6- Cementoblastoma (true cementoma)

Cementoblastoma: Round radiopacity with radiolucent rim at the apical region of

tooth obscuring the outline of the root.

Cementoblastoma: Calcified mass fused to the root of a molar tooth

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Cementoblastoma: Expansile bone forming mass adherent to the root of the tooth
(dotted line, with arrow).

Cementoblastoma: Histopathologic examination showing dens, irregularly

lamellated, hypocellular cemental mass.
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Cementoblastoma: Cementum with basophilic reversal lines and intervening loose
fibrovascular connective tissue stroma.

Cementoblastoma: Cementum with prominent cementoblastic rimming (blue

arrow)

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 7- Ameloblastic fibroma

Ameloblastic fibroma exhibiting cellular myxoid ectomesenchymal stroma

containing scattered ameloblastic islands with central stellate reticulum.

Ameloblastic fibroma: nests and bilayered cords of epithelium within a loosely

arranged, primitive mesenchymal stroma. The epithelial nests exhibit a
peripheral layer of columnar cells and a central zone of loosely arranged, stellate
reticulum-like cells. However, in contrast to follicular ameloblastoma, these
islands tend to be relatively small without cyst formation.
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Ameloblastic fibroma: cords and islands of odontogenic epithelium set in primitive
appearing background.

Ameloblastic fibroma: odontogenic cords within immature mesenchyme.

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Ameloblastic fibroma: Higher magnification showing compressed ameloblastic
follicle which is surrounded by juxta epithelial hyalinization.

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 Autoimmune diseases

1. Pemphigus vulgaris

Histopathologic examination of specimens from the gingiva. Suprabasal acantholysis near the
tips of two adjacent rete pegs is recognized.

Histopathology of oral mucosa of pemphigus vulgaris shows acantholysis in the lower spinous
cell layers. Basal layer cells are attached to the connective tissue and suprabasal cleft are seen
at the tips of the epithelial rete ridges (scale = 200 μm).

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The photomicrograph showing suprabasal epithelial clefts. The arrow shows acantholytic cells
between the split.

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Pemphigus vulgaris of the oral mucosa. Immunofluorescence light micrograph of pemphigus
vulgaris, showing separation of oral mucous membrane layers.

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Direct immunofluorescence of pemphigus vulgaris (PV), IgG and complement component deposition in the
intercellular spaces (fish-net appearance) (magnification ×100)

2. Mucous Membrane Pemphigoid

Histopathological examination of mucosa reveals a sub-epidermal blister and a mixed

leukocytic infiltrate.

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Direct immunofluorescence microscopy shows IgG deposits at the dermo-epidermal junction
of a patient with mucous membrane pemphigoid.

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Mucous membrane pemphigoid: Hematoxylin and eosin stain: subepithelial split on a
perilesional skin biopsy.

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Mucous membrane pemphigoid: Direct immunofluorescence of a bullous skin lesion. Linear
IgG deposition at the basement membrane.

3. Lichen planus

Lichen Planus: Band-like lympho-histiocytic infiltrate with saw-toothed rete ridges and
hyperkeratosis.

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 Lichen planus: Civatte bodies within the lower half of the surface epithelium.

Lichen planus: Acanthosis (saw-toothed rete ridges). A band-like infiltrate hugs the rete
ridges.

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Essential histological feature of oral lichen planus: are liquefactive degeneration of basal
epithelial cells, dense, band-like inflammatory infiltrate consisting of lymphocyte, normal
maturation epithelium , saw-tooth appearance of rate ridges, Civatte bodies and
hyperkeratosis

Shaggy fibrin deposition at the dermo-epidermal junction in lichen planus.

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 4. Sjögren syndrome

Sjögren syndrome: Fruit-laden branchless tree pattern

Microscopic examination of salivary gland affected by Sjogren syndrome showing

lymphocytic infiltration, epimyoepithelial island and acinar destruction.

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Sjögren syndrome: blue arrow: lymphocytes, red arrow: Epimyoepithelial
islands green arrow: Destructed acini

Good Luck
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