Papilloma

It is benign tumor of surface epithelium

:Clinically
Sessile or pedunculated exophytic growth made of numerous, small finger
.like projection
:Intraorally
Found on tongue. Lips, buccal mucosa, gingiva & palate
Varaible in size from few mm to several cm in diameter
At any age
:Histologically
Acanthotic & hyperkeratotic stratified squamous epithelium
Thin, long & finger like projections
Each finger covered by hyperkeratotic squamous epithelium & supported by
.thin layer of c.t
.Chronic inflammatory cells may or may not be present
Treatment : surgical removal including the base

Keratoacanthoma
It is benign tumor of surface epithelium
N.B : Clinically & histologically similar to epidermoid carcinoma
: Etiology
Uknown or
Genetic or
Viral or
Chemical carcinogens
:Clinically
Men more than females
Age 50- 70 years
Site : Exposed skin ( cheek, nose & dorsum of the hands ) 8.1 % in lips
:Characters
Elevated umblicated or crateriform one with depressed central core
Rare over 15 cm in diameter
Regional lymphadenopathy ( inflammatory)

:Clinical courseBegins as small nodul that develops to full size over a periods of
4-8 weeks
Persist as a static lesion for another 4-8 weeks
Regress spontaneously over the next 6-8 weeks by expulsion of
the keratin core
Recurrence is rare
: Histologically
Hyperplastic stratified squamous epithelium growing into the c.t
The epithelium cells do not show atypia
The surface is cover by a thick layer of parakeratin with central
crater plugg
Island of epithelium present in the underling c.t
:Most characteristic features
At the lateral margin where an abrupt change in the norma
epithelium occurs & it is diagnostic
: Treatment; surgical excision

Pigmented cellular nevus

it is benign tumor of epithelium
a congenital developmental malformaiom of the skin & mucous membrane
Considered as hamartoma
This pigmented nevus is a superficial lesion composed of the so called nevus cells
:Types
Intradermal nevus
Junctional nevus
Compound nevus
Spindal cell nevi
Blue nevus
Melanotic- frickle of huchinson's
:Clinically
Well circumscribed flat or elevated lesion
Most persons exhibit dozens, scattered over the body
It may be brown, blue or black in color & contain hair or not
Varaible in size from few mm to several cm in diameter
Orally occur in hard palate , buccal mucosa, lips & gingiva, but more common on
the skin
Painless, not crusted, not ulcerated & not bleed
Spindal cell nevi not present orally

:Histologically
Origin of nevus cells are derived from neural crest
Nevus cells grouped in island, sheets or cord & may be contain melanin & present in
the c.t
Nevus cells are large cell with ovoid, vesicular nucleus & pale cytoplasm
Multinucleated giant cells are sometimes seen
Intradermal nevus
The cells are present in the c.t & are separated from overlying epithelium by band of c.t
Junctional nevus
The overlying epithelium is thin & shows cells crossing the junction growing down in the
c.t
The nevus cells are attached to the overlying epithelium & the zone of demarcation is
absent
The junctional activity has a serious implication due to its liability to malignant
transformation
Compound nevus
Shows features of the intradermal & junctional nevus
Spindal cell nevi
Consists of pleomorphic cells, spindle , epithelioid cells & multinucleated giant cells

Blue nevus
Consists of two types
common blue nevus- 1
elongated melanocytes packed with melanin lie in bundle & parallel to the
epidermis. There is no junctional activity
Cellular blue nevus- 2
Consists of melanocytes & spindle cells with vaculated cytoplasm
arranged in an alveolar pattern
Melanotic- fricke of huchinson's
Melanocyte present in epithelium & replaced the basal cell layers

Premalignant Epithelial Tumors

Leukoplakia
It is a clinical term indicating non specific white patch of the oral mucosa that
can not be rubbed off . This lesion excludes lichen planus, candidosis, leukoedema,
.white spongy nevus & syphilitic white patch
:Etiology
Unknown- 1
Tobacco- 2
Alchol- 3
Ultraviolet radiation- 4
Infections as candida albicans- 5
Oral sepsis- 6
Vitamin deficiency- 7
Chronic local irritation- 8
Industerial hazard-9
: Clinical features
Site : Tongue, mandibulor mucosa,&buccal mucosa are the most common sites.
.Palat, maxillary alveolar ridge & lower lip are less common
Age : Mainly after age of 40 years
Sex : Males more than females

:Types clinically
-A
Homogeneous leukoplakia : White, smooth, thin or thick base, non palpable &- 1
.translucent
Speckled leukoplakia : White lesion contain red zones & slightly elevated- 2
Granular leukoplakia : White, soft, smooth or finely granular in texture- 3
Nodulor leukoplakia- 4
Verrucous leukoplakia : exophytic in growth- 5
B- Ward classification
Acute leukoplakia ( take several weekes )- 1
Chronic leukoplakia ( take years )- 2
Intermediated types- 3
Depend on the coarse of the disease & prognosis
C- Hobak classification
leukoplakia plana- 1
leukoplakia verrucosa- 2

:Histologic Features
Ranged from hyperkeratosis, hyperparakeratosis &acanthosis, mild, moderate & sever types of epithelial
.dysplasia to squamous cell carcinoma
Diagnosis depend & named according to the chariteria.under the microscope
:Tretment & prognosis
Depend on the histopathologic features -

Carcinoma in situ
It is a oremalignant epithelial tumors exhibits top to bottom changes & the basment
membrane is intact
:Clinical feature
Age : Old age
Sex : No sex predilection
Sit : Skin & mucous membrane ( gingiva, soft palat, uvula, tonsillar pillars, tongue, floor
of the mouth, buccal mucosa & lips )
Color : Red
Shape : Raised & velvety plaque
Spread : Spread laterally & metastasis is impossible
:Histologic Features
;The epithelial cells having chariteria of malignancy from top to bottom as- 1
PleomorphismHyperchromatismAbnormal mitosisPoikilocaryonosis ( division of the nuclus without division of the cytoplasm )Individual cell keratinizationAlteration in the nuclear cytoplasmic ratioBasillar hyperplasiaDyskariosis.Basment membrane is intact- 2
.Prognosis : If left untreated may be transfored into squamous cell carcinoma

Oral Submucous Fibrosis

It is a chronic, progressive and precancerous condition . Characterized by a
whitish yellow in color, preceded or associated by vesicle formation, trismus &
.inability to eat
:Etiology
Vitamin deficiency- 1
Hypersensitivity to some dietary componant as chilis or spicy food- 2
:Clinical feature
Site: Buccal mucosa, retromolor area, soft palate, pharynx & eosophagus
Age : From 20- 40 years
Color : Whitish yellow in color
:Signs & symptoms
Burning sensation of the oral mucosa- 1
Followed by- 2
A- Vesical formation
B- Ulceration
C- Excessive salivation or xerostomia
D- Trismus & inability to open the mouth

:Histologic Features
Atrophy of covering epithelium with variable degrees of dysplasia- 1
Lamina propria is dens, hypalinized & a vascular collageneous c.t- 2
Submucosa contain few fibroblasts- 3
:Tretment
Corticosteroid injections- 1
Surgical removal of fibrous bands- 2
Complecation : squamous cell carcinoma

Malignant Tumor of Epithelial Tissue

Squamous cell carcinoma- 1
Basal cell carcinoma- 2
Verrcous carcinoma- 3
Spindle cell carcinoma- 4
Lymphoepithelioma- 5

Squamous Cell Carcinoma

It is a malignant tumor of epithelium originating from the prickle cells
:Etiology
Tobacco
2- Alcohol
3- Syphilis - 1
Nutritional deficiency
5- Sun light - 4
:Miscellaneous factors including- 6
.Heat , trauma , sepsis & irritation from sharp teeth & dentures :Clinically
Presents as painful or painless swelling white or red in color , ulcerated ,papillary with or without ulcers in shape
If it represents as ulcer, it has indurated raised border, granular , easyblessing floor & bad odor
The most common affected site is the tongue followed by buccal mucosa,gingiva, floor of the mouth, palate & maxillary sinus
Age : most commonly 50-60 years , rarely in young ageSex : Males more than females-

:In the tongue

Develops mostly on the lateral or ventral surface & rarely occurs on thedorsum especially in syphilitic glossitis
Near the base are higher grad of malignancy, poor prognosis, metastasizeearly & characterized by a soar throat & dysphagia
:In the gingiva
It affect mandibular gingiva more than maxillary gingivaIt involve attached gingiva more than free gingiva & also arises from the
socket after extraction
It mainly appeared as ulcerated & may also present as exophetic or.verrucous welling
:In the lips
The lower lip is more than upper lip. Metastasis is usually on the same side orcontrolateral if the lasion is near the midline
:In the buccal mucosa
It is commonly a painful ulcer or exophytic or verrucous growthIn the floor of mouth
Extend into lingual mucosa & mandible it may also invade the deeper tissue as
: submandibular & sublingual glands give limitation to movement of the tongue

:In the palate

Mostly appeared as ulcer whereas the tumor of salivary glands often not ulcerated. Onthe hard palate may invade into bone or into the nasal cavity. On the soft palate nay
.extend into the nasopharynx
: In the maxillary sinus
Lack of metastasis does not indicate a favorable course. The early invasion to the.adjacent vital structures as eye occurs
It is exceeding dangerous disease:The first sign
Swelling on the palate, maxillary alveolar ridge & mucobuccal fold- 1
Loosening or elongation of maxillary molars- 2
Swelling of the face inferior & lateral to eye- 3
Unilateral stuffiness of the nose- 4
Inability to tolerate the prosthetic appliance, some patient die from local infiltration- 5
alone

:Clinical staging of oral cancer

Refers to the extent of the disease before undertaking treatment
:Its purpose
Selection of the most important treatment- 1
The prognosis- 2
The system is known as TNMs system- 3
T : The size of the primary tumor- 4
N : Regional lymph node
M : Distant metastasis
S : Site
Definition of TNM : Categories of the oral cavity In table (1)- 5
Clinical staging of oral cancer in table (2)- 6
Histopathologic grading of cancer is not involved in the clinical staging- 7

:Table (1) Definition of the TNMs categories of malignant tumors about the oral cavity
T- Primary tumor size
Tis- Carcinoma in situ
T1- tumor 2 cm or less in the greatest diameter
T2- Tumor greater than 2 cm but not greater 4 cm in the greatest diameter
T3- - Tumor greater than 4 cm
N- Regional lymph nodes
NO- No clinically palpable cervical lymph nodes or palpable lymph nodes but metastasise not suspected
N1- Clinically palpable homolateral lymph nodes that are not fixed ; metastasis suspected
N2- Clinically palpable contralateral or bilateral cervical lymph nodes that are not fixed ; metastasis suspected
N3- Clinically palpable lymph nodes that are fixed ; metastasis suspected
M- Distant metastasis
MO- No distant metastasis
M1- Clinical & radiographic evidence of metastasis other than cervical lymph nodes
S- Site of the primary tumor

:Table 2- Clinical stage grouping of carcinoma of the oral cavity

Stage I
T1 NO MO
Stage IV T1 N2 MO
Stage II
T2 NO MO
T2 N2 MO
T3 NO MO
T3 N2 MO
Stage III T1 N1 MO
T1 N3 MO
T2 N1 MO
T2 N3 MO
T3 N1 MO
T3 N3 MO
Or any T or N category with M1

Basal Cell Carcinoma

) (Rodent Ulcer
It is malignant tumor of epithelial originating from basal cells& no tendency for
metastasis
N.B : The lesion may be kill the patient by direct invasion
:Etiology
Prolonged exposure to sunlight- 1
Exposure to known or unknown carcinogenic agents- 2
General atrophy associated with the aging process- 3
:Clinically
In the middle third of the face, but may occur any where on the skin- 1
never seen in the oral mucosa unless by invasion & infiltration from the skin- 2
Common in males more than females- 3
Common in fourth decade of life- 4
:Begins as- 5
A- Small, slightly elevated papule
B- Ulcerated
C- Heal over then breaks down again
D- It enlarges but still evidences
periods of attempted healing
:Character of ulcers- 6
A- Crusting ulcers, rolled border & spread laterally
B- Untreated ulcer continue to enlarge , infiltrate into adjacent & deeper tissues &
may even erode into cartilage or bone

:Histologically
Islands , nests, cords- 1
Cells showing , large, deeply staining nuclei & little variation in- 2
appearance
The periphery of cell nests is composed of well polarized cells- 3
similar to basal cells
Due to pluripotentiality of basal cells it may form hair, sebaceous- 4
glands or squamous cells & keratin
:The basal cell carcinoma may be
A- Form lesion mimics glands called adenoid basal cell carcinoma
B- Form cyst & called cystic basal cell carcinoma
C- Keratotic basal cell carcinoma refers to the formation of parakeratin
& horn cells & attempted formation of hair mimic trichoepithelioma

Verrucous Carcinoma
It is form of epidermoid carcinoma appeared chiefly exophytic & papillary in nature
It differs from epidermoid carcinoma from the following
Slow growing
Exophytic & superficial invasion
Low metastatic potential
Amenable to simple local excision
:Clinically
Age : 60 -70 years
Males more than females ( about 65 % occure in males )
Site : Commonly in buccal mucosa , gingiva , palat & floor of the mouth
Exophutic papillary lesion covered by a white leukoplakic film
Regional lymph nodes are tender , enlarged & simulating metastatic tumor but is
usually inflammatory
Bleeding is rare
Pain & difficulty in mastication are common complaint
:Histologically
Marked epithelial prolifeation with down growth of the epithelium into the c.t without
true invasion
The epithelium is well differentiated & show little mitosis, pleomorphism &
hyperchromatism
Cleft like spaces lined y parakeratin pluge
Basment membran is intact
Treatment : Surgical removal