EPITHELIAL DISORDERS

LECTURE 3
DR FAIQA YASSER
Associate professor
 EPITHELIAL HYPERPLASIA
 HYPERKERATOSIS

 Excessively thickened layer of stratum

corneum
 It can be:
 HYPERORTHOKERATOSIS
 HYPERPARAKERATOSIS
 CONTD…
 On histopathologic examination the majority of
leukoplakias are either orthokeratosis or
hyperparakeratosis
 Keratins functions as a protective barrier on
skin or mucous membranes
 Various stimuli like chronic frictional irritation
caused by ill fitting dentures can cause it
 Smoking and use of smokeless tobacco
 SMOKER’S KERATOSIS

 Hyperorthokeratosis
 Hyperparakeratosis
 It is induced by :
 Cigarette
 Cigar
 Pipe smoking
 Clinically it appears as a series of slightly
elevated white striations on the labial mucosa
 Histopathologically it exhibits characteristic
chevron or church spire organization of the
parakeratin
 ACANTHOSIS
 It is defined as :
 Excessive thickening of the spinous layer of
squamous epithelium resulting in broadening
and elongation of the rete pegs
 It is a benign hyperplasia of squamous
epithelium
 CLINICAL PRESENTATION
 Clinically seen as an area of leukoplakia
 Can occur alone or with hyperkeratosis
 Develops in response to chronic irritants like
 ill fitting dentures
 Smoking
 Tobacco chewing
 Infections such as chronic candidiasis
 PSEUDOEPITHELIOMATOUS
HYPERPLASIA

 An excessive but benign proliferation of

squamous epithelium that histologically
resembles the proliferation seen in a squamous
cell carcinoma
 ORAL CONDITIONS
 In which pseudoepitheliomatous hyperplasia is
seen :

 Inflammatory papillary hyperplasia

 Chronic hyperplastic candidiasis
 Granular cell tumor
 Blastomycosis
 NICOTINE STOMATITIS
 It is a :
 Diffuse white change of the palate , the buccal
mucosa, or both caused by combination of
hyperkeratosis and acanthosis, frequently
exhibiting multiple small dimpled nodules
around moinor salivary gland duct openings
found primarily in chronic pipe smokers .
 Rarely seen in cigar or cigarette smokers
 CLINICAL FEATURES
 Palate is whiter than normal
 Multiple small circular papules with tiny
umbilicated red centers on hard palate
 May be seen on buccal mucosa
 Usually the same side where pipe is mostly
held
 HISTOPATHOLOGY
 Hyperkeratosis
 Acanthosis
 Dilated salivary gland duct exhibiting
squamous metaplasia of the ductal lining
 Connective tissue adjacent to salivary gland
duct reveals chronic inflammation
 TREATMENT
 Quit smoking

 Pre malignant ?
 PROLIFERATIVE VERRUCOUS
LEKOPLAKIA (PVL)

It is presented as :
Diffuse white and / or papillary (“warty”) areas
of the oral mucosa resulting from varying degrees
of epithelial hyperplasia; has the potential to
develop into verrocous carcinoma or well
differentiated squamous cell carcinoma. Also
known as verrucous hyperplasia
 CLINICAL FEATURES
 Primarily occurs in older patients
 Strong predilection for females
 Female to male ratio is 4:1
 Clinical course of PVL is relatively slow
 It has relentless progression to SCC
 Cause of this progression to malignancy is
unknown
 HISTOPATHOLOGY

 Hyperkeratosis
 Verrucous keratosis
 Verrucous carcinoma
 Squamous cell carcinoma
 TREATMENT
 Surgical excision for smaller size lesion
 If the entire arch or both arches are involved
then treatment become more difficult
 We have to preserve vital anatomical structure
 In maxilla involvement of soft palate uvula and
tonsillar pillars can be problematic
 Laser therapy is helpful