Oral Patho 1
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Transcript of Oral Patho 1
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Hyperplastic,Neoplastic,and related disordersToday the lecture is about
of Oral Mucosa
and you know from general pathology the difference between the
hyperplasia and Neoplasia
continuous division>>: Increase in the number of the cellsHyperplasia
but without metastases
New growth with a change in the normal cell cycle >>:Neoplasia
uncontrolled division .
Not benign Tumor They1 .:Hyperplastic Legion of the Oral Cavity#
use the Legion >< The, There usually a stimulus that ca*ARE Reactive
irritation to the oralstimulus usually low grade >Mucosa
Pt with habitual cheek bite at a certain location >> There will be a time
for the body to deposit fibrous tissue and lead to hyperplasia .
*Hyperplastic legions are REACTIVE Not Due to a genetic mutation in
the cell cycle control >> Not benign Tumors .flammation you knowusually chronic inirritationchronic.because it's2
that chronic inflammation associated with repair > Granulation tissue matures we have fibrous tissue and decre
in the amount of the B.V
ALL of this the Granulation tissue and the mature dense collagen which
avascular ( relatively not inflamed ) will give us exophitic mass .
Where can we see hyperplastic legions in the oral cavity ?!
Everywhere 1. Gingiva ( Called epulis ) 2. Buccal mucosa 3. Soft and hard
palat 4.floor of the mouth 5. Tongue .
Epulis : Hyper-plastic lesion in the gingiva
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Localized hyperplastic lesions of oral Mucosa :
1. Pyogenic Granuloma
2. peripheral giant cell granuloma
3.peripheral ossifying fibroma
plasia )-4. Irritation fibroma ( focal fibrous hyper
cell fibroma5. Gaint
6.Retrocuspid papilla
7. Fibroepithelial polyp
8. Epulis fissuratum , Inflammatory fibrous hyperplasia , denture
irritation hyperplasia
9.Inflammatory papillary hyperplasia of the palate
Let US start with EPULIS :
Hyperplastic lesion occurring in Gingiva
( Hyperplastic legion = granulation tissue ) and by now you should know
that the granulation tissue shows different amount of B.V and Fibrous
tissue .
# If the granulation tissue gets more mature then we will have bale color
lesion with more fibrous tissue > If The granulation is young and still
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immature we will have red legion with high amount of B.V and it will bleed
easily .
More common to occur between the teeth Why ?!
because usually have plaque and calculus more between the teeth and thestimulation of them with bacteria will be more so we will have epulis more
can occur also in anterior premolar region / Maxilla More than the
mandible ( cus the pt are mouth breathers , the gingiva which irritated
the upper not the lower > Increase the
inflammation >>
# It can Recur if the : 1. Causative factor persists
2. Incompletely excised as * PGCG
Epulis have Three Types :
1 . Fibrous Epulis : ( More fibrous tissue >> less B.V ) DOSENT
bleed easily the most common type , Usually its ( sessile = wide
broad base ) but it may be ( pedunculted = narrow base )
The lesion is having a space to occur between the lateral and canine
but if there is no enough space the legion may squeeze it self
between the teeth , usually firm , similar color with gingiva ,
ulceration depend on the trauma ^ _^ ( if it 2nd traumatized it may
ulcerate )
Histopathology :
pic # 2
What I see in the histopathology : depend if I looking to
hyperplastic gingivitis or peripheral ossifying fibroma
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In hyperplastic gingivitis I see granulation tissue and some
mineralized tissue or bone formation ( reactive bone formation ,
due to the present of inflammation )
Ossifying fibroma :
pic # 3
* well-formed bundles of fibroblast * bone formation in addition
and collagen to the bundles
____________________________________________
this is the peripheral ossifying fibroma " ending by *oma* but not
benign tumor " it's hyperplastic fibrous epulis , and reactive to
irritation .
Different from the central ossifying fibroma which is benign tumor
and it will keep growing and reach big sizes .
Pic # 4
2. Vascular Epulis : ( More B.V >> less fibrous tissue ) young and
bleed easily , usually red
*we see a growth here in the
buccal aspect of the teeth ,
anterior to the first molar
which pedunculated " can be
removed " has a constricted
neck .
*red color compare to the surrounding
mucosa grows rapidly
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It's other name : Pyogenic Granuloma is a vascular epulis occurring
when it occur in the gingiva we call itanywhere in the oral cavity ,
purple / bleeds/rapid growthSoft / lobulated / red:/ it'sEpulis
cially when it occur in the*usually there is a history of trauma spe
buccal mucosa
## DR . has seen a mass in the buccal mucosa which
red bleeding easily and it was of 2 days duration , but
the mass was big So it shows rapid growth in the action
of trauma .
It's occur in the gingiva 75% of the time , but it may occur in othersite .
Pregnancy tumor orOther name of the pyogenic granuloma is
Pregnancy epulis .
** it's pyogenic granuloma and occur more in the pregnancy
women's due to the changes in hormones and Endothelial cell ( the
lining of the B.V have a receptors of progesterone & estrogen so
there may be increase in the granulation tissue formation , the
response is higher and more vascular )should not be removed during pregnancy , cus it will return back ,
we delayed until after delivery .
So it regress after delivery and then it will reach a static size,, it
can be removed
pyogeniccus previosly think thatWhy they call it " Pyogenic " ?!
ion ( pyogenic = puss forming ) but here therebacteria cause the les
is no puss >
There was one case of pregnancy granuloma, it was very
aggressive it destroy 6 / 7 and extend to the lingual and buccal
aspect.
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Where we can find the lesion :
1. upper lib
2. Gingiva
3. Dorsum of the tongue
______________________________________
Pyogenic granuloma will mature with time it will form more fibrous
tissue so it will look pale sometimes
Histopathology: look at the B.V you see numerous small capillary size B.V
it's also called lobular capillary hemangioma .
Ulceration is + / - due to secondary trauma to the legion.
When the legion become old it will be more fibrous .
Treatment : 1. In pregnancy we will delay it
2. Need conservative surgical removal
** and make sure that the cause is removed .
Now we know 2 types of Epulids fibrous epulis ( 1. Chronic hyperplastic
gingivitis 2. Peripheral ossifying fibroma )
And vascular epulis ( called pyogenic granuloma )
THIRD TYPE OF EPULIS :
3. Peripheral gaint cell granuloma : you remember the central gaint cell
granuloma in the bone , having 2 clinical variant aggressive and non-aggressive but it's not a tumor the same here this is not a tumor it have
the same histology as the central gaint cell granuloma , it may be also
associated with hyper- parathyrodisim , if it's multiple , and it may be
extension to the central gaint cell granuloma ( when it perforated the
bone ) .
What is the differences between the peripheral gaint cell
granuloma and pyogenic granuloma ?!
the peripheral occur only in the gingiva , or only in the* alveolar
mucosa while the pyogenic anywhere in the oral cavity .
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* the gingiva after the extraction of the tooth .
## Peripheral gaint cell granuloma is dark red as you know , cus it's
vascular and sometimes we can see hemosiderin ,, can bleed easily = )
We need a radiograph why ?! To roll out central legion , it may be a
continuation of a central legion .
The origin of these Multinucleated gaint cells , from either macrophages
or periosteum ( they think it's from periosteum cus it's not occurring in
other location of the jaw except the alveolar mucosa or gingiva )
## I f it presented interdentally seques between the teeth and give a
hour glass appearance .
Stroma " supporting tissue , cells between the multinecluated gaint cell" :
spindled cell or ovoid , can be macrophage and may contain fibroblast or
endotheial cells .
Treatment : surgical removal down to the periosteum dont leave any part
of the legion , cus there is recurrent rate of 10% .
Other Hyperplastic lesion :In General the fibroepthelial polyp is the most common lesion in the oral
cavity at all , most common in the in the buccal mucosa / labial mucosa /
tongue and gingiva , also known as irritation fibroma , not neoplastic ,
reactive lesion , more fibrous and collagen tissue ,
Caused by chronic minor trauma appears to be the cause /ill-fitting
denture / sharp cusp .
** The net result will be excessive amount of fibrous tissue as A reaction
of the trauma , the body is trying to protect him self .
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** Here it seem that the patient has buccaly erupted 3rd molar , more
borne to cheek biting to buccal mucosa , it not a tumor because doesnt
increase significantly in size with time , it's grows a reach certain size
and stop .
## Sharp sever trauma dont give us fibrous polyp , it will result in ulcerof sever injury , but the fibrous tissue formation need time ( chronic
minor trauma ) .
Look at this lesion , here in the surface epithelium and it look atrophic
actually in the buccal mucosa we have broad rete ridges , cus it's pushed
by the underlying fibrous tissue .
The fibrous tissue tissue here is relatively avascular , also is not
cellular I dont see here a bundles of fibroblast , I see amount of collagen
pale pink : collagen , black dots : some of them are lymphocytes or
fibroblast .
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## All over it's fibrous , and the epithelium is mainly atrophic
** Treatment : excision or surgical removal .
Now we have a variant of irritation fibroma : Gaint cell fibroma
We have an interesting finding microscoply , it's gaint fibroblast
And the fibroblast it self not spindle , it's having still late appearance
and some time it's multinucleated .
** More fibrous tissue .
the best location is keratinized mucosa : 1. Dorsum of the tongue
2. Gingiva
We have other gaint cell fibroma but appear in other location ( specific
location ) > as a small nodules lingual to
lower canine , and the histology of them > and it
called " Retrocuspid papilla "
Considered as a normal variation , cus high percentage of the adults and
children are having retrocuspid papilla , and it usually bilateral , they
think that covers neurovascular bundles .
Excessive amount of fibrous tissue and hyperplasia of the* oral mucosa (
mean surface epithelium and the underlying tissue ) , when I say
hyperplasia of the oral mucosa , I mean the underlying tissue ( C.T in
general ) C.T may be give you hyperplastic lesions , they look like folds
and between the folds fissures and these fissures may be ulcerated cus
inside them they will be the denture flange , and cus the denture is ill-
fitting it will cause minor chronic trauma of the mucosa ,, there is enough
time for the body to form fibrous tissue , it will give the lesion specific
name ( epulis fissuratum ) another common name is ( Denture irritation
hyperplasia ) .
** more common buccaly ** more common also in the upper denture .
## If occurred under the denture in the palate , it will be squeezed cus
of the denture , and give us appearance of the leaf called ( Leaf Fibroma )
Microscopically : I see exophitic mass , the underlying tissue is pale andfibrous , not cellular not vascular .
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Sometimes the palate show small papillary projection , next to each other
the denture here either it's ill-fitting , or the pt wear the patient day
and night .
This lesion is papillary hyperplasia, numerous papillary projection in the
palate , reactive to a chronic minor trauma over long duration .
Later on in the chapter of infections Candida will colonize the surface of
the denture, specially the upper denture .
Histopathology : The underlying mucosa , or sub mucosa is hyperplastic
forming fibrous tissue going under these projections , not cellular all of
the deep pink is collagen , fibrous tissue .
__________________________________________________Done by : Heba Radaideh
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