Preliminary Diagnosis of Oral Lesions (1) 口腔病理學 Preliminary Diagnosis of Oral Lesions (1) 口腔病灶之初步診斷 (1) 陳玉昆副教授: 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

學 習 目 標 Understanding: 1. 口 腔 診 斷 及 口 腔 病 理 介紹 2. Conditions produce exophytic lesions

參考資料 References: 1. Van der Stelet PF. Dent Clin North Am 2000;44:237-48 2. Kaohsiung Medical University, Oral Pathology Department 3. 自購網路資源：super_toolcool

口 腔 診 斷 及 口 腔 病 理 介 紹 口 腔 診 斷 頭頸部 Refs. 1, 3

口 腔 診 斷 口 腔 診 斷 及 口 腔 病 理 介紹 Refs. 1, 3 Real-time polymerase chain reaction (RT-PCR) Refs. 1, 3

口 腔 診 斷 Dentist A 口 腔 診 斷 及 口 腔 病 理介紹 A 40 y/o female suffered from 37 toothache for 3 months No other abnormal mucosal lesion was noted Diagnosed her symptoms as periodontitis Prosthetic crown of 37 was removed to perform endodontic tx Dentist A Refs. 1, 2, 3

口 腔 診 斷 Dentist B 口 腔 診 斷 及 口 腔 病 理 介紹 Severe pain of tooth 37 was still persisted Dentist B Tooth 37 was extracted The post extraction wound remained unhealed Referred her to visit KMU dental dept for further tx Refs. 1, 2, 3

口 腔 診 斷 及 口 腔 病 理 介紹 病 理 診 斷 口 腔 病理 Biopsy—活體切片檢查 Refs. 1, 3

口 腔 病理 口 腔 診 斷 及 口 腔 病 理 介 紹 Dentist C 病 理 診 斷 Extraction 切片檢查 口腔癌 of tooth 37 切片檢查 病 理 診 斷 口腔癌 Refs. 1, 2, 3

口 腔 診 斷 及 口 腔 病 理介 紹 口 腔 病 理 學 口 腔 診 斷 學 病 理 診 斷 臨 床 診 斷 一 體 的 兩 面 牙科放射線影像學 口 腔 病 理 學 口 腔 診 斷 學 口腔組織學 病 理 診 斷 臨 床 診 斷 一 體 的 兩 面 Ref. 3

Conditions produce exophytic lesions Hypertrophy-tongue (muscle) Hyperplasia-dilantine hyperplasia What is the difference between hyperplasia & hypertrophy ? Neoplasia-tumor Pooling of fluid-pus, mucocele, cyst Ref. 2

Lingual Tonsil Hyperplasia/Hypertrophy Exophytic lesions Refs. 2, 3 Geminal center Lymphoid aggregates Follicle Refs. 2, 3

Circumvallate Papillae Buccal Papillae Hyperplasia/Hypertrophy Exophytic lesions Circumvallate Papillae Buccal Papillae Orifice of Stensen duct Refs. 2, 3

Hyperplasia/Hypertrophy Exophytic lesions Exostosis/Tori Refs. 2, 3

Inflammatory Hyperplasia Hyperplasia/Hypertrophy Exophytic lesions Inflammatory Hyperplasia Irritating chronic injury inflammation Formation of granulation tissue (endothelial cells, capillary bed, round cells & fibroblasts) Refs. 2, 3

Inflammatory Hyperplasia Hyperplasia/Hypertrophy Exophytic lesions If etiology is eliminated Subside Inflammatory Hyperplasia If not, granulation increases & fibrosis occurs pales, pink, smooth firm lesion (irritating fibroma) Refs. 2, 3

Pyogenic Granuloma Hyperplasia/Hypertrophy Exophytic lesions Granlomatous stage: red, soft, easily bleeding Mixed stage: red with pink color Fibrosis: light pink & firm to palpation (fibroma or fibroid epulis) Refs. 2, 3

Peripheral odontogenic Hyperplasia/Hypertrophy Exophytic lesions Epulis granulo- matosum Pyogenic Granuloma -- D.D. Pregnancy tumor Exophytic capillary hemangioma Ulcerative peripheral giant cell granuloma Peripheral odontogenic tumor Kaposi sarcoma Abscess Refs. 2, 3

Epulis Fissuratum Hyperplasia/Hypertrophy Exophytic lesions Due to unfit denture Refs. 2, 3

Papillary Hyperplasia Hyperplasia/Hypertrophy Exophytic lesions Papillary Hyperplasia Beneath a denture Usu. <0.3cm Nicotinic stomatitis Refs. 2, 3

Malignant tumor from extraction wound (X-ray-bone destruction) Hyperplasia/Hypertrophy Exophytic lesions Epulis Granulomatosum Malignant tumor from extraction wound (X-ray-bone destruction) Arising from extraction socket Pulp Polyp Refs. 2, 3

Mucocele/Ranula Pooling of fluid Exophytic lesions Mucocele Ranula Soft, bluish, dome (nodular)-shaped, painless exophytic mass/swelling Refs. 2, 3

Cyst Formation Pooling of fluid Exophytic lesions Incisive canal cyst Soft, pinkish, dome-shaped, painless exophytic sessile mass/swelling with smooth surface Refs. 2, 3

Pus discharge/Sinus tract Pooling of fluid Exophytic lesions Pus discharge/Sinus tract Gutta Percha point Refs. 2, 3

Hemangioma Neoplasia/Tumor Exophytic lesion Irregular surface Firm, bluish, dome-shaped, smooth-surfaced painless exophytic mass/swelling Refs. 2, 3

Lymphangioma Neoplasia/Tumor Exophytic lesion Fissure tongue There is an irregular (rough) surface, firm, painless swelling, measured about 3x4cm in dimension, consisting of multiple reddish small nodules over the dorsal tongue Refs. 2, 3

Ameloblastoma Neoplasia/Tumor Exophytic lesion There is a well-defined, smooth surface, firm, tender swelling, measured about 3x4cm in dimension, over the right cheek. It is covered with normal appeared skin without hyperemia (hot feeling) Refs. 2, 3

Odontoma- Compound type Neoplasia/Tumor Exophytic lesion Odontoma- Compound type Refs. 2, 3

Papilloma/Verrucous Hyperplasia Neoplasia/Tumor Exophytic lesion Papilloma/Verrucous Hyperplasia Refs. 2, 3

Exophytic Squamous Cell Carcinoma Neoplasia/Tumor Exophytic lesion Exophytic Squamous Cell Carcinoma Reddish-whitish Ulcerative Round shaped crater-like Left lateral border There is an ulcerative, firm, painful, tender, reddish, indurated swelling, measured about 3x4cm in dimension, over the anterior border of tongue Refs. 2, 3

Exophytic Squamous Cell Carcinoma Neoplasia/Tumor Exophytic lesion Exophytic Squamous Cell Carcinoma Refs. 2, 3

Exophytic Squamous Cell Carcinoma—D.D. Neoplasia/Tumor Exophytic lesion Exophytic Squamous Cell Carcinoma—D.D. Pyogenic granuloma Malig salivary gl tumor Peripheral malig CT tumor Verrucous ca Peripheral meta tumor Refs. 2, 3

Summaries Knowing: 1. 口 腔 診 斷 及 口 腔 病 理學 2. The various conditions produce exophytic lesions