ORAL LESION Prof. Hesham Saad

Objectives Inflammatory & reactive conditions - Candidiasis - Herpes simplex - Aphthous ulcer - Pyogenic granuloma - Epulis Precancerous & Malignant lesions - Leukoplakia & Erythroplakia - Squamous cell carcinoma Salivary glands diseases - Sialadenitis - Tumors of salivary glands

Inflammatory & reactive conditions Fungal (Candidiasis) : Candida albicans, (thrush, moniliasis), adherent white, circumscribed plaque anywhere within the oral cavity Viral (Herpes simplex): (HSV) type 1, vesicles and ulcers, intracellular edema. Aphthous ulcer : painful shallow ulcers with red rim

Candida albicans infection of the palate

Aphthous ulcer : shallow ulcers

Inflammatory & reactive conditions Pyogenic granuloma : after trauma, proliferating capillaries, edema, inflammatory infiltrate Epulis (prepheral giant cell granuloma): Aggregate of foreign body like giant cells separated by fibroangiomatous stroma

Pyogenic granuloma ulcerated

Pyogenic granuloma

Precancerous & Malignant oral cavity lesions Leukoplakia : whitish, well-defined mucosal patch or plaque caused by epidermal thickening, hyperkeratosis with various degree of dysplasia Erythroplakia: red, velvety, granular, circumscribed areas may or may not be elevated, poorly defined, irregular boundaries, marked dysplasia Squamous cell carcinoma : moderately to well- differentiated keratinizing tumors. Predisposing factors: leukoplakia, erythroplakia, smoking, HPV, trauma, alcohol

Leukoplakia of the tongue in a smoker. Microscopically, this lesion showed severe dysplasia with transformation to squamous cell carcinoma in the posterior elevated portion

Salivary glands diseases Sialadenitis : Inflammation of the major salivary glands may be - Viral (mumps) : diffuse, interstitial inflammation marked by edema -Bacterial : * Acute : obstruction or retrograde entry of oral cavity bacteria, (interstitial, focal suppurative necrosis or abscess formation) * Chronic sialadenitis arises from decreased production of saliva with subsequent inflammation -Autoimmune : bilateral, (Sjögren syndrome), All of the salivary glands & lacrimal glands

Salivary gland : Sjogren’s syndrome ( destroyed acini, lymphoid infiltrate, fibrous stroma)

Tumors of salivary glands Males and females are affected equally sixth or seventh decade of life Distribution – Parotid: 80% overall; 80% benign – Submandibular: 15% overall; 50% benign – Sublingual/Minor: 5% overall; 40% benign 70% to 80% of all tumors are benign

Tumors of salivary glands BENIGN Pleomorphic adenoma Monomorphic adenoma Papillary cystadenoma Oncocytoma MALIGNANT Mucoepidermoid carcinoma. Adenoid cystic carcinoma Acinic cell carcinoma Adenocarcinomas

Tumors of salivary glands BENIGN Pleomorphic adenoma (mixed tumor) is the commonest (90% of benign tumors of the salivary glands) Cystadenoma lymphomatosum (Warthin tumor) small, well-encapsulated, epithelial layer lining cleft like spaces,well-developed lymphoid tissue MALIGNANT Malignant mixed tumors : Carcinoma developing in the epithelial component of preexisting pleomorphic adenoma parotid gland (15%), submandibular glands (40%) Mucoepidermoid carcinoma : only in the region of the parotid (adenocarcinomatous and squamous cell carcinomatous features)

Pleomorphic adenoma

Warthin tumor (Cystadenolymphoma) : epithelial layer lining cleft like spaces,well-developed lymphoid tissue

Mucoepidermoid Carcinoma : (Atypical squamous cells with eosinophilic cytoplasm and very large nuclei with prominent nucleoli, within the group there are also several small cysts contain mucin)

Mucoepidermoid Carcinoma Histology—Low-grade – Mucus cell > epidermoid cells Histology—Intermediate- grade – Mucus = epidermoid Histology—High-grade – Epidermoid > mucus