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Written and designed by Oral Pathology Scripting Team 2010.

Jordan University of Science and Technology, Faculty of

Dentistry, Irbid, Jordan.

Doctor Rima Al-Safadis Lectures.1

Chapter 8 :Hyperplastic,neoplastic, andrelated disorders of

oral mucosa.

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Chapter 8Hyperplastic, neoplastic, and related disorders of

oral mucosa

Lab 1

Connective tissue neoplasms and allied

conditions

Hyperplasias of oral mucosa

Tumours of fibrous tissue Tumours of adipose tissue

Tumours of vascular tissue

Tumours of peripheral nerves

The granular cell tumour

Tumours of muscle

Malignant lymphomas

Epulides

Pyogenic granuloma

Fibroepithelial polyp

Denture irritation hyperplasia papillary hyperplasia of the palate

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Hyperplasias of oral mucosa Fibrous Epulis

It should be inflamed

because the etiology ofthis lesion is chronic

inflammation.

Pale lesion which does not

bleed easily, the color issimilar to the surroundings.

The commonest location

between the teeth,

because plaque presentsmore there and its the

stimulation of the

inflammation.

Wide base (sessile)

Maxilla > Mandible

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Buccal growth of the gingiva anterior

to the first molar.

Pedunculated, have a constricted

neck can be raised.

Fibrous Epulis

Fib E li

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Reactive bone formation

less cellular and less vascular

Fibrous Epulis

Fib E li

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Reactive bone

formation or

some mineralized

tissue


Granulation tissue

High cellularity

YOU DO NOT HAVE TO DEFRENTIATE BETWEEN THEM HISTOLOGUCALLY

Fibrous Epulis

Fib E li

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Well-formed

Bundles of

fibroblasts and

collagen fibers

YOU DO NOT HAVE TO DEFRENTIATE BETWEEN THEM HISTOLOGUCALLY

Fibrous Epulis

V l E li

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Hyperplasias of oral mucosa Vascular Epulis

Pyogenic granuloma : can be located any where in the oral cavity but most of the time (75%)

on gingiva .

Located only on the gingiva.

lobulated

Soft and Red-purple in colorbecause its highly vascular .

Bleeding is common

Pyogenic granuloma

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Located on :

LipDorsum of the tongue

gingiva.

Pyogenic granuloma

l i f l Pyogenic granuloma or vascular epulis

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Highly vascular , small

capillary sizes blood

vessels

So its also called lobular

capillary hemangioma

Pyogenic granuloma or vascular epulis

H l i f l Peripheral giant cell granuloma

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Hyperplasias of oral mucosa Peripheral giant cell granuloma

Dark-red in color , havehigh vascular

components may bleed

easily.

Located only on the

gingiva or alveolar

mucosa.


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May be squeezed

between teeth to give

hourglass appearance


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The same histology as the central giant

cell granuloma

Multinucleated giant cells

Peripheral giant cell granuloma

Highly vascular


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Multinucleated giant cell

Blood vessel

Hemosiderin

Stromal cells:Macrophage or fibroblasts or

endothelial cells

Peripheral giant cell granuloma


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If its multible and central lesion we

should think about :

HYPERPARATHYROIDISMand rarly Neurofibromatosis

Peripheral giant cell granuloma, could be

continuous to reach the outsild to the

oral cavity

Hyperplasias of oral mucosa Fibroepithelial polyp

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Irritation fibroma)

The most common exophytic

mass in the oral cavity.

Pale color because its highly

fibrous and not highly

vascular.

Buccally erupted 8

caused the fibroeithelial

polyp.

Fibroepithelial polyp


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Atrophic epithelium because it is pushed

by the underling fibrous tissue.

But all over its fibrous, Collagen fibers

are the promenant.

Relatively avascular acellular , cells are

lymphocytes and fibroblasts.


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Treatment is surgical

excision.

Hyperplasias of oral mucosa Giant cell fibroma

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Giant cell fibroblasts having

stellate appearance and sometime its multinucleated

Fibers

Best location on the keratinized

mucosa : dorsum of the tongue

and gingiva. But it could appeare

any where also


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Hyperplasias of oral mucosa G ce b o

The same histopathologyof giant cell fibroma ,

appears specifically

lingual to the lower

canines , usually bilateral.

Hyperplasias of oral mucosa Denture irritation hyperplasia

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Hyperplasias of oral mucosa yp p

Fissures , the denture flange

sets and cause ulcers.

Folds


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Caused by palatal ill-fitting

denture.


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Fissure which is not

ulcerated because we

still see the epithelium.

Pale fibrous underling

tissue.

Hyperplasias of oral mucosa Papillary Hyperplasia of the Palate

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ype p s s o o ucos

Small numerous papillary

projections near to each other

on the papte.


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yp p

papillary projections

Hyper plastic fibrous

tissue under these

projections


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yp p

papillary projections,

they appeared asthey are in air when

we cut the lesion in

the lab.

Hyper plastic fibrous

tissue under these

projections

Hyperplasias of oral mucosa Not neoplasms

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yp p

We differentiate it from fibroma that there is no

malignant features histologicaly.

We differentiate it from Irritation fibroma that its

highly cellular.

Hyperplasias of oral mucosa Tumours of fibrous tissue

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yp p

Mitotic figure

Pleomorphism

hyperchromatism

It is hyper cellular and

also have malignant

features :

Hyperplasias of oral mucosa Tumours of adipose tissue

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Circumscribedmass of

mature tissue , may be

herniation of the buccalpad due to trauma.

Yellowish colored swellingmost commonly in buccalmucosa and tongue

Mature adipocyts becausethey have nuclei pushed tothe periphery


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fibrolipoma

Mature adipocytsbecause they havenuclei pushed to theperiphery

Collagen fibers


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Mitotic figurePleomorphism hyperchromatism

Hyperplasias of oral mucosa Tumours of vascular tissue

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Located any where in

the oral cavity:Mucosa, muscles,

bone, major salivary

gland

If its multible we will

think ofsturge-webersyndrome.

Blue to purple in color

, its not red because

the blood vessels are

deep in the tissue.

Can be smooth,

lobulated, soft or hard.

Multi lobulated


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small blood vessels lined by

epithelium.


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Dilated blood vessels lined by

epithelium, located superfacialand also deep in the tissue.


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Sheets of Endothelialcells forming few

capillary sized vessels.

Sheets of Endothelial

cells can bedifferentiated from

other cell types by

stained positive to

CD 34 stain .

More common inchildren.


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Thick walled artery

next to a thin walledvein without passing

through the capillary

stage, we could feel

pulsation.


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Sinosoidal vascular spaces

lined by pleomophicendothelial cells

Malignant features:

Mitotic figures

Pleomorphism

Hyperchromatism


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Multiple hemangioma followingthe five branches of the

trigeminal nerve intra and extra

orally.


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Small numerous lobulescaused by the superficial

located lymphatic channels.


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A lymphatic channel located immediately bellow the lining epithelium, we

can differentiate it from a blood vessel by S100 stain , its location

superficially and its content is lymph.


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Swilling extra orally submandibular orsublingual.

Hyperplasias of oral mucosa Tumours of nervous tissue

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A firm mass containing

shwan cells and fibroblasts,most of the time has

defused bordered.


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Wavy shaped shwan cells nucleus Collagen fibers Fibroblasts


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Wavy shaped shwan cells nucleus


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Multiple neurofibromas of cutanous

nerves , mutation in NF1 gene.


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Contain only schwan cells , arise

adjacent to the nerve, nerve

fibers do not pass through

theschwannoma.

Arranged in a manner that thecytoplasm of the cells on the

periphery. So there is areas

named :

Cellular areas

Acellular areas

If we applied S100 it will be

almost 100% positive +


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Schwann cells and scar

tissue

nerve fibers

Painful, firm, reactive

not neoplastic


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Oreginated from schwan

cells (give + with S100

stain)

Firm , located any where

in the oral cavity, notwell circumscribed

Granular cells filled withabundant cytoplasm

with granules.


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Hyper plastic lesion

have an ultimateattach with the

surface and underling

tissues , so it give a

wrong impression that

its malignant.

Hyperplasias of oral mucosa Tunmors of muscles

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Hyperplasias of oral mucosa Malignant lymphoma

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Starts on an intra nodal location,

usually on the cervical lymphnodes.

Reed- Sternberg cell , The

malignant component inhodgkins lymphoma, have the

pop-corn appearance.

Firm or rubbery

Normal Lymphocytes, their

prominence is better to have a

good prognosis to the patient

situation.


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Aggressive mass , loosening the

teeth, ulcerated, ugly rapidly

growing,,, its malignant.

Sheets of small B lymphocytes

which have malignant features:hyperchromatism, Mitosis using

CD 20 stain positively.


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Starry appearance cells,

Macrophages with lymphocytes

engulfed in their cytoplasm.

Malignant cells, B cells


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Malignant cells, T cells

and natural killer cells

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Done By : Baraah Al-Salamat

Oral PathoLogy Laboratory Team 2010

lab 1 ch 8

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