Dent 355 Oral Pathology Laboratory Session Oral Epithelial Tumors, Melanocytic Nevi, and Melanoma Dr.

Rima Safadi Oral and Maxillofacial Pathologist

Modified from Dr. Huda Hammad

OSCC

CIS

Oral squamous cell carcinoma

Human Papilloma Virus-Associated Lesions: Squamous Cell Papilloma

Human Papilloma Virus-Associated Lesions: Squamous Cell Papilloma

Histopathologic Features:

Finger-like epithelial proliferation thin fibrovascular cores.

Hecks disease

Koilocytes

Human Papilloma Virus-Associated Lesions: Verruca Vulgaris (Common Wart)

Human Papilloma Virus-Associated Lesions: Verruca Vulgaris (Common Wart)

Histopathologic Features:

Papillary finger-like epithelial proliferation supported by thin fibrovascular cores. Acanthosis and hyperkeratosis. Hyperplastic rete ridges around margins slope inwards towards center. Large vacuolated cells (koilocytes) with prominent keratohyalin granules.

Verruca vulgaris

Human Papilloma Virus-Associated Lesions: Condyloma Acuminatum (Venereal Wart)

Human Papilloma Virus-Associated Lesions: Condyloma Acuminatum (Venereal Wart)

Histopathologic Features: Prominent acanthosis with marked broadening and elongation of rete ridges. Keratinization is not a prominent feature.

Koilocytosis.

Squamous Cell Carcinoma: Clinical Presentation, Early Lesions

1. White patch. 2. Small exophytic growth which in early stages shows no ulceration or erythema

Squamous Cell Carcinoma: Clinical Presentation, Early Lesions

3. Small indolent ulcer. 4. Erythroplakia.

Squamous Cell Carcinoma: Clinical Presentation, Early Lesions

5. Carcinoma of vermilion border of lip: slightly raised swelling, or crusty, inconspicuous lesion resembling delayed healing of herpes labialis.

Squamous Cell Carcinoma: Clinical Presentation, Advanced Lesions

Advanced lesions may present as:

1. Broad-based, exophytic mass with rough, nodular, warty, hemorrhagic, or necrotic surface.

Squamous Cell Carcinoma: Clinical Presentation, Advanced lesions

2. Deeply destructive, crater-like ulcer with raised, rolled everted edges.

Squamous Cell Carcinoma: Clinical Presentation, Advanced Lesions

3. Infiltration of musculature may result in functional disturbances including impaired speech and difficult swallowing.
4. Pain may be a feature.

Squamous Cell Carcinoma: Clinical Presentation, Advanced Lesions

5. Radiographic evidence of bone destruction.
6. Mobility of teeth. 7. Altered sensation over distribution of mental nerve.

8. Pathologic fracture of mandible.

Squamous Cell Carcinoma: Clinical Presentation

9. Metastatic spread to regional lymph nodes.

Size of surface lesion does not indicate extent of underlying invasion.

Squamous Cell Carcinoma: Clinical Presentation

Squamous Cell Carcinoma: Pathology

Considerable variation. Invasion and destruction of local tissues accounts for induration and fixation detected clinically. Cytologically malignant squamous epithelium with variable degrees of differentiation. Keratinization varies with
degree of differentiation. Invasive malignant epithelium

Keratin pearl

Squamous Cell Carcinoma: Pathology

Well-differentiated tumors: Obvious squamous differentiation. Masses of prickle cells with limiting layer of basal cells around them. Recognizable intercellular bridges. Central keratin pearl formation. Nuclear and cellular pleomorphism is not prominnemt. Relatively few mitotic figures.

Keratin pearl

Squamous Cell Carcinoma: Pathology

Moderately differentiated tumors: Less keratinization. More pleomorphism of cells and nuclei. Abundant and atypical mitotic figures. Still readily identified as squamous type.

Squamous Cell Carcinoma: Pathology

Poorly differentiated tumors: - Keratinization usually absent. - Marked atypical features. - Cells may be hardly recognizable as epithelial.

Poorly differentiated OSCC

Squamous Cell Carcinoma:

Pathology

Squamous Cell Carcinoma: Verrucous Carcinoma

Squamous Cell Carcinoma: Verrucous Carcinoma

Histopathologic Features:

Very well differentiated, heavily keratinized SCC with little or no cytological atypia. Mitoses are rare.

Squamous Cell Carcinoma: Verrucous Carcinoma

Histopathologic Features:

Although it is an exophytic tumor, it also has a slowly advancing, pushing, cohesive invasive front causing local destruction.

Squamous Cell Carcinoma: Carcinoma-In-Situ

A term used to describe severe epithelial dysplasia in which the whole, or almost the whole thickness of epithelium is involved, but basement membrane is intact and there is no invasion of lamina propria.

Carcinoma in Situ

Squamous Cell Carcinoma: Carcinoma-In-Situ

Usually presents clinically as leukoplakia or erythroplakia. In some patients it may progress to invasive carcinoma, but in others it may remain static or even regress.

Oral Premalignant Lesions and Conditions

The following may be considered premalignant lesions or conditions:

1. Precancerous lesions: a) Leukoplakia- homogeneous, non-homogeneous, nodular, and speckled types, including chronic hyperplastic candidosis and proliferative verrucous leukoplakia. b) erythroplakia c) carcinoma in situ.

Oral Premalignant Lesions and Conditions

2. Precancerous conditions: a) oral submucous fibrosis b) lichen planus c) actinic keratosis or cheilitis. d) other conditions associated with oral epithelial atrophy, e.g. sideropenic dysphagia.

Basal Cell Carcinoma (Rodent Ulcer): Clinical Features

Basal Cell Carcinoma (Rodent Ulcer): Clinical Features

Basal cell nevus syndrome.

Basal Cell Carcinoma (Rodent Ulcer): Histopathologic Features

Histologically consists of malignant basaloid cells arranged in various patterns , invading adjacent tissues.

Melanocytes

Acquired Melanocytic Nevi: Clinical Features

Acquired Melanocytic Nevi: Histopathologic Features

Junctional Nevus

Acquired Melanocytic Nevi: Histopathologic Features

Compound nevus

Acquired Melanocytic Nevi: Histopathologic Features

Intramucosal (intradermal) nevus

Malignant Melanoma: Clinical Features

1.

2. 3. 4.

ABCD Clinical Features: Asymmetry (uncontrolled growth pattern) Border irregularity Color variation Diameter greater than 6 mm

Malignant Melanoma: Histopathologic Features

Highly pleomorphic neoplasms. Variable melanin production, may be absent (amelanotic melanoma). Immunohistochemical studies using specific markers for malignant melanocytes (S-100 and HMB-45) are useful. Ultrastructural examination to identify immature melanosomes can be used.

Oral Malignant Melanoma