Dent 355 Laboratory Session Keratoses and Related Disorders of Oral Mucosa

Dr. Rima Safadi Modified from Dr. Huda Hammad

Normal Oral Mucosa



Color of normal oral mucosa

Normal Oral Mucosa



Color of normal oral mucosa: vascularity, melanin, epithelial thickness, keratinization.

Normal Oral Mucosa

NonNon-keratinized parts

Normal Oral Mucosa

NonNon-keratinized parts

Normal Oral Mucosa Keratinized Parts

White Patches

Debris

Hyperkeratosis

Definition of Histopathological Terms

orthokeratin

Pyknotic nuclei: parakeratosis

Granular cell layer

Definition of Histopathological Terms

Atrophy Acanthosis

Cellular atypia, Epithelial dysplasia.

Dysplasia

Hereditary Conditions (Genodermatoses): Oral Epithelial Nevus (White Sponge Nevus)

Hereditary Conditions (Genodermatoses): Oral Epithelial Nevus (White Sponge Nevus)

Hyperkeratosis

-Intracellular

edema of prickle and cell layers.

Hereditary Conditions (Genodermatoses): Leukoedema

Hereditary Conditions: Leukoedema

Intracellular edem And glycogen Cells appear vacula

Thick epithelium with broad rete ridges

Traumatic Keratoses: Mechanical TraumaTrauma-Frictional Keratosis

TraumaTrauma-Frictional Keratosis Habitual cheek biting

Traumatic Keratoses: Mechanical TraumaTrauma-Frictional Keratosis

 -

Histopathology: Hyperkeratosis +/+/acanthosis. There is no dysplasia.

Traumatic Keratoses: Chemical

Aspirin burn.

Traumatic Keratoses: Chemical



Snuff dipper s lesion.

Similar to chronic friction

Traumatic Keratoses: Thermal Nicotinic Stomatitis

Dilated duct of minor salivary gland

Leukoplakia

Homogenous Leukoplakia
Homogeneous - flat, uniform, predominantly white plaques - may show shallow cracks/fissures


Leukoplakia: Clinical Features

Speckeled Speckeled

Erythroplakia

Leukoplakia: Pathology, Epithelial Dysplasia

2 features are highly suggestive of smoking as an etiological factor: 1. presence of chevron peaks in keratin.


2. increased melanin production in basal keratinocytes and leakage of melanin into the underlying connective tissue (melanin incontinence).

Leukoplakia: Pathology, Epithelial Dysplasia

Leukoplakia: Pathology, Epithelial Dysplasia

Leukoplakia: Pathology, Epithelial Dysplasia

Leukoplakia: Pathology, Epithelial DysplasiaDysplasiaFeatures of Epithelial Dysplasia

1. Increased and abnormal mitoses.

Leukoplakia: Pathology, Epithelial DysplasiaDysplasiaFeatures of Epithelial Dysplasia

2. Basal cell hyperplasia.

Leukoplakia: Pathology, Epithelial DysplasiaDysplasiaFeatures of Epithelial Dysplasia

3. Drop-shaped rete ridges. Drop-

Leukoplakia: Pathology, Epithelial DysplasiaDysplasiaFeatures of Epithelial Dysplasia

4. Disturbed polarity of basal cells or loss of cellular orientation.

Leukoplakia: Pathology, Epithelial DysplasiaDysplasiaFeatures of Epithelial Dysplasia

5. Increase in nuclear/ cytoplasmic ratio.

Leukoplakia: Pathology, Epithelial DysplasiaDysplasiaFeatures of Epithelial Dysplasia

6. Nuclear hyperchromatism.

Leukoplakia: Pathology, Epithelial DysplasiaDysplasiaFeatures of Epithelial Dysplasia

7. Prominent and enlarged nucleoli.

Leukoplakia: Pathology, Epithelial DysplasiaDysplasiaFeatures of Epithelial Dysplasia

8. Irregular epithelial stratification or disturbed maturation.

Leukoplakia: Pathology, Epithelial DysplasiaDysplasiaFeatures of Epithelial Dysplasia

9. Nuclear and cellular pleomorphism.

Leukoplakia: Pathology, Epithelial DysplasiaDysplasiaFeatures of Epithelial Dysplasia

10. Abnormal keratinization (dyskeratosis).

Leukoplakia: Pathology, Epithelial DysplasiaDysplasiaFeatures of Epithelial Dysplasia

11. Loss or reduction of intercellular adhesion.

Regezi

Lichen Planus: Clinical Features Planus:

Skin lesions:

Lichen Planus: Clinical Features

Skin Lesions:

Lichen Planus: Clinical Features

Skin and Nail Lesions:

Lichen Planus: Clinical Features

Oral Lesions:

Reticular pattern

Lichen Planus: Clinical Features

Oral Lesions: NonNon-erosive types: - reticular or annular, papular, plaque-like. plaque

Lichen Planus: Clinical Features

Oral Lesions:


Erosive/atrophic types

Lichen Planus: Clinical Features

Oral Lesions:


Lichen planus involving the gingiva often presents as a desquamative gingivitis.

Lichen Planus: Pathology

Histopathologic Features:


OrthoOrtho- or parakeratosis. Epithelial atrophy or acanthosis (sawtooth pattern of rete ridges). Dense, well-defined band of wellsubepithelial mononuclear infiltrate, mainly T-cells. T-

Lichen Planus: Pathology

Histopathologic Features:

Lichen Planus: Pathology

Histopathologic Features:


Liquefactive degeneration of basal cell layer associated with edema and lymphocytic infiltration. Civatte bodies: hyaline shrunken bodies representing apoptotic cells.

Lichen Planus: Pathology

Histopathologic Features:


Basal cell degeneration may result in subepithelial bullae formation and ulceration.

Lupus Erythematosus: Clinical Features

Chronic Discoid Lupus Erythematosus (DLE):

Lupus Erythematosus: Clinical Features

Chronic Discoid Lupus Erythematosus (DLE): Oral Lesions

Lupus erythematosus histopathology

Deep perivascular Lymphocytic infiltrate

Lupus Erythematosus: Histopathologic Features

Subepithelial and deep perivascular lymphocytic infiltrates. Liquefactive degenerartion of basal cells.