Oral Cavity Pathology

Last Updated: Oct. 3, 2006

Lichen Planus
• variable and present as white striations
(Wickham striae), white papules, white
plaques, erythema (mucosal atrophy),
erosions (shallow ulcers), or blisters.
• The lesions predominantly affect the buccal
mucosa, tongue, and gingivae, although other
oral sites are occasionally involved.
• a T-cell–mediated autoimmune disease in
which autocytotoxic CD8 + T cells trigger the
apoptosis of oral epithelial cells
• Slightly increased risk of oral SCCa
Lichen Planus
• Spider web.
• The buccal
mucosa
involved most
often
• reticular form
most common
Reticular Oral Lichen Planus
Lichen Planus
• A very high power view
of the dermoepidermal
junction
• Civatte bodies
(arrows),
• keratinocyte
enlargement, and
coarse collagen
bundles are illustrated.
Reference

• E-Medicine Article:
– http://www.emedicine.com/derm/topic663.h
tm
Leukoplakia

• Definition: a whitish patch or plaque

that cannot be characterized clinically or
pathologically as any other disease, and
is not associated with any physical or
chemical causative agent, except the
use of tobacco.
• between 5% and 25% of these lesions
are premalignant
Leukoplakia: Etiology
• No etiologic factor can be identified for most persistent oral
leukoplakias (idiopathic leukoplakia). Known causes of
leukoplakia include the following:
– Trauma (eg, chronic trauma from a sharp or broken tooth or
from mastication may cause keratosis)
– Tobacco use: Chewing tobacco is probably worse than smoking.
– Alcohol
– Infections (eg, candidosis, syphilis, Epstein-Barr virus infection):
Epstein-Barr virus infection causes a separate and distinct non–
premalignant lesion termed hairy leukoplakia.
– Chemicals (eg, sanguinaria)
– Immune defects: Leukoplakias appear to be more common in
transplant patients.
Homogeneous Leukoplakia
Erythroleukoplakia
Verrucous or Nodular Leukoplakia
Carcinoma(leukoplakia appearing)
Leukoplakia- Histopathology

• Features highly variable

– Ranging from hyperkaratosis and
hyperplasia to atrophy and severe
dysplasia
– Significant intrapathologist and
interpathologist variation in diagnosing
dysplasia
– Molecular studies indicated
Erythroplakia (Erythroplasia)
• A CLINICAL entity that carries no
pathological connotation
• a red and often velvety lesion, which, unlike
leukoplakias, does not form a plaque but is
level with or depressed below the
surrounding mucosa.
• Red oral lesions usually are more dangerous
than white oral lesions.
• Carcinomas are seen 17 times more
frequently in erythroplakias than in
leukoplakias, but leukoplakias are far more
common
Erythroplakia

• 75-90% carcinoma or carcinoma in situ

or show severe dysplasia.
• Erythroplasia affects patients of either
sex in their sixth and seventh decades
and typically involves the floor of the
mouth, the ventrum of the tongue, or the
soft palate.
Erythroplakia
 Erythroplakia

Reference: Kumar: Robbins and Cotran: Pathologic Basis of Disease, 7th ed.,
Copyright © 2005 Saunders
Oral Hairy Leukoplakia

• Whittish corrugated thickening of

mucosa on lateral tongue border
• Occurs almost exclusively in HIV-
infected patients
– Probability of developing AIDS is 50% at
16 months and 80% at 30 months in
patients with hairy leukoplakia
• EBV present in tissue
Oral Hairy Leukoplakia
References

• E-Medicine Article: Leukoplakia

– http://www.emedicine.com/derm/topic227.h
tm
• E-Medicine Article: Oral Mucosa
Cancers
– http://www.emedicine.com/derm/topic227.h
tm
 Oral Cancer-Progression

Reference: Kumar: Robbins and Cotran: Pathologic Basis of Disease, 7th ed.,
Copyright © 2005 Saunders, An Imprint of Elsevier
Oral Squamous Cell Carcinoma

• Carcinoma in situ.
Oral Squamous Cell Carcinoma

Invasive
Oral Squamous Cell Carcinoma
• ominous
characteristic of
squamous
carcinoma is its
ability to surround
nerves and to
infiltrate for long
distances in a
perineural fashion
Oral Squamous Cell Carcinoma
• marked
hyperchromatism
and extremely
atypical mitoses
Oral Squamous Cell Carcinoma
• Many nuclei show
clumping of
chromatin.
• There is an
abnormal mitotic
figure in the center
of the
photomicrograph.
Oral Squamous Cell Carcinoma
• Most cells are easily
identifiable as
squamous cells. At
one end there is a
mass of parakeratin
("keratin pearl").
Squamous Cell Carcinoma
Squamous Cell Carcinoma

• Desmosomal bridges between cells.

• Abundant organophilic (keratinized)
cytoplasm,
• Extracellular squamous pearls, ("keratin
pearl").
• Nuclear anaplasia., hyperchromatism.
• Frequent abnormal mitosis.