1. Dr.Farahnaz Bidari Robbins
Oral cavity neoplasms
Dr.Farahnaz Bidari
Robbins

2. Pyogenic granuloma
Usually in gingiva
Pregnancy tumor
ulcerated

6. Peripheral giant cell granuloma
Epulis
Clinically similar to pyogenic granuloma
Giant cells
Fibrovascular stroma

9. Hairy leukoplakia 80% HIV infected White patches of fluffy thikening
Fungal and bacterial overgrowth

11. Tumors and precancerous lesions
1) Leukoplakia and erythroplakia
2)squamous cell Ca.

13. Leukoplakia White plaque ( a clinical not pathologic term)
Rule out of known causes like lichen planus and candidiasis
Favoured location : buccal ,floor of mouth ,tongue
Dysplasia (1-16%)

15. Erythroplakia Red ,velvety,possibly eroded area
Less common and much higher risk of malignant transformation than leukoplakia
Dysplasia (50%)

16. Risk factors Use of tobacco , most common antecedent Alcohol
Persistent irritants ( hot pizza)
HPV specially type 16

17. Squamous cell ca. 95% of cancers Many of them detected late
Age : y

18. pathogenesis Tobacco = 2-4 fold Tobacco + alcohol = 15 fold
Marijuana , betel nuts ( india) ,HPV( waldeyer ring) , sunlight area and pipe ( lower lip)
Chromosomal abnormality : INT2,BCL1 oncogens

19. Morphology Irregular or verrucous mucosal thikening
Favoured location :floor of mouth , tongue
Grade : 1-3
Prognosis : beter with lip lesion and poorer with tumors in floor of mouth

25. Odontogenic cysts and tumors
Odontogenic cysts : lined with keratinizing squamous epithelium
Multiple form is a component of nevoid basal cell carcinoma syndrome(Gorlin syn)

28. Odontogenic tumors
Neoplasms of the jaws which differentiated toward tooth structures
Ameloblastoma: most common , from inner dental epithelium of developing tooth follicle ( ameloblastic layer) ,enamel and dentine are not seen,cystic, slow growing and locally invasive

32. Odontoma
Odontogenic tumors featuring production of calcified parts of teeth

35. Nasal polyp
Mostly non allergic

38. Sinusitis ( fungal)
Mucormycosis
Diabetic

40. Angiofibroma
Adolescent males
Benign nature
Tendency to bleeding

43. Nasal papilloma Benign neoplasms HPV 6,11
Inverted papilloma :invasive locally

47. Esthesioneuroblastoma
Uncommon
Superolateral of nose
IHC :NSE , S100 , chromogranin
Surgery and chemoradiotherapy
50% 5 years

50. Nasopharyngeal carcinoma
EBV
Three patterns : kerainizing SCC , nonkeratinizing SCC , undifferentiated
Undifferentiated also called lymphoepithelioma
radiotherapy

52. Vocal cord polyp
Most often in heavy smokers
Singers nodule

54. Laryngeal papilloma Usually on TVC Rarely more than 1 cm
Papillomatosis in children (HPV 6,11)
Malignant transformation is rare

56. Salivary gland neoplasms
relatively uncommon neoplasm of human
65-80% arise within parotid
Chance of malignancy increase with decrease in the size of gland
Slight female predominance( except for warthin tumor)
Adult (5% of cases less than 16y)

57. Benigns: slow growing, well defined
Malignants:rapid growth , ill defined , fixed

58. Benign neoplasms
Pleomorphic adenoma (50%)
Warthin tumor ( 5-10%)

59. Malignant Mucoepidermoid ca.(15%) Adenoca.,NOS (10%)
Adenoid cystic ca.(5%)
Acinic cell tumor(5%)
Malignant mixed tumor (3-5%)

60. Pleomorphic adenoma Also called mixed tumor 60% in parotid
Radiation exposure increase the risk
Treatment: adequate parotidectomy (4%)
enucleation (25%)
Malignant transformation : increase with duration, common form is adenoca.
Malignant mixed tumor most aggressive salivary gland tumor

62. Morphology Well demarcated <6cm
Encapsulated( not fully) with tongue like protrusions
Cut surface is gray white and translucent
Epithelial elements (ducts nests of squamous or nests of myoepithelial cells) embedded in myxoid ,hyalin or chondroid stroma (both of them from epithelial and myoepithelial cells of ducts)

65. Warthin tumor Almost always in parotid gland More common in males
10% multifocal , 10% bilateral
Smokers ( 8 times)

66. morphology Round , encapsulated , 2-5 cm Gray , cystic
Cysts lined by double layer of epithelium resting on a dense lymphoid stroma
Lining cells are columnar cells with abundant eosinophilic cytoplasms containing many mitochondria( oncocytic cells) upon cuboidal cells

69. Mucoepidermoid ca. 60-70% in parotid
Large fraction of salivary gland neoplasms in other glands
Most common form of malignant tumors
Most common radiation induced neoplasm

70. Morphology Lack well defined capsule Infiltrative margin
Pale gray white , small cysts
Cords , sheets , cystic area
Squamous , mucus cells , intermediate (hybrid cells)

72. Grade Low , intermediate , high Low grade : largly of mucus secreting
High grade: largly squamous cells
Low , intermediate , high : recur in 15% , 25% , 30%
Low :90% 5-year
High : 50% 5-year

75. Adenoid cystic ca.
Most common neoplasm in minor salivary gland (mouth , nose , sinuses, upper airway)
Slow growing , unpredictable tumor
Tendency to invade perineural spaces
Most painfull salivary gland neoplasm
50%disseminate widely to distant sites, sometimes decades later
60- 70% 5-year survival

77. Morphology Infiltrative , gray pink
Small cells with dark compact nuclei and scant cytoplasms
Forming tubular, solid or cribriform patterns
Histologically is like cylindroma of skin
Gland like structures filled with excess basement membrane

81. Acinic cell tumor ( ca) Uncommon
Most in parotid. Rarely in minor salivary glands
Sometimes bilateral or multicentric
Recurrence uncommon
10-15% metastasize to LN
Survival:90% 5-year

82. Morphology Generally small , discrete
Sheets , glandular and papillary patterns
Neoplastic cells have clear cytoplasms like normal acinar cells