1. Preliminary Diagnosis of Oral Lesions (1)
口腔病理學
Preliminary Diagnosis of Oral Lesions (1)
口腔病灶之初步診斷 (1)
陳玉昆副教授: 高雄醫學大學 口腔病理科
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2. 學 習 目 標 Understanding: 1. 口 腔 診 斷 及 口 腔 病 理 介紹
2. Conditions produce exophytic lesions

3. 參考資料
References:
1. Van der Stelet PF. Dent Clin North Am 2000;44:237-48
2. Kaohsiung Medical University, Oral Pathology
Department
3. 自購網路資源：super_toolcool

4. 口 腔 診 斷 及 口 腔 病 理 介 紹
口 腔 診 斷
頭頸部
Refs. 1, 3

5. 口 腔 診 斷 口 腔 診 斷 及 口 腔 病 理 介紹 Refs. 1, 3 Real-time polymerase
chain reaction
(RT-PCR)
Refs. 1, 3

6. 口 腔 診 斷 Dentist A 口 腔 診 斷 及 口 腔 病 理介紹
A 40 y/o female suffered from 37 toothache for 3 months
No other abnormal mucosal lesion was noted
Diagnosed her symptoms as periodontitis
Prosthetic crown of 37 was removed to perform endodontic tx
Dentist A
Refs. 1, 2, 3

7. 口 腔 診 斷 Dentist B 口 腔 診 斷 及 口 腔 病 理 介紹
Severe pain of tooth 37 was still persisted
Dentist B
Tooth 37 was extracted
The post extraction
wound remained unhealed
Referred her to visit KMU
dental dept for further tx
Refs. 1, 2, 3

8. 口 腔 診 斷 及 口 腔 病 理 介紹
病 理 診 斷
口 腔 病理
Biopsy—活體切片檢查
Refs. 1, 3

9. 口 腔 病理 口 腔 診 斷 及 口 腔 病 理 介 紹 Dentist C 病 理 診 斷 Extraction 切片檢查 口腔癌
of tooth 37
切片檢查
病 理 診 斷
口腔癌
Refs. 1, 2, 3

10. 口 腔 診 斷 及 口 腔 病 理介 紹 口 腔 病 理 學 口 腔 診 斷 學 病 理 診 斷 臨 床 診 斷 一 體 的 兩 面
牙科放射線影像學
口 腔 病 理 學
口 腔 診 斷 學
口腔組織學
病 理 診 斷
臨 床 診 斷
一 體 的 兩 面
Ref. 3

11. Conditions produce exophytic lesions
Hypertrophy-tongue (muscle)
Hyperplasia-dilantine hyperplasia
What is the difference between hyperplasia & hypertrophy ?
Neoplasia-tumor
Pooling of fluid-pus, mucocele, cyst
Ref. 2

12. Lingual Tonsil Hyperplasia/Hypertrophy Exophytic lesions Refs. 2, 3
Geminal center
Lymphoid
aggregates
Follicle
Refs. 2, 3

13. Circumvallate Papillae Buccal Papillae
Hyperplasia/Hypertrophy Exophytic lesions
Circumvallate
Papillae
Buccal
Papillae
Orifice of
Stensen duct
Refs. 2, 3

14. Hyperplasia/Hypertrophy Exophytic lesions
Exostosis/Tori
Refs. 2, 3

15. Inflammatory Hyperplasia
Hyperplasia/Hypertrophy Exophytic lesions
Inflammatory Hyperplasia
Irritating chronic injury
inflammation
Formation of granulation tissue
(endothelial cells, capillary bed,
round cells & fibroblasts)
Refs. 2, 3

16. Inflammatory Hyperplasia
Hyperplasia/Hypertrophy Exophytic lesions
If etiology is eliminated Subside
Inflammatory Hyperplasia
If not, granulation increases & fibrosis occurs
pales, pink, smooth firm lesion (irritating fibroma)
Refs. 2, 3

17. Pyogenic Granuloma Hyperplasia/Hypertrophy Exophytic lesions
Granlomatous stage: red,
soft, easily bleeding
Mixed stage: red with pink
color
Fibrosis: light pink & firm to palpation
(fibroma or fibroid epulis)
Refs. 2, 3

18. Peripheral odontogenic
Hyperplasia/Hypertrophy Exophytic lesions
Epulis granulo-
matosum
Pyogenic Granuloma -- D.D.
Pregnancy tumor
Exophytic capillary
hemangioma
Ulcerative peripheral
giant cell granuloma
Peripheral odontogenic
tumor
Kaposi sarcoma
Abscess
Refs. 2, 3

19. Epulis Fissuratum Hyperplasia/Hypertrophy Exophytic lesions
Due to unfit denture
Refs. 2, 3

20. Papillary Hyperplasia
Hyperplasia/Hypertrophy Exophytic lesions
Papillary Hyperplasia
Beneath a denture
Usu. <0.3cm
Nicotinic stomatitis
Refs. 2, 3

21. Malignant tumor from extraction wound (X-ray-bone destruction)
Hyperplasia/Hypertrophy Exophytic lesions
Epulis Granulomatosum
Malignant tumor from extraction
wound (X-ray-bone destruction)
Arising from extraction socket
Pulp Polyp
Refs. 2, 3

22. Mucocele/Ranula Pooling of fluid Exophytic lesions Mucocele Ranula
Soft, bluish, dome (nodular)-shaped,
painless exophytic mass/swelling
Refs. 2, 3

23. Cyst Formation Pooling of fluid Exophytic lesions
Incisive canal cyst
Soft, pinkish, dome-shaped,
painless exophytic sessile
mass/swelling with smooth
surface
Refs. 2, 3

24. Pus discharge/Sinus tract
Pooling of fluid Exophytic lesions
Pus discharge/Sinus tract
Gutta Percha point
Refs. 2, 3

25. Hemangioma Neoplasia/Tumor Exophytic lesion Irregular surface
Firm, bluish, dome-shaped, smooth-surfaced
painless exophytic mass/swelling
Refs. 2, 3

26. Lymphangioma Neoplasia/Tumor Exophytic lesion Fissure tongue
There is an irregular (rough) surface, firm, painless swelling,
measured about 3x4cm in dimension, consisting of
multiple reddish small nodules over the dorsal tongue
Refs. 2, 3

27. Ameloblastoma Neoplasia/Tumor Exophytic lesion
There is a well-defined, smooth surface, firm, tender swelling,
measured about 3x4cm in dimension, over the right cheek.
It is covered with normal appeared skin without hyperemia
(hot feeling)
Refs. 2, 3

28. Odontoma- Compound type
Neoplasia/Tumor Exophytic lesion
Odontoma- Compound type
Refs. 2, 3

29. Papilloma/Verrucous Hyperplasia
Neoplasia/Tumor Exophytic lesion
Papilloma/Verrucous Hyperplasia
Refs. 2, 3

30. Exophytic Squamous Cell Carcinoma
Neoplasia/Tumor Exophytic lesion
Exophytic Squamous Cell Carcinoma
Reddish-whitish
Ulcerative
Round shaped
crater-like
Left lateral border
There is an ulcerative, firm, painful, tender, reddish, indurated
swelling, measured about 3x4cm in dimension, over the
anterior border of tongue
Refs. 2, 3

31. Exophytic Squamous Cell Carcinoma
Neoplasia/Tumor Exophytic lesion
Exophytic Squamous Cell Carcinoma
Refs. 2, 3

32. Exophytic Squamous Cell Carcinoma—D.D.
Neoplasia/Tumor Exophytic lesion
Exophytic Squamous Cell Carcinoma—D.D.
Pyogenic granuloma
Malig salivary
gl tumor
Peripheral malig CT tumor
Verrucous ca
Peripheral meta tumor
Refs. 2, 3

33. Summaries Knowing: 1. 口 腔 診 斷 及 口 腔 病 理學
2. The various conditions produce
exophytic lesions