Oral Pathology II Forth Year

1. For all student:
main source is (Regezi)
This outline not enough for exam
Lymphoid lesions
 Reactive lesions
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Lymphoid hyperplasia
Angiolymphoid hyperplasia
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Lymphoepithelial cyst
 Developmental lesions
 Neoplasms:
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Lymphomas
• Hodgkin’s lymphomas
• Non-Hodgkin’s lymphoma
 Myeloma/plasmacytoma
Reactive lesions
*Lymphoid hyperplasia
Normal lymphoid tissue in/around the oral cavity:
Pharyngeal tonsils
Lingual tonsils
Oral tonsils
Regional lymph nods
and lymphoid tissue
1. LH: is a proliferation of lymphocytes without cytological atypia.
2. Mitotic figures often remain restricted to the germinal center.
3. Occasionally, it may mimic the “starry-sky” appearance
Follicular lymphoid hyperplasia:
is a reactive condition involving the soft tissue covering the hard palate
Lymphoproliferative disease of the palate:
Similar to follicular lymphoid hyperplasia but always associated with malignancy
*Angiolymphoid hyperplasia with eosinophilia
"Epithelioid or histiocytoid hemangioma"
 Nodular subcutaneous benign disease [Aggregates of lymphocytes and eosinophils]
 Regional lymphadenopathy
 Blood eosinophilia
ALHE Clinically
 Oral mucosal involvement is rare, however, it is common in the head & neck area
 If occur, labial mucosa is the common site
 Predominant in males
 Affect persons in all ages
 1-2cm. Solitary painless mobile lesion that enlarged gradually
ALHE Histopathology
 Well developed lymphoid follicles containing
 Proliferating and dilated capillaries
germinal centers

2.  Intensive infiltration of lymphocytes with eosinophils and fewer number of macrophages
Treatment:
Surgical excision
Intralesional steroid injections might be effective
*Kimura’s Disease
 Similar to ALHE but without the association with regional lymphadenopathy
 Different but related entity
Developmental
*Lymphoepithelial cyst
Neoplasm
Hodgkin’s Lymphomas
Non-Hodgkin’s Lymphomas
**Hodgkin’s Lymphomas
 Affect bone or soft tissues
 Painless enlargement of lymph nods or extra-nodal lymphoid tissue
 Rarely affect the oral cavity
 Malignant lymphoid cells
 Non-neoplastic inflammatory cells
 Reed-Sternberg cells
Lukes-Bulter histologic classification
1. Lymphocytic predominance
2. Nodular sclerosis
3. Mixed cellularity
4. Lymphocyte depletion
Ann Arbor classification
 Stage I:
=Involvement of single LN or single extralymphatic site
 Stage II:
= 2 or more LN chains
 Stage III:
=Positive disease in both sides of diaphragm
 Stage IV:
= bone marrow, liver or other extralymphatic organs
Treatment and prognosis:
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External radiotherapy
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Chemotherapy
**Non-Hodgkin’s Lymphomas
 Middle-age and elderly
 Gradual, asymptomatic, Focal enlargement of lymph node
 Ann Arbor classification
1-Nodular lymphoma
 3 subtypes:
• Poorly differentiated
• Mixed lymphocytic-histiocytic
• Histiocytic [least favorable prognosis]
2-Diffuse lymphoma
 Lymphocytic
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 Histiocytic
Well-differentiated
Poorly-differentiated

3.  Mixed
Treatment
- Stage I: radiotherapy
- Other stages: chemotherapy or both
*Burkett's lymphoma
 Non-Hodgkin’s Lymphoma
 African children lymphoma
 Translocation of distal part of chromosome 8 to chr. 14.
• Translocation of long arm of chromosome 22 to Chr. 9. is called Philadelphia Chr. [seen in
leukemia]
 Highest proliferation rate in humans
Clinically
African
American
% of all childhood
malignancy
Mean age
Race
Jaw involvement
50%
6-10%
3-10 years
#100 blacks
Relatively common
11 years
#77% whites
R. uncommon
Association with EBV
90%
10%
Radiographically
 Poorly marginated radiolucency
 Cortex: expanded, eroded or perforated
Histopathologically
 B-cell proliferation
 Nodular or diffuse proliferation
 Proliferation of lymphocytes with numerous scattered macrophages [starry-sky]
Treatment and prognosis
 Chemotherapy
 2 years survival
Plasma cell neoplasms
1-Multiple myeloma
2-Solitary plasmacytoma of bone
*Multiple myeloma
 What is plasma cell?
 May present in soft tissue or in bone [solitary or
multiple]
 80% of bone plasmacytomas involve head and neck region
 Mean age 63 years
 May be asymptomatic. In symptomatic cases: pain, swelling, expansion, numbness or mobility of
teeth. Loss of weight and anemia in some cases.
 Immunoglobulin components [IgG, IgA] maybe
detected in serum and urine of 91% and 97%
Radiographically
 85% of patients have abnormal radiographic
skeletal survey
 Multiple well-defined radiolucent areas
Histopathology
 Proliferation of plasma cells
Treatment and prognosis
 Chemotherapy and steroids and local radiation
 Most patients die of infection or renal failure

4.  Mean survival is 2-5 years
*Solitary plasmacytoma of bone
 Mean age 50 years
 Rarely affect jaw [angle of the mandible]
 It may progress to multiple myeloma
Radiographically
 Well defined radiolucency
 It may penetrate the cortical bone to the adjacent soft tissue
 Peripheral blood picture is normal
 Bone biopsy reveals proliferation of plasma cells producing immunoglobulin components
Treatment
Local radiotherapy
Survival of patients is 10 years

5. Metabolic and Genetic jaw diseases
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Paget’s disease
Hyperparathyroidism
Hyperthyroidism
Acromegaly
Cherubism
Osteopetrosis
Paget’s disease
Chronic progressive disease of unknown etiology
 3 stages:
1. Bone resorption
2. Vascular phase
3. Osteoblastic repair
Clinical Features
 ≈90% >55 years of age
 Rare <40 years of age
 Slightly more common in men (4:3)
 More common in Europe mainly in England
 Site: Femora, cranium, pelvis and sternum
HP:
according to it’s stage, activity of osteoclast and osteoblast,
diagnosable…Why?].
mosaic picture [is characteristic but not
Treatment:
symptomatic includes analgesics, calcitonin.
Hyperparathyroidism
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Etiology: unknown, neoplasm or hereditary
Elevated levels of [PTH] and hypercalcimia
Bone demineralization
Treatment: management of the primary cause and treatment of associated problems as renal failure
Excessive amount of T3 and T4 hormones
Common in female between 10 to 14 years
Tremor, muscle weakness palpitation, diarrhea, anxiety and loss of weight
Treatment:
 thyroid-suppressive drugs [Thiocarbamides]
 Radioactive iodine administration
 Stress or epinephrine may precipitate
“thyroid storm”
Acromegaly
 Hypersecretion of pituitary growth hormone
 Common in 4th decade
 Muscle weakness, paresthesia, new periosteal bone formation, enlargement of maxilla and mandible
and paranasal sinuses, hypertension
 Treatment: Controlling levels of growth hormone
Cherubism
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Children of 5 years
Hereditary
Bone expansion particularly the posterior region of the mandible
Cervical and submandibular lymphadenopathy are common

6. Osteopetrosis
 Hereditary bone condition
 Generalized symmetrical increase in skeletal density and bone abnormalities
 2 main types
 Infantile [malignant]
 Adult [benign]
 Prognosis is poor, in adults is less sever
 Treatment of complications
Most common lesions containing large number of multinucleated giant cells are:
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cherubism
giant cell tumor (osteoclastoma)
fibro-osseous lesions
bone lesion of hyperparathyroidism
hereditary hyperparathyroidism
jaw tumors syndrome
aneurysmal bone cyst