Tumors and Precancerous

lesions of oral cavity

FIBROUS PROLIFERATIVE
LESIONS

Soft Tissue Tumors

Reactive and Benign lesions of Fibroblastic and Histiocytic Origin

Irritation Fibroma
Giant Cell fibroma
Inflammatory Fibrous Hyperplasia
Inflammatory Papillary Hyperplasia
Fibrous Histiocytoma
Fibromatosis and Myofibromatosis
Oral Focal Mucinosis
Pyogenic Granuloma
Peripheral Giant Cell Granuloma
Peripheral Ossifying Fibroma
Benign Tunors of Fat tissue origin
Lipoma
Benign Tumors of Neural Origin
Traumatic Neuroma
Palisaded Encapsulated Neuroma
Schwannoma
Neurofibroma
Granular Cell Tumor
Congenital Epulis
Melanotic Neuroectodermal Tumor of Infancy

Benign Tumors of Vascular Origin

Hemangioma
Lymphangioma
Benign Tumors of Muscle Origin
Leiomyoma
Rhabdomyoma
Osseous and Cartilaginous Choristomas
Malignant Tumors of Connective Tissue
Fibrosarcoma
Malignant Fibrous Histiocytoma
Liposarcoma
Neurofibrosarcoma
Angiosarcoma
Kaposis Sarcoma
Leiomyosarcoma
Rhabdomyosarcoma
Metastases to Oral Soft Tissues

Inflammatory/Reactive Tumor-like
Lesions
Several soft-tissue lesions of the oral cavity, which present as
tumor masses or ulcerations, are reactive in nature and represent
inflammations induced by irritation or by unknown mechanisms.
All suspicious lesions, however, should be examined by biopsy.
Reactive nodules of the oral cavity are fairly common and
microscopically diverse. The most common fibrous proliferative lesions
of the oral cavity include fibroma (61%), peripheral ossifying fibroma
(22%), pyogenic granuloma (12%), and peripheral giant-cell granuloma
(5%).
The most common inflammatory/reactive ulcerations of the oral
cavity are traumatic and aphthous ulcers.

Irritation Fibroma (Traumatic Fibroma)

Clinical Features
Reactive hyperplasia of fibrous connective tissue
Can occur anywhere in the oral cavity that is susceptible to constant
trauma like buccal mucosa and tongue due to biting
Color is similar to surrounding mucosa and is pedunculated or sessile
Symptoms present only if ulcerated
4th to 6th decades of life
Treatment: Conservative surgical excision

Irritation Fibroma

Pyogenic Granuloma
Common tumor-like growth of the oral cavity
Exuberant response to irritation or trauma; periodontal irritation
could be a major source
Smooth or lobulated pedunculated mass which appears pink
to red in color and is commonly ulcerated
Range from a few mm to several cm hormone dependent
GINGIVA however other sites also affected
Most common in children and young adults with females>males
Develops in pregnant women during first trimester and increases
through 7th months - Pregnancy tumors; Some will resolve
after delivery

is a highly vascular pedunculated lesion, usually occurring in the gingiva of children, young adults, and,
commonly, pregnant women (pregnancy tumor). The surface of the lesion is typically ulcerated and red to purple
in color. In some cases growth is alarmingly rapid, raising the fear of a malignant neoplasm. Histologically these
lesions demonstrate a highly vascular proliferation that is similar to granulation tissue. Because of this histologic
picture, pyogenic granulomas are considered by some authorities to be a form of capillary hemangioma.

PYOGENIC
GRANULOMA

Epulis Fissuratum (Inflammatory Fibrous hyperplasia;

Denture Injury Tumor)
Clinical Features
Tumor-like hyperplasia of fibrous connective tissue that
develops in association with the flange of an ill-fitting denture
Presents as single or multiple folds of tissue in the alveolar
mucosa; usually presents as two folds with denture flanges
in between
The size varies from < 1 cm to large lesions involving the entire
length of the vestibule
Appears as firm, fibrous tissue with variable ulcerations and
erythema
Most common location is facial aspect of alveolar ridges;anterior
portions of jaws and older adults with female predilection

Fibrous epulis

Giant cell epulis

Canker
sore
=
Aphthous
ulcer
These extremely common superficial ulcerations of the oral mucosa affect up to 40%
of the population in the United States. They are more common in the first two decades
of life, are extremely painful and often recurrent, The lesions appear as single or
multiple, shallow, hyperemic ulcerations covered by a thin exudate and rimmed by a
narrow zone of erythema.

Precancerous lesions

Leukoplakia
Leukoplakia means white patch.
Lesions vary in appearance and texture
from a fine white transparency to a heavy,
thick, warty plaque.
The cause is unknown but is commonly
linked to chronic irritation or trauma.
Leukoplakia very often precedes the
development of a malignant tumor.

 Leukoplakia= carcinoma in situ ( 5% risk of

squamous cell carcinoma.)
Erythroplakia = Dysplastic leukoplakia
Precancerous Lesion
A red area, level with the mucosal surface or slightly
depressed.
Marked epithelial dysplasia
Indicative of a high malignant potential (50%).

A white patch of oral mucous membrane that Cannot be

wiped off

Related primarily to tobacco smoking or chewing

Biopsy is mandatory

Leukoplakia

Histologic Features
Leukoplakia usually shows
hyperkeratosis or acanthosis with or
without dysplasia (20% show
dysplasia)
white colour change is the sign of
hyperkeratosis

Erythroplakia

Oral cancer

Oral Squamous Cell

Carcinoma
Most common malignant tumour of
oral cavity
male to female ratio 3:1
usually beyond 4th decade in life
contributing factors: tobacco and
alcohol (also: lack of oral hygiene,
mechanical irritation, sunlight, viruses)

Oral Squamous Cell

Carcinoma
Well differentiated, moderately
differentiated and poorly
differentiated tumours can be
distinguished (prognostic marker)
about 80% of tumours show
keratinization

Squamous cell carcinoma

ODONTOGENESIS and ODONTOGENIC

CYSTS AND TUMORS
Dental Lamina
(Rests of Serres)**

Inner and Outer Enamel Epithelium

(Reduced Enamel Epithelium)**
Dental Lamina

Stratum Intermedium

Dental Papillae

Dental Papillae

Hertwigs Root Sheath

(Rests of Malassez)**

Stelate Reticulum

Enamel Organ

Ameloblasts

Odontoblasts

**Give Rise to
Odontogenic Cysts and
Epithelial Tumors
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The Cysts and Tumors:

Odontogenic cysts:
Inflammatory:
Periapical (radicular) cyst
Residual periapical (radicular) cyst
Buccal bifurcation cyst (usually first
molars)
Paradental cysts (partially
erupted third molars
Developmental:
Dentigerous cyst
Odontogenic keratocyst (KOT)
Orthokeratinized odontogenic cyst
Gingival (alveolar) cyst of the newborn
Gingival cyst of the adult
Lateral periodontal cyst
Calcifying odontogenic (Gorlin) cyst
Glandular odontogenic cyst
Eruption cyst

Odontogenic Tumors:
Epithelial Tumors:
Ameloblastoma
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic
tumor (Pindborg tumor)
Squamous odontogenic tumor
Clear cell odontogenic carcinoma
Ectomesenchymal Tumors:
Odontogenic myxoma
Granular cell odontogenic tumor
Central odontogenic fibroma
Cementoblastoma
Mixed Odontogenic Tumors:
Odontoma
Compound
Complex
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Ameloblastic fibrosarcoma
Odontoameloblastoma

ODONTOGENIC
CYSTS/TUMORS

INFLAMMATORY CYSTS (e.g.,

Radicular[periapical] most
common)
DEVELOPMENTAL CYSTS
(DENTIGEROUS most common)
MALIGNANT TUMORS of
ODONTOGENIC ORIGIN
(AMELOBLASTOMAS) (rare)

Radicular cyst

 Odontogenic Cysts & Tumors

1) Dentigerous cyst - most often associated
with impacted third molar (wisdom) teeth
2)Odontogenic keratocyst - Multiple in
nevoid basal cell carcinoma syndrome
(Gorlin syndrome)
3) Ameloblastoma -invasive but benign
course
4) Odontoma -most common type of
odontogenic tumor

Radicular cyst

Radicular cyst

Primordial Cyst
Cyst Arising in place of a Tooth
May Always Represent OKC (qv)
This is Controversial

Recurrence Potential Low Unless OKC

36

Dentigerous Cyst

Quit

Histopathology

Variable
Non-Specific
May have Secondary Inflamation
Lining Epithelium

Lumen

Wall
37

Eruption Cyst

Cyst Associated with Erupting Tooth

Soft Tissue Swelling Over Crown
Histology Same as Dentigerous Cyst
Excise or Unroof with no Recurrence

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Neoplasms / Carcinoma
Arising in Odontogenic Cysts

RARE : Any Cyst Type

- Mostly DC
Ameloblastoma /
Ameloblastomatous
Transformation
Mucoepidermoid
Carcinoma
Squamous Cell
Carcinoma

Ameloblastomatous
Transformation in
Dentigerous Cyst

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Odontogenic tumors

Odontogenic Tumors
Ameloblastoma
Calcifying
Epithelial
Odontogenic
Tumor
Adenomatoid
Odontogenic
Tumor

Squamous
Odontogenic
Tumor
Calcifying
Odontogenic Cyst

Ameloblastoma

Most common odontogenic tumor

Benign, but locally invasive
Clinically and histologically similar to BCCa
4th and 5th decades
Occasionally arise from dentigerous cysts
Subtypes multicystic (86%), unicystic
(13%), and peripheral (extraosseous 1%)

Ameloblastoma
Histology
Two patterns plexiform and follicular (no
bearing on prognosis)
Classic sheets and islands of tumor cells,
outer rim of ameloblasts is polarized away
from basement membrane
Center looks like stellate reticulum
Squamous differentiation (1%) Diagnosed
as ameloblastic carcinoma

Ameloblastoma

Ameloblastoma

Ameloblastoma

Salivary glands

Sjogren syndrome

Sjogren syndrome

Salivary glands - cysts

Mucocele

Salivary glands - tumors

Pleomorphic adenoma

Pleomorphic adenoma

Basal cell adenoma

Oncocytoma

Warthins tumor cystic

adenolymphoma

Acinic cell carcinoma