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Keratoacanthoma
It is benign tumor of surface epithelium
N.B : Clinically & histologically similar to epidermoid carcinoma
: Etiology
Uknown or
Genetic or
Viral or
Chemical carcinogens
:Clinically
Men more than females
Age 50- 70 years
Site : Exposed skin ( cheek, nose & dorsum of the hands ) 8.1 % in lips
:Characters
Elevated umblicated or crateriform one with depressed central core
Rare over 15 cm in diameter
Regional lymphadenopathy ( inflammatory)
:Clinical courseBegins as small nodul that develops to full size over a periods of
4-8 weeks
Persist as a static lesion for another 4-8 weeks
Regress spontaneously over the next 6-8 weeks by expulsion of
the keratin core
Recurrence is rare
: Histologically
Hyperplastic stratified squamous epithelium growing into the c.t
The epithelium cells do not show atypia
The surface is cover by a thick layer of parakeratin with central
crater plugg
Island of epithelium present in the underling c.t
:Most characteristic features
At the lateral margin where an abrupt change in the norma
epithelium occurs & it is diagnostic
: Treatment; surgical excision
:Histologically
Origin of nevus cells are derived from neural crest
Nevus cells grouped in island, sheets or cord & may be contain melanin & present in
the c.t
Nevus cells are large cell with ovoid, vesicular nucleus & pale cytoplasm
Multinucleated giant cells are sometimes seen
Intradermal nevus
The cells are present in the c.t & are separated from overlying epithelium by band of c.t
Junctional nevus
The overlying epithelium is thin & shows cells crossing the junction growing down in the
c.t
The nevus cells are attached to the overlying epithelium & the zone of demarcation is
absent
The junctional activity has a serious implication due to its liability to malignant
transformation
Compound nevus
Shows features of the intradermal & junctional nevus
Spindal cell nevi
Consists of pleomorphic cells, spindle , epithelioid cells & multinucleated giant cells
Blue nevus
Consists of two types
common blue nevus- 1
elongated melanocytes packed with melanin lie in bundle & parallel to the
epidermis. There is no junctional activity
Cellular blue nevus- 2
Consists of melanocytes & spindle cells with vaculated cytoplasm
arranged in an alveolar pattern
Melanotic- fricke of huchinson's
Melanocyte present in epithelium & replaced the basal cell layers
:Types clinically
-A
Homogeneous leukoplakia : White, smooth, thin or thick base, non palpable &- 1
.translucent
Speckled leukoplakia : White lesion contain red zones & slightly elevated- 2
Granular leukoplakia : White, soft, smooth or finely granular in texture- 3
Nodulor leukoplakia- 4
Verrucous leukoplakia : exophytic in growth- 5
B- Ward classification
Acute leukoplakia ( take several weekes )- 1
Chronic leukoplakia ( take years )- 2
Intermediated types- 3
Depend on the coarse of the disease & prognosis
C- Hobak classification
leukoplakia plana- 1
leukoplakia verrucosa- 2
:Histologic Features
Ranged from hyperkeratosis, hyperparakeratosis &acanthosis, mild, moderate & sever types of epithelial
.dysplasia to squamous cell carcinoma
Diagnosis depend & named according to the chariteria.under the microscope
:Tretment & prognosis
Depend on the histopathologic features -
Carcinoma in situ
It is a oremalignant epithelial tumors exhibits top to bottom changes & the basment
membrane is intact
:Clinical feature
Age : Old age
Sex : No sex predilection
Sit : Skin & mucous membrane ( gingiva, soft palat, uvula, tonsillar pillars, tongue, floor
of the mouth, buccal mucosa & lips )
Color : Red
Shape : Raised & velvety plaque
Spread : Spread laterally & metastasis is impossible
:Histologic Features
;The epithelial cells having chariteria of malignancy from top to bottom as- 1
PleomorphismHyperchromatismAbnormal mitosisPoikilocaryonosis ( division of the nuclus without division of the cytoplasm )Individual cell keratinizationAlteration in the nuclear cytoplasmic ratioBasillar hyperplasiaDyskariosis.Basment membrane is intact- 2
.Prognosis : If left untreated may be transfored into squamous cell carcinoma
:Histologic Features
Atrophy of covering epithelium with variable degrees of dysplasia- 1
Lamina propria is dens, hypalinized & a vascular collageneous c.t- 2
Submucosa contain few fibroblasts- 3
:Tretment
Corticosteroid injections- 1
Surgical removal of fibrous bands- 2
Complecation : squamous cell carcinoma
:Table (1) Definition of the TNMs categories of malignant tumors about the oral cavity
T- Primary tumor size
Tis- Carcinoma in situ
T1- tumor 2 cm or less in the greatest diameter
T2- Tumor greater than 2 cm but not greater 4 cm in the greatest diameter
T3- - Tumor greater than 4 cm
N- Regional lymph nodes
NO- No clinically palpable cervical lymph nodes or palpable lymph nodes but metastasise not suspected
N1- Clinically palpable homolateral lymph nodes that are not fixed ; metastasis suspected
N2- Clinically palpable contralateral or bilateral cervical lymph nodes that are not fixed ; metastasis suspected
N3- Clinically palpable lymph nodes that are fixed ; metastasis suspected
M- Distant metastasis
MO- No distant metastasis
M1- Clinical & radiographic evidence of metastasis other than cervical lymph nodes
S- Site of the primary tumor
:Histologically
Islands , nests, cords- 1
Cells showing , large, deeply staining nuclei & little variation in- 2
appearance
The periphery of cell nests is composed of well polarized cells- 3
similar to basal cells
Due to pluripotentiality of basal cells it may form hair, sebaceous- 4
glands or squamous cells & keratin
:The basal cell carcinoma may be
A- Form lesion mimics glands called adenoid basal cell carcinoma
B- Form cyst & called cystic basal cell carcinoma
C- Keratotic basal cell carcinoma refers to the formation of parakeratin
& horn cells & attempted formation of hair mimic trichoepithelioma
Verrucous Carcinoma
It is form of epidermoid carcinoma appeared chiefly exophytic & papillary in nature
It differs from epidermoid carcinoma from the following
Slow growing
Exophytic & superficial invasion
Low metastatic potential
Amenable to simple local excision
:Clinically
Age : 60 -70 years
Males more than females ( about 65 % occure in males )
Site : Commonly in buccal mucosa , gingiva , palat & floor of the mouth
Exophutic papillary lesion covered by a white leukoplakic film
Regional lymph nodes are tender , enlarged & simulating metastatic tumor but is
usually inflammatory
Bleeding is rare
Pain & difficulty in mastication are common complaint
:Histologically
Marked epithelial prolifeation with down growth of the epithelium into the c.t without
true invasion
The epithelium is well differentiated & show little mitosis, pleomorphism &
hyperchromatism
Cleft like spaces lined y parakeratin pluge
Basment membran is intact
Treatment : Surgical removal