60 yr old male, mass buccal mucosa

Differential diagnosis?????

Solitary fibrous tumor Leiomyoma Fibroma

Recent explosion of reports citing SFT at unrecognized sites. Region of head and neck is one of the more common sites. SFT is not very aggressive in head and neck sites. In the head and neck buccal mucosa is the commonest site. Fibroblast like cells with patternless pattern, thin striplike bands of collagen and gaping vessels. IHC; CD34, bcl2+ Fibroma CD34-, Leiomyoma ; actin/desmin+ CD34-

40 year female ulcer lip

Differential diagnosis????

Well differentiated squamous cell carcinoma Granular cell tumor

Benign neoplasms very rarely malignant Female prdilection. Can occur in a variety of sites in head and neck region.Tongue is the commonest site. H/P; border of lesion ; ill defined with tumor infiltrating in the stroma. When the tumor arises in the muscle , granular cells can be difficult to recognize Cytology; bland, distinct cytoplasmic borders, fine granulations

Closely associated with nerves. N.B. If a graular cell tumor is present, a diagnosis of squamous cell carcinoma should not be rendered; no matter how closely the squamous proliferation resembles squamous cell carcinoma. IHC; S100+, inhibin+ CD68+, Alpha 1 antitrypsin +

66 yr old man treated with radiation for carcinoma oral cavity. Polypoid nodule radiation site.

Differential diagnosis?????

Reactive fibroblastic proliferation Pseudosarcomatous reaction to an associated carcinoma or radiation True sarcoma Sarcomatoid carcinoma

Rare, diagnostically challenging esp in head and neck region. May show prominent or exclusively spindle cell component. Cellular atypia is highly variable. IHC may help but not always relaible. Cytokeratin 50 -75% but absence of CK +vty does not excludes sarcomatoid SCC CK +vty does not confirm presence of sarcomatoid SCC. p63 is very useful as its expression is not encoutered in most sarcomas or benign spindle cell lesions.

60 yr old male ,mandible resection for recurrent squamous cell carcinoma

Differential diagnosis?????

Silaometaplasia Squamous cell carcinoma Jxtaoral organ of chievitz

Vestigial epithelial remnant Site; medial aspect of mandible along the angle. May serve some mechanosensory function ( some suggest that it is a neuroendocrine receptor) Resemblance to squamous cell carcinoma but lack cytologic atypia May undergo hyperplasia

68 yr old female, large solid pale yellow swelling soft palate, tumor excision done

Lipomatosis or fatty replacement Lipomatous pleomorphic adenoma Lipoadenoma of salivary glands Hamartoma Sialopliopma

Slow growing painless mass Mean age; 51 years. Male predominance H/P; well circumscribed, may be encapsulated. Focii of atrophic acini and ducts contained within lipomatous proliferation. Ductal structures may be dilated with fibrosis of the wall.

40 yr old male , dome shaped nodule soft palate

Differential diagnosis????

Traumatic neuroma Palisaded encapsulated neuroma Spindle cell melanoma

Nodular neuroma consisting of schwan cells and numerous axons with a delicate perineural capsule. 90% affect lips,face , oral cavity Usually a solitary nodule May poorly or prtially encapsulate. Retraction artefact common. Vague palisading may be present. Nuclear regimentation into verocay bodies occasionally seen. Mitosis, atypia not seen.

Palisaded encapsulated neuroma Peripheral delicate EMA positivity

schwanoma Completely surrounded by perineural capsule

Axons throught the lesion

Axons when present are typically peripheral, subcapsular

GFAPNo organization into Antoni A & B areas

GFAP+ common

Traumatic neuroma H/O trauma, surgery

PEN

Can have irregular margins

Numerous well formed small nerve twigs

Circumscribed
Random proliferation of schwan cells and axons Lack collagenous stroma

EMA+ perineurium surrounds individual nerve twigs

EMA+ perineurium restricted to perphery of entire neuroma

40 yr old man red patch hard palate

Differential diagnosis???

Kaposi sarcoma Fibrosarcoma

Vascular lesion of low grade malignant potential May originate from cell type capable of undergoing lymphatic differentiation based on D2 40 staining. Sites; skin , mucus membranes, visceral organs, lymph nodes. IHC: FL1 (nuclear), VEGFR-3, HHV8,fVIII related antigen,CD34,CD31 KS represents the most frequent oral malignancy seen in association with HIV infection.

50 year old male , mass hard palate

Differential diagnosis???

Solitary fibrous tumor Myoepithelioma Inflammatory myofibroblastic tumor Sarcomatoid carcinoma

Solitary fibrous tumor

25 yr female painful swelling buccal aspect of alveolar ridge. Xray shows radio opaque lesion surrounded by radiolucent area connected with a tooth

Differential diagnosis????

Cementoblastoma Osteoblastoma

Def; a cementoblastoma is characterized by the formation of cementum like tissue in connection with the root of a tooth. Benign tumor. Male to female ratio 2.1:1 Mostly in permanent dentition Symptomless or pain & swelling Also called true cementoma H/P; formation of sheets of cementum like tissue cotaining a large number of basophilic reversal lines and lack of mineralization at the periphery of the mass. The diagnosis can not be made on the biopsy alone.

35 yr male, painless jaw swelling. Xray shows mottled mixed radio opaque/lucent lesion suggestive of fibro osseous origin.

Differential diagnosis????

Desmoplastic ameloblastoma Squamous odontogenic tumor Odontogenic fibroma Ameloblastic fibroma

Ameloblastoma is the most common odontogenic tumor of epithelial tissue origin. Desmoplastic ameloblastoma is one of its variants with specific clinical, imaging & histological features. Slowly growing, no gender predilection,wide age range, locally invasive& high rate of recurrence with incomplete removal. Frequency slightly higher in Asian population Show more aggressive behavior than other types of ameloblastoma. Common location; maxilla

H/P; 1) Stromal desmoplsia (moderately cellular fibrous connective tissue with abundant collagen) 2)islands of different shapes in the epithelial component. 3)peripheral layer of cuboidal cells 4)hypercellular central area composed of spindle shaped or polygonal epithelial cells. X ray; diffuse ill defined lesion

50 yr old female swelling of jaw, loosening of teeth. Xray shows ill defined radiolucency

Differential diagnosis?????

Clear cell lesions of salivary glands Melanoma Metastatic renal cell carcinoma Clear cell odontogenic carcinoma

It is characterized by sheets and islands of vacuolated and clear cells. Strong female predilection. Older adults On x ray ill defined radiolucency H/P; A biphasic pattern often seen Fibrous stroma withislands of epithelial cells having clear to faintly eosinophilic cytoplasm. The cells have distint boundries and irregular dark stainig nucleus. Cords of basaloid cells seen. Ameloblastomatous islands

PAS +, Mucin IHC; CK 13,14,19,8,18, EMA+ Negative stains; vimentin, S100, desmin,SMA, HMB 45 Aggressive behavior, may metastsize.

Tumor histologic type and pattern Tumor size and location Tumor histologic grade Depth of invasion (not used for TNM staging) Pattern of invasion (noncohesive irregular cords, infiltrative single cells, well defined blunt pushing borders, thick rounded invasive cords) Tumor extension to adjacent structures Status of resection margins Vascular invasion Perineural invasion Lymph nodes: for each level, number obtained, number involved by tumor, size of nodal metastases, presence of extracapsular spread Dysplasia