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Home , Sialolithiasis

Oral Cavity

Tumors and precancerous lesions Learning objectives:

. Risk factors and features of premalignant lesions . Clinical and pathological features of premalignant lesions . Etiology, pathogenesis, morphology and clinical features of SCC

. Risk factors and clinical features of and sialolithiasis

. Classification of neoplasms and their relative incidence . Clinico-pathological features of

Precancerous Lesions

• •Erythroplasia/ •Speckled leukoerythroplakia

Leukoplakia . Definition? . White patch of the that can not be scrapped off and can not be characterized as any other disease.

. Males: Female 2:1

. Use of tobacco Leukoplakia

•Histologic evaluation is important – upto 25% lesions are precancerous

•Histology ranges from orderly epithelial thickening, hyperkeratosis without dysplasia to varying degrees of dysplasia

Erythroplakia

. Less common, more threatening than leukoplakia . Red, velvety eroded (slightly depressed) areas

. Histology . Erosions, dysplasia of varying degrees, carcinoma in situ or carcinoma . Sub-epithelial inflammation

Squamous cell carcinoma

. Most common in head and neck region is SCC (HNSCC) – 95% . Sixth most common tumor . Most of these occur in oral cavity

. High mortality – similar since last 50 years . Late diagnosis . Multiple primary tumors (field cancerization)

Squamous cell carcinoma

. Risk factors

. Tobacco, smoking & chewing

. Heavy alcohol intake

. HPV oncogenic variants in 50% oropharynx – expected to increase in the next decade

. Family history of head and neck cancer

. Chronic irritation – acts as promoter

. Leukoplakia, erythroplakia SCC – molecular biology Squamous cell carcinoma

•Morphology •Ventral surface of tongue, floor of mouth •Lower , soft , gingiva •Plaques, ulcers, verrucous growths •Bulging ulcerated masses

•Ca in Situ – may or may not be present •Well differentiated to anaplastic

•Cervical lymph nodes •Mediastinal lymph nodes, lungs liver, bone Oral Cavity

Salivary gland lesions Sialadenitis

. Ductal obstruction – sialolithiasis . . S. aureus . S. viridans

. Unilateral enlargement . Ductal discharge

. Interstitial inflammation to abscess formation Neoplasms

. Relatively uncommon tumors . Most occur in parotids . Slightly more common in females . Smaller the gland involved – higher the chances of malignancy . Benign tumors grow slowly

. Morphological evaluation is definite answer Neoplasms

. Relatively uncommon tumors . Most occur in parotids . Slightly more common in females . Smaller the gland involved – higher the chances of malignancy

. Benign tumors grow slowly

. Morphological evaluation is definite answer

Neoplasms

Benign Malignant

. Pleomorphic adenoma . Mucoepidermoid (50%) (mixed tumor) carcinoma (15%) . (NOS) (10%) . . Warthin tumor (5% to 10%) . .

Pleomorphic adenoma

. Tumors of . Mixed tumors . Pleomorphic adenoma vs. teratoma . Represent divergent differentiation

. Myoepithelial cells or ductal reserve cells

. High recurrence rate – wide margin resection

Warthin tumor

. Papillary cystadenoma lymphomatosum

. From heterotopic rests of SG in parotid areas

. Well circumscribed . Cleft like/cystic spaces on cut section . 2 rows of epithelial cells lining spaces, lymphoid tissue

. High recurrence rate

Mucoepidermoid carcinoma

•Most common primary tumor of salivary gland

•Combination of squamous, mucus secreting and intermediate cells

•Well circumscribed but not capsulated

•Prognosis varies with grade

References

. Pathologic Basis of Disease 8th Ed.

. Essentials of Rubin’s Pathology 5th Ed.