Malignant Neoplasms of

the Oral Structures

 Case 1
■ A 55 year old male
patient came to the
surgery department
with an exophytic
white lesion on his
buccal mucosa.
■ Central ulceration,
bleeding, foul odor,
and induration were
present.
Histopathologic Features
Biopsy specimen reveals invasion of the connective
tissue by epithelial cells showing hyperchromatism,
cellular & nuclear pleomorphism, individual cell
keratinization and keratin pearls .
1. What is the possible diagnosis of this
lesion?
2. Mention the possible clinical forms of
this lesion.
1. Well-Differentiated Squamous Cell Carcinoma.
2. The lesion may be present as a white patch
(leukoplakia), red patch (erythroplakia), speckled
red-white patch, an exophytic mass or ulcer.
Case 2
■ A 68 year old female came to the clinic
complaining of a large ulcer that has been
present for 4 months and was not related to
any source of irritation.
■ The ulcer had raised borders, rough necrotic
floor invading deep into the connective
tissue, recurrent bleeding and foul odor.
Histopathologic Features
Biopsy specimen reveals invasion of the connective
tissue by malignant cells with various signs of
dysplasia.
The exact origin of the cells was confirmed by
positive immunoreactivity to cytokeratins.
1. What is the possible diagnosis of this lesion?
2. Mention 5 signs of epithelial dysplasia seen
in this lesion.
1. Poorly-Differentiated Squamous Cell Carcinoma.

2. Abnormal mitosis, increased nclear/cytplasmic ratio,

dyskaryosis (nuclear pleomorphism), cellular pleomorphism,
prominent nucleoli, hyperchromatism, loss of cellular
adherence, polikilokaryonosis. (Any 5 signs of the previous
without cell nest nor keratin pearl formation as they are
absent in the poorly differentiated form).
Case 3
■ A 50 years old male presented to your clinic with
an prominent white papillary growth involving the
anterior buccal mucosa.
 Histopathologic Features
The biopsy specimen showed:
■ An exo-endophytic epithelial growth
■ Bulbous rete ridges
■ Rough papillary surface
■ Keratin plugging
1. What is the possible diagnosis of this
lesion?
2. Mention the precautions taken during
clinical and histopathological examination of
this lesion.
1. Verrucous Carcinoma.

2. Careful examination of the pharynx to check for

additional lesions and a deep biopsy should be
taken and carefully examined to check for foci of
invasive carcinoma.
Case 4
■ A 25 years old patient complains from a soft
fleshy pink swelling on the dorsum of
tongue.
Histopathologic Features
The lesion showed interlacing bundles of spindle
cells arranged in herringbone pattern. Scanty
collagen fibers can be seen among these cells, as
well as thin walled dilated blood vessels.
Higher magnification of the lesion showed
hyperchromatism, prominent nucleoli and
abnormal mitotic figures.
What is the possible diagnosis of this lesion?
Fibrosarcoma
Case 5
A 49-year-old male reported with chief complaint
of painless swelling in the midleine of the lower
jaw for the past 3 months. Past medical and
family history was negative for any disease.
Radiographic Features
A mixed, ill-defined lesion
was seen on both
panoramic and occlusal
views.
Histopathologic Features
The lesion showed lobules of atypical hyaline
cartilage with increased cellularity. Cartilage cells
were plump, hyperchromatic and often binucleated or
multinucleated.
What is the possible diagnosis of this
lesion?
Chondrosarcoma
Case 6

A 21 year old patient suffered from a lesion which

showed both buccal and lingual expansion of the
mandible. The expansion was hard and the patient
complained of pain and parethesia.
Radiographic Features

Radiograph showed radiating bone spicules and

large mottled opaque lesion in the posterior
mandible.
Histopathologic Features
The lesion showed osteoid matrix areas with partial
calcification embedded in a malignant mesenchymal
stroma.

Malignant
osteoid
tissue
1. What is the possible diagnosis of this lesion?

2. Enumerate the different histopathological

patterns present in this lesion?

3. Mention the characteristic name of the

radiographic appearance?
1. Osteosarcoma
2. Osteoblastic, Chondroblastic and
Fibroblastic.
3. Sun-ray or sun burst appearance.
 Case 7
A 50 year old, HIV positive, male patient presented
with a diffuse, nodular red lesion on his palate. The
lesion did not blanch on pressure.
Histopathologic Features
❑ Biopsy specimen reveals slit-like spaces -formed by
spindle cells- filled with erythrocytes.
❑ Mitotic figures are moderate among these cells.
❑ Considerable hemorrhage throughout the tumour can
be seen.
1. What is the possible diagnosis of this lesion?

2. Mention the causative microorganism.

3. What are the categories (types) of this tumor

1. Kaposi Sarcoma

2. Human herpes virus (HHV8)

3. Epidemic (AIDS-related),
immunocompromised, classic (sporadic)
and endemic (African).
Case 8
An 8 year old girl presented with a rapidly growing
mandibular swelling. The swelling was painful and
ulcerative. This patient also manifests fever,
leukocytosis and elevated erythrocyte sedimentation
rate.
 Radiographic Features
An ill-defined, large osteolytic lesion causing
mobility and loss of the teeth was seen on the
panoramic radiograph.
 Histopathologic Features
The lesion showed sheets of monotonous round
cells (A). The cells had scanty cytoplasm and
round nuclei with evenly distributed finely
granular chromatin (B).

A B
1. What is the possible diagnosis of this
lesion?

2. What are the expected laboratory

investigations?
1. Ewing’s Sarcoma.

2. Leucocytosis; due to tumor necrosis &

anemia; due to tumor bulk.
Thank You!