Hyperplasia, neoplasia and related disorders of oral mucosa. Localized hyperplastic lesions are caused by chronic inflammation. -inflammation and repair together will produce hyperplasy.
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Hyperplasia, neoplasia and related disorders of oral mucosa. Localized hyperplastic lesions are caused by chronic inflammation. -inflammation and repair together will produce hyperplasy.
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Original Title
Hyperplastic and related disorders of OM 1 (Script # 1)
Hyperplasia, neoplasia and related disorders of oral mucosa. Localized hyperplastic lesions are caused by chronic inflammation. -inflammation and repair together will produce hyperplasy.
Copyright:
Attribution Non-Commercial (BY-NC)
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Download as DOCX, PDF, TXT or read online from Scribd
Hyperplasia, neoplasia and related disorders of oral mucosa. Localized hyperplastic lesions are caused by chronic inflammation. -inflammation and repair together will produce hyperplasy.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOCX, PDF, TXT or read online from Scribd
Before starting Dr.RIMA assigned that there will be an AVG by 5 marks
on labs lec.s, so you have to be ready to answer any Q related to lectures and you may asked more than one Q during the whole sem. Firstly, Dr.Rima whishes for us all the luck for this course, and she wishes that ORAL PATHOLOGY 2 will be easier than ORAL PATHOLOGY 1 according to us. Unfortunately, Dr didn't give full lec. Because of having meeting on 12:00 and she promised us that this shortage will be compensated later on. So let's start the first lec. Which is about hyperplasia this lec. Covers the slides ( 2-27)
Hyperplasia, Neoplasia and related disorders of oral mucosa.
Slide #2 What's the difference between hyperplasia and neoplasia? increasing in cells number but under control of Hyperplasia : normal cell cycle proteins due to stimulus, but the hyperplastic tissue will regress after stimulus removal. loss of normal control of cell cycle due to mutation, Neoplasia: so in this process there will be proliferation for ever ( abnormal control of cell cycle).
Slide # 3 Hyperplasia of oral mucosa is usually localized. - -How does localized hyperplastic oral mucosa will be clinically? Will it be flat? It will not be flat; it will look like increasing-sized exophitic mass. Note: most of the localized hyperplastic lesions in oral mucosa , which is caused by chronic inflammation are caused by 1-chronic mechanical trauma like in case of over-extended denture; which causes non-sever trauma (NO ulceration, NO bleeding, but it's CONTINOUS) Friction. 2- Heat. 3- Plaque and calculus accumulation of food debris on gingiva , 4- ( kinds of irritants to gingival, deposit on tooth surface and induce chronic inflammation so lead to hyperplasia ). -Inflammation and repair together will produce hyperplasia of oral mucosa. Dr. said that we studied inflammation process, inflammatory mediators, production of granulation tissue, proliferation of endothelial cells and increasing of fibroblastic nom. -Excessive production of granulation tissue will cause exophilic mass . -Usually the hyperplasia of oral mucosa due to over growth of granulation tissue is relatively avascular , because this granulation tissue varies in cellualrity and vascularity which could be a scar-like due to decreased in cellularity and vascularity. -We conclude that hyperplasia of oral mucosa is caused by chronic inflammation of variable sources. any where in the mouth but if it's Location of hyperplasia: epulis. it's called gingiva occurred in the Epulis :non-neoplastic localized, reactive over-growth mass in gingiva . the oral mucosa specifically Slide # 4 Kinds of epulis: Fibrous epulis. - -Vascular epulis Peripheral giant cell granuloma. - What are the differential diagnosis of hyperplasia in the oral mucosa? What could the epulis be? Pyogenic granuloma vascular epulis. - but it's , separated entity Peripheral giant cell granuloma - vascular lesion because of high capillary content. Peripheral ossifying fibroma considerd as fibrous epulis - irritation fibroma - -Giant cell fibroma Retrocuspid papilla - All these may enter the differential diagnosis of epulis. Slide # 6 Epulides ( plural of epulis ) Again, epulis is hyperplastic growth of the gingiva which has in these lesions are lesion, its differential diagnosis more than one divided into vascular and fibrous and PGCG. In general comparison between vascular and fibrous epulis * -Vascular epulis : red, soft, edentulous and easily bleeding mass. -Fibrous epulis : not easily bleeding mass, like adjacent epithelial color. Look at this pic. This is localized mass on gingiva, slightly pinkish. This lesion is firstly described until proving its clinically as epulis microscopically. diagnosis
Slide # 7 : Epulides : More common on females. More common on max. than mand. ( with some exceptions). Occur mainly anteriorly to molars, rarely present posteriorly to molars. Recurrence is possible when: 1- causative factors are not removed (when the plaque and calculus are not controlled , and teeth are not clean ;for example ) ell c iant g eripheral p as in PGCG ( Or in incompletely excision - 2 ) ranuloma g Slide # 8 Firstly, what is the difference between pedunculated and sessile? Pedunculated: constructed base of the lesion. Sessile: broad base of the lesion. of fibrous epulis? atures clinical fe What are the * -Pedunculated or sessile. -Firm. -Similar on color to adjacent gingiva. Presence / absence e of ulceration according to a trauma. - Bleeding is NOT a feature, unless secondarily trauma occurred.
Slide # 9 and 10 Histopathology of fibrous epulis: 1-Cellular variability: according to number of cells; -If there is cellular fibrous stroma (if you can see the nuclei of fibroblasts) so it's peripheral ossifying fibroma. : bone ng ossifyi outside the bone; in gingiva, (peripheral: : cellularity of fibrous fibroma matrix, formation in fibrous tissue. ) -If the number of nuclei is small by the presence or absence of calcification then it's acellular fibrous tissue so it's hyperplastic gingivitis. Mature collagen. 2- 3-Inflammatory infiltration is present in most of the gingival biopsies, because gingiva is exposed to plaque and calculus accumulation ( the source of bacteria) , the main infiltration is plasma cells. the -Hyperplastic lesion reacts with plaque and calculus on gingival specifically, so it's common to have inflammatory infilteratation on epulides. Bone formation. 4- 5-Stroma could be less cellular and less vascular so it's called hyperplastic gingivitis. this image in the slide is cellular fibrous tissue ( see the black dots ) contains calcified material in the center, so it's peripheral ossifying fibroma. This biopsy could be from gingiva because black dots indicate plasma cells which are the main infiltration of inflammation , which is most occurred on gingiva.
Slide # 11
(2) ) 1 ( Which one of these epulides is sessile and which one is pedunculated? (1)is pedunculated lesion because of base construction. (2) is sessile because the base is flat or broad. ulcerated vascular epulis. secondarily emage (1) is Note :
Slide # 15 : Clinical features of vascular epulis: -Dark red-purple: because of high vascularity so having different color of adjacent tissue. -It may secondarily ulcerated. Easily bleeding. - -Soft, because of having a lot of blood vessels, unlike fibrous epulis which is fibrous tissue having a lot of collagen ( firm tissue ). -Rapidly growth specifically pyogenic granuloma, so it may reach a big size even in one week, and the clinician may think that it's malignant tumor. Usually there is a history of trauma. -
but it pyogenic granuloma is common on gingiva , Imp. Note: this may occur in any part of the mouth such as lip and skin , point is very important to distinguish it from other lesions not on , only which occur just in gingiva and alveolar mucosa buccal mucosa or soft palate. What is the difference between gingiva and alveolar mucosa? - Alveolar mucosa: in case of teeth absence or extracted teeth. Gingiva : in case of teeth presence. Both seen on slide # 21. Slide # 16 If pyogenic granuloma occurs in pregnancy on gingiva then it's pregnancy epulis. called Pregnancy epulis = pyogenic granuloma=lobular capillary hemangioma. Why does pyogenic granuloma occur usually on pregnancy? - endothelial cells in gingiva are responsive to Pregnancy hormones such as estrogen and progesterone because of having receptors for these hormones, so these hormones stimulate endothelial cells proliferation, so pyogenic granuloma reach a big size during pregnancy. removal of pyogenic granuloma in pregnancy surgical Note: should be delayed because if it's removed it will recur again, because she(pregnant pt.) still have the same receptors and the same hormones, so the treatment should be delayed after except in some cases. delivery
Slide # 17, 18 Pyogenic granuloma could occur on lip or skin due to trauma, and it's vascular and bleeds easily. In the tongue as in the image it could be pale because this chronic lesion ( pyogenic granuloma) will have less vessels and more fibrous so color is more pale and bleeding is decreased. Although it looks pale and firm but it's pyogenic granuloma that happens when it's mature and become chronic so become more fibrous. any reactive tissue could have mineralized tissue Note: formation such as gingivitis. may be a bone formation on the tongue as an : there Note ectopic lesion. Slide # 19 Histopathology of pyogenic granuloma: Look at the image in this slide, look at the spaces which are capillaries and there are fibrous septa. 1-This represent pyogenic granuloma as lobular capillary : lobules separated by fibrous septa, lobular hemangioma ( use of having small blood vessels not : beca capillary having a lot of vascular spaces). : hemangioma *cavernous, Cavernous : dilated blood vessel. This term (lobular capillary hemangioma) is the 2 nd name of pyogenic granuloma but it's more descriptive. 2- Highly vascular proliferation. Presence / absence of ulceration due to trauma. 3- 4-Older lesions are getting more fibrous and pale as seen on the tongue image. Slide # 20 Treatment of pyogenic granuloma: Surgical removal of the irritant or the cause to avoid recurrence. But in pregnancy it's delayed. Slide # 21 Peripheral giant cell granuloma
Slide # 22 -So when having central giant cell granuloma we should measure parathyroid hormone level to rule out hyperparathyroidism. Both PGCG and CGCG are non-neoplastic, both look like each other clinically because CGCG perforate the bone and PGCG occur on gingival and alveolar mucosa, and in both cases we should ask about parathyroid hormone level, but they could be distinguished radiographically. Remember: central giant cell granuloma: bony lesion occur ant. To mand. Contain multi nucleated giant cells and stroma of fibroblast like cells, and (?) and it's vascular because of having plenty of capillary. And it looks like brown tumor of hyperparathyroidism. So PGCG occur on gingiva and alveolar mucosa and CGCG occur inside the bone so when it perforates the bone it will be appear on gingiva and alveolar mucosa. -There maybe superficial bone erosin in peripheral type, like ( for example ) when taking radiograph and find soserization ( not sure) in alveolar bone crest that doesn't mean that this lesion is CGCG. What's the origin of giant cell? (From where it arises)? - Macrophages or osteeoclat or periosteum. So the sources of PGCG are: macrophages, osteocalst and periosteum. and alveolar mucosa. : PGCG occurs only on gingiva Note
Slide # 23, 24 -PGCG is usually red because of having a lot of capillaries and RBC's such the case in CGCG,and there maybe hemosidren presence due to RBC's destruction. -It's commonly ulcerated. If PGCG occurs on interdental papilla it will look like hour-glass, so named because it's squeezed between teeth. And it protrudes buccally and lingually and constructed in the middle as in slide # 25. So in PGCG diagnosis we have to rule out both CGCG and in NOT hyperparathyroidism, but this ruling out is just on PGCG pyogenic granuloma. Look how vascular it is, due to these congested capillary y3ni and by RBC's destruction hemosidren is with RBC's, full produced that gives the lesion its brown color. What does stromal cells mean? Stromal cells are spindle or ovoid cells( which have capillary , fibroblast, macrophages, endothelial cells and inflammatory mediators ) which are extended between these multinucleated giant cells as seen in these slides. Most of the reactive lesions due to a certain cause will have bone formation and it could be found in more than one place. slide # 25 -this is a lingual mass on gingiva ( and it could be buccally but it's not obvious) -this mass may occur buccally or lingually or both, it may start buccally and then protrude lingually. -Because most of the calculus occurs lingually, so the masses could occur lingually. Slide # 26 we should rule out multiple PGCG In case of hyperparathyroidism mainly, and in rare cases neurofibromatosis 1. Slide # 27 Treatment of PGCG: -Local excision and removal or correction of underlying cause to prevent recurrence. -If PGCG not treated well or not completely removed it will recur by 60% that means more than half of the cases will recur and Dr. said that the AVG is 10%!! - - I have changed the order of some points to ease its studying. Special thanks to my twin. Bone by Nays }aiauat