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Red Blue Lesin
Red Blue Lesin
Done By :
Weam Mahmoud Faroun
NEOPLASMS
INTRAVASCULAR LESIONS
• CONGENITAL VASCULAR ANOMALIES
• Congenital Hemangiomas and Congenital Vascular
Malformations
• MalformationsEncephalotrigeminal Angiomatosis
(Sturge-Weber Syndrome)
Pyogenic Granuloma
Kaposi’s Sarcoma
Etiology
• Erythroplakia is a clinical term that refers to a red
patch on oral mucous membranes.
• It does not indicate a particular microscopic diagnosis,
although after a biopsy most cases are found to be
severe dysplasia or carcinoma.
• The causes of this lesion are believed to be similar to
those responsible for oral cancer.
• Therefore tobacco use probably has a significant role in
the induction of many of these lesions, as does heavy
alcohol consumption. Nutritional deficits and other
factors may have modifying roles.
Clinical Features
• Erythroplakia is seen much less commonly than
its white lesion counterpart, leukoplakia.
• A strong association with tobacco consumption
and use of alcohol has been noted. In comparison
with leukoplakia, it should, however, be viewed
as a more serious lesion because of the
significantly higher percentage of malignancies
associated with it
• The lesion appears as a red patch with well-
defined margins
• Common sites of involvement include the floor of
the mouth, the tongue, retromolar mucosa, and
the soft palate.
• Individuals between 50 and 70 years of age are
usually affected, and no gender predilection is
apparent.
• Focal white areas representing keratosis may be
seen in some lesions (erythroleukoplakia).
Erythroplakia is usually supple to the touch
unless the lesion is invasive, in which case
induration may be noted.
Histopathology.
• Approximately 40% of erythroplakias show severe
dysplastic change; about 50% are squamous cell carcinoma
and 9% mild or moderate dysplasia.
• A relative reduction in keratin production and a relative
increase in vascularity account for the clinical color of these
lesions.
• A histologic variant of carcinoma in situ exhibits changes
analogous to the skin lesion called Bowen’s disease.
• Microscopic features that separate this bowenoid change
from the usual carcinoma in situ include marked disordered
growth, multinucleated keratinocytes, large
hyperchromatic keratinocyte nuclei, and atypical individual
cell keratinization.
Differential Diagnosis
• should include Kaposi’s sarcoma, ecchymosis,
contact allergic reaction, vascular
malformation, and psoriasis.
• The clinical history and examination should
distinguish most of these lesions.
• A biopsy provides a definitive answer
Treatment
• The treatment of choice for erythroplakia is surgical
excision.
• Generally, it is more important to excise widely than to
excise deeply in dysplastic and in situ lesions because
of their superficial nature and the fact that dysplastic
cells usually extend beyond the clinically evident
lesion.
• However, because epithelial changes may extend along
the salivary gland excretory ducts in the area, the deep
surgical margin should not be too shallow
• Several histological sections may be necessary to
adequately assess the involvement of salivary ducts
• It is generally accepted that severely dysplastic
and in situ erosions eventually become
invasive.
• The time required for his event can range from
months to years.
• Follow-up examinations are critical for
patients with these lesions because of the
potential field effect and corresponding
genetic and molecular alterations caused by
etiologic agents.
Etiology
• Kaposi’s sarcoma is a proliferation of endothelial cell
origin, although dermal/submucosal dendrocytes,
macophages, lymphocytes, and probably mast cells
may have a role in the genesis of these lesions.
• A relatively recently disovered herpesvirus known as
human herpesvirus 8 (HHV8), or Kaposi’s sarcoma
herpesvirus (KSHV), has been identified in all forms of
Kaposi’s sarcoma lesions, as well as in acquired
immunodeficiency syndrome (AIDS)-associated body
cavity lymphomas and in multicentric Castleman’s
disease.
• This virus is believed to have a significant role in the
induction and/or maintenance of Kaposi’s sarcoma
through perturbation of focally released cytokines and
growth factors via virally encoded microRNAs.
Clinical Features
• Three different clinical patterns of Kaposi’s
sarcoma have been described
• In this classic form, it appears as multifocal
reddish-brown nodules primarily in the skin of
the lower extremities, although any organ may be
affected
• Oral lesions are rare in this type.
• This classic form has a rather long indolent course
and only a fair prognosis.
• The most commonly affected organ is the skin.
• Oral lesions are rarely seen.
• The clinical course is prolonged, and the overall
prognosis is only fair.
• The third pattern of Kaposi’s sarcoma has been seen in
patients with immunodeficiency states, including
patients with organ transplants and especially AIDS
• This type differs from the other two forms in several
ways.
• Skin lesions are not limited to the extremities, and they
may be multifocal.
• Oral mucosal and regional lymph node lesions are
relatively common. Visceral organs may also be
involved, and a younger age group is afected.
• The clinical course is relatively rapid and aggressive,
and the prognosis is correspondingly poor.
• Kaposi’s sarcoma, once occurring in about one third of
patients with AIDS, is now seen with considerably less
frequency—a shift that appears to be related to
suppression of human immunodefciency virus (HIV)
replication by antiretroviral drug therapy and concurrent
improvement in CD4 lymphocyte levels, particularly with
the use of highly active antiretroviral therapy (HAART).
• About half of AIDS- affected patients with cutaneous
Kaposi’s sarcoma develop oral lesions.
• Of significance is that oral lesions may be the initial site or
the only site of involvement.
• Kaposi’s sarcoma has been described in most oral regions,
although the palate, gingiva, and tongue seem to be the
most commonly affected sites
• Clinical presentation of oral Kaposi’s sarcoma
ranges from early, rather trivial-appearing, fat
lesions to late, nodular, exophytic lesions.
Lesions may be single or multifocal.
• The color is usually red to blue.
• AIDS-affected patients with oral Kaposi’s
sarcoma may have other oral problems
concomitantly, such as candidiasis, hairy
leukoplakia, advancing periodontal disease,
and xerostomia.
Differential Diagnosis
Clinical considerations include hemangioma, erythroplakia,
melanoma, and pyogenic granuloma.
• Another remarkable look-alike, known as bacillary
angiomatosis, mimics Kaposi’s sarcoma both clinically and
microscopically.
• The causative organism is Bartonella henselae or Bartonella
quintana.
• Cats are reservoirs for this organism, and feas may be
vectors.
• Microscopically, neutrophils and bacterial colonies are
seen.
• This condition is cured with erythromycin or tetracycline
therapy. Bacillary angiomatosis is uncommon in the skin
and is very rare in oral mucous membranes.
Treatment
• Various forms of treatment have been used for Kaposi’s
sarcoma, but none has been uniformly successful.
• Surgery has been useful on localized lesions, and low-dose
radiation and intralesional chemotherapy have been used.
• For larger and multifocal lesions, systemic
chemotherapeutic regimens are being used.
• Improvement in the underlying immunosuppression may
help to reduce the size and number of the lesions.
• In cases of Kaposi’s sarcoma associated with organ
transplant–related immunosuppression and HIV disease,
resolution has been achieved by alteration of the
immunosuppression regimen and antiretroviral therapy.
Thank You