ORAL HISTOPATHOLOGY SESSION Epithelial & connective tissue tumours Yeo Jin Fei PBM BDS, MSc, MDS,...

ORAL HISTOPATHOLOGY SESSION Epithelial & connective

tissue tumours

Yeo Jin Fei PBMBDS, MSc, MDS, FAMS, FDSRCSEd,

FFOPRCPAAssociate Professor

Discipline of Oral & Maxillofacial Surgery National University of Singapore

Senior Consultant Oral & Maxillofacial Surgeon National University Hospital

Slide No. 35 Lab. No. 252/72 T/P 44

Case History :

A 13 year old, Chinese boy presented with two small, pedunculated “cauliflower” out-growths at the commissure of his right cheek. The lesions were painless and has been present for approximately three months.Differential diagnosis :

Slide No. 35 Lab. No. 252/72 T/P 44

Case History : A 13 years old chinese boy presented with two small, pedunculated “cauliflower” out-

growths at the commissure of his right cheek. The lesions were painless and has been present for approximately three months.

Differential diagnosis :

Histopathology Findings: The specimen is composed mainly of stratified squamous epithelium

arranged in a number of papillary or finger-like processes, each enclosing a central core of vascular connective tissue. Keratin formation is prominent. The underlying stroma of fibrous connective tissue is unremarkable.

Diagnosis: SQUAMOUS PAPILLOMA

Slide No. 36 Lab. No. 191/65 T/N 4

Case History : This specimen was removed from the left

cheek of a 42 years old Chinese woman. The lesion presented as a raised black papule of unknown duration. It was asymptomatic.



Case History :

This specimen was removed from the left cheek of a 42 years old Chinese woman. The lesion presented as a raised black papule of unknown duration. It was asymptomatic.


Histopathology Findings:

The surface epithelium is normal. Beneath it are three groups of nevus cells which are completely within the stroma. These are arranged in nests of closely-packed cells and is separated from the flattened surface epithelium by a band of normal connective tissue. The superficial cells are heavily pigmented. The nevus cells are small and uniform with round nuclei and a regular amount of pink staining cytoplasm.

Diagnosis : INTRADERMAL NEVUS

Slide No. 37 Lab. No. 61/59 T/L 4

Case History :

The specimen was removed from a white patch on the cheek of 50 year old Indian patient. He has been a habitual betel-nut chewer for many years.

Differential Diagnosis :


Case History :

The specimen was removed from a white patch on the cheek of 50 year old Indian patient. He has been a habitual betel-nut chewer for many years.


Histopathology Findings :

The surface epithelium on the left of the section is non-keratinized and of normal thickness. On the right, the epithelium is increased in thickness and shows a well formed parakeratin layer. Dyskeratosis (keratin forming at the wrong place, keratin pearls and individual cell keratinization) is evident at the extreme right. Chronic inflammation consisting of diffuse aggregates of lymphocytes and plasma cells is seen within the stroma.

The histologic diagnosis is hyperparakeratosis, acanthosis and dyskeratosis.

Dyskeratosis is an ominous change in leukoplakia.

Definitive Diagnosis : LEUKOPLAKIA


Case History : A 30 year old Indian male, an inveterate betel-nut chewer was noted to have wide-spread leukoplakia of the oral mucosa with tightness of the tissue. The specimen was removed from the cheek.



Case History : A 30 year old Indian male, an inveterate betel-nut chewer was noted to have wide-spread leukoplakia of the oral mucosa with tightness of the tissue. The specimen was removed from the cheek. Differential Diagnosis :

Histopathology Findings : The epithelium shows an overall increase in thickness. There is a thick layer of orthokeratin beneath which is a prominent granular cell layer. The underlying connective tissue consists of hyalinised collagen fibres within which is a diffuse infiltration of lymphocytes and plasma cells.

The histologic diagnosis is hyperorthokeratosis and acanthosis.

Definitive Diagnosis : LEUKOPLAKIA


Case History :

Mr Wan, a 44 year old Chinese was found to have diffuse white patches on the mucosae of his hard and soft palate. The white lesions were interspersed by fissures and numerous raised red papules. The lesions were asymptomatic. The patient had been a pipe smoker for 20 years.



Case History :

Mr Wan, a 44 year old Chinese was found to have diffuse white patches on the mucosae of his hard and soft palate. The white lesions were interspersed by fissures and numerous raised red papules. The lesions were asymptomatic. The patient had been a pipe smoker for 20 years.


Histopathology Findings : The surface stratified squamous epithelium exhibits a thick orthokeratin layer. Beneath this is a prominent granular layer and a spinous layer of normal thickness and maturation pattern. The stroma is unremarkable with little or no inflammation. Many lobules of accessory mucous glands are present. In the centre they appear to open onto the surface via an epithelial-lined duct.

Definitive Diagnosis : NICOTINIC STOMATITIS

Slide No. 40 Lab. No. 197/72 T/F 22

Case History :

A 23 year old, Indian woman presented with diffuse white lesions of the mucosae of the cheeks, lips and palate. The affected mucosae were tight and non-stretchable. She complained of some limitation in opening the mouth but was otherwise asymptomatic. She had been chewing betel-nut since childhood and is fond of eating spicy-hot food.



Case History :

A 23 year old, Indian woman presented with diffuse white lesions of the mucosae of the cheeks, lips and palate. The affected mucosae were tight and non-stretchable. She complained of some limitation in opening the mouth but was otherwise asymptomatic. She had been chewing betel-nut since childhood and is fond of eating spicy-hot food.



The surface epithelium is somewhat atrophic with absence of rete ridges. Orthokeratinization is prominent. Maturation pattern of the epithelial cells, however, is normal. The juxta-epithelial stroma shows dense collagen bundles with relatively few fibroblasts. Early hyalinization of the collagen bundles is evident. Inflammatory infiltrate is present and consists mainly of lymphocytes and plasma cells. Lobules of normal accessory salivary glands are also observed.

Definitive Diagnosis : SUBMUCOUS FIBROSIS

Slide No. 41 Lab. No. 41/60 T/C 39

Case History :

This section was taken from the edge of an ulcer at the molar region of the maxillary alveolus in a 46 year old Chinese female patient. She noticed the ulcer only six weeks ago. It was painless.



Case History :

This section was taken from the edge of an ulcer at the molar region of the maxillary alveolus in a 46 year old Chinese female patient. She noticed the ulcer only six weeks ago. It was painless.



The specimen shows a well differentiated squamous cell carcinoma which has invaded into the connective tissue stroma and beneath the normal surface epithelium. The tumour is composed of irregular columns and islands of neoplastic squamous cells, which exhibit considerable pleomorphism, hyperchromatism, altered nuclear-cytoplasmic ratio and atypical mitoses. Keratin formation in the form of epithelial nests and individual cell keratinization is prominent. Chronic inflammation is evident within the tumour and adjoining stroma.

Definitive Diagnosis : SQUAMOUS CELL CARCINOMA


Case History :

This 61 year old Chinese seaman complained of pain at the upper left alveolar ridge for the past 10 days. He has been a heavy smoker for the last 20 years.

Examination showed a painless, fungating, ulcerated swelling of the upper left alveolar ridge about 3 x 4cm in size. The ulcerated area was haemorrhagic and had everted edges. The surrounding mucosa was indurated. The palate was covered by diffuse white patches, which were interspersed by numerous small red spots. The submandibular nodes were palpable, slightly tender and mobile.

X-rays showed diffuse irregular destruction of the alveolar bone.



Case History :This 61 year old Chinese seaman complained of pain at the upper left alveolar ridge for the past 10 days. He has been a heavy smoker for the last 20 years.

Examination showed a painless, fungating, ulcerated swelling of the upper left alveolar ridge about 3 x 4cm in size. The ulcerated area was haemorrhagic and had everted edges. The surrounding mucosa was indurated. The palate was covered by diffuse white patches, which were interspersed by numerous small red spots. The submandibular nodes were palpable, slightly tender and mobile.

X-rays showed diffuse irregular destruction of the alveolar bone.


Histopathology Findings : The specimen is covered by relatively normal surface stratified squamous epithelium. The

underlying stroma is infiltrated by irregular columns and sheets of neoplastic squamous cells. The tumour cells show marked pleomorphism, hyperchromatism and altered nuclear-cytoplasmic ratio. Mitotic figures are plentiful, many of which are atypical. Keratin formation is evident though not particularly prominent. The histology is that of a moderately differentiated squamous cell carcinoma.

Definitive Diagnosis : SQUAMOUS CELL CARCINOMA


Case History :

A 74 year old Chinese housewife complained of a sessile, papillary, white growth on the /67 region of the alveolar ridge which she claimed had been present for only 3 weeks. The lesion was painless and measured 3 x 2cm in size. There were no palpable nodes. X-rays showed no bony involvement.

The patient was wearing full upper and lower dentures. She gave a history of betel-nut chewing for the past fifty years.



Case History : A 74 year old Chinese housewife complained of a sessile, papillary, white growth on the /67 region of the

alveolar ridge which she claimed had been present for only 3 weeks. The lesion was painless and measured 3 x 2cm in size. There were no palpable nodes. X-rays showed no bony involvement.

The patient was wearing full upper and lower dentures. She gave a history of betel-nut chewing for the past fifty years.


Histopathology Findings : The multisected specimen shows surface stratified squamous epithelium arranged in irregular fronds with bulbous rete ridges. Parakeratin formation is prominent and typically extends deep into the epithelium. The spinous and parabasal cells show some loss of normal stratification but are otherwise relatively well differentiated. The basal cells are pleomorphic and haphazardly arranged with large hyperchromatic nuclei. Mitotic figures are readily demonstrable in this region. The subjacent stroma is essentially normal except for chronic inflammation within the superficial regions.

Definitive Diagnosis : VERRUCOUS CARCINOMA

Slide No. 44 Lab. No. 245/61 T/M 4

Case History : A 61 years old Chinese lady was seen at the Johore Bahru General

Hospital for a painless, fungating growth in the palate, which has been present for about a year. The lesion was charcoal-black in colour, about 1cm thick and has occupied the entire palate.

Radiographs showed no evidence of bone resorption.



Case History : A 61 years old Chinese lady was seen at the Johore Bahru General Hospital for a painless, fungating

growth in the palate, which has been present for about a year. The lesion was charcoal-black in colour, about 1cm thick and has occupied the entire palate.

Radiographs showed no evidence of bone resorption.


Histopathology Findings : Beneath the normal surface epithelium the stroma is densely infiltrated

by pigmented neoplasm. The tumour cells are markedly pleomorphic, heavily pigmented and randomly arranged. Mitotic figures are readily demonstrable

Definitive Diagnosis : MELANOMA


Case History :

Mrs Yap, a 53 year old Chinese housewife was referred by her dentist because of a painful swelling over the right ramus of the mandible. The swelling was diffuse and firm. It had been present for 2 months. She also complained of numbness of the right lower lip. The patient was edentulous. There was no obvious intra-oral lesion. The mucosa in the region of complaint was intact and normal in colour. The right cervical lymph nodes were palpable. Radiographs showed bone destruction in the ascending ramus.

On questioning, she gave a history of having undergone radiation therapy for cancer of the bronchus one year ago.



Case History : Mrs Yap, a 53 year old Chinese housewife was referred by her dentist because of a painful swelling over the right ramus of the

mandible. The swelling was diffuse and firm. It had been present for 2 months. She also complained of numbness of the right lower lip. The patient was edentulous. There was no obvious intra-oral lesion. The mucosa in the region of complaint was intact and normal in colour. The right cervical lymph nodes were palpable. Radiographs showed bone destruction in the ascending ramus.

On questioning, she gave a history of having undergone radiation therapy for cancer of the bronchus one year ago.



The specimen is a biopsy from the ramus and consists of irregular spicules of lamellar bone and intervening fibrous haemopoietic marrow. Scattered diffusely throughout the bone marrow are tiny islands of neoplastic epithelial cells. The tumour cells are markedly pleomorphic with eosinophilic cytoplasm and hyperchromatic nuclei. In areas abortive formation of glandular structures are observed, the lumina of which are filled with a pinkish material. Tumour giant cells are also evident. The histology is consistent with a metastatic adenocarcinoma.

Definitive Diagnosis : METASTATIC CARCINOMA


Case History : The specimen was removed from the alveolus of a 55

year old Indian man. The growth was pedunculated, firm in consistency and normal in colour except at its under-surface where it was ulcerated. It has been present for the last 2 years.



Case History : The specimen was removed from the alveolus of a 55 year old Indian man. The

growth was pedunculated, firm in consistency and normal in colour except at its under-surface where it was ulcerated. It has been present for the last 2 years.


Histopathology Findings : The lesion consists essentially of intertwining bundles of

collagen fibres interspersed by fibrocytes and fibro-blasts. It is covered by hyperplastic, keratinized mucosa with sprinkling of chronic inflammatory cells throughout.

Definitive Diagnosis : FIBROUS EPULIS \ “FIBROMA”

Slide No. 47 Lab. No. 244/72 T/H 9

Case History : A 40 year old Chinese female presented with very

mobile fibrous ridge extending from tooth #13 to #23 region. The patient has been wearing full upper dentures for more than 15 years.


Slide No. 47 Lab. No. 244/72 T/H 9

Case History : A 40 year old Chinese female presented with very mobile fibrous ridge extending from tooth #13 to

#23 region. The patient has been wearing full upper dentures for more than 15 years.


Histopathology Findings : The lesion is composed mainly of dense fibrous connective tissue arranged in thick

bundles. In a few areas the stroma has undergone myxomatous degeneration and appears as lightly-stained, loose fibrillar areas. Chronic inflammation is present and confined to the superficial stroma. The overlying surface stratified to the superficial squamous epithelium is normal but somewhat hyperplastic.

Definitive Diagnosis :

INFLAMMATORY FIBROUS HYPERPLASIA / “DENTURE HYPERPLASIA”


Case History : This 35 year old, Chinese housewife complained of a “growth‟ on the lower right

alveolar ridge. The lesion has been present for the last four years. It was slow-growing and painless. Examination showed a pedunculated soft tissue mass on the crest of the right alveolar ridge distal to the lower right canine. The growth was 2.0 x 1.0cm in size, fibrous in consistency and covered by mucosa of normal colour. It was not painful on palpation. An excisional biopsy was carried out and the specimen submitted for microscopic examination.

Differential Diagnosis : Fibrous epulis;


Case History : This 35 year old, Chinese housewife complained of a “growth‟ on the lower right alveolar ridge. The lesion has been

present for the last four years. It was slow-growing and painless. Examination showed a pedunculated soft tissue mass on the crest of the right alveolar ridge distal to the lower right canine. The growth was 2.0 x 1.0cm in size, fibrous in consistency and covered by mucosa of normal colour. It was not painful on palpation. An excisional biopsy was carried out and the specimen submitted for microscopic examination. Differential Diagnosis : Fibrous epulis;

Histopathology Findings : The specimen is covered by normal surface stratified squamous epithelium which is thin and

ulcerated. The underlying stroma is composed of bundles of collagen fibers interspersed by the usual fibroblasts and fibrocytes. At the centre of the specimen the stroma is much more cellular. Here the fibroblasts are plumping, more numerous and closely packed with little collagen formation. Interspersed within this stroma are many homogenous, acellular, calcified droplets of calcification. Chronic inflammation is present and confined to the stroma immediately beneath the ulcerated surface.

Definitive Diagnosis : PERIPHERAL OSSIFYING FIBROMA


Case History : The patient was a 17 year old Indonesian girl who was referred to our

clinic because of a swelling of her right mandible, which had been present for 3 years. The swelling was located within the body of the mandible and extended from #43 to #48 region. It was circumscribed, painless, slow growing and bony hard in consistency. There was noticeable buccal and lingual expansion of the mandible. The overlying skin and mucosa was intact and normal in colour. She was edentulous except for wisdom teeth. Radiographs showed a circumscribed radiolucent area with many small opaque areas. The cortical bone was thinned out. The lesion was about 7 x 3 cm in size.



Case History : The patient was a 17 year old Indonesian girl who was referred to our clinic because of a swelling of her right

mandible, which had been present for 3 years. The swelling was located within the body of the mandible and extended from 3/ to 8/ region. It was circumscribed, painless, slow growing and bony hard in consistency. There was noticeable buccal and lingual expansion of the mandible. The overlying skin and mucosa was intact and normal in colour. She was edentulous except for 8/8. X-rays showed a circumscribed radiolucent area with many small opaque areas. The cortical bone was thinned out. The lesion was about 7 x 3 cm in size.


Histopathology Findings : The tumour is composed of cellular fibrous connective tissue within which

are irregular trabeculae of woven bone and acellular calcified droplets. The cells are mainly fibroblasts, which are arranged in whorls in a stroma of loose collagen fibres. The bony trabeculae show osteocytes and are rimmed by osteoblasts with occasional osteoclasts. Mitotic figures are present but only infrequently.

Definitive Diagnosis : CENTRAL OSSIFYING FIBROMA

Slide No. 50 Lab. No. 95/60 T/G 20

Case History : This 6 year old Indian boy presented with a

painless, pedunculated fleshy growth attached to the labial gingiva between the A/A. The growth bled easily and had been present for 3 weeks. Differential Diagnosis :


Case History : This 6 year old Indian boy presented with a painless, pedunculated fleshy growth

attached to the labial gingiva between the A/A. The growth bled easily and had been present for 3 weeks. Differential Diagnosis :

Histopathology Findings : The essential features of the lesion is the presence of multinucleated

giant cells in a stroma of collagen fibers and young fibroblasts. The lesion is separated from the ulcerated surface epithelium by a layer of normal looking corium. Many capillaries and areas of old haemorrhage are seen scattered throughout the lesion.

Definitive Diagnosis : PERIAPICAL GIANT CELL GRANULOMA


Case History : A Chinese boy, aged 14 years developed a soft tissue

growth attached by a pedicle to the palatal aspect of the interdental papilla between 21/. It was first noticed only two weeks previously and had grown rapidly since then. The surface was smooth and red. It bled readily. The gingival margins were red and hyperplastic. There was a varying amount of calculus adhering to the necks of the teeth. Differential Diagnosis :


Case History : A Chinese boy, aged 14 years developed a soft tissue growth attached by a pedicle to the palatal aspect of the

interdental papilla between 21/. It was first noticed only two weeks previously and had grown rapidly since then. The surface was smooth and red. It bled readily. The gingival margins were red and hyperplastic. There was a varying amount of calculus adhering to the necks of the teeth. Differential Diagnosis :

Histopathology Findings : The lesion is covered in areas by stratified squamous epithelium, but for the

greater part the latter is lost and a pyogenic membrane forms the surface of the growth. The outstanding feature of the growth is its abundant vascularity. Blood vessels and spaces of various sizes are present and endothelial cells are conspicuous. Fibroblasts are also numerous. A few strands of collagen fibres ramify through the tissue dividing it into septae. Chronic inflammatory cells and polymorphs are found throughout, the latter mostly concentrated peripherally.

Definitive Diagnosis : GRANULOMA PYOGENICUM

Slide No. 53: Lab. No. 106/54 T/H 2

Case History : A 4 day old Chinese female baby presented with a fluctuant swelling on

the alveolus of the mandible at the midline. It was bluish in colour and had been present since birth. It was provisionally diagnosed as a median inclusion cyst and an attempt at marsupialisation was abandoned through marked haemorrhage. The growth later was excised by diathermy and healing was uneventful. Differential Diagnosis :

Slide No. 53: Lab. No. 106/54 T/H 2

Case History : A 4 day old Chinese female baby presented with a fluctuant swelling on the alveolus of the mandible at the midline. It was

bluish in colour and had been present since birth. It was provisionally diagnosed as a median inclusion cyst and an attempt at marsupialisation was abandoned through marked haemorrhage. The growth later was excised by diathermy and healing was uneventful. Differential Diagnosis :

Histopathology Findings : The section contains numerous capillaries and large sinusoidal spaces lined by

endothelium and filled with red blood cells. These blood vessels and spaces lie within a stroma of loose connective tissue in which there are infiltrations of inflammatory cells. Large areas of haemorrhage are seen and haemosiderin granules in association with histiocytes are present in places.

Definitive Diagnosis : HAEMANGIOMA


Case History : This section was taken from a “sausage‟

shaped pedunculated soft tissue mass in lower molar region of a new-born baby boy. Differential Diagnosis :


Case History : This section was taken from a “sausage‟ shaped pedunculated soft tissue

mass in lower molar region of a new-born baby boy. Differential Diagnosis :

Histopathology Findings : Section showed that there are many spaces, which are filled

with slightly pinkish coloured material and lined with a thin layer of endothelial cells. The walls are extremely delicate and fragile. There is much inflammatory cell infiltration and the covering stratified squamous epithelium is thinned.

Definitive Diagnosis : LYMPHANGIOMA

Slide No. 55 Lab. No. 35/59 T/0 2

Case History : A 16 year old Malay boy complained of gradually increasing

prominence of his left cheek over the last few years. Clinical and radiographic examination showed a bony mass arising from the left zygomatic bone. Mandibular movement was normal except for lateral movement to the affected side. At operation, the bony growth was found to be attached to the lower border and inferior surface of the anterior half of the zygomatic arch. Differential Diagnosis :

Slide No. 55 Lab. No. 35/59 T/0 2

Case History : A 16 year old Malay boy complained of gradually increasing prominence of his left cheek over the

last few years. Clinical and radiographic examination showed a bony mass arising from the left zygomatic bone. Mandibular movement was normal except for lateral movement to the affected side. At operation, the bony growth was found to be attached to the lower border and inferior surface of the anterior half of the zygomatic arch. Differential Diagnosis :

Histopathology Findings : Decalcified sections show that the tumour consists essentially of

trabeculae of lamellar bone with fatty marrow spaces. Peripherally there is a layer of cortical bone covered by fibrous tissue.

Definitive Diagnosis : OSTEOMA


Case History : A small soft tissue nodule, approximately 3mm in

diameter, was excised from the buccal sulcus of this 48 year old Chinese female. The lesion was asymptomatic and had been present for more than one month. Differential Diagnosis :


Case History : A small soft tissue nodule, approximately 3mm in diameter, was excised

from the buccal sulcus of this 48 year old Chinese female. The lesion was asymptomatic and had been present for more than one month. Differential Diagnosis :

Histopathology Findings : The specimen is covered by normal surface stratified

squamous epithelium. A number of nerve bundles are seen within the superficial and deep stroma together with the usual collagen fibres.

Definitive Diagnosis : TRAUMATIC NEUROMA

Slide No. 58 Lab. No. 166/72/1 T/N 5

Case History : This is a case of Neurofibromatosis (Von Recklinghausen disease of

skin) in a 35 year old Chinese female. She had nodular lesions all over her body, hands, legs, face and trunk. The lesions were soft, about 0.5 to 1.0cm in size, and covered by normal skin. Cafe-au-lait spots were present. There were few oral lesions. These were located on the tongue, alveolus and palate. X-rays films showed no intra-bony lesions. The present specimen was removed from the alveolar ridge. Differential Diagnosis : Neurofibromatosis;

Slide No. 58 Lab. No. 166/72/1 T/N 5

Case History : This is a case of Neurofibromatosis (Von Recklinghausen disease of skin) in a 35 year old Chinese female.

She had nodular lesions all over her body, hands, legs, face and trunk. The lesions were soft, about 0.5 to 1.0cm in size, and covered by normal skin. Cafe-au-lait spots were present. There were few oral lesions. These were located on the tongue, alveolus and palate. X-rays films showed no intra-bony lesions. The present specimen was removed from the alveolar ridge. Differential Diagnosis : Neurofibromatosis;

Histopathology Findings : The tumour is circumscribed but non-encapsulated and consists of

numerous small, spindle-shaped schwann cells in a stroma of fine interlacing collagen fibrils. Inter-cellular oedema is prominent in the superficial region of the lesion. Bundles of normal nerves are present at the deep margin. The overlying normal surface epithelium shows melanin pigmentation in the basal cells.

Definitive Diagnosis : NEUROFIBROMATOSIS

Slide No. 59 Lab. No. 184/74/ii T/N 6

Case History :This 8-year old Malay school-boy was referred to the Oral Surgery Unit because of a painless swelling over his right nasolabial fold and labial sulcus. The swelling was circumscribed, firm in consistency and 3cm in diameter. The floor of the right nostril was raised. It has remained static in size. X-rays showed no involvement of the underlying bone. The lesion was provisionally diagnosed as a nasolabial cyst. At operation, the lesion was found to be very firm, hour-glass in shape measuring 2 cm by 1.5cm by 1 cm.

Differential Diagnosis : nasolabial cyst;

Slide No. 59 Lab. No. 184/74/ii T/N 6

Case History :This 8-year old Malay school-boy was referred to the Oral Surgery Unit because of a painless swelling over his right nasolabial fold and labial sulcus. The swelling was circumscribed, firm in consistency and 3cm in diameter. The floor of the right nostril was raised. It has remained static in size. X-rays showed no involvement of the underlying bone. The lesion was provisionally diagnosed as a nasolabial cyst. At operation, the lesion was found to be solid, hour-glass in shape and 2 x 1.5 x 1 cm size.


Histopathology Findings : Sections show a circumscribed soft tissue tumour composed of loose connective tissue fibrils interspersed by numerous stellate and spindle-shaped cells. Bundles of normal nerves are typically seen in this variety of neurofibroma.

Definitive Diagnosis : PLEXIFORM NEUROFIBROMA

Slide No. 52 Lab. No. 83/72/1 T/S 7

Case History : A 19 year old Chinese male presented with a swelling

of his right cheek, which he first noticed 2 months ago. The swelling was painless, rubbery in consistency, fairly well defined and about 3 x 5 cm in size. The overlying mucosa was normal.


Slide No. 52 Lab. No. 83/72/1 T/S 7

Case History : A 19 year old Chinese male presented with a swelling of his right cheek, which he first noticed 2

months ago. The swelling was painless, rubbery in consistency, fairly well defined and about 1.5 x 2 inches in size. The overlying mucosa was normal.


Histopathology Findings : The specimen is composed of a highly cellular neoplasm of spindle shaped

cells. The nuclei of these cells vary considerably in shape and size but are generally plump and darkly stained. Mitotic figures are present in large numbers. Collagen fibers formation is present but scant. The tumour cells are arranged in a variety of patterns ranging from compacted areas with typical herring-bone pattern to a loose myxomatous arrangement with much intervening fibrillar and mucoid stroma.

Definitive Diagnosis : FIBROSARCOMA

Slide No. 56 Lab. No. 44/72 T/S 8

Case History : The patient was a 27 year old Chinese male who had a swelling of the left maxilla in the region

of the upper first and second molars 3 months ago. The associated teeth were very loose. He thought to have a gum boil and the teeth were extracted. The swelling, however, continued to grow in size. He complained of epitaxis from the left nostril and difficulty in breathing. There was numbness in the left infraorbital region. A diffuse swelling was seen in the left maxilla extending from the first premolar to the tuberosity. The swelling was irregular in outline, firm and fleshy in consistency. There was buccal and palatal expansion of the ridge. Radiographs showed an osteolytic lesion.



Case History : The patient was a 27 year old Chinese male who had a swelling of the left maxilla in the region of the upper first

and second molars 3 months ago. The associated teeth were very loose. He thought to have a gum boil and the teeth were extracted. The swelling, however, continued to grow in size. He complained of epitaxis from the left nostril and difficulty in breathing. There was anaesthesia in the left infraorbital region. A diffuse swelling was seen in the left maxilla extending from the first premolar to the tuberosity. The swelling was irregular in outline, firm and fleshy in consistency. There was buccal and palatal expansion of the ridge. Radiographs showed an osteolytic lesion. Differential Diagnosis :

Histopathology Findings : The surface epithelium is atrophic but intact. The subjacent stroma has been

completely replaced by a mesenchymal tumour composed of large anaplastic spindle and polyhedral cells. The tumour cells are markedly pleomorphic with deeply stained nuclei and prominent nucleoli. Many of these haphazardly arranged tumour cells assume huge proportions and present as multi-nucleated tumour giant cells. Atypical mitoses are present and multiple foci of irregular tumour bone and osteoid are readily demonstrable throughout the lesion.

Definitive Diagnosis : OSTEOSARCOMA


Case History : A 41 year old Indian shop-keeper complained of pain and swelling in the

left jaw following extraction of the lower left first molar 20 days ago. A well-defined, 4 x 3 cm, firm swelling was present over the left mandible. Intra-orally there was a purplish red, firm, fungating mass at the alveolar ridge. The mass extended from #33 to #37 region and has involved the buccal and lingual aspects of the ridge. Radiograph showed diffused irregular destruction of the alveolar bone.



Case History : A 41 year old Indian shop-keeper complained of pain and swelling in the left jaw following extraction of the

lower left first molar 20 days ago. A well-defined, 4 x 3 cm, firm swelling was present over the left mandible. Intra-orally there was a purplish red, firm, fungating mass at the alveolar ridge. The mass extended from #33 to #37 region and has involved the buccal and lingual aspects of the ridge. Radiograph showed diffused irregular destruction of the alveolar bone. Differential Diagnosis :

Histopathology Findings : The overlying surface stratified squamous epithelium is normal. The stroma has been

completely infiltrated by sheets of poorly differentiated lymphocytes with round hyperchromatic nuclei and little cytoplasm. Their nuclei show considerable variation in size and shape. Mitotic figures are plentiful

Definitive Diagnosis : LYMPHOSARCOMA


Case History :The gingivae of this 9 year old Chinese school-boy showed generalized enlargement which were spongy in texture. All his teeth were very mobile. There was also swelling of his left upper eye-lid for the past two weeks. X-rays showed marked alveolar bone resorption of the upper and lower jaws.



Case History :The gingivae of this 9 year old Chinese school-boy showed generalized enlargement which were spongy in texture. All his teeth were very mobile. There was also swelling of his left upper eye-lid for the past two weeks. X-rays showed marked alveolar bone resorption of the upper and lower jaws.


Histopathology Findings : The gingival biopsy shows a neoplasm composed of sheets of immature

lymphocytes with little intervening stroma. The tumour cells show little variation in size and shape. Each tumour cell has a large round nuclei with coarsely reticulated chromatin, prominent nucleoli and nuclear membrane and a narrow rim of cytoplasm. Mitotic activity is high. Macrophages with abundant clear cytoplasm containing tumour cells or cell debris are found scattered uniformly throughout the tumour, producing the characteristic “starry-sky‟ pattern.

Definitive Diagnosis : BURKITT ‘S LYMPHOMA


Case History :This 17 year old Chinese male was referred to our clinic because of a swelling at the gingivae of the 654/ region which was previously diagnosed as an abscess. The swelling had been present for 5 days. It was firm, about 2cm in diameter and involved both the buccal and palatal mucosae. The surface was ulcerated and covered by slough. He had frequent bouts of fever for 3 months and malaise for 1 month. X-rays showed no abnormality. Peripheral blood count showed WBC 8,800, blast cells 50%. Marrow biopsy confirmed acute promyelocytic leukemia. He was treated with 6-mercaptopurine and cystosine arabinoside. The present specimen is a biopsy from the gingiva.


Acute promyelocytic leukemia is a subtype of acute myelogenous leukemia (AML), a cancer of the blood and bone marrow. It is also known as acute progranulocytic leukemia; APL; AML with t(15;17)(q24;q21), PML-RARA and variants; FAB subtype M3[1] and M3 variant.In APL, there is an abnormal accumulation of immature granulocytes called promyelocytes

http://en.wikipedia.org/wiki/Acute_myelogenous_leukemia

http://en.wikipedia.org/wiki/Cancer

http://en.wikipedia.org/wiki/Blood

http://en.wikipedia.org/wiki/Bone_marrow

http://en.wikipedia.org/wiki/Granulocytes

http://en.wikipedia.org/wiki/Promyelocyte


Case History :This 17 year old Chinese male was referred to our clinic because of a swelling at the gingivae of the 654/ region which was previously diagnosed as an abscess. The swelling had been present for 5 days. It was firm, about 2cm in diameter and involved both the buccal and palatal mucosae. The surface was ulcerated and covered by slough. He had frequent bouts of fever for 3 months and malaise for 1 month. X-rays showed no abnormality. Peripheral blood count showed WBC 8,800, blast cells 50%. Marrow biopsy confirmed acute promyelocytic leukemia. He was treated with 6-mercaptopurine and cystosine arabinoside. The present specimen is a biopsy from the gingiva.


Histopathology Findings : The surface epithelium is ulcerated beneath which the stroma shows dense infiltrates of markedly pleomorphic, poorly differentiated leukocytes of the myelogenous series. Mitotic figures are present.

Definitive Diagnosis : LEUKEMIA


Case History : A Chinese seaman, aged 46 years, developed a soft rubbery swelling involving the left palate and alveolar process. It was first noticed 6 months previously. A tooth had recently exfoliated from the involved area. The patient was otherwise in good health. Radiographs showed a well-defined area of bone destruction in the maxilla. The root of #24 was resorbed. Skeletal survey showed no involvement of other bones. Urine test for Bence-Jones proteins was negative.



Case History : A Chinese seaman, aged 46 years, developed a soft rubbery swelling involving the left palate and alveolar process. It was first noticed 6 months previously. A tooth had recently exfoliated from the involved area. The patient was otherwise in good health. Radiographs showed a well-defined area of bone destruction in the maxilla. The root of #24 was resorbed. Skeletal survey showed no involvement of other bones. Urine test for Bence-Jones proteins was negative.


Histopathology Findings : The lesion is composed almost exclusively of neoplastic plasma cells with

little intervening stroma. The cells are avoid or polygonal in outline with eccentric nuclei showing the typical clock-face chromatin pattern and abundant eosinophilic cytoplasm. There is some variation in nuclear size and cells with two nuclei are also seen.

Definitive Diagnosis : SOLITARY MYELOMA

Slide No. Case History :



Definitive Diagnosis :

ORAL HISTOPATHOLOGY SESSION Epithelial & connective tissue tumours Yeo Jin Fei PBM BDS, MSc, MDS,...

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Transcript of ORAL HISTOPATHOLOGY SESSION Epithelial & connective tissue tumours Yeo Jin Fei PBM BDS, MSc, MDS,...