This document provides an overview of common lesions of the oral cavity and salivary glands, including inflammatory, preneoplastic, and neoplastic conditions. Key topics discussed include oral leukoplakia, squamous cell carcinoma, ameloblastoma, pleomorphic adenoma, Warthin's tumor, mucoepidermoid carcinoma, and adenoid cystic carcinoma. The document describes the etiology, pathogenesis, morphology, and clinical manifestations of these various oral and salivary gland lesions.

1. Dr Neha Mahajan
MBBS,MD Pathology
PDCC Hematopathology
Associate Professor
Lesions of Oral cavity and
salivary glands

2. Understand the common disorders of the
upper airway and upper digestive tract (i.e.,
head and neck) in the usual context of:
DEGENERATIVE,
INFLAMMATORY,
and
NEOPLASTIC
…deviations of normal anatomy and histology

3. Today`s lecture
 Lesions of Oral Cavity
Inflammatory
Neoplastic
 Lesions of Odontogenic origin
Ameloblastoma
 Salivary gland neoplasm.
Benign
Malignant

4. ETIOLOGY
PATHOGENESIS
MORPHOLOGY
CLINICAL MANIFESTATIONS

5. ORAL CAVITY

6. ORAL CAVITY
 DEVELOPMENTAL ANOMALIES- Facial clefts,fordyce`s
granules,leukodema.Tongue defects-
macroglossia,microglossia,fissued tongue,bifid tongue
 MUCOCUTANEOUS LESIONS-Lichen planus and vesicular lesions-
Pemphigus vulgaris,pemphigoid,Erythema multiforme,Stevesn
johnson syndrome
 INFLAMMATORY/”REACTIVE” LESIONS- Apthous ulcers,herpetic &
necrotising stomatitis
 INFECTIONS: HSV, VIRAL, FUNGI
 LEUKOPLAKIA/”HAIRY” LEUKOPLAKIA
 SQUAMOUS TUMORS: BEN/MALIG
 ODONTOGENIC CYSTS/TUMORS

7. Tumour & tumour like lesions of oral
soft tissue
TUMOUR LIKE LESIONS
Fibrous growths( Fibroepthelial polyps,fibrous epulis,denture
hyperplasia)
Pyogenic granuloma,Mucocoele,Ranula,Dermoid cyst.
BENIGN TUMOURS
Squamous papilloma
Hameangioma,Lymphangioma,Fibroma,Fibromatosis gingivae
Tumour of minor salivary glands,Granular cell myoblastoma
PREMALIGNANT TUMOURS
Hyperkeratotic leucoplakia
Dysplastic leucoplakia.
MALIGNANT TUMOURS
Squamous cell carcinoma and others

8. PYOGENIC
GRANULOMA

9. “Irritation” Fibroma

10. “Canker” sore = Aphthous ulcer

12. MUCOCELE

17. TZANCK SMEAR

18. Arnault Tzanck, Russian dermatologist, 1886-1954

22. ORAL LEUCOPLAKIA
 Def: Leukoplakia(white plaque) may be clinically
defined as a white plaque or patch on oral mucosa
not exceeding 5 mm in diameter, which cannot be
rubbed off nor can be classified into any diagnosable
disease.
CAUSES OF WHITE LESIONS :
Benign: Fordyce`s granules,Hairy
tongue,Leukoedema,Lupus erythematosus,white
sponge nevus.
Premalignant:Leukoplakia,Oral lichen planus
Malignant: Squamous cell carcinoma

23.  INCIDENCE:
Males>Females
Lesions-variable size & appearances
Site: Cheek mucosa,angles of mouth,alveolar
mucosa,angles of mouth, alveolar mucosa,
tongue, lip, hard & soft palate
4 to 6% cases progress to carcinoma
Speckled and nodular forms-malignant
transformation.
ALL WHITE PATCHES BE
BIOPSIED

25. ETIOLOGY:
 Strong association with
tobacco(smoking,paan,zarda,gutkha)
 Smokers keratosis/Stomatitis nicotina.
 Other factors- chonic friction and local irritation
 HAIRY LEUCOPLAKIA- seen in patients of AIDS.
MORPHOLOGY:
Lesions- white,whitish yellow,red velvety >5mm
Circumscribed,slightly elevated,smooth or
wrinkled,speckled,nodular.
MICROSCOPY:
1.Hyperkeratotic
2.Dysplastic

26. “Hairy” leukoplakia

27. Malignant tumors-Squamous cell
carcinoma
 Incidence:
SCC comprises of 90% of oral tumors
Age: 40 to 45 years ,Male preponderance.
Site: Lips,tongue,anterior floor of mouth,buccal
mucosa,palate.
 Etiology:
Tobacco, chronic alcohol, HPV 16,18 and 33 types.
Chronic irritation,submucous fibrosis,Poor orodental
hygiene,nutritiona deficiencies,Exposure to
sunlight,radiation.

28. Oral Cancer-Progression
Reference: Kumar: Robbins and Cotran: Pathologic Basis of Disease, 7th ed.,
Copyright © 2005 Saunders, An Imprint of Elsevier

29.  Morphology:
Gross:
Ulcerative-indurated ulcer & firm everted/rolled edges
Papillary-soft,wart like growth
Nodular –Firm slow growing submucosal nodule.
Scrhirrhous-infiltration into deeper structure
Histologically:
Squamous cell carcinoma
Spread to regional lymph nodes.

32. WELL
MODERATE
POOR

33. ODONTOGENIC
CYSTS/TUMORS
 INFLAMMATORY CYSTS (e.g., “Radicular”[peri-apical]
most common inflammatory cyst)
 DEVELOPMENTAL CYSTS (DENTIGEROUS most
common developmental cyst and surgical specimen)
 MALIGNANT TUMORS of ODONTOGENIC ORIGIN
(AMELOBLASTOMAS) (rare)

34. Ameloblastoma
 Most common benign but locally invasive
epithelial odontogenic tumor.
 3rd to 5th decade.
 Sites:Mandible in molar ramus area and maxilla
 Tumor originates from dental epithelium of
enamel or epthelium residues,epithelium lining of
dentigerous cysts.
 X ray- multilocular destruction of bone

35. they ma yarise from
rests of dental lamina
a developing enamel organ
the epithelial lining of an odontogenic cyst
the basal cells of the oral mucosa
the epithelial cell rests of Malessez

36. Three different clinicoradiographic situations
1)Conventional solid or multicystic (86%)
2)Unicystic (13%)
3)Peripheral (Extraosseous) (1%)
differing therapeutic considerations and prognosis.

38. Radiographic feature
Multilocular radiolucent lesion, soap bubble / honey
combed
Buccal & lingual cortical expansion
resorption of the roots of teeth
"soap bubble" appearance.
In many cases an unerupted teeth specially 3rd molar is associated with defect
"honeycombed" appearance.

39. Histopathologic Features
I. Follicular
II. plexiform
III. Acanthomatuos
IV. granular cell
V. desmoplastic
VI. basal cell
The follicular and plexiform patterns are the most common
No correlation
between clinical
behavior and these
microscopic
patterns

40. Follicular pattern

42. Plexiform pattern Acanthomatous pattern

43. SALIVARY GLAND

44. SALIVARY GLANDS
 DEGENERATION: Xerostomia
 INFLAMMATION:
Sialadenitis(Viral,bacterial and
autoimmune)
 NEOPLASMS: Benign and maligant

45. P
A
R
O
T
I
D

47. Benign Malignant
Pleomorphic adenoma (50%)
(mixed tumor)
Mucoepidermoid carcinoma
(15%)
Warthin tumor (5% to 10%) Adenocarcinoma (NOS)
(10%)
Oncocytoma (1%) Acinic cell carcinoma (5%)
Other adenomas (5% to 10%) Adenoid cystic carcinoma
(5%)
Basal cell adenoma Malignant mixed tumor (3% to
5%)
Canalicular adenoma Squamous cell carcinoma
(1%)
Ductal papillomas Other carcinomas (2%)
Histologic Classification and Incidence of Benign and Malignant Tumors of
the Salivary Glands

48. PLEOMORPHIC ADENOMA
 Most common tumor of major (60 to 75%) and
minor (50%) salivary glands.
 Benign tumors that consist of mixture of
ductal(epithelial) &mesenchymal differentiation
 Histological diversity-Mixed tumors.
 Common in women,3rd to 5th decade.
 Painless,slow growing,mobile discrete masses.
 Recurrence.
 Carcinoma ex pleomorphic adenoma.

51. WARTHIN`S TUMOR
PAPILLARY CYSTADENOMA
LYMPHOMATOSUM.
 Benign neoplasm,second most common salivary
gland neoplasm.
 RESTRICTED TO PAROTID.
 Males> Females, 5th to 7th decade
 10% cases are bilateral &multifocal.
 GROSS: Round to oval encapsulated masses,2 to
5cm in diameter.Cut section pale gray with cytic &
cleft like spaces filled with seromucionous secretions
 MICROSCOPY:These spaces are lined by double
layer of neoplastic cells resting on dense lymphoid
stroma with germinal centres.Inner columnar
epithelium with eosinophilic granular cytoplasm over

54. MUCOEPIDERMOID CARCINOMA
 Most common malignant salivary gland
tumor(major & minor glands)
 30 to 60 years
 Most common example of radiation induced
malignant tumor.
 GROSS: Circumscribed, unencapsulated,1 to 4
cm.
 MICROSCOPY: Low,Intermediate & high grade
depending upon degree of differentiation & tumor
invasiveness.
4 types of cells: Mucin
producing,squamous,Intermediate & clear cells.

55.  Prognosis: Low-grade tumors- invade locally and
recur in about 15% of cases, but only rarely do
they metastasize and so yield a 5-year survival
rate of more than 90%.
 High-grade neoplasms and, to a lesser extent,
intermediate-grade tumors are invasive and
difficult to excise and so recur in about 25% to
30% of cases and, in 30% of cases, metastasize
to distant sites.
 The 5-year survival rate in patients with these
tumors is only 50%.

57. ADENOID CYSTIC
CARCINOMA
 Adenoid cystic carcinoma is a relatively
uncommon tumor.
 50% of cases is found in the minor salivary
glands (in particular the palate). Parotid and
submandibular glands,nose, sinuses, and upper
airways and elsewhere.
 Morphology: Small, poorly encapsulated,
infiltrative, gray-pink lesions.
 Microscopy: Small cells with dark, compact
nuclei and scant cytoplasm. Patterns- tubular,
solid, or cribriform patterns .The spaces between
the tumor cells are often filled with a hyaline
material thought to represent excess basement
membrane.

59.  Adenoid cystic carcinomas are relentless and
unpredictable tumors with a tendency to invade
perineural spaces and they are stubbornly
recurrent.
 50% or more disseminate widely to distant sites
such as bone, liver, and brain, sometimes
decades after attempted removal.
 Thus, although the 5-year survival rate is about
60% to 70%, it drops to about 30% at 10 years
and 15% at 15 years.
 Neoplasms arising in the minor
salivary glands have, on average,
a poorer prognosis than those
primary in the parotids.

60. What have we studied???
 Lesions of Oral Cavity
Inflammatory (Pyogenic granuloma,Fibroma,Canker
sore,Mucocele,Glossitis
Preneoplastic(Leukoplakia)
Neoplastic(Squamous cell carcinoma)
 Lesions of Odontogenic origin
Ameloblastoma
 Salivary gland neoplasm.
Benign(Pleomorphic adenoma,Warthins tumor)
Malignant(Mucoepidermoid,Adenoid cystic
carcinoma,Acinic cell carcinoma)

61. THANK YOU
for your
attention!!!