Benign Epithelial Pathology PDF

BENIGN EPITHELIAL PATHOLOGY o Angela C. Chi, DMD Professor [email protected] taking photos or video recording during this live class session is not permitted  Learnin...

BENIGN EPITHELIAL PATHOLOGY o Angela C. Chi, DMD Professor [email protected] taking photos or video recording during this live class session is not permitted  Learning Objectives Discuss the etiopathogenesis, clinicopathologic features, differential diagnosis, prevention, treatment, and prognosis of benign epithelial lesions involving the oral, head and neck region, including those in the following categories: – HPV-related – Papillary – Cutaneous – Pigmented  HUMAN PAPILLOMAVIRUS (HPV)-RELATED EPITHELIAL LESIONS low risk malignant HIGH RISK tyres 6,11 6,18  HPV Infection site HPV types Skin 1, 2, 3, 4, and others Mucosal Low risk (6, 11, 42, 43, cancer 44, and others https://commons.w ikimedia.org/w iki/F ile:5keq.png, Opabinia regalis, CC High risk (16, 18, 31, 33, BY-SA 4.0 cancer , via Wikimedia Commons 35, 39, 45, 51, 52, 56, 58, 59, 68, and others) enters through micro tears to attack basallayer Spurgeon, M.E.; Lambert, P.F. Human Papillomavirus and the Stroma: Bidirectional Crosstalk during the Virus Life Cycle and Carcinogenesis. Viruses 2017, 9, 219. https://doi.org/10.3390/v9080219, https://creativecommons.org/licenses/by/4.0/  malignant cancer Raybould R, Fiander A, Hibbitts S. Human papillomaivus integration and it srole in cervical malignant progressions. Open Clinical Cancer Journal. 5:1-7, 2011. https://benthamopen.com/FULLTEXT/TOCCJ-5-1; reative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/  HPV-RELATED EPITHELIAL LESIONS Oral/Head & Neck mucosa HPV types Skin HPV types Oral squamous papilloma 6,11 Verruca vulgaris 2 Recurrent respiratory 6,11 Verruca plana 3, 10 papillomatosis Sinonasal papillomas 6,11 Palmoplantar wart 1, 4 Multifocal epithelial 13, 32 Butcher’s wart 2,7 hyperplasiatypically 109199,1 Oropharyngeal SCCsquamouscell 16 ANOGENITAL HPV types Conjunctival squamous 6, 11, 16 Condyloma 6, 11 (HR also papilloma acuminatum possible) Lonighrisk know lesion Intraepithelial 6,11, 16, 18, 31, 33 type neoplasia Cervical SCC 16, 18  like Finger papillyditation SQUAMOUS PAPILLOMA esp. HPV 6 and 11 softpalate tongue lipsex  Squamous Papilloma Esp. soft palate, tongue, lips, etc. Rakhewar P S, Patil HP, Thorat M. Diode laser treatment of an oral squamous papilloma of soft Misir AF, Demiriz L, Barut F. Laser treatment of an oral squamous papilloma in a palate. J Dent Lasers [serial online] 2015 [cited 2021 Aug 30];9:114-7. Available pediatric patient: A case report. J Indian Soc Pedod Prev Dent [serial online] 2013 from: https://www.jdentlasers.org/text.asp?2015/9/2/114/170564. Creative Commons Attribution- [cited 2021 Aug 30];31:279-81. Available NonCommercial-ShareAlike License (CC BY-NC-SA) from: https://www.jisppd.com/text.asp?2013/31/4/279/121833, Creative Commons Attribution-NonCommercial-ShareAlike License (CC BY-NC-SA finger Kapitan Squamous Papilloma https://www.intechopen.com/chapters/46324, Helena Lucia Barroso dos Reis, Silvia Paula de Oliveira, et al. (April 23rd 2014). Oral HPV Related Diseases: A Review and an Update, Trends in Infectious Diseases, Shailendra K. Saxena, IntechOpen, DOI: 10.5772/57574. Available from: https://www.intechopen.com/chapters/46324, Creative Commons Attribution 3.0 Unported License (CC BY 3.0) Harold M Reed, Joan C Delto, Harry Sendzischew, Pukhraz Basra and Lydia H Howard, CC BY 4.0 , via Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Gross_pathology_of_a_large_squamous_cell_p apilloma.jpg Tx: Conservative excision Px: Recurrence unlikely Nephron, CC BY-SA 3.0 , via Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Squamous_papilloma_--_very_low_mag.jpg  2 Kids out coil Verruca scantoral VERRUCA VULGARIS esp. HPV 2 Benign Skin more than or a bcs of kids sucking Finger can be oral  Verruca Vulgaris skin>oral mucosa, esp. children, autoinnoculation Klaus D. Peter, Wiehl, Germany, CC BY 3.0 DE , via Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Verruca.jpg Verruca Vulgaris https://www.intechopen.com/chapters/46 324, Helena Lucia Barroso dos Reis, Silvia Paula de Oliveira, et al. (April 23rd 2014). Oral HPV Related Diseases: A Review and an Update, Trends in Infectious Diseases, Shailendra K. Saxena, IntechOpen, DOI: 10.5772/57574. Available from: https://www.intechopen.com/chapters/46 324, Creative Commons Attribution 3.0 Unported License (CC BY 3.0) Ed Uthman from Houston, TX, USA, CC BY 2.0 , via Koilocytes Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Verruca_Vulgaris_(5242100122).jpg Nephron, CC BY-SA 3.0 , via Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Verruca_vulgaris_- _high_mag.jpg  Verruca Vulgaris Tx: – Skin: topicals (salicylic acid/lactic acid), cryotherapy – Oral: excision Px: – Recurrence infrequent – 2/3 resolve spontaneously (oral) Jmarchn, CC BY-SA 3.0 , via Wikimedia Commons; https://creativecommons.org/licenses/by-sa/3.0/; https://commons.wikimedia.org/wiki/File:Penile_warts.jpg Rimkevič ius, A. et al. “Condyloma acuminatum: some aspects.” Acta Medica Lituanica 18 (2011): n. pag. Creative Commons Attribution 4.0 International License.  Condyloma Acuminatum HPV vaccination Tx: – Oral: excision – Anogenital: topicals (imiquimod, podophyllotoxin)  dad 32 Hecks he 13 DRY HLA homeless MULTIFOCAL EPITHELIAL HYPERPLASIA “Heck’s disease” esp. HPV 13 and 32 Risk factors: poor hygiene, low socioeconomic status, malnutrition, HIV, HLA-DR4(DRB1*0404)  Multifocal Epithelial Hyperplasia esp. young pts https://www.intechopen.com/chapters/46324, Helena Lucia Barroso dos Reis, Silvia Paula de Oliveira, et al. (April 23rd 2014). Oral HPV Related Diseases: A Review and an Update, Trends in Infectious Diseases, Shailendra K. Saxena, IntechOpen, DOI: 10.5772/57574. Available from: https://www.intechopen.com/chapters/46324, Creative Commons Attribution 3.0 Unported License (CC BY 3.0) PAPULONODULAR VARIANT Multifocal Epithelial Hyperplasia PAPILLOMATOUS VARIANT  Multifocal Epithelial Hyperplasia Tx: – Observe (spontaneous resolution months-years) – Excision (or cryotx, laser, electrosurgery) Xtremecold tempstoremove lesions  HPV-associated lesions in HIV pt. Vale, Daniela Assis do et al. Unusual presentation of a disseminated oral HPV infection after combined antiretroviral therapy initiation. Revista do Instituto de Medicina Tropical de São Paulo [online]. 2019, v. 61 [Accessed 30 August 2021] , e54. Available from:. Epub 10 Oct 2019. ISSN 1678-9946. https://doi.org/10.1590/S1678-9946201961054.Creative Commons Attribution Non-Commerical License  HPV-associated lesions in HIV pts. greater oflesio moreseverelesio Flarecanbecaused bypt startingantivir Hivmeds Vale, Daniela Assis do et al. Unusual presentation of a disseminated oral HPV infection after combined antiretroviral therapy initiation. Revista do Instituto de Medicina Tropical de São Paulo [online]. 2019, v. 61 [Accessed 30 August 2021] , e54. Available from:. Epub 10 Oct 2019. ISSN 1678-9946. https://doi.org/10.1590/S1678-9946201961054.Creative Commons Attribution Non-Commerical License  SINONASAL PAPILLOMAS  Sinonasal Papillomas Oliver, J.D et al. Novel synchronous nasal involvement of inverted papilloma and recurrent respiratory papillomatosis with confirmed human papillomavirus isolated from nasal septum and Unilateral obstruction, middle turbinate: a case report. J Med Case Reports 13, 215 (2019). https://doi.org/10.1186/s13256- 019-2153-1; https://creativecommons.org/licenses/by/4.0/legalcode epistaxis nosebleed Etiology: uncertain (HPV, allergies, chronic sinusitis, pollutants, etc.)  Sinonasal Papillomas 3 major types: exophytic, inverted, oncocytic Inverted type: 0 – Aggressive sarge too – Malignant transformation (5- 15%) https://radiopaedia.org/articles/convoluted-cerebriform-pattern?lang=us; (http://creativecommons.org/licenses/by-nc-sa/3.0/ VERRUCIFORM XANTHOMA can be right next to a different lesion Etiology unknown (reaction to epithelial trauma/damage?)  Verruciform Xanthoma Hiraishi Y et al. A cases of verruciform xanthoma arising in the tongue. JCDR 10(12), 2016. DOI : 10.7860/JCDR/2016/22157.8965 Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND  Verruciform Xanthoma Joshi R, Ovhal A. Verruciform xanthoma: Report of five cases. Indian J Dermatol [serial online] 2012 [cited 2021 Aug 30];57:479-82. Available from: https://w ww.e- ijd.org/text.asp?2012/57/6/479/103069, Creative Commons Attribution-NonCommercial- ShareAlike License (CC BY-NC-SA)  Verruciform Xanthoma Joshi R, Ovhal A. Verruciform xanthoma: Report of five cases. Indian J Dermatol [serial online] 2012 [cited 2021 Aug 30];57:479-82. Available from: https://www.e-ijd.org/text.asp?2012/57/6/479/103069, Creative Commons Attribution-NonCommercial-ShareAlike License (CC BY-NC-SA)  Verruciform Xanthoma TX: conservative excision associated NOI W HPV PX: recurrence rare, benign (but may occur in assoc. w/other lesion types)  espyoung MOLLUSCUM CONTAGIOSUM smallcentraldimple canpopcurdlike MCV (DNA poxvirus) substancefrom sexual or nonsexual contact viral infection  Molluscum Contagiosum Esp young pts.; neck/face/other sites https://www.cdc.gov/poxvirus/molluscum-contagiosum/long-term- effects.html https://dermnetnz.org/topics/molluscum-contagiosum/; Creative Commons Attribution- NonCommercial-NoDerivs 3.0 (New Zealand) at https://creativecommons.org/licenses/by-nc- nd/3.0/nz/legalcode Molluscum Contagiosum https://dermnetnz.or g/topics/molluscum- contagiosum/; Creative Commons Attribution- NonCommercial- NoDerivs 3.0 (New Zealand) at https://cr eativecommons.org/l icenses/by-nc- nd/3.0/nz/legalcode,  Molluscum Contagiosum Immunocompromised: severe/larger lesions Al-Herz W and Essa S (2019) Spectrum of Viral Infections Among Primary Immunodeficient Children: Report From a National Registry. Front. Immunol. 10:1231. doi: 10.3389/fimmu.2019.01231, https://creativecommons.org/licenses/by/4.0/  Molluscum Contagiosum Tx: Mostgounderspontaneous remission – Monitor (spontaneous remission in most cases) – Curettage, cryotherapy – Immunosuppressed: interferon-alpha, cidofivir; ART (if HIV+) Fantiretroviraltherapy  especially old Pt SEBORRHEIC KERATOSIS Wr Common skin lesion Benign chronic sun exposure, hereditary factors, somatic mutations (FGFR3 & PIK3CA)  Seborrheic Keratosis Esp. older pts; “stuck on” May be removed for aesthetic reasons (cryotherapy, excision, curettage) https://dermnetnz.org/topics/seborrhoeic-keratosis-images/ Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand) at https://creativecommons.org/licenses/by-nc-nd/3.0/nz/legalcode  Seborrheic Keratosis https://dermnetnz.org/topics /dermatosis-papulosa-nigra https://creativecommons.or g/licenses/by-nc-nd/3.0/nz/ DERMATOSIS PAPULOSA NIGRA  Seborrheic Keratosis A LESER-TRÉLAT SIGN: – multiple SKs & pruritus – internal James Heilman, MD, CC BY-SA 3.0 , via Wikimedia Commons, malignancy https://commons.w ikimedia.org/w iki/File:Sebo rrheic_keratosis_on_human_bac k.jpg canbeindicativeof underlying gi commonly Malignancy  the face esp towaxyoilysubstance SEBACEOUS HYPERPLASIA pearly opalescentpresentation can have central depression Etiology: unkown in lesion Associations: cyclosporine/transplant pts, ART/HIV, Muir Torre syndrome (visceral malignancies/sebaceous neoplasms/KAs)  SEBACEOUS HYPERPLASIA esp. facial skin Mimics BCC Clinical Clinically mimics basal cell carcinoma https://dermnetnz.org/topics/sebaceous-hyperplasia-images/, Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand) at https://creativecommons.org/licenses/by-nc-nd/3.0/nz/legalcode Toshitsugu Sato, Masaru Tanaka, CC BY 4.0 , via Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Histopathology_of_sebaceous_hyperplasia.jpg  EPHELIS (FRECKLE) common small pigmented macule of skin darkerappearance  EPHELIS appear 1st decade light brown macules Tx: none necessary – removal for cosmetic reasons – sunscreen Michelle, CC BY 2.0 , via Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Pick_a_love!.jpg  ACTINIC LENTIGO (solar lentigo, senile lentigo, liver spot) benign brown macule of sun-damaged skin >90% of whites > 70 years old  ACTINIC LENTIGO Tx: ablative therapy for aesthetic reasons https://dermnetnz.org/topics/solar-lentigo/; Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand) at https://creativecommons.org/licenses/by-nc-nd/3.0/nz/legalcode  LENTIGO SIMPLEX melanocytic hyperplasia of skin not exposed to sunlight  LENTIGO SIMPLEX Tan to dark brown macule Esp. children Tx: not required, removal for cosmesis https://dermnetnz.org/topics/lentigo-simplex/, Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand) at https://creativecommons.org/licenses/by-nc-nd/3.0/nz/legalcode  MELASMA Esp. adult F Pregnancy, oral contraceptives, HRT, etc. TX: sun avoidance, TriLuma cream (hydroquinone, tretinoin, fluocinolone acetonide) https://dermnetnz.org/topics/melasma-images/; Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand) at https://creativecommons.org/licenses/by-nc-nd/3.0/nz/legalcode ORAL MELANOTIC MACULE containsmelanin (focal melanosis)  ORAL MELANOTIC MACULE https://dermnetnz.org/topics/labial- melanotic-macule/; Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Esp lower lip (New Zealand) at https://creativecommons.org/lic enses/by-nc-nd/3.0/nz/legalcode vermilion macule presentation Biopsy: recent onset, large size, irregular pigmentation, unknown duration, maxillary mucosa Fig 10.39 Neville BW et al. Oral and Maxillofacial Pathology. Available from: VitalSource Bookshelf, (4th Edition). Elsevier Health Sciences (US),  ORAL MELANOTIC MACULE Increased melanin deposition in basal cell layer https://dermnetnz.org/topics/labial-melanotic-macule/; Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand) at https://creativecommons.org/licenses/by-nc-nd/3.0/nz/legalcode  melanin ORAL of MELANOACANTHOMA thickening spinosum Bo layer of (melanoacanthosis) epithelium  Oral Melanoacanthoma Esp. blacks & buccal mucosa africanAmericans F>M Rapid increase in size Spontaneous resolution after incisional biopsy Lakshminarayanan V, Ranganathan K. Oral melanoacanthoma: a case report and review of the literature. J Med Case Rep. 2009;3:11. Published 2009 Jan 13. doi:10.1186/1752-1947- 3-11 , Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),  Oral Melanoacanthosis Peters SM, Mandel L, Perrino MA. Oral melanoacanthoma of the palate: An unusual presentation of an uncommon entity. JAAD Case Rep. 2018 Jan 16;4(2):138-139. doi: 10.1016/j.jdcr.2017.11.02 PMID: 29387765; PMCID: PMC5789764. Creative Commons CC-BY-NC-ND acanthosis w/ dendritic melanocytes in spinous cell layer MELANOCYTIC NEVI occurlater Acquired Ire Congenital Other variants: Blue, Spitz, halo cavity present in oral ACQUIRED MELANOCYTIC NEVUS “Mole” Common on skin (avg 10-40/white adult) Oral lesions uncommon Localized proliferation of nevus cells (neural crest origin/migrate to epidermis during development)  ACQUIRED MELANOCYTIC NEVUS DEVELOPMENTAL STAGES: JUNCTIONAL COMPOUND (“flat” mole) (center raised) INTRADERMAL (raised/less pigmented) ACQUIRED MELANOCYTIC NEVUS Bashamalla R, Rao GV, Ramulu S, Sravya T. Pigmented intramucosal nevus of Nagarajan J, Raghuram S, Bandalore SR, Patil S. Intramucosal nevus as a lesion on gingiva with a special insight on its pathophysiology: Report of a rare entity. J the lip: A case report. J Indian Acad Oral Med Radiol [serial online] 2016 [cited 2021 NTR Univ Health Sci [serial online] 2017 [cited 2021 Aug 30];6:181-4. Available Aug 30];28:48-51. Available from: https://www.jdrntruhs.org/text.asp?2017/6/3/181/215529, Creative from: https://www.jiaomr.in/text.asp?2016/28/1/48/189983 Creative Commons Commons Attribution-NonCommercial-ShareAlike License (CC BY-NC-SA Attribution-NonCommercial-ShareAlike License (CC BY-NC-SA)  BLUE NEVUS Skin or oral (esp. palate) Tyndall effect makesit lookblue benign excision conservative Liviu Feller, Razia A.G. Khammissa and Johan Lemmer (March 1st 2017). Oral Mucosal Melanosis, Melanin, Miroslav Blumenberg, IntechOpen, DOI: 10.5772/65567. Available from: https://www.intechopen.com/chapters/53118; Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)  BLUE NEVUS LWozniak&KWZielinski, CC BY-SA 3.0 , via Wikimedia Commons https://commons.wikimedia.org/wiki/File:SkinTumors-408.jpg  References Oral and Maxillofacial Pathology (5th Edition) by Neville BW, Damm D, Allen CM, Chi AC. Available from VitalSource Bookshelf, Elsevier Health Sciences (US, 2023), pages 354-380.