Oral Pathology Piks

Oral & dental consideration in leukemia 1. Dentist may be the first clinician to suspect the disease 2. Oral complications are common throughout the disease 3. The dental management is complex & the mouth is potential source of morbidity and mortality 4. Head & neck signs results from leukemic infiltrates or marrow failure. These include cervical lymphadenopathy, oral bleeding, gingival infiltrates, oral infection & oral ulcers

Prominent reversal & resting lines

Hyperparathyroidism Histologic Features:  increased osteoclastic activity  thinning of the trabecular bone  wide zones of osteoid rimmed with activated osteoblasts  multinucleated giant cells  fibrous connective tissue stroma

SUNRAY APPEARANCE • SMALL STREAKS OF BONE RADIATING OUTWARD

CODMAN’S TRIANGLE • IN LONG BONES, PERIOSTEUM IS ELEVATED OVER THE EXPANDING TUMOR MASS IN A TENT LIKE FASHION. AT THE POINT ON THE BONE WHERE THE PRIOSTEUM BEGINS TO MERGE, AN ACUTE ANGLE IS FORMED KNOWN AS CODMAN’S TRIANGLE

Macroscopic appearance

• Chondrosarcoma arising from the vertebral column. It appears as a large lobulated destructive mass with a characteristic translucent whitish appearance due to the chondroid stroma

ODONTOGENIC KERATOCYST CONNECTIVE TISSUE COLUMNAR CELLS WITH REVERSE POLARISATION SATELLITE CYSTS EPITHELIAL RESTS

CORRUGATION OF SURFACE EPITHELIUM SEPERATION OF EPITHELUM FROM CONNECTIVE TISSUE

Odontogenic keratocyst. The epithelial lining is 6 to 8 cells thick (arrow), with a hyperchromatic and palisaded basal cell layer. Note the corrugated parakeratotic surface.

• Odontogenic keratocyst. The characteristic microscopic features have been lost in the central area of this portion of the cystic lining because of the heavy chronic inflammatory cell infiltrate. ( arrow)

Odontogenic Keratocyst (‘primordial cyst’, ‘benign cystic tumor’) Screening for Gorlin-Goltz syndrome: multiple jaw cyst, bifid rib, multiple naevi and basal cell carcinomas of the skin

Management & Prognosis: vigorous enucleation followed by prolonged follow-up as recurrence rate is high compared to other jaw cysts.

Histological Features

Dentigerous cyst: formation of Dentigerous cyst: low power view the lining by splitting of the shows attachment of the cyst wall reduced enamel epithelium. to the neck of the tooth (arrow ) Remnants of the latter were attached to the enamel surface

DENTIGEROUS CYST CYSTIC LINING WITH FLATENDED EPITHELIAL CELLS

CYSTIC LUMEN

CONNECTIVE TISSUE

BLOOD CAPILLARY FIBROBLAST

Dentigerous cyst. This inflamed dentigerous cyst shows a thicker epithelial lining with hyperplastic rete ridges. (Arrow ) The fibrous cyst capsule shows a diffuse chronic inflammatory infiltrate.

Dentigerous cyst. This noninflamed dentigerous cyst shows a thin, nonkeratinized epithelial lining. ( arrow)

Dentigerous cyst. Scattered mucous cells can be seen within the epithelial lining. ( Arrow)

CALCIFYING ODONTOGENIC CYST CONNECTIVE TISSUE FIBROBLAST GHOST CELLS

CYSTIC LUMEN

STELLATE RETICULUM LIKE CELLS AMELOBLAST LIKE CELLS CALCIFICATIONS BLOOD CAPILLARY

• ‘cracked-mud’, ‘corrugated’

Nodular (‘speckled

Hyperkeratosis

Acanthosis

NBCCS

SATELLITE CYSTS

Cholesterol clefts