Oral Pathology Revision –

contd.
Dr. S Shafiq
✓This is an outline of topics that can be asked. Prepare all the details related to
them - in whichever form they come.
✓More topics can be included from what you have been taught.
✓It is not mandatory to only enlist the things mentioned here. Pls refer to text
books for information and answer according to the question.
✓Do not leave any question/section unattempted.
✓Please do not write the abbreviations as written here. You must write the full
form
(eg; premalignant in place of PM, osteomyelitis in place of OM, dentigerous cyst in place of DC, radiographs, histopathology, and clinical features in place of RG/HP/CF).

*For guidance of session 2018 only. Not to be passed on to the juniors.

 Scenario 27
Patient reported to maxfacs clinic 3 days post-extraction with severe intense
pain. On clinical examination the following presentation was seen.
A. Give most likely diagnosis?
B. Enlist risk/ predisposing factors and clinical features
Alveolar osteitis/dry socket/ fibrinolytic alveolitis. Partial/total disintegration of blood clot.
*Should know details related to this etiology/pathogenesis/CF - everything!

Risk/Predisposing factors: when the blood clot at the site of the tooth extraction fails to develop, or it dislodges or dissolves
before the wound has healed.
Difficult removal of tooth, mandibular jaw extraction, improper hygiene instruction post-extraction, spitting, smoking, blood
thinners roots/bone fragments remaining in the wound, excessive irrigation/curettage of socket after extraction local
anaesthesia, oral micro-organisms, oral contraceptives.

Clinical features:
Occurs 1-3 days post-extraction.
1. Severe pain following tooth removal. Denuded alveolar bone may be tender and painful
2. Exposed bone causing intense/continuous pain radiating to ipsilateral ear/temporal/eye region
3. Bad taste/breath (foeter ex ore), unpleasant taste
4. Pus discharge
5. Swelling/tenderness
6. Regional lymphadenopathy
7. Trismus
 Station 28
Diagnose. Enlist clinical & radiographic features?
Dentinogenesis Imperfecta
1. Opalescent teeth (bluish-grey to brown to
yellow colour)
2. composed or irregularly formed and
undermineralized dentin that obliterates
pulp chambers and pulp canals
3. Abnormally soft dentin fails to support
overlying enamel which chips off easily,
exposing dentin which ultimately undergoes
attrition.
4. Exposed dentin makes teeth caries prone
5. Bluish tint to sclera of eyes in type I (DI)
where pt is affected by osteogenesis
imprefecta (DI type I)
Radiographic features:
1. Bulb-shaped crowns,
constricted CEJ, thin roots
2. Obliteration of pulp chamber
an canals
 Station 29
A. Identify and give two DD?
B. Consequences if left untreated?

A: 1. Radicular cyst 2. Periapical abscess/granuloma

• If well-circ, grossly carious = PA granuloma or periapical/ radicular cyst

• Scenario given – give DD for radicular cyst (RC, PA abscess), etiopathogenesis (dental caries /trauma & spread of infection), outcome if left
untreated OR tooth discolouration without caries (h/o trauma) with well-defined RL on apex (RC)

B. Consequences if left untreated:

1. Caries & pulpitis leading to nonvital tooth and its fracture
2. Non-vital tooth if occurs due to trauma
3. Abscess formation
4. Cellulitis
5. Root resorption, bone resorption & ankylosis
6. Hypercementosis.
 Scenario 30
• A 30 yo male pt presented with lower right posterior mandibular swelling,
unilocular radioluccency (RL) at angle of mandible with ramus/ scalloped
margins/ multilocular polycystic RL, h/o operation 3 years back from surgical
wound of cystic lesion in same anatomic location. HP reveals thin stratified
squamous epithelial cells with flat cuboidal cells, most likely diagnosis?

• Diagnose and give Clinical features

• Or give Histological features,
• Or Radiographic features,
• Enslist its causes and reason for recurrence.
HP:​
1. Thin uniform lining of perakeratinized squamous epithelium, 6 to 10 cells thick​
2. Palisaded layer of columnar or cuboidal basal cells​
3. Corrugated layer of parakeratin on luminal surface​
4. Lack of rete pegs​
5. Exhibits separation of epithelium from connective tissue that is often loose fibrillar and inflammation-free.​
6. Cystic lumen contains variable amount of desquamated parakeratin
7. Also include microcyst formation, satellite daughter cysts causing high recurrence rates.​
 Scenario 31
• 29 yo presented with lower left swelling and facial symmetry. Unilocular RL,
associated with third molar, resorption of adjacent tooth, Histopathology is
shown. A. Give diagnosis? B. Write identification points?
• 4-6 layered non-keratinized stratified
squamous epithelium
• Cystic lining with chronic inflammatory
cells present in connective tissue
containing odontogenic epithelial rests
 Station 32
Clinical and histological picture is given
A. Diagnose salivary gland condition
B. Give histological features OR Clinical features?
 Mucoepidermoid carcinoma

Histological features:
1. Mucous cells are seen with a few
cystic areas/spaces
2. No distinct fibrous capsule
2. Tumour cells show pleomorphism and
hyperchromatism
3. Foci of squamous cells are seen but
no keratin pearls formation is seen
Gland-like structures of different sizes
with mucoid material image .
 Scenario 33

A 35 years old male patient presented with mandibular swelling extending from 1st molar
to ascending ramus causing facial deformity.
Give DD/ Diagnose with HP/Enlist CF and RG features?
* should know everything related
 Ameloblastoma
• CF: *Outline mentioned here only
Discuss all points – Origin, age range, site, appearance (uni/multi), types (Clinical and HP), slow or
aggressive?, expansion (egg-shell cracking), status of adjacent teeth, status of neighbouring structures, affect on
nerve, facial deformity, if left untreated, recurrence if any??

• RG:
Uni/multilocular, soap-bubble appearance, root resorption?

• HP:
1. Epithelial islands, strands and medullary arrangements, background stroma of fibrous connective tissue
2.Border with palisaded ameloblasts and reverse polarized cells
3. Stellate reticulum like cells like loosely arranged cells triangular shaped cells
4. Follicular ameloblastoma islands demonstrate peripheral columnar cells exhibiting reversal of polarity and
central stellate-reticulum like cells with cystic degeneration
• Posterior mandible
• Most common HP pattern is follicularMost commons type is conventuonal or solid-multicystic type
• RG: Multilocular expansile lytic lesion with cortical thinning and root resorption
• HP: Islands of epithelium with peripheral palisading of elongated columnar clls with reverse polarization like
preameloblasts of normal tooth development. Centrally islands contain loosely arranged stellate cells showing
resemblance to stellate reticulum of tooth germ
 Scenario 34
A 30-year-old girl, who presented with a bony hard swelling in the right mandibular posterior
region since over 2 months. Intraoral examination revealed an ulceroproliferative growth on
the right mandibular gingiva extending from the mesial aspect of mandibular lateral incisor
to the retromolar pad area. The overlying mucosa was erythematous in color
measuring approximately 3 × 2 cm in its greatest dimension. Radiograph shows ill-defined
mixed radiopaque-radiolucent lesion in the right mandibular region with
sunburst appearance.
A. Give most likely diagnosis and radiographic features?
B. Enlist histological variants?
 RG features:
1. Widening of PDL and separation of teeth.
2. Radiograph shows ill-defined mixed radiopaque-radiolucent
lesion in the right mandibular region with
sunburst appearance.
CT scan revealing large bony expansile heterogeneous
mass lesion involving the right hemimandible with
adjacent soft tissue edema with multiple areas of
calcification and necrosis

1. Osteosarcomas are composed of sarcomatous tumor cells

that produces malignant bone or osteoid
2. Spindle shaped fibroblasts cells with hyperchromatic nuclei
and tumor osteoid
3. Types: Osteoblastic, chondroblastic, fibroblastic, telangiectatic
 Scenario 35
Radiograph of 8 yo old boy who presented with delayed eruption of permanent
tooth shows following.

A. Identify? B. Give identification points?

A. Compound odontome (Odontoma)

B. Identification points:
1. Most common non-cystic odontogenic lesions found during 1st and 2nd
decade of life
2. site usually maxilla affected , particularly anterior area
3. Found over unerupted teeth, usually found when a tooth fails to erupt at
its scheduled time
4. contain enamel, dentin, pulp, cementum in either recognizable
tooth shape (compound odontome)
5. resemblance to normal teeth as occur during tooth development
 Scenario 36
A 10 years old patient reports with multiple punctate, shallow ulcers which
coalesce to large superficial ulcers and are present on keratinized and no-
keratinized mucosa. Pt also c/o fever, malaise, muscle pain and lymphadenopathy
along with recent difficulty in swallowing.
A. Give diagnosis
B. Give Histological features
*Should know about all viral infections
 Acute primary herpetic gingivostomatitis
• HP features:
1. Prodromal stage. Keratinocytes uptake fluid and swell
giving cytoplasm vacuolated appearance – ballooning
degeneration
2. Margination of chromatin with
large eosinophilic intranuclear inclusion bodies ultimately
resulting in multi-nucleated giant cells
3. Accumulation of intracellular and intercellular edema results in
lysis of cells resulting in appearance of visible papules/vesicles
4. Vesicles have fluid containing fibrin, ballooning
degenerated and MNG epithelial cells + acute inflammatory cells.
 Scenario 37
An elderly male patient comes to your clinic with complaint of intense pain and multiple
draining sinuses near angle of mandible with h/o extraction of third molar few months back.
Yellow-green exudate from draining tract was sent for hisological examination.
A. Identify the condition and mention organism responsible?
B. Give identification points?
 Actinomyces – Actionomyces Israelii
1. H/o traumatic incident/ injury or surgical procedure allowing entry of
organism to invade tissues
2. Soft tissue swelling with acute inflammatory reaction and
intense pain, localized osteomyelitis causing bone destruction when bone
invaded
3. Exudate from draining sinus typically in form of yellow-
green coloured calcific structures called sulfur granules showing colonies of
A. Israelii.
4. HP similar to acute abscess with central cavity containing purulent
exudate surrounding multiple calcified colonies of filamentous bacteria. Centrally
amorphous appearance and peripherally filamentous organism arranged in sun-
burst pattern.
 Station 38
A. Give diagnosis
B. Give identification points
 Kaposi's sarcoma

1. Location- lesion on hard palate,

2. clinically – red purplish macular lesion
3. HP: Endothelial cells lining of blood vessels
4. Sinusoidal blood spaces
5. Extravasated blood. Endothelial cells are plump
6. Background stroma contains high concentration of plasma cells
7. Aggregation of endothelial cells seen which
show incomplete vascular channel formation
 Station 39
Write Differential diagnosis considering the clinical appearance?
OR
Classify premalignant lesions (Refer to book)
*Enlist according to picture/scenario given
1. Lichen planus?
2. Lichenoid reaction?
3. Leukoplakia?
4. Systemic lupus erythematosus?
5. Oral submucous fibrosis?
6. Candidiasis?
7. Leukoedema?
 Give Histopathological features for pet diagnosis

1. White lace-like network (wickham striae)

2. Saw tooth rete pegs​
3. Lymphocytic band infiltration in basal and parabasilar area​
4. hyperplasia of epithelium of spinous layer​
5. Civatte bodies
 Scenario 40:
A 72 years old male pt comes to maxfacs clinic with the c/o non-healing ulcer on
right anterio-lateral border of tonsillar area for few months. Clinical picture and
HP is shown.
1. Diagnose. Give identification points?
2. Give factors determining survival of the condition

• Click to add text

 Squamous cell carcinoma
• Factors determining survival of SCC (Read from book)
*Keep into consideration all factors as site, duration, grade, histological
grading, h/o habits LN involvement

*Should know everything!

 Scenario 41
A 40 yo male presented with round, painless, slowly growing rubbery mass infront
of ear, covering lower border of mandible. HP shows pronounced fibrous
capsul, diffuse sheets of monomorphicc epithelial cells, ductal and tubular
elements of cuboidal cells around lumen and associated myo-epithelial cells.

A. Diagnose and give histological features?

 A. Pleomorphic adenoma (HP – refer to book) OR
Enlist clinical features? OR
Give WHO classification for salivary gland tumours?
(Refer to book for details)
 Station 42:
A. Diagnose the syndrome?
B. Enlist features?
Papillon–Lefèvre syndrome
• Rapid generalized periodontal
destruction
• Palmoplantar hyperkeratosis
• Juvenile periodontitis affecting
both dentitions

Refer to book
 Station 43
A. Identify and enlist other names
B. Enlist features expected in a pt with this condition

*The above investigation is called a three-

dimensional CT scan (you will read in
OMFS)
*Usually we cover pt's eyes to avoid
disclosing the identity. It is intentionally
left uncovered here
 Treacher Collins syndrome/
mandibulofacial dysostosis/
Treacher Collins-Franceschetti syndrome
• Defects in structures derived from first brachial arch
• Down-ward-sloping (antimongoloid slant) palpebral fissures
• Hypoplastic malar complexes
• Mandibular retrognathia
• Deformed pinnas
• Hypoplastic air sinuses
• Colobomas in outer third of eye
• Middle and inner ear hypoplasia (hencce deafness)
• Cleft palate
Best wishes for exams!