Oral Pathology: Hyperparathyroidism, Osteomyelitis & Tumors

Bone Lesions and Inflammatory Diseases

Hormonal Hyperparathyroidism (Brown Tumor)

Hormonal hyperparathyroidism (brown tumor)

Histology: Few bone fragments, multinucleated giant cells, blood vessels, osteoblasts and osteoclasts.

Inflammatory Diseases of the Jaw

1) Dry Socket (Alveolar Osteitis)

Clinical: Pain after tooth extraction due to loss of clot.

Treatment: Irrigation with saline, placement of ZOE paste.

2) Osteomyelitis (Inflammatory Condition of Bone and Bone Marrow)

Acute pyogenic osteomyelitis

• Clinical: Fever.
• Etiology: Infection (may follow dry socket).
• Pathogenesis: Usually non-specific bacteria; formation of sequestrum; formation of pus with drainage via cloaca.
• Histology: Sequestrum surrounded by acute inflammatory cells and pus.
• Radiograph (RG): No change in the first 2 weeks; later an ill-defined radiolucency with a "worm-eaten" appearance.
• Complications: Pathological fracture, loose teeth, numbness of the lip, toxemia.

3) Chronic Focal Sclerosing Osteomyelitis

Radiograph (RG): Localized ~1 cm radiopacity without radiolucency.

4) Chronic Diffuse Sclerosing Osteomyelitis

(Chronic diffuse sclerosing osteomyelitis)

5) Osteoradionecrosis

Pathophysiology: Hypoxia, hypocellularity, hypovascularity of irradiated bone.

6) Eosinophilic Granuloma

• Age: Young adult.
• Site: Mandible, typically a solitary lesion affecting one bone.
• Clinical: Pain, swelling, loosening of teeth.
• Histology: Eosinophils, foam cells, fat cells, histiocytes.
• Radiograph (RG): Radiolucent area.

Salivary Gland Tumors

Benign Tumors

A) Pleomorphic Adenoma

Histogenesis: Epithelial and myoepithelial cells (intercalated duct origin).

Histology:

• 1) Capsule of variable thickness.
• 2) Epithelial cells forming solid masses, strands, and duct-like structures.
• 3) Myoepithelial cells—spindle-shaped and plasmacytoid forms.
• 4) Unusual matrix: chondroid and myxoid material.

B) Papillary Cystadenoma Lymphomatosum (Warthin Tumor)

Histogenesis: Epithelial cells of striated ducts trapped in intraparotid lymphoid tissue.

Histology:

• 1) Epithelial element: double-layered epithelium — inner tall columnar cells and outer cuboidal cells.
• 2) Lymphoid element with germinal centers.

Malignant Tumors

A) Mucoepidermoid Carcinoma

Histogenesis: Excretory duct epithelium.

Histology:

• 1) Mucous-secreting cells with pale cytoplasm.
• 2) Epidermoid (squamous) cells with rounded eosinophilic cytoplasm.
• 3) Intermediate cells.

B) Adenoid Cystic Carcinoma

Histogenesis: Epithelial and myoepithelial cells of the intercalated duct.

Histology: Masses of malignant basaloid epithelium and myoepithelium with patterns:

• 1) Cribriform
• 2) Tubular
• 3) Solid
• 4) Trabecular

Epithelial Dysplasia and Premalignant Lesions

Signs of Epithelial Dysplasia

1. Basilar hyperplasia.
2. Loss of basal cell polarity.
3. Abnormal mitoses.
4. Cellular pleomorphism.
5. Nuclear pleomorphism.
6. Increased nucleus-to-cytoplasm (N:C) ratio.
7. Nuclear hyperchromatism.
8. Prominent nucleoli.
9. Individual cell keratinization.
10. Cell nests and keratin pearls.
11. Poikilokaryosis.
12. Loss of cohesion.

Premalignant Lesions

1) Leukoplakia

Definition: A white patch; may be associated with iron deficiency.

Sites: Alveolar mucosa, buccal mucosa.

Histology: Intact basement membrane, hyperkeratosis, acanthosis.