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Granulomatous & Pigmented Lesions (Sarcoidosis (A Multi-systemic…
Granulomatous & Pigmented Lesions
Granulomatous Inflammation
A pattern of chronic inflammation
= infiltrate w/ macrophages and formation of granulation tissue
Granuloma Focal
Collection of inflammatory cells, Includes:
Macrophages
Epithelioid cells, inflammatory infiltrate
Giant cells
Immune Granuloma
Caused by insoluble particles that are capable of including a cell-mediated immune response
Foreign-Body Granuloma
When a foreign material is too large to be phagocytosed by macrophages, it is warded off by epitheliod cells
Sarcoidosis
A Multi-systemic condition with environmental and/or microorganism involvement
ie Lymph, skin, lungs, mouth and salivary glands
Clinically
Oral lesion = buccal mucosa
Erythematous papule, area of granularity
ulcer; pink, brown/red, violaceous or hyperkeratotic
Rx = Opacities in chest
Histology
Multiple granuloma formation(non-caseating) -
Astroid/schumann bodies (non-characteristic)
Epitheloid cells, macrophages, MNG cells, fibrosis
Diagnosis
Clinical appearance + Rx
Lab = ACE levels are elevated
Chron's Disease
Inflammatory/Immune-mediated condition affecting the gastrointestinal tract
Lesions seen all along GIT, skin, eyes and joints
Oral appearence
Buccal mucosa has cobblestone appearance
Linear ulcer at buccal vestibule
Mucosal tags
Aphthous-like ulcer
Diagnosis
Established by clinical features
GI-Tract assessment (GI-Endoscopy)
Orofacial granulomatosis
Nonspecific granulomatous inflammation which is Dx by exclusion and elimination
idiopathic but appears to represent an abnormal immune reaction to a various etiological agents
Clinically
Common in the lips, = non-tender, persistent swelling, papaules
Buccal mucosa - cobblestone appearance (similar to Chron's)
In tongue - develop fissures, oedema, paraesthesia, taste alteration
Facial paralysis
Diagnosis
PAS(fungal) = negative
Ziehl–Neelsen(bacteria) = negative
patch test(allergy) = negative
Foreign body Giant Cell Granuloma
foreign body - (such as suture, hair, amalgam, endodontic sealer, hyaluronic acid, alvogyl etc) penetrates the oral mucosa followed by acute inflammation and formation of a granuloma
Non-ulcerated pink nodules
Multiple cystic spaces surrounded by MNG cells
Amalgam Tattoo
Implantation of dental amalgam that results in a greyish-black pigmentation of the oral mucosa
Causes:
Laceration
Impaction at the time of placement of the restoration
Chronic rubbing
Histology
No inflammation
Grey-black macules aligned along collagen fibers
Present in macrophages
Oral Melanotic Macules
Increased melanin production - EPHELIS (freckle)
Solitary, flat, brownish
Causes: many conditions SLE, OLP, Wilson's, Addison's...
Naevi
Altered melanocyte which has proliferated to form a naevus
Types:
Junctional
Nests of melanocytes in the lower aspect of epithelium
Compound
Nests & strands of melanocytes/naevus cells in junctional & dermis
Intradermal
Invasion of connective tissue, completely intramucosal naevi
Blue Naevus
arrested migration of melanocyte
occur intraorally in the palate
No nest-like arrangement, not a PMOD
Malignant Melanoma
Malignant neoplasm of melanocytes, usually involving the skin
Usually from a new lesion but can proceed from a PMOD
Intraoral is rare, but has poor prognosis
Clinically
15% are non-pigmented
Reddish nodule
Asymptomatic initially; may become painful & bleed easily
Histology
Intraepithelial component
Invasion of connective tissue
Atypical melanocytes
Vertical Growth
Tumour composed of large nests of melanoma cells
Cytological atypia
Metastatic spread
Radial Growth
Intraepithelial component
Invasion into supf. c.t
Small nests of melanocytes
Atypical melanocytes with clear cytoplasm are clustered within the epithelium