Differential Diagnosis of Oral Masses. Palatal Lesions

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1 Differential Diagnosis of Oral Masses Palatal Lesions

2 Palatal Masses Periapical Abscess Torus Palatinus Mucocele Lymphoid Hyperplasia Adenomatous Hyperplasia Benign Salivary Neoplasms Malignant Salivary Neoplasms Mesenchymal Neoplasms MALT Lymphoma Carinoma (Verrucous, Antral)

3 Apical Palatal Abscess Carious, nonvital tooth Spread of infection from palatal root Fluctuant or compressible Off midline Purulent aspirate Pain

4 Palatal Abscess

5 Torus Palatinus Onset during adulthood Females>Males Quite variable in size Tendency for lobulation Midline localization Bone hard to palpation Other exostoses may be present Remove for Prosthetic reasons

6 Midline Hard Palate Torus Palatinus

7 Reactive Lesions of Palatal Gingiva Pyogenic Granuloma Peripheral Fibroma Peripheral Ossifying Fibroma Peripheral Giant Cell Granuloma

8 Pyogenic Granuloma

9 Mucocele Soft Palate, Fauces

10 Hyperplastic Tonsillar Tissue

11 Adenomatous Hyperplasia Overgrowth of normal salivary tissue (acini and ducts) Soft to palpation Adults Mistaken for salivary tumor clinically Biopsy to confirm diagnosis

12 Adenomatous Hyperplasia

13 Benign Salivary Tumors Pleomorphic Adenoma Myoepithelioma Monomorphic Adenoma Basal Cell Adenoma

14 Pleomorphic Adenoma Encapsulated Capsule may fuse to periostium Extracapsular invasion is common Wide histologic variation Ductal and myoepithelial component Heterogeneous Pleomorphic stroma Myxoid, Cartilage, bone, fat Enucleation, subperiosteal dissection Low Recurrence in Palate

15 Pleomorphic Adenoma

16 capsule Mixed Tumor

17 Pleomorphic adenoma Plasmacytoid Myoepithelial Cells Tyrosine Crystals

18 Malignant Salivary Tumors Mucoepidermoid Carcinoma Polymorphous Low Grade Adenocarcinoma Adenoid Cystic Carcinoma Adenocarcinoma (NOS) Rare Adenocarcinomas Epithelial-Myoepithelial Carcinoma Carcinoma ex Mixed Tumor Salivary Duct Carcinoma Adenosquamous Carcinoma

19 Mucoepidermoid Carcinoma Midlife, yet may occur at young age Behavior varies with histologic grade Low Grade: Nonmetastasizing Intermediate Grade High Grade: Behavior Similar to Squamous Cell CA Wide local excision including bone Evaluation of neck for metastasis Clinical MRI, nodes > 1.0 cm positive

20 Mucoepidermoid Carcinoma

21 Low Grade Polymorphous AdenoCA Nonencapsulated Often misdiagnosed as Adenoid Cystic Carcinoma Histologic variations Solid nests, cribriform, perineural, Indian file, papillary cystic, tubular Wide local excision Metastases Nodal, more common with papillary patterns histologically (15%) Distant (8%)

22 Polymorphous Low Grade AdenoCA

23 Adenoid Cystic Similar histology to PLGA Recurrence and Metastasis Histology Tubular, Solid, Cribriform Stromal hyalinization Wide local excision Neck node assessment Clinical MRI, nodes > 1.0 cm positive

24 Adenoid Cystic Carcinoma

25 Adenocarcinoma, NOS Histologically not distinctive Ductal differentiation Most are intermediate to high grade Local and Distant Metastases Wide local excision, Radiation

26 Various Adenocarcinomas Myoepithelial Carcinoma Polymorphous low grade adenocarcinoma

27 Mesenchymal Neoplasms Benign Traumatic Fibroma (Fibrous Hyperplasia) Nerve Sheath Tumors Granular Cell Tumors (Soft Palate) Malignant MALT Lymphoma All sarcomas are very rare

28 Inflammatory Papillary Hyperplasia)

29 Fibroma, Pyogenic Granuloma

30 Atypical Lymphoreticular Disease of the Palate (MALT Lymphomas) Low Grade Malignancies Diffuse soft swelling hard and soft palate junction Histology Diffuse or Nodular Plasmacytoid/Histiocytoid May show benign lymphoepithelial lesion Radiation Therapy

31 Atypical Lymphoproliferative Lesion

32 Atypical Lymphoreticular Lesion diffuse follicular

33 IHC Markers Lymphoma Bcl=2 oncogene

34 IHC Lymphoma CD 20 B Lymphocytes

35 MALT Lymphoma Lymphoepithelial Lesion Pattern

36 Carcinoma Squamous Cell CA is rare in palate Soft Palate>Hard Palate Verrucous Carcinoma Palate, alveolar ridge White or pink, verrucous or papillary Antral Carcinoma Palatal perforation, oral mass Often ulcerated Most are Squamous Cell CAs or SNUC

37 Squamous Cell CA Papillary Variant Moderately Differentiated, SCCA Spindle Cell Carcinoma

38 Antral Squamous Cell CA

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