Oral cancer differential diagnosis: Difference between revisions
Line 13: | Line 13: | ||
!Epidemiology | !Epidemiology | ||
!Etiology | !Etiology | ||
!Localization | !Localization | ||
!Clinical features | !Clinical features | ||
!Diagnostic procedures | !Diagnostic procedures | ||
|- | |- | ||
|Squamous cell carcinoma | |||
* Basaloid squamous cell carcinoma | |||
* Papillary squamous cell carcinoma | |||
* Spindle cell carcinoma | |||
* Spindle cell carcinoma | |||
* Acantholytic squamous cell carcinoma | |||
* Acantholytic squamous cell carcinoma | |||
* Adenosquamous carcinoma | |||
|Verrucous carcinoma | |Verrucous carcinoma | ||
|8051/3 | |8051/3 | ||
| | | | ||
* Older males | |||
* 5th and 6th decades of life | |||
* Males are affected more often than females | |||
| | |||
* Tobacco smoking and alcohol | |||
* Chronic smokeless tobacco | * Chronic smokeless tobacco | ||
* HPV 16 and 18 | * HPV 16 and 18 | ||
| | | | ||
* Lip SCC arise almost exclusively on the lower lip | |||
* Buccal mucosa | |||
* Upper and lower gingiva | |||
* Hard palate | |||
* Anterior two-thirds of the tongue, including dorsal, ventral and lateral surfaces, and the floor of mouth | |||
| | | | ||
* Often asymptomatic or may present with vague symptoms and mini- mal physical finding | |||
|Biopsy shows: | |||
Thickened club-shaped | |||
papillae and blunt stromal invaginations | |||
| | |||
of well-differentiated squamous epitheli- | |||
um with marked keratinization | |||
|- | |- | ||
|Lymphoepithelial carcinoma | |Lymphoepithelial carcinoma | ||
| | | | ||
| | | | ||
Line 101: | Line 67: | ||
| | | | ||
| | | | ||
| | |Seen in the entire digestive tract | ||
| | |White patches (leukoplakia) and red patches (erythroplasia/erythroplakia) or mixed red and white lesions | ||
| | |Biopsy shows: | ||
* Hyperplasia | |||
* Dysplasia, / squamous intraepithelial neoplasia / atypical hyperplasia | |||
* Carcinoma in-situ | |||
|- | |- | ||
|Proliferative verrucous leukoplakia and precancerous conditions | |Proliferative verrucous leukoplakia and precancerous conditions | ||
Line 110: | Line 78: | ||
| | | | ||
| | | | ||
* Average age at diagnosis is 62 years | |||
* Women are more commonly afflicted (ratio, 4:1) | |||
|Unknown | |||
| | | | ||
| | * Buccal mucosa in women | ||
| | * Tongue in men. | ||
|An aggressive form of oral leukoplakia with considerable morbidity and | |||
strong predilection to malignant transformation | |||
|Biopsy shows: | |||
* Extensive, thick, white plaques | |||
* Hyperplasia and dense hyperkeratosis | |||
* Verrucous surface with hyperkeratosis, hypergranulosis and a dense inflammatory infiltrate in the corium | |||
|- | |- | ||
| rowspan=" | | rowspan="3" |Papillomas | ||
|Squamous cell papilloma and | |Squamous cell papilloma and | ||
verruca vulgaris | verruca vulgaris | ||
| | | | ||
| | | | ||
* Common in children and in adults in the 3rd to 5th decades | |||
* Almost equal sex incidence with a slight male predominance | |||
|HPV subtype | |||
2,4,6,7,10,40. | |||
|Any oral site may be affected mostly: | |||
* Hard and soft palate | |||
* Labial mucosa | |||
* Tongue | |||
* Gingiva | |||
| | | | ||
* Soft, peduncu- | |||
| | lated lesions formed by a cluster of finger-like fronds or a sessile, dome- | ||
shaped lesion with a nodular, papillary or | |||
verrucous surface | |||
|Biopsy shows: | |||
* Exophytic and comprise folds of hyperplastic stratified epithelium | |||
* Cluster of finger-like projections | |||
|- | |- | ||
|Condyloma acuminatum | |Condyloma acuminatum | ||
Line 132: | Line 123: | ||
| | | | ||
* HPV, most commonly types 6,11,16 and 18 | * HPV, most commonly types 6,11,16 and 18 | ||
| | | | ||
* Labial mucosa | |||
* Tongue | |||
* Palate | |||
| | | | ||
* Painless, rounded, dome-shaped exophytic nodules | |||
* 15mm in diameter | |||
* Have a broad base and a nodular or mulberry-like surface that is slightly red, pink or of normal mucosal color. | |||
* Lesions may be multiple and are then usually clustered | |||
|Biopsy shows: | |Biopsy shows: | ||
Several sessile, cauliflower-like swellings forming a cluster | Several sessile, cauliflower-like swellings forming a cluster | ||
|- | |- | ||
|Focal epithelial hyperplasia | |Focal epithelial hyperplasia | ||
Line 156: | Line 145: | ||
13 and 32 | 13 and 32 | ||
| | | | ||
* All areas of the oral cavity | * All areas of the oral cavity | ||
Line 182: | Line 170: | ||
* Females are affect- ed more often than males with an M/F ratio of 2:1 | * Females are affect- ed more often than males with an M/F ratio of 2:1 | ||
|No etiological factors are known | |No etiological factors are known | ||
| | | | ||
* Tongue is the most common single site | * Tongue is the most common single site | ||
Line 206: | Line 193: | ||
men as in women | men as in women | ||
|Associated with uptake of carcinogens(e.g. via particular smoking habits) | |Associated with uptake of carcinogens(e.g. via particular smoking habits) | ||
| | | | ||
* Skin of the face,including the lips | * Skin of the face,including the lips | ||
Line 227: | Line 213: | ||
* Individuals with a high arched palate | * Individuals with a high arched palate | ||
* HIV infection | * HIV infection | ||
|Palate | |Palate | ||
|Asymptomatic nodular or papillary mucosal lesion | |Asymptomatic nodular or papillary mucosal lesion | ||
Line 238: | Line 223: | ||
| | | | ||
|Associated with chronic candidal infection | |Associated with chronic candidal infection | ||
|Dorsum of the tongue at the junction of the anterior two thirds | |Dorsum of the tongue at the junction of the anterior two thirds | ||
and posterior third | and posterior third | ||
Line 257: | Line 241: | ||
* Male to female ratio of 1.5:1 | * Male to female ratio of 1.5:1 | ||
|Unknown | |Unknown | ||
| | | | ||
* Buccal mucosa | * Buccal mucosa | ||
Line 274: | Line 257: | ||
* 9.5-23% of all minor gland tumors | * 9.5-23% of all minor gland tumors | ||
|Unknown | |Unknown | ||
| | | | ||
* Palate (most common site) | * Palate (most common site) | ||
Line 292: | Line 274: | ||
* 42.5% of minor gland tumors | * 42.5% of minor gland tumors | ||
* | * | ||
| | | | ||
| | | | ||
Line 311: | Line 292: | ||
carcinoma | carcinoma | ||
|8562/3 | |8562/3 | ||
| | | | ||
| | | | ||
Line 321: | Line 301: | ||
NOS | NOS | ||
|8310/3 | |8310/3 | ||
| | | | ||
| | | | ||
Line 332: | Line 311: | ||
|8147/3 | |8147/3 | ||
|Rare in minor glands | |Rare in minor glands | ||
| | | | ||
| | | | ||
Line 347: | Line 325: | ||
|8450/3 | |8450/3 | ||
|32% developed in the minor glands | |32% developed in the minor glands | ||
| | | | ||
| | | | ||
Line 364: | Line 341: | ||
|Mucinous adenocarcinoma | |Mucinous adenocarcinoma | ||
|8480/3 | |8480/3 | ||
| | | | ||
| | | | ||
Line 373: | Line 349: | ||
|Oncocytic carcinoma | |Oncocytic carcinoma | ||
|8290/3 | |8290/3 | ||
| | | | ||
| | | | ||
Line 385: | Line 360: | ||
* Rare in minor salivary glands | * Rare in minor salivary glands | ||
* Age range was 23-80 years (mean 56 years) | * Age range was 23-80 years (mean 56 years) | ||
| | | | ||
| | | | ||
Line 402: | Line 376: | ||
|Myoepithelial carcinoma | |Myoepithelial carcinoma | ||
|8982/3 | |8982/3 | ||
| | | | ||
| | | | ||
Line 412: | Line 385: | ||
adenoma | adenoma | ||
|8941/3 | |8941/3 | ||
| | | | ||
| | | | ||
Line 423: | Line 395: | ||
|8940/0 | |8940/0 | ||
|40-70% of minor gland tumors | |40-70% of minor gland tumors | ||
| | | | ||
| | | | ||
Line 437: | Line 408: | ||
|8982/0 | |8982/0 | ||
|42% of minor gland tumors | |42% of minor gland tumors | ||
| | | | ||
| | | | ||
Line 447: | Line 417: | ||
|8147/0 | |8147/0 | ||
|20% of minor gland tumors | |20% of minor gland tumors | ||
| | | | ||
| | | | ||
Line 460: | Line 429: | ||
|8149/0 | |8149/0 | ||
|7% of benign minor gland tumors | |7% of benign minor gland tumors | ||
| | | | ||
| | | | ||
Line 480: | Line 448: | ||
* HHV-8 | * HHV-8 | ||
* Immunologic, genetic, and environmental factors | * Immunologic, genetic, and environmental factors | ||
| | | | ||
* Skin ( most common) | * Skin ( most common) | ||
Line 502: | Line 469: | ||
* Genetic abnormalities | * Genetic abnormalities | ||
* Turner's syndrome | * Turner's syndrome | ||
|Tongue | |Tongue | ||
| | | | ||
Line 518: | Line 484: | ||
* Age range varies from 9-78 years | * Age range varies from 9-78 years | ||
* No distinct sex predilection. | * No distinct sex predilection. | ||
| | | | ||
| | | | ||
Line 533: | Line 498: | ||
* Rare in children | * Rare in children | ||
* There is no distinct sex predilection. | * There is no distinct sex predilection. | ||
| | | | ||
| | | | ||
Line 557: | Line 521: | ||
* Females are affected ten times more often than males | * Females are affected ten times more often than males | ||
|Etiology uncertain | |Etiology uncertain | ||
| | | | ||
* Maxilla | * Maxilla | ||
Line 580: | Line 543: | ||
* Underlying immunodeficiency state (e.g. HIV Infection) | * Underlying immunodeficiency state (e.g. HIV Infection) | ||
* Strong association with EBV | * Strong association with EBV | ||
| | | | ||
* Palate, | * Palate, | ||
Line 610: | Line 572: | ||
|Extramedullary plasmacytoma | |Extramedullary plasmacytoma | ||
|9734/3 | |9734/3 | ||
| | | | ||
| | | | ||
Line 623: | Line 584: | ||
* Eosinophilic granulomas | * Eosinophilic granulomas | ||
* Multifocal multisystem disease | * Multifocal multisystem disease | ||
| | | | ||
* Jaw bone | * Jaw bone | ||
Line 650: | Line 610: | ||
| | | | ||
|Strongly associated with Epstein- Barr Virus | |Strongly associated with Epstein- Barr Virus | ||
| | | | ||
* Waldeyer ring, particularly the pala-tine tonsil | * Waldeyer ring, particularly the pala-tine tonsil | ||
Line 668: | Line 627: | ||
predominantly in the monocytic or | predominantly in the monocytic or | ||
myelomonocytic subtypes | myelomonocytic subtypes | ||
| | | | ||
* Palate | * Palate | ||
Line 684: | Line 642: | ||
* Affects wide age range | * Affects wide age range | ||
|History of underlying hya-line-vascular Castleman disease | |History of underlying hya-line-vascular Castleman disease | ||
| | | | ||
* Tonsil | * Tonsil | ||
Line 710: | Line 667: | ||
* Incidence 0.02 per 100,000 | * Incidence 0.02 per 100,000 | ||
|No known etiological factors associated with oral melanoma | |No known etiological factors associated with oral melanoma | ||
|80% arise: | |80% arise: | ||
* Palate | * Palate |
Revision as of 16:12, 7 February 2018
Oral cancer Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Oral cancer differential diagnosis On the Web |
American Roentgen Ray Society Images of Oral cancer differential diagnosis |
Risk calculators and risk factors for Oral cancer differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
There are different types of cancers of the oral cavity and oropharynx. It is important that they are differentiated from one another.
Oral cancer must be differentiated from actinic keratosis, dermatologic manifestations of oral leukoplakia, erythroplasia, lichen planus and mucosal candidiasis.
Oral cancer differential diagnosis
Type of cancer | Subtype | ICD-O Code | Epidemiology | Etiology | Localization | Clinical features | Diagnostic procedures |
---|---|---|---|---|---|---|---|
Squamous cell carcinoma
|
Verrucous carcinoma | 8051/3 |
|
|
|
|
Biopsy shows:
Thickened club-shaped papillae and blunt stromal invaginations of well-differentiated squamous epitheli- um with marked keratinization |
Lymphoepithelial carcinoma | |||||||
Epithelial precursor lesions | Seen in the entire digestive tract | White patches (leukoplakia) and red patches (erythroplasia/erythroplakia) or mixed red and white lesions | Biopsy shows:
| ||||
Proliferative verrucous leukoplakia and precancerous conditions |
|
Unknown |
|
An aggressive form of oral leukoplakia with considerable morbidity and
strong predilection to malignant transformation |
Biopsy shows:
| ||
Papillomas | Squamous cell papilloma and
verruca vulgaris |
|
HPV subtype
2,4,6,7,10,40. |
Any oral site may be affected mostly:
|
lated lesions formed by a cluster of finger-like fronds or a sessile, dome- shaped lesion with a nodular, papillary or verrucous surface |
Biopsy shows:
| |
Condyloma acuminatum | 2nd and 5th decade with a peak in teenagers and young adults |
|
|
|
Biopsy shows:
Several sessile, cauliflower-like swellings forming a cluster | ||
Focal epithelial hyperplasia | Disease of children,adolescents and young adults | HPV
13 and 32 |
|
|
Biopsy shows:
| ||
Granular cell tumour | 9580/0 |
|
No etiological factors are known |
|
|
Biopsy shows:
| |
Keratoacanthoma | 8071/1 |
whites
men as in women |
Associated with uptake of carcinogens(e.g. via particular smoking habits) |
|
|
Biopsy shows:
| |
Papillary hyperplasia | Affects all age groups | Associated with:
|
Palate | Asymptomatic nodular or papillary mucosal lesion | Biopsy shows:
| ||
Median rhomboid glossitis | Associated with chronic candidal infection | Dorsum of the tongue at the junction of the anterior two thirds
and posterior third |
Forms a patch of papillary atrophy in the region of the
embryological foramen caecum |
Biopsy shows:
| |||
Salivary gland tumours | Acinic cell carcinoma | 8550/3 |
|
Unknown |
|
Tumors usually
form non-descript swellings |
Biopsy shows:
|
Mucoepidermoid carcinoma | 8430/3 |
|
Unknown |
|
|
Low power microscopy shows low-grade tumor with both cystic and solid areas and an inflamed, fibrous stroma | |
Adenoid cystic carcinoma | 8200/3 |
|
|
|
Predominantly solid variant shows peri- and intraneural invasion. | ||
Epithelial-myoepithelial
carcinoma |
8562/3 | ||||||
Clear cell carcinoma,
NOS |
8310/3 | ||||||
Basal cell
adenocarcinoma |
8147/3 | Rare in minor glands |
|
Asymptomatic, smooth or lobulated sub-mucosal masses | Microscopically similar to basal
cell adenocarcinomas of the major gland | ||
Cystadenocarcinoma | 8450/3 | 32% developed in the minor glands |
|
Slow growing and painless but
some palatal tumors may erode the underlying bone causing sinonasal complex. |
|||
Mucinous adenocarcinoma | 8480/3 | ||||||
Oncocytic carcinoma | 8290/3 | ||||||
Salivary duct carcinoma | 8500/3 |
|
|
Tumours formed painless swellings but many in the palate can be painful and ulcerated or fungated with metastases to regional lymph nodes. | The range of
microscopical appearances os similar to that seen in the major glands. | ||
Myoepithelial carcinoma | 8982/3 | ||||||
Carcinoma ex pleomorphic
adenoma |
8941/3 | ||||||
Salivary gland adenomas | Pleomorphic adenoma | 8940/0 | 40-70% of minor gland tumors |
|
Painless, slow growing, submucosal masses, but when
traumatized may bleed or ulcerate. |
Biopsy shows cellular, and hyaline or plasmacytoid cell | |
Myoepithelioma | 8982/0 | 42% of minor gland tumors |
|
||||
Basal cell adenoma | 8147/0 | 20% of minor gland tumors |
|
They are histologically
similar to those in major glands. | |||
Cystadenoma | 8149/0 | 7% of benign minor gland tumors |
|
||||
Kaposi sarcoma |
|
|
|
|
Biopsy of all 4 types show:
| ||
Lymphangioma | 9170/0 |
|
|
Tongue |
|
Biopsy shows:
| |
Ectomesenchymal chondromyxoid
tumour of the anterior tongue |
|
Asymptomatic, slow growing solitary nodule in the anterior dorsal tongue | Biopsy shows:
| ||||
Focal oral mucinosis (FOM) |
|
|
Asymptomatic fibrous or cystic-like lesion | Histopathology is characterized by:
tissue
| |||
Congenital granular cell epuli |
|
Etiology uncertain |
|
Solitary, somewhat pedunculated fibroma-like lesion attached to the alveolar
ridge near the midline |
| ||
Haematolymphoid tumours | Non-Hodgkin lymphoma | Second most com-
mon cancer of the oral cavity |
|
|
NHL of the lip presents with:
|
Biopsy shows:
| |
Extramedullary plasmacytoma | 9734/3 | ||||||
Langerhans cell histiocytosis | 9751/1 | Associated with:
|
and
|
Common oral symptoms
include:
|
Biopsy shows ovoid Langerhans cells
with deeply grooved nuclei, thin nuclear membranes and abundant eosinophilic cytoplasm | ||
Hodgkin lymphoma | Strongly associated with Epstein- Barr Virus |
|
Most patients present with localized disease (stage I/II), with
|
||||
Extramedullary myeloid
sarcoma |
9930/3 | History of acute myeloid leukaemia,
predominantly in the monocytic or myelomonocytic subtypes |
|
Isolated tumor-forming intraoral mass | Biopsy shows an Indian-file pattern of infiltration | ||
Follicular dendritic cell
sarcoma / tumour |
9758/3 |
|
History of underlying hya-line-vascular Castleman disease |
|
The patients usually
present with a painless mass |
Biopsy usually exhibits
borders and comprises:
| |
Mucosal malignant melanoma | 8720/3 |
|
No known etiological factors associated with oral melanoma | 80% arise:
gingivae Others:
|
|
|