 Hello everyone welcome back to another session in dentistry and more today we have benign tumors That is we are studying most common for benign tumors squamous papilloma Veruca vulgaris, which is also known as common. What? keratocantoma and oral nevus tumor is nothing but a Swirling a simple swirling of the tissue If we apply very strict protocol, we cannot say that it is a Neopelastic process, but sometimes we interchangeably use tumor and neoplasm So the tumors of oral cavity we can divide it is based on the tissue of origin They are basically five types one is epithelial in origin and the second one is Connective tissue in origin third one is muscular and fourth one is nerve tissue and fifth one is the tumors of Joe metastatic Tumors of Joe So today's session is about epithelial tumors that is epithelial benign tumors of Oral cavity and the very various tumors and n number of tumors But we are mainly focusing on squamous papilloma Veruca vulgaris keratocantoma and oral nevus. So let's see one by one So the first tumor is squamous papilloma Veruca vulgaris. So these two should be studied together because both are caused by HPV virus 6 and 11, okay So this squamous papilloma and veruca vulgaris the causative virus is HPV All HPV lesions are very infective, but the squamous papilloma Do not seem to be contagious. Okay, so this is not very contagious the rest of the HP viruses are contagious So veruca vulgaris. It is also known as Skin what is a generic term for veruca vulgaris? Squamous papilloma and veruca vulgaris all which is also known as skin warts. These two are clinically and microscopically are almost same While coming to the clinical features The growth is exophytic pedunculated Painless which is made up of numerous small finger-like projections Which result in a lesion with roughened or a veruca or cauliflower surface Veruca means a cauliflower which has a cauliflower appearance We know how the common what looks like which will be a pedunculated one And intra-orlet is most commonly on the tongue, lips, Bacchal mucosa, Ginger palate and the area adjacent to uvula and The common what the common what or Eureka vulgaris which is a tumor of skin, which is analogous to oral papilloma But uncommon on the oral mucous membrane. However, these can be seen on the lips and occasionally intra-orly In patients with veruca on the hands or fingers So patients with veruca vulgaris or skin what on the hands or fingers Sometimes the intra-oral lesions also will be present Because these people they have the tendency to Fingers sucking or fingernail beating there will be auto-inoculation from the fingers to the oral cavity And Along with scoma is papilla. We need to study the cowden syndrome So papillomatics or pebbly lesions and fibromas of various sites in the oral cavity are recognized as one of the Many manifestations of multiple hama-toma and neoplasia syndrome, which is known as Cowden syndrome, so it has both fibromas and papilloma so In histologic features it has long thin finger-like projections Extending above the mucosal surface each made up of continuous layer of stratified squamous cells stratified squamous cells That is epithelium and which contains a thin central connected tissue core which supports the nutrient blood vessels The essential feature is proliferation of the spina cells in the papillary pattern, spina cells Which proliferate in a papillary pattern and the connected tissue Is supportive stroma and it is not a part of this neoplastic element. So Mainly it happens on the spina cells in the papillary pattern Okay, we have you know papillary layer and reticular layer and connective tissue layer And the next Thing is koelosites koelosites Which is a hpv altered epithelial cells with perinuclear clear spaces and pycnotic nuclei And it may or may not be found in the superficial layers of epithelium So koelosites are also associated with ferruca vulgaris And moving on to the treatment The Most accepted treatment as we all know is excision Including the base of the mucosa into which the pedicle inserts. So there is a Pedicle the stalk is there. So We need to remove the base of the mucosa where this pedicle inserts If it is properly excised the recurrence chance is very rare Some other methods also we have like conservative surgical excision Curatage and also newer methods like liquid nitrogen cryotherapy And topical keratolytic agents which the agents liquids which containing salicylic acid Salicylic acid And lactic acid. So these are keratolytic agents And also cryotherapy Also we can opt but most commonly excision is opted So that is all about squamous papilloma or verruca vulgaris. Now, let's move on to the keratocantoma Keratocantoma which is also known as self healing casinoma moluscum sebacea or verucoma verucoma So all these are keratocantomas other names. It is a relatively common low-grade malignancy Which originate in the pillow sebaceous glands So sebaceous glands pillow sebaceous glands And it is considered to be a variant of invasive squamous cell casinoma the common etiological Factors are sunlight chemical casinogens trauma HPV virus genetic factors and impuno immunocompromised status So it occurs in all age group But incidence increases with age men to women is two ways to understate is commonly seen on men And more common in fair skin people And in sun exposed areas, so it is mostly associated with the sunlight exposure So fair skin and sun exposed areas are more prone to This keratocantoma the face neck and awesome of upper extremities are the most common sites Intra oral lesions are Quite uncommon now may be seen on the lips because it is exposed to sunlight and The lesions are typically solid tree elevated umbilicated or Creator form with a depressed central core or plague So a depressed central core And it is often painful and there will be a regional lymphadenopathy And in histologic features this consists of hyperplastic Squamous epithelium which grows into the underlying connective tissue So, you know, this is epithelium and Connective tissue when we take a epithelial cross section So there will be hyperplastic squamous epithelium which grows into the connective tissue And the surface is covered by a layer of para or ortho keratin with central plugging And at the deep Margin of this tumor there will be islands of epithelium Which invades and usually this area cannot be differentiated from squamous cell cosinoma So sometimes it may also invade the perineural spaces But this is not a distinguishing feature between squamous cell cosinoma and keratocantoma So it is misdiagnosed as squamous cell And there will be a pseudo-cosinomatous infiltration which typically Presents as a smooth well demarcated front that does not extend beyond the level of sweat glands And the connective tissue shows chronic inflammatory cell infiltration So The characteristic feature is found at the margins where the normal adjacent epithelium is elevated towards the central portion of the crater Okay, so this is a crater So at the margin we get the normal adjacent epithelium It will be elevated towards the central portion it will be elevated towards the central portion Of the crater there an abrupt change in the normal epithelium As the hypoplastic acanthotic epithelium is reached So there will be hyper plastic acanthotic acanthotic epithelium Is reached at this borders. So that is why diagnosis may be impossible if the normal adjacent epithelium is not included in the biopsy. So always we should take normal and along with the lesion So without the normal epithelium, we will not be able to differentiate the margins So this is where the Unique feature of keratocerectoma lies which can differentiate it from squamous cell cosinoma So in treatment part Just like any other venanylations, we need to do a surgical excision And patient should follow for the development of any new primary skin Cancer, okay. So that is about keratocerectoma. Next we have oral nevy Next we have nevers Which is a benign exophytic pigmented congenital lesion of skin or mucosa, which is composed of focal collection of frowned melanocytes So these melanocytes are known as nevers cell The term nevers we commonly used for mole and nevy most Commonly occur on skin occasionally on mucous membrane And it is also called as birthmark. So birthmark and mole, we are Generic terms, we are commonly using these two terms. They are nothing but nevers So we have five types of nevers. The first one is intradermal or mucosal Junctional nevers, compound nevers, blue nevers, which is also known as macular form And epithelioid nevers or it is known as spitz We'll start with the intramucosal Nevers or intradermal nevers So it the lesion grows very slowly. It is usually less than one centimeter and It is occurs on young patients and is one of the Common skin lesion on this young group of people On skin, it is a raised or a flat lesion And it is tan or dark brown in color It will often contain more hair than the surrounding normal skin And the intramucosal nevers occurs in oral cavity mostly on heart palate and jinjiva heart palate Or jinjiva, okay And it is asymptomatic pigmented brown or black in color And it is like a slightly elevated papule or flat macule So it will be a slightly elevated with presence of hair on the skin or sometimes without hairs And sometimes it will be a flat macule. So it could be a elevated papule Or a flat macule Okay So in histopathology it is characterized by nests, chords or sheets of nevers cells confined to connective tissue And the cells of nevers may be epithelioid lymphocyte Like or spindle or multinucleator types There will be mitotic figures and the most Striking feature of nevers is a presence of fibrous connected tissue zone which separates it from the Overlying epithelium. Okay. So these are the histopathology features And the treatment has a general rule for all solitary pigmented papules or nodules Of the oral cavity. It should go for Exition And once excised anyway, uh, do not tend to recur. So recurrence is Uh, very Few percentage And the second one is junctional nevers, which is benign brown toe black lesion occurs primarily on the skin and occasionally on oral mucosa And within oral cavity, it usually appears as a pigmented macular maculation on the heart palate or genieva So maculation will not be very much elevated. It is Just a color change, uh, which we can see on the surface unlike papule, which will be a elevated lesion And in junctional nevers, the histopathology is characterized by presence of neversal nest in the basilar region of epithelium and, uh There is no neversals found in surround connected tissue And it presents as a solitary small pink to reddish brown papule. So the color is, uh Pink or reddish brown. It occurs on the skin of face and extremities of children In histopathology It is usually composed of spindle shaped and large epithelioid nevers With abundant cytoplasm and it is relatively circumscribed Uh nest located at or near the dermal and epidermal interface. It is multi-nucleated And the treatment is conservative excision So that's all about, uh, nevers We have five types, intradermal or intramucosal, junctional, compound, blue and epithelioid spits The intra the mixed pattern Of intradermal and junctional that is seen in the basal region and, uh, Connected tissue, which is known as compound The color is blue and pink here And junctional epithelium has potential to change malignant melanoma Most of the lesions are seen in heart, palate and ginger and the treatment is excision and we should send for Exitional biopsy Okay, so that is all about nevers