Oral Pathology Histopathological Diagrams - All in one - Histology made easy

This post contains 33 sorted diagrams of histopathological pictures of pathologies related to oral and maxillofacial regions. From benign to malignant neoplasms of oral cavity, salivary gland tumors, cyst and tumors of jaws and oral cavity, to lesions affecting nerves and muscles and soft tissues, it contains all you need to have a good command in oral pathology. 

These diagrams were drawn with Hematoxylin and Eosin colored Pencils by Raman Dhungel during his Bachelor of Dental Surgery course on third year at B.P. Koirala Institute of Health Sciences, BPKIHS Dharan.  The slides included in this video are: Fibroma, FIbrosarcoma, Papilloma, Verrucous carcinoma, Mild dysplasia, Carcinoma in situ, Squamous cell carcinoma (well differentiated), Neurilemmoma, Neurofibroma, Oral submucous fibrosis, cavernous hemangioma, Lipoma, Lichen planus, malignant melanoma, osteosarcoma, pleomorphic adenoma, warthin's tumor, Adenoid cystic carcinoma, Mucoepidermoid carcinoma, Calcifying epithelial odontogenic tumor, Adenomatoid odontogenic tumor, Keratocystic odontogenic tumor, Dentigerous cyst, Radicular cyst, Plexiform ameloblastoma, Follicular ameloblastoma, Central giant cell granuloma, Peripheral giant cell granuloma, Fibrous dysplasia, Paget's disease of bone, Pemphigus, Pemphigoid (Bullous pemphigoid), and pyogenic granuloma.

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Behcet's Syndrome

Behçet’s syndrome is a multisystem disease that predominantly affects young males and is
characterized by multiple superficial, painful “aphthous-like ulcers” in the oral cavity.
However to fulfill the criteria of being Behçet’s syndrome, clinically there should be a presence of an aphthous-like ulcer in the oral cavity along with at least two of the following lesions e.g. skin lesion, eye lesion or genital lesion, etc.

ETIOLOGY
Etiology of Behcet’s syndrome is unknown; however, the disease is believed to be caused by
some immunologic abnormality.

CLINICAL FEATURES
Oral lesions: Aphthous-like ulceration in the oral cavity.

Skin lesions: Erythematous macular, papular, vesicular or pustular lesions in the skin; thrombophlebitis may also sometimes develop.

Eye lesions: Ocular lesions in Behçet’s syndrome include uveitis, conjunctivitis, photophobia and retinitis, etc.

Genital lesions: Ulceration in the genitalia, which looks similar to those of the oral cavity.

Other lesions: Behcet’s syndrome sometimes presents some additional features like neural,
vascular, articular, renal or gastrointestinal lesions of various kinds.

HISTOPATHOLOGY
Microscopically the lesions produce similar feature to what is found in a minor aphthous ulcer. However, there can be some additional features like severe vasculitis and vascular damage, etc.

TREATMENT
Behçet’s syndrome is treated by systemic steroid therapy.

Pyogenic Granuloma

Pyogenic granuloma represents an over-exuberant tissue reaction to some known stimuli or injuries. The term pyogenic granuloma is somewhat a misnomer since the condition is not associated with pus formation.

CLINICAL FEATURES
Age: occurs at an early age.
Sex: seen more frequently in females.
Site: mostly occurs in relation to the gingiva, however on rare occasions, other mucosal sites may be involved.

PRESENTATION
• The lesion appears as a small, pedunculated or sessile, painless, soft, lobulated growth on the gingiva

• Labial surface of the gingiva is more frequently affected than the lingual surface.

• The lesion is often ulcerated and bleeds profusely, either upon provocation or spontaneously.

• The ulcerated area of the lesion is often covered by a yellow fibrinous membrane.

• The rate of growth of the lesion is very rapid and its maximum size could be up to 1 cm in
diameter

•Untreated lesion of pyogenic granuloma undergoes fibrosis due to decreased vascularity and in such cases it appears small, firm with little tendency to bleed. This lesion is called “fibroepithelial polyp”

• Similar lesions appearing on the gingival tissue of pregnant women are known as “pregnancy tumor”.

HISTOPATHOLOGY 
• Histologically, the lesion is composed of lobular masses of hyperplastic granulation tissue, containing multiple proliferating fibroblasts, many blood capillaries and a variable number of chronic inflammatory cells.

• The lesion is a vascular one and it occurs due to the proliferation of the endothelial cells.

• The overlying epithelium is thin and ulcerated, and in most of the cases the underlying
connective tissue shows intercellular edema.

• Areas of hemorrhage and hemosiderin pigmentation are often seen within the connective tissue stroma.

TREATMENT
Pyogenic granuloma is treated by surgical excision.

Oral Biology Past Question - 2nd Year BDS BPKIHS March 2016

Time: 2 Hours                             Total Marks: 125
1. Mention five points of difference between cellular and acellular cementum.    - 5

2. Mention five points of difference between primary and permanent pulp tissues.    - 5

3. Define Crest of Curvature. Describe the Crest of Curvature of a maxillary canine from all four aspects with a neat labeled diagram.    - 2+4 = 6

4. Describe six points of difference between primary and permanent human dentition.      - 6

5. Describe the labial aspect of the permanent mandibular right lateral incisor.      - 6

6. List and discuss the functions of dental pulp.    - 6

7. Mention the different types of the cementoenamel junction and discuss the formation of any one.  - 6

8. Discuss the phenomenon of formation of Hunter-Schreger band.      - 6

9. Describe late bell stage of amelogenesis with suitable diagram.       - 4+3 = 7

10. List the transitory structures formed during the development of teeth and describe any one.     - 7

11. Discuss the development of periodontal ligament fibers.     - 7

12. Discuss the formation of the root of the permanent mandibular central incisor.   - 7

13. Describe the process of modulation in amelogenesis with suitable diagrams.      - 7

14. Discuss the keyhole pattern of enamel.    - 7

15. Discuss reciprocal induction in context to the development of teeth.     -7

16.  Discuss in detail the anatomy of the permanent maxillary right central incisor.    -10


17. WRITE SHORT NOTES ON: (3*5 = 15)
a. Perikymata
b. Prismless enamel
c. Intermediate plexus
d. Neural crest cells
e. Plexus of Rashkow

18. Define the following. (1*5 = 5)
a. Fossa
b. Ridge
c. Lobe
d. Cingulum
e. Point angle

ABSCESS : Types and Methods of Treatment

An abscess is a cavity filled with pus and lined by a pyogenic membrane. There are three varieties of abscess :

• Pyogenic abscess (commonest)
• Pyaemic abscess
• Cold abscess

Sometimes, the abscess cavity persists, which becomes firm and contains sterile pus. The firmness is due to thickness of its wall. This is known as 'antibioma'. This is due to continuous administration of antibiotics. The lump may even be hard, when it may mimic a carcinomatous lump.

Basic principle of treatment of an abscess is:

• to drain the pus
• to send the pus for culture and sensitivity test, and
• to give proper antibiotic

Drainage of a pus can be obtained by free incision or by Hilton's method. Hilton's method is chosen when there are plenty of important structures like nerves and vessels around the abscess cavity, which are liable to be injured. 

Incision should be made parallel to important structures like nerves and vessels, while the muscle should be incised along the line of the fibers.

Counter incision : When the most prominent part is not the most dependent part, complete drainage of the pus is not possible with single incision. So, counter incision is required at the most dependent part to facilitate the drainage by gravity.

A corrugated rubber drain is usually used for drainage of an abscess cavity. When counter incision is used, the drain extends from the first incision to the counter incision.

Pyaemic Abscess : In this condition, multiple abscesses develop from infected emboli in pyaemia. Pyaemia is a condition characterized by formation of secondary foci of suppuration in various parts of the body. These foci are caused by lodgement of septic emboli formed as a result of  breaking up of an infected thrombus.

Pyaemia  is also seen in acute appendicitis when the infective emboli pass in to the portal venous system and cause portal vein pyaemia. (forming multiple pyaemic liver abscesses) 

Bacteremia Vs Septicemia : 

Bacteremia is the condition in which bacteria circulate in the blood stream. The organisms are usually very rapidly destroyed.

Septicemia is the development of certain clinical manifestations due to liberations of toxins by the bacteria in the blood stream. The manifestations include pyrexia, rigors, hypotension, petechial hemorrhages, etc. In absence of  systemic disease, B hemolytic streptococci. 

Toxaemia : Condition in which toxins, either chemical or bacterial blood circulate in the blood stream

Cold Abscess: This abscess is cold and non reacting in nature. It does not produce hot and painful abscess as seen in pyogenic abscess. It is almost always a sequel of tubercular infection anywhere in the body, commonly in the lymph nodes, bone and joint. Caseation of the lymph nodes forms the cold abscess. The commonest sites are the neck and axilla.

Once the diagnosis is established, full antitubercular regime should be started. An incision should not be made on a cold abscess for drainage, as it almost always invites secondary infection and forms a persistent sinus. Aspiration may be attempted through the normal surrounding skin and not the most prominent and most dependent part as this will innvariably cause sinus formation.

BPKIHS Anatomy Past Questions for MBBS and BDS Second Year - Basic Sciences : Central Nervous System

Anatomy
2016
1. Draw a well-labeled diagram of the transverse section of midbrain at the level of the superior colliculus. 5
2. Write down the blood supply of internal capsule with suitable diagram. 5
3. Mention the blood vessels forming the Circle of Willis along with a diagram. 5
4. Name the lobes of the cerebral cortex. Name the functional areas & the functions related to any one lobe of the cerebral cortex.  5
5. Write a short note on: 2x5=10
a. Medial Medullary Syndrome
b. Nuclei of thalamus

2015
1. Draw a well-labeled diagram of T.S. of midbrain at the level of the superior colliculus. 5
2. Draw a well-labeled diagram of T.S. of spinal cord showing ascending and descending tracts. 5
3. Draw a labeled histological diagram of cerebrum.5
4. Mention nuclei of thalamus with suitable diagram. 5
5. Draw a labeled diagram of Circle of Willis. 5
6. Draw a labeled diagram of the floor of the fourth ventricle. 5

2014
1. Draw a labeled diagram of blood supply of spinal cord. 5
2. Draw a labeled diagram of T.S. of medulla at the level of secondary decussation. 5
3. Enumerate the structures present on the floor of the fourth ventricle with suitable diagram. 5
4. What is corpus callosum? Illustrate with the help of a diagram the different lobe of the cerebral hemisphere. 5
5. Draw a labeled diagram of the circle of Willis. 5
6. Mention the arterial supply of internal capsule. 5
2013
1. Draw a well-labeled diagram of the floor of the fourth ventricle. 5
2. Write blood supply of Internal Capsule. 5
3. Write about Medial lemniscus. 5
4. Write about the White matter of cerebrum. 5
5. Write about the Lateral Medullary Syndrome. 5
6. Draw a labeled diagram of the transverse section of midbrain at the level of the superior colliculus. 5

2012
1. Draw a labeled diagram of the floor of the 4th ventricle. What is neurobiotaxis? 5
2. Name the nuclei of the cerebellum with the phylogenetic origin and draw a labeled diagram of these nuclei. 4+1=5
3. With well-labeled diagram write briefly about the floor of the fourth ventricle. 5
4. What are the structures present in the floor of 4th ventricle? 2.5
5. Write the venous drainage of the cerebrum. 2.5
6. Draw a labeled diagram of Circle of Willis. 5
7. What are the functions of Broadman’s areas 39 and 40? Where are they located? 5

2011
1. Write briefly on: 3x5=15
a. Lateral spinothalamic tract.
b. Red Nucleus.
c. Lateral medullary syndrome

2. Enumerate the deep cerebellar nuclei and write the features of the cerebellar syndrome. 2+3=5
3. Illustrate with a labeled diagram the:
a. Arterial supply of superolateral surface of the cerebrum. 5
b. Structures at the floor of 4th ventricle. 5

Inspirational Story : Struggle is necessary for Success

A man found a cocoon of a butterfly. One day a small opening appeared, he sat and watched the butterfly for several hours as it struggled to force its body through that little hole. Then it seemed to stop making any progress. It appeared as if it had gotten as far as it could and it could go no further.

Then the man decided to help the butterfly, so he took a pair of scissors and snipped off the remaining bit of the cocoon. The butterfly then emerged easily. But it had a swollen body and small, shriveled wings. The man continued to watch the butterfly because he expected that, at any moment, the wings would enlarge and expand to be able to support the body, which would contract in time. Neither happened! In fact, the butterfly spent the rest of its life crawling around with a swollen body and shriveled wings. It never was able to fly.
What the man in his kindness and haste did not understand was that the restricting cocoon and the struggle required for the butterfly to get through the tiny opening were nature’s way of forcing fluid from the body of the butterfly into its wings so that it would be ready for flight once it achieved its freedom from the cocoon.

Sometimes struggles are exactly what we need in our life. If we were allowed to go through our life without any obstacles, it would cripple us. We would not be as strong as what we could have been. And we could never fly.