Fibrosarcoma: Causes, Diagnosis, and Treatment

1. Fibrosarcoma

• Malignant neoplasm of fibroblasts.
• May arise from the periosteum/extraosseous soft tissue.
• Fibrosarcoma are composed of spindle shaped cells with
  hyperchromatic nuclei many of which are exceptionally large.
• Through out specimen there are bones of tissue in which the cells are oriented in one direction giving them a Herring appearance. Some of the bands are at a right angles to others.

2. Lichen Planus

• Histologic features of the lichen planus include: Liquefaction degeneration of the basal layer Saw-toothed rate pegs.
• Prominent granular layer.
• Moderate deposit of orthokeratosis/rarely parakeratosis.
• Intense inflammatory cell infiltration in intimate relation to epithelium, limited to upper lamina propria.

3. Calcified Epithelial Odontogenic Tumm

• Histologically composed of sheets of polyhedral epithelial cells in a connective tissue stroma, these closely packed cells sometimes are divided into islands or strands by stroma.
• The nuclei are variable in size and shape.
• The eosinophillic cytoplasm degenerates & tends to calcify with formation of “Liesegang rings”.
• Amyloid has been described in tumour cells and stroma.

4. Follicular Ameloblastoma

• It may arise from remnants of the dental lamina, from epithelial rests of malassez, Enamal organ (or) sometimes from lining cells of dentigerous cysts.
• Follicular ameloblastoma consists of epithelial islands having peripheral cells representing of ameloblasts with central delicate tissue of stellate reticulum type.
• The follicles are separated by delicate connective tissue stroma.

5. Central Giant Cell Granuloma

• Occurs as a central lesion with in bone.
• Histologically demonstrates spindle cells stroma and multinucleated giant cells.
• Other characteristic features include Haemosiderin filled macrophages and numerous red blood cells located in sinusoidal spaces and extravascularly.
• Numerous inflammatory cells are also seen.

6. Intra Epithelial Carcinoma

• Keratin may (or) may not be found on the surface of the lesion if present it is more cyst to be parakeratin rather than orthokeratin.
• These appear to be the hallmark of transformation of the carcinoma in situ into the invasive carcinoma.
• One of the most conspicuous and consistent alteration in loss of orientation of cells and loss of their normal polarity.

7. Odontogenic Keratocyst

• The epithelium is corrugated thin 6-10 layers thick. The basement membrane show picket fence/ palisaded arrangement of nuclei.
• The surface is parakeratinised, sometimes orthokeratinised.
• The connective tissue wall shows delicate fibers with few inflammatory cells.

8. Fordyce’s Spots

• Numerous small light yellow macular areas formed in the Buccal mucosa and sometimes lips: Retromolar areas.
• They are ectopic, sebaceous glands in close relation to covering epithelium.
• More prominent after puberty and rarely seen in children.
• Inoocous and need no treatment.

9. Squamous Cell Carcinoma

• The epithelium is dysplastic.
• The superficial tissue is infiltrated heavily with inflammatory cells.
• Sometimes large/small nuclear hyaline masses are seen in connective tissue “Keratin Pearls” suggestive of well and moderately differentiated squamous cell carcinoma.
• Nests of a typical epithelial cells seen infiltrating the connective tissue.

10. Plexiform Ameloblastoma

• In this solid type of ameloblastoma there is very
• little connective tissue stroma
• Numerous islands of epithelial cells closely approximate each other.
  These islands are bordered by palysaded columnar cells that resemble ameblasts.
• In central position of each aggregation in a loose network ofcells suggestion of stellate reticulum.

11. Basal Cell Carcinoma

• The malignant epithelial cells are oval/cylindrical and have deeply staining nuclei.
• These cells are arranged in islands of various sizes and shapes.
• At the periphery of each island there is single row of radially oriented cells.
• Basal cell carcinoma arises from the basal cells of epidermis.

12. Pleomorphic Adenoma

• The most common salivary gland neoplasm. The epithelial component of tumour may consist of round, polyhedral, elongated/stellate cells, stellate cells staining uniformly, these cells are arranged in strands, islands duct like structures/large masses.
• The mesenchymal portion of neoplasm composed of fibrous tissue (dense hyalinised, loose arranged of myxoid; pseudo cartilage on bone).

13. Periapical Cyst/Radicular Cyst

• Arises in long standing cases of periapical granuloma.
• Radiologically appears as radiolucent area.
• The epithelium is stratified squamous type, arises from epithelial rest proliferation.
• The connective tissue wall of the cyst in continuous with the periodontal ligament.
• The upper cavity is filled with tissue debris and fluid.

14. Mucoepidermoid Carcinoma

• The mucoepidermoid carcinoma consists of mucous cells; epidermoid cells and intermediate cells.
• The neoplastic cells may be arranged in sheets/islands, they may also form thick walled duct like structures.
• The stroma shows presence of mucous surrounded by inflammatory cells.

15. Cavernous Hemangioma

• Benign tumour of blood vessel Developmental anomalies.
• Two types: Capillary Cavernous
• Haemangiomas are blue, purple, purplish red in colour and blanched when pressure in applied.
• Cavernous haemangiomas show large vascular endotheliumlined spaces containing numerous blood vessels.
• Haemangiomas are not capsulated

16. Adenomatoid Odontogenic Tumour.

• Histologically several duct like structures lined by a simple row of columnar epithelial cells are apparent. Structures, typical of adinomastoid odontogenic tumour consists of double row of tall epithelial cells with basally placed nuclei.
• Between the two rows of cells in a dark staining material that appears to have been secreted by cells.

17. Paget’s Disease

• Disease of uncertain etiology
• Characterised by rapid resorption and extensive deposition of bone in a manner not related to functional needs.
• The dark-blue staining irregularly curved line indicate where resorption ceased and osteoid was again deposited “Mosaic Pattern”.
• The marrow is fibrous and vascular.

18. Periapical Granuloma

• Periapical inflammation if not reached leads to periapical granuloma.
• A large area of bone is replaced by granulomatous tissue in which is numerous inflammatory cells.
• Periapical granuloma if not treated can progress to periapical cyst.

19. Adenoid Cystic Carcinoma

• Tumour consists of small dark staining cells arranged in groups (or) anastomosing cords of cells that surrounded by various sized and shapes.
• Dense cords of hyaline stroma separates groups epithelial cells.
• It is non encapsulated, slow growing tumour, with distinct metastasis and frequent recurrence.

20. Pit And Fissure Caries

• This form of caries occur in pit and fissure of teeth.
• Presents as a small opening leading to a large carious lesion.
• The carious process results in a cone shaped lesion with base towards the dentino-Enamel junction.

21. Dental Caries (Inter Proximal Caries)

• The initial lesion of the dentinal caries, clinically is a white spot which may become stained.
• Histologically the appearance of lesion on the interproximal surfaces is a cone shaped region of the decalcification with its broad base at the surface.