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YOU’VE JUST PURCHASED MORE THAN A TEXTBOOK! Evolve Student Learning Resources for Regezi/Sciubba/Jordan: Oral Pathology: Clinical Pathologic Correlations, Seventh Edition, offers the following features: • 3 0 case studies demonstrate “unknown” cases. • 1 50 multiple choice questions (created in the Board Review format). • I nteractive lecture modules for practice in decision-making and proper clinical identifcation of lesions and conditions. • 5 0 image-based questions to test recognition and diagnosis. Activate the complete learning experience that comes with each textbook purchase by registering at http://evolve.elsevier.com/Regezi/oralpathology/ REGISTER TODAY! You can now purchase Elsevier products on Evolve! Go to evolve.elsevier.com/html/shop-promo.html to search and browse for products. 2015v1.0 Oral Pathology: Clinical Pathologic Correlations i This page intentionally left blank CHAPTER iii Oral Pathology: Clinical Pathologic Correlations Seventh Edition Joseph A. Regezi, DDS, MS Professor Emeritus, Oral Pathology University of California San Francisco San Francisco, California James J. Sciubba, DMD, PhD Professor (Ret), Otolaryngology, Pathology, Dermatology Te Johns Hopkins School of Medicine Consultant, Te Milton J. Dance Head & Neck Center Te Greater Baltimore Medical Center Baltimore, Maryland Richard C.K. Jordan, DDS, MSc, PhD, FRCD(C), FRCPath Professor of Oral Pathology, Pathology, Radiation Oncology, and Dermatology University of California San Francisco San Francisco, California 3251 Riverport Lane St. Louis, Missouri 63043 ORAL PATHOLOGY: CLINICAL PATHOLOGIC CORRELATIONS, SEVENTH EDITION ISBN: 978-0-323-29768-4 Copyright © 2017, by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. Tis book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this feld are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identifed, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or other- wise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2012, 2008, 2003, 1999, 1989 International Standard Book Number: 978-0-323-29768-4 Executive Content Strategist: Kathy Falk Professional Content Development Manager: Jolynn Gower Senior Content Development Specialist: Courtney Sprehe Publishing Services Manager: Julie Eddy Project Manager: Mike Sheets Design Direction: Paula Catalano Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 “For my family, Yoon, Amy, Rachel, and Sara” Richard C.K. Jordan Contributors Eric R. Carlson, DMD, MD, FACS Jefery C.B. Stewart, DDS, MS Professor and Kelly L. Krahwinkel Chairman Associate Professor Director of Oral and Maxillofacial Surgery Residency Department of Pathology Program School of Dentistry Director of Oral/Head and Neck Surgery Fellowship Oregon Health and Science University Program Portland, Oregon Department of Oral and Maxillofacial Surgery University of Tennessee Graduate School of Medicine and Richard J. Zarbo, DMD, MD the University of Tennessee Cancer Institute Kathleen D. Ward Endowed Chair of Pathology Knoxville, Tennessee Chair of Pathology Henry Ford Hospital John Kim, MD, FRCP(C) Senior Vice President of Pathology and Laboratory Staf, Radiation Oncologist Medicine Princess Margaret Cancer Centre Henry Ford Health System University Health Network Detroit, Michigan Associate Professor, Department of Radiation Oncology University of Toronto Toronto, Ontario, Canada vi Preface/Acknowledgments Evolve Resources Te latest edition of Oral Pathology: Clinical Pathologic Correlations continues the tradition of presenting oral pa- Student thology in a clinically relevant format in which diseases and conditions are classifed according to their appear- • 30 case studies demonstrate “unknown” cases. Tese ance and presentation. cases provide excellent opportunities to become more familiar with diagnosing lesions and conditions based on What is the beneft of this presentation? clinical presentation. • 150 multiple choice questions (created in the Board Re- Tis presentation is designed to assist the student or clini- view format) provide an excellent review for the NBDE. cian in the recognition of specifc conditions and in the • Each chapter features an accompanying interactive lec- development of diferential diagnosis and a rational treat- ture module that walks the student through decision- ment approach. making practices and proper clinical identifcation of Te correlation of histopathology with clinical features of lesions and conditions. Each module contains case un- the oral diseases illustrated and discussed further enhances knowns in which there are correlations of clinical and the reader’s understanding of underlying processes. Tis radiographic features with histopathology. Also included leads to more skilled diagnoses and improved patient care. in each module are summary slides and additional exam- ples of the diseases presented. To further assist in retaining Key Features this information, a self-assessment quiz is included at the end of each module. • Each chapter begins with a list of diseases or conditions • 50 image-based questions provide an excellent way to that will be covered. Within the chapter are detailed test the reader’s skill at recognition and diagnosis. descriptions of etiology, pathogenesis, clinical features, histopathology, diferential diagnosis, and treatment and Instructor prognosis of the listed diseases. Tis matches what the clinician expects to see in practice and makes this book • An electronic image collection includes all the images a useful tool for the development of diferential diagno- from the text. Tese images are downloadable in various ses and subsequent treatment planning. formats to create lectures and class exercises. • Te atlas-style Clinical Overview section covers the most • Over 500 multiple choice questions are provided common lesions and symptoms in table format with cor- and can be used to create quizzes or fnal exams. Te responding clinical photographs, which facilitates quickly questions follow the Board Review format. locating key information on each condition described • Answer Key for Image-based Questions. whether at the chairside, in the lab, or as a quick review for exam preparation. ACKNOWLEDGMENTS • Over 1,000 high-quality, full-color clinical photographs, radiographs, photomicrographs, and drawings—including Te authors gratefully acknowledge the contributions made advanced imaging and drawings from the authors’ personal by the talented and professional staf at Elsevier. In particu- collections—clearly illustrate various lesions and disease lar, we ofer special thanks to Courtney Sprehe, Senior states. Content Developmental Specialist; Michael Sheets, Project • Almost 200 boxes and tables on clinical conditions are Manager; and Kathy Falk, Executive Content Strategist, found throughout the text, and they provide easy access who were instrumental in making the production of this to key information. book possible. vii Contents Clinical Overview O-1 Leprosy 33 Mucosal (Surface) Lesions O-1 Actinomycosis 34 Vesiculobullous Diseases O-1 Noma 35 Ulcerative Conditions O-6 Fungal Infections 35 White Lesions O-14 Deep Fungal Infections 35 Red-Blue Lesions O-22 Subcutaneous Fungal Infection: Sporotrichosis 37 Pigmented Lesions O-28 Opportunistic Fungal Infections: Mucormycosis Verrucal-Papillary Lesions O-32 (Phycomycosis) and Aspergillosis 37 Submucosal Swelling (By Region) O-36 Immunologic Diseases 38 Gingival Swellings O-36 Aphthous Ulcers 38 Floor-of-Mouth Swellings O-40 Chronic Ulcerative Stomatitis 43 Lips and Buccal Mucosal Swellings O-42 Behçet’s Syndrome 43 Tongue Swellings O-44 Reiter’s Syndrome 44 Palatal Swellings O-46 Erythema Multiforme 44 Neck Swellings O-48 Drug Reactions 47 Diferential Diagnosis Approach to Jaw Contact Allergies 49 Lesions O-52 Clinical Features 49 Cysts of the Jaws and Neck O-52 Wegener’s Granulomatosis (Granulomatosis Odontogenic Tumors O-58 with Polyangiitis) 50 Benign Nonodontogenic Tumors O-62 Midline Granuloma 51 Infammatory Jaw Lesions O-66 Chronic Granulomatous Disease 52 Malignancies of the Jaws O-68 Cyclic Neutropenia 52 Metabolic and Genetic Diseases O-72 Neoplasms 52 Squamous Cell Carcinoma of the Oral Cavity 52 1 Vesiculobullous Diseases 1 Carcinoma of the Maxillary Sinus 73 Viral Disease 1 Basal Cell Carcinoma of the Skin 74 Herpes Simplex Infection 1 Squamous Cell Carcinoma of the Skin 75 Varicella-Zoster Infection 6 Hand-Foot-and-Mouth Disease 8 3 White Lesions 80 Herpangina 9 Hereditary Conditions 80 Measles (Rubeola) 10 Leukoedema 80 Immunologic Disease 11 White Sponge Nevus (Cannon’s Disease) 81 Pemphigus Vulgaris 11 Hereditary Benign Intraepithelial Dyskeratosis 81 Mucous Membrane Pemphigoid 15 Follicular Keratosis (Darier’s Disease) 82 Bullous Pemphigoid 18 Reactive Lesions 83 Dermatitis Herpetiformis 18 Focal (Frictional) Hyperkeratosis 83 Linear Immunoglobulin A Bullous White Lesions Associated with Smokeless Disease (LAD) 19 Tobacco 84 Hereditary Disease 19 Nicotine Stomatitis 86 Epidermolysis Bullosa 19 Hairy Leukoplakia 87 Hairy Tongue (Black Hairy Tongue) 89 2 Ulcerative Conditions 23 Dentifrice-Associated Slough 89 Reactive Lesions 23 Preneoplastic and Neoplastic Lesions 90 Traumatic Ulcerations 23 Actinic Cheilitis 90 Bacterial Infections 27 Actinic Keratoses (Solar Keratoses) 91 Syphilis 27 Idiopathic Leukoplakia 91 Gonorrhea 30 Other White Lesions 95 Tuberculosis 31 Geographic Tongue 95 viii