Pathology of the Head and Neck

334 Pages·2006·16.05 MB·English

Antonio Cardesa · Pieter J. Slootweg (Eds.)
Pathology of the Head and Neck
Antonio Cardesa ·Pieter J. Slootweg (Eds.)

Pathology
of the Head and Neck
With 249 Figures in 308 separate Illustrations
and 17 Tables
123
Professor Dr. Antonio Cardesa
Department of Pathological Anatomy
Hospital Clinic
University of Barcelona
Villarroel 170
08036 Barcelona
Spain
Professor Pieter J. Slootweg
Department of Pathology
University Medical Center St. Radboud
P.O. Box 9101
6500 HB Nijmegen
The Netherlands
Library of Congress Control Number: 2006922731
ISBN-10 3-540-30628-5 Springer Berlin Heidelberg New York
ISBN-13 978-3-540-30628-3 Springer Berlin Heidelberg New York
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To
Gerhard Seifert and to Leslie Michaels,
great pioneers of Head and Neck Pathology
in Europe and founding members
of the Working Group
on Head and Neck Pathology
of the European Society of Pathology.
Foreword
Pathology of the Head and Neck is an easy sounding pathology of the head and neck that remain an unex-
title for a complex subject matter. This title stands for an plored world. Examples include the never-ending prob-
accumulation of diverse diseases occurring in different lem of prognostication of tumour diseases, the patho-
organs whose relationship to each other consists in the genetic significance of tumour precursor lesions and
fact that they are located between the base of the skull the validation of appropriate sets of tumour markers as
and the thoracic aperture. One reason for assembling meaningful predictors of malignancy.
all these different organs under the title “Pathology of The editors of the book, Professor Antonio Carde-
the Head and Neck” is that the proximity of the organs sa and Professor Pieter Slootweg, are leading experts in
of the head and neck region makes it difficult for the the field of the pathology of the head and neck. As such
surgical pathologist to focus on one of these organs and they are the main members of the Working Group on
neglect the pathology of others, which are only a centi- Pathology of the Head and Neck of the European Society
metre apart. A second reason, however, is that the upper of Pathology, one of the first European working groups
digestive tract and the upper respiratory tract, which to be founded under the auspices of the European Soci-
meet in the larynx, have some basic diseases in com- ety of Pathology. In this multi-author book the exper-
mon, notably squamous cell carcinoma. Thus pathology tise of outstanding experts on the pathology of the head
of the head and neck is both an arbitrary compilation of and neck in Europe is reflected. The chapters are char-
diseases and, at least to some extent, a group of disease acterised by the desire to correlate pathology with all
entities with a common morphological and pathoge- necessary information on clinical features, epidemiolo-
netic trunk. gy, pathogenesis and molecular genetics. The authors of
The past years have seen remarkable advances in these chapters have not attempted to be encyclopaedic,
many fields of pathology, including that of the head and but rather have aimed at providing concise, yet adequate
neck. There is a need for a book that integrates surgical knowledge. They are therefore to be warmly commend-
pathology with molecular genetics, epidemiology, clin- ed for providing us with an excellent book, which will
ical behaviour and biology. This book provides a com- prove useful to surgical pathologists involved in the pa-
prehensive description of the manifold aspects of the thology of the head and neck.
morphology and pathology of the organs of the head
and neck region. These description, as comprehensive as Kiel, Germany Günter Klöppel
they may be, also show that there are some areas of the March 2006
Contents IX
Preface
This book was initially conceived as a unitary group of adnexa. The pathology of the thyroid and parathyroid
chapters on “Pathology of the Head and Neck”, to be glands and lymph nodes is covered in greater detail
published in German within the series of volumes of elsewhere.
Remmele’s Textbook of Pathology. From the outset, the Since the authors selected for writing the different
editorial approach was to concentrate on pathological chapters are international experts and members of the
entities that are either unique to or quite characteristic of Working Group on Head and Neck Pathology of the
the head and neck. At the same time, we strove to avoid European Society of Pathology, the chief editors of the
as much as possible unnecessary details on systemic series, Prof. Wolfgang Remmele, Prof. Hans Kreipe and
diseases that, although involving the head and neck Prof. Günter Klöppel, accepted that all manuscripts
region, have their main focus of activity in other organs. should be in English. After the original texts had been
Thus, “Pathology of the Head and Neck” encompasses submitted, it became clear to the editors and publisher
the wide range of diseases encountered in the complex that, in addition to their translation to fit into Remme-
anatomic region extending proximally from the frontal le’s Textbook, the work warranted publication in English
sinuses, orbits, roof of the sphenoidal sinuses and clivus as a separate book. Therefore, we want to thank the chief
to distally the upper borders of the sternal manubrium, editors and the publisher Springer for their stimulating
clavicles and first ribs. This includes the eyes, ears , upper support and trust. We add our special thanks to the au-
aerodigestive tract, salivary glands, dental apparatus, thors who produced such an excellent work, as well as to
thyroid and parathyroid glands, as well as all the those secretaries, photographers and others who helped
epithelial, fibrous, fatty, muscular, vascular, lymphoid, them.
cartilaginous, osseous and neural tissues or structures Finally, we should like to express our wish that this
related to them. book on “Pathology of the Head and Neck”, the first
The contents have been divided into ten chapters. The ever written as a joint project by a Working Group of the
first covers the spectrum of precursor and neoplastic European Society of Pathology, could serve as an example
lesions of the squamous epithelium. It is followed by for new books written by other Working Groups.
chapters devoted to the nasal cavities and paranasal
sinuses, oral cavity, maxillofacial skeleton and teeth, Barcelona, Spain Prof. Antonio Cardesa
salivary glands, nasopharynx and Waldeyer`s ring,
larynx and hypopharynx, ear and temporal bone, Nijmegen, The Netherlands Prof. Pieter J. Slootweg
neck and neck dissection, as well as eye and ocular March 2006
Contents
1 Benign and Potentially Malignant
1.3.2.4 Invasive Front . . . . . . . . . . . . . . . . 15
Lesions of the Squamous Epithelium
1.3.2.5 Stromal Reaction . . . . . . . . . . . . . . 15
and Squamous Cell Carcinoma . . . . 1
1.3.2.6 Diff erential Diagnosis . . . . . . . . . . . . 15
N. Gale, N. Zidar
1.3.2.7 Treatment and Prognosis . . . . . . . . . . 15
1.1 Squamous Cell Papilloma 1.3.3 Spindle Cell Carcinoma . . . . . . . . . . . 16
and Related Lesions . . . . . . . . . . . . . 2 1.3.3.1 Aetiology . . . . . . . . . . . . . . . . . . . 16
1.1.1 Squamous Cell Papilloma, Verruca Vulgaris, 1.3.3.2 Pathologic Features . . . . . . . . . . . . . 16
Condyloma Acuminatum 1.3.3.3 Diff erential Diagnosis . . . . . . . . . . . . 17
and Focal Epithelial Hyperplasia . . . . . 2 1.3.3.4 Treatment and Prognosis . . . . . . . . . . 17
1.1.2 Laryngeal Papillomatosis . . . . . . . . . 3 1.3.4 Verrucous Carcinoma . . . . . . . . . . . . 17
1.3.4.1 Aetiology . . . . . . . . . . . . . . . . . . . 17
1.2 Squamous Intraepithelial Lesions (SILS) 4
1.3.4.2 Pathologic Features . . . . . . . . . . . . . 18
1.2.1 General Considerations . . . . . . . . . . 4
1.3.4.3 Diff erential Diagnosis . . . . . . . . . . . . 18
1.2.2 Terminological Problems . . . . . . . . . 4
1.3.4.4 Treatment . . . . . . . . . . . . . . . . . . . 18
1.2.3 Aetiology . . . . . . . . . . . . . . . . . . . 5
1.3.4.5 Prognosis . . . . . . . . . . . . . . . . . . . 19
1.2.3.1 Oral Cavity and Oropharyn . . . . . . . . . 5
1.3.5 Papillary Squamous Cell Carcinoma . . . . 19
1.2.3.2 Larynx . . . . . . . . . . . . . . . . . . . . 5
1.3.5.1 Aetiology . . . . . . . . . . . . . . . . . . . 19
1.2.4 Clinical Features
1.3.5.2 Pathologic Features . . . . . . . . . . . . . 19
and Macroscopic Appearances . . . . . . . 6
1.3.5.3 Diff erential Diagnosis . . . . . . . . . . . . 20
1.2.4.1 Oral and Oropharyngeal Leukoplakia,
1.3.5.4 Treatment and Prognosis . . . . . . . . . . 20
Proliferative Verrucous Leukoplakia
1.3.6 Basaloid Squamous Cell Carcinoma . . . . 20
and Erythroplakia . . . . . . . . . . . . . . 6
1.3.6.1 Aetiology . . . . . . . . . . . . . . . . . . . 20
1.2.4.2 Laryngeal and Hypopharyngeal
1.3.6.2 Pathologic Features . . . . . . . . . . . . . 20
Leukoplakia and Chronic Laryngitis . . . 7
1.3.6.3 Diff erential Diagnosis . . . . . . . . . . . . 21
1.2.5 Histological Classifi cations . . . . . . . . . 8
1.3.6.4 Treatment and Prognosis . . . . . . . . . . 21
1.2.5.1 WHO Dysplasia System . . . . . . . . . . 8
1.3.7 Adenoid Squamous Cell Carcinoma . . . . 22
1.2.5.2 Th e Ljubljana Classifi cation . . . . . . . . 9
1.3.7.1 Pathologic Features . . . . . . . . . . . . . 22
1.2.5.3 Comparison Between
1.3.7.2 Diff erential Diagnosis . . . . . . . . . . . . 22
the Ljubljana Classifi cation
1.3.7.3 Treatment and Prognosis . . . . . . . . . . 22
and WHO 2005 Classifi cation . . . . . . . 11
1.3.8 Adenosquamous Carcinoma . . . . . . . . 23
1.2.6 Biomarkers Related to Malignant Potential
1.3.8.1 Aetiology . . . . . . . . . . . . . . . . . . . 23
of SILs Recognised by Auxiliary
1.3.8.2 Pathologic Features . . . . . . . . . . . . . 23
and Advanced Molecular Methods . . . . . 12
1.3.8.3 Diff erential Diagnosis . . . . . . . . . . . . 23
1.2.7 Treatment and Prognosis . . . . . . . . . . 12
1.3.8.4 Treatment and Prognosis . . . . . . . . . . 24
1.2.7.1 Oral Cavity and Oropharynx . . . . . . . . 12
1.3.9 Lymphoepithelial Carcinoma . . . . . . . 24
1.2.7.2 Larynx . . . . . . . . . . . . . . . . . . . . . 13
1.3.9.1 Aetiology . . . . . . . . . . . . . . . . . . . 24
1.3 Invasive Squamous Cell Carcinoma . . . . 13 1.3.9.2 Pathologic Features . . . . . . . . . . . . . 24
1.3.1 Microinvasive Squamous 1.3.9.3 Diff erential Diagnosis . . . . . . . . . . . . 25
Cell Carcinoma . . . . . . . . . . . . . . . 13 1.3.9.4 Treatment and Prognosis . . . . . . . . . . 25
1.3.2 Conventional Squamous
1.4 Second Primary Tumours . . . . . . . . . . 25
Cell Carcinoma . . . . . . . . . . . . . . . 13
1.3.2.1 Aetiology . . . . . . . . . . . . . . . . . . . 14 1.5 Tumour Spread and Metastasising . . . . 25
1.3.2.2 Pathologic Features . . . . . . . . . . . . . 14 1.5.1 Invasion of Lymphatic
1.3.2.3 Grading . . . . . . . . . . . . . . . . . . . . 14 and Blood Vessels . . . . . . . . . . . . . . 26
XII Contents
1.5.2 Perineural Invasion . . . . . . . . . . . . . 26 2.6.2 Mucormycosis . . . . . . . . . . . . . . . . . 44
1.5.3 Regional Lymph Node Metastases . . . . . 26 2.6.3 Rhinosporidiosis . . . . . . . . . . . . . . . 44
1.5.3.1 Extracapsular Spread
2.7 HIV-Related Infections . . . . . . . . . . . 44
in Lymph Node Metastases . . . . . . . . . 26
1.5.3.2 Metastases in the Soft Tissue 2.8 Mid-Facial Necrotising
of the Neck . . . . . . . . . . . . . . . . . . 27 Granulomatous Lesions . . . . . . . . . . . 45
1.5.4 Distant Metastasis . . . . . . . . . . . . . . 27 2.8.1 Wegener’s Granulomatosis . . . . . . . . . 45
1.5.5 Micrometastasis . . . . . . . . . . . . . . . 27 2.8.2 Lepromatous Leprosy . . . . . . . . . . . . 45
2.8.3 Tuberculosis . . . . . . . . . . . . . . . . . . 45
1.6 Molecular Pathology
2.8.4 Sarcoidosis . . . . . . . . . . . . . . . . . . . 45
of Squamous Cell Carcinoma . . . . . . . 28
2.8.5 Rhinoscleroma . . . . . . . . . . . . . . . . 45
1.6.1 Detecting Tumour Cells . . . . . . . . . . 28
2.8.6 Leishmaniasis . . . . . . . . . . . . . . . . . 45
1.6.2 Clonal Analysis . . . . . . . . . . . . . . . 28
2.8.7 Cocaine Abuse . . . . . . . . . . . . . . . . 46
1.6.3 Assessment of Risk
2.8.8 Local Steroid Injections . . . . . . . . . . . 46
for Malignant Progression . . . . . . . . . 29
1.6.4 DNA/RNA Profi ling 2.9 Benign Epithelial Neoplasms . . . . . . . . 46
in Predicting Metastatic Disease . . . . . . 29 2.9.1 Sinonasal Papillomas . . . . . . . . . . . . . 46
2.9.1.1 Squamous Cell Papilloma . . . . . . . . . . 46
References . . . . . . . . . . . . . . . . . . 29
2.9.1.2 Exophytic Papilloma . . . . . . . . . . . . . 46
2.9.1.3 Inverted Papilloma . . . . . . . . . . . . . . 46
2 Nasal Cavity
2.9.1.4 Oncocytic Papilloma . . . . . . . . . . . . . 47
and Paranasal Sinuses . . . . . . . . . . 39
2.9.2 Salivary-Type Adenomas . . . . . . . . . . 48
A. Cardesa, L. Alos
2.9.3 Pituitary Adenomas . . . . . . . . . . . . . 48
2.1 Introduction . . . . . . . . . . . . . . . . . . 40
2.10 Benign Sinonasal
2.1.1 Embryology . . . . . . . . . . . . . . . . . . 40
Soft Tissue Neoplasms . . . . . . . . . . . . 48
2.1.2 Anatomy . . . . . . . . . . . . . . . . . . . . 40
2.10.1 Haemangiomas . . . . . . . . . . . . . . . . 48
2.1.3 Histology . . . . . . . . . . . . . . . . . . . . 40
2.10.2 Haemangiopericytoma . . . . . . . . . . . . 48
2.2. Acute and Chronic Rhinosinusitis . . . . . 40 2.10.3 Solitary Fibrous Tumour . . . . . . . . . . . 48
2.2.1 Viral Infections (Common Cold) . . . . . . 40 2.10.4 Desmoid Fibromatosis . . . . . . . . . . . . 49
2.2.2 Bacterial Infections . . . . . . . . . . . . . . 40 2.10.5 Fibrous Histiocytoma . . . . . . . . . . . . 49
2.2.3 Allergic Rhinitis . . . . . . . . . . . . . . . 40 2.10.6 Leiomyoma . . . . . . . . . . . . . . . . . . 49
2.2.4 Atrophic Rhinitis . . . . . . . . . . . . . . . 41 2.10.7 Schwannoma and Neurofi broma . . . . . . 49
2.2.5 Hypertrophic Rhinitis . . . . . . . . . . . . 41 2.10.8 Meningioma . . . . . . . . . . . . . . . . . . 50
2.2.6 Non-Suppurative Chronic Sinusitis . . . . 41 2.10.9 Paraganglioma . . . . . . . . . . . . . . . . 50
2.10.10 Juvenile Angiofi broma . . . . . . . . . . . . 50
2.3 Sinonasal Polyps . . . . . . . . . . . . . . . 41
2.3.1 Allergic Polyposis . . . . . . . . . . . . . . . 41 2.11 Malignant Sinonasal Tumours . . . . . . . 50
2.3.2 Polyposis in Mucoviscidosis . . . . . . . . . 41 2.11.1 Keratinising Squamous
2.3.3 Polyposis in Immotile Cilia Syndrome Cell Carcinoma . . . . . . . . . . . . . . . . 51
and in Kartagener’s Syndrome . . . . . . . 41 2.11.2 Cylindrical Cell Carcinoma . . . . . . . . . 52
2.3.4 Antrochoanal Polyps . . . . . . . . . . . . . 41 2.11.3 Sinonasal
Undiff erentiated Carcinoma . . . . . . . . 53
2.4 Sinonasal Hamartomatous
2.11.4 Small Cell (Neuroendocrine)
and Teratoid Lesions . . . . . . . . . . . . . 42
Carcinoma . . . . . . . . . . . . . . . . . . . 54
2.4.1 Hamartomas . . . . . . . . . . . . . . . . . 42
2.11.5 Primary Sinonasal
2.4.2 Teratoid Lesions . . . . . . . . . . . . . . . 42
Nasopharyngeal-Type
2.5 Pseudotumours . . . . . . . . . . . . . . . . 43 Undiff erentiated Carcinoma . . . . . . . . 54
2.5.1 Mucocele . . . . . . . . . . . . . . . . . . . . 43 2.11.6 Malignant Melanoma . . . . . . . . . . . . 55
2.5.2 Organising Haematoma . . . . . . . . . . . 43 2.11.7 Olfactory Neuroblastoma . . . . . . . . . . 57
2.5.3 Amyloidosis . . . . . . . . . . . . . . . . . . 43 2.11.8 Primitive Neuroectodermal Tumour . . . . 58
2.5.4 Myospherulosis . . . . . . . . . . . . . . . . 43 2.11.9 High-Grade Sinonasal
2.5.5 Eosinophilic Angiocentric Fibrosis . . . . 43 Adenocarcinomas . . . . . . . . . . . . . . 58
2.5.6 Heterotopic Brain Tissue . . . . . . . . . . 43 2.11.9.1 Intestinal-Type
Adenocarcinoma . . . . . . . . . . . . . . . 58
2.6 Fungal Diseases . . . . . . . . . . . . . . . . 44
2.11.9.2 Salivary-Type High-Grade
2.6.1 Aspergillosis . . . . . . . . . . . . . . . . . 44
Adenocarcinoma . . . . . . . . . . . . . . . 60
Contents XIII
2.11.10 Low-Grade Sinonasal 3.4.7 Hairy Tongue . . . . . . . . . . . . . . . . . 85
Adenocarcinomas . . . . . . . . . . . . . . . 60 3.4.8 Hairy Leukoplakia . . . . . . . . . . . . . . 85
2.11.10.1 Non-Salivary-Type 3.4.9 Geographic Tongue . . . . . . . . . . . . . 85
Low-Grade Adenocarcinomas . . . . . . . 60 3.4.10 Frictional Keratosis . . . . . . . . . . . . . 86
2.11.10.2 Salivary-Type
3.5 Pigmentations . . . . . . . . . . . . . . . . 86
Low-Grade Adenocarcinomas . . . . . . . 61
3.5.1 Amalgam Tattoo . . . . . . . . . . . . . . . 86
2.11.11 Sinonasal Malignant Lymphomas . . . . . 61
3.5.2 Localised Melanotic Pigmentation . . . . 86
2.11.12 Extramedullary Plasmacytoma . . . . . . 62
3.5.2.1 Oral Melanotic Macules . . . . . . . . . . . 86
2.11.13 Fibrosarcoma . . . . . . . . . . . . . . . . . 62
3.5.2.2 Melanoacanthoma . . . . . . . . . . . . . . 87
2.11.14 Malignant Fibrous Histiocytoma . . . . . 63
3.5.2.3 Pigmented Naevi . . . . . . . . . . . . . . . 87
2.11.15 Leiomyosarcoma . . . . . . . . . . . . . . . 63
3.5.3 Premalignant Oral Melanoses
2.11.16 Rhabdomyosarcoma . . . . . . . . . . . . . 63
and Oral Melanoma . . . . . . . . . . . . . 87
2.11.17 Malignant Peripheral
3.5.4 Addison Disease . . . . . . . . . . . . . . . 88
Nerve Sheath Tumour . . . . . . . . . . . . 63
3.5.5 Peutz Jeghers Syndrome . . . . . . . . . . . 89
2.11.18 Teratocarcinosarcoma . . . . . . . . . . . . 63
3.5.6 Racial Pigmentation . . . . . . . . . . . . . 89
References . . . . . . . . . . . . . . . . . . 64 3.5.7 Laugier Hunziker Syndrome . . . . . . . . 89
3.5.8 Smoker’s Melanosis . . . . . . . . . . . . . 89
3 Oral Cavity . . . . . . . . . . . . . . . . . 72 3.5.9 Drug-Associated
J.W. Eveson Oral Pigmentation . . . . . . . . . . . . . 90
3.1 Embryonic Rests and Heterotopias . . . . 72 3.6 Hyperplastic Lesions . . . . . . . . . . . . 90
3.1.1 Fordyce Granules/Spots . . . . . . . . . . . 72 3.6.1 Fibrous Hyperplasias . . . . . . . . . . . . 90
3.1.2 Juxtaoral Organ of Chievitz . . . . . . . . 72 3.6.2 Papillary Hyperplasia . . . . . . . . . . . . 90
3.6.3 Generalised Gingival
3.2. Vesiculo-Bullous Diseases . . . . . . . . . 72
Fibrous Hyperplasia . . . . . . . . . . . . . 91
3.2.1 Herpes Simplex Infections . . . . . . . . . 72
3.6.4 Crohn’s Disease . . . . . . . . . . . . . . . 91
3.2.2 Chickenpox and Herpes Zoster . . . . . . 73
3.6.5 Orofacial Granulomatosis . . . . . . . . . 92
3.2.3 Hand-Foot-and-Mouth Disease . . . . . . 73
3.6.6 Chronic Marginal Gingivitis
3.2.4 Herpangina . . . . . . . . . . . . . . . . . . 74
and Localised Gingival
3.2.5 Pemphigus Vulgaris . . . . . . . . . . . . . 74
Fibrous Hyperplasia . . . . . . . . . . . . . 92
3.2.6 Pemphigus Vegetans . . . . . . . . . . . . . 74
3.6.7 Peripheral Giant Cell Granuloma
3.2.7 Paraneoplastic Pemphigus . . . . . . . . . 75
(Giant Cell Epulis) . . . . . . . . . . . . . . 93
3.2.8 Mucous Membrane Pemphigoid . . . . . . 75
3.6.8 Pyogenic Granuloma . . . . . . . . . . . . 93
3.2.9 Dermatitis Herpetiformis . . . . . . . . . 76
3.6.9 Pulse (Vegetable) Granuloma . . . . . . . 93
3.2.10 Linear IgA Disease . . . . . . . . . . . . . . 76
3.2.11 Erythema Multiforme . . . . . . . . . . . . 77 3.7 Benign Tumours
and Pseudotumours . . . . . . . . . . . . . 94
3.3 Ulcerative Lesions . . . . . . . . . . . . . . 77
3.7.1 Giant Cell Fibroma . . . . . . . . . . . . . 94
3.3.1 Aphthous Stomatitis
3.7.2 Lingual Th yroid . . . . . . . . . . . . . . . 94
(Recurrent Aphthous Ulceration) . . . . . 77
3.7.3 Verruciform Xanthoma . . . . . . . . . . . 95
3.3.2 Behçet Disease . . . . . . . . . . . . . . . . 78
3.7.4 Haemangiomas . . . . . . . . . . . . . . . . 95
3.3.3 Reiter Disease . . . . . . . . . . . . . . . . 78
3.7.5 Lymphangioma . . . . . . . . . . . . . . . . 95
3.3.4 Median Rhomboid Glossitis . . . . . . . . 78
3.7.6 Benign Nerve Sheath Tumours . . . . . . . 95
3.3.5 Eosinophilic Ulcer
3.7.6.1 Neurofi broma . . . . . . . . . . . . . . . . 96
(Traumatic Ulcerative Granuloma
3.7.6.2 Schwannoma . . . . . . . . . . . . . . . . . 96
with Stromal Eosinophilia) . . . . . . . . . 79
3.7.6.3 Neurofi bromatosis . . . . . . . . . . . . . . 96
3.3.6 Acute Necrotising
3.7.6.4 Multiple Neuromas
Ulcerative Gingivitis . . . . . . . . . . . . . 79
in Endocrine Neoplasia Syndrome . . . . 96
3.3.7 Wegener’s Granulomatosis . . . . . . . . . 80
3.7.7 Granular Cell Tumour
3.3.8 Tuberculosis . . . . . . . . . . . . . . . . . 81
(Granular Cell Myoblastoma) . . . . . . . 96
3.4 White Lesions . . . . . . . . . . . . . . . . 81
3.8 Squamous Cell Carcinoma . . . . . . . . . 96
3.4.1 Candidosis . . . . . . . . . . . . . . . . . . 81
3.8.1 Introduction . . . . . . . . . . . . . . . . . 96
3.4.2 Lichen Planus . . . . . . . . . . . . . . . . . 82
3.8.2 Clinical Features . . . . . . . . . . . . . . . 97
3.4.3 Lupus Erythematosus . . . . . . . . . . . . 83
3.8.2.1 Buccal Mucosa . . . . . . . . . . . . . . . . 97
3.4.4 Oral Epithelial Naevi . . . . . . . . . . . . 84
3.8.2.2 Tongue . . . . . . . . . . . . . . . . . . . . 97
3.4.5 Smoker’s Keratosis . . . . . . . . . . . . . . 84
3.8.2.3 Floor of Mouth . . . . . . . . . . . . . . . . 97
3.4.6 Stomatitis Nicotina . . . . . . . . . . . . . 84