Student Names: Jessica Udovich, Miguel, & Helena

RDH 220 Oral Pathology

Case Study Assignment
Assignment #6 - Due 1/10/2022

Directions: You can work with your group of up to four students to complete this assignment. It may
be hand-written. Follow the directions for each case separately as they are given below.
When submitting – Please just include the case number and your responses. There is no need to
submit the photos or x-rays and patient information. Please submit for each student under assignment
#6. (14 Case Studies 10 Points Each 140 Points total)

Case #1
Patient: 25 year old man

Chief Complaint: Patient requests a routine

examination.
Medical History: No abnormalities are identified.
Dental History: No abnormalities are identified.
Clinical Findings: Tooth #32 is unerupted and
displaced by a well circumscribed radiolucent lesion
associated with the crown of the tooth.

Conditions/lesions to exclude from your differential diagnosis:

1. Radicular cyst Why? Well circumscribed radiolucency but associated with the roots of non-
vital teeth
2. Calcifying cys c odontogenic tumor Why? Around crown of the tooth but ghost cells are the
main di erence that is not in this radiograph
3. Erup on cyst Why? No abnormali es with the gingiva noted but also a radiolucency that
occurs around the crown of the tooth.
4. Residual cyst Why? Forms a er tooth extrac ons and this pa ent s ll has all his teeth but
#32 is impacted
5. Ameloblastoma Why? Majority occur in the mandible but has a mul ocular (soap bubble)
appearance
Conditions/lesions to include in the Differential Diagnosis:
- Primordial cyst
-Odontogenic keratocyst

ti
ff

ti

ft

ti

ti

ti

ti
ti

 Final Diagnosis: Dentigerous cyst

Justification: Forms around crown of unerupted/impacted 3rd molars, well defined radiolucency that
occurs within the bone

What usually causes this condition? Unerupted or impacted tooth

Case #2
Patient: Young adult.

Case record:
Chief Complaint: Patient complains of painful oral
ulcers of five days duration. The patient has not noticed
blisters. The lesions have occurred five times
previously, always in the same location. The lesions
resolved in two weeks for each episode.
Medical History: No abnormalities identified.
Dental History: An amalgam restoration was placed in
a maxillary right tooth one week ago.
Clinical Findings: Multiple ulcers are present on the
right hard palate in the first molar region. The lesions
are tender when palpated and are not thickened.

Conditions to exclude:
1. Aspirin burn Why? Tissue becomes necro c and white before leaving and ulcer but this
pa ent did not have ssue coming o before the ulcer appeared.
2. Herpangia Why? Vesicles on palate with fever, sore throat, and di culty swallowing which
pa ent has not no ced blisters
3. Necro zing sialometaplasia Why? Blockage of salivary glands causes ulcers on the palate but
rarely reoccurs and makes it unlikely this pa ent had it ve mes.
4. Syphilis secondary mucous patches Why? Ulcers are painless and covered in gray/ white
plaques
5. Depp fungal infec on Why? Non healing ulcers but pa ent’s ulcers healed within the 2 weeks

ti
ti
ti

ti
ti
ti

ff

ti
ti

ti
fi
ti
ffi

 Conditions/lesions to Include in the Differential Diagnosis:

—Aphthous ulcers
—Burn from hot food
—HIV infection
—Herpes simplex virus (recurrent)
—Canker sores
Final Diagnosis: Traumatic ulcer

Justification: Keeps reoccurring in same area but clears up after 2 weeks (normal healing time),
could be the patient is eating something really hot that is causing trauma to the roof of their mouth

What usually causes this condition? Cheek/ lip/ tongue biting, denture irritation, mucosal injury,
over brushing.

Patient: Adult, either sex.

Chief Complaint: Patient requests a routine

examination.
Medical History: No abnormalities identified.
Dental History: No abnormalities identified. The
patient does not wear dentures.
Clinical Findings: Multiple, blue to black areas with
irregular borders are located on the right maxillary
tuberosity, hard palate, and soft palate. The pigmented
lesions are nontender and smooth to palpation. They do
not blanch and do not rub off. Some of the lesions are
flat and nonthickened, while other areas are thickened
and firm to palpation. All the pigmented areas are fixed
to the surface mucosa, but only the thickened areas are
fixed to the underlying structures. No radiographic
abnormalities are identified. The patient was unaware of
the lesions. There are no palpable lymph nodes or other
palpable masses. No skin lesions are identified.

Conditions to exclude:

 1. Black hairy tongue Why? Similar color but occurs on the tongue and not the palate or
mucosa
2. Hemangioma Why? Similar in color but is more vascular and bulges out from the mucosa
3. Melanosis Why? Normal pigmenta on of the skin but no change in skin texture
4. Nevus Why? Well circumscribed and uniform in color (looks more like a mole)
5. Hutchinson’s freckle Why? Tends to occur on the sun exposed skin of the face, neck, and
scalp
Conditions/lesions to Include in the Differential Diagnosis:
—Nicotine stomatitis
—Melanoma
—Hyperpigmentation
—kaposi sarcoma
—hematoma
Final Diagnosis: Malignant melanoma

Justification: rapidly enlarging black/blue mass with irregular borders, most common on palate and
gingiva

What usually causes this condition? Too much exposure to the sun that can spread from the skin to
oral cavity

Case #4
Patient: 14 year old woman.
Chief Complaint: Patient reports a slowly
progressive enlargement.
Medical History: No abnormalities are identified.
Dental History: No abnormalities are identified.
Clinical Findings: The progressive enlargement of
the right face is of 4 years duration. The enlargement
is nonpainful. Panoramic radiograph reveals a
diffuse uniform radiopaque lesion of the right
maxillary sinus. No other abnormalities are
identified

Hint: it is not well-circumscribed; it

is diffuse and there is a characteristic
look to the bone. There is
progressive swelling on her facial
4(buccal) plate.

ti

 Conditions/lesions to exclude from your differential diagnosis:

1. Central cemen fying and central ossifying broma Why? This is not it because most cases are
in the mandible and is well-circumscribed as well as occurring in adult females aged 30+

2. Bening cementoblastoma Why? This is a well de ned radiopaque mass and the one above is
not well-circumscribed, it is also painful and the pa ent above has no pain and it’s been
growing for 4 years

3. nasolabial cyst Why? Because it is a swelling near maxillary canine and oor of nose and the
swelling in the pa ent above is on the right face and has no bone involvement

4. Glandular odontogenic cyst Why? Because this is seen in ages 50-59 and has mul cys c
lesions

5. Aneurysmal bone cyst Why? Because this is a blood- lled space surrounded by
mul nucleated giant cells and brous connec ve ssue and is more of a honeycomb or soap
bubble appearance vs the radiopaque lesion on the pa ent

Conditions/lesions to include in the Differential Diagnosis:

-- Osteogenic sarcoma
-- nonodontogenic cyst
-- adenomatoid odontogenic tumor
-- Nasopalatine cyst

Final Diagnosis: Adenomatoid odontogenic cyst

Justification: this is an encapsulated benign epithelial odontogenic tumor more common in the
maxilla with 70% occurring in females younger than 20 years of age and 70% involves the
anterior portion of the maxilla

What usually causes this condition? Impacted teeth usually associated with this condition

ti

ti
ti

fi

fi
ti
fi
ti

ti
ti
fi

fl

ti
ti

 Case # 5
Patient: 58 year old man
Chief Complaint: The patient reports swelling in the
left mandible of 3 months duration. The swelling is not
painful.
Medical History: No abnormalities are identified.
Dental History: No abnormalities are identified.
Clinical Findings: Nontender bony expansion is
palpated in the left body of the mandible. Radiographic
examination reveals a radiolucent lesion with well-
defined, corticated borders. No other abnormalities are
identified.

Note: This case is about finding the pathology to exclude, and finding the pathology to include.
There is no way to know for sure what this is without a histological examination and biopsy.
State 5 lesions to include in your differential diagnosis, and state why you are including them:
1. Keratocys c odontogenic tumor

2. Sta c bone cyst

3. Calcifying epithelial odontogenic tumor

4. Calcifying Cys c Odontogenic Tumor

5. Residual cyst

Why are you including the ones listed above? I have included all of the above because they are all
well-defined radiolucency’s that are similar to what is being shown in the x-ray above as well as what
is described. It is also in the premolar area and most of the ones listed above have to do with that area
State 4 lesions to exclude and state why you are including them:
1. Aneurysmal bone cyst

2. Simple bone cyst

3. Primordial cyst

4. Ameloblastoma

Why are you excluding the ones listed above? I have decided to exclude the ones above because they
are similar to the x-ray but most are having to do with a tooth and the x-ray above has no tooth where
the radiolucency is present. Also some of them have to do with being more in the posterior/molar
region and this is in the premolar area

ti

ti

ti

 Case # 6
Patient: 37 year old man
Chief Complaint: Patient requests a routine
examination.
Medical History: No abnormalities are identified.
Dental History: No abnormalities are identified.
Clinical Findings: During routine radiographic
examination, a radiolucent lesion with well
defined borders is noted in the mandibular right
body of the mandible. There appear to be
radiopaque areas within the radiolucent areas.

Note: This case is about finding the pathology to exclude, and finding the pathology to include.
There is no way to know for sure what this is without a histological examination and biopsy.
State 7 lesions to include in your differential diagnosis, and state why you are including them:

1. Calcifying cys c odontogenic tumor

2. Aneurysmal bone cyst

3. Ameloblastoma

4. Pindborg tumor

5. Calcifying cys c odontogenic tumor

6. Trauma c bone cyst

7. Primordial cyst

- I included all of these because they are all are cysts that have other radiopaque areas within the
radiolucency or mul locular appearances.

State 7 lesions to exclude and state why you are including them:
1. Residual cyst

2. Keratocys c odontogenic tumor

3. Botryoid odontogenic cyst

4. Sta c bone cyst

5. Odontogenic myxoma

ti
ti
ti

ti
ti

ti

 6. Central ossifying bromas

7. Ameloblas c bro-odontoma

- I chose these lesions to be excluded because although some are in the correct area they are mostly
all unilocular and do not match with what the pa ent is showing above. Also the lesions listed above
are around the apices of teeth and the pa ent above has no teeth in the area where the lesion is.

Case # 7
Patient: 31 year old adult, either sex.
Chief Complaint: The patient is concerned about
a bony swelling of the mandible. The lesion is
persistent, progressively increasing in size,
nontender and of several months duration. The
patient reports bruising the swelling when
chewing something hard.
Medical History: No abnormalities are
identified.
Dental History: No dental abnormalities relevant
to the diagnosis of this case are identified.
Clinical Findings: The enlargement involves the
right posterior alveolus and body of the mandible
with evidence of buccal and lingual expansion.
The enlargement is firm and nontender. Crepitus
is evident on palpation of the lingual cortical
plate. The mandibular right first molar
demonstrates vertical mobility. Radiographic
examination reveals a circumscribed, delineated,
radiolucent lesion with a corticated border in the
right body and ramus of the mandible. The second
molar is displaced posteriorly and inferiorly.
There is directional root resorption of the first
molar. The inferior mandibular cortical plate is
thinned. Neuropathy, thrill and bruit are not
present.
Note: Again, this case is about finding the pathology to exclude, and finding the pathology to include. There is no way
to know for sure what this is without a histological examination and biopsy.

ti
fi

fi

ti

ti

 State 5 lesions to include in your differential diagnosis, and state why you are including them:

1. Den gerous cyst- develops on a crown of a developing or un-erupted tooth

2. Odontogenic myxoma- it can displace teeth because of its size

3. Odontogenic keratocyst- usually found in the jaw in the 3rd molar region

4. Ameloblastoma- 80% are found in the mandible in the 3rd molar region

5. Ameloblas c bro-odontoma- typically found in posterior region of the jaw

State 3 lesions to exclude and state why you are exluding them:

1. Erup on cyst- this develops in place of a tooth and this men ons it being around rst and 2nd
molars

2. Primordial cyst- This is a 31 year old so no new teeth should be erup ng

3. Lateral periodontal cyst- this is located in the canine and premolar region

What is your best guess as to the diagnosis? Odontogenic Keratocyst

Case #8
Patient: Young adult, either sex
Chief Complaint: The patient complains of a
persistent, progressive, tender swelling of three
weeks duration. The patient is not aware of the
lesion bleeding, and there is no history of trauma
to the area.
Medical History: No abnormalities are
identified. Dental History: No abnormalities are
identified.
Clinical Findings: The lesion is a circumscribed,
2 x 3 cm swelling posterior to the right maxillary
tuberosity with extension onto the soft and hard
palate. The ulcerated portion of the lesion bleeds
during the examination. The lesion appears to be
of submucosal origin because the epithelium is
not thickened, rough, or uneven. The lesion is
firm, mildly tender, and fixed to surface mucosa
and underlying structures. The surface is smooth
and does not blanch. No lymphadenopathy.

ti
ti

ti

fi

ti

ti

fi

 State 4 lesions to include in your differential diagnosis, and state why you are including them:

1. Pleomorphic adenoma- most common loca on is the palate

2. Adenoid cys c carcinoma- might be painful on the so or hard palate

3. Mucoepidermoid carcinoma- major gland tumor found on palate

4. Squamous cell carcinoma- can be found on palate or molar areas

State 3 lesions to exclude and state why you are including them:

1. Basal cell carcinoma- not seen in the oral cavity

2. Verrucous carcinoma- numerous papillary projec ons “wart like”

3. Erythroplakia- smooth, granular or velvety patch

What is your educated guess as to the diagnosis? Pleomorphic adenoma

What usually causes this condition? Obstraction of salivary glands

Case # 9
Patient: Young adult, either sex.
Chief Complaint: The patient complains of a persistent,
nontender soft tissue enlargement of six months
duration. The lesion has not changed in size during the
past three or four months.

Medical History: No abnormalities are identified.

Dental History: No abnormalities are identified.

Clinical Findings: The lesion is a well-circumscribed,

pedunculated, soft tissue enlargement on the right lateral
border of the tongue. The lesion is firm, rough and fixed
to the surface mucosa but not the underlying structures.

10

ti

ti

ti

ft

 Conditions/lesions to exclude from your differential diagnosis:

1. Basal cell carcinoma Why? Not in the oral cavity

2. Herpes simplex virus Why? No vesicles on the lesion

3. Aphthous ulcer Why? Usually on the lip, not highly kera nized and can be mul ple lesions

4. Erythema Mul forme Why? Looks like a bull’s eye lesion, mul ple lesions

5. Geographic tongue Why? Mul ple lesions on the tongue

Conditions/lesions to include in the Differential Diagnosis:

— Erythroplakia
—Epithelial Dysplasia
—Lichen Plans
—Squamous papilloma lesion
--
Final Diagnosis: Squamous papilloma lesion

Justification: A lesion on the lateral side of the tongue, well circumscribed, can be pedunculate or
sessile.

What usually causes this condition? Tumor of squamous epithelium

Case # 10
Patient: Adult male.

Summary of Visuals: The skin of the chest, palms, and

soles contains multiple lesions exhibiting a concentric
pattern of erythematous rings alternating with rings that
are of normal skin color. A large ulcer on the right soft
palate is covered by a white fibrin clot. Ulcers are also
present on the uvula, buccal mucosa, and labial mucosa.

11

ti

ti

ti

ti

ti

 Chief Complaint: The patient has had persistent oral

discomfort of four days duration. The lesions bleed
when the patient brushes his teeth. The patient says the
lesions have spread to other areas since first noted. He
has not noticed blisters. Eating and brushing his teeth
make the discomfort worse. Rinsing with baking soda
did not result in improvement. The patient also reports a
history of oral "canker sores."
Medical History: The patient smokes one and a half
packs of cigarettes per day and reports a history of
athlete's foot.
Clinical Findings: The oral lesions consist of painful
ulcers on the right soft palate, uvula, and buccal and
labial mucosa bilaterally. A Nikolsky's sign is not
present. The oral mucosal ulcers bleed during palpation.
The skin of the palms, soles, and chest contains
multiple, mildly tender lesions exhibiting a concentric
pattern of erythematous rings alternating with rings of
normal skin color. No lymph nodes are palpable.

Case #10 Continued

Conditions/lesions to exclude from your differential diagnosis:

1. Herpetiform aphthous ulcers Why? Painful, does not look like a target, in oral cavity

2. Lichen plans Why? Lace like appearance not targets

3. Pemphigus Vulgaris Why? There is no posi ve Nikolsky sign

4. Systemic Lupus Erythematosus Why? Has a white stria look to it, bu er y rash on nose
12

ti

tt
fl

 5. Mucous membrane pemphigoid Why? Blisters and a posi ve Nikolsky sign

Conditions/lesions to include in the Differential Diagnosis:

—Stevens Jhonson syndrome
—Fixed drug eruptions
—Phephigus vulgaris
—Secondary stage of syphilis
— Erythema multiforme
Final Diagnosis: Erythema Multiforme
Justification: The lesions look like a target and there are multiple lesions on the skin and oral
mucosa

What usually causes this condition? There is no known cause but can be from hypersensitive
reaction.

13

ti

 Case # 11
Summary of Visuals: Examination of the visuals
reveals ulcerations of the buccal mucosa bilaterally,
gingival erythema and ulceration, plaque, calculus, and
periodontitis.
Patient: Adult woman.
Chief Complaint: The patient reports a sore mouth of
eight to nine months duration. The discomfort
consistently involves the gingiva and buccal mucosa.
The discomfort has varied in intensity, but has never
resolved. Blisters have been observed on the buccal
mucosa. The discomfort is worse when the patient
drinks fruit juice, rinses with peroxide and Listerine,
and when her mouth is dry. The patient's physician
prescribed Decadron and Kenalog in Orabase. Both of
these medications resulted in some improvement, but
not total resolution of the discomfort. The patient
reports soreness of the left eye five months ago. This
was treated with an unknown ointment, resulting in
improvement.
Medical History: The patient reports hypertension
treated with Ser-Ap-Es and occasional arthritis in the
left shoulder treated with aspirin. The patient previously
used Minipress for hypertension, but this medication
caused xerostomia and a sore throat. The patient has had
a cholecystectomy (gallbladder removed) because of
gallstones, and varicose veins stripped.
Dental History: The patient has had numerous teeth
extracted due to caries. Her last dental visit was
approximately one year ago for adjustment of partial
dentures. The patient has used maxillary and mandibular
partial dentures for ten years. She does not wear her
partial dentures at night. She has difficulty wearing her
partial dentures because they irritate her gingiva. She
has difficulty brushing her teeth because of her gingival
discomfort.
Clinical Findings: Ulcerations are present on the buccal
mucosa, attached gingiva and attached alveolar mucosa.
The ulcerations are mildly compressible, tender, and
fixed to surface mucosa and underlying structures. A
Nikolsky's sign is present. Cervical lymphadenopathy
and skin lesions are not present.
14

 Case #11 continued

Conditions/lesions to exclude from your differential diagnosis:
1. Necrotizing ulcerative gingivitis Why? Not posi ve of Nikolsky, symptoms of a fever, and
lymphadenopathy

2. Pseudomembranous candidiasis Why? A white curd like material

3. Deep fungal infec ons Why? Mostly involve the lungs, oral lesions happen a er lung
symptoms and resemble squamous cell carcinoma

4. Denture stoma s Why? It is asymptoma c, and only in the area of the denture

Conditions/lesions to include in the Differential Diagnosis:

— Bullous Pemphigoid
—Behcet syndrome
—Benign mucous membrane pemphigoid
—Pemphigus vulgaris
Final Diagnosis: Benign mucous membrane pemphigoid

Justification: Found on the gingiva, positive sign of Nikolsky, not as severe as pemphigus but can
still leave scars

What usually causes this condition? This is a autoimmune disease more benign than with
Pemphigus. Attacks attachment of epithelial cells to the basement membrane

15



ti

ti
ti

ti

ti

ft

 Case # 12
Patient: 13 year old, either sex.
Chief Complaint: The patient complains of a sore
mouth of four days duration. The lesions are painful
and bleed when the patient eats. The patient has had
difficulty eating or drinking for the past two days
because of the discomfort
Medical History: No abnormalities are identified.
Dental History: No abnormalities are identified.
Clinical Findings: The gingival mucosa and soft
tissue distal to the mandibular second molars are
swollen, erythematous, compressible, and blanch
upon pressure. Ulcerations are present on the
dorsum of the tongue, soft palate, and soft tissue
distal to the mandibular second molars. The
ulcerated areas bleed during examination and are
tender to palpation. Submandibular and anterior
cervical lymph nodes are enlarged bilaterally,
tender to palpation and slightly compressible.

Conditions/lesions to exclude from your differential diagnosis:

1. Recurrent herpes simplex Why? There is no record of having herpes before

16

 2. Hairy leukoplakia Why? It is an irregular, corrugated, white lesion

3. Acute lymphonodular pharyngi s Why? On the so palate or tonsilar pillars and is yellowish
or dark pink nodules
4. Kaposi sarcoma Why? Usually found on palate or gingiva, dark, and large lesions
5. Mucosal melanin pigmenta on Why? Not painful, doesn’t bleed, on the palate and gingiva,
not the tongue
Conditions/lesions to include in the Differential Diagnosis:
— Coxsackievirus infection
—Aphthous ulcer
—Bechet syndrome
- Secondary stage of syphilis
Final Diagnosis: Aphthous ulcer
Justification: Round or oval ulcers that can be on moveable mucosa and very painful
What usually causes this condition? Can be from trauma “most common reason. There is a unclear
etiology.

Case #13
Patient: Adult, either sex.
Chief Complaint: The patient reports a non-tender, soft
tissue enlargement of at least two months duration that
doesn't bleed except when the patient bites it.
Medical History: No abnormalities identified.
Dental History: Last dental visit was six months ago.
The patient has good oral hygiene.
Clinical Findings: A well circumscribed, nonbleeding,
soft tissue enlargement, 2 cm in diameter, is present on
the left buccal mucosa at the level of the occlusal plane.
The lesion is nontender, mildly compressible, smooth
surfaced, and fixed to surface mucosa but not deep
structures. The lesion does not blanch upon pressure.

Conditions/lesions to exclude from your differential diagnosis:

1. Granular tumor Why? This is mostly found on the tongue

2. Congenital Epulis Why? This person wasn’t born with this

3. Hermangioma Why? It is usually on the tongue, full of capillaries, dark blue color

4. Basal cell carcinoma Why? Not found in oral cavity

5. Ranula Why? Since it is not under the tongue on the oor of the mouth

Conditions/lesions to include in the Differential Diagnosis:

— Tumor
17

ti

ti

ft

fl

 —Fibroma
—Salivary gland tumor
—Granuloma
—Mucoepidermoid carcinoma
Final Diagnosis: Fibroma

Justification: Sessile base, no bleeding, can be caused from trauma, and fixed to the surface

What usually causes this condition? Since it is at the occlusal plane, it can be from biting on the
buccal mucosa

Final Deduction/s: Fibroma

Case # 14

Young boy.
Chief Complaint: The patient complains of multiple,
painful sores which started as blisters, of three days
duration. Two episodes of similar lesions occurred
earlier this year. The previous lesions healed
spontaneously in ten to fourteen days. The lesions have
always been in the same location and have not occurred
intraorally.
Medical History: No abnormalities are identified.
Dental History: No history of dental problems.
Clinical Findings: Multiple, soft, fluid-filled, tender
vesicles are present on the lips, paraoral skin and
fingers. The skin and mucosa surrounding the vesicles
are erythematous, slightly raised, compressible, and
blanch upon pressure. The vesicles are covered by a
hard, dry crust which feels rough to palpation and rubs
off.

Conditions/lesions to exclude from your differential diagnosis:

1. Primary herpes simplex virus Why? This is the rst me that you get symptoms of the virus
18

fi

ti

 2. Chronic mucocutaneous candidiasis Why? Lesions on the skin not vesicles

3. Measels Why? It can also be found in the mouth, looks more like a rash

4. Varicella zoster virus Why? Causes chicken pox, no vesicles

5. Syphilis Why? Mucous patches that can occur in the oral cavity and the skin

Conditions/lesions to include in the Differential Diagnosis:

—Recurrent herpes simplex virus
—Hand-foot-mouth disease
—Herpetic whitlow
—Coxsackie virus infection herpangia
—Impetigo
Final Diagnosis: herpetic whitlow

Justification: Multiple, soft fluid filled vesicles on the fingers

19