Demystifying Dysplasia- Histology dataset
Figure 1a
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Normal hard palate WSI
Figure 2c
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Normal soft palate WSI
Figure 3
Figure 3a/3b
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Ellipse: Area of scaring from previous biopsy.
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Figure 3d/3e
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Circle: A sub-geminal neurogenous plaque at the centre of a fungiform papillae. Arrow: A tastebud, note the disrupted epithelium adjacent the tastebud giving the impression of disordered stratification.
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Figure 3a and 3b WSI- Normal Lip
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Figure 3d and 3e WSI- Normal posterior tongue
Figure 4
Figure 4a
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Rectangle: This is a good example of disordered stratification. The layers of the epithelium are hard to distinguish at low power.
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Figure 4b
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Line: Two patterns of dysplasia can be seen side by side here. On one side of the line there is parakeratosis with bulbous elongated rete processes. On the other side of the line there is hyperorthokeratosis with shorter but still somewhat bulbous rete processes. Rectangle: There is generalised premature keratinisation in this case, with eosinophilic keratinising cells in the rete processes.
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Figure 4c
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Rectangle: There is an abrupt transition between the area of dysplasia and normal epithelium. there are also areas of dysplasia separated by areas of normal epithelium.
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Figure 4E – same as 6a
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Ellipse: Loss of cellular cohesion can be seen with widening intercellular spaces.
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Ellipse: Loss of cellular cohesion can be seen with widening intercellular spaces.
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Figure 4f
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Circle: Oral epithelial dysplasia extending along a minor salivary gland duct.
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Figure 4a WSI- Severe OED with disordered stratification
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Figure 4b WSI- Severe OED with premature keratinisation
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Figure 4c WSI- Severe OED with abrupt transition
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Figure 4f WSI- Extension of OED along salivary duct
Figure 5
Figure 5a
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Rectangle: The epithelium has a verrucous architecture and despite only limited cytological atypia, this architectural pattern is very worrisome.
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Figure 5e
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Rectangle: In this example there is basal cell nesting, with atypical basal cells budding into the adjacent lamina propria but without evidence of invasion.
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Figure 5f
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Line: There are two patterns of dysplasia on each side of the line. On one side (more severe) there is highly disordered stratification with basal cell nesting and loss of basal cell polarity. On the opposing side (less severe) there is maintenance of basal cell polarity, though there is hyperchromatism and pleomorphism as well as loss of epithelial cell cohesion.
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Figure 5a WSI- Severe OED with verrucous architecture
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Figure 5e WSI- Severe OED with basal cell nesting
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Figure 5f WSI- Severe OED with multiple patterns of dysplasia
Figure 6
Figure 6a
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Figure 6a (1).jpg
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Rectangle: Almost all of the cytological features of oral epithelial dysplasia can be seen in this area.
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Figure 6b
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Arrow: Here an abnormal mitotic figure can be seen. This is due to failure of abnormal segregation of the chromosomes. Ellipse: This is a good example of loss of basal cell polarity. The basal keratinocytes are haphazardly arranged with several nuclei located away from the basement membrane. In the normal epithelium the basal keratinocyte nuclei are normally orientated towards the basement membrane.
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Figure 6b.jpg
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Figure 6c
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Figure 6c (1).jpg
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Arrows: Frequent single cell keratinisation can be seen in this case.
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Figure 6a WSI- Severe OED with cytological features of OED and loss of cellular cohesion
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Figure 6b WSI- severe abnormal mitotic figure
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Figure 6c WSI- Severe OED with single cell keratinisation
Supplementary Figure 1
Supplementary Figure 1
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Circle: This case has many normal mitoses. Arrows: This case also has many abnormal mitotic figures as well as supra-basal mitoses and mitoses in mature cells.
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Supplementary Figure 1 WSI- Severe OED with abnormal mitotic figures
Supplementary Figure 2
Supplementary figure 2a
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Rectangle: This epithelium shows parakeratosis, full thickness dysplasia and an overall basaloid appearance. Solid arrow: A mitosoid body. They are abundant in this HPV infected epithelium.
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Solid arrow: A mitosoid body. They are abundant in this HPV infected epithelium. Rectangle: This epithelium shows parakeratosis, full thickness dysplasia and an overall basaloid appearance.
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Circles: Apoptotic cells are also present in this epithelium.
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Supplementary figure 2b
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Rectangle: The basaloid keratinocytes in this HPV infected lesion are in contrast to the eosinophilic surface hyperparakeratosis. There is full thickness atypia in this case. Arrows: Multiple mitosoid bodies can be seen throughout the epithelium.
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Supplementary figure 2c
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Rectangle: There is full thickness atypia with hyperparakeratosis and abundant mitosoid bodies. All typical for HPV associated oral epithelial dysplasia.
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Supplementary Figure 2a WSI- HPV associated dysplasia (example 1)
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Supplementary Figure 2d WSI- in situ hybridisation for HPV 16 and HPV 18
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Supplementary Figure 2b WSI- HPV associated dysplasia (example 2)
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Supplementary Figure 2c WSI- HPV associated dysplasia (example 2)
Supplementary Figure 5
Supplementary figure 5a
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Circle: Some of the rete processes are club shaped, which may mimic the bulbous rete processes of oral epithelial dysplasia. Rectangle: There is hyperparakeratosis, extensive acanthosis and reactive atypia. There is no bulbosity to the rete processes and neutrophils can be seen in the epithelium. There is a predominantly plasmocytic infiltrate int he lamina propria.
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Supplementary figure 5b
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Rectangle: Though the atypia seen is likely reactive to the candida present, the degree is concerning. This is an example of a case where a further biopsy may be warranted if the lesion fails to resolve after anti-fungal therapy.
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Supplementary figure 5c
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Arrow: Fungal hyphae within the superficial epithelium (PAS-D staining).
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Supplementary Figure 5a WSI- Chronic Hyperplastic Candidosis H&E
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Supplementary Figure 5b WSI- Chronic Hyperplastic Candidosis with atypia
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Supplementary Figure 5c WSI- Chronic hyperplastic candidosis PAS-D stain
Supplementary Figure 6
Supplementary figure 6a
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Rectangle: The epithelium is hyperparakeratotic, though some of the rete processes are long all narrow with depth or are an even thickness. There is a band like lymphocytic infiltrate in the lamina propria. Circle: There is loss of basal cells and lymphocyte epithelial trophism.
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Supplementary figure 6b-d
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Large rectangle: Here there is generalised premature keratinisation and single cell keratinisation. Small rectangle: Despite features of a lichenoid tissue reaction, features of oral epithelial dysplasia are also seen including bulbous rete processes, loss of basal cell polarity and pleomorphism.
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Supplementary Figure 6a WSI- Oral Lichen Planus
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Supplementary Figure 6b to 6d WSI- OED with lichenoid infiltrate
Supplementary Figure 7
Supplemental Figure 7
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Large rectangle: The ulcerated area comprises a fibrino-purulent slough and granulation tissue with loss of the epithelium. Ellipse: The epithelium adjacent to the ulcer shows reactive atypia. Small rectangle: There is less atypia in the epithelium more distant to the ulcer.
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Supplementary Figure 7 WSI- Non-specific ulcer
Supplementary Figure 8
Supplemental Figure 8
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Circle: There is ulceration centrally, formed of a fibrinopurulent slough on the surface covering granulation tissue. Rectangle: Despite being far from the ulcer, the epithelium still shows significant atypia, including disordered stratification, cellular and nuclear pleomorphism and loss of basal cell polarity amongst many other features of dysplasia.
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Supplementary Figure 8 WSI- Severe OED with ulcer
Supplementary Figure 9
Supplementary figure 9a/c
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Arrows: Vacuolation of keratinocytes in the prickle cell layer. Ellipse: The epithelium is thickened with elongated but not bulbous rete processes. There is also a lack of cellular or nuclear pleomorphism, hyperchromatism or disordered stratification. Rectangle: Thick hyperparakeratosis.
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Arrows: Vacuolation of keratinocytes in the prickle cell layer. Ellipse: The epithelium is thickened with elongated but not bulbous rete processes. There is also a lack of cellular or nuclear pleomorphism, hyperchromatism or disordered stratification. Rectangle: Thick hyperparakeratosis.
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Supplementary figure 9b/d
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Ellipse: As well as the hyperkeratosis and hyperplasia seen in this case, there is cellular and nuclear pleomorphism as well as hyperchromatism of the basal and para-basal keratinocytes.
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Supplementary Figure 9a and 9c WSI- Hyperkeratosis and epithelial hyperplasia
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Supplementary Figure 9b and 9d WSI- Mild OED
Supplementary Figure 10
Supplementary figure 10a
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Rectangle: Thick hyperparakeratosis containing fungal hyphae. Ellipse: Vacuolated 'balloon cell' keratinocytes in the granular cell and prickle cell layers.
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Rectangle: Thick hyperparakeratosis containing fungal hyphae. Ellipse: Vacuolated 'balloon cell' keratinocytes in the granular cell and prickle cell layers.
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Supplementary figure 10b
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Circle: Abundant fungal hyphae are present in the superficial epithelium.
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Supplementary figure 10c
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Circle: Positive nuclear staining with EBER in-situ hybridisation.
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Supplementary Figure 10a WSI- Oral hairy leukoplakia H&E
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Supplementary Figure 10b WSI- Oral hairy leukoplakia PAS-D
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Supplementary Figure 10c WSI- Oral hairy leukoplakia EBER ISH
Supplementary Figure 11
Supplementary Figure 11
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Ellipse: A collection of koilocytes in the superficial epithelium. See WSI.
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Supplementary Figure 11 WSI- Multifocal epithelial hyperplasia
Supplementary Figure 3
Supplementary Figure 3a
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Ellipse: There is abnormal orthokeratinisation with an abrupt transition from the adjacent normal mucosa. Epithelial atophic can also be seen.
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Supplementary Figure 3b
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Ellipse: There is abnormal orthokeratinisation with an abrupt transition from the adjacent normal mucosa. Cytological atypia can also be seen.
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Supplementary Figure 3b WSI- Differentiated dysplasia 02
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Supplementary Figure 3a WSI- Differentiated dysplasia
Supplementary Figure 4
Supplementary Figure 4c
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Ellipse: There is a verrucous surface architecturer with an abrupt transition from the adjacent normal epithelium. No cytological atypia is seen. A focal lichenoid infiltrate is also observed.
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Supplementary Figure 4d
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Ellipse: There is a verrucous morphology with elongated, rounded and pushing rete processes. Focal evidence of atypia is seen.
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Supplementary Figure 4c WSI- Verrucous Hyperplasia with surface changes only
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Supplementary Figure 4d WSI- Verrucous Hyperplasia with dysplasia (altered epithelial proliferation/morphology)
