10 - Soft tissue lesions and biopsy techniques Flashcards
What is the function of biopsy?
- sample tissue for histopathological analysis
- confirm or establish diagnosis
- determine prognosis
What considerations should be taken before biopsy?
- should I biopsy? or refer
- why am I biopsying?
- what do I need to ask the pathologist?
What are the different tissue sampling techniques?
- aspiration
- surgical
What are the types of aspiration biopsy?
- blood sample
- aspiration from lesion
- fine needle aspiration
Describe a blood sample.
- type of biopsy as blood is tissue
- venous blood typically used
- FBC, U and Es, haematinics etc
Describe an aspiration from a lesion.
- aspiration from an abscess prevents contamination form oral fluids
- protects anaerobic species
- aspiration determines if lesion is solid or fluid filled
Describe a fine needle aspiration.
- aspiration of cells from solid lesion
- useful in neck swellings, salivary gland lesions
- sent to cytology
What are the types of surgical biopsy?
- excisional
- incisional
- punch
Describe an excisional biopsy.
- removal of all clinically abnormal tissue
- should be confident of provisional diagnosis
- typically benign lesions
- discrete lesions
Describe an incisional biopsy.
- representative tissue sample of larger lesions
- in uncertain of diagnosis
- typically leukoplakia, lichen planus, SCC
Why is an incisional biopsy preferred for a suspected SCC?
Leave evidence of lesion for surgeons who require a clear margin
Describe a punch biopsy.
- type of incisional biopsy
- removes core of tissue with minimal damage
+/- sutures to close - hollow trephine 4/6/8mm diameter
How should you select an area to biopsy?
- large enough
- representative
- may require more than one biopsy
- include periolesional tissue when biopsying ulcers
When should you refer to a specialist to complete a biopsy?
- suspicious lesions
- lumps within upper lip
Why are lumps within the upper lip of concern?
- always assume cancerous until proven otherwise
- small salivary neoplasm are very common in this site
How should you sent a sample to pathology?
- in 10% formalin
- suture can aid orientation
- relevant clinical information should be included in referral
- can be placed on filter paper, but gauze distorts
What areas should you avoid biopsying?
- salivary gland orifices
- tip of tongue
- areas close to nerves and large blood vessels
Define pedunctulated.
Attached with stalk like projection
What is a fibrous epulis?
- swelling arising from gingivae
- hyperplastic response to irritation (eg plaque, calculus, restoration)
- smooth surface, rounded swelling, pink, pendunculated
How do you manage a fibrous epulis?
- excisional biopsy
- coe pack dressing
- removal of source of irritation
What is a coe pack dressing?
Eugenol free periodontal dressing
What is a fibroepithelial polyp?
- fibrous overgrowth caused by frictional irritation or trauma
- semi pedunctulated or sessile
- pink, smooth surface
- most commonly found on buccal mucosa and inner surface of lip
- low cancer transformation
Define sessile.
Fixed in place
How do you manage a fibroepithelial polyp?
- surgical excision
- no need for deep excision or wide margin
What is a giant cell epulis?
- peripheral giant cell granuloma
- common in teenagers in the anterior regions of mouth
- deep red/purple, wide base
What is the management of a giant cell epulis?
- xray to ensure not centrally originating (appears radiolucent, +ve requires blood test)
- surgical excision with curettage of base
- coe pack dressing
What is a haemangioma?
- developmental overgrowth
- exophytic (appears like bunch of grapes)
- blue in colour, pressure will blanche
Define exophytic.
Tending to grow outward beyond the surface epithelium from which it originates
What is the management of a haemangioma?
- surgical removal
- cryotherapy (doesn’t allows for histological diagnosis, although not required as behavioural is classical)
What is a lipoma?
- benign neoplasm of fat
- soft pale yellow swelling
- sessile
What is the management of a lipoma?
Excision
What is pregnancy epulis?
- histologically the same as a pyogenic granuloma
- often bleed easily, related to calculus
- hormonal changes enhance response to tissue irritation
What is the management of pregnancy epulis?
- small lesions do not require excision and usually regress after birth
- larger lesions should be excised
What is a pyogenic granuloma?
- arises from failure of normal healing
- overgrowth of granulation tissue
- can be related to extraction sockets of traumatic soft tissue injuries
- red in colour
What is the management of a pyogenic granuloma?
- surgical excision
- curettage of base
What is a squamous cell papilloma?
- benign neoplasm
- most commonly found on palate, buccal mucosa or lips
- pedunculated
- white surface with cauliflower appearance
What is the management of a squamous cell papilloma?
- excision at base
- test for HPV
What is denture hyperplasia?
- hyperplastic reaction to poorly fitting denture
- roll of excess tissue on outer aspect of denture flange or between flange and ridge
- most common in lower labial sulcus
What is the management of denture hyperplasia?
- trim flange of denture (new denture required long term)
- remove excess tissue
- is large area removed, coe pack dressing
What is a leaf fibroma?
- chronic irritation caused by denture
- would be round, but covered by denture so is flattened
- pedunculated
What is the management of a leaf fibroma?
Excision
What is a mucocele?
- mucus extravasation cyst
- damage to minor salivary gland
- saliva leaks into submucosal layer
- soft bluish swelling, fluid filled
- recurrent
In what orientation should the excision of a mucocele be?
- vertical
- horizontal incision can cause nerve damage and numbness
Why is removing a ranula risky?
Surrounding structures including nerves and major blood vessels can be damaged
What is a squamous cell carcinoma?
- may present as a lump, red or white patch, or as a non-healing ulcer
- classically described as ulcer, rolled margin and indurated
- lesion may bleed easily and is fixed in placed
Define induration.
Hard
What are the steps when you discover a suspected SCC?
- incisional biopsy
- urgent referral vi rapid access pathway
- referral by phone then ski gateway
