12. Soft Tissue Lesions & Biopsy

Question 1

Name examples of types of biopsy.

Answer 1

Blood test (aspiration biopsy).
Aspiration from lesion (abscess).
Fine needle aspiration biopsy (solid lesions).
Surgical biopsy - incisional or excisional.

Question 2

What type of blood tests might you ask for ?

Answer 2

FBC, U&E, haematinics, glucose.

Question 3

What is the benefit of aspiration of lesions such as abscesses ?

Answer 3

Avoids contamination by oral commensals.
Will also determine if lesions is solid or fluid filled.

Question 4

When would fine needle aspiration biopsy be used ?

Answer 4

Aspiration of cells from solid lesions i.e. neck swellings, salivary gland lesions. Will be sent to cytology rather than histopathology.

Question 5

Define excisional biopsy.

Answer 5

Removal of all clinically abnormal tissue.

Question 6

When should an excisional biopsy be used ?

Answer 6

When fairly confident of provisional diagnosis.
Benign lesions or discrete lesions - fibrous overgrowths, denture hyperplasia, mucoceles.

Question 7

Define discrete lesion.

Answer 7

Localised to one area of the mouth and can be entirely removed.

Question 8

What is a incisional biopsy ?

Answer 8

Representative tissue sample.

Question 9

When is an incisional biopsy taken ?

Answer 9

Larger lesions with uncertain diagnosis i.e. leukoplakia, lichen planus, squamous cell carcinoma.

Question 10

What 3 sizes of punch biopsy can be used ?

Answer 10

4, 6, 8mm diameter.

Question 11

What should be in the criteria for a adequate biopsy ?

Answer 11

Must be large enough.
Must be representative.
Maybe requires more than one biopsy.
Include perilesional tissue.

Question 12

What is the transport medium for biopsy ?

Answer 12

10% formalin.

Question 13

What can be used to help lab orientate sample ?

Answer 13

Suture.

Question 14

Define a fibrous epulis.

Answer 14

Swelling arising from gingivae - hyperplastic response to irritation i.e. overhanging restoration or subgingival calculus.

Question 15

Describe the appearance of a fibrous epulis.

Answer 15

Pedunculate - attached at one point.
Smooth surface, rounded swelling.
Pink.

Question 16

How should a fibrous epulis be treated ?

Answer 16

Can be left untreated or excisional biopsy, coe pack dressing and removal of source of irritation.

Question 17

Define a fibrous overgrowth (or fibroepithelial polyp).

Answer 17

Swelling caused by frictional irritation or trauma.

Question 18

Describe the appearance of a fibroepithelial polyp (fibrous overgrowth).

Answer 18

Semi-pedunculate or sessile.
Smooth surface.
Buccal mucosa or inner surface of lower lip.

Question 19

Define giant cell epulis.

Answer 19

Peripheral giant cell granuloma (multi-nucleated giant cells in vascular storm).

Question 20

Who is most commonly affected by giant cell epulis ?

Answer 20

Teenagers.

Question 21

Where do giant cell epuli most commonly form ?

Answer 21

Anterior regions of the mouth.

Question 22

What treatment should be given for giant cell epulis ?

Answer 22

X-ray to ensure not centrally originating.
Surgical excision with curettage of base.
Coe pack dressing.

Question 23

What is a Coe pack dressing ?

Answer 23

Eugenol-free, surgical dressing and periodontal pack that has no burning sensation, no unpleasant taste or odor, and offers proven protection to surgical sites.