12 Soft tissue tumors Flashcards
Fibroma
- Can occur anywhere
- most common buccal mucosa labial mucosa, tongue and gingiva
- smoothed-surface, pink nodule
- May be keratinized (trauma)
- usually sessile
- Tx-excision, rare recurrence
- sessile or pedunculated
- Younger age than traditional fibroma
- variant of fibroma, looks the same
- 50% of cases on gingiva
- Histology shows large stellate and multinucleated fibroblasts
Giant cell fibroma
- Unilateral or bilateral papular lesions on the gingiva lingual to the canines
- Seen mainly in children
- Normal anatomic variation that disappears with age
retrocuspid papilla
- mandibular canines
- from the picture know that it’s SOFT TISSUE lesion, to distinguish from tori
- Tumor-like hyperplasia of fibrous connective tissue that develops in association with the flange of an ill-fitting complete or partial denture
- Inflammatory hyperplasia
- Denture injury tumor
- Denture epulis
epulis fissuratum
- usually more anterior
- txt: surgical removal
- more of a clinical term than histologic term
-Reactive tissue growth that usually develops beneath a denture
-Clinical Features
–usually on hard palate beneath denture
base
–edentulous mandibular alveolar ridge
–can occur on palate due to mouth breathing
–Appears as small pebbles or cobblestones
inflammatory papillary hyperplasia
-txt: remove denture, allow to heal, surgical intervention, remake denture
- Exhibit fibrous and histiocytic differentiation
- Unlike other fibrous growths discussed, this represents a true neoplasm
- On the skin known as a dermatofibroma
Fibrous Histiocytoma
- Surgical excision and recurrence uncommon
- he got rid of this slide in his lecture and didn’t talk about it
- Histologic pattern intermediate between benign fibrous lesions and a fibrosarcoma
- Locally aggressive and high recurrence rate
- AKA Desmoplastic fibroma and juvenile aggressive fibromatosis
- can cause a limitation of opening (painless, no numbness, thrill or bruit, no hx of trauma, neg medial hx)
fibromatosis
-txt: partial mandibular resection, placement of bone plate
what are the “3 P’s?”
-KNOW THESE
- pyogenic granuloma
- peripheral ossifying fibroma
- peripheral giant cell granuloma
- when they give you one of the three p’s, when looking at the histo, look for giant cells and bone cells
- Common tumor-like growth of the oral cavity considered non-neoplastic
- Unrelated to infection
- Response to local irritant or trauma
- Any age and most common in children and young adults
- Develop in pregnant women so much so that the terms pregnancy tumor or granuloma gravidarum are often used
- reaction to local irritant or trauma
- 75% occur on gingiva
Pyogenic granuloma
-txt: conservative surgical excision down to periosteum and remove any irritants (calculus)
- Hyperplastic growth of granulation tissue that sometimes arise in healing extraction sockets
- Resemble pyogenic granuloma and represent a granulation tissue response to bony sequestra in the socket
epulis granulomatosa
-I think this may be on the test, it’s very similar to a pyogenic granuloma
-relatively common tumor-like growth of the oral cavity
-reactive lesion caused by local irritation or trauma
-Clinical Features
-ONLY on the gingiva or
edentulous alveolar ridge
-31-41 and 60% female
-redorreddish-bluenodularmass
-“cupping resorption”of underlying bone
peripheral giant cell granuloma
- txt: local surgical excision, 10% recurrence
- no association with hyperparathyroidism and osteoclastic “brown tumors” unless intraosseous
- histologically look for the giant cells
- This tumor-like mass occurs only on the gingiva and is most common in 10-19 YEAR OLDS. 2/3 of all cases occur in females.
- ONLY on gingiva
- origination from PDL,
peripheral ossifying fibroma
- txt: excision down to periosteum, can recur about 16%
- look for calcification (esp on radiographs)
benign tumor of fat cell origin
-most common mesenchymal neoplasm, usually on the trunk
lipoma
-Not a true neoplasm
-Proliferation of neural tissue due to
transection or other trauma (nerve gets cut)
-Clinical Features
-smooth-surfaced nonulcerated nodule
-mental foramen area, tongue, lower lip
-25-30% are painful
-often Hx of trauma, extraction, other surgery
traumatic neuroma
-Benign neural neoplasm of Schwann cell origin
-Relatively uncommon
-25-50% of all cases in H&N
region
-Tongue is most common location
-Asymptomatic
-can occur in vestibular schwann cells and ususally causes total deafness
neurilemoma -txt: excision, histopathology: -Antoni A: streaming fascicles of spindle shaped Schwann cells and form a palisaded arrangement around a central accelular area (Verocay bodies) -Antoni B: randomly arranged -S-100 positive
what is the most common type of peripheral nerve neoplasm? and what are its’ features?
neurofibroma
- Mixture of Schwann cells and perineural fibroblasts
- Clinical Features
- slow growing, soft, painless
- skin most common site
- solitary or component of neurofibromatosis
- most common intraoral–tongue and buccal mucosa
Spindle shaped cells with wavy nuclei
neurofibroma
-Von Recklinghausen’s Disease of the Skin
-relatively common hereditary
condition
-1/3000 births (50% new mutation)
-type I is most common–85-90% of cases
-Mutation of NF1 gene on chromosome 17q11.2 and responsible for a tumor suppressor protein know as neurofibromin
-cafe au lait pigmentation
neurofibromatosis (NF1)
what is the stain for nerve
S100
what is the histology of a neurilemoma?
- Antoni A tissue (): streaming fascicles of spindle shaped schwann cells and form a palisaded arrangement around a central accelular area (verocay bodies)
- Antoni B: randomly arranged
- S-100 positive
-cafe au lait pigmentation
-axillary feckling (crowes sign)
Lisch nodules (brown pigmented spots on iris in nearly all affected individuals)
-oral lesions in 72-92% of cases
Neurofibromatosis (NF1) or Von recklinghausen’s disease of the skin
A group of rare conditions characterized by tumors or hyperplasias of neuroendocrine origin
MULTIPLE ENDOCRINE NEOPLASIAS
-Type 1–pancreatic islet, adrenal cortex, parathyroid, pituitary
n Type 2A–pheochromocytoma, medullary thyroid carcinoma
n Type 2B same as type 2A plus mucosal neuromas (this is the one that concerns dentistry the most)
most patients have a marfanoid habitus (thin
elongated limbs with muscle wasting)
n oral mucosal neuromas (usually 1st sign)
n soft, painless papules or nodules
n lips and anterior tongue, buccal mucosa, gingiva, palate
n bilateral neuromas of the commissural mucosa are highly characteristic
n pheochromocytomas in 50% of all patients
n medullary carcinoma of the thyroid–90% of cases–marked propensity for metastasis— arise 18-25
MEN type 2B (MULTIPLE ENDOCRINE NEOPLASIAS)
-Calcitonin – thyroid carcinoma
**Increased vanillylmandelic acid - pheochromocytoma
**Increased epinephrine- norepinephrine ratios
n Life-threatening hypertension
MEN type 2B
Rare pigmented neoplasm that usually occurs during first year of life
n Neural crest origin
n Clinical features
n 65-70% maxilla
n rapidly expanding mass, frequently blue or black
n may destroy underlying bone and displace teeth
n elevated vanillylmandelic acid
n small percent are malignan
MELANOTIC NEUROECTODERMAL TUMOR OF INFANCY
what two diseases have elevated vanillymandelic acid?
MEN 2B and MELANOTIC NEUROECTODERMAL TUMOR OF INFANCY
-specialized tissue of neural crest origin associated with autonomic nerve and ganglia throughout the body
0paraganglioma (carotid body tumor
most common paraganglioma
n bifurcation of internal and external carotids
n slowly enlarging painless mass
n upper lateral neck below angle of ja
carotid body tumor
-txt: surgery and/or radiation depending on extent and location
benign soft tissue neoplasm that shows a predilection for the oral cavity
n Probably origin from Schwann cells or neuroendocrine cells
n Most common location tongue/dorsal followed by buccal mucosa
n 4th to 6th decades; females 2X
n Color–pink, yellow and sometimes whit
granular cell tumor (**)
Pseudoepitheliomatous hyperplasia is found in…
Squamous cell carcinoma and/or granular cell tumor
- Rare soft tissue tumor that occurs exclusively on the alveolar ridges of newborns.
- S-100 positive, GCT S-100 negative
congenital epulis
-90% female
Currently considered benign tumors of infancy that display rapid growth phase with endothelial proliferation, followed by gradual involution
-blanches on pressure
hemangioma
- arise by at least the first 8 weeks of life
- vascular malformations are anomalies of blood vessels without endothelial proliferation
examples of vascular malformations
- capillary hemangioma
- juvenile hemangioma
- cavernous hemangioma
- arteriovenous malformation
- In contrast to hemangiomas are present at birth and persist through life
- Typically blue and compressible and grow proportionally with patient
- Secondary thrombosis and phlebolith formation can occur
low-flow vascular malformations
- Result from direct arterial and venous communication
- Present at birth but not noticed until later
- Fast vascular flow causes thrill or bruit
high flow vascular malformations
Rare, non-hereditary developmental condition characterized by hamartomatous vascular proliferations, involving the brain and face
Sturge-Weber syndrome
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- port-wine stain or nevus-flammeus
- unilateral distribution along one or more segments of the trigeminal nerve
- not all patients with port-wine nevi have Sturge-Weber Syndrome (only a small %)
- leptomeningeal angiomatosis
- ocular involvement may include glaucoma, and vascular malformations of the conjunctiva, episclera
sturge-weber angiomatosis
-encephalo-trigeminal angiomatosis
- Rare tumor of the nasopharynx
- Exclusively males between 10-17
- Nasal obstruction and epistaxis
- Vascular malformation rather than true neoplasm
- Surgery with 20-40% recurrence rates
- Can be destructive
Nasopharyngeal Angiofibroma
-“I probably won’t ask you this)
-Oral common – 75% buccal mucosa
-Histology—staghorn appearance of blood
vessels surrounded by pericytes
-IH CD34 positive—rare in children
-4 or more mitoses per 10 high power fields suggests a possibly malignant lesion
-Treatment—Surgery and more aggressive for tumors of malignant characteristics
-86% 5 year survival–follow-up
Hemangiopericytoma–Solitary fibrous tumor
-“I think I will leave this one out too”
Benign hamartomatous tumors of lymphatic vessels—arbitrary classification because all three sizes of vessels found in the same lesion
- Do not communicate with the rest of the lymphatic system
- Cystic L neck and axilla
- Cavernous in the mouth
Lymphangioma
-capillary lymphangioma (L simplex)
-cavernous lymphangioma
-cystic lymphangioma (cystic hygroma)
the cystic L can interfere with the airway-marked predilection for the head and
neck (50-75%)
-90% develop by two years of age
-anterior 2/3 of tongue - macroglossia
-usually superficial with pebbly appearance
-deeper tumors present as soft, ill- defined masses
-cervical lymphangiomas can cause dysphagia and/or respiratory difficult
Lymphangioma
-histo, looks just like a hemangioma, but no RBCs
- benign neoplasms of smooth muscle
- rare in oral cavity
- vascular know as angiomyoma
Leiomyoma
- benign neoplasms of skeletal muscle
- floor of mouth, soft palate, base of tongue
- histology: Rounded and polygonal cells with focal vacuolization
Rhabdomyoma
- normal tissue in an abnormal location
- striking predilection for the tongue
Choristoma
hamartoma
just means its not a true neoplasm (tumor) it’s just mal-formed
port-wine stain
sturge-weber angiomatosis or encephalo-trigeminal angiomatosis (two names for the same thing)
