13. Traumatic and Reactive Lesions Flashcards
• Sessile
○ A bump, mass that’s growing ____ surface of any tissue
○ Removal: go into ____ tissue to excise
• Pedunculated
○ Attached to tissue via ____
under
underlying
stalk
Biospy
Excisional v. incisional
• Surgical technique used to diagnose clinical pathology • Excisional ○ Excise the lesion in \_\_\_\_ • Incisional ○ Remove a \_\_\_\_ of the actual lesion • For excisional, the lesion is \_\_\_\_ and it won't casue morbidity after surgery (only a couple sutures) ○ If 1cm (medium sized), but access surgically is \_\_\_\_ (ant tongue, lower lip) ○ But typically \_\_\_\_-related • Incisional biopsy ○ Worried about \_\_\_\_; leave enough tissue for surgeon afterwards to know how much more to remove ○ Lesion is too \_\_\_\_ to move entirely, would cause too much discomfort ○ Posteriorly located where \_\_\_\_ is difficult (post tongue, soft palate, uvula) ○ Own experience, how \_\_\_\_ you are • \_\_\_\_ and \_\_\_\_ are two important factors
entirety piece small easier size cancer large access confident size surgical access
Incisional Biopsy
• Right: regular scalpel, laser, taking tissue and putting into \_\_\_\_ (diluted formaldehyde) which helps to fix the tissue ○ Tissue remains at state \_\_\_\_ ○ Cells undergoing \_\_\_\_ under microscope bc at time of biopsy it's undergoing division • Left: punch biopsy ○ \_\_\_\_ blade, removing circular tissue to put into bottom to send into analysis ○ Punches have different \_\_\_\_ (2,3 4, 6 and 10mm) • Rest of lesion remains
formalin forever mitosis circular diameter
Differential diagnosis
A process of listing two or more diseases with similar signs and symptoms
– Increase likelihood of establishing correct diagnosis
– Direct diagnostic and therapeutic plans
Initially list ____ possible diagnoses, all with similar signs and symptoms
Use accumulated information to narrow list to no more than ____ diagnoses
* Done with every patient (toothache, aesthetic concern, etc.) * Help inform the testing you will conduct to help further understand the problem
5-7
three
Oral mucosa • \_\_\_\_ epithelium • Connective tissue – \_\_\_\_ (superficial) lamina propria – \_\_\_\_ (deep) lamina propria • Submucosa
• Papillary ○ Less \_\_\_\_ ○ More superficial, below the epithelium • Reticular • Submucosa ○ Lower lip: \_\_\_\_ ○ Tongue: \_\_\_\_ muscle ○ Buccal mucosa: fat, salivary gland and muscle • Attached gingiva and hard palate has no \_\_\_\_
papillary reticular collagenized salivary gland skeletal submucosa
Linea alba
• Chronic friction leading to epithelial ____ and ____
* Technically a \_\_\_\_, but not pathologic * Chronic irritation to buccal mucosal tissue and epithelial cells * Hyperplasia - normal cells, but increased in \_\_\_\_ * Surface of tissue - \_\_\_\_, due to hyperkeratosis
hyperplasia
hyperkeratosis
number
white
Petechiae • \_\_\_\_ bleeding • Causes: – Trauma – Systemic disease – Infection
• Common in \_\_\_\_ of oral cavity (but can get it anywhere) • Systemic disease ○ AIDs • Infection ○ Mononucleosis ○ HIV ○ Measles ○ Streptococcus (strep throat) • Coaggulation disorders are causes because they weaken \_\_\_\_, thus allowing blood to rush into the surrounding tissues. Patients that are pone to bruising, are also susceptible to petechiae. • \_\_\_\_ is one of the most common causes of petechiae that is systemic in nature. It is defines as low \_\_\_\_ count. Thus, do NOT assume that all causes of bruising are \_\_\_\_ in origin.
pinpoint soft palate blood vessels thrombocytopenia platelet traumatic
Purpura • Slightly larger than \_\_\_\_ • Causes: – Trauma – Systemic disease – Infection
* Caused by similar things to \_\_\_\_ * Slightly larger area of \_\_\_\_
pinpoint
petechiae
hemorrhage
Ecchymosis
• ____ accumulation
• Greater than ____ cm
• Following \_\_\_\_ of tooth * Typically caused by \_\_\_\_ * Can be more prone to ecchymosis due to coagulation disorder (\_\_\_\_)
hemorrhagic
2
extraction
trauma
hemophilia
Hematoma
• Accumulation of blood resulting in ____ mass
This is a boy who was chewing on a pen and then it went through his palate.
This is a ____ mass. It will heal, and will go through the same evolution as any bruise on a skin. It will go from purple, to blue, to green, to brown/yellow, and the resolution.
You wouldn’t ____ this because it is a bruise
Chin trauma from ____
Over a few hours, bruises will ____. This is clotted blood being squeezed out by doctor to relieve pressure.
Not necessary to biopsy but if you do biopsy a bruise, all you will see is ____ and ____ (clotted blood).
You will not see ____ cells. However, as a few days pass, you will see some ____ & other cells, because the ____ response will kick in.
palpable
raised
biopsy
car accident
clot
blood fibrin inflammatory macrophages wound healing
Non-specific ulcer
• Non-specific histology
• If no resolution after ____ weeks then MUST biopsy
• Happens to \_\_\_\_ • Has non-specific histology ○ Acute inflam ○ Chronic inflam ○ Granulation tissue within lam prop ○ Vascularity - wound healing response • Common cause: \_\_\_\_ ○ Will go away on their own • 2 weeks ○ Non-healing ulceration, warranting a biopsy ○ Cause: trauma, cancer, and by infection \_\_\_\_, or \_\_\_\_*
epithelium
trauma
Tb
histoplasmosis
Non-specific ulcer
• Above patient did not resolve • Ulceration: loss of \_\_\_\_ • Surface of ulceration ○ \_\_\_\_ exudate* § Microscopically: lots of fibrin, neutrophils embedded, chronic inflam cells and dead cells § \_\_\_\_-rich • Wound healing = \_\_\_\_ tissue ○ Highly vascularized ○ Myofibroblasts § Help \_\_\_\_ the tissue back together ○ Fibroblasts produce collagen (with myo) ○ \_\_\_\_/\_\_\_\_ inflam and macrophages clean up debris
epithelium fibrinous protein granulation contract
Eosinophilic ulcer
• Has distinct ____
• ____ most common site
* Cause of \_\_\_\_, but microscopically distinct * Anywhere on the tongue it can occur
histology
tongue
trauma
Eosinophilic ulcer
• Look into lamina propia ○ \_\_\_\_, lots of them ○ Larger cells: \_\_\_\_ § Big nuclei ○ Smaller, blue: \_\_\_\_ § T cells (cannot tell from slide) • \_\_\_\_ - B cell marker • \_\_\_\_ - T cell marker
eosinophils fibroblasts lymphocytes CD20 CD3
Eosinophilic ulcer
* \_\_\_\_ induced, resolves on its \_\_\_\_ * Continue to return until complete resolution * Follow patient's at regular intervals, routinely, until completely resolved (can be via phone call)
traumatically
own
Differential diagnosis of non-healing ulceration
• Trauma
• Cancer
• Infection
• \_\_\_\_ presents as ulceration (most common cancer in the mouth)
squamous cell carcinmoa
Biopsy
• Biopsy of an ulcer should ALWAYS include a portion of adjacent ____ tissue
normal
Fibroma • Most common t \_\_\_\_ growth • Develops in frequently t \_\_\_\_ areas • Histology – Densely \_\_\_\_ tissue – \_\_\_\_ fibroblasts
• Due to chronic irritation, repetitive injury • Soft tissue pathology - most common what we'll see in clinic ○ Doesn't happen floor of \_\_\_\_, \_\_\_\_ tongue, \_\_\_\_ palate ○ Occurs when areas are often traumatized/irritated • Caused by fibrous \_\_\_\_ ○ Increased fibroblasts, resulting in more collagen • Typically \_\_\_\_ masses (can be pedunculated), and can perform an \_\_\_\_ biopsy (both diagnostic and \_\_\_\_ as long as no repeat irritation)
soft tissue traumatized collagenized scattered mouth ventral soft hyperplasia sessile excisional curative
Fibroma
• All \_\_\_\_ lesions • \_\_\_\_ tongue, buccal mucosa, \_\_\_\_ lip and floor of mouth • \_\_\_\_ is not a typical site ○ However he's a male escort…..
sessile
frenulum
dorsum
lower
Fibroma
• ____ and ____
fibroblasts
collagen
Pyogenic granuloma
• Chronic ____ or altered ____ state
• ____ predilection
• May occur anywhere, usually ____
* First of the three P's * Mass-forming lesion: \_\_\_\_ or \_\_\_\_ * Altered physiologic state: \_\_\_\_, \_\_\_\_
irritation physiologic gingiva sessile pedunculated pregnancy puberty
Pyogenic granuloma
• \_\_\_\_ of tongue • Arising from \_\_\_\_ tissue (not bone) • The bone will ultimately resorb from the mass ○ \_\_\_\_ - pathology from tissue § Dip in crest of ridge (\_\_\_\_)
dorsum
soft
cupping resorption
radiolucent
Pyogenic Granuloma
• Pedunculated lesion • Strictly composed of \_\_\_\_ tissue ○ Do not harbor \_\_\_\_ ○ Not a \_\_\_\_ reaction ○ Very \_\_\_\_, collagen and elastic fibers • Bright red = BV ○ Don't worry microscopically ○ Clinically: lesions \_\_\_\_ easily § Brushing teeth, touch gum • Treat: \_\_\_\_ the mass • Cause: chronic \_\_\_\_
granulation granuloma granulomatous inflammatory vascularized bleeds excise irritation
Pregnancy tumor
Epulis granulomatosum
• Pregnancy ○ Gingival pyogenic granulomas • \_\_\_\_ do not get… • Related to altered \_\_\_\_ balance ○ \_\_\_\_/\_\_\_\_ • Epulis granulomatosum ○ Name is misnomer ○ Pyogenic granuloma developed in \_\_\_\_ socket in a recently extracted rooth ○ \_\_\_\_ tissue within socket • Alevolar \_\_\_\_ ○ Socket remains unhealed which is painful • Treat: \_\_\_\_ lesions
men
hormone
estrogen
progesterone
extraction
granulation
osteomyelitis
excise
Peripheral ossifying fibroma • Exclusively on \_\_\_ • Radiograph – Superficial \_\_\_\_ – \_\_\_\_ radiopacities
• Whether there are teeth or no teeth… exclusively on the gingiva • Looks the same as \_\_\_\_ grossly ○ Histologically/mechanistically they are very different • \_\_\_\_ gingiva • Small divot that accomodated mass over time, not a \_\_\_\_ in the bone
gingiva cupping resportion scattered cupping resorption palatal hole
Peripheral ossifying fibroma
- Metaplastic bone
- Dystrophic calcifications• Microscopically
○ Differs from pylogenic granuloma due to ____ tissue, but also ____:
§ ____: Conversion of one normal cell type to another normal cell type
□ Here, ____ convert to ____
§ ____ calcifications: Arise in the backdrop of inflammation
□ ____ deposition of phosphate and calcium
• This picture shows bone
granulation calcification metastatic fibroblasts osteoclasts dystrophic random
Peripheral giant cell granuloma • Exclusively on \_\_\_\_ • Treat: \_\_\_\_ and eliminate irritation ○ Misnomer ○ \_\_\_\_ ○ Looks same as two others P's, but only occurs on \_\_\_\_ • Both caused by trauma • Large lesion of gum causing \_\_\_\_ of surface
gingiva excise reactive gingiva resorption
PGCG
- ____ giant cells
- ____ hemorrhage
- ____• Multinucleated giant cells
○ Large ____, that contain multiple nuclei
○ Unlike granulomas where they’re contained in ____ structures
§ ____ distributed throughout the tissue in PGCG
• Hemorrhage
○ Extravasted (outside ____)
• Hemosiderin
○ Breakdown product of ____ due to hemorrhage
○ ____ on the slide
• Not ____ inflammation
• Treat: excise and remove source
multinucleated
extravasated
hemosiderin
macrophages
small
randomly
BV
blood
brown
granulomatous
Drug – Induced Generalized Gingival Hyperplasia
• Anti-seizure medications – ____ and others
• Calcium – channel blockers
– ____ and others
- Immunosuppressants – ____
- ____ and ____ essential to etiology
• More \_\_\_\_ = extensive area of involvement Canine to canine here • Poor oral hygiene ○ Impeccable - if taking drugs will not have manifestations ○ Requires a \_\_\_\_ to trigger pathology • Initiatior = plaque/calculus Promoter = \_\_\_\_ • Cannot tell which \_\_\_\_ induces
phenytoin nifedipine cyclosporine plaque calculus
diffuse
biofilm
drug
drug
DIGGH
• Doesn't look exact same… but same pathology • \_\_\_\_ ○ Predisposes to retention of plaque/calculus • May \_\_\_\_ the teeth • Perio probe ○ Measure pockets, but will be off - not a true pocket § \_\_\_\_
crowding
envelope
pseudopocket
Differential diagnosis of diffuse gingival overgrowth
- ____
- Hormonal influences
- ____
- Genetic disease• Leukemia of gums
○ Green
§ ____
• Born with gingival overgrowth - genetic
local factors
malignancy
myeloperoxidase
[CHECK OUT THE DIFFERENTIAL DIAGNOSES AT THE END]
YAY
