5. Oral hyperplasia Flashcards
What are labile cells?
Proliferate continuously through post-natal life.
Eg, bone marrow, epithelia of mouth, skin, gut, bladder.
Susceptible to toxic agents
What are stable cells?
Divide only infrequently but can be stimulated to divide when cells are lost.
Eg, bone, liver, renal tubular cells, fibroblasts in connective tissue
What are permanent cells?
Normally only divide in embryonic, fetal and maybe in early post natal life.
Have very limited ability to divide.
Eg, cardiac muscle cells, neurons, retinal photoreceptors
What types of cells are odontoblasts?
Permanent cells
What is the definition of aplasia?
No growth, lack of development of a tissue
What is the definition of hyperplasia/hypoplasia?
Increase/decrease in the number of cells in response to a stimulus
What is hyperplasia often secondary to?
Hormones and growth factors in tissues able to divide or that continue abundant stem cells.
What is physiologic example of hyperplasia?
Breast epithelium during pregnancy
Compensatory hyperplasia of liver
What is pathologic example of hyperplasia?
Epithelial hyperplasia in viral warts
What is hypoplasia?
Lack of development of tissue or organ
What is hypertrophy/atrophy?
Increase/decrease in the size of cells in response to a stimulus. Will often get additional intracellular structural components.
What is a pathologic example of hypertrophy?
When cells that cannot undergo cell division become larger, eg. myocardial fibres.
What is metaplasia?
Other growth- differentiation from one mature type into another mature type
How does metaplasia occur?
Occurs through altered differentiation pathways of tissue stem cells
What are examples of metaplasia?
In smokers, respiratory epithelium which is normally pseudostratified squamous epithelium with cilia and goblet cells turns into metaplasia squamous cell epithelium. You get loss of mucous secretion and ciliary action.
What is the definition of dysplasia?
Wrong growth or disturbance in the maturation of a tissue
Mitotic figures seen outside of the basal cell layer
What is atypia?
Refers to deviation in the morphology of cells
What is the definition of neoplasia?
An independent, uncoordinated new growth of tissue, capable of unlimited proliferation and which does not regress after removal of the stimulus which produced the lesion.
What is benign neoplasia?
Innocent behaviour, localised lesion, without spread, amenable to surgical resection
What is malignant neoplasia?
Aggressive behaviour, invasion and destruction of adjacent tissue, capacity for spread to distant sites (metastasis)
What does differentiation mean?
Extent to which cells resemble their ancestor
What does anaplasia mean?
Lack of differentiation of a tissue- characteristic of some tumour cells
What is the definition of choristoma?
Normal tissue in the wrong location- ectopic
What is fordyce spots?
Yellow, white spots that are sebaceous glands present in the submucosa of the oral cavity.
Sebaceous glands are typical of the skin.
What is a chondroma?
Example of choristoma- eg, cartilage in the tongue
What is an osteochondroma?
Example of choristoma- eg, cartilage and bone in the tongue
What is osteoma of the tongue?
Example of choristoma, completely made of bone
What is a hamartoma?
Abnormal amount of tissue in the right location.
What are examples of hamartomas?
Odontoma
Haemangioma
Torus palatinus/torus mandibularis
What is a teratoma?
Tumours containing tissue recognisable from more than one germ layer.
Originate from germ cells capable of differentiation into any one of the cell types in the body.
Comes from testes or ovaries
What is an epulides?
Tumour like growth on the gum.
Hyperplastic
What are the 3 true epulis?
Fibrous epulis, vascular epulis, giant cell epulis
What does fibrous epulis clinically look like?
Wide range of ages- 11-40
Sessile or pedunculated
Firm, surface may be ulcerated
Might contain metaplastic bone
Colour of lesion is similar to rest of gingiva
What is the treatment for fibrous epulis?
Surgical excision
What is the histology of fibrous epulis?
Stratified squamous epithelium
Cellular fibroblastic tissue and bundles of collagen
May contain calcified deposits and metaplastic bone
Variable inflammatory infiltration
What is another name for vascular epulis?
Pyogenic granuloma/pregnancy epulis
What does vascular epulis clinically look like?
Soft
Deep red/purple swelling
Haemorrhage is common
Commonly ulcerated
May occur anytime during pregnancy, size may decrease after delivery
What is the histology of vascular epulis?
Sheets of endothelial cells and angioblasts
Ulcerated surface
Proliferation of small vessels towards surface
Large, thin walled vascular spaces in deeper aspects
Variable inflammatory infiltration
What is another name for giant cell epulis?
Peripheral giant cell granuloma
What does giant cell epulis look like clinically?
Affects 30-40 year olds
2 times more likely to affect females
Anterior to molar teeth
Slightly more common in mandible
Pedunculated or sessile dark red mass
Why is radiograph essential for giant cell epulis?
Histologically, central giant cell granuloma looks very similar to this. However, CGCG appears inside the jaw bone but it is possible that is is a central lesion that grew large in the jawbone and the tip showed through peripherally.
What is the histology of a giant cell epulis?
Focal collection of multinucleated giant cells, separated by fibrous septa
Rich vascular and cellular stroma
Fibrous tissue may separate the core from covering epithelium
What is another name for congenital epulis?
Congenital gingival granular cell tumour
What is congenital epulis?
Rare neoplasm- not a hyperplasia
Affects newborns
What is the histology of congenital epulis?
Large, closely packed granular cells covered by squamous epithelium
unknown origin, but not related to the granular cell tumour
What does a fibroepithelial polyp look like clinically?
Mainly in cheeks (occlusal line), lips, tongue
Pedunculated or sessile
Pink, painless polypoid swelling
Leaf fibroma
Usually not ulcerated
Once established, no size change
What is the histology of fibroepithelial polyp?
Stratified squamous epithelium
Little or no inflammatory reaction
Core of dense avascular and acellular fibrous tissue
What is denture irritation hyperplasia?
Leaf like folds related to the periphery of an ill fitting denture
Usually firm, not very inflamed
What is the histology of denture irritation hyperplasia?
A core of dense fibrous tissue containing small blood vessels
Covering epithelium may show hyperplasia or ulceration
What is the tx for denture irritation hyperplasia?
Denture adjustment, surgical excision, new denture
What is papillary hyperplasia of palate?
Numerous small papillary projections
May be associated with chronic erythematous candidosis
Red and oedematous mucosa
Perhaps due to trauma and rotation of ill fitting dentures
What is the histology of papillary hyperplasia?
Hyperplastic granulation tissue
Chronic inflammation
Hyperplastic covering epithelium, keratin pearls
What is gingival fibromatosis?
Hereditary autosomal dominant condition
Associated with hypertrichosis, epilepsy, mental retardation
