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benign lesions of the oral mucosa Flashcards

1
Q

are most congenital/hereditary or acquired?

A

some congenital/hereditary but majority are acquired

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2
Q

epithelial origin lesions

A

papilloma

drug-induced gingival overgrowth

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3
Q

lamina propria origins

A 
traumatic fibroma
pyogenic granuloma
peripheral GC granuloma
mucocele
lipoma
haemangioma
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4
Q

papilloma aetiology

A

neoformation epithelial origin

HPV

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5
Q

clinical papilloma

A 
hairy like elongated lesion
single/multiple
white/pinkish
pedunculated/sessile
no malignant potential
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6
Q

tx papilloma

A

surgical - may recur

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7
Q

another name for traumatic fibroma

A

fibroepithelial polyp

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8
Q

location of traumatic fibroma

A

usually buccal mucosa, lips, tongue

NOT gingiva

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9
Q

traumatic fibroma aetiology

A

accidental biting
chronic irritation
trauma/infection

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10
Q

traumatic fibroma clinical presentation

A 
dome-shaped
soft
same colour as surrounding mucosa, can be keratinised
sessile/pedunculated
can be ulcerated
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11
Q

what is a traumatic fibroma called if on gingivae?

A

epulis

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12
Q

traumatic fibroma tx if excessive dimension

A

surgically remove

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13
Q

traumatic fibroma histology

A

fibrous tissue
covered by keratinised SSE
- buccal mucosa NK: paler cells (store glycogen)
- to withstand trauma
- atrophic - thinner than normal epithelium
collagen fibres, fibroblasts, a few chronic inflammatory cells
- relatively acellular CT

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14
Q

drugs responsible for drug-induced gingival overgrowth

A

anticonvulsants - phenytoin
immunosuppressants - cyclosporin
Ca channel blockers - nifedipine, amlodipine

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15
Q

clinical presentation drug-induced gingival overgrowth

A 
enlargement 1-3m of taking drug
entire U and L gingiva
more severe anterior regions
starts from ID papilla
may cover a portion or entire tooth crown
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16
Q

drug-induced gingival overgrowth consequences

A

may prevent OH
painful eating
disfigurement
impair QOL

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17
Q

drug-induced gingival overgrowth tx

A

liase w physician: discontinuation of drug and switch to another
professional OH and CHX rinse
gingivectomy
if med not stopped may recur

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18
Q

pyogenic granuloma aetiology

A

benign, vascular, reactive?
aetiology unknown
- seems constant insults may lead to rapid proliferation of capillaries w a friable and lobulated aspect
hormonal factors - associated with pregnancy

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19
Q

clinical presentation pyogenic granuloma

A

begins small red papule
then red pedunculated exophytic lesion
surface often friable and ulcers - bleeding
often gingival margin (vascular epulis) and tongue

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20
Q

pyogenic granuloma consequences

A

no malignant potential but complications - ulceration, bleeding, secondary infections

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21
Q

pyogenic granuloma tx

A

surgical (but may recur)

also to stop angiomatous proliferation or to rule out chancre, carcinoma or kaposi-sarcoma

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22
Q

peripheral giant cell granuloma/GC epulis aetiology

A

usually described as reaction to chronic local factors
- supra/subgingival dental biofilm
- ill fitting Rxs
- dentures
- associated to implants
unknown aetiology - seems to come from PDL, or periosteum, or persistence of cells from PDL after tooth ext

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23
Q

peripheral giant cell granuloma/GC epulis clinical

A 
younger pts
anterior
exophytic
smooth
red/purple
firm/elastic consistency
freq asymptomatic except if surface ulcerated
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24
Q

peripheral giant cell granuloma/GC epulis radiographic

A

resorption alv bone
widening PDL space
rarely RR

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25
peripheral giant cell granuloma/GC epulis histology
MN GCs with background of GT mononuclear stromal cells and extravased rbcs, v cellular sharply demarcated but no fibrous capsule surrounding hyperlastic SSE - parakeratinised red cell areas - haemorrhage - haemosidrin - brown GCs might be macrophages joined together
26
peripheral giant cell granuloma/GC epulis tx
conservative excision with PD therapy but high chance of recurrence exclude systemic disease - raised PTH - low vit D in diet - malabsorption - renal disease
27
CGCG (bony)
uncommon found only in tooth bearing regions of jaws most common in mandible 20-30yrs may mimic malignant neoplasm can erode through cortical bone - domed purplish mucosal swelling may have haemosidrin due to new and old haemorrhages (v vascular)
28
mucocele aetiology
lesion caused by disruption of salivary flow from minor salivary glands origin
29
types of mucoceles
extravasation - collection of saliva in CT following trauma to ducts retention - accumulation of saliva within ductal system due to obstruction of the salivary ducts ranula - from major salivary gland origin, occur on FOM
30
mucocele clinical
soft neoformations usually L lip and buccal mucosa colour from normal mucosa to light blue/white tend to be larger and smaller periodically - may want to wait 2-3m to see if it gets larger. Bursts and recurs
31
mucocele tx
surgical removal inc underlying minor salivary gland
32
mucocele histology
``` wall of GT lined by compact layer of macrophages saliva in lumen foam cells - some macrophages break off into cyst to try and absorb saliva - become large foam cells cystic cavity ```
33
lipoma aetiology
uncertain hereditary/endocrine/trauma/infections? genetic, Gardner syndrome
34
lipoma definition
neoplasm from adipose tissue
35
lipoma clinical
submucosal mobile yellowish to pinkish soft to fibrous long-lasting swellings covered by normal oral mucosa as gets bigger may ulcerate buccal mucosa and tongue most common
36
lipoma histology
adipose tissue
37
lipoma tx
usually none but if painful/growing SR recurrences uncommon
38
white sponge naevus aetiology
congenital/hereditary | thought to be due to mutations in genes responsible for making keratin and also shedding mucosa
39
white sponge naevus clinical
asymptomatic | affects NKSSE - buccal mucosa, ventral tongue, FOM, SP
40
white sponge naevus histology
normally don't biopsy parakeratosis with intracellular oedema in keratin layer acanthosis
41
white sponge naevus tx
none
42
how oral mucosa reacts to trauma depends on:
irritation time (how long and how many times) person (genetics) reactions may be in form of: - inflammation - keratosis - ulceration - fibrous tissue formation - vesicles and bullae - other types
43
epulis
any ST swelling on gingiva
44
parakeratinised
when keratin contains remains of nuclei
45
orthokeratinised
no nuclei remnants in keratin
46
haemangioma aetiology
benign, enlarged vascular tumour develops due to abnormal proliferation of blood vessels - endothelial cells usually present at birth - developmental hamartoma - tends to grow first 6m of life - then shrinks as becomes fibrotic blood present within vessels and is in continuation with circulation of rest of body hamartoma composed of vascular tissue
47
haemangioma presentation
painless, smooth/lobulated, sessile/pedunculated soft mass red/blue/purple blanching effect - pressure causes disappearance, when released fill up slowly again
48
haemangioma histology classification
capillary: small capillaries lined by a single layer of endothelial cells supported in a CT stroma cavernous: large, thin-walled vessels, or sinusoids lined by epithelial cells, separated by thin CT layer
49
haemangioma tx
usually none, can undergo spontaneous regression | small % - tx with surgery, laser, intralesional injection of fibrosing agent
50
herpes simplex/PHG
``` inflammation/formation of vesicles which easily rupture and can coalesce don't biopsy ballooning degeneration - operlant colour - large size - may fuse ```
51
fibrous epulis cause
reaction to trauma - form of chronic inflammation | - will recur if don't address cause
52
fibrous epulis clinical
``` mainly fibrous tissue firm pink ST swelling keratinised areas of ulceration most common posterior gingivae ```
53
fibrous epulis histology
SSE - hyperplastic or ulcerated, parakeratinised ulceration - break in continuity of epithelium - surface zone distinctly pink/yellow, base fibrin - zone just beneath ulceration highly cellular and vascular (GT) mass of GT - 1st stage of healing - capillaries, fibroblasts, macrophages, plasma cells, neutrophils, lymphocytes LP - white - papillae project upwards into epithelium - rete pegs - epithelial, project downwards into LP metaplastic bone formation - reprogramming of mesenchymal SCs that are present - produce bone - reaction to chronic low grade irritation/trauma - tissue may feel "gritty" when remove - uniform pink staining areas - less cellular
54
fibrous epulis tx
surgical removal scaling OHI
55
vascular epulis presentation
gingivae (if not on gingivae pyogenic granuloma - same) | lots of bv's - bleeds lots
56
vascular epulis aetiology
thought to be exaggerated response of tissue to some sort of chronic trauma pregnancy? - most commonly found - pregnancy epulis - and changing OCP - delay removal until after birth - becomes fibrotic and smaller so easier to remove
57
vascular epulis outcome
fairy simple to remove but may recur if inflammation/subgingival calculus isn't txed
58
vascular epulis histology
``` base has epithelium (darkest bit) - remove base or recurrence likely - pedunculated/sessile no epithelium on surface - ulcerated - red (inflammation) and yellow (fibrin) surface - get fibrin from fibrinogen - part of clotting process after bleeding vascular loose CT - GT - neutrophils - lots of bv's - can bleed into GT - fibroblasts - macrophages - plasma cells ```
59
GC epulis/granuloma - ruling out underlying bone lesion
radiograph as look the same histologically as other GC lesions - osteitis fibrosa cystica (brown tumour) in hyperparathyroidism - central GC granuloma: grows along jaw in AP direction, causes erosion of alveolar bone, pops out and sits on gingiva as GC epulis - esp if lesion keeps recurring suspect this - OFG - TB - sarcoidosis - foreign body GC granuloma (e.g. suture or amalgam)
60
denture-induced hyperplasia
fibrous overgrowth trauma from denture flange if fix denture it may resolve but may need surgical removal
61
leaf fibroma
on hard palate (get squashed by denture)
62
papillary hyperplasia of palate
pseudo-epitheliomatous hyperplasia - GT, covered on surface by hyperplastic keratinised SSE - groups of epithelial cells denture associated
63
what condition is haemangioma associated with?
Sturge-Weber syndrome - can involve oral mucosa/alv bone - can rarely affect brain meninges - epilepsy - distribution of lesions corresponds to area innervated by branches of CN5 - don't cross midline
64
hamartoma
tumour-like overgrowth of tissues which are normally found at the site growth usually limited to a certain period, not lesions of continued growth - distinguishes from neoplasm
65
vascular malformation
same as haemangioma but appears later on (though present at birth) - atrophy/trauma/calcification may make them visible
66
atrophy
thinning of the epithelium | - skin may appear dry and wrinkled
67
causes of atrophy
age nutritional deficiency - iron, vit B12, folate chronic sun exposure inflammatory and neoplastic skin diseases - cutaneous T cell lymphoma - lupus erythematosus long term use of potent topical CS
68
consequence of atrophy
predisposes to infection - protective fct down
69
histology of an ulcer
epithelium hyperplastic and keratinised break in continuity of epithelium - ulcer surface of ulcer - fibrin with inflammatory cells and necrotic tissue, yellow base - GT moves up and new bv's deep to that zone of inflammatory cells - plasma cells epithelium at margins - comes to abrupt end - atrophic and keratinised with inflammatory cells present in the epithelium
70
what do keratosis and hyperplasia in an ulcer suggest?
that there has been frictional irritation and therefore the chronic irritation at the point where the epithelium has broken down has exceeded the epithelial capacity to react
71
white edge to an ulcer
keratin - can occur when get trauma to a NK surface - forms keratin to try and protect itself - frictional keratosis
72
non-specific ulcer
no characteristic features to diagnose it as anything else - not malignant - can be aphthous, traumatic etc
73
types of oral mucosa
masticatory gustatory (specialised) lining - NK
74
types of ulceration
``` trauma ROU - RAS - infections - secondary to systemic disease carcinoma ```
75
env causes of ulceration
``` trauma allergy smoking infection stress ```
76
what often causes a papilloma?
HPV 6 and 11
77
histology of papilloma
``` hyperkeratotic surface papillary (finger-like) projections projections have fibrovascular CT cores SSE covers cores no dysplasia ```
78
condyloma acuminatum
wart HPV 6, 11, 16 and 18 tongue and palate
79
condyloma acuminatum histology
acanthotic and sometimes hyperkeratotic epithelium with occasional koilocytosis

Oral medicine (14 decks)

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