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AU15 - Oral Pathology Exam 2 > Benign Mesenchymal Neoplasms > Flashcards

Benign Mesenchymal Neoplasms Flashcards

1
Q

What oral path lesion does this describe?

“collagen deposition secondary to chronic trauma”

A

fibroma

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2
Q

What are the signs and symptoms of a fibroma?

A

smooth-surfaced, dome-shaped nodule on the buccal mucosa/tongue

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3
Q

Describe the histology of a fibroma.

A

dense fibrous connective tissue histopathologically

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4
Q

What is the recommended treatment for a fibroma?

A

conservative excision

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5
Q

What is inflammatory fibrous hyperplasia also known as?

A
  • denture epulis
  • epulis fissuratum
  • denture-induced fibrous hyperplasia
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6
Q

What is the clinical appearance and histology of inflammatory fibrous hyperplasia?

A
  • usually flange of ill-fitting denture
  • may have central fissure
  • histologically similar to fibromas; mostly collagen with inflammatory cells
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7
Q

What is the recommended treatment for inflammatory fibrous hyperplasia?

A
  • conservative excision

- re-make denture

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8
Q

What oral path lesion is described?

“denture papillomatosis due to a maxillary complete denture”

A

inflammatory papillary hyperplasia

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9
Q

What is the clinical appearance of inflammatory papillary hyperplasia?

A
  • on the central region of the hard palate mucosa
  • numeraous asymptomatic red papules
  • irritation, low grade inflammation
  • histologically, widened vessels (causes erythema), black inflammatory cells
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10
Q

What is the recommended treatment for inflammatory papillary hyperplasia?

A

surgical removal (is curative)

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11
Q

What is the clinical appearance of pyogenic granuloma?

A
  • rapidly growing, painless red mass
  • on any body surface; gingiva, lips, tongue
  • bleeds easily
  • frequently occurs during pregnancy
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12
Q

Describe the histology of pyogenic granuloma. Treatment?

A
  • granulation tissue

- excise, remove irritants, 15% recur

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13
Q

Describe the clinical appearance of peripheral giant cell granuloma. Where does it often occur?

A
  • painless mass with a dusky-purple hue
  • found ONLY on gingiva and alveolar process
    Note:
  • caused by local irritation
  • can cause pressure resorption in bone
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14
Q

Describe the histology of peripheral giant cell granuloma. Treatment?

A
  • granulation tissue with numerous benign multinucleated giant cells
  • treatment is excise, remove irritants, and 15% recur
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15
Q

Describe the clinical appearance of peripheral ossifying fibroma. Where does it often occur?

A
  • painless firm coral-pink mass
  • found ONLY on gingiva
  • almost all are associated with root tip or tooth nearby
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16
Q

Describe the histology of peripheral ossifying fibroma. Treatment?

A
  • cellular fibrous connective tissue with variable amounts of calcification
  • excise, remove irritants, 15% recur
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17
Q

What oral path lesion does this describe:
“benign tumor of adipose tissue”

Who does it most often occur in?

A

lipoma

adult patients

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18
Q

What is the clinical appearance of lipoma? Histology?

A
  • slow-growing, non-tender, soft, doughy, usually encapsulated
  • common in head and neck, may be found intraorally
  • yellow if close to the surface
  • histology: demarcated or encapsulated collection of mature fat cells
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19
Q

What is the recommended treatment for a lipoma? Prognosis?

A
  • treatment: enucleation or conservative surgical excision

- virtually no tendency to recur; no evidence of malignant transformation

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20
Q

What oral path lesion does this describe?

“represents an uncommon reaction to the sectioning of a nerve”

A

traumatic neuroma

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21
Q

What is the clinical appearance of a traumatic neuroma? Where does it often occur?

A
  • smooth-surfaced, dome-shaped papule, usually less than 1 cm
  • tongue, buccal vestibule are often affected
  • may be tender on palpation
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22
Q

Describe the histology of a traumatic neuroma.

A
  • a tangled mass of peripheral nerve fibers is seen

- usually set in a collagenous background

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23
Q

What oral path lesion does this describe?

“benign tumor of Schwann cell origin”

A

neurilomoma (Schwannoma)

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24
Q

What age group does neurilomoma (Scwannoma) most often occur in? What sites?

A
  • adults

- lips, tongue, buccal mucosa, may be seen within the mandible

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25
Q

What is the clinical appearance of a neurilomoma?

A

slow-growing, solitary, encapsulated, rubbery-firm, non-tender mass

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26
Q

Describe the histology of a neurilomoma.

A
  • well-developed connective tissue capsule
  • benign proliferation of spindle-shaped Schwann cells
  • Antoni A and B patterns seen
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27
Q

What is the difference between Antoni A and B patterns in a neurilomoma?

A
  • Antoni A: palisaded nuclei arranged around acellular hyaline material (Verocay bodies)
  • Antoni B: more disorganized, myxoid
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28
Q

What is the recommended treatment for neurilomoma? Prognosis?

A
  • conservative excision; lesion usually “shells out” due to dense connective tissue capsule
  • virtually no tendency to recur; extremely rare malignant transformation
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29
Q

What oral path lesion does this describe?

“benign tumor of neural fibroblast origin”

A

neurofibroma

30
Q

Describe the clinical appearance of a neurofibroma.

A
  • over 90% are solitary; most of remainder are multiple and associated with neurofibromatosis
  • soft, dome-shaped, non-tender, superficial nodule affecting skin or mucosa
  • demarcated, but unencapsulated
31
Q

Describe the histology of a neurofibroma.

A
  • collection of fibroblastic cells that have wavy nuclei
  • quite a few mast cells seen within these lesions
  • lesional tissue tends to mingle with adjacent normal tissue
32
Q

What is the treatment of a neurofibroma? The prognosis?

A
  • simple conservative excision
  • prognosis is generally good
  • uncommon possibility of malignant tranformation to malignant peripheral nerve sheath tumor (especially rare for small, superficial lesions)
33
Q

What oral path lesion is one of the most common autosomal genetic problems that affects humans?

A

neurofibromatosis

  • occurs at a frequency of approximately 1 in 3,000 live births
  • approximately half are transmitted as autosomal dominant while the other half are mutations
34
Q

Describe the clinical presentation of neurofibromatosis.

A
  • highly variable gene expression (some cases are mild, some are severe)
  • variety of manifestations, including both oral and cutaneous
  • skin lesions: cafe au lait spots, multiple neurofibromas, axillary freckling
  • oral lesions consist of neurofibromas that may affect the tongue, gingiva, or bone
35
Q

What is the proposed treatment for neurofibromatosis?

A
  • remove traumatized neurofibromas or disfiguring lesions
  • genetic counseling
  • follow-up for potential malignant transformation
36
Q

What is the prognosis of neurofibromatosis?

A

fair to guarded

if malignant transformation occurs, prognosis is poor

37
Q

What oral path lesion is described below?

“rare tumor seen in the first 2-3 years of life”

A

melanotic neuroectodermal tumor of infancy

38
Q

Describe the clinical appearance of melanotic neuroectodermal tumor of infancy.

A
  • most develop in anterior maxilla
  • rapid growth
  • may be brown, black, or purple in color
  • radiographic appearance is characteristic (radiolucency in anterior maxilla, deciduous maxillary incisor is pushed labially as if it is floating in space)
39
Q

Describe the histology of melanotic neuroectodermal tumor of infancy.

A
  • proliferation of small, dark, neuroectodermal-appearing cells that are in nested aggregates
  • surrounded by plump epithelial cells that produce melanin
40
Q

What is the treatment for melanotic neuroectodermal tumor of infancy?

A
  • conservative excision is usually curative

- good prognosis; aggressive behavior is probably over-reported

41
Q

What oral path lesion is also known as “granular cell myoblastoma”?

A

granular cell tumor

42
Q

What is the clinical appearance of a granular cell tumor? Sites most affected?

A
  • can develop on any mucosal surface, but 40% develop on the tongue (buccal mucosa or floor of the mouth may also be affected)
  • slow-growing demarcated (unencapsulated) non-tender submucosal nodule
  • most are
43
Q

Describe the histology of a granular cell tumor.

A
  • collection of mesenchymal cells with a granular-appearing cytoplasm
  • PEH (pseudoepitheliomatous hyperplasia) is present in about 30% of granular cell tumors (may be mistaken for squamous cell carcinoma)
  • large ovoid cells with dot-like cytoplasm
  • keratin pearl
  • epithelial cells driving into connective tissue
  • S100+ muscle cells
44
Q

What is the recommended treatment for granular cell tumor? Prognosis?

A
  • conservative excision is usually curative

- prognosis is excellent

45
Q

What is the clinical appearance of congenital epulis? Who is most susceptible?

A
  • found at birth on maxillary ridge of girl babies
  • smooth-surfaced, often pedunculated
  • vary in size
46
Q

Describe the histology of congenital epulis.

A
  • benign proliferation of cells having granular cytoplasms
  • no pseudoepitheliomatous hyperplasia
  • no S-100 positivity
47
Q

What is the recommended treatment for congenital epulis? Prognosis?

A
  • conservative excision

- no tendency to recur; some reports of spontaneous involution without surgery

48
Q

What oral path lesion is described below?

“some consider this to be a vascular hamartoma rather than a true neoplasm”

A

hemangioma

49
Q

What is the most common tumor of childhood?

A

hemangioma

50
Q

What site is most often affected by hemangioma? What is another name for a hemangioma?

A
  • head and neck region is frequently affected; tongue is the most common intraoral site
  • AKA “stork bites”
51
Q

Describe the clinical appearance of hemangioma.

A
  • usually red in color, but can range through various shades of purple depending on the caliber of vessels
  • most are elevated, but macular lesions are also seen (“port wine stain”; nevus flammeus)
  • variable in size
  • diascopy is helpful in determining the source of red lesion
52
Q

What technique is used to diagnose hemangioma?

A

diascopy - may be helpful in determining whether a red lesion is due to extravasated blood or to blood that is contained within vessels (blood within vessels will be pushed to adjacent vessels and tissue will blanche upon pressure)

53
Q

What is the recommended treatment for hemangioma?

A
  • surgical excision, cryotherapy, embolization, or use of sclerosing agents if cosmetically unacceptable
  • if lesion impairs vision, treat as soon as possible, otherwise, wait until child is 6 years old
54
Q

What oral path lesion is also known as Sturge-Weber syndrome?

A

encephalotrigeminal angiomatosis

55
Q

True or false: Encephalotrigeminal angiomatosis is an inherited lesion.

A

FALSE. It is congenital

56
Q

Describe the clinical appearance of encephalotrigeminal angiomatosis.

A
  • nevus flammeus in distribution of cranial nerve CN V1 (and sometimes V2 and V3, but must have V1)
  • involvement of deeper soft tissues as well as meninges of brain
  • seizure disorders, mental retardation, and hemiplegia (paralysis on one side of body) may be present
  • classic radiographic finding of “tramline” calcifications seen on skull film; parallel calcifications probably represent the calcified walls of abnormal blood vessels

Note: “port wine stain”

57
Q

What oral path lesion is described below?

“benign neoplasm of lymphatic vessel differentiation”

A

lymphangioma

58
Q

What age is most susceptible to lymphangioma? What site?

A
  • often present at birth

- tongue is the most common intraoral site

59
Q

Describe the clinical appearance of lymphangioma.

A

surface has a vesicular appearance, similar to “frog eggs” or “tapioca pudding”

60
Q

What is another term for a very large lymphangioma?

A

cystic hygroma

61
Q

What sites are common for a cystic hygroma? What can this lead to?

A
  • neck, mediastinum, axilla, and the oral cavity

- may lead to airway obstruction, especially if secondary infection

62
Q

What is the recommended treatment for a lymphangioma? Recurrence rate?

A
  • treatment depends on the size of the lesion; surgical excision is the treatment of choice
  • relatively high recurrence rate (up to 40%)

*this is more difficult to treat than hemangioma because it is often difficult to discern the borders of the tumor

63
Q

What oral path lesion is described below?

“benign tumor of smooth muscle differentiation”

A

leiomyoma

64
Q

What type of smooth muscle usually results in leiomyoma in the oral cavity? What sites are most common?

A
  • vascular smooth muscle

- upper lip, buccal mucosa, and palate

65
Q

Describe the clinical appearance of leiomyoma.

A
  • well-demarcated, rubbery firm, less than 1 cm in diameter

- may have red or purple coloring due to their vascular nature

66
Q

Describe the histology of leiomyoma.

A
  • benign proliferation of cells that resemble smooth muscle
  • spindle-shaped, with cigar-shaped nuclei and eosinophilic cytoplasms
  • no significant atypia and no mitotic activity
  • positive for markers of muscle differentiation
  • cell fascicles running all directions
  • smooth muscle cells are proliferating
67
Q

What is the recommended treatment for leiomyoma? Prognosis?

A
  • conservative excision

- prognosis is excellent; virtually no chance of recurrence

68
Q

What oral path lesion is described below?

“very rare, benign tumor of skeletal muscle differentiation”

A

rhabdomyoma

69
Q

What is the most common site of rhabdomyoma? What is it usually associated with?

A
  • most arise in heart (“cardiac rhabdomyoma”) but can develop in the head and neck, specifically submandibular or base of tongue region
  • associated with syndrome tuberous sclerosis
70
Q

Describe the clinical appearance of rhabdomyoma

A

non-tender well-circumscribed mass in submandibular or base of tongue region

71
Q

What is the recommended treatment of rhabdomyoma? Prognosis?

A
  • conservative surgical excision

- recurrence has been reported but is not common

AU15 - Oral Pathology Exam 2 (4 decks)

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