Benign Mesenchymal Neoplasms Flashcards
What oral path lesion does this describe?
“collagen deposition secondary to chronic trauma”
fibroma
What are the signs and symptoms of a fibroma?
smooth-surfaced, dome-shaped nodule on the buccal mucosa/tongue
Describe the histology of a fibroma.
dense fibrous connective tissue histopathologically
What is the recommended treatment for a fibroma?
conservative excision
What is inflammatory fibrous hyperplasia also known as?
- denture epulis
- epulis fissuratum
- denture-induced fibrous hyperplasia
What is the clinical appearance and histology of inflammatory fibrous hyperplasia?
- usually flange of ill-fitting denture
- may have central fissure
- histologically similar to fibromas; mostly collagen with inflammatory cells
What is the recommended treatment for inflammatory fibrous hyperplasia?
- conservative excision
- re-make denture
What oral path lesion is described?
“denture papillomatosis due to a maxillary complete denture”
inflammatory papillary hyperplasia
What is the clinical appearance of inflammatory papillary hyperplasia?
- 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
What is the recommended treatment for inflammatory papillary hyperplasia?
surgical removal (is curative)
What is the clinical appearance of pyogenic granuloma?
- rapidly growing, painless red mass
- on any body surface; gingiva, lips, tongue
- bleeds easily
- frequently occurs during pregnancy
Describe the histology of pyogenic granuloma. Treatment?
- granulation tissue
- excise, remove irritants, 15% recur
Describe the clinical appearance of peripheral giant cell granuloma. Where does it often occur?
- 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
Describe the histology of peripheral giant cell granuloma. Treatment?
- granulation tissue with numerous benign multinucleated giant cells
- treatment is excise, remove irritants, and 15% recur
Describe the clinical appearance of peripheral ossifying fibroma. Where does it often occur?
- painless firm coral-pink mass
- found ONLY on gingiva
- almost all are associated with root tip or tooth nearby
Describe the histology of peripheral ossifying fibroma. Treatment?
- cellular fibrous connective tissue with variable amounts of calcification
- excise, remove irritants, 15% recur
What oral path lesion does this describe:
“benign tumor of adipose tissue”
Who does it most often occur in?
lipoma
adult patients
What is the clinical appearance of lipoma? Histology?
- 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
What is the recommended treatment for a lipoma? Prognosis?
- treatment: enucleation or conservative surgical excision
- virtually no tendency to recur; no evidence of malignant transformation
What oral path lesion does this describe?
“represents an uncommon reaction to the sectioning of a nerve”
traumatic neuroma
What is the clinical appearance of a traumatic neuroma? Where does it often occur?
- smooth-surfaced, dome-shaped papule, usually less than 1 cm
- tongue, buccal vestibule are often affected
- may be tender on palpation
Describe the histology of a traumatic neuroma.
- a tangled mass of peripheral nerve fibers is seen
- usually set in a collagenous background
What oral path lesion does this describe?
“benign tumor of Schwann cell origin”
neurilomoma (Schwannoma)
What age group does neurilomoma (Scwannoma) most often occur in? What sites?
- adults
- lips, tongue, buccal mucosa, may be seen within the mandible
What is the clinical appearance of a neurilomoma?
slow-growing, solitary, encapsulated, rubbery-firm, non-tender mass
Describe the histology of a neurilomoma.
- well-developed connective tissue capsule
- benign proliferation of spindle-shaped Schwann cells
- Antoni A and B patterns seen
What is the difference between Antoni A and B patterns in a neurilomoma?
- Antoni A: palisaded nuclei arranged around acellular hyaline material (Verocay bodies)
- Antoni B: more disorganized, myxoid
What is the recommended treatment for neurilomoma? Prognosis?
- conservative excision; lesion usually “shells out” due to dense connective tissue capsule
- virtually no tendency to recur; extremely rare malignant transformation
What oral path lesion does this describe?
“benign tumor of neural fibroblast origin”
neurofibroma
Describe the clinical appearance of a neurofibroma.
- 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
Describe the histology of a neurofibroma.
- 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
What is the treatment of a neurofibroma? The prognosis?
- simple conservative excision
- prognosis is generally good
- uncommon possibility of malignant tranformation to malignant peripheral nerve sheath tumor (especially rare for small, superficial lesions)
What oral path lesion is one of the most common autosomal genetic problems that affects humans?
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
Describe the clinical presentation of neurofibromatosis.
- 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
What is the proposed treatment for neurofibromatosis?
- remove traumatized neurofibromas or disfiguring lesions
- genetic counseling
- follow-up for potential malignant transformation
What is the prognosis of neurofibromatosis?
fair to guarded
if malignant transformation occurs, prognosis is poor
What oral path lesion is described below?
“rare tumor seen in the first 2-3 years of life”
melanotic neuroectodermal tumor of infancy
Describe the clinical appearance of melanotic neuroectodermal tumor of infancy.
- 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)
Describe the histology of melanotic neuroectodermal tumor of infancy.
- proliferation of small, dark, neuroectodermal-appearing cells that are in nested aggregates
- surrounded by plump epithelial cells that produce melanin
What is the treatment for melanotic neuroectodermal tumor of infancy?
- conservative excision is usually curative
- good prognosis; aggressive behavior is probably over-reported
What oral path lesion is also known as “granular cell myoblastoma”?
granular cell tumor
What is the clinical appearance of a granular cell tumor? Sites most affected?
- 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
Describe the histology of a granular cell tumor.
- 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
What is the recommended treatment for granular cell tumor? Prognosis?
- conservative excision is usually curative
- prognosis is excellent
What is the clinical appearance of congenital epulis? Who is most susceptible?
- found at birth on maxillary ridge of girl babies
- smooth-surfaced, often pedunculated
- vary in size
Describe the histology of congenital epulis.
- benign proliferation of cells having granular cytoplasms
- no pseudoepitheliomatous hyperplasia
- no S-100 positivity
What is the recommended treatment for congenital epulis? Prognosis?
- conservative excision
- no tendency to recur; some reports of spontaneous involution without surgery
What oral path lesion is described below?
“some consider this to be a vascular hamartoma rather than a true neoplasm”
hemangioma
What is the most common tumor of childhood?
hemangioma
What site is most often affected by hemangioma? What is another name for a hemangioma?
- head and neck region is frequently affected; tongue is the most common intraoral site
- AKA “stork bites”
Describe the clinical appearance of hemangioma.
- 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
What technique is used to diagnose hemangioma?
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)
What is the recommended treatment for hemangioma?
- 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
What oral path lesion is also known as Sturge-Weber syndrome?
encephalotrigeminal angiomatosis
True or false: Encephalotrigeminal angiomatosis is an inherited lesion.
FALSE. It is congenital
Describe the clinical appearance of encephalotrigeminal angiomatosis.
- 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”
What oral path lesion is described below?
“benign neoplasm of lymphatic vessel differentiation”
lymphangioma
What age is most susceptible to lymphangioma? What site?
- often present at birth
- tongue is the most common intraoral site
Describe the clinical appearance of lymphangioma.
surface has a vesicular appearance, similar to “frog eggs” or “tapioca pudding”
What is another term for a very large lymphangioma?
cystic hygroma
What sites are common for a cystic hygroma? What can this lead to?
- neck, mediastinum, axilla, and the oral cavity
- may lead to airway obstruction, especially if secondary infection
What is the recommended treatment for a lymphangioma? Recurrence rate?
- 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
What oral path lesion is described below?
“benign tumor of smooth muscle differentiation”
leiomyoma
What type of smooth muscle usually results in leiomyoma in the oral cavity? What sites are most common?
- vascular smooth muscle
- upper lip, buccal mucosa, and palate
Describe the clinical appearance of leiomyoma.
- well-demarcated, rubbery firm, less than 1 cm in diameter
- may have red or purple coloring due to their vascular nature
Describe the histology of leiomyoma.
- 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
What is the recommended treatment for leiomyoma? Prognosis?
- conservative excision
- prognosis is excellent; virtually no chance of recurrence
What oral path lesion is described below?
“very rare, benign tumor of skeletal muscle differentiation”
rhabdomyoma
What is the most common site of rhabdomyoma? What is it usually associated with?
- 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
Describe the clinical appearance of rhabdomyoma
non-tender well-circumscribed mass in submandibular or base of tongue region
What is the recommended treatment of rhabdomyoma? Prognosis?
- conservative surgical excision
- recurrence has been reported but is not common
