Benign Mesenchymal Tumors Part 2 Flashcards
Benign tumor of adipose tissue
Lipoma
What color are lipomas if they are close to the surface?
Yellow
Histology of lipomas: demarcated or ___ collection of mature ___ cells (____)
Encapsulated
Fat
Adipocytes
Treatment of lipoma
Enucleation or conservative surgical excision
Prognosis for lipoma
Good - no recurrence or transformation
5 types of nerve benign mesenchymal tumors
- Traumatic neuroma
- Neurilemoma (Schwannoma)
- Neurofibroma (Neurofibromatosis)
- Melanotic Neuroectodermal Tumor of Infancy
- Granular Cell Tumor
“Amputation neuroma”
Traumatic neuroma
Traumatic neuroma
Reactive proliferation of nerve tissue after damage of the nerve bundle
How does a traumatic neuroma happen?
Attempts to regenerate innervation of the distal segment and encounters scar tissue
True/False: most oral traumatic neuromas are painful
False
Common intraoral sites for traumatic neuroma
Tongue, buccal vestibule (esp. mental foramen area)
Histology of traumatic neuroma
Tangled mass of peripheral nerve fibers in a collagenous background
Treatment for traumatic neuroma
Surgical excision, including a small portion of the proximal nerve bundle
Benign tumor of Schwann cell origin
Neurilemoma
Most common intraoral locations for neurilemoma
Lips, tongue, buccal mucosa
Neurilemoma may cause ___
Expansion
Radiographically, neurilemomas may be ___ or ____
Unilocular or multilocular
Neurilemoma shows benign proliferation of ____-shaped Schwann cells
Spindle
2 patterns seen microscopically in neurilimoma
Antoni A and Antoni B
Antoni A shows palisaded nuclei arranged around ___ bodies
Verocay
Antoni B is less ___ and sometimes ___
Organized, myxoid
Why does a neurilemoma usually “shell out”?
Due to dense connective tissue capsule
Benign tumor of neural fibroblast origin
Neurofibroma
Most neurofibromas are ____
Solitary
Are neurofibromas encapsulated?
No
Most common location for neurofibromas
Skin
Histology of neurofibroma shows a collection of spindle-shaped cells with _____ nuclei and ___ cells
Wavy, Mast
What protein highlights mast cells?
S-100
Common hereditary condition with a variable number of neurofibromas/schwannomas
Neurofibromatosis
3 types of Neurofibromatosis
- NF1 - mainly neurofibromas
- NF2 - mainly schwannomas
- Schwannomatosis - mainly schwannomas
NF1 can also be called
Von Recklinghausen disease of the skin
NF1 is autosomal ___
Dominant
3 types of NF1 manifestations
Cutaneous, Oral, Ocular
Cutaneous manifestations of NF1 also called ____ ___. How many must an adult have? What size?
Cafe-au-lait spots. 6 or more, greater than 1.5 cm
What is pathognomonic for NF1
Plexiform neurofibroma
What is another cutaneous manifestation for NF1
Axillary and inguinal freckling
Oral findings of NF1
Neurofibromas on tongue, gingiva, bone. Enlargement of fungiform papilla
Ocular manifestations of NF1
Lisch nodules of the iris
What are lisch nodules
Clear, yellow to brown aggregates of dendritic melanocytes within iris
Diagnosing NF1
- Six or more cafe-au-lait spots measuring > 5mm in children and > 15mm in adults
- Two or more neurofibromas, or one plexiform
- Freckling in the armpit or groin
- Two or more Lisch nodules
- Tumor on the optic nerve (optic nerve glioma)
- Abnormal spine, temple, or tibia development
- Partent, sibling, or child with NF1
Treatment for NF1
Remove traumatized neurofibromas, genetic counseling, follow up (malignant transformation)
Prognosis for NF1
Poor of malignant transformation occurs
Melanotic neuroectodermal tumor of infancy (MNTI) has ___ ___ origin
Neural crest
MNTI usually develops:
In the first year of life
Where is MNTI typically seen
Anterior maxilla
What color is MNTI
Brown/Black
Are most MNTIs benign or malignant?
Benign
Characteristic radiographic feature of MNTI
Radiolucency in the anterior maxilla pushes the deciduous maxillary incisor labially and appears as a “tooth floating in space”
What is prudent in regards to MNTI
Follow up
Previously called “myoblastoma”, but immunohistochemistry shows neural differentiation
Granular Cell Tumor
Many granular cell tumors occur on the ____
Tongue
Granular cell tumors often have ___ ___ present, which makes them similar to SCC
Pseudoepitheliomatous hyperplasia
____ ___ can be found at birth on the maxillary ridge in females
Congenital epulis
Histologicallky, a congenital epulis shows proliferation of ____ cytoplasm and atrophy of ___ ___ with no ___
Granular
Rete Ridges
PEH
Congenital epulis is S-100 (____), while granular cell tumors are S-100 (_____)
(-) - doesn’t stain for neural differentiation
(+) - stains for neural differentiation
2 blood benign mesenchymal tumors
Hemangioma
Vascular malformations
Vascular malformations are also called:
Port wine stain Encephalotrigeminal angiomatosis (Sturge-Weber syndrome)
A hemangioma may be a ___ ____
Vascular hamartoma (overgrowth of tissue normally present in the site)
Most common tumor of childhood
Hemangioma (what Toby had)
Are most hemangiomas obvious at birth? What is the exception?
No - arise by 8 weeks
Exception is non-involuting congenital hemangioma (developed fully at birth)
Most common intraoral site for a hemangioma
Tongue
Hemangioma treatment
Watch and do nothing (most will resolve) unless problematic or life-threatening unless is impairs vision (otherwise wait until 6 yo)