Benign neoplasms and inflammatory lumps Flashcards
List some inflammatory lumps that can arise in the oral cavity
- Fibroepithelial polyp
- Fibrous epulis (and ossifying fibrous epulis)
- Denture induced fibroepithelial hyperplasia
- Pyogenic granuloma
- Giant cell epulis
- Mucocele
List the benign neoplasms and hamartomas that may arise in the oral cavity
- Papilloma
- Lipoma
- Nerve sheath tumours
- Granular cell tumour
- Haemangioma
- Lymphangioma
Define hamartoma
Benign, tumour-like malformation made of an abnormal mixture of cells and tissues found in areas of the body where it grows
What is a fibroepithelial polyp?
Most common benign epithelial tumour associated with minor trauma
Describe the presentation of the fibroepithelial polyp
Firm, pink and painless swelling
The surface may be white due to frictional keratosis
Most commonly found on the buccal mucosa (level with occlusal plane), lips or tongue
Superficial (above the muscle)
Tx of fibroepithelial polyp and fibrous epulis
Excision with a base of normal tissue
What is a fibrous epulis?
Fibroepithelial polpy located on the GINGIVA due to hyperplasia
Describe the presentation of fibrous epulis
Painless, firm, pink
Located on the interdental papilla of anterior teeth
Aetiology of fibrous epulis
Trauma and chronic irritation e.g. subgingival calculus
Drug induced
How do inflammatory hyperplasias develop?
Encourages by increased capillaries, ulceration, collagen
With less blood vessels, more collagen and intact epithelium a polyp generally forms
What is ossifying fibrous epulis
Lesion composed of cellular fibroblastic granulation tissue but contains bone or cementum-like mineralisations (fibrous epulis with bone formation)
What is denture-associated hyperplasia?
Formation of hyperplastic tissue associated with the margin of an ill fitting denture
Describe the presentation of denture-induced hyperplasia
- Vary in size and shape
- Firm consistency (firbous) without gross inflammation
- May be ulcerated where the flange sits
- May appear like a flat leaf in the palate
Tx of denture-induced hyperplasia
- Denture hygiene
- Tx of superimposed candida infection if present
What is a pyogenic granuloma
Ulcerated nodule of granulation tissue
Describe the presentation of a pyogenic granuloma
- Found on the gingiva, tongue, BM due to trauma
- Red with yellow slough (ulceration) and white margin due to keratinisation
Aetiology of pyogenic granuloma
OCP
Pregnancy
Puberty
Histology of pyogenic granuloma
Inflammatory cell infiltrate usually prominent under ulcerations
Vascular proliferation and an oedematous cellular fibrous stroma
Describe the presentation of giant cell epulis
- Gingival margin between teeth anterior to molars
- Round and soft swelling
Dark red, blue or purple - Usually singular
Histology of giant cell epulis
Multiple multinucleate cells lying in a vascular stroma below the superficial epithelium
Highly vascular and haemosiderin present
Tx of giant cell epulis
Excision along with the gingival base
Underlying bone curetted
What is a papilloma
Benign nodule most probably caused due to human papillomavirus (HPV)
Describe the presentation of papilloma
- Spiky exophytic or round cauliflower shapes
- May have a white surface due to keratinisation
- Can be multiple
- Any aspect of the mucosa but common on dorsal tongue
Epidemiology of papilloma
Children and immunocompromised (HIV)
Histology of squamous papilloma
Stratified squamous epithelium with a vascular connective tissue core
Most are keratinised giving a white surface
Are papillomas premalignant?
No
Tx of papilloma
Local excision
V difficult if extensive lesions
What are the two types of nerve sheath tumours?
Schwannomas
Neurofibromas
What are nerve sheath tumours?
Benign neoplasms of supporting tissues of the nerves
What are schwannomas?
Benign neoplasms arising from schwann cells (S100 positive)
What are neurofibromas?
Uncommon benign tumour arising from the nerve sheath, forming a smooth, painless lump located intraorally, on the skin or GI tract
What is it called when there are multiple neurofibromas?
Neurofibromatosis
Describe the presentation of granular cell tumours
Asymptomatic
Smooth swelling
Common on the tongue (can occur anywhere on the mucosa, skin or GI tract)
Histology of granular cell tumours
Large granular cells originating from Schwann cells (S100 positive)
Merge with muscle
Tx of granular cell tumours
Simple excision
Why are granular cell tumours often mistaken for carcinoma?
Histology shows hyperplasia of the epithelium
What is a haemangioma?
Haemartoma of blood vessels (vascular malformation)
Describe the presentation of haemangiomas
- Localised (can be diffuse) often on the lip or tongue
- Flat or nodular, purple which blanch on pressure
Histology of haemangiomas
Highly vascular
Can be capillary or cavernous vessels, or both
What is Sturge-Weber syndrome?
Haemagiomas occuring on the meninges, causing epilepsy and a mental defect
Tx of haemangiomas
Excsision is avoided due to risk of excessive bleeding
Cryosurgery may be carried out instead
What is a lymphangioma
Haemartoma of lymphatic vessels
Describe the presentation of lymphangiomas
Pale or transluscent
Smooth or nodular elevations
Can suddenly swell and becomme dark-purple and symptomatic
Macroglossia or enlargement of the tongue
Why may a lymphangioma become purple?
Due to bleeding into the lymphatic space
Histology of lymphangiomas
Thin walls and vascular spaces with amorphous material (due to fixated lymph)
Special strains may show the lymphatic endothelial cells
Tx of lymphangiomas
Excise if localised
Staged surgery if diffuse
What is a lipoma?
Benign neoplasm of adipose tissue due to encapsulated lobules of mature fat cells
Rare in the oral cavity
Presentation of lipoma
Yellow tinted lesion, may be pedunculated
Occur on areas not prone to trauma
Slow growth
