Benign Neoplasms and Reactive Lesions Flashcards
Summarise Localised- epulides (5)
- Fibrous hyperplasia (fibro-epithelial polyp)
- Pyogenic granuloma
- Peripheral giant cell granuloma
- Gingival cysts
- Bohns nodules
List Generalised swellings of gingival tissues (6)
- Chronic hyperplastic gingivitis
- Leukaemic infiltration
- Endocrine related (puberty, pregnancy)
- Crohn’s disease
- Gingival fibromatosis
- Drug induced hyperplasia
Pedunculated or sessile
- Same colour as normal mucosa
- Firm
- Painless unless traumatised
- Caused by trauma
- Overgrowth of fibrous connective tissue
- Covered by hyperkeratinised stratified squamous epithelium
- Management: excision. Get rid of cause.
- Send for histopathological examination
Summarise the aetiology and clinical appearance of Pyogenic granuloma (6)
- Red/blue/purple vascular growth
- Sessile or pedunculated
- Rapid growth
- Soft, bleeds easily
- Usually < 40 years
- Common in pregnancy/puberty (pregnancy epulis)
Summarise the causes of a Pyogenic granuloma (4)
- Trauma e.g plaque, calculus, denture, orthodontic appliance
- In pregnancy/puberty hormonal induced exuberant response to above
- Overgrowth of very vascular granulation tissue (endothelial cells & fibroblasts)
- Explains the red colour seen clinically
Summarise the management of a Pyogenic granuloma (4)
- Excision and remove cause
- If pt. pregnant improve oral hygiene and excise but may recur.
- Lesions may mature into dense fibrous tissue (fibrous epulis)
- Also found at other sites in oral mucosa
Give differential diagnoses for fibrous epulis, how do you establish a definitive diagnosis? What should you exclude? (5)
- Firm, mucosa coloured: fibrous epulis
- Soft, red, red/blue: pyogenic granuloma, giant cell granuloma.
- If patient pregnant/puberty then more likely pyogenic granuloma.
- Definitive diagnosis by excisional biopsy.
- Remember to exclude an abscess from tooth or gum- red/yellow/soft/fluctuant.
What can cause generalised gingival swellings? (7)
- Hereditary: Gingival fibromatosis
- Inflammatory: Chronic hyperplastic gingivitis
- Hormonal: Endocrine related (puberty, pregnancy)
- Diet related: Scurvy
- Drug related: Drug induced hyperplasia
- Neoplastic: Leukaemic infiltration; Wegners granulomatosis
- Associated with GI tract disease: Crohn’s disease
Summarise a gingival fibromatosis (5)
- Hereditary
- Lifelong
- Pale pink, firm overgrowth
- May cover and submerge teeth
- May regrow after removal
Describe the clinical appearance and associated of Chronic Hyperplastic Gingivitis (2)
- Associated with poor oral hygiene
- Erythematous gingivae, bleed on probing
What is Hormonal related gingival hyperplasia associated with and how does it appear? (3)
- Puberty and pregnancy
- Exuberant response to plaque
- Red, erythematous, bleeds easily on probing
Describe Diet related: Gingival hyperplasia in scurvy (5)
- Diet poor in vitamin C
- Failure to synthesise collagen
- Loss of teeth
- Inflammatory type hyperplasia
- Very rare in UK
Describe the clinical appearance of Neoplastic: Gingival hyperplasia associated with leukaemia, what is in response to and associated with? (5)
- Red, swollen gingivae
- May exude pus
- Ulceration
- Response in excess of amount of plaque
- May be associated with petechial haemorrhages, tiredness
Describe Drug induced gingival hyperplasia, what is it associated with? What is the management? (6)
- Associated with cyclosporin (immunosupressant), nifedipine (antihypertensive) and phenytoin (anticonvulsant)
- Gingivae pale, lobulated surface, little inflammation
- Dense fibrous tissue
- Little inflammation
- Long epithelial rete ridges
- Management: surgical reduction, improve oral hygiene, change drug regime if possible.
Describe Differential Diagnoses for Generalised Gingival Hyperplasia, associated with specific symptoms (3)
- Pale, un-inflamed gingivae: gingival fibromatosis or drug induced. Distinguish on duration and drug history
- Red, inflamed gingivae: inflammatory hyperplasia or hormonal induced. Distinguish by history
- Red, inflamed, pus, ulceration: leukaemia. Further investigations
Broadly summarise Swellings affecting the oral mucosa (3)
- These may be derived from any of the tissues in the oral mucosa
- Most are reactive or inflammatory in nature
- A few are benign neoplasms or developmental
Summarise Squamous cell papilloma and its management (8)
- Benign neoplasm but some be viral- HPV.
- White cauliflower like growth
- Pedunculated or sessile
- Common on palate
- Overgrowth of epithelium which is hyperkeratinised- hence white colour
- Surface thrown into fronds
- Vascular connective tissue core
- Management: excision with a margin
Summarise Fibrous Hyperplasia- fibro-epithelial polyp (3)
- Continued trauma
- Common on cheeks, tongue, lip
- Mucosal coloured, firm nodule
Summarise Pyogenic granuloma (4)
- Caused by trauma
- Red/red-white
- Overgrowth of vascular granulation tissue
- Usually ulcerated
Summarise Lipoma and its management (6)
- Benign neoplasm
- Composed of fat
- Yellow/pink
- Smooth surface
- Common
- Management: excision
Summarise Haemangioma clinical appearance (5)
- Hamartoma
- Excess blood vessels
- Blue/blue-purple colour
- Localised or diffuse
- May bleed excessively. Care!
Summarise Lymphangioma (2)
- Similar to haemangioma but an overgrowth of lymphatic vessels
- Paler colour clinically
Summarise Neural tumour (5)
- Neurofibroma or neurilemmoma.
- More deep seated
- Relatively rare
- Firm
- Mucosal coloured
Summarise Granular cell tumour (2)
- Common on tongue
- Neural origin
Give Differential diagnoses of mucosal swellings specific to symptoms/clinical features (6)
- Cauliflower-like and white- squamous cell papilloma
- Smooth, mucosal coloured, related to denture, or other source of trauma- fibrous hyperplasia.
- Smooth, yellow- lipoma
- Red/red-white, related to trauma -pyogenic granuloma
- Red/blue- haemangioma, mucocoele
- Deep seated/ normal mucosa- neuroma, neural tumour, salivary gland tumour
