Benign neoplasms and reactive lesions Flashcards
Oral diseases affecting epithelium (6)
Reactive: mucoceles
Infective: focal epithelial hyperplasia, verruca vulgaris, papilloma
Neoplastic: squamous cell carcinoma, salivary gland tumours
Oral diseases affecting fibrous tissue (5)
Congenital/ developmental: gingival fibromatosis
Inflammatory: gingival hyperplasia
Reactive: pyogenic granuloma, fibrous hyperplasia, giant cell granuloma
Neoplastic: fibroma
Oral diseases affecting blood vessels (3)
Congenital/ developmental: haemangioma, lymphangioma
Neoplastic: angiosarcoma
Oral diseases affecting fat (1)
Neoplastic: lipoma
Oral diseases affecting nerves (4)
Reactive: traumatic neuoma
Neoplastic: neurofibroma, neurilemmona
Idiopathic: granular cell tumour
Oral diseases affecting muscle (3)
Neoplastic: rabdomyoma, leiomyoma, sarcomas
What is an epulis? (1)
A gingival swelling
Examples of localised epulides (5)
Fibrous hyperplasia (fibro-epithelial polyp) Pyogenic granuloma Peripheral giant cell granuloma Gingival cysts Bohns nodules
Examples of generalised swellings of gingival tissue (6)
Chronic hyperplastic gingivitis Leukaemic infiltration Endocrine related (puberty, pregnancy) Crohn's disease Gingival fibromatosis Drug induced hyperplasia
Clinical features of fibrous epulis (fibrous hyperplasia) (5)
Pedunculated or sessile Same colour as normal mucosa Firm Painless unless traumatised Caused by trauma: dentures, teeth orthodontic appliances
Fibrous hyperplasia: histological appearance (2)
Overgrowth of fibrous CT
Covered by hyperkeratinised stratified squamous epithelium
Management of fibrous hyperplasia (3)
Excision
Remove cause
Send for histopathological examination
Features of a pyogenic granuloma (6)
- clinical
- who if affects
Red/ blue/ purple vascular growth Sessile or pedunculated Rapid growth Soft, bleeds easily Usually <40yrs Common in pregnancy/ puberty (pregnancy epulis)
Causes of pyogenic granuloma (2)
Caused by trauma e.g. plaque, calculus, denture, orthodontic appliance
In pregnancy/ puberty hormonal induced exuberant repsonse to above
Pyogenic granuloma: histological appearance (2)
Overgrowth of very vascular granulation tissue (endothelial cells and fibroblasts)
Explains red colour seen clinically
Management of pyogenic granuloma (4)
Excision and remove cause
If patient is 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
Peripheral giant cell granuloma features (6)
Soft red/ blue sessile or pedunculated swelling
Usually anterior teeth, mandible > maxilla
Average <40yrs
Similar to pyogenic granuloma clinically
May cause superficial bone resorption
Only found on gingiva
Peripheral giant cell granuloma (5)
Vascular fibrous tissue
Numerous multinucleate giant cells
Haemorrhage
Histological diagnosis: giant cell lesion
-same as those arising in bone histologically e.g. central giant cell granuloma and hyperparathyroidism
Management of peripheral giant cell granuloma (3)
Determine whether lesions has arisen on gingiva or within bone and burst through cortical plate - rads
If arisen in bone differential diagnosis includes central giant cell granuloma and hyperparathyroidism
Excision
-curettage of underlying bone to prevent recurrence
-send for histopathological examination
Differential diagnosis of epulides (4)
Firm, mucosa coloured: fibrous epulis
Soft, red, red/ blue: pyogenic granuloma, giant cell granuloma
Pregnant/ puberty more likely pyogenic granuloma
Definitive diagnosis by excisional biopsy
EXCLUDE ABSCESS from tooth or gum: red/ yellow/ soft/ fluctuant
Hereditary generalised gingival swellings (1)
Gingival fibromatosis
Inflammatory generalised gingival swellings (1)
Chronic hyperplastic gingivitis
Hormonal generalised gingival swellings (1)
Endocrine related (puberty, pregnancy)
Diet related generalised gingival swellings (1)
Scurvy
Drug related generalised gingival swellings (1)
Drug induced hyperplasia
Neoplastic generalised gingival swellings (2)
Leukaemic infiltration
Wegner’s granulomatosis
generalised gingival swellings associated with GI tract disease (1)
Crohn’s disease
Gingival fibromatosis features (5)
Hereditary (AD) Lifelong Pale pink, firm overgrowth May cover and submerge teeth May regrow after removal
Features of chronic hyperplastic gingivitis (2)
Associated with poor OH
Erythematous gingivae, bleed on probing
Hormonal related gingival hyperplasia features (3)
Puberty and pregnancy
Exuberant response to plaque
Red, erythematous, bleeds easily on probing
Diet related: gingival hyperplasia in scurvy - features (5)
Diet poor in vit C Failure to synthesise collagen Loss of teeth Inflammatory type hyperplasia Very rare in UK
Neoplastic: gingival hyperplasia associated with leukaemia - features (5)
Red, swollen gingivae May exude pus Ulceration Response in excess of amount of plaque May be associated with petechial haemorrhages, tiredness
Drug induced gingival hyperplasia associated with which drugs (3)
Cyclosporin (immunosuppressant)
Nifedipine (antihypertensive)
Phenytoin (anticonvulsant)
Drug induced gingival hyperplasia features (3)
Gingivae pale
Lobulated surface
Little inflammation
Drug induced gingival hyperplasia - histology (3)
Dense fibrous tissue
Little inflammation
Long epithelial rete redges
Management of drug induced gingival hyperplasia (3)
Surgical reduction
Improve OH
Change drug regime if possible
Features of Crohn’s related gingival hyperplasia (4)
Labial swelling
Apthous ulcers
Mucosal tags
Cobblestoning in GI tract
Differential diagnosis of generalised gingival hyperplasia (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
Squamous cell papilloma features (4)
Benign neoplasm HPV driven
White cauliflower like growth
Pedunculated or sessile
Common on palate
Squamous cell papilloma - histology (3)
Overgrowth of epithelium which is hyperkeratinised - hence white colour
Surface thrown into fronds
Vascular connective tissue core
Management of squamous cell papilloma (1)
Excision with a margin
Features of Heck’s disease (5)
Multiple papillomas Caused by HPV 13+32 Multiple flat viral warts May resolve spontaneously/ excise Inuit/ central America
Fibrous hyperplasia - fibro-epithelial polyp - features (3)
Continued trauma
Common on cheeks, tongue, lip
Mucosal colours, firm nodule
Fibrous hyperplasia - fibro-epithelial polyp - histology (2)
Overgrowth of mature fibrous tissue
Stratified squamous epithelium
Pyogenic granuloma features (4)
Caused by trauma
Red/ red-white
Overgrowth of vascular granulation tissue
Usually ulcerated
Traumatic neuroma features (4)
Haphazard overgrowth of nerve fibres
Usually caused by trauma
Mental foramen region
Frequently painful
Features of lipoma (5)
Benign neoplasm Composed of fat Yellow/ pink Smooth surface Common on cheek and tongue
Management of lipoma (1)
Excision
Haemangioma features (6)
Hamartoma Choristoma Excess BVs Blue/ blue-purple colour Localised or diffuse May bleed excessively
Sturge-Weber syndrome characteristic features (4)
Port wine stain Varying degrees of mental retardation Seizures Glaucoma *present from birth (congenital)*
What is a lymphangioma (3)
Similar to haemangioma but an overgrowth of lymphatic vessels
Paler colour clinically
Cystic hygroma
What is a neural tumour (neurofibroma or neurilemmona) (4)
More deep seated
Relatively rare
Firm
Mucosal coloured
What is a granular cell tumour (2)
Common on tongue
Neural origin?
What is a congenital epulis? (2)
Similar to granular cell tumour histologically but occurs in neonates
Differential diagnosis of mucosal swellings (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
