Benign Oral Neoplasms Flashcards
what do Fibroepithelial hyperplasias include?
What is the origin, how do you diagnose and what is the management?
- Include: fibroepithelial polyp, fibrous epulis, denture-induced fibroepithelial hyperplasia
- Although different names they are similar in origin and nature
- Hyperplastic response to chronic irritation or low-grade infection
- Diagnose with biopsy
- Should be excised complete, as well as the base of the normal tissue. Also remove the source of irritation
What is the histopathology of Fibroepithelial hyperplasias?
Lesion composed of mature fibrous tissue covered by hyper plastic epithelium (as opposed to papilloma which is almost all epithelium)
What are the clinical features of a fibrous epulis and fibrous epulis with ossification?
- Most common near the front of the mouth on the gingiva between two teeth
- Caused by irritation of the gingival margin by edge of carious cavity, calculus or plaque trap
- Fibrous epulis with ossification is similar to fibrous epulis but contains bone or cementum-like mineralisations and may arise from PDL connective tissue
What are the Clinical features of fibroepithelial polyps?
- Smooth-surfaced fibrous mucosal nodule
- Form on the buccal mucosa along the occlusal line or on the lip at sites of biting
- Predominantly fibrous tissue (firm)
What are the Clinical features of denture-induced fibroepithelial hyperplasia?
- Form in mucosa at the edge of dentures
- caused by irritation of alveolar or palatal mucosa by overextended or rough part of denture
- ‘Leaf fibroma’: fibrous overgrowth forms under denture which becomes flattened against palate
What are the Clinical features of Papillary hyperplasia of the palate and what is the management?
- Nodular overgrowth of palatal mucosa seen beneath complete dentures
- Usually poor denture hygiene or poor denture fit
- Candidosis can sometimes be superimposed but it is not the cause
- Management: denture hygiene and possible surgical removal or nodules
What are the Clinical features of of Pyogenic granuloma?
What is the management?
- Proliferative mass of endothelial cells and fibroblasts forming an ulcerated nodule of granulation tissue
- Usually on gingiva
- Painless, red and relatively soft. Consists of lots of blood vessels
- Contraceptive pill or pregnancy may predispose
- May resolve following removal of cause or revert to a fibrous epulis
- Pregnancy epulis: only distinguished by pt’s pregnancy and usually associated with pregnancy gingivitis
What are the Clinical features of Giant cell epulis?
What is the management?
- Hyperplastic lesion
- Arises only on gingival margin usually anterior to molars interdentally
- Swelling is soft, rounded, purple and as large as 2cm
- Osteoclast-like giant cells, macrophages, very vascular
- Should be excised with gingival base and underlying bone curetted
What are the Clinical features of papillomas?
- Epithelial warty nodule, presenting as white patch
- Common in children and immunocompromised
- Caused by HPV
- Not premalignant
- Painless and low infectivity
Types of papillomas? (6)
- Squamous cell papilloma
- Cauliflower like and papillae consist of stratified squamous epithelium supported by vascular CT core - Infective warts
- May appear identical to squamous cell papillomas - Multifocal epithelial hyperplasia
- Rounded mucosal papillomas clustered
- Lesions pink - no keratin - Verruciform xanthoma
- Rare hyperplastic hyperkeratotic lesion
- White or red usually found on gingiva - Calibre-persistent artery
- Loop of labial artery lies superficially below vermillion border or labial mucosa
- Forms nodule sometimes pulsatile and appears bluish - Mucocele (mucous extravasation cyst)
- Traumatic
- Damage to salivary excretory duct - pooling of saliva in CT and walled off by fibrous tissue
- Cavity lined by macrophages
What are the clinical features of nerve sheath tumours?
- Benign neoplasms of supporting tissues of peripheral nerves (Schwann cell)
- Schwannomas lie on a nerve and are composed of Schwann cells
- Neurofibromas often multiple and are composed of nerve processes and fibroblasts
- Firm, mobile soft tissue lumps
What are the clinical features of Lipoma and fibrolipoma?
- Benign neoplasms of adipose tissue
- Smooth, soft, yellowish, slow growing swellings
- Rare is oral tissues: found on tongue, lips and buccal fat pad
- Histologically, lipomas consist of normal fat with variable amount of supporting fibrous tissue
- When fibrous tissue is prominent the lesion is called fibrolipoma
What are the clinical features of Granular cell tumour?
- Painless domed smooth swellings
- Granular cells form the bulk of the lesion
- Granular cell tumour can induce pseudocarcinomatous hyperplasia of overlying epithelium - misdiagnosis as carcinoma
What are the clinical features of congenital granular cell epulis?
- Present at birth as soft smooth nodule
- Upper alveolar ridge, occasionally on tongue
- If small, spontaneous resolution
What are the clinical features of Haemagiomas?
what are the differences between Capillary and cavernous haemangiomas AND arteriorvenous and venous malformations
- Hamartoma of blood vessels found on lip and tongue
- Capillary (lots of small BVs) and cavernous (blood-filled sinusoid) haemangiomas form purple flat superficial lesions
- arteriorvenous and venous malformations are of higher blood flow and thrombosis is common causing pain - they affect deep and superficial tissue
