benign soft tissue lesions Flashcards
two main categories of benign soft tissue lesions
inflammatory
neoplastic/hamartomatous
list benign inflammatory soft tissue lesions (4)
- fibroepithelial hyperplasias
- pyogenic granuloma
- peripheral giant cell granuloma (giant cell epulis)
- mucocele
what are the different types of fibroepithelial hyperplasias? (4)
- fibroepithelial polyp
- fibrous epulis (FEP of gingiva)
- denture-induced fibroepithelial hyperplasia
- ossifying fibrous epulis/peripheral ossifying fibroma
4 Ps (differential diagnosis of gingival lumps)
- peripheral ossifying fibroma
- pyogenic granuloma
- peripheral giant cell granuloma (giant cell epulis)
- peripheral odontogenic fibroma
describe fibroepithelial polyp clinical appearance (4)
- round firm nodule with normal overlying mucosa +/- traumatic ulceration
- pedunculated or sessile
- caused by trauma or low grade infection
- BM, lower lip, tongue
histology of fibroepithelial polyp (2)
- unencapsulated, scar-like fibrous connective tissue nodule
- normal thickness, keratinised epithelium, mildly acanthotic
common sites for fibroepithelial polyp (3)
BM
lower lip
tongue
fibroepithelial polyp treatment (2)
- remove cause
- conservative surgical excision
describe fibrous epulis (types, causes)
- single or drug-induced gingival overgrowth
- may be progression from pyogenic granuloma
- caused by irritation by plaque/calculus
fibrous epulis treatment
- improve OH, PMPR
- conservative surgical excision
describe the clinical appearance of denture-induced fibroepithelial hyperplasia (5)
- firm fibrous tissue +/- ulceration
- leaf fibroma = compressed/flat
- papillary hyperplasia of palate - ill-fitting denture. poor denture hygiene +/- candida
- caused by ill-fitting dentures and poor hygiene
- sulci and palatal border
common sites for denture-induced fibroepithelial hyperplasia
- sulci
- palatal border
denture-induced fibroepithelial hyperplasia histology (3)
similar to FEP but more inflamed CT:
- unencapsulated, scar-like fibrous connective tissue nodule
- normal thickness, keratinised epithelium, mildly acanthotic
denture-induced fibroepithelial hyperplasia treatment (2)
- improve denture fit and hygiene
- +/- surgical/laser excision
describe peripheral ossifying fibroma/ossifying fibrous epulis (3)
- fibrous epulis with bone/cementum-like mineralisations within the connective tissue and hypercellular
- may arise from PDL
- high recurrence rate
peripheral ossifying fibroma/ossifying fibrous epulis treatment (3)
- remove cause (irritation)
- excision and curettage
- monitor for recurrence
describe clinical presentation of pyogenic granuloma (4)
- ulcerated red nodule of granulation tissue
- smooth/nodular, sessile/pedunculated
- caused by irritation coinciding with hormonal changes (endothelial cell proliferation)
- mostly on gingivae (maxilla, labial)
what may a pyogenic granuloma mature into?
fibroepithelial polyp
commonest site for pyogenic granuloma
upper labial gingivae
pyogenic granuloma histology (3)
- fibrinous slough
- ulcerated epithelium
- CT mostly consisting of granulation tissue under ulceration
pyogenic granuloma treatment
- remove cause, improve OH
- excision
- monitor during pregnancy (bleeding and recurrence risk)
describe clinical presentation of peripheral giant cell granuloma (giant cell epulis) (4)
- single round bluish/maroon gingival lump +/- ulceration
- often females
- due to local chronic trauma/irritation
- high recurrence rate
important differential for peripheral giant cell granuloma
hyperparathyroidism (take bloods and exclude bony involvement)
peripheral giant cell granuloma (giant cell epulis) histology (2)
- OC-like giant cells, macrophages
- very vascular, brown haemosiderin
peripheral giant cell granuloma (giant cell epulis) treatment
excision and curettage of bone (to decrease recurrence)
describe mucocele (general) (4)
- salivary gland cyst
- sessile, bluish, soft
- history of bursting and regrowing
- mucus extravasation cyst (trauma) or mucus retention cyst
describe mucus extravasation cyst (age, site, development, histology)
- 11-20yo
- lower lip
- trauma –> duct rupture and mucus in connective tissue –> walled off by fibrous CT and granulation tissue
- lined by foamy macrophages
- dilated duct and acini loss
mucus extravasation cyst age group
11-20yo
describe mucus retention cyst (what, site, age, histology)
- retention of mucin in dilated duct
- minor or major glands; BM or palate
- > 60yo
- fibrous cyst wall, epithelial lining, mucin filled lumen
mucus retention cyst age group
> 60yo
mucus retention cyst common sites (2)
BM
palate
mucocele treatment (2)
excise with underlying gland
remove traumatic habit
describe papillomatous lesion of oral mucosa (presentation, cause, histology)
- solitary white cauliflower-like growth
- HPV 6 or 11
- children or immunocompromised pts
- lips, tongue, soft palate
- epithelial hyperplasia (acanthotic frond) on slender vascular connective tissue papillae
- keratinised
what virus is associated with benign papillomatous lesions
HPV 6 or 11
papilloma common sites (3)
lips
tongue
soft palate
papilloma histology (2)
- epithelial hyperplasia (acanthotic frond) on slender vascular connective tissue papillae
- keratinised
papilloma treatment
simple excision with margin
histological appearance of koilocyte
dark nucleus with ring of clear cytoplasm
describe lipoma (definition, presentation, histology)
- benign neoplasm of adipose tissue (rare orally)
- smooth soft nodule, slow-growing and painless
- yellowy
- > 40yo, obese pts
- BM and FOM common
- well-circumscribed/thin capsule, lobules of adipocytes and bands of fibrous CT
important differential of lipoma
well-differentiated liposarcoma
lipoma treatment
surgical excision
lipoma histology
- well-circumscribed/thin capsule
- lobules of adipocytes and bands of fibrous CT
lipoma demographic
> 40yo
obese
describe haemangioma (definition, presentation, histology)
- hamartoma of blood vessels
- infants or adults
- capillary or cavernous types
- compressible dark red/purple mass which bleeds on trauma
- lip or tongue
- rarely intraosseous (RL, multilocular)
- may present as Port-wine stain
- unencapsulated mass of disorganised blood vessels
haemangioma common sites (2)
lip
tongue
appearance of intraosseous haemangioma
radiolucent
multilocular
(rare)
haemangioma histology
unencapsulated mass of disorganised blood vessels
difference between capillary and cavernous haemangiomas?
capillary = many small vessels
cavernous = several large dilated thin-walled vessels
describe port-wine stain and significance (4)
- type of haemangioma distributed along CV1 nerve
- malar, cheek and intraoral
- part of Sturge-Weber syndrome (developmental)
- significance = XLA bleeding risk, epilepsy (intracranial)
haemangioma treatment
cryotherapy and embolisation +/- surgery
+/- sclerosing solutions
describe lymphangioma (definition, presentation, histology)
- hamartoma of lymph vessels
- ≤2yo
- superficial translucent nodule on tongue dorsum, may be large and multinodular with brown areas
- unencapsulated mass of distended vessels with cyst-like spaces containing lymph
lymphangioma age group
≤2yo
lymphangioma common site
tongue dorsum
lymphangioma histology
unencapsulated mass of distended vessels with cyst-like spaces containing lymph
lymphangioma treatment (2)
small = surgical excision
large = sclerosing agents to block vessels and resolve lesion
describe granular cell tumour (presentation, histology)
- benign neoplasm
- adult females
- solitary rounded nodule, well-circumscribed, sessile
- tongue dorsum or BM
- pale polygonal cells with granular cytoplasm in superficial connective tissue; stains with S100
- pseudoepitheliomatous hyperplasia
granular cell tumour common sites
tongue dorsum
BM
granular cell tumour demographic
adult females
granular cell tumour histology
- pale polygonal cells with granular cytoplasm in superficial connective tissue; stains with S100
- pseudoepitheliomatous hyperplasia
what are the two main types of nerve sheath tumours
Schwannoma
neurofibroma
describe Schwannoma (definition, presentation, histology)
- benign neoplasm consisting of Schwann cells
- lie on the nerve
- swelling on tongue or BM
- outer capsule, thin elongated spindle cells with parallel nuclei, striped appearance (blue Antoni A, pink Antoni B)
- S100 positive
Schwannoma histology
- outer capsule
- thin elongated spindle cells with parallel nuclei, striped appearance (blue Antoni A, pink Antoni B)
- S100 positive
Schwannoma common sites
tongue
BM
describe neurofibroma (definition, presentations, histology)
- benign neoplasm consisting of Schwann cells and perineural fibroblasts
- single = young adults, slow growing, soft, painless lump on skin, occasionally tongue or BM and do not recur
- rarely in bone
- often present as part of neurofibromatosis
- S100 positive spindle cells with small nerve fibres running through
describe single neurofibromas
- young adults
- slow growing, soft, painless lump on skin, occasionally tongue or BM
- do not tend to recur
single neurofibroma common oral sites
tongue
BM
single neurofibroma treatment
excision (curative)
neurofibroma histology
S100 positive spindle cells with small nerve fibres running through
describe neurofibromatosis (definition, features)
- group of hereditary conditions, 8 types
- type I most common (AD, NF1 gene)
- multiple neurofibromas of the skin
- cafe au lait spots, freckling
- optic gliomas, Lisch nodules
- other bone lesions
- rarely develop cancers - malignant peripheral nerve sheath tumour (5%), leukaemia, CNS tumour, rhabdomyosarcoma
signs/symptoms of neurofibromatosis (5)
- multiple neurofibromas of the skin
- cafe au lait spots, freckling
- optic gliomas, Lisch nodules
- other bone lesions
- rarely develop cancers - malignant peripheral nerve sheath tumour (5%), leukaemia, CNS tumour, rhabdomyosarcoma
neurofibromatosis treatment
- no therapy
- may excise for cosmetics but will recur/develop new lesions
