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BDS5 oral disease > benign soft tissue lesions > Flashcards

benign soft tissue lesions Flashcards

1
Q

two main categories of benign soft tissue lesions

A

inflammatory
neoplastic/hamartomatous

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2
Q

list benign inflammatory soft tissue lesions (4)

A
  • fibroepithelial hyperplasias
  • pyogenic granuloma
  • peripheral giant cell granuloma (giant cell epulis)
  • mucocele
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3
Q

what are the different types of fibroepithelial hyperplasias? (4)

A
  • fibroepithelial polyp
  • fibrous epulis (FEP of gingiva)
  • denture-induced fibroepithelial hyperplasia
  • ossifying fibrous epulis/peripheral ossifying fibroma
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4
Q

4 Ps (differential diagnosis of gingival lumps)

A
  • peripheral ossifying fibroma
  • pyogenic granuloma
  • peripheral giant cell granuloma (giant cell epulis)
  • peripheral odontogenic fibroma
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5
Q

describe fibroepithelial polyp clinical appearance (4)

A
  • round firm nodule with normal overlying mucosa +/- traumatic ulceration
  • pedunculated or sessile
  • caused by trauma or low grade infection
  • BM, lower lip, tongue
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6
Q

histology of fibroepithelial polyp (2)

A
  • unencapsulated, scar-like fibrous connective tissue nodule
  • normal thickness, keratinised epithelium, mildly acanthotic
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7
Q

common sites for fibroepithelial polyp (3)

A

BM
lower lip
tongue

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8
Q

fibroepithelial polyp treatment (2)

A
  • remove cause
  • conservative surgical excision
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9
Q

describe fibrous epulis (types, causes)

A
  • single or drug-induced gingival overgrowth
  • may be progression from pyogenic granuloma
  • caused by irritation by plaque/calculus
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10
Q

fibrous epulis treatment

A
  • improve OH, PMPR
  • conservative surgical excision
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11
Q

describe the clinical appearance of denture-induced fibroepithelial hyperplasia (5)

A
  • 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
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12
Q

common sites for denture-induced fibroepithelial hyperplasia

A
  • sulci
  • palatal border
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13
Q

denture-induced fibroepithelial hyperplasia histology (3)

A

similar to FEP but more inflamed CT:
- unencapsulated, scar-like fibrous connective tissue nodule
- normal thickness, keratinised epithelium, mildly acanthotic

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14
Q

denture-induced fibroepithelial hyperplasia treatment (2)

A
  • improve denture fit and hygiene
  • +/- surgical/laser excision
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15
Q

describe peripheral ossifying fibroma/ossifying fibrous epulis (3)

A
  • fibrous epulis with bone/cementum-like mineralisations within the connective tissue and hypercellular
  • may arise from PDL
  • high recurrence rate
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16
Q

peripheral ossifying fibroma/ossifying fibrous epulis treatment (3)

A
  • remove cause (irritation)
  • excision and curettage
  • monitor for recurrence
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17
Q

describe clinical presentation of pyogenic granuloma (4)

A
  • 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)
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18
Q

what may a pyogenic granuloma mature into?

A

fibroepithelial polyp

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19
Q

commonest site for pyogenic granuloma

A

upper labial gingivae

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20
Q

pyogenic granuloma histology (3)

A
  • fibrinous slough
  • ulcerated epithelium
  • CT mostly consisting of granulation tissue under ulceration
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21
Q

pyogenic granuloma treatment

A
  • remove cause, improve OH
  • excision
  • monitor during pregnancy (bleeding and recurrence risk)
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22
Q

describe clinical presentation of peripheral giant cell granuloma (giant cell epulis) (4)

A
  • single round bluish/maroon gingival lump +/- ulceration
  • often females
  • due to local chronic trauma/irritation
  • high recurrence rate
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23
Q

important differential for peripheral giant cell granuloma

A

hyperparathyroidism (take bloods and exclude bony involvement)

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24
Q

peripheral giant cell granuloma (giant cell epulis) histology (2)

A
  • OC-like giant cells, macrophages
  • very vascular, brown haemosiderin
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25
Q

peripheral giant cell granuloma (giant cell epulis) treatment

A

excision and curettage of bone (to decrease recurrence)

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26
Q

describe mucocele (general) (4)

A
  • salivary gland cyst
  • sessile, bluish, soft
  • history of bursting and regrowing
  • mucus extravasation cyst (trauma) or mucus retention cyst
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27
Q

describe mucus extravasation cyst (age, site, development, histology)

A
  • 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
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28
Q

mucus extravasation cyst age group

A

11-20yo

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29
Q

describe mucus retention cyst (what, site, age, histology)

A
  • retention of mucin in dilated duct
  • minor or major glands; BM or palate
  • > 60yo
  • fibrous cyst wall, epithelial lining, mucin filled lumen
30
Q

mucus retention cyst age group

A

> 60yo

31
Q

mucus retention cyst common sites (2)

A

BM
palate

32
Q

mucocele treatment (2)

A

excise with underlying gland
remove traumatic habit

33
Q

describe papillomatous lesion of oral mucosa (presentation, cause, histology)

A
  • 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
34
Q

what virus is associated with benign papillomatous lesions

A

HPV 6 or 11

35
Q

papilloma common sites (3)

A

lips
tongue
soft palate

36
Q

papilloma histology (2)

A
  • epithelial hyperplasia (acanthotic frond) on slender vascular connective tissue papillae
  • keratinised
37
Q

papilloma treatment

A

simple excision with margin

38
Q

histological appearance of koilocyte

A

dark nucleus with ring of clear cytoplasm

39
Q

describe lipoma (definition, presentation, histology)

A
  • 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
40
Q

important differential of lipoma

A

well-differentiated liposarcoma

41
Q

lipoma treatment

A

surgical excision

42
Q

lipoma histology

A
  • well-circumscribed/thin capsule
  • lobules of adipocytes and bands of fibrous CT
43
Q

lipoma demographic

A

> 40yo
obese

44
Q

describe haemangioma (definition, presentation, histology)

A
  • 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
45
Q

haemangioma common sites (2)

A

lip
tongue

46
Q

appearance of intraosseous haemangioma

A

radiolucent
multilocular
(rare)

47
Q

haemangioma histology

A

unencapsulated mass of disorganised blood vessels

48
Q

difference between capillary and cavernous haemangiomas?

A

capillary = many small vessels
cavernous = several large dilated thin-walled vessels

49
Q

describe port-wine stain and significance (4)

A
  • type of haemangioma distributed along CV1 nerve
  • malar, cheek and intraoral
  • part of Sturge-Weber syndrome (developmental)
  • significance = XLA bleeding risk, epilepsy (intracranial)
50
Q

haemangioma treatment

A

cryotherapy and embolisation +/- surgery
+/- sclerosing solutions

51
Q

describe lymphangioma (definition, presentation, histology)

A
  • 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
52
Q

lymphangioma age group

A

≤2yo

53
Q

lymphangioma common site

A

tongue dorsum

54
Q

lymphangioma histology

A

unencapsulated mass of distended vessels with cyst-like spaces containing lymph

55
Q

lymphangioma treatment (2)

A

small = surgical excision
large = sclerosing agents to block vessels and resolve lesion

56
Q

describe granular cell tumour (presentation, histology)

A
  • 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
57
Q

granular cell tumour common sites

A

tongue dorsum
BM

58
Q

granular cell tumour demographic

A

adult females

59
Q

granular cell tumour histology

A
  • pale polygonal cells with granular cytoplasm in superficial connective tissue; stains with S100
  • pseudoepitheliomatous hyperplasia
60
Q

what are the two main types of nerve sheath tumours

A

Schwannoma
neurofibroma

61
Q

describe Schwannoma (definition, presentation, histology)

A
  • 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
62
Q

Schwannoma histology

A
  • outer capsule
  • thin elongated spindle cells with parallel nuclei, striped appearance (blue Antoni A, pink Antoni B)
  • S100 positive
63
Q

Schwannoma common sites

A

tongue
BM

64
Q

describe neurofibroma (definition, presentations, histology)

A
  • 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
65
Q

describe single neurofibromas

A
  • young adults
  • slow growing, soft, painless lump on skin, occasionally tongue or BM
  • do not tend to recur
66
Q

single neurofibroma common oral sites

A

tongue
BM

67
Q

single neurofibroma treatment

A

excision (curative)

68
Q

neurofibroma histology

A

S100 positive spindle cells with small nerve fibres running through

69
Q

describe neurofibromatosis (definition, features)

A
  • 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
70
Q

signs/symptoms of neurofibromatosis (5)

A
  • 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
71
Q

neurofibromatosis treatment

A
  • no therapy
  • may excise for cosmetics but will recur/develop new lesions

BDS5 oral disease (26 decks)

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