Benign Soft Tissue Tumors and Vascular Malformations II Flashcards
What are vascular malformations?
Structural anomalies of blood vessels with no endothelial proliferation
Present at birth and persist through life
How can vascular malformations be categorized?
Can be categorized by type of vessels involved and according to hemodynamic features
What are the clinical features of vascular malformations?
Port wine stains are common esp on the face along the dsitribution of the trigeminal nerve
Typicall pink or purple macular lesions that grow commensurately with the patient
How do vascular malformations lesion colors change over time?
Lesions farkens and becomes nodular because of vascular ectasia over time
What is the clinical appearance low flow venous malformations?
typically blue and easily compressible
Grows proportionately with patient, may swell when dependent or with increased venous pressure
Secondary thrombosis and phlebolith formation can occur
Isolated ecstasias to complex growths involving multiple organs
What are the clinical features of arteriovenous malformations?
High flow lesions that result from persistent direct arterial and venous communication
Because of fast vascular flow through these lesions, a palpable thrill or bruit is noticeable
Overlying skin feels warmer to touch
Presenting symptoms = pain, bleeding and skin ulceration
Clinical features of intrabony vascular malformations
mobility of teeth or bleeding from the gingival sulcus may occur
Bruit or pulsation may be apparent on asuculation and palpation
Multilocular raidoluscent defect
Individual malformations may be small (honeycomb) or large (soap bubble)
What can large intrabony vascular malformations cause?
Large intrabony vascular malformations can cause cortical expansion, and occasionally a sunburst radiographic pattern is produced
Histopathologic features of vascular malformations
capillary malformations – vascular proliferation forming multiple capillary blood vessels
venous malformations – multiple, large dilated blood vessels
Tx for vascular malformaition port wine stains
flashlamp pulsed dye lasers
Tx for small stable vascular malformations
no Tx
Tx for large problematic vascular malformation lesions
combination of sclerotherapy (sclerosing agent induces fibrosis) and surgical excision
Tx for arteriovenous malformation?
depends on size and degre of involvement of vitla structures
Why must vascular malformation lesions be aspirated before biopsy or extraction of teeth on vascular malformation area?
Fatal hemorrhages have
occurred after incisional
biopsy or extraction of teeth
in the area of such lesions
What is Sturge-Weber angiomatosis?
Rare nonhereditary developmental condition that is characterized by hamartomatous vascular proliferation involving the tissues of the brain and face
What are the non-oral clinical features of Sturge-Weber angiomatosis?
Patients born with port wine stain or nevus flammeus (dermal capillary vascular malformation of the face). Unilateral distribution along the trigeminal nerve
Affected individuals have leptomeningeal angiomas that overlie the ipsilateral cerebral cortex. Associated with convulsive disorder and results in mental retardation or contralateral hemiplegia
Brain reveals gyriform “tramline” calcifications on the affected side
Glaucoma and vascular malformation on the conjuctiva, episclera, choroid and retina
What are the oral manifestations of Sturge-Weber angiomatosis?
Gingiva may exhibit slight vascular hyperplasia or a more massive hemangiomatous proliferation. May be from increased vascular component, phenytoin therapy used to control epileptic seizures or both
Destruction of underlying alveolar bone seen in some cases
What are the histopathologic features of Sturge-Weber angiomatosis?
Port wine nevus is characterized by excessive numbers of dilated blood vessels in the middle and deep dermis
Intraoral lesions show vascular dilation
Proliferative gingival lesions may resemble pyogenic granuloma
Tx for Sturge-Weber angiomatosis
Tx depends on the nature and severity of the possibile clinical features
Port wine nevi can be improved with flashlamp pulsed laser dyes
Cortical excision of the angiomatous meningeal lesions
PTs with intractable epilepsy and progressive mental retardation may require further neurological tx (lobectomy or hemispherectomy)
How can port wine nevi in Sturge-Weber angiomatosis affect oral health?
Can make flossing and dental prophy difficult
What is a lymphangioma?
Benign hamartomatous tumors of lymphatic vessels
Developmental malformation that arises from the sequestrations of lymphatic tissue that do not communicate normally with the rest of the lymphatic system
What is the clinical appearance of lymphangioma lesions?
Pebbly, vesicle appearance
What part of the body does lymphagioma usually occur?
Marked predilection for the head and neck (50-75% of all cases)
What is the histopathologic feature of cavernous lymphangioma?
dilated lymphatic vessels beneath the atrophic surface epithelium and in the deeper CT
Tx for lymphangioma
surgical excision
lymphangioma does not respond to sclerosing agents like hemangiomas
Reccurence in lymphangiomas?
Recurrence is common
Prognosis for lymphangiomas?
Prognosis is good for most patients although some large tumors may result in airway obstruction
What is Leiomyoma?
Benign tumor of smooth muscle
Where are Leiomyomas most often seen?
Uterus, GI tract and skin
How often do Leiomyomas occur in the oral cavity?
Rarely
What are the clinical features of Leiomyoma lesions?
Usually a slow-growing, firm mucosal nodule
Oral Leiomyoma can occur at any age
What kind of stain is used to determine the histopathologic features of Leiomyoma and what are the features?
Masson trichoma stain shows bundles of smooth muscle with normal collagen
How are oral Leiomyoma treated?
local surgical excision
Recurrence for oral Leiomyoma
lesions should not recur
What is a rhabdomyoma?
benign neoplasm of skeletal muscle
Where do rhabdomyomas often occur?
Predilection for the head and neck
Histopathologic appearance of rhabdomyomas?
Uniform tumor composed of rounded and polygonal cells with focal vacuolization (spider web appearance)
Cells exhibit abundant granular eosinophilic cytoplasm
PTAH stain demonstrates focal cross striations in some cells
