Biopsy Flashcards
What is a biopsy
- sample of tissue for histopathology analysis
What is the function of a biopsy
- confirm or establish a diagnosis
- determine prognosis
What are the different tissue sampling techniques
- Aspiration - can be a blood sample or from a lesion
- Fine needle aspiration
- Excisional
- Incisional
What is the advantages of an aspiration biopsy
- avoids contamination by oral commensals
- protection from anaerobic species
- may also aspirate cystic lesions
- aspiration will determine whether lesion is solid or fluid filled
- occasionally it may yield blood - haemangioma
What is a fine needle aspiration biopsy
- aspiration of cells from solid lesions
What is an excisional biopsy
- remove all clinically abnormal tissue
When should we use an FNA biosy
- e.g neck swellings, salivary gland lesions
- cytology
When do we do excisional biopsies
- usually fairly confident of provisional diagnosis
- usually benign lesions e.g fibrous overgrowths, denture hyperplasia, mucoceles
- discrete lesions
What is an incisional biopsy
- representative tissue sample
When do we use an incisional biopsy
- larger lesions
- uncertain diagnoses
- e.g leukoplakia, lichen planus, SCC
Why may you want to leave some of an SCC post biopsy
if its positive for SCC
surgeons need to go back in and clear margins
will be easier for them to see if its partly there
What is a punch biopsy
- type of incisional
- removes core tissue
- minimal damage
- sometimes get away with no sutures
- comes as 4,6,8mm
What should samples be placed in prior to sending to lab
10% formalin
How should we take care of the specimen
- sutures - can be useful for orientation
- biopsy is fragile
- filter paper - to reduce sample distortion
How should we choose an area to biopsy
- choose a representative sample
- try to avoid salivary gland duct orifices, tip of tongue, areas close to nerves and large BV
What are examples of soft tissue lesions
- carcinoma
- denture hyperplasia
- fibrous epulis
- fibrous overgrowth
- giant cell epulis
- pregnancy epulis
- haemangioma/lymphangioma
- lipoma
- pyogenic granuloma
- squamous cell papilloma
- salivary gland lesions
- lichen planus
- lichenoid reactions
- pemphigus/pemphigoid
- behcets
- leuko and erythroplakia
What are fordyce spots
- Sebaceous glands in underlying mucosa
- doesnt need biopsied
What is a fibrous epulis
- swelling arising from gingiva
- hyperplastic response to irritation e.g overhang or calculus
- smooth surface, round swelling
- pink and pedunctulated
What type of biopsy for fibrous epulis
excisional
What is a fibropeithelial polyp
- frictional irritation or trauma
- semi pedunculated or sessile
- pink
- smooth surface
- most common buccal mucosa and inner surface of lip
- can be excised
What is a giant cell epulis
- peripheral giant cell granuloma
- multinucleated giant cells in vascular stroma
- common in teens, anterior region of mouth
- deep red or purple broad base
- need x-ray to ensure not centrally originating
- surgical excision with curettage of base
What is a haemangioma
- looks like small grapes
- collection of BV
- hamartoma
- developmental overgrowth
- blue in colour
- pressure causes blanching
- surgical removal or cryotherapy
What is a lipoma
benign neoplasm of fat
seen in buccal mucosa
pale yellow
sessile
excision
What is a pregnancy epulis
- histologically same as pyogenic granuloma
- may be related to calculus
- bleed easily
- hormonal changes enhance response to tissue irritation
- small lesions may not require excision and may regress after birth
- larger lesions should be excised
What is a pyogenic granuloma
- arises from failure of normal healing
- overgrowth of granulation tissue
- may be related to extraction sockets or traumatic soft tissue injuries
- red in colour
- surgical excision
- curettage of base
Where is squamous cell papilloma most common
palate
buccal mucosa
lips
What is a squamous cell papilloma
- benign neoplasm
- white surface
- usually pedunculated
- cauliflower appearance
- similar to viral warts
- excision at base required
What types of HPV can cause squamous cell papilloma
- hpv 6 and 11
What is denture hyperplasia due to
poorly fitting denture
How does denture hyperplasia present
roll of excess tissue on outer aspect of denture flange or between flange and alveolar ridge
most common on lower labial sulcus
How should denture hyperplasia be managed
- trim flange of denture
- remove excess tissue
- if v large area, pack and dress
What is a leaf fibroma
- due to chronic irritation from denture
- associated with dentures in palate
- polyp
- would be round if not covered by denture but is flattened
- pedunculated
- excision
What is a mucocele
- mucous extravasation cyst
- most common minor salivary gland problem
- damage to minor gland duct - saliva leaks into submucosa layer
- soft bluish swelling fluid filled
- recurrent
- called a ranula in FOM
What is the tx for mucocele
excise
px should be warned of recurrence
How may squamous cell carcinoma present
lump, red or white patch, non healing ulcer
What is the classic squamous cell carcinoma description
- ulcer
- rolled margin
- induration
- lesion may bleed easily and be fixed to surrounding issue
What type of biopsy for squamous cell carcinoma
incisional
refer via urgent rapid access pathway
