Ch12 Soft Tissue Tumors Flashcards
Pg 473 - 526
Most common location for a fibroma
buccal mucosa bite line
Likely that many fibromas represent fibrous maturation of a pre-existing _______
pyogenic granuloma
Fibroma: age and gender
4th-6th decades, 2:1 female
Recurrence for fibroma?
extremely rare
Which type of fibroma clinically resembles a papilloma?
giant cell fibroma
Giant cell fibroma: age, gender, location
young, slight female, mandibular gingiva
What entitiy occurs on the lingual gingiva of the mandibular cuspid? 25-__% of children and young adults have them
retrocuspid papilla 25-99% lol
What lesion? *numerous large, stellate fibroblasts with several nuclei *pebbly surface
Giant cell fibroma
______ is a generic term that can be applied to any tumor of the gingiva or alveolar mucosa
epulis
What are the 4 epulides? (lol - the four entities with the word epulis in them)
- Epulis fissuratum 2.giant cell epulis (peripheral giant cell granuloma) 3.ossifying fibroid epulis 4.Congenital epulis
Epulis fissuratum: classically HOW many folds of tissue?
2..the denture flange fits inside the two folds
Occasional examples of epulis fissuratum demonstrate surface areas of inflammatory _________
papillary hyperplasia
The epulis fissuratum usually develops on the ________…with the Anterior/posterior portions more often?? Gender?
facial aspect of the alveolar ridge…Anterior more affected than posterior…FEMALE predilection (2/3 to 3/4 of cases)
The edge of WHAT lesion (2 names) often is serrated and resembles a leaf
Fibroepithelial polyp / leaflike denture fibroma
Some instances of epulis fissuratum the epithelium shows what two distinct features?
- inflammatory papillary hyperplasia 2.pseudoepitheliomatous hyperplasia
What specific type of immune cell likes to show up in epulis fissuratum? If minor salivary glands are included in the specimen, what do they like to show?
eosinophils…chronic sialadenitis
What is the RARE phenomenon caused by an ill fitting denture that can be seen microscopically in epulis fissuratum?
osseous and chondromatous metaplasia.. so DON’T mistake it for a freaking sarcoma
What is the alternate name for inflammatory papillary hyperplasia?
Denture Papillomatosis
What are the 4 possible causes for denture papillomatosis? What % of patients who wear their denture 24hrs/day develop inflammatory papillary hyperplasia?
1.ill-fitting denture 2.poor denture hygiene 3.wearing the denture 24 hours a day 4. POSSIBLY candida infection (but role is uncertain)…..20% of 24hr denture wearers dev denture papillomatosis
Where does inflammatory papillary hyperplasia typically occur FIRST? What other 2 locations can it also show up?
palatal vault…less common edentulous ridge of mandible or surface of an epulis fissuratum
Denture papillomatosis (inflammatory papillary hyperplasia) CAN occur in pts without a denture…what 3 situations make you susceptible?
- habitual mouth breathing 2. vaulted palate 3.HIV infected pts
inflammatory papillary hyperplasia is usually asymptomatic/symptomatic? the mucosa is erythematous and _______ and in many cases is associated with ________
Asymptomatic…pebbly/papillary…denture stomatitis
_________ are a diverse group of tumors that
exhibit fibroblastic and histiocytic differentiation
Fibrous histiocytomas
What are the 4 names used for Fibrous histiocytomas?
- dermatofibroma 2.sclerosing hemangioma 3.fibroxanthoma 4.nodular subepidermal fibrosis
A Fibrous histiocytoma is called a _______ when it presents on the skin
dermatofibroma
Fibrous histiocytomas of the oral cavity and perioral cavity are rare and its likely that many of the reports are ACTUALLY what entity?
Solitary fibrous tumor (hemangiopericytoma)
Can you get a Fibrous histiocytoma in the bone?
yes. rare. but yes.
Oral Fibrous histiocytomas happen in old/young pts? What about DFs?
oral Fibrous histiocytomas = older pts (middle aged to older) vs DFs = young adults
fibrous histiocytoma is characterized by a cellular proliferation of _______-shaped fibroblastic cells with _____ nuclei
spindle…vesicular
The margins of a fibrous histiocytoma often are not _______.
sharply defined
fibrous histiocytoma cells are arranged in short, intersecting fascicles, known as a ______ pattern
storiform
fibrous histiocytoma: Rounded histiocyte-like cells, lipid-containing ________ cells, or multinucleated giant cells can be seen occasionally, as may scattered lymphocytes.
xanthoma
fibrous histiocytoma: The stroma may demonstrate areas of _____ change or focal ________.
myxoid…hyalinization
fibrous histiocytoma: tx? recurrance?
excision..recurrance rare for superficial tumors, still rare but less so for deep tumors
Where was the solitary fibrous tumor (hemangiopericytoma) first discovered?
pleura so from mesothelial cells or submesothelial fibroblasts
A pericytic origin appears doubtful, for hemangiopericytomas, they propably represent cellular variants within the spectrum of __________.
solitary fibrous tumor
LOL what are the 3 names for a hemangiopericytoma in the sinonasal tract? (why the fuck are there 3 names for this?)
1.sinonasal-type hemangiopericytoma 2.glomangiopericytoma 3.myopericytoma
Solitary fibrous tumors have been reported primarily in
age? and are rare in age?. The tumor often is described as a ____-growing, painless/painful?, submucosal, or deep soft tissue mass that is ______removed from the surrounding tissues.
primarily in adults, rare in children…slow-growing, painless, easily removed
Solitary fibrous tumors of the head and neck region are
most common in the ________, which accounts for
approximately one-third of such cases.
buccal mucosa
Sinonasal-type hemangiopericytoma occurs primarily in
_____ and _____ adults.
middle-aged and older
What lesion? At one end of the spectrum, the lesional cells appear as tightly packed cells and surround endothelium-lined vascular channels
solitary fibrous tumor
Name that lesion: The cells are haphazardly arranged and demonstrate round to ovoid nuclei and indistinct cytoplasmic borders
solitary fibrous tumor
Name that lesion: The blood vessels often show irregular branching, which results in a characteristic “staghorn” and “antlerlike” appearance
solitary fibrous tumor
Name that lesion: At the other end of the spectrum, the cells are more spindled and arranged in either short fascicles or in a disorganized fashion (“patternless pattern”)
solitary fibrous tumor
Immunohistochemical studies show the lesional cells in solitary fibrous tumors to be positive for ____ and ____ in nearly all cases.
CD34 and bcl-2
Solitary fibrous tumor The identification of ____ or more mitoses per ten highpower fields suggests a rapidly growing tumor that is capable of metastasis…The presence of _______ also suggests malignancy.
4 or more….necrosis
Sinonasal-type hemangiopericytomas have a more prominent _______ pattern, with the cells arranged in a more orderly fashion.
spindle cell
In contrast to a solitary fibrous tumor, the cells of a sinionasal-type hemangiopericytoma are usually NEGATIVE for _____ and _____
CD34 and bcl-2
Most sinionasal-type hemangiopericytoma are positive for what IHC marker? What is the recurrence?
SMA…17%
What group of lesions is intermediate (histo and behavior) between those of benign fibrous lesions and fibrosarcoma?
fibromatosis
What are the two most common forms of fibromatosis in the head and neck?
juvenile aggressive fibromatoses and extraabdominal desmoids
Similar histological lesions as Fibromatosis but located in the bone are called _______
desmoplastic fibromas
People with FAP/Gardner syndrome have an increased risk for WHAT soft tissue lesions?
aggressive fibromatosis
The most common oral site for fibromatosis is the ________ region, although the lesion can occur almost anywhere.
paramandibular soft tissue
Soft tissue ________ is characterized by a cellular proliferation of spindle-shaped cells that are arranged in
streaming fascicles and are associated with a variable amount of collagen
fibromatosis
Along with spindle cells in streaming fascicles, this lesion is usually poorly circumscribed and infiltrates the adjacent tissues and this is excised with generous margins
fibromatosis
Recurrence of fibromatosis of the head and neck? Does it met?
30% (wow, thats high)..no mets
What is an alternate name for myofibroma?
myofibromatosis
________ is a rare spindle cell neoplasm that consists of cells with both smooth muscle and fibroblastic features
myofibroma (myofibroblasts)
Solitary myofibromas develop most frequently in the first ____ decades of life, with a mean age of ___ years.
first 4 decades…22 years
The most common oral location for a myofibroma is the ______, followed by the tongue and buccal mucosa….what are some radiographic characteristics?
mandible…RL defects poorly defined (can be well defined or multilocular)
_________ primarily affects neonates and infants who may have tumors of the skin, subcutaneous tissue, muscle, bone, and viscera. The number of tumors can vary from several to more than 100.
Multicentric myofibromatosis
What entity? - interlacing bundles of
spindle cells with tapered or blunt-ended nuclei -BIPHASIC (nodular fascicles + cellular zones) - scattered mitoses - centrally vascular (like a SFT)
Myofibromas
Myofibromas are positive for ______ and _____, negative for _______
positive: SMA, MSA(muscle specific actin)….NEGATIVE for desmin
What is the recurrence for solitary myofibromas? Multifocal myofibromas?
“small percentage” of solitary myofibromas recur…multifocal RARELY recur (some spontaneously regress)
_________ involving the viscera or vital organs in infants can act more aggressively and sometimes proves to be fatal within a few days after birth.
myofibromatosis (multifocal myofibromas)
Oral focal mucinosis is an uncommon tumorlike mass that is believed to represent the oral counterpart of __________ or a __________.
cutaneous focal mucinosis or a cutaneous myxoid cyst
The cause of focal melanosis is unknown, although the lesion may result from overproduction of _______ by fibroblasts.
hyaluronic acid
Oral focal mucinosis is most common in what age range? and shows a 2 : 1 _______ predilection.
young adults….2:1 female-to-male
What is the most common site of oral focal mucinosis? Whats the second most common?
gingiva…hard palate
What lesion usually presents as sessile or pedunculated and as a painless nodular mass that is the same color as the surrounding mucosa?
Oral focal mucinosis
Recurrence of oral focal mucinosis?
does not tend to recur
Sino-nasal hemangiopericytoma compared to but differentiated from ________
solitary fibrous tumor
What does sinonasal type hemangiopericytoma stain positive for
SMA and muscle specific actin
UNLIKE solitary fibrous tumor which it is compared to for some unknown reason it is NEGATIVE for CD34 and BCL2
What two syndromes have an increased risk for developing aggressive fibromatosis?
FAP (familial adenomatous polyposis) and Gardner syndrome
Soft tissue fibromatosis of the head and neck most frequently occurs in what age group?
children / young adults hence: juvenile fibromatosis
