Ch12 Soft Tissue Tumors II -3Ps Flashcards
_________: an exuberant tissue response to local irritation or trauma
Pyogenic granuloma (not cause by pyogenic organisms, nor is it a granuloma lol)
What are three alternate names for pyogenic granuloma?
Lobular Capillary Hemangioma…pregnancy tumor…granuloma gravidarum
Young _________ are highly vascular in appearance; older lesions tend to become more collagenized and pink…
pyogenic granulomas
Oral PGs: 75%-85% on what surface? What are the 3 other sites?
gingiva…lips, tongue,buccal mucosa
PG’s most common sites? Age?
maxillary anterior facial gingiva…children, young adults
PG: gender preference? What hormones are blamed?
female…increase in estrogen and progesterone in pregnancy
What happens to a PG that developed in pregnancy and was left intact?
regresses or becomes a fibroma
___________ is a term used to describe hyperplastic growths of granulation tissue (in healing ext sockets)…thus resembling a PG
Epulis granulomatosa
For gingival PGs, the excision should extend down to periosteum and the adjacent teeth should be thoroughly scaled to remove any source of continuing irritation….A recurrence rate of __% to __% has been reported in most studies.
3-15%
What is the treatment of a PG during pregnancy?
For lesions that develop during pregnancy, usually treatment should be deferred unless significant functional or aesthetic problems develop.
The recurrence rate is higher for __________ removed during pregnancy, and some lesions will resolve spontaneously after parturition.
pyogenic granulomas
What is the alternate name for Peripheral Giant Cell Granuloma (PGCG)?
Giant Cell Epulis
PGCG probably does not represent a true neoplasm but rather is a _______ lesion
reactive….caused by local irritation or trauma.
What are the two theories for the presence of Giant Cells in a PGCG?
1.osteoclasts 2.mononuclear phagocytes
What is the ONLY location for a PGCG?
gingiva or edentulous alveolar ridge
The peripheral giant cell granuloma often is more _____-_____ colored compared with the bright ____ of a typical pyogenic granuloma.
blue-purple…red
PGCG mean age range? Gender? location?
31-46 years…52-60% cases female..favor mandible, no anterior/post preference
If you see “CUPPING” of the underlying bone…you can favor which lesion?
PGCG (cupping = resorption of the underlying bone)
Dont be alarmed in a PGCG…________ are fairly common in the background mesenchymal cells
Mitotic figures
What lesion can have abundant hemorrhage is characteristically found throughout the mass, which often results in deposits of hemosiderin pigment, especially at the PERIPHERY of the lesion?
PGCG
PGCG: do they have bone formation?
they can have bone formation…or calcifications..fair game
What is the recurrence rate (range) for PGCG?
10-18%
Can you have a peripheral browns tumor (hyperparathyroidism)?
YEP. Much more likely to be intraosseous, but can be peripheral
What are three alternate names for peripheral ossifying fibroma? (POF)
Ossifying fibrous epulis, peripheral fibroma with calcification, calcifying fibroblastic granuloma
The peripheral ossifying fibroma is a relatively common
gingival growth that is considered to be ______ rather than ______ in nature.
reactive…neoplastic
The mineralized product probably has its origin from cells of the ______ or _______.
periosteum or periodontal ligament
The peripheral ossifying fibroma does not represent the soft tissue counterpart of _______
the central ossifying fibroma (total BS man)
POFs occur EXCLUSIVELY where?
on the gingiva
POF: age range? gender? location?
10-19 (young and young adults)…females(2/3)..maxillary incisor-canine region
What lesion am I? a fibrous proliferation associated with the formation of a mineralized product
Peripheral Ossifying Fibroma
What are the three types of hard tissue found in Peripheral Ossifying Fibromas?
bone, cementum-like material, or dystrophic calcifications.
When bone is formed in a Peripheral Ossifying Fibroma, what type is seen most often?
immature woven/trabecular…less often its mature lamellar
If you were to see dystrophic calcifications in a Peripheral Ossifying Fibroma, what does that say about its age?
its an early, ulcerated lesion (later progression usually forms mature bone or cementum)
What is important for the excision of a Peripheral Ossifying Fibroma? What is the range of recurrence for these?
Excise from the periosteum (increased recurrence if not completely excised)…8-16% recurrence rate
What is the most common mesenchymal neoplasm? (in the body)
Lipoma!
What % of lipomas are found in the oral and maxillofacial region?
only 1-4% of all body lipomas
Lipomas are more common in what demographic?
obese people (although the metabolism is separate - you can’t lose weight and then shirnk your lipoma)
What color is a lipoma clinically? What about deeper in the lesion?
yellow on the surface clinically, pink deeper
What are the two most common oral sites for a lipoma?
buccal mucosa and vestibule. 50% of cases
When a lipoma is found on the buccal mucosa, its either a true lipoma or what may have happened?
herneation of the buccal fat pad through the buccinator s/p trauma
What are the 3 other sites for a lipoma beside the buccal mucosa/vestibule? Age range? gender?
tongue, floor of mouth, and lips…40 years or older…no gender predilection
Rarely what two types of metaplasia can occur in an otherwise normal lipoma? (NOT a variant of the lipoma)
osseous or cartilagenous metaplasia
What is the most common VARIANT of lipoma? what are the 6 other not-as-common variants of lipomas?
Most common: fibrolipoma…angiolipoma…spindle cell lipoma..myxoid lipoma..pleomorphic lipomas…intramuscular lipomas…sialolipoma
What type of lipomas are characterized by the presence of spindle cells plus bizarre, hyperchromatic giant cells?
Pleomorphic lipomas
What is the recurrence for a lipoma? Which type of lipoma is most likely to recur?
rare. no difference..except for intramuscular lipomas, but they are rare in the oral cavity
What is the alternate name for a traumatic neuroma?
amputation neuroma
Mechanism of a traumatic neruoma: After a nerve has been damaged or severed, the proximal portion attempts to regenerate and reestablish innervation of the distal segment by the growth of axons through tubes of proliferating ______cells.
schwann
What are the three most common sites for traumatic neuroma?
mental foramen area, tongue, lower lip
it has been estimated that traumatic neuromas of the _________ nerve develop in 5% to 10% of patients undergoing surgery for pleomorphic adenomas of the parotid gland.
greater auricular
traumatic neuromas are most often diagnosed in what age group? gender?
middle aged adults…female
What are the three symptoms typically associated with traumatic neuromas?
anesthesia, dysthesia, pain
What % range of traumatic neuromas are painful?
25-33%
Clincal-histological correllation: Traumatic
neuromas with ___________ are more likely to be
painful than those without it.
inflammation
What is the recurrence rate for Traumatic
neuromas?
“most lesions do not recur”…pain can persist or return
What is the alternate name for a PALISADED ENCAPSULATED NEUROMA? WHY did it get the alternate name?
Solitary Circumscribed Neuroma (I love pathology)…its not always encapsulated and the cells are not usually truely palisaded
Most likely origin for Palisaded Encapsulated Neuroma?
Likely trauma.. thought to be more reactive than a true neoplasm
What % of Palisaded Encapsulated Neuromas are in the face? What are the 2 most common sites on the face? Age range?
90%..nose and cheek…50-60’s
What are the 3 most common sites of Palisaded Encapsulated Neuromas in the oral cavity? They are common, but have probably been diagnosed as what two lesions in the past?
hard palate, gingiva, labial mucosa……schwannomas or neurofibromas
Palisaded Encapsulated Neuromas consist of moderately cellular interlacing fascicles of spindle cells that are consistent with _______ cells
Schwann
Palisaded Encapsulated Neuromas stain positive for _____ and NEGATIVE for ______ (helping to exclude other neural tumors)
S100…negative GFAP (GFAP + CNS tumors)
What is the recurrence for Palisaded Encapsulated Neuromas?
rare
What two important entities are RULED OUT by a diagnosis of Palisaded Encapsulated Neuroma?
Neurofibromatosis and MEN 2B (NO association with Palisaded Encapsulated Neuromas and these entities)
What are the two alternate names for PGs that develop on the gingiva during pregnancy?
pregnancy tumor or granuloma gravidarum
If a PG on the gingiva develops during pregnancy, what term do they usually begin? How long does their prevalence increase?
1st trimester….prevelene increases up to 7 months
