Chapter 12 Flashcards
What is the most common tumor of the oral cavity?
Fibroma
Why is it that fibromas aren’t “true” tumors?
It is more of an inflammatory reactive response. Fibroblasts are stimulated to produce more collagen.
Where is the most common location of a fibroma?
Buccal mucosa along the bite line
What is the appearance of a fibroma?
Asymptomatic
Sessile
Smooth-surfaced
Similar color to surrounding mucosa
What is the treatment for a fibroma?
Conservative surgical excision is curative
MUST submit the excised tissue for microscopic examination
What is a giant cell fibroma?
Fibrous tumor with distinctive features (plump fibroblasts); not associated with chronic irritation like a normal fibroma
Typically has a papillary surface
Which occurs at a younger age, fibromas or giant cell fibromas?
Giant cell fibromas occur at a younger age
Where is the most common location for giant cell fibromas?
Gingiva
What is a retrocuspid papilla?
Microscopically similar lesion to giant cell fibromas. Lingual to mandibular canine.
Typically bilateral and present in up to 99% of children
Normal anatomical variation that regresses with age
What is inflammatory fibrous hyperplasia?
Tumor-like hyperplasia of fibrous CT
What is an epulis fissuratum?
Name given for inflammatory fibrous hyperplasia in association with the flange of an ill-fitting denture
Epulis fissuratum = clinical diagnosis
Histological diagnosis = inflammatory fibrous hyperplasia
Where does inflammatory fibrous hyperplasia typically occur?
On the facial aspect of the alveolar ridge
What is inflammatory papillary hyperplasia?
Reactive tissue growth that develops under a denture (typically on hard palate)
Asymptomatic
Erythematous
Pebbly (papillary) surface
Inflammatory papillary hyperplasia is a condition relating to what three things?
Ill-fitting denture
Poor denture hygiene
Wearing denture 24hrs a day
(Also note that most patients also have a candidal infection. Condition may show improvement after antifungal therapy)
True or false… for early inflammatory papillary hyperplasia lesions, removal of the denture may allow healing
True
__% of patients who continuously wear their denture have IPH (inflammatory papillary hyperplasia)
20%
When you see a bump on the gums, it is usually one of four things. What is the differential?
IFH (inflammatory fibrous hyperplasia)
Pyogenic granuloma
Peripheral giant cell granuloma
Peripheral ossifying fibroma
What is considered the oral counterpart of cutaneous focal mucinosis?
Oral focal mucinosis
Oral focal mucinosis results from overproduction of ____ by fibroblasts. It most commonly occurs in the ___ population. 2/3s of lesions occur on the ___ and 1/3rd occur on the ___.
Hyaluronic acid
Young female
Gingiva
Hard palate
True or false.. surgical excision of oral focal mucinosis is curative
True
Why is a pyogenic granuloma considered a misnomer?
It is not a true granuloma (TB, sarcoidosis, foreign body), but a reactive lesion to local irritation or trauma or *poor oral hygiene.
True or false… pyogenic granulomas are typically slow growing
False, they exhibit rapid growth
75% of cases of pyogenic granulomas occur on the ___, followed by __, ___, and ___. Pyogenic is most common in what population?
Gingiva
Lips
Tongue
Buccal mucosa
Children/young adults
What does a pyogenic granuloma look like?
Red due to capillary blood (oxygen) (older lesions are more collagenized and pink)
Ulcerative and bleeds easily
Smooth/lobulated mass typically pedunculated
___% of the time, pyogenic granulomas are ulcerative.
75%
What are two other names for pyogenic granulomas? Why are they given these names?
Pregnancy tumor - frequently occurs in pregnant women in 1st trimester
Granuloma gravidarum
What is the treatment for pyogenic granulomas?
Surgical excision (make sure that for gingival lesions the excision extends to periosteum)
Lesions occasionally recur
If you are looking at the histology of a bump on the gums and it has blood vessels, what is the most probable diagnosis?
Pyogenic granuloma
What “bump on the gums” lesion is characterized by a purple-ish hue, cupping resorption of underlying alveolar bone, is caused by local irritation or trauma, and has big purple cells in histology?
Peripheral giant cell granuloma
What is it called when cupping resorption goes through bone into the medullary bone?
Central giant cell granuloma
Peripheral giant cell granulomas occur exclusively on the ___. Treatment is surgical excision down to underlying bone and you should also ___. __% recur.
Gingiva or edentulous alveolar ridge
Scale adjacent teeth
10%
Peripheral ossifying fibromas occur exclusively on the ___. It appears as a modular mass originating from the ___. 50% of cases occur in the ___ region.
Gingiva
Dental papilla
Incisor-cuspid region
What is the most common mesenchymal neoplasm? (It most commonly occurs on the trunk)
Lipoma (a benign tumor of fat)
True or false… lipomas are more commonly found in skinny patients
False. It is most common in obese patients, but the metabolism is independent of normal body fat
Most lipomas of the oral cavity occur in the __
Buccal mucosa
Once a lipoma is removed, what is a diagnostic test to ensure that it is a lipoma?
It will float in formalin
What are the two types of neuromas?
Traumatic neuroma
Palisaded encapsulated neuroma (PEN)
Traumatic neuromas are not true neoplasms, why?
Where is the most common location for a neuroma?
About 1/__ cases are painful upon palpation.
It is a proliferation of neural tissue after nerve injury
Mental foramen area
1/3 cases
What is a Schwannoma?
A benign neural neoplasm of Schwann cell origin
What is another name for a schwannoma?
Neurilemoma
A schwannoma is a __-growing, encapsulated tumor which arises in association with a ___. They are typically symptomatic/asymptomatic.
Slow-growing
Nerve trunk
Asymptomatic
Bilateral schwannoma of auditory-vestibular nerves are a characteristic feature of ___
Neurofibromatosis type 2 (NF2)
Neurofibromatosis type 2 is autosomal ___. It results from a mutation of a ___ gene (called __) on chromosome ___.
It causes acoustic neuromas and causes symptoms of ___, __, and ___
Dominant
Tumor suppressor gene (called Merlin)
22
Deafness, dizziness, tinnitus
Where is the most frequent location for oral schwannomas?
Tongue
Schwannoma histopathologic features include Antoni A and Antoni B. Describe them.
Antoni A - streaming fascicles of spindle-shaped Schwann cells which form a palisaded arrangement around central acellular, eosinophilic areas known as Verocay bodies.
Antoni B - basically everything that’s not Antoni A
In which, Antoni A or Antoni B, will you find Verocay bodies?
Antoni A
What is the most common type of peripheral nerve neoplasm?
Neurofibroma
Describe neurofibromas
Can arise as solitary tumors or be a component of neurofibromatosis
Most common in young adults and present as slow-growing, soft, painless lesions
Where are the most common locations for neurofibromas?
Skin
Tongue and buccal mucosa are the most common intraoral sites
Neurofibromatosis is a hereditary condition (autosomal __) affecting 1 in ___ people
Dominant
3000
What is another name for NF1 (neurofibromatosis type 1)
Von recklinghausen’s disease
___ variant of neurofibromatosis type 1 is pathognomonic. What does this feel like?
Plexiform
Plexiform NF feels like a bag of worms because it has a bunch of thick nerves in it that move around as you palpate it.
In order to be diagnosed with neurofibromatosis type 1, you must meet __ or more diagnostic criteria. Name all 7 of the diagnostic criteria
2
Six or more cafe au lait macules
2 or more NF or one plexiform NF
Optic glioma
Two or more iris hamartomas (Lisch nodules)
Freckling of the axillary region (Crowe’s sign)
Osseous lesion such as sphenoid dysplasia
First degree relative with NF1
What are lisch nodules?
Associated with neurofibromatosis type 1
Increased proliferation or collection of multiple normal tissue types
Oral manifestations of neurofibromatosis occurs ___% of the time
90%
Name three oral manifestations associated with neurofibromatosis type 1.
Enlargement of fungiform papilla (occur in 50%)
Intraoral neurofibromas (occur in 25%)
Enlargement of the mandibular foramen or canal
Up to __% of pts with NF1 have MPNST with an associated 5 year survival of 15%. What is MPNST?
5
Malignant peripheral nerve sheath tumors
What does MEN2B stand for?
Multiple endocrine neoplasia type 2B
Multiple endocrine neoplasia type 2B is a system complex characterized by what 6 things?
Pheocrhomocytoma (Adrenal gland tumors)
Thyroid tumors (medullary carcinoma)
Mucosal neuromas with a predilection for the oral cavity
Parathyroid tumors
Pituitary tumors
Pancreatic tumors
Patients with MEN2B have a ___ build which means…
Marfanoid
Thin, elongated limbs
Narrow face with characteristically thick protuberant lips
What is the first typical sign of MEN2B?
Oral mucosal neuromas
bilateral neuromas of the commissary mucosa is highly characteristic of ___?
Multiple endocrine neoplasia Type 2B
___% of patients with multiple endocrine neoplasia develop pheochromocytoma, which is…
50%
Adrenal gland tumors
___% of patients with multiple endocrine neoplasia type 2B develop medullary carcinoma of the thyroid gland
90%
Multiple endocrine neoplasia type 2B is usually diagnosed between the ages of __-__ and has marked propensity for metastasis. The average age of death for these patients is __
18-25
21 because it isn’t caught early enough
What soft tissue tumor has a rare pigmented tumor (black/blue/purple) and usually occurs during the first year of life. The mass is rapidly expanding yet benign.
Melanotic neuroectodemal tumor of infancy
Melonatic neuroectodermal tumor of infancy has a striking predilection for the ___ (__%).
Anterior maxilla. 61%
What is a diagnostic tool to diagnose melanotic neuroectodermal tumor of infancy?
High urinary levels of vanillymandelic acid
Granular cell tumors are benign soft tissue neoplasms that show a predilection for the oral cavity. The most common is the __ surface of the ___ (__%). It occurs twice as often in females. It may be ___-colored.
Dorsal
Tongue (50%)
Yellow or mucosal
What race may experience multiple granular cell tumors?
African Americans
Which tumors exhibit significant pseudoepithelimatous hyperplasia? What does it kind of look like under a microscope?
Granular cell tumors
Looks similar to squamous cell carcinoma
Granular cell tumors are S-100 positive or negative?
Positive
Congenital epulis occurs almost exclusively on ___
The alveolar ridges of newborns
Congenital epulis appears as a mucosal-colored, smooth-surfaced, polyploid mass that’s typically less than 2cm. It appears 3xs more commonly in the ___ ridge, and more specifically in the ___ area
Maxillary
Developing lateral incisor-canine area
90% of congenital epulis cases occur in males or females?
Females
Since both granular cell tumors and congenital epulis are both composed of granular cells, how do you tell the difference?
Congenital epulis has no PEH (pseudoepitheliomatous hyperplasia) and is S-100 negative
What is the most common tumor of infancy?
Hemangioma
What is the most common location for hemangioma?
In the head and neck (60% of cases)
Name and describe the two types of hemangiomas
Capillary: may not blanch clinically, usually red in color
Cavernous: typically blanches, darker red to purple.
Puts with sturge-Weber antiomatosis are born with a dermal capillary vascular malformation known as __ or ___. It is a rare, nonhereditary developmental condition. What is it caused by?
Port wine stain
Nevus flammeus
Persistence of a vascular plexus around the cephalic portion of the neural tube
Patients with sturge-Weber angiomatosis, in addition to nevus flammeus, have ___. What are these? Describe their relationship to intraoral lesions.
Leptomeningeal angiomas
They over lie the ipsilateral cerebral cortex possibly causing MR or contralateral hemiplagia (one side paralysis)
Sturge-Weber angiomatosis is typically associated with a __ disorder.
Convulsive
Describe the intraoral lesions associated with sturge-Weber angiomatosis
Intraoral involvement is common and results in hypervascular changes to the ipsilateral mucosa
What is a lymphangioma? What are the different types?
Benign tumor of lymphatic vessels
Capillary, cavernous, cystic
Cavernous lymphangiomas are most frequently found where?
In the mouth
Cystic lympangiomas most often occur where?
Neck
True or false.. half of all lymphangioma lesions are noted at birth and 90% develop by 2 years of age
True
Where is the most common location for lymphangiomas?
Anterior two-thirds of the tongue
Which soft tissue tumor looks like frog eggs or tapioca pudding?
Lymphangioma
What is a leiomyoma? Where are the most common locations?
Benign tumor of smooth muscle. Typically asymptomatic, slow growing, firm, mucosal nodule.
uterus, GI tract, skin
What are rhabdomyomas?
Benign neoplasm of skeletal muscle (usually occur in the heart, but if they occur elsewhere they usually occur in the head and neck)
What are the two types of rhabdomyomas?
Adult - 70% in adult men(in pharynx and FOM)
Fetal - young male patients (predilection for the face)
What are six types of soft tissue sarcomas?
Fibrosarcomas (head and neck)
Malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma)
Liposarcoma (thigh, retroperitoneum)
Leiomyosarcoma (uterus, GI)
Angiosarcoma (scalp and forehead)
Malignant peripheral nerve sheath tumor
True or false… soft tissue sarcomas are common in the oral and maxillofacial region
False, they are rare.
Koposi’s sarcoma is caused by HHV-__. What are its four clinical presentations?
8
Classic (hereditary)
Endemic (African)
Iatrogenic immunosuprssion associated
AIDS related
The classic type of koposis sarcoma is 80% of the time found in older __, specifically of ___ descent. What does the appearance look like?
Men
Italian/Jewish/Slavic
Multiple, asymptomatic blue-purple macules on the lower extremities which grow into nodules
What are the four types of endemic koposis sarcoma?
Benign nodular
Aggressive
Florid
Lymphadenopathic
Iatrogenic koposis sarcoma is most common in ___.
Organ transplant recipients
0.5% of renal transplant patients
What is the prognosis for classic, endemic and for transplant patients for kaposis sarcoma?
Classic - 90% survival
Endemic - poor prognosis
Transplant patients - prognosis somewhere between classic and endemic
What is rhabdomyosarcoma?
Malignancy of skeletal muscles
What makes up 60% of soft tissue sarcomas of childhood?
Rhabdomyosarcoma
35% are found in the head and neck region
True or false… metastasis of the oral soft tissues are likely blood-bone and therefore would be expected to be found in the lungs
True
Describe one possible explanation of metastases in the head and neck in the absence of mestastses in the lung.
Batson’s plexus
This is a valveless vertebral venous plexus that might allow retrograde spread of tumor cells and bypass of the lungs
Where is the most common location for mestastes in the oral soft tissues?
Gingiva (50%)
Then tongue (25%)
True or false… most cases of metastases in the oral soft tissues are sarcomas rather than carcinomas
False. Most cases represent carcinomas rather than sarcomas
