Chapter 12 Soft Tissue Tumors

Question 1

What is this

Answer 1

Peripheral Ossifying Fibroma (POF)

Exclusively on the gingiva

Nodular mass usually from dental papilla

Average age is 15, 2/3s in females

50% are in the incisor cuspid region

Question 2

What is this

Answer 2

Port wine stain or nevus flammeus

Sturge weber angiomatosis

Rare, nonhereditary developmental condition

Usually occurs along one of more of the branches of the trigeminal nerve

No all patients with a port wine stain have sturge weber angiomatosis

Convulsive disorders (phenytoin)

Question 3

What is this

Answer 3

Fibroma

Most common tumor in the oral cavity

Reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma

Most common location is along the buccal mucosa along the occlusal plane

Question 4

What is this

Answer 4

Melanotic Neuroectodermal Tumor of Infancy

Rare pigmented tumor (black and/or blue)

Striking predilection for anterior maxilla (61%)

High urinary levels of VMA (vanillylmandelic acid)

Most are benign

Question 5

Metastasis to the oral soft tissues

Answer 5

One possible explanation of H&N mets in the absence of lung mets is Batson’s plexus

This is a valveless vertebral venous plexus that might allow retrograde spread of tumor cells & bypass the lungs

Gingiva is the most common site for soft tissue

Usually carcinomas not sarcomas

2/3s of METs go to soft tissue and 1/3 to bone

Question 6

What is this

Answer 6

Neurofibromatosis Type 1

Hereditary

aka von Recklinghausen’s disease of the skin

Plexiform variant of NF is pathognomonic (feel like a “bag of worms”)

Café au lait (coast of california)

Freckling in the axillary region (Crowe’s sign)

2 or more iris hamartomas (Lisch nodules)

90% have oral lesions

Up to 5% have malignant peripheral nerve sheath tumors

Question 7

Rhabdomyosarcoma

Answer 7

Malignancy of skeletal muslces

60% of soft tissue sarcomas in childhood

Painless, infiltrative mass that grows rapidly

Question 8

What is this

Answer 8

Lipoma

Benign tumor of fat

By far the most common mesenchymal neoplasm

Float in formalin

Yellow to pink

Question 9

What is this

Answer 9

Palisaded Encapsulated Neuroma (PEN)

aka solitary circumscribed neuroma

90% found on the face

Question 10

Leiomyoma

Answer 10

Benign tumor of smooth muscle

Most oral lesions are a vascular variant (angioleiomyoma)

Question 11

What is this

Answer 11

Inflammatory papillary hyperplasia (IPH)

Reactive tissue growth under denture, caused by ill fit, poor hygiene, wearing 24/7

20% of patients with dentures have it

Typically occurs on hard palate

Erythematous with pebbly/papillary surface

Patient might also have candida infection

Question 12

What is this

Answer 12

Peripheral Giant Cell Granuloma (PGCG)

Reactive lesion cause by local irritation or trauma

Exclussively on gingiva or edentulous alveolar ridge

More blue to purple when compared to PG

“Cupping” resorption of the underlying alveolar bone

Question 13

What is this

Answer 13

Inflammatory fibrous hyperplasia (IFH)

Tumor like hyperplasia of connective tissue

If caused by the flange on an ill fitting denture it is called epulis fissuratum

Usually on the facial surface of the alveolar bone

Surgical removal and remake of denture

Question 14

What is this

Answer 14

Traumatic Neuroma

Not a true neoplasm; it is a proliferation of neural tissue after nerve injury

Most common in mental nerve area

1/3 are painful

Question 15

Multiple Endocrine Neoplasia Type 2B (MEN 2B)

Answer 15

Charcterized by tumors of endocrine origin: parathyroid, pituitary, pancrease, adrenal gland (pheochromocytosis, 50%), thryoid (medullary carcinoma, 90%), mucosal neuromas

Marfanoid build

Oral mucosal neuromas are typically the first sign of the condition

Bilateral neuromas of the commissural mucosa are highly characteristic

Marked propensity for metastasis

Diagnosed between 18-25

Question 16

Rhabdomyoma

Answer 16

Benign tumor of skeletal muscle

Extracardiac rhabdomyomas are very rare but have a predilection for the H&N

Adult and fetal types

70% of adult type are in men, nodular mass occuring in the pharynx or the floor of the mouth

Question 17

What is this

Answer 17

Pyogenic granuloma (PG)

Reactive lesion from local irritation or trauma

May exhibit rapid growth

75% on gingiva

Most common in children and young adults

Bleeds easily due to extreme vascularity

Red to pink color

Frequently appears in pregnant women (1st trimester) called pregnancy tumor or granuloma gravidarum

Question 18

What is this

Answer 18

Giant Cell Fibroma

Fibrous tumor with distinctive features, not caused by chronic irritation

Papillary surface

In children it can form on the retrocuspid papilla of the mandible (bilaterally), usually goes away with age

If bilateral there is no need for biopsy (because it is recognized for what it is)

Question 19

Hemangioma

Answer 19

Most common tumor of infancy

2 types: capillary and cavernous

Capillary: may not blanch clinically, usually red

Cavernous: typically blanches, darker red to purple

Question 20

Schwannoma

Answer 20

aka Neurilemoma

benign neural neoplasm of of Schwann cell origin

50% of cases in H&N

Bilateral schwannomas of auditory-vestibular nerve are a characteristic feature of the neurofibromatosis type II (NF2)

tongue is the most common location for oral lesions

Antoni-A, organized, verocay bodies

Antoni-B, disorganized

Question 21

Neurofibroma

Answer 21

Most common type of peripheral nerve neoplasm

can be solitary tumors or part of neurofibromatosis

Most common location for lesions is the skin, and intra oral lesions occur on the tongue and buccal mucosa

If diagnosed with neurofibroma patient must screened for neurofibromatosis

Question 22

What are 2 types of neuromas?

Answer 22

Traumatic and palisaded encapsulated neruoma