chpt 12- soft tissue tumors Flashcards
Most common tumor of the oral cavity
FIBROMA
Reactive hyperplasia of fibrous connective tissue in response to local irritation or injury
Fibroma
Most common location for a fibroma
Buccal mucosa at bite line
Clinical description of Fibroma
smooth surfaced pink nodule w/ same color as surrounding tissue(may be darker in African Americans), sessile, can be pedunculated
Fibroma treatment
Surgical excision, low recurrence
Commonly observed fibrous hyperplasia most frequently occurring on the maxillary labial frenum
frenal tag
Fibrous tumor, not associated with chronic irritation, whose surface may appear papillary so it can be mistaken for a papillom
Giant cell Fibroma
unilateral or bilateral papular lesions on the mandibular gingival lingual to the canines, seen mainly in children that is a variant of normal that will disappear with age
Retrocuspid papilla
Tumor like hyperplasia of fibrous connective tissue that develops in association with the flange of an ill- fitting complete or partial denture
epulis Fissuratum
Epulis Fissuratum clinical features
single or multiple folds in vestibule usually firm and fibrous, facial, anterior
Trauma to tissue can cause 2 things
1) tissue breakdown causing an ulcer
2) Tissue hyperplasia to protect
Epulis fissuratum treatment
surgical excision and remake or refit denture
Reactive tissue growth that commonlhy develops beneath a denture, especially when worn constantly
Inflammatory hyperplasia
Inflammatory papillary hyperplasia clinical features
hard palate beneath denture or on mandibular alveolar ridge as small pebbles or cobblestones
Other causes of inflammatory papillary hyperplasia
High arch
Mouth breathing
Drugs
Know the Histology for Papillary Hyperplasia
numerous papillary growths covered by hyperplastic stratified squamous epithelium
Inflammatory Hyperplasia treatment
remove denture allow time to heal, surgical removal of hyperplasia, remake or reline denture
Diverse group of tumors that look like a fibroma but have fibrous and histiocytic differentiation. Most commonly occur on the skin as a dermatofibroma
Fibrous histiocytomas
Fibrous proliferations with a histologic pattern between benign fibrous lesions and fibrosarcoma
Fibromatosis
Character of Fibromatosis
locally aggressive with high recurrence rate
What age does Fibromatosis normally occur in
head and neck of children and young adults (Juvenile Aggressive Fibromatosis)
Dangers of Fibromatosis/Juvenile Aggressive Fibromatosis
limited opening with negative medical history and boney invasion
Fibromatosis/Juvenile aggressive fibromatosis treatment
surgical resection with large margin of adjacent normal tissue
Does metastaiss occur in Fibromatosis
NO
Why keep condylar head in any aggressive surgical resection in the mandible
It is a growth center so don’t want to induce asymmetric mandibular growth if avoidable
Three P’s of Soft Tissue tumors
Pyogenic Granuloma
Periperhal Ossifying Fibroma
Peripheral Giant Cell Granuloma
Common tumor like growth of oral cavity that is non-neoplastic and unrelated to infection, but is fast growing
Pyogenic Granuloma
Specific demographic beyond children and young adults whom Pyogenic Granuloma is common in
Pregnant women (called pregnancy tumor or granuloma gravidium)
Common sites for Pyogenic Granuloma
Lips, tongue, buccal mucosa
Progression of pyogenic Granuloma
vascular and red at first, fibrosis over time to eventual hyperplasia/fibroma/scar
Pyogenic Granuloma clinical appearance
smooth or lobulated mass usually pedunculated painless on gingival, cause a local irritant reaction
Pyogenic Granuloma treatment
conservative surgical excision down to periosteum and remove any irritants (e.g. calculus)
Know histology of Pyogenic Granuloma
granulation like tissue w/ ulcerated surface. Can have blood vessels
Hyperplastic growth that resembles a Pyogenic granuloma but is associated with a healing extraction socket
Epulis Granulomatosa
Common tumor-like growth orally, reactive lesion to trauma, exclusively on the gingival or alveolar ridge (exclusively on gums, whereas Pyogenic granuloma can grow anywhere)
Periphearl Giant Cell Granuloma
Though it closely resembles a pyogenic granuloma on the gingival, what is a difference of the Peripheral Giant Cell Granuloma
Blue-purple nodular mass
What can be seen radiographically with Peripheral Giant Cell Granuloma
cupping resorption of underlying bone, eventhough it is a soft tissue tumor
Treatment for Peripheral Giant Cell Granuloma
local surgical excision w/ 10% recurrence
peripheral Giant Cell Granuloma can be mistaken for a tumor associated with what disease
Brown tumor of hyperparathyroidism
what is a major difference with the Brown’s tumor of Hyperparathyroidism and the Peripheral Giant Cell Granuloma
Brown’s tumor is intraosseous
The intraosseous brown’s tumor of hyperparathyroid ism can mimic what bone pathology orally
Central Giant Cell Granuloma (female predilection, crosses midline anterior mandible)
Know Histology of Peripheral Giant cell Granuloma
mucosa or ulcerated mucosa covering a lesion composed of multinucleated giant cells
Tumor like mass occurs only on the gingiva (Like the Peripheral Giant Cell Granuloma) except this is most common in 10-19 year olds and 2/3 of all cases occur in females
Peripheral Ossifying fibroma
Peripheral Ossifying Fibroma treatment
Local excision down to periosteum
Which of the 3 P’s (Pyogenic Granuloma, Peripheral Giant Cell Granuloma, or Peripheral Ossifying Fibroma) has the highest recurrence rate
Peripheral Ossifying Fibroma, 16% recurrence
Know histology of Peripheral Ossifying Fibroma
ulcerated, cellular fibrous connective tissue containing viable bone trabeculae and or focal calcifications
Benign tumor of fat cell origin
LIPOMA
Most common mesenchymal neoplasm, and most commonly occurs on the trunk
Lipoma
What hue will a lipoma have
YELLOW
Most common site for Lipoma
buccal mucosa, buccal vestibule
Lipoma treatment
conservative surgical excision
What histologically differentiates this from fibroma
fat is clear histologically
Not a true neoplasm but a reactive proliferation of neural tissue after transaction or other damage of nerve bundle
Traumatic Neuroma
Clinical features Traumatic Neuroma
smooth nodule, not ulcerated, pain common, history of trauma, extraction, surgery. Near mental foramen, on tongue, or lower lip
Know the histology for the Traumatic Neuroma
mature myelinated & unmyelinated nerve bundles in fibrous connective tissue stroma. Can stain with S- 100 nerve stain
Benign neural neoplasm of Schwann cell origin commonly occurring on the tongue, but otherwise asymptomatic
Neurilemoma/Schwannoma
What will the Neurilemoma cause radiographically if associated with nerve and bone (IAN)
Radiolucency
Know the Histology for Neurilemoma
streaming fascicles of spindle shaped Schwann cells form a palisaded arrangement around a central accellular body (Verocay body)
What are the acellular zones of neurolimoma called
Verocay bodies
What will a person be if they have vestibular neurilemomas and the NF2 condition
Deafness
Most common type of peripheral nerve neoplasm
Neurofibroma
Is growth slow or fast for neurofibroma
slow growing, soft, painless
Most common oral location for Neurofibroma (skin is most common location for neurofibroma)
tongue and buccal mucosa
Histology of neurofibroma
spindle shaped cells with wavy nuclei
Treatment for neurofibroma
surgical excision, rare recurrence, rare malignant transformation
If patient has a neurofibroma, what other pathology should they be evaluated for
Neurofibromatosis
Hereditary condition, type I most common, with mutation at NF1 gene for tumor suppressor protein neruofibromin
Neurofibromatosis/vonReckinghausen’s Disease of skin
6 Diagnostic criteria for Neurofibromatosis NF1/von Recklinghausens’ Disease of the skin(must have 2 of the 6)
1) 6+ café au lait macule, >5mm prepuberty, >15mm postpuberty
2) 2+neurofibromas or 1 plexiform neurofibroma
3) Axillary & inguinal freckling
4) 2+Lisch nodules (Iris Hamartomas)
5) Distinct Osseous lesion
6) 1st degree relative diagnosed NF1 Optic glioma
What are café au lait spots of NF1/von Recklinghausen’s Disease of the Skin
Coffee w/ milk pigment
What is Crowe’s sign of NF1/von Recklinghausen’s Disease of the Skin
axillary freckling (underarms)
translucent brown-pigmented spots on the iris in nearly all affected individuals with NF1/von Recklinghausen’s Disease of the Skin
Lisch nodules
What is the malignant transformation for Neurofibromatosis 1/vonRecklinghausen’s Disease of the skin
malignant nerve sheath tumor (neurofibrosarcoma, malignant schwannoma)
Disease reminiscent of Elephant man, John Merrick
Neurofibromatosis 1/von Recklinghausen’s Disease of the skin (differential is Proteus syndrome)
Group of rare conditions characterized by tumors or hyperplasias of the neuroendocrine tissue
Multiple Endocrine neoplasia
Multiple Endocrine Neoplasia type 1 character
pancreatic islet tumors
Adrenal cortex tumors
Parathyroid tumors
Pituitary tumors
MEN Type 2A character
pheochromocytoma
Medullary thyroid carcinoma
MEN Type 2 B character
same as Type 2b, but with mucosal neuromas
Patients with MEN2b have what look
Marfanoid habitus: thin, elongated limbs w/ muscle wasting, narrow faces, full lips, everted upper eyelid
usually first sign of MEN 2B
oral mucosal neuromas, soft painless papule or nodules
Where are oral mucosal neuromas of MEN 2B common
lips, anterior tongue, buccal mucosa, gingival, palate (that’s the whole darn mouth)
What is highly characteristic intraoral neuroma of MEN 2B
bilateral neuromas of commissural mucosa (the flaps at either side inside corners of mouth)
in MEN2b with the pheochromocytoma, what is the risk and subsequent treatment
high EPI, calcitonin, and vanillylmandelic acid leading to life threatening HTN. Therefore, prophylactic thyroid removal
rare pigmented neoplasm that usually occurs during first year of life. Neural Crest origin
Melanotic Neuroectodermal Tumor of Infancy
Melanotic Neuroectodermal Tumor of Infancy clinical features
65-70% maxilla rapidly expanding mass blue or
black that can destroy bone or underlying teeth
What is elevated in Melanotic Neuroectodermal Tumor of Infancy that is also elevated in MEN 2B
Vanillylmandelic acid
Histology of Melanotic Neuroectodermal Tumor of Infancy
small hyperchromatic round cells and larger epitheliod cells with vesicular nuclei and some melanin
Specialized tissue of neural crest origin associated with autonomic nerves and ganglia throughout the body
Paraganglioma
paranganglia cells do what in the Carotid body (at the bifurcation)
act as chemoreceptors to detect changes in pH or oxygen tension to cause a change in respiration or heart rate
Tumors of the Carotid body
Carotid body tumor
The most common paraganglioma and anatomic location
-Carotid body tumor
-Upper lateral neck at angle of the mandible (where
Carotid bifurcates)
Benign soft tissue neoplasm prefereing oral cavity that may originate from Schwann cells or neruoendocrine cells
Granular Cell Tumor
Most common location for Granular Cell tumor
Dorsal tongue #1, Buccal mucosa #2
age and gender for Granular Cell Tumor
4th -6th decade, Females 2x
Is a Granular Cell tumor S-100 positive (nerve stain)
No
Because the Granular Cell tumor histo shows pseudoepithelimatous hyperplasia, for what can it be mistaken
Squamous Cell Carcinoma
Granular Cell Tumor treatment
Conservative excision with rare recurrence
Soft tissue tumor that occurs exclusively on the alveolar ridges of newborns
congenital Epulis
Gender predilection for Congenital Epulis
90% Female
Gender predilection for Warthin tumor
90% Male
What does Congenital Epulis look like histologically
Granular Cell Tumor
What does Congenital Epulis lack histologically that Granular Cell tumor has
pseudoepithelimatous hyperplasia that can be mistaken for Squamous Cell Carcinoma
Is Congenital Epulis S-100 positive
Yes. Note, Granular cell tumor is S-100 Negative
Growth character of Congenital Epulis and treatment
Stops growing at birth
Benign tumore of infancy that grows rapidly and has endothelial proliferation then eventually involutes. Most are not noticed at birth but after first 8 weeks of life
Hemangioma
Big way to diagnose Hemangioma
put glass slide on top, and it blanches under pressure
Know histology of Hemangioma
vascular with blood cells
difference between vascular malformation and hemangioma
Vascular Malformations are present at birth and persist through life
Low Flow Vascular Malformations character
Blue, compressible, grow proportionately with patient with a secondary thrombosis or phlebolith risk.
High Flow Vascular Malformations character
not noticed until childhood. Result from direct ateriorvenous communication with the resulting fast flow causing a bruit/ thrill (whoosh sound). Overlying skin is warm to the touch
Of the low and high flow vascular malformations, which is worse
High Flow. Risk of bleeding out if cut the malformation
Hamartomous vascular proliferation involving tissues of the brain and face
Sturge Weber Angiomatosis/Encephalotrigeminal Angiomatosis
This is the port wine stain/nevus flammeus with a unilateral distribution along one or more segments of the trigeminal nerve
Sturge Weber Angiomatosis/ Encephalotrigeminal Angiomatosis
Do all patients with a port wine nevi have Sturge- Weber Syndrome/Encephalotrigeminal angiomatosis
NO
other parts of Sturge-Weber Syndrome/encephalotrigeminal angiomatosis
Leptomeningial angiomatosis with convulsive disorder and ocular involvement (vascular malformations of the eye)
Oral involvement of Sturge-Weber Syndrome/encephalotrigeminal angiomatosis
Hypervascular gingival or gingival hyperplasi that can resemble pyogenic granuloma
Beyond hypervascularity inducing hyperplasia of the gingival in Sturge-Weber Syndrome/ encephalotrigeminal angiomatosis, what else could cause the gingival hyperplasia in this syndrome
phenytoin therapy used to control epileptic seizures
Fibrous tumor of the nasopharynx that occurs exclusively in males between 10-17. Can be destructive and cause epistaxis
Nasopharyngeal angiofibroma
Common lesion on the buccal mucosa with a characteristic staghorn appearance of blood vessels surrounded by pericytes
Solitary Fibrous Tumor
Treatment and risk for Solitary Fibrous Tumor
local excision or more aggressive surgery due to high risk of malignant transformation
Benign hamartomatous tumor of lymphatic vessels that looks like hemangioma, just filled with lymph
Lymphangioma
Intraoral common location for Lymphangioma and appearance
anterior 2/3 of tongue with characteristic pebbly appearance
Treatment for Lymphangioma
biopsy to diagnose and no further
When are Lymphangiomas diagnosed
Birth to 2 years
Benign Neoplasm of smooth muscle
Leiomyoma
A beging Neoplasm of vascular smooth muscle
Angiomyoma
Malignant Neoplasm of Smooth Muscle
Leiomyosarcoma
Leiomyoma in oral cavity
Rare
Benign neoplasms of skeletal muscle
Rhabdomyoma
Where are Rhabdomyomas found intraorally
floor of mouth, soft palate, base of tongue
Malignant neoplasm of skeletal muscle
Rhabdomyosarcoma
Normal tissue in an abnormal location
Choristoma
Choristomas prefer what intraoral location
Tongue
Synonymn for Malignant Peripheral Nerve Sheath Tumor
Neurofibrosarcoma
Half of the cases of Neurofibrosarcoma occur in patients with…
Neurofibromatosis type 1
Character of Neurofibrosarcoma intraorally
Young adults, mandible lips and buccal mucosa associated with a nerve. Can see widening IAN X-ray
Neurofibrosarcoma treatment
surgical excision and radiation and chemo with poor prognosis
Malignancy of vascular endothelium that can arise from blood vessels or lymphatics, 50% occurring in head and neck
Angiosarcoma
Most common site for Angiosarcoma
Scalp & forehead
Clinical look of Angiosarcoma
initially look like a bruise, but continue to enlarge and become nodular
Treatment of Angiosarcoma
surgical excision and radiation with poor prognosis
Malignant neoplasm of smooth muscle that occurs most often in GI tract and uterine wall, but rarely orally
Leiomyosarcoma
Half of all oral cases of Leiomyosarcoma occur where
jawbone
Treatment of Leiomyosarcoma
surgical excision, chemo, radiation, guarded prognosis
Malignant neoplasm of skeletal muscle
Rhabdomyosarcoma
60% of soft tissue sarcomas in children
Rhabdomyosarcoma
Alveolar Rhabodmyosarcoma common in what age
10-25 yrs
Rhabdomyosarcoma treatment
surgical excision and multiagent therapy with good prognosis
Malignant neoplasm of fatty origin and is considered the most common soft tissue sarcoma
Liposarcoma
Most frequent oral sites for Liposarcoma
tongue and cheek, neck on head and neck
Treatment for Liposarcoma
surgical excision with good prognosis in head and neck because usually caught early
Most common site for oral soft tissue mestastases
gingival, usually as a nodular mass such as pyogenic granuloma
3 things that are known to metastasize to the oral soft tissues in order
1) lung
2) Renal
3) Melanoma
