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Oral Pathology, Stephen > chpt 12- soft tissue tumors > Flashcards

chpt 12- soft tissue tumors Flashcards

1
Q

Most common tumor of the oral cavity

A

FIBROMA

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2
Q

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

A

Fibroma

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3
Q

Most common location for a fibroma

A

Buccal mucosa at bite line

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4
Q

Clinical description of Fibroma

A

smooth surfaced pink nodule w/ same color as surrounding tissue(may be darker in African Americans), sessile, can be pedunculated

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5
Q

Fibroma treatment

A

Surgical excision, low recurrence

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6
Q

Commonly observed fibrous hyperplasia most frequently occurring on the maxillary labial frenum

A

frenal tag

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7
Q

Fibrous tumor, not associated with chronic irritation, whose surface may appear papillary so it can be mistaken for a papillom

A

Giant cell Fibroma

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8
Q

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

A

Retrocuspid papilla

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9
Q

Tumor like hyperplasia of fibrous connective tissue that develops in association with the flange of an ill- fitting complete or partial denture

A

epulis Fissuratum

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10
Q

Epulis Fissuratum clinical features

A

single or multiple folds in vestibule usually firm and fibrous, facial, anterior

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11
Q

Trauma to tissue can cause 2 things

A

1) tissue breakdown causing an ulcer

2) Tissue hyperplasia to protect

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12
Q

Epulis fissuratum treatment

A

surgical excision and remake or refit denture

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13
Q

Reactive tissue growth that commonlhy develops beneath a denture, especially when worn constantly

A

Inflammatory hyperplasia

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14
Q

Inflammatory papillary hyperplasia clinical features

A

hard palate beneath denture or on mandibular alveolar ridge as small pebbles or cobblestones

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15
Q

Other causes of inflammatory papillary hyperplasia

A

High arch
Mouth breathing
Drugs

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16
Q

Know the Histology for Papillary Hyperplasia

A

numerous papillary growths covered by hyperplastic stratified squamous epithelium

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17
Q

Inflammatory Hyperplasia treatment

A

remove denture allow time to heal, surgical removal of hyperplasia, remake or reline denture

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18
Q

Diverse group of tumors that look like a fibroma but have fibrous and histiocytic differentiation. Most commonly occur on the skin as a dermatofibroma

A

Fibrous histiocytomas

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19
Q

Fibrous proliferations with a histologic pattern between benign fibrous lesions and fibrosarcoma

A

Fibromatosis

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20
Q

Character of Fibromatosis

A

locally aggressive with high recurrence rate

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21
Q

What age does Fibromatosis normally occur in

A

head and neck of children and young adults (Juvenile Aggressive Fibromatosis)

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22
Q

Dangers of Fibromatosis/Juvenile Aggressive Fibromatosis

A

limited opening with negative medical history and boney invasion

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23
Q

Fibromatosis/Juvenile aggressive fibromatosis treatment

A

surgical resection with large margin of adjacent normal tissue

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24
Q

Does metastaiss occur in Fibromatosis

A

NO

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25
Q

Why keep condylar head in any aggressive surgical resection in the mandible

A

It is a growth center so don’t want to induce asymmetric mandibular growth if avoidable

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26
Q

Three P’s of Soft Tissue tumors

A

Pyogenic Granuloma
Periperhal Ossifying Fibroma
Peripheral Giant Cell Granuloma

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27
Q

Common tumor like growth of oral cavity that is non-neoplastic and unrelated to infection, but is fast growing

A

Pyogenic Granuloma

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28
Q

Specific demographic beyond children and young adults whom Pyogenic Granuloma is common in

A

Pregnant women (called pregnancy tumor or granuloma gravidium)

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29
Q

Common sites for Pyogenic Granuloma

A

Lips, tongue, buccal mucosa

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30
Q

Progression of pyogenic Granuloma

A

vascular and red at first, fibrosis over time to eventual hyperplasia/fibroma/scar

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31
Q

Pyogenic Granuloma clinical appearance

A

smooth or lobulated mass usually pedunculated painless on gingival, cause a local irritant reaction

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32
Q

Pyogenic Granuloma treatment

A

conservative surgical excision down to periosteum and remove any irritants (e.g. calculus)

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33
Q

Know histology of Pyogenic Granuloma

A

granulation like tissue w/ ulcerated surface. Can have blood vessels

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34
Q

Hyperplastic growth that resembles a Pyogenic granuloma but is associated with a healing extraction socket

A

Epulis Granulomatosa

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35
Q

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)

A

Periphearl Giant Cell Granuloma

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36
Q

Though it closely resembles a pyogenic granuloma on the gingival, what is a difference of the Peripheral Giant Cell Granuloma

A

Blue-purple nodular mass

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37
Q

What can be seen radiographically with Peripheral Giant Cell Granuloma

A

cupping resorption of underlying bone, eventhough it is a soft tissue tumor

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38
Q

Treatment for Peripheral Giant Cell Granuloma

A

local surgical excision w/ 10% recurrence

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39
Q

peripheral Giant Cell Granuloma can be mistaken for a tumor associated with what disease

A

Brown tumor of hyperparathyroidism

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40
Q

what is a major difference with the Brown’s tumor of Hyperparathyroidism and the Peripheral Giant Cell Granuloma

A

Brown’s tumor is intraosseous

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41
Q

The intraosseous brown’s tumor of hyperparathyroid ism can mimic what bone pathology orally

A

Central Giant Cell Granuloma (female predilection, crosses midline anterior mandible)

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42
Q

Know Histology of Peripheral Giant cell Granuloma

A

mucosa or ulcerated mucosa covering a lesion composed of multinucleated giant cells

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43
Q

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

A

Peripheral Ossifying fibroma

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44
Q

Peripheral Ossifying Fibroma treatment

A

Local excision down to periosteum

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45
Q

Which of the 3 P’s (Pyogenic Granuloma, Peripheral Giant Cell Granuloma, or Peripheral Ossifying Fibroma) has the highest recurrence rate

A

Peripheral Ossifying Fibroma, 16% recurrence

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46
Q

Know histology of Peripheral Ossifying Fibroma

A

ulcerated, cellular fibrous connective tissue containing viable bone trabeculae and or focal calcifications

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47
Q

Benign tumor of fat cell origin

A

LIPOMA

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48
Q

Most common mesenchymal neoplasm, and most commonly occurs on the trunk

A

Lipoma

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49
Q

What hue will a lipoma have

A

YELLOW

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50
Q

Most common site for Lipoma

A

buccal mucosa, buccal vestibule

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51
Q

Lipoma treatment

A

conservative surgical excision

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52
Q

What histologically differentiates this from fibroma

A

fat is clear histologically

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53
Q

Not a true neoplasm but a reactive proliferation of neural tissue after transaction or other damage of nerve bundle

A

Traumatic Neuroma

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54
Q

Clinical features Traumatic Neuroma

A

smooth nodule, not ulcerated, pain common, history of trauma, extraction, surgery. Near mental foramen, on tongue, or lower lip

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55
Q

Know the histology for the Traumatic Neuroma

A

mature myelinated & unmyelinated nerve bundles in fibrous connective tissue stroma. Can stain with S- 100 nerve stain

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56
Q

Benign neural neoplasm of Schwann cell origin commonly occurring on the tongue, but otherwise asymptomatic

A

Neurilemoma/Schwannoma

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57
Q

What will the Neurilemoma cause radiographically if associated with nerve and bone (IAN)

A

Radiolucency

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58
Q

Know the Histology for Neurilemoma

A

streaming fascicles of spindle shaped Schwann cells form a palisaded arrangement around a central accellular body (Verocay body)

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59
Q

What are the acellular zones of neurolimoma called

A

Verocay bodies

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60
Q

What will a person be if they have vestibular neurilemomas and the NF2 condition

A

Deafness

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61
Q

Most common type of peripheral nerve neoplasm

A

Neurofibroma

62
Q

Is growth slow or fast for neurofibroma

A

slow growing, soft, painless

63
Q

Most common oral location for Neurofibroma (skin is most common location for neurofibroma)

A

tongue and buccal mucosa

64
Q

Histology of neurofibroma

A

spindle shaped cells with wavy nuclei

65
Q

Treatment for neurofibroma

A

surgical excision, rare recurrence, rare malignant transformation

66
Q

If patient has a neurofibroma, what other pathology should they be evaluated for

A

Neurofibromatosis

67
Q

Hereditary condition, type I most common, with mutation at NF1 gene for tumor suppressor protein neruofibromin

A

Neurofibromatosis/vonReckinghausen’s Disease of skin

68
Q

6 Diagnostic criteria for Neurofibromatosis NF1/von Recklinghausens’ Disease of the skin(must have 2 of the 6)

A

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

69
Q

What are café au lait spots of NF1/von Recklinghausen’s Disease of the Skin

A

Coffee w/ milk pigment

70
Q

What is Crowe’s sign of NF1/von Recklinghausen’s Disease of the Skin

A

axillary freckling (underarms)

71
Q

translucent brown-pigmented spots on the iris in nearly all affected individuals with NF1/von Recklinghausen’s Disease of the Skin

A

Lisch nodules

72
Q

What is the malignant transformation for Neurofibromatosis 1/vonRecklinghausen’s Disease of the skin

A

malignant nerve sheath tumor (neurofibrosarcoma, malignant schwannoma)

73
Q

Disease reminiscent of Elephant man, John Merrick

A

Neurofibromatosis 1/von Recklinghausen’s Disease of the skin (differential is Proteus syndrome)

74
Q

Group of rare conditions characterized by tumors or hyperplasias of the neuroendocrine tissue

A

Multiple Endocrine neoplasia

75
Q

Multiple Endocrine Neoplasia type 1 character

A

pancreatic islet tumors
Adrenal cortex tumors
Parathyroid tumors
Pituitary tumors

76
Q

MEN Type 2A character

A

pheochromocytoma

Medullary thyroid carcinoma

77
Q

MEN Type 2 B character

A

same as Type 2b, but with mucosal neuromas

78
Q

Patients with MEN2b have what look

A

Marfanoid habitus: thin, elongated limbs w/ muscle wasting, narrow faces, full lips, everted upper eyelid

79
Q

usually first sign of MEN 2B

A

oral mucosal neuromas, soft painless papule or nodules

80
Q

Where are oral mucosal neuromas of MEN 2B common

A

lips, anterior tongue, buccal mucosa, gingival, palate (that’s the whole darn mouth)

81
Q

What is highly characteristic intraoral neuroma of MEN 2B

A

bilateral neuromas of commissural mucosa (the flaps at either side inside corners of mouth)

82
Q

in MEN2b with the pheochromocytoma, what is the risk and subsequent treatment

A

high EPI, calcitonin, and vanillylmandelic acid leading to life threatening HTN. Therefore, prophylactic thyroid removal

83
Q

rare pigmented neoplasm that usually occurs during first year of life. Neural Crest origin

A

Melanotic Neuroectodermal Tumor of Infancy

84
Q

Melanotic Neuroectodermal Tumor of Infancy clinical features

A

65-70% maxilla rapidly expanding mass blue or

black that can destroy bone or underlying teeth

85
Q

What is elevated in Melanotic Neuroectodermal Tumor of Infancy that is also elevated in MEN 2B

A

Vanillylmandelic acid

86
Q

Histology of Melanotic Neuroectodermal Tumor of Infancy

A

small hyperchromatic round cells and larger epitheliod cells with vesicular nuclei and some melanin

87
Q

Specialized tissue of neural crest origin associated with autonomic nerves and ganglia throughout the body

A

Paraganglioma

88
Q

paranganglia cells do what in the Carotid body (at the bifurcation)

A

act as chemoreceptors to detect changes in pH or oxygen tension to cause a change in respiration or heart rate

89
Q

Tumors of the Carotid body

A

Carotid body tumor

90
Q

The most common paraganglioma and anatomic location

A

-Carotid body tumor
-Upper lateral neck at angle of the mandible (where
Carotid bifurcates)

91
Q

Benign soft tissue neoplasm prefereing oral cavity that may originate from Schwann cells or neruoendocrine cells

A

Granular Cell Tumor

92
Q

Most common location for Granular Cell tumor

A

Dorsal tongue #1, Buccal mucosa #2

93
Q

age and gender for Granular Cell Tumor

A

4th -6th decade, Females 2x

94
Q

Is a Granular Cell tumor S-100 positive (nerve stain)

A

No

95
Q

Because the Granular Cell tumor histo shows pseudoepithelimatous hyperplasia, for what can it be mistaken

A

Squamous Cell Carcinoma

96
Q

Granular Cell Tumor treatment

A

Conservative excision with rare recurrence

97
Q

Soft tissue tumor that occurs exclusively on the alveolar ridges of newborns

A

congenital Epulis

98
Q

Gender predilection for Congenital Epulis

A

90% Female

99
Q

Gender predilection for Warthin tumor

A

90% Male

100
Q

What does Congenital Epulis look like histologically

A

Granular Cell Tumor

101
Q

What does Congenital Epulis lack histologically that Granular Cell tumor has

A

pseudoepithelimatous hyperplasia that can be mistaken for Squamous Cell Carcinoma

102
Q

Is Congenital Epulis S-100 positive

A

Yes. Note, Granular cell tumor is S-100 Negative

103
Q

Growth character of Congenital Epulis and treatment

A

Stops growing at birth

104
Q

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

A

Hemangioma

105
Q

Big way to diagnose Hemangioma

A

put glass slide on top, and it blanches under pressure

106
Q

Know histology of Hemangioma

A

vascular with blood cells

107
Q

difference between vascular malformation and hemangioma

A

Vascular Malformations are present at birth and persist through life

108
Q

Low Flow Vascular Malformations character

A

Blue, compressible, grow proportionately with patient with a secondary thrombosis or phlebolith risk.

109
Q

High Flow Vascular Malformations character

A

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

110
Q

Of the low and high flow vascular malformations, which is worse

A

High Flow. Risk of bleeding out if cut the malformation

111
Q

Hamartomous vascular proliferation involving tissues of the brain and face

A

Sturge Weber Angiomatosis/Encephalotrigeminal Angiomatosis

112
Q

This is the port wine stain/nevus flammeus with a unilateral distribution along one or more segments of the trigeminal nerve

A

Sturge Weber Angiomatosis/ Encephalotrigeminal Angiomatosis

113
Q

Do all patients with a port wine nevi have Sturge- Weber Syndrome/Encephalotrigeminal angiomatosis

A

NO

114
Q

other parts of Sturge-Weber Syndrome/encephalotrigeminal angiomatosis

A

Leptomeningial angiomatosis with convulsive disorder and ocular involvement (vascular malformations of the eye)

115
Q

Oral involvement of Sturge-Weber Syndrome/encephalotrigeminal angiomatosis

A

Hypervascular gingival or gingival hyperplasi that can resemble pyogenic granuloma

116
Q

Beyond hypervascularity inducing hyperplasia of the gingival in Sturge-Weber Syndrome/ encephalotrigeminal angiomatosis, what else could cause the gingival hyperplasia in this syndrome

A

phenytoin therapy used to control epileptic seizures

117
Q

Fibrous tumor of the nasopharynx that occurs exclusively in males between 10-17. Can be destructive and cause epistaxis

A

Nasopharyngeal angiofibroma

118
Q

Common lesion on the buccal mucosa with a characteristic staghorn appearance of blood vessels surrounded by pericytes

A

Solitary Fibrous Tumor

119
Q

Treatment and risk for Solitary Fibrous Tumor

A

local excision or more aggressive surgery due to high risk of malignant transformation

120
Q

Benign hamartomatous tumor of lymphatic vessels that looks like hemangioma, just filled with lymph

A

Lymphangioma

121
Q

Intraoral common location for Lymphangioma and appearance

A

anterior 2/3 of tongue with characteristic pebbly appearance

122
Q

Treatment for Lymphangioma

A

biopsy to diagnose and no further

123
Q

When are Lymphangiomas diagnosed

A

Birth to 2 years

124
Q

Benign Neoplasm of smooth muscle

A

Leiomyoma

125
Q

A beging Neoplasm of vascular smooth muscle

A

Angiomyoma

126
Q

Malignant Neoplasm of Smooth Muscle

A

Leiomyosarcoma

127
Q

Leiomyoma in oral cavity

A

Rare

128
Q

Benign neoplasms of skeletal muscle

A

Rhabdomyoma

129
Q

Where are Rhabdomyomas found intraorally

A

floor of mouth, soft palate, base of tongue

130
Q

Malignant neoplasm of skeletal muscle

A

Rhabdomyosarcoma

131
Q

Normal tissue in an abnormal location

A

Choristoma

132
Q

Choristomas prefer what intraoral location

A

Tongue

133
Q

Synonymn for Malignant Peripheral Nerve Sheath Tumor

A

Neurofibrosarcoma

134
Q

Half of the cases of Neurofibrosarcoma occur in patients with…

A

Neurofibromatosis type 1

135
Q

Character of Neurofibrosarcoma intraorally

A

Young adults, mandible lips and buccal mucosa associated with a nerve. Can see widening IAN X-ray

136
Q

Neurofibrosarcoma treatment

A

surgical excision and radiation and chemo with poor prognosis

137
Q

Malignancy of vascular endothelium that can arise from blood vessels or lymphatics, 50% occurring in head and neck

A

Angiosarcoma

138
Q

Most common site for Angiosarcoma

A

Scalp & forehead

139
Q

Clinical look of Angiosarcoma

A

initially look like a bruise, but continue to enlarge and become nodular

140
Q

Treatment of Angiosarcoma

A

surgical excision and radiation with poor prognosis

141
Q

Malignant neoplasm of smooth muscle that occurs most often in GI tract and uterine wall, but rarely orally

A

Leiomyosarcoma

142
Q

Half of all oral cases of Leiomyosarcoma occur where

A

jawbone

143
Q

Treatment of Leiomyosarcoma

A

surgical excision, chemo, radiation, guarded prognosis

144
Q

Malignant neoplasm of skeletal muscle

A

Rhabdomyosarcoma

145
Q

60% of soft tissue sarcomas in children

A

Rhabdomyosarcoma

146
Q

Alveolar Rhabodmyosarcoma common in what age

A

10-25 yrs

147
Q

Rhabdomyosarcoma treatment

A

surgical excision and multiagent therapy with good prognosis

148
Q

Malignant neoplasm of fatty origin and is considered the most common soft tissue sarcoma

A

Liposarcoma

149
Q

Most frequent oral sites for Liposarcoma

A

tongue and cheek, neck on head and neck

150
Q

Treatment for Liposarcoma

A

surgical excision with good prognosis in head and neck because usually caught early

151
Q

Most common site for oral soft tissue mestastases

A

gingival, usually as a nodular mass such as pyogenic granuloma

152
Q

3 things that are known to metastasize to the oral soft tissues in order

A

1) lung
2) Renal
3) Melanoma

Oral Pathology, Stephen (13 decks)

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