Class: Exam 2 Benign Neoplasms Flashcards
Neoplasm
Pathologic new growth of tissue in which growth is not controlled by normal regulatory functions and which does not regress after removal of the stimulus which produced it.
3 variants of Epithelial Benign Neoplasms with HPV etiology
Papilloma
Verruca vulgaris
Condyloma Acuminatum
Epithelial Benign Lesions can be classified into what two categories
A. Human Papilloma Virus (HPV) etiology
B. Keratoacanthoma (KA)
All HPV Epithelial Benign neoplasms are what type of growths?
Papillary or verrucous growths
Describe clinical features of papilloma
exophytic
often pedunculated
pink to white
Where is the most common location of a Papilloma
Soft palate
Describe clinical features of Verruca Vulgaris
“Common Wart”
usually HPV2
Similar to papilloma
Many patients have verruca on hands
Describe clinical features of Condyloma Acuminatum
“venereal warts”
Usually HPV 6/11
Often multiple
Less exophytic than papillomas
How are Epithelial HPV benign neoplasms treated?
By removal
Keratoacanthoma (KA) has similar clinical and histological features with what cancer?
Skin cancer (Squamous cell carcinoma)
T or F, Keratoacanthoma is not neoplastic
True, Considered reactive, not neoplastic
Where is Keratoacanthoma normally located?
Sun exposed areas of head and neck
Older patients
10% on lips/have been reported intraorally
Clinical features of Keratoacanthoma
Rapid growth
Often umbilicated with rolled borders
name the 3 Mesenchymal Benign neoplasms that are connective tissue origin
Fibroma (most common)
Lipoma
Verruciform Xanthoma
Define Lipoma and it’s clinical features
Benign neoplasm of fat
may appear yellowish
very common in skin
less so orally
Define Verruciform xanthoma
Reactive lesion with predilection for hard palate or gingiva. Most common orally but reported on skin and genitals
Clinical features of Verruciform xanthoma
Surface irregular (verrucous, "verruciform") Pink to white
histological features of Verruciform xanthoma
Epithelium displays papillary hyperplasia. Connective tissue papillae contain phagocytic cells which have engulfed lipid (xanthoma cells)
Name all of the muscle benign neoplasms
- Leiomyoma (angioleiomyoma)(vascular leiomyoma)
- Rhabdomyoma
- Granular cell tumor
- Congenital epulis of the newborn
Describe Leiomyoma and its clinical features
Benign neoplasm of smooth muscle Common in uterus (fibroids) Rare orally Most normal color Reddish to purple
Describe Rhabdomyoma
Benign neoplasm of skeletal muscle
> Heart
Rare orally
> tongue
Describe Granular cell tumor
Originally thought to arise from muscle (granular cell myoblastoma)
–> Now thought to be of nerve origin, possibly sheath
Where are granular cell tumors most common?
Common in skin and orally
–> >tongue (most common site) but can affect other sites
Clinical features of granular cell tumors
Clinical: firm and fixed, not freely movable on palpation
Histological features of granular cell tumors
Histological: Large polygonal cells with granular cytoplasm, about 1/2 cause overlying epithelium to react in a pattern that simulates carcinoma called pseudoepitheliomatous hyperplasia
Describe Congenital epulis of the newborn
Congenital tumor of anterior alveolar ridge
Maxillary:Mand = 2:1
F:M = 8-10:1
Histological features of congenital epulis of the newborn
Identical cells to granular cell tumor but cells don’t react to immunohistochemical markers for nerve
*** No PEH
Name the 5 Mesenchymal Nerve Benign Tumors
- Traumatic Neuroma
- Neurofibroma
- Neurilemmoma (Schwannoma)
- Melanotic neuroectodermal tumor of infancy
- Multiple Endocrine Neoplasia Type 3 (MEN 3)(2b)
Describe Traumatic Neuroma
- Not neoplasm but aberration of healing following trauma
- Mass of tangled regenerating nerve in scar tissue
Locations where Traumatic Neuroma are most commonly found
Lateral and Anterior borders of tongue
Lower lip
at Mental Foramen
T or F, Traumatic neuroma is asymptomatic and palpation produces no stimulus
False, Palpation produces pain
Describe Neurofibroma
Benign neoplasm occurring in a nerve and composed of Schwann cells, axons and fibrous tissue
Where are Neurofibromas found?
Can occur in most tissues and organs of body, including oral cavity, soft tissue and bone
Most Asymptomatic
Describe Neurofibromatosis (Von Reckblinghausens Disease of Skin)
a developmental condition of neuroectoderm ranging from simple skin pigmentation to widespread involvement of central and peripheral nervous system
1/2 inherited as autosomal dominant trait
Other 1/2 somatic mutations (gene for most on chromosome #17)
Describe appearance of Neurofibroma
light brown skin pigmentation (cafe-au-lait spots)
- Axillary freckling, pigmentary defects of iris (Lisch spots)
Can Neurofibroma become malignant?
1-5% of patients develop malignancy in their neurofibromas
Describe Neurilemmoma (Schwannoma)
Benign encapsulated neural neoplasm arising within the sheath or neurilemma of a peripheral nerve
Clinical features of Neurilemmoma
Painless
Often freely movable
Histological features of Neurilemmoma
Encapsulated neoplasm
Antoni A or Antoni B
Describe the difference between Antoni A and Antoni B in a Neurilemmoma
Antoni A: Acellular areas of replicated basement membrane material surrounded by Schwann cell nuclei
Antoni B: Haphazardly arranged spindled Schwann cells in loose stroma
Describe Melanotic neuroectodermal tumor of infancy
Neural crest tumor occurring almost exclusively in jaws but does occur in extragnathic sites
Where and when do Melanotic neuroectodermal tumors of infancy appear
Most congenital - 1 year
Anterior jaws, Maxillary(more common)
Clinical features of Melanotic neuroectodermal tumors of infancy
Rapidly growing destructive radiolucency Often pigmented (melanin) Tumor cells produce VMA (Vanilymandelic Acid) in serum and urine
Treatment of Melanotic neuroectodermal tumors of infancy
Aggressive curettage 10-20% recur
Describe Multiple Endocrine Neoplasia Type 3 (MEN 3) (2b)
95% of patients with mutation of RET gene, a photo-oncogene on chromosome 10
50% inherited as autosomal dominant
50% somatic mutation
What are three signs or neuromas associated with a somatic mutation causing Describe Multiple Endocrine Neoplasia Type 3 (MEN 3) (2b)
Mucosal neuromas (predates other tumors) Pheochromocytoma of adrenal medulla Medullary carcinoma of thyroid (occurs in 90% of cases)
