Class: Exam 2 Benign Neoplasms

Question 1

Neoplasm

Answer 1

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.

Question 2

3 variants of Epithelial Benign Neoplasms with HPV etiology

Answer 2

Papilloma
Verruca vulgaris
Condyloma Acuminatum

Question 3

Epithelial Benign Lesions can be classified into what two categories

Answer 3

A. Human Papilloma Virus (HPV) etiology

B. Keratoacanthoma (KA)

Question 4

All HPV Epithelial Benign neoplasms are what type of growths?

Answer 4

Papillary or verrucous growths

Question 5

Describe clinical features of papilloma

Answer 5

exophytic
often pedunculated
pink to white

Question 6

Where is the most common location of a Papilloma

Answer 6

Soft palate

Question 7

Describe clinical features of Verruca Vulgaris

Answer 7

“Common Wart”
usually HPV2
Similar to papilloma
Many patients have verruca on hands

Question 8

Describe clinical features of Condyloma Acuminatum

Answer 8

“venereal warts”
Usually HPV 6/11
Often multiple
Less exophytic than papillomas

Question 9

How are Epithelial HPV benign neoplasms treated?

Answer 9

By removal

Question 10

Keratoacanthoma (KA) has similar clinical and histological features with what cancer?

Answer 10

Skin cancer (Squamous cell carcinoma)

Question 11

T or F, Keratoacanthoma is not neoplastic

Answer 11

True, Considered reactive, not neoplastic

Question 12

Where is Keratoacanthoma normally located?

Answer 12

Sun exposed areas of head and neck
Older patients
10% on lips/have been reported intraorally

Question 13

Clinical features of Keratoacanthoma

Answer 13

Rapid growth

Often umbilicated with rolled borders

Question 14

name the 3 Mesenchymal Benign neoplasms that are connective tissue origin

Answer 14

Fibroma (most common)
Lipoma
Verruciform Xanthoma

Question 15

Define Lipoma and it’s clinical features

Answer 15

Benign neoplasm of fat
may appear yellowish
very common in skin
less so orally

Question 16

Define Verruciform xanthoma

Answer 16

Reactive lesion with predilection for hard palate or gingiva. Most common orally but reported on skin and genitals

Question 17

Clinical features of Verruciform xanthoma

Answer 17

Surface irregular (verrucous, "verruciform")
Pink to white

Question 18

histological features of Verruciform xanthoma

Answer 18

Epithelium displays papillary hyperplasia. Connective tissue papillae contain phagocytic cells which have engulfed lipid (xanthoma cells)

Question 19

Name all of the muscle benign neoplasms

Answer 19

1. Leiomyoma (angioleiomyoma)(vascular leiomyoma)
2. Rhabdomyoma
3. Granular cell tumor
4. Congenital epulis of the newborn

Question 20

Describe Leiomyoma and its clinical features

Answer 20

Benign neoplasm of smooth muscle
Common in uterus (fibroids)
Rare orally
Most normal color
Reddish to purple

Question 21

Describe Rhabdomyoma

Answer 21

Benign neoplasm of skeletal muscle
> Heart
Rare orally
> tongue

Question 22

Describe Granular cell tumor

Answer 22

Originally thought to arise from muscle (granular cell myoblastoma)
–> Now thought to be of nerve origin, possibly sheath

Question 23

Where are granular cell tumors most common?

Answer 23

Common in skin and orally

–> >tongue (most common site) but can affect other sites

Question 24

Clinical features of granular cell tumors

Answer 24

Clinical: firm and fixed, not freely movable on palpation

Question 25

Histological features of granular cell tumors

Answer 25

Histological: Large polygonal cells with granular cytoplasm, about 1/2 cause overlying epithelium to react in a pattern that simulates carcinoma called pseudoepitheliomatous hyperplasia

Question 26

Describe Congenital epulis of the newborn

Answer 26

Congenital tumor of anterior alveolar ridge Maxillary:Mand = 2:1 F:M = 8-10:1

Question 27

Histological features of congenital epulis of the newborn

Answer 27

Identical cells to granular cell tumor but cells don't react to immunohistochemical markers for nerve *** No PEH

Question 28

Name the 5 Mesenchymal Nerve Benign Tumors

Answer 28

1. Traumatic Neuroma 2. Neurofibroma 3. Neurilemmoma (Schwannoma) 4. Melanotic neuroectodermal tumor of infancy 5. Multiple Endocrine Neoplasia Type 3 (MEN 3)(2b)

Question 29

Describe Traumatic Neuroma

Answer 29

* Not neoplasm but aberration of healing following trauma | - Mass of tangled regenerating nerve in scar tissue

Question 30

Locations where Traumatic Neuroma are most commonly found

Answer 30

Lateral and Anterior borders of tongue Lower lip at Mental Foramen

Question 31

T or F, Traumatic neuroma is asymptomatic and palpation produces no stimulus

Answer 31

False, Palpation produces pain

Question 32

Describe Neurofibroma

Answer 32

Benign neoplasm occurring in a nerve and composed of Schwann cells, axons and fibrous tissue

Question 33

Where are Neurofibromas found?

Answer 33

Can occur in most tissues and organs of body, including oral cavity, soft tissue and bone Most Asymptomatic

Question 34

Describe Neurofibromatosis (Von Reckblinghausens Disease of Skin)

Answer 34

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)

Question 35

Describe appearance of Neurofibroma

Answer 35

light brown skin pigmentation (cafe-au-lait spots) | - Axillary freckling, pigmentary defects of iris (Lisch spots)

Question 36

Can Neurofibroma become malignant?

Answer 36

1-5% of patients develop malignancy in their neurofibromas

Question 37

Describe Neurilemmoma (Schwannoma)

Answer 37

Benign encapsulated neural neoplasm arising within the sheath or neurilemma of a peripheral nerve

Question 38

Clinical features of Neurilemmoma

Answer 38

Painless | Often freely movable

Question 39

Histological features of Neurilemmoma

Answer 39

Encapsulated neoplasm | Antoni A or Antoni B

Question 40

Describe the difference between Antoni A and Antoni B in a Neurilemmoma

Answer 40

Antoni A: Acellular areas of replicated basement membrane material surrounded by Schwann cell nuclei Antoni B: Haphazardly arranged spindled Schwann cells in loose stroma

Question 41

Describe Melanotic neuroectodermal tumor of infancy

Answer 41

Neural crest tumor occurring almost exclusively in jaws but does occur in extragnathic sites

Question 42

Where and when do Melanotic neuroectodermal tumors of infancy appear

Answer 42

Most congenital - 1 year | Anterior jaws, Maxillary(more common)

Question 43

Clinical features of Melanotic neuroectodermal tumors of infancy

Answer 43

``` Rapidly growing destructive radiolucency Often pigmented (melanin) Tumor cells produce VMA (Vanilymandelic Acid) in serum and urine ```

Question 44

Treatment of Melanotic neuroectodermal tumors of infancy

Answer 44

Aggressive curettage 10-20% recur

Question 45

Describe Multiple Endocrine Neoplasia Type 3 (MEN 3) (2b)

Answer 45

95% of patients with mutation of RET gene, a photo-oncogene on chromosome 10 50% inherited as autosomal dominant 50% somatic mutation

Question 46

What are three signs or neuromas associated with a somatic mutation causing Describe Multiple Endocrine Neoplasia Type 3 (MEN 3) (2b)

Answer 46

``` Mucosal neuromas (predates other tumors) Pheochromocytoma of adrenal medulla Medullary carcinoma of thyroid (occurs in 90% of cases) ```