Class: Exam 2 Reactive Tumors

Question 1

Most common “tumor” of the oral cavity

Answer 1

fibroma

Question 2

What is a Fibroma

Answer 2

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

Question 3

Where is the most common location for a fibroma?

Answer 3

the buccal mucosa along the bite line

*However, it occurs almost anywhere…

Question 4

Name the clinical features of Fibromas

Answer 4

Usually sessile (immobile), Smooth surfaced, normal color, and Asymptomatic

Question 5

Treatment of irritation fibroma

Answer 5

Treated by conservative surgical excision

Question 6

Define Giant Cell Fibroma

Answer 6

A “papillary” fibrous tumor of connective tissue comparable to an irritation fibroma but not associated with chronic irritation.

Question 7

What other lesion may a giant cell fibroma be clinically mistaken for?

Answer 7

A papilloma

Question 8

What is the hallmark of a giant cell fibroma

Answer 8

Presence of numerous large, stellate fibroblasts within the superficial connective tissue.
Also, often bi or trinucleated fibroblasts.

Question 9

Other than the major hallmark, what other feature/features distinguish giant cell fibromas from irritation fibromas

Answer 9

The lesion usually occurs a a younger age, usually diagnosed during the first 3 years of life. (a.ka. –>more in children)

Question 10

Clinical features of giant cell fibroma?

Answer 10

Asymptomatic
Sessile (immobile) or pedunculate nodule
Less than 1 cm in size
Surface often appears papillary

Question 11

What is the major location in which giant cell fibroma’s are found

Answer 11

Approx. 50% cases found on gingiva

Tongue also common site

Question 12

Define Peripheral Ossifying Fibroma

Answer 12

Reactive fibroblastic lesion of PDL

Question 13

Describe the location/s where peripheral ossifying fibromas may be found

Answer 13

Exclusively on the gingiva

Question 14

Describe the clinical features of a Peripheral Ossifying fibroma

Answer 14

Asymptomatic
Sessile or Pedunculated mass (usually emanates from interdental papilla)
Color: red to pink
Sometimes ulcerated
Most are less than 2 cm in size

Question 15

What age is common for peripheral ossifying fibroma

Answer 15

1-3 decades

predominantly a lesion of teenagers and young adults with peak prevalence between 10-19 yrs.

Question 16

Histologic features of peripheral ossifying fibromas

Answer 16

Cellular fibroblastic lesion with bone and/or cementum and/or dystrophic calcification

Question 17

Treatment for peripheral ossifying fibromas

Answer 17

Excision including superficial PDL
Submission of specimen for exam (biopsy)
Recurrence rate of 15-20% –> Highest of any reactive gingival lesions

Question 18

Define Inflammatory Fibrous Hyperplasia (Epulis Fissuratum)

Answer 18

Reactive folds of hyper plastic fibrous connective tissue along border of ill-fitting, over extended denture

Question 19

Histologic features of Epulis Fissuratum

Answer 19

Fibrous hyperplasia +- inflammation

Question 20

Treatment of Epulis Fissuratum

Answer 20

Excision and remake/reline denture

Question 21

Define Inflammatory Papillary Hyperplasia (Papillomatosis)

Answer 21

Reactive tissue growth of hyper plastic palatal mucosa usually developing beneath a denture.

Question 22

Histologic features of Inflammatory Papillary Hyperplasia

Answer 22

Papillary Hyperplasia +- Inflammation +- Pseudoepitheliomatous Hyperplasia (PEH)

Question 23

Treatment options for Inflammatory Papillary Hyperplasia

Answer 23

Early lesions - removal of denture may allow erythema and edema to subside and tissues may resume normal appearance

Advanced lesions - excision and remake/reline denture.

Question 24

Define Peripheral Giant Cell Granuloma

Answer 24

Tumor of well vascularized fibrous connective tissue containing numerous multinucleated giant cells

Question 25

Where does Peripheral Giant Cell Granuloma occur?

Answer 25

Occurs exclusively on the gingiva or edentulous alveolar ridge

Question 26

Clinical features of Peripheral Giant Cell Granuloma

Answer 26

``` Reddish-brown-purple-blue color Pedunculate or sessile mass Asymptomatic Any age Female:male --> 2:1 ```

Question 27

Pyogenic granulomas and Peripheral giant cell granulomas are similar but can be distinguished by color. What color denotes which?

Answer 27

Peripheral GC Granuloma --> Blue-Purple | Pyogenic granuloma --> Bright red

Question 28

Does the Peripheral Giant Cell Granuloma only occur on soft tissue?

Answer 28

It develops within the soft tissue but may produce cupping respiration of underlying bone.

Question 29

Treatment of Peripheral Giant Cell Granuloma

Answer 29

Excision and removal of irritants, may recur

Question 30

Define Pyogenic Granuloma

Answer 30

Reactive lesion representing hyperplasia of body's basic reparative tissue - granulation tissue - thought to represent an exuberant tissue response to local irritation or trauma

Question 31

Clinical Features of Pyogenic Granuloma

Answer 31

Reddish Ulcerated Pedunculate or sessile mass Asymptomatic but may bleed easily

Question 32

Where is a pyogenic granuloma most likely to occur?

Answer 32

75% of cases on gingiva | Can occur anywhere including the skin

Question 33

What age is a pyogenic granuloma most common?

Answer 33

2-4 decades | - Children and young adults

Question 34

What sex is pyogenic granulomas most common?

Answer 34

Females, often in pregnancy "pregnancy tumor"

Question 35

True or False, pyogenic granuloma are uncommon to be found in extraction sockets/

Answer 35

False, Not uncommon in extraction sockets - epulis granulomatosa

Question 36

Histologic features of Pyogenic granuloma

Answer 36

Hyperplastic granulation tissue, fibroblasts with delicate collagen Endothelial cells + capillaries and dilated larger vessels

Question 37

Treatment for Pyogenic granuloma

Answer 37

Excision and removal of irritants | May recur

Question 38

Parulis "Gum Boil" description

Answer 38

Represents draining from a source of odontogenic infection of either pulpal or periodontal origin - Pus (purulence, suppuration) = Bacterial infection

Question 39

Define Localized Juvenile Spongiotic gingival hyperplasia

Answer 39

Localized hyperplasia presumably from externalized sulcular epithelium on gingiva

Question 40

At what age does LJ Spongiotic gingival hyperplasia occur?

Answer 40

Almost exclusively 1-2 decades

Question 41

What sex is Localized Juvenile Spongiotic gingival hyperplasia normally found in?

Answer 41

Female 2:1

Question 42

What location is Localized Juvenile Spongiotic gingival hyperplasia normally found?

Answer 42

Almost all anterior gingiva | Maxillary 5:1

Question 43

Clinical features of Localized Juvenile Spongiotic gingival hyperplasia

Answer 43

Red often papillary gingival lesions

Question 44

Histology features of Localized Juvenile Spongiotic gingival hyperplasia

Answer 44

Papillary proliferation of inflamed epithelium with intercellular edema (Spongiosis)

Question 45

Treatment of Localized Juvenile Spongiotic gingival hyperplasia

Answer 45

Excision

Question 46

Define Hemangioma

Answer 46

Overgrowth of blood vessels | - Hamartoma --> localized overgrowth of tissues native to the part, often developmental

Question 47

Clinical characteristics of Hemangioma

Answer 47

- Rapid proliferation of endothelial cells at birth or shortly thereafter, Characteristically involute - Reddish to purple mass lesions that tend to blanch with pressure - can occur in bone, often multilocular or soap bubble appearance (why you aspirate before bone biopsy) - Oral ones often later and don't involute

Question 48

Most common tumor of infancy

Answer 48

Hemangioma

Question 49

What gender is hemangioma more common?

Answer 49

Females 3:1

Question 50

What percent of hemangioma are found in the H&N?

Answer 50

60%

Question 51

What age is Hemangioma more common?

Answer 51

0-5 years rarely congenital 90% complete but slow involution by age 10

Question 52

Histologic features of Hemangioma

Answer 52

Endothelial cell proliferation with formation of small capillaries (capillary) or larger dilated vascular spaces (cavernous)

Question 53

Treatment of Hemangioma

Answer 53

Natural history is involution | Laser pulse, excision, sclerosing agents, steroids both intralesional and systemic propanolol

Question 54

Define Sturge-Weber Angiomatosis

Answer 54

Nonhereditary developmental, congenital condition characterized by vascular proliferation of brain and face usually along distribution of ophthalmic branch of the trigeminal nerve

Question 55

Clinical features of Sturge-Weber Angiomatosis

Answer 55

Large purplish lesions - identical clinically to port-wine stains. Ipsilateral oral mucosal involvement common Leptomingeal angiomas of cerebral cortex

Question 56

Define Lymphangiomas

Answer 56

Developmental overgrowth of lymphatic vessels

Question 57

What age are Lymphangiomas most common

Answer 57

0-5 years of age

Question 58

Where are lymphangiomas most commonly found

Answer 58

H&N | Orally --> Tongue (may produce macroglossia)

Question 59

Difference between Superficial and Deeper lymphangiomas

Answer 59

Superficial --> Pebbly surface covered by translucent vesicles Deeper --> More diffuse

Question 60

Cystic Hygroma

Answer 60

Variant of Lymphangiomas that infiltrates and becomes very large (>neck)

Question 61

Histologic features of Lymphangiomas

Answer 61

Proliferation of thin walled lymphatic vessels capillary sized Dilated (cavernous) or mystically dilated (cystic hygroma)

Question 62

Treatment of Lymphangiomas

Answer 62

Lesions dont involute Excision Deeper ones often recur Sclerosing agents