Class: Exam 2 Reactive Tumors Flashcards
Most common “tumor” of the oral cavity
fibroma
What is a Fibroma
A reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma
Where is the most common location for a fibroma?
the buccal mucosa along the bite line
*However, it occurs almost anywhere…
Name the clinical features of Fibromas
Usually sessile (immobile), Smooth surfaced, normal color, and Asymptomatic
Treatment of irritation fibroma
Treated by conservative surgical excision
Define Giant Cell Fibroma
A “papillary” fibrous tumor of connective tissue comparable to an irritation fibroma but not associated with chronic irritation.
What other lesion may a giant cell fibroma be clinically mistaken for?
A papilloma
What is the hallmark of a giant cell fibroma
Presence of numerous large, stellate fibroblasts within the superficial connective tissue.
Also, often bi or trinucleated fibroblasts.
Other than the major hallmark, what other feature/features distinguish giant cell fibromas from irritation fibromas
The lesion usually occurs a a younger age, usually diagnosed during the first 3 years of life. (a.ka. –>more in children)
Clinical features of giant cell fibroma?
Asymptomatic
Sessile (immobile) or pedunculate nodule
Less than 1 cm in size
Surface often appears papillary
What is the major location in which giant cell fibroma’s are found
Approx. 50% cases found on gingiva
Tongue also common site
Define Peripheral Ossifying Fibroma
Reactive fibroblastic lesion of PDL
Describe the location/s where peripheral ossifying fibromas may be found
Exclusively on the gingiva
Describe the clinical features of a Peripheral Ossifying fibroma
Asymptomatic Sessile or Pedunculated mass (usually emanates from interdental papilla) Color: red to pink Sometimes ulcerated Most are less than 2 cm in size
What age is common for peripheral ossifying fibroma
1-3 decades
predominantly a lesion of teenagers and young adults with peak prevalence between 10-19 yrs.
Histologic features of peripheral ossifying fibromas
Cellular fibroblastic lesion with bone and/or cementum and/or dystrophic calcification
Treatment for peripheral ossifying fibromas
Excision including superficial PDL
Submission of specimen for exam (biopsy)
Recurrence rate of 15-20% –> Highest of any reactive gingival lesions
Define Inflammatory Fibrous Hyperplasia (Epulis Fissuratum)
Reactive folds of hyper plastic fibrous connective tissue along border of ill-fitting, over extended denture
Histologic features of Epulis Fissuratum
Fibrous hyperplasia +- inflammation
Treatment of Epulis Fissuratum
Excision and remake/reline denture
Define Inflammatory Papillary Hyperplasia (Papillomatosis)
Reactive tissue growth of hyper plastic palatal mucosa usually developing beneath a denture.
Histologic features of Inflammatory Papillary Hyperplasia
Papillary Hyperplasia +- Inflammation +- Pseudoepitheliomatous Hyperplasia (PEH)
Treatment options for Inflammatory Papillary Hyperplasia
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.
Define Peripheral Giant Cell Granuloma
Tumor of well vascularized fibrous connective tissue containing numerous multinucleated giant cells
Where does Peripheral Giant Cell Granuloma occur?
Occurs exclusively on the gingiva or edentulous alveolar ridge
Clinical features of Peripheral Giant Cell Granuloma
Reddish-brown-purple-blue color Pedunculate or sessile mass Asymptomatic Any age Female:male --> 2:1
Pyogenic granulomas and Peripheral giant cell granulomas are similar but can be distinguished by color. What color denotes which?
Peripheral GC Granuloma –> Blue-Purple
Pyogenic granuloma –> Bright red
Does the Peripheral Giant Cell Granuloma only occur on soft tissue?
It develops within the soft tissue but may produce cupping respiration of underlying bone.
Treatment of Peripheral Giant Cell Granuloma
Excision and removal of irritants, may recur
Define Pyogenic Granuloma
Reactive lesion representing hyperplasia of body’s basic reparative tissue - granulation tissue
- thought to represent an exuberant tissue response to local irritation or trauma
Clinical Features of Pyogenic Granuloma
Reddish
Ulcerated
Pedunculate or sessile mass
Asymptomatic but may bleed easily
Where is a pyogenic granuloma most likely to occur?
75% of cases on gingiva
Can occur anywhere including the skin
What age is a pyogenic granuloma most common?
2-4 decades
- Children and young adults
What sex is pyogenic granulomas most common?
Females, often in pregnancy “pregnancy tumor”
True or False, pyogenic granuloma are uncommon to be found in extraction sockets/
False, Not uncommon in extraction sockets - epulis granulomatosa
Histologic features of Pyogenic granuloma
Hyperplastic granulation tissue, fibroblasts with delicate collagen
Endothelial cells + capillaries and dilated larger vessels
Treatment for Pyogenic granuloma
Excision and removal of irritants
May recur
Parulis “Gum Boil” description
Represents draining from a source of odontogenic infection of either pulpal or periodontal origin
- Pus (purulence, suppuration) = Bacterial infection
Define Localized Juvenile Spongiotic gingival hyperplasia
Localized hyperplasia presumably from externalized sulcular epithelium on gingiva
At what age does LJ Spongiotic gingival hyperplasia occur?
Almost exclusively 1-2 decades
What sex is Localized Juvenile Spongiotic gingival hyperplasia normally found in?
Female 2:1
What location is Localized Juvenile Spongiotic gingival hyperplasia normally found?
Almost all anterior gingiva
Maxillary 5:1
Clinical features of Localized Juvenile Spongiotic gingival hyperplasia
Red often papillary gingival lesions
Histology features of Localized Juvenile Spongiotic gingival hyperplasia
Papillary proliferation of inflamed epithelium with intercellular edema (Spongiosis)
Treatment of Localized Juvenile Spongiotic gingival hyperplasia
Excision
Define Hemangioma
Overgrowth of blood vessels
- Hamartoma –> localized overgrowth of tissues native to the part, often developmental
Clinical characteristics of Hemangioma
- 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
Most common tumor of infancy
Hemangioma
What gender is hemangioma more common?
Females 3:1
What percent of hemangioma are found in the H&N?
60%
What age is Hemangioma more common?
0-5 years
rarely congenital
90% complete but slow involution by age 10
Histologic features of Hemangioma
Endothelial cell proliferation with formation of small capillaries (capillary) or larger dilated vascular spaces (cavernous)
Treatment of Hemangioma
Natural history is involution
Laser pulse, excision, sclerosing agents, steroids both intralesional and systemic propanolol
Define Sturge-Weber Angiomatosis
Nonhereditary developmental, congenital condition characterized by vascular proliferation of brain and face usually along distribution of ophthalmic branch of the trigeminal nerve
Clinical features of Sturge-Weber Angiomatosis
Large purplish lesions - identical clinically to port-wine stains.
Ipsilateral oral mucosal involvement common
Leptomingeal angiomas of cerebral cortex
Define Lymphangiomas
Developmental overgrowth of lymphatic vessels
What age are Lymphangiomas most common
0-5 years of age
Where are lymphangiomas most commonly found
H&N
Orally –> Tongue (may produce macroglossia)
Difference between Superficial and Deeper lymphangiomas
Superficial –> Pebbly surface covered by translucent vesicles
Deeper –> More diffuse
Cystic Hygroma
Variant of Lymphangiomas that infiltrates and becomes very large (>neck)
Histologic features of Lymphangiomas
Proliferation of thin walled lymphatic vessels capillary sized
Dilated (cavernous) or mystically dilated (cystic hygroma)
Treatment of Lymphangiomas
Lesions dont involute
Excision
Deeper ones often recur
Sclerosing agents
