Connective Tissue Lesions Flashcards
Fibroma
Most common “tumor” of the oral cavity
Reactive hyperplasia of fibrous connective tissue
Most common in buccal mucosa, along bite line
sessile, smooth, pink nodule
Occurs most commonly in areas susceptible to trauma
Inflammatory fibrous hyperplasia (Epulis Fissuratum)
Tumor-like hyperplasia of fibrous connective tissue due to ill-fitting denture
75% of cases seen in women
Can affect both maxilla and mandible
Especially anterior region
Single or multiple fold of hyperplastic tissure on the alveolar
Gingival Fibromatosis
SOSI gene (HGFI gene) - SOSI protein - collagen overgrowth
Enlargement begins before age 20 and correlates w/ teeth eruption
Growth is more frequent in maxilla and can be localized or generalized
Drug-related gingiva hyperplasia
Abnormal growth of tissue secondary to medications
Phenytoin, Cyclosporine, nifedipine
After 1-3 months, enlargement originate in dental papilla
Growth can cover a portion (or all) of the crowns of several teeth
Degree of enlargement related to susceptibility and hygiene
Nasopharyngeal Angiofibroma
Vascular and fibrous Tumor-like lesion
Almost exclusive in adolescent males
Nasal obstruction and epitaxis
Locally destructive and aggressive
Anterior bowing of the posterior wall of the maxillary sinus
Fibrosarcoma
Very common in cats and dogs
About 10% occur in head and neck
Surgical excision 40 - 70% survival rates
Benign Fibrous Histiocytoma
Usually seen in skin of extremities (aka dermatofibroma)
Oral lesions: buccal mucosa and vestibule
Factor XIIIa and CD68
Malignant Fibrous Histiocytoma
Expanding mass (may be painful and/or ulcerated)
Surgical excision (40% recurrence)
Survival rates worse for oral lesions
Lipoma
Most cases seen on trunk and extremeties
50% of cases seen in buccal mucosa buccal vestibule
Yellow/pink, painless, sessile nodule
Liposarcoma
Malignant tumor of fat
20% of all sarcomas
neck, tongue, cheek
Lymphangioma
Benign growth of lymphatic vessels (malformation?)
50-70% of all cases seen in the head and neck
Cystic hygroma (cystic lymphangioma)
Lymphangioma
Oral lesions: usually in anterior of tongue, causing macroglossia
Angiosarcoma
50% in head and neck (scalp/forhead)
Early lesions resemble bruise
Traumatic Neuroma
Reactive proliferation of neural tissue after transection
Seen in middle-aged adults
Slighly more common in females
Smooth surfaced, non-ulcerated nodule
History of trauma (eg. extraction) sometimes seen
Pain in 25% of cases, especially if area of mental nerve
Abundant nerve tissue and collagen in haphazard arrangement
Traumatic Neuroma
Traumatic Neuroma
Granulae Cell Tumor
Abrikossoff’s Tumor
Schwann cell
2:1 female predilection 4th-6th decades (rare in children)
Asymtomatic, pink/yellow sessile nodule which is <2cm in size
About 30 - 50% occur in tongue, especially dorsal surface
Large, polygonal cells with abundant granular cytoplasm
Schwannoma (Neurilemmoma)
Schwann Cell
50% seen in the head and neck
Tongue most common intra oral location
Slow-growing, solitary, encapsulated
Neurofibroma
Slow-growing, soft, painless lesion varying in size
Surgical excision
Evaluate for neurofibromatosis
Neurofibromatosis
von Recklinghausen’s disease of the skin
However, about 50% of the cases are new mutations
Tumor supressor protein - Neurofibromin (NF1) gene
Multiple neurofibromas, cafe au lait macules, Crowe’s sign (axillary freckling), Lisch nodules (pigmented spots on iris)
cafe au lait macules
Crowe’s sign ( axillary freckling)
Lisch nodules (pigmented spots on iris)
Malignant Peripheral Nerve Sheath Tumor
50% develop in the context of NF
Malignant Peripheral Nerve Sheath Tumor
10-15% in head neck
Oral: mandible, lips, buccal mucosa
Leiomyoma
Most commonly seen in the uterus
Leiomyoma
80% of oral leiomyomas are seen in the following locations: palate, cheek, tongue, lips
Pink/bluish, firm, slow-growing mucosal nodule
Leiomyosarcoma
Radical excision
Radiotherapy, chemotherapy
Rhabdomyoma
Adult - 70% men, middle aged/older, pharynx, larynx, mouth
Fetal - male predilection, young children, face periauricular
Rhabdomyosarma
60% of all childhood sarcomas
Usually in first decade of life
Head and neck most common site
Orbit is a very common location - sudden and rapidly progressive proptosis
Connective tissue - In conclusion
All mesenchymal tissues can give rise to lesions
Benign and malignant
Biopsy to achieve final disgnosis
Surgical excision often required
