Connective Tissue Lesions (fibrous) Flashcards
Reactive conditions are derived from ___ cells and are represented by fibrous hyperplasia or exuberant proliferations of granulation tissue
Mesenchymal
Reactive conditions are derived from ___ cells and are represented by fibrous hyperplasia or exuberant proliferations of granulation tissue
Mesenchymal
____ hyperplasias comprise a group of fibrous connective tissue lesion that commonly occur in the oral mucosa secondary to injury
Reactive
A reactive hyperplastic mass that occurs on the gingiva and is believed to be derived from connective tissue of the submucosa or PDL
Peripheral fibroma
Any age
Males > females
Gingiva anterior to to permanent molars is most often affected
Peripheral fibroma
Presents clinically as a stalk (pedunculated) or a broad-based (sessile) mass that is similar in color to surrounding connective tissue
Peripheral fibroma
Hyperplastic scar
Highly collagenous and relatively avascular. Contains mild to moderate chronic inflammatory cell infiltrate
Peripheral fibroma
Gingival counterpart of peripheral fibroma
Traumatic fibroma (oral mucosa)
A subtype of peripheral fibroma that is a gingival mass in which islands of women (immature)bone and osteoid are seen.
Peripheral ossifying fibroma
A subtype of peripheral fibroma that is a gingival mass composed of well-vascularized, non encapsulated fibrous connective tissue.
Strands of odontogenic epithelium are often abundant
Amorphous hard tissue resembling tertiary dentin
Peripheral odontogenic fibroma
A subtype of peripheral fibroma that is a fibrous hyperplasia in which many of the mesenchymal cells are relatively larger than normal fibroblasts and assumes a stellate shape
Giant cell fibroma
DD of peripheral fibroma
Peirpheral giant cell granuloma
Pyogenic granuloma
Treatment of peripheral fibroma
Local excision, which should include the PDL
Reactive lesion usually caused by chronic trauma to oral mucous membrane
Overexuberant fibrous connective tissue repair results in a clinically evident submucosal mass
These are misnomers because there lesions are not benign tumor of fibroblasts
Focal fibrous hyperplasia
No gender and racial predilection
Very common reactive hyperplasia - typically found in buccal mucosa, lateral border of the tongue, and lower lip.
Painless, broad-based swelling that is pale in color, due to lack of vascular channels
Focal fibrous hyperplasia
These lesion have limited growth potential and do not exceed by 1-2 cm in diameter
Focal fibrous hyperplasia
If multiple focal fibrous hyperplasia, what are the syndrome that is commonly associated with?
Cowden’s syndrome or multiple hamartoma syndrome
Organ system associated with focal fibrous hyperplasia
Skin
Breast
Mucosa
Throid
Colon
Frequently encountered abnormalities in focal fibrous hyperplasia
Numerous fibromas and papillomas:
Cutaneous papules
Keratosses
Trichilemmomas
Benign and malignant neoplasms of the breast and thyroid
Colonic polyps
Underlying genetic problem appears to be related to germline mutation of the tumor suppressor gene in focal fibrous hyperplasia
PTEN found on chromosome 10q23
Histopath of focal fibrous hyperplasia
Collagen overproduction
Hyperkeratotic epithelium
DD of focal fibrous hyperplasia
IF TONGUE
Neurofibroma
Schwannoma
Granular cell tumor
LOWER LIP AND BUCCAL MUCOSA
Lipoma
Mucocele
Salivary gland tumor
Treatment of focal fibrous hypeplasia
Simple surgical excision
Benign proliferation of spindle cells of disrupted but probable Fibroblastic origin
Was first described as a tumor of the pleura
Buccal mucosa
Solitary fibrous tumor
Rare case of these lesion cause hyperglycemia due to tumor production of insulin like growth factors
Solitary fibrous tumor
Pattern less proliferation of spindle cells
Solitary fibrous tumor
IHC of solitary fibrous tumor
STAT-6 - 100%
CD34 - 90-95%
CD99. - 70%
Bcl-2. - 20-25%
Factor XIIIa- positive cells may be found
Treatment for solitary fibrous tumor
Surgical excision
Oral Fibroblastic proliferations
Very common oral lesions
Uncommon to rare tumor
Rare oral tumor
VCOL - fibrous hyperplasia
UTRT - solitary fibrous tumor, myofibroma, benign fibrous histiocytoma
ROT - Nodular fasciitis, fibromatosis, fibrosarcoma, malignant fibrous histiocytoma
Gene associated with solitary fibrous tumor
NAB2-STAT6 gene
What are the reactive hyperplasias? (PPT NI DOC)
Pyogenic granuloma
Peripheral giant cell granuloma
Peripheral fibroma
Focal fibrous hyperplasia
Location: gingiva
Color: red lesions
Histopath: high vasularity, fibroblastic
Pyogenic granuloma
Periapical giant cell granuloma
Color: same with gingival/surrounding tisues
Histopath: avascular, fibroblastic
Peripheral fibroma
Focal fibrous hyperplasia
Hyperplastic granulation tissue predominantly on the gingiva
Pyogenic granuloma
Exuberant connective tissue proliferation to a known stimulus or injury
Pyogenic granuloma
Appears as red mass because it is composed of hyperplastic granulation tissue in which capillaries are very prominent
Pyogenic granuloma
2nd decade of life
Commonly seen on the attached gingiva
Tongue, lower lip, buccal mucosa are most common
Pyogenic granuloma
Histopath of pyogenic granuloma
Lobular mass of hyperplastic granulation tissue
Vascularization
Neutrophils, ulceration ay be present
DD of pyogrnic granuloma
Peirpheral GCG
Peripheral dontogenic fibroma
Peripheral ossifying fiboma
Kasposi sarcoma
Metastatic cancer
Treatment of pyogenic granuloma
Surgical excision
Removal of local etiologic factor
Reactive localized proliferation of mononuclear cels and osteoclasts (multinucleated giant cells) in a vascular stroma located in the soft tissue soft gingiva or alveolar ridge mucosa
Peripheral giant cell granuloma
Scattered fibrblasts are the basic element
Non0functional osteoclast like multinucleated giant cells
Peripheral giant cell granuloma
Essential diagnostic criteria of peripheral giant cell granuloma
Located on gingiva/alveolar ridge
cellular mononuclear stroma clustered osteoclasts
Hermorrhage
No origin from underlying intraosseous giant cell granuloma
DD of peripheral giant cell granuloma
Pyogenic granuloma
Bone resorption in PGCG than PG
Treatment for PGCG
Surgical excision m underlying bone may be reduced to minimize recurrence
Removal of local etiologic factors
IHC for nerve sheath tumor
S-100
Neurofilament
IHC for myofibroma
Muscle actin
IHC for leiomyoma/saarcoma
Muscle actin
Desmin
Rhabdomyoma/sarcoma
Muscle actin
Desmin
IHC for fibrous histiocytoma and malignant counterpart
All negative
IHC for solitary fibrous tumor
CD34
CD99
IHC for kaposi sarcoma
CD31
Tumor is also positive for HHV-8
Most common soft tissue sarcoma
Fibrosarcoma
Considered now as rare malignant spindle cell tumor represented a range of spindle cell malignancies
Fibrosarcoma
Soft tissue and bone malignancy of the head and neck
Proloferstion of malignant mesencymal cells
Secondary ulceration
Young adults are commonly affected
Fibrosarcoma
exhibits malignant-appearing fibroblasts, typically in a herringbone or interlacing fascicular pattern
Collagen may be sparse, and mitotic figures frequent.
Atypical spindle cells
Fibrosarcoma
5 year survival rate: 30-50%
Fibrosarcoma
