Connective Tissue Lesions of the Oral Region Flashcards
Define Tumor
Swellings
Benign vs. Malignant
Benign ends in -oma and can’t metastasize or kill the host.
Hypertrophy vs. Hyperplasia
-trophy is an increase in cell size while -plasia is an increase in cell number.
What is the difference between a hyperplasia and a neoplasm?
A hyperplasia will get to a stage where it will stop growing. A neoplasm never stops growth.
Other names for Irritation Fibroma.
Traumatic Fibroma, Focal Fibrous Hyperplasia.
Irritation Fibroma
Most common hyperplastic growth of the oral cavity. Results from long-standing irritation. Akin to a scar. Ex: you bite your tongue.
Irritation Fibroma Clinical Appearance
Firm, pale, elevated nodular mass. Tongue and buccal mucosa are the most common locations. Lesion may be ulcerated (most likely through biting) and become painful. Low grade chronic inflammation is the cause.
Irritation Fibroma Histopathology
Covered with normal epithelium, it is the CT that is hyperplastic. The bulk of the lesion is composed of hyperplastic collagen. May be proliferation of endothelial cells, fibroblasts and vascular channels.
Stellate giant cells may predominate and is called a giant cell fibroma. This has no meaning clinically.
Irritation Fibroma Treatment and Prognosis
Surgical excision is curative and recurrence is uncommon.
Peripheral Ossifying Fibroma General Features.
A form of reactive hyperplasia exclusive to the gingiva. Associated with long-term irritation and often contains bone. Arises from the PDL or periosteum. Origin may explain more aggressive behavior. Appears as a gingival nodule. Bump on the gum. Occurs most often in women.
Peripheral Ossifying Fibroma Clinical Features.
Bump on the gum. Can be hemorrhagic and vascular or very dense, it depends on what stage it is in.
Peripheral Ossifying Fibroma Histopathology.
Covered with epithelium that may be ulcerated. Lesion is composed of fibrous CT. Reactive bone fragments are present in 70% of cases. Fibroblasts have switched to producing bone. Epithelial Odontogenic rests may be present.
Peripheral Ossifying Fibroma Treatment and Prognossis
Surgical excision. Must include the PDL base. If it has extended into the PDL and has destroyed alveolar bone it is very important to get the entire lesion out or it will keep growing. Recurrence is often in the 15% range. No malignant potential but can be destructive locally.
Peripheral Giant Cell Granuloma General features.
Occurs exclusively on the gingiva at any age. Most common in the mandible. May arise from the PDL. Periapical radiograph may show a saucerized radiolucency.
Peripheral Giant Cell Granuloma Clinical Features
Appears as a bump on the gum, or gingival nodule that is dome shaped. May resemble the common pyogenic granuloma.
Peripheral Giant Cell Granuloma Histopathology
Vascular CT stroma. Filled with foreign body type giant cells. Hemosiderin may be prominent. The histology is not specific. Looks similar to brown tumor or hyperparathyroidism, cherubism or Central Giant Cell Granuloma.
Peripheral Giant Cell Granuloma Treatment and Prognosis
Surgical excision. Steroid injections may reduce size of large lesions. PDL involvement explains recurrence rates of 12-20%. The recurrent lesions may require extraction of associated teeth.
What is another name for Inflammatory Fibrous Hyperplasia?
Epulis Fissuratum.
Inflammatory Fibrous Hyperplasia General Fetures
Proliferation of fibrous CT associated with long-standing Irritation. Most commonly comes from an ill-fitting denture flange in either MX or MN dentures.
Inflammatory Fibrous Hyperplasia Clinical Features
Appear as hyperplastic folds around denture flange. Folds appear as flabby, soft, freely moveable tissues.
Inflammatory Fibrous Hyperplasia Histopathology
The hyperplastic growth will be covered with epithelium that may be ulcerated. Epithelium may be acanthotic (thickened). Inflamed fibrous CT is common.
Inflammatory Fibrous Hyperplasia Treatment and Prognosis
Large lesions may need to be excised. Small ones may respond to denture rebasing, but the most successful treatment is excision.
Inflammatory Papillary Hyperplasia General Features
Most often (but not all the time) associated with ill-fitting maxillary dentures. Occurs on the palate 90% of the time. Needs to be differentiated from verrucous carcinoma, an epithelial malignancy.
Inflammatory Papillary Hyperplasia Clinical Features
Appears as many small, usually red, papillary nodules of the hard palate, giving it a “cobblestone” appearance. Also described as a cauliflower appearance.
Inflammatory Papillary Hyperplasia Histopathology
Papillary nodules covered with epithelium and cores consist for fibrous CT often with chronic inflammation.
Inflammatory Papillary Hyperplasia treatment and Prognosis
Surgical excision, electrocautery and laser surgery. Lesion has no malignant potential….unless you have misdiagnosed and it is actually verrucous carcinoma….
What is another name for Hyperplastic Gingivitis?
Generalized Fibrous Hyperplasia.
Hyperplastic Ginvitis General and Clinical Features
A form of gingivitis in which the gingival tissue becomes overgrown and redundant. It is diffuse. Can be associated with puberty or pregnancy. Gingiva appears inflamed and enlarged. Often confused with routine periodontal disease.
Hyperplastic Gingivitis Histopathology
The hyperplastic tissue will be covered with keratinized stratified squamous epithelium (masticatory mucosa) with underlying inflamed fibrous CT.
Hyperplastic Gingivitis Treatment and Prognosis
Usually resolves after a scaling. May persist through out puberty or pregnancy. Some gingival contouring may be necessary.
Hereditary Gingival Fibromatosis General Features
A rare generalized gingival hyperplasia that can be idiopathic or familial. Autosomal dominant or autosomal recessive inheritance may be evident.
Slowly progressive gingival enlargement restricted to fibroblasts.
May be associated with hypertelorism, epilepsy, mental retardation, hypertrichosis when it is familial.
Hereditary Gingival Fibromatosis Clinical Features.
Can be firmer and less hemorrhagic than Hyperplastic Gingivitis. Enlarged gingiva may cover the teeth. Starts at puberty and can interfere with tooth eruption. Key to diagnosis is a good history, you can’t tell this apart from other gingival disorders.
Hereditary Gingival Fibromatosis Histopathology
Covered with stratified squamous keratinizing mucosa. Supported by dense collagen. Proliferating fibroblasts and inflammation are common.
Hereditary Gingival Fibromatosis Treatment and Prognosis
Scaling and root planning or gingivectomy. Recurs about 40% of the time. Oral hygiene is usually not a recurrence factor.
Drug-Induced Gingival Hyperplasia General and Features
Fibrous gingival hyperplasia in response to medications. Once called Dilantin Hyperplasia, but other medicines such as cyclosporine (immunosuppressant), nifedipine (a calcium channel blocker), Carbamazepine, anticonvulsants, oral contraceptives, erythromycin.
Drug-Induced Gingival Hyperplasia Clinical features.
May cause pseudopockets around teeth. Interdental papilla enlargement.
Drug-Induced Gingival Hyperplasia Histopathology
Overlying epithelium may show elongated rete ridges. Dense collagen with widely-spaced fibroblasts will characterize the CT. Some inflammation may be present.
Drug-Induced Gingival Hyperplasia treatment and prognosis
Gingivectomy and gingivoplasty are the usual treatment. Recurrence common with continuance of medication. Plaque and calculus may exacerbate hyperplasia. Good hygiene may retard recurrences.
Indeterminate Fibrous CT proliferations
Desmoplastic Fibroma, Nodular Fasciitis, Benign Fibrous Histiocytoma.
The lesions are all thought to be intermediate between reactive and malignant growths. They can be proliferative destructive fibrous growths.
Desmoplastic Fibroma of the bone
OCCURS IN THE MANDIBLE OF YOUNG PATIENTS. Average age is 14 years. Benign infiltrative fibrous proliferation. Lesion composed of dense collagen. Quite aggressive. May require mandibular resection. 25% recurrence rate. Can occur in the soft tissue. Caused by mutations in the CTTNB1 gene which encodes for beta-catenin.
Nodular Fasciitis
Fibrous CT that just keeps growing. Pseudosarcomatous fasciitis. Affects the oral mucosa as a polypoid growth and resembles a sarcoma microscopically. Spindle cell proliferation and 20% recurrence rate.
Benign Fibrous Histiocytoma
Combined fibrous and histiocyte proliferation. May occur in soft tissue or bone. Appear as nodular swellings or radiolucencies.
Benign Fibrous Histiocytoma Microscopic findings, treatment and Prognosis
Storiform or cartwheel accumulation of histiocytes. Wide excision is necessary. 20% recurrence rates are common.
Fibrosarcoma General Features
Rare collagen associated cancer. Malignant neoplasm of fibroblasts. Affects both soft tissue and bone, with a higher incidence in soft tissue.
Fibrosarcoma Clinical Features
Often associated with pain, paresthesia, bleeding. In the bone, root resorption, tooth displacement, cortex expansion and cortical erosion are common.
Fibrosarcoma Histopathology
Highly cellular tumor composed of atypical fibroblasts. Show a “herringbone” pattern with marked cytologic atypia.
Fibrosarcoma Treatment and Prognosis
Surgery, radiation therapy and chemotherapy. Poor prognosis. Death usually occurs in 5 to 7 years where survival rates range from 40-60%.
Neural Tissue Tumors General Features
Oral nerve tumors are relatively common. Some are hyperplasias, others are true neoplasms. Most arise from proliferation of nerve sheath cells.
Neural Tissue Tumors Classifications
Hyperplasias
Hamartomas
Benign Neoplasms
Malignant Neoplasms
Traumatic Neuroma General Features
Hyperplasia. Not a true neoplasm. Painful. Proliferation of nerve tissue after nerve injury or transection. Nerve displacement may prevent nerve sheaths from reuniting.
Traumatic Neuroma Clinical Features
Nerve sheath cells proliferate producing a painful submucosal mass.
Appears as a painful nodular growth.
Mental nerve, the tongue, and the lower lip are the most common sites.
Traumatic Neuroma Histopathology
Proliferation of axis cylinders, schwann cells and perineural fibroblasts. Appear as jumbled mixture of these hyperplastic elements. Cause continuous communication.
Traumatic Neuroma Treatment and Prognosis
Surgical excision. Only successful 6/10 times. Recurrence is uncommon.