Exam 2 Flashcards
1
Q
Fibroma
A
- Hyperplasia of fibrous connective tissue
- most common tumor of the oral mucosa
- CT neoplasm (mesenchymal)
- usually sessile, smooth surfaced, normal color, asymptomatic
- ↑↑ cheek (buccal mucosa) but occurs almost anywhere
- usually sessile-the attachment of the tumor is the same size as the base of the tumor. Sometimes grow on a stalk or a pedicle, called pedunculated. Grow slowly but most of them stop
- Tx: surgical excision. Almost no regrowth potential
2
Q
Giant Cell Fibroma
A
- “papillary” tumor of fibrous connective tissue containing plump, stellate and often bi or trinucleated fibroblasts. Fibroblasts are exceedingly large and multinucleated
- ↑ children (most fibromas are in older adults)
- ↑↑ gingiva, ↑ tongue
- often confused clinically with papillomas
- look pebble like
3
Q
Peripheral odontogenic (ossifying) fibroma
A
- Reactive fibroblastic lesion of PDL (exclusively on the gingiva since come from PDL
- Strong predilection kids and young adults (more common in females), anterior regions
- ↑↑ 1-3 decades, occurs only on gingiva, asymptomatic; pedunculated or sessile mass ± red ± ulceration
- Histology: Cellular fibroblastic lesion with bone and/or cementum and/or dystrophic calcification
- Treatment: Excision including superficial PDL
- recurrence rate 15-20%, highest recurrence of any of the reactive gingival lesions
4
Q
Inflammatory Fibrous Hyperplasia (Epulis Fissuratum)
A
- Reactive folds of hyperplastic fibrous connective tissue along border of ill-fitting, over extend denture
- clinically called epilatus fissuratum, pathologically: inflammatory fibrous hyperplasia. Flabby folds
- Histology: Fibrous hyperplasia ± inflammation
- Treatment: Excision and remake/reline denture
5
Q
Inflammatory Papillary Hyperplasia (Papillomatosis)
A
- Hyperplastic response of palatal mucosa to ill-fitting denture
- Histology: Papillary hyperplasia + inflammation ± pseudoepitheliomatous (looks like cancer) Hyperplasia (PEH)
- Treatment: Excise + remake/reline denture
6
Q
Peripheral Giant Cell Granuloma
A
- Tumor of well vascularized fibrous connective tissue containing numerous multinucleated giant cells
- questionable histogenesis but occurs only on gingiva (↑ anterior) got to be over bone
- any age, asymptomatic
- usually reddish-brown-purple pedunculated or sessile mass
- peripheral ones are about 5x as common as central ones
- female:male; 2:1
- may produce cupping resorption of underlying bone (especially in edentulous areas)
- Treatment: Excision and removal of irritants, may recur
7
Q
Pyogenic Granuloma
A
- Pyo – pus genic – produces (misnomer) Do Not Have Pus
- reactive lesion representing hyperplasia of body’s basic reparative tissue –granulation tissue (lots of blood vessels, highly vascularized)
- reddish, ulcerated pedunculated or sessile mass
- ↑ 2-4 decades, ↑↑ gingiva but occurs anywhere including skin
- Asymptomatic but may bleed easily
- ↑ females, often in pregnancy “pregnancy tumor” bc when you are pregnant you develop more blood vessels to support another persons
- The angiogenic effect of pregnancy not uncommon in extraction sockets – epulis granulomatosa
- Histology: Hyperplastic granulation tissue, fibroblasts with delicate collagen, endothelial cells + capillaries and dilated larger vessels
- Treatment: Excision and removal of irritants, may recur
8
Q
Parulis (“gum boil”)
A
- Can occur anywhere but on gingiva, it represents draining from a source of odontogenic infection of either pulpal or periodontal origin
- pus (purulence, suppuration) = bacterial infection
- A sinus tract draining an odontogenic infection
9
Q
Localized juvenile spongiotic gingival hyperplasia
A
- Localized hyperplasia presumably from externalized sulcular epithelium on gingiva
- Developmentally some people are born with this epithelium exteriorized (on the gingiva) and if it gets irritated, this can develop.
- Almost exclusively 1-2 decades (children and teens), female 2:1,
- Almost all anterior gingiva, Max 5:1,
- Clinical: red often papillary gingival lesions
- Histology: Papillary proliferation of inflamed epithelium with intercellular edema (spongiosis)
- Very superficial and vascular
- Treatment: Excision
10
Q
Hemangioma
A
- Overgrowth of blood vessels (hamartoma – localized overgrowth of tissues native to the part, often developmental)
- rapid proliferation of endothelial cells at birth or shortly thereafter, characteristically involute most common tumor of infancy (5-10% incidence)
- ↑ females 3:1
- 60% H&N
- ↑↑↑ 0-5 years, rarely congenital, 90% complete but slow involution by age 10
- reddish to purple mass lesions that tend to blanch with pressure
- oral ones often later and don’t involute
- can occur in bone, often multilocular or soap bubble appearance (why you aspirate before bone biopsy)
- Histology: Endothelial cell proliferation with formation of small capillaries (capillary) or larger dilated vascular spaces (cavernous)
- Treatment: Natural history is involution laser pulse, excision, sclerosing agents, steroids both intralesional and systemic propranolol
- If traumatize, they will bleed very easily
- They can calcify
11
Q
Sturge-Weber Angiomatosis (Encephalotrigeminal angiomatosis)
A
- Nonhereditary developmental, congenital condition characterized by vascular proliferation of brain and face usually along distribution of ophthalmic branch of the trigeminal nerve. Stop at the midline
- Sturge-Weber and port wine stains are due to somatic activation mutation in GNAQ which encodes Gαq, a member of the q class of G-protein alpha subunits that mediates signals between G-protein–coupled receptors and downstream effectors. The difference is when and where the mutation occurs
- Large purplish lesions –identical clinically to port-wine stains, ipsilateral oral mucosal involvement common leptomingeal angiomas of cerebral cortex
12
Q
Lymphangiomas
A
- Developmental overgrowth of lymphatic vessels
- ↑↑ H&N, ↑↑ 0-5 years of age
- Orally: ↑↑ tongue (may produce macroglossia)
- Full of lymph, not blood
Superficial ones – pebbly surface covered by translucent vesicles
Deeper ones – more diffuse
Cystic hygroma: variant that infiltrates and becomes very large (↑ neck)
- Histology: Proliferation of thin walled lymphatic vessels capillary sized, Dilated (cavernous) or cystically dilated (cystic hygroma)
- Treatment: Lesions don’t involute; excision-deeper ones often recur; sclerosing agents
13
Q
Human Papilloma Virus (HPV) etiology
A
- Benign epithelial neoplasm
- All are papillary or verrucous growths.
- Papilloma: exophytic (grow outward into air (path of least resistance), often pedunculated, pink to white, most common site: soft palate.
- Verruca vulgaris (common wart): usually HPV2, similar to papilloma. Many patients have verruca on hands. Kids stick warty fingers in mouth-spread
- Condyloma Acuminatum“venereal warts” usually HPV 6/11, often multiple, less exophytic than papillomas. Flatter, more sessile
14
Q
Keratoacanthoma (KA)
A
- benign epithelial neoplasm
- Clinical and histological features similar to skin cancer (squamous cell carcinoma), considered reactive, not neoplastic.
- Sun exposed areas of head and neck, ↑ older patients, 10% on lips/have been reported intraorally. Rapid growth, often umbilicated with rolled borders
- Natural history: Involution and healing.
15
Q
mesenchymal neoplasms
A
most look identical clinically and present as asymptomatic, slowly growing submucosal masses (fibrous, bone/cartilage, fat & vascular)
16
Q
Lipoma
A
- CT neoplasm (mesenchymal)
- Benign neoplasm of fat, may appear yellowish, very common in skin, less so orally
- Grow slowly, painless.
- Floats if biopsy
17
Q
Verruciform xanthoma
A
- CT neoplasm (mesenchymal)
- Reactive lesion with predilection for hard palate or gingiva.
- Most common orally but reported on skin and genitals
- Surface irregular (verrucous, “verruciform”)
- Pink to white
- Histology: Epithelium displays papillary hyperplasia. Connective tissue papillae contain phagocytic cells which have engulfed lipid (xanthoma cells)
18
Q
Leiomyoma (angioleiomyoma-blood inside lumen) (vascular leiomyoma)
A
- Benign neoplasm of smooth muscle (mesenchymal)
- Common in uterus (“fibroids”), rare orally, most normal color, can be reddish to purple
19
Q
Rhabdomyoma
A
- Benign neoplasm of skeletal muscle,↑ heart, rare orally, ↑ tongue
- To us will look benign and mesenchymal
