Fibrous CT Proliferations

Question 1

what is the MOST COMMON hyperplastic growth of the oral cavity?

Answer 1

irritation fibroma

Question 2

how do irritation fibromas form?

Answer 2

chronic irritation (chronic low grade inflammation)

Question 3

what is the most common location of an irritation fibroma?

Answer 3

lateral borders of tongue & buccal mucosa (cheek)

Question 4

how to you treat irritation fibromas?

Answer 4

excision (recurrence is rare)

Question 5

when an irritation fibroma presents on the gingiva (INTERDETNAL PAPILLA) what is it called?

Answer 5

peripheral ossifying fibroma

Question 6

do irritation fibromas involve bone?

Answer 6

NO (they are extraosseous)

Question 7

do peripheral ossifying fibromas involve bone?

Answer 7

YES (has focal areas of bone)

Question 8

histological features of irritation fibromas

Answer 8

fibroblasts and extensive COLLAGEN resembling scar like tissue

Question 9

what is the histological variant of irritation fibromas with lots of STELLATE GIANT CELLS called?

Answer 9

giant cell fibromas

Question 10

are irritation fibromas common in children or elderly?

Answer 10

NO

Question 11

where do peripheral ossifying fibromas arise from?

Answer 11

PDL or periosteum

Question 12

what group of people are peripheral ossifying fibromas are more common among?

Answer 12

WOMEN (20-30 y/o)

Question 13

how do you treat peripheral ossifying fibromas?

Answer 13

excision, MUST include PDL BASE (i.e. needs to be accompanied by SRP to ensure all sources of irritation are removed)

Question 14

although still rare, which has a greater chance of recurrence irritation fibroma or peripheral ossifying fibroma?

Answer 14

peripheral ossifying fibroma

Question 15

what are peripheral giant cell granulomas?

Answer 15

a VASCULAR, extraosseous (purely in soft tissue), nodule of giant cells found on the gingival or alveolar ridge

Question 16

do peripheral giant cell granulomas have a particular affinity for a certain age group?

Answer 16

NO, can occur at any age. However, peak incidence at 30 y/o and children w/ mixed dentition

Question 17

what might you see radiographically to help you diagnose a peripheral giant cell granuloma?

Answer 17

a SAUCERIZED radiolucency

Question 18

what is the most common location of peripheral giant cell granulomas?

Answer 18

MANDIBLE

Question 19

histologically peripheral giant cell granulomas look similar to what other lesions?

Answer 19

• brown tumor of hyperthyroidism
• Cherubism
• central giant cell granuloma
  (histology alone is NOT diagnostic)

Question 20

lots of HEMOSIDERIN is present in what hyperplastic CT lesion

Answer 20

peripheral giant cell granulomas

Question 21

do peripheral giant cell granulomas involve bone?

Answer 21

NO, they are extraosseous

Question 22

how do you treat peripheral giant cell granulomas?

Answer 22

excision, STEROID INJECTIONS to reduce the size of the lesion

Question 23

if peripheral giant cell granulomas recur what might be the cause and how do you treat it?

Answer 23

recurrence may be associated to PDL INVOLVEMENT, may need to extract associated teeth

Question 24

histologically what are you likely to see in peripheral giant cell granulomas

Answer 24

GIANT CELLS (duh) and lots of HEMOSIDERIN (iron-storage complex found in blood)

Question 25

what hyperplastic CT lesions are associated with ILL-FITTING DENTURES?

Answer 25

- inflammatory fibrous hyperplasia | - inflammatory papillary hyperplasia

Question 26

where are inflammatory fibrous hyperplasias likely to occur?

Answer 26

around the DENTURE/PROSTHESIS flange in the MX or the MN

Question 27

where are inflammatory papillary hyperplasias likely to occur

Answer 27

in the MAXILLARY PALATE (never occurs in the MN)

Question 28

what is histologically unique about inflammatory fibrous hyperplasias?

Answer 28

the epithelium ACANTHOTIC (thickened)

Question 29

how do you treat inflammatory fibrous hyperplasia?

Answer 29

small lesions may resolve with a denture adjustment, but most require excision

Question 30

what is the clinical appearance of inflammatory papillary hyperplasia?

Answer 30

- small, red, papillary nodules on the hard palate | - palate has a "cobblestone" appearance

Question 31

how do you treat inflammatory papillary hyperplasia?

Answer 31

- excision - electrocautery - laser surgery

Question 32

if properly diagnosed are you worried about this transforming to a malignancy?

Answer 32

NO, no malignant potential

Question 33

what malignant condition looks similar to this

Answer 33

VERRUCOUS CARCINOMA

Question 34

how can you tell the difference between verrucous carcinoma and inflammatory papillary hyperplasia?

Answer 34

- if it is only on the hard palate (i.e. it does not extend to the alveolar ridges), then it is inflammatory papillary hyperplasia - extension to alveolar ridges is indicative of verrucous carcinoma

Question 35

what is hyperplastic gingivitis?

Answer 35

focal or generalized fibrous hyperplasia of marginal gingiva associated with an inflammatory response (gingiva become overgrown)

Question 36

hyperplastic gingivitis has a predilection for what group of people?

Answer 36

WOMEN

Question 37

hyperplastic gingivitis is associated with what hormonal changes?

Answer 37

pregnacy and puberty

Question 38

how do you treat hyperplastic gingivitis?

Answer 38

usually resolves with SRP

Question 39

what hyperplastic CT lesion is associated with AUTOSOMAL DOMINANT or RECESSIVE disorders?

Answer 39

hereditary gingival fibromatosis

Question 40

hereditary gingival fibromatosis is associated with what other disorders?

Answer 40

HYPERTELORISM (wideset eyes), epilepsy, mental retardation, hypertrichosis

Question 41

what drugs cause drug-induced gingival hyperplasia?

Answer 41

- DILANTIN (anticonvulsants) - CYCLOSPORIN - NIFEDIPINE - oral contraceptives - erythromycin

Question 42

what is histologically unique about drug-induced gingival hyperplasia?

Answer 42

overlying epithelium has ELONGATED RETE RIDGES

Question 43

what are the three intermediate fibrous tissue proliferations?

Answer 43

- desmoplastic fibroma - nodular facitis - benign fibrous histiocytoma

Question 44

what intermediate fibroblastic CT proliferation is primarily found in the MN of young patients (avg. age 14 y/o)

Answer 44

desmoplastic fibroma

Question 45

key features of desmoplastic fibromas

Answer 45

- MN of young patients - AGGRESSIVE - DENSE COLLAGEN - TX MN resection - 25% recurrence - assoc. with CTTNB1 mutations

Question 46

key features of nodular fascitis

Answer 46

- often mistaken for a malignancy (microscopically looks like SARCOMA - SPINDLE CELL FORMATION) - 20% recurrence

Question 47

key features of benign fibrous histiocytomas

Answer 47

- "CARTWHEEL" accumulation of histiocytes - nodular swelling or radiolucency - 20% recurrence

Question 48

what proliferative fibrous connective tissue lesion is a malignancy?

Answer 48

fibrosarcoma

Question 49

what is fibrosarcoma?

Answer 49

malignant neoplasm of FIBROBLASTS

Question 50

key features of fibrosarcomas

Answer 50

- MALIGNANT - affects ATYPICAL FIBROBLASTS - extraosseous and intraosseous - affects SOFT TISSUE > bone - assoc. with pain, paresthesia, bleeding - poor prognosis (DEATH in 5-7 yrs), 40-60% survival - TX: excision, radiation therapy, chemo