Fibrous CT Proliferations Flashcards
what is the MOST COMMON hyperplastic growth of the oral cavity?
irritation fibroma
how do irritation fibromas form?
chronic irritation (chronic low grade inflammation)
what is the most common location of an irritation fibroma?
lateral borders of tongue & buccal mucosa (cheek)
how to you treat irritation fibromas?
excision (recurrence is rare)
when an irritation fibroma presents on the gingiva (INTERDETNAL PAPILLA) what is it called?
peripheral ossifying fibroma
do irritation fibromas involve bone?
NO (they are extraosseous)
do peripheral ossifying fibromas involve bone?
YES (has focal areas of bone)
histological features of irritation fibromas
fibroblasts and extensive COLLAGEN resembling scar like tissue
what is the histological variant of irritation fibromas with lots of STELLATE GIANT CELLS called?
giant cell fibromas
are irritation fibromas common in children or elderly?
NO
where do peripheral ossifying fibromas arise from?
PDL or periosteum
what group of people are peripheral ossifying fibromas are more common among?
WOMEN (20-30 y/o)
how do you treat peripheral ossifying fibromas?
excision, MUST include PDL BASE (i.e. needs to be accompanied by SRP to ensure all sources of irritation are removed)
although still rare, which has a greater chance of recurrence irritation fibroma or peripheral ossifying fibroma?
peripheral ossifying fibroma
what are peripheral giant cell granulomas?
a VASCULAR, extraosseous (purely in soft tissue), nodule of giant cells found on the gingival or alveolar ridge
do peripheral giant cell granulomas have a particular affinity for a certain age group?
NO, can occur at any age. However, peak incidence at 30 y/o and children w/ mixed dentition
what might you see radiographically to help you diagnose a peripheral giant cell granuloma?
a SAUCERIZED radiolucency
what is the most common location of peripheral giant cell granulomas?
MANDIBLE
histologically peripheral giant cell granulomas look similar to what other lesions?
- brown tumor of hyperthyroidism
- Cherubism
- central giant cell granuloma
(histology alone is NOT diagnostic)
lots of HEMOSIDERIN is present in what hyperplastic CT lesion
peripheral giant cell granulomas
do peripheral giant cell granulomas involve bone?
NO, they are extraosseous
how do you treat peripheral giant cell granulomas?
excision, STEROID INJECTIONS to reduce the size of the lesion
if peripheral giant cell granulomas recur what might be the cause and how do you treat it?
recurrence may be associated to PDL INVOLVEMENT, may need to extract associated teeth
histologically what are you likely to see in peripheral giant cell granulomas
GIANT CELLS (duh) and lots of HEMOSIDERIN (iron-storage complex found in blood)
what hyperplastic CT lesions are associated with ILL-FITTING DENTURES?
- inflammatory fibrous hyperplasia
- inflammatory papillary hyperplasia
where are inflammatory fibrous hyperplasias likely to occur?
around the DENTURE/PROSTHESIS flange in the MX or the MN
where are inflammatory papillary hyperplasias likely to occur
in the MAXILLARY PALATE (never occurs in the MN)
what is histologically unique about inflammatory fibrous hyperplasias?
the epithelium ACANTHOTIC (thickened)
how do you treat inflammatory fibrous hyperplasia?
small lesions may resolve with a denture adjustment, but most require excision
what is the clinical appearance of inflammatory papillary hyperplasia?
- small, red, papillary nodules on the hard palate
- palate has a “cobblestone” appearance
how do you treat inflammatory papillary hyperplasia?
- excision
- electrocautery
- laser surgery
if properly diagnosed are you worried about this transforming to a malignancy?
NO, no malignant potential
what malignant condition looks similar to this
VERRUCOUS CARCINOMA
how can you tell the difference between verrucous carcinoma and inflammatory papillary hyperplasia?
- 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
what is hyperplastic gingivitis?
focal or generalized fibrous hyperplasia of marginal gingiva associated with an inflammatory response (gingiva become overgrown)
hyperplastic gingivitis has a predilection for what group of people?
WOMEN
hyperplastic gingivitis is associated with what hormonal changes?
pregnacy and puberty
how do you treat hyperplastic gingivitis?
usually resolves with SRP
what hyperplastic CT lesion is associated with AUTOSOMAL DOMINANT or RECESSIVE disorders?
hereditary gingival fibromatosis
hereditary gingival fibromatosis is associated with what other disorders?
HYPERTELORISM (wideset eyes), epilepsy, mental retardation, hypertrichosis
what drugs cause drug-induced gingival hyperplasia?
- DILANTIN (anticonvulsants)
- CYCLOSPORIN
- NIFEDIPINE
- oral contraceptives
- erythromycin
what is histologically unique about drug-induced gingival hyperplasia?
overlying epithelium has ELONGATED RETE RIDGES
what are the three intermediate fibrous tissue proliferations?
- desmoplastic fibroma
- nodular facitis
- benign fibrous histiocytoma
what intermediate fibroblastic CT proliferation is primarily found in the MN of young patients (avg. age 14 y/o)
desmoplastic fibroma
key features of desmoplastic fibromas
- MN of young patients
- AGGRESSIVE
- DENSE COLLAGEN
- TX MN resection
- 25% recurrence
- assoc. with CTTNB1 mutations
key features of nodular fascitis
- often mistaken for a malignancy (microscopically looks like SARCOMA - SPINDLE CELL FORMATION)
- 20% recurrence
key features of benign fibrous histiocytomas
- “CARTWHEEL” accumulation of histiocytes
- nodular swelling or radiolucency
- 20% recurrence
what proliferative fibrous connective tissue lesion is a malignancy?
fibrosarcoma
what is fibrosarcoma?
malignant neoplasm of FIBROBLASTS
key features of fibrosarcomas
- 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
