Granuloma & Lipoma

Question 1

What is pyogenic granuloma?

Answer 1

Common tumor-like growth of the oral cavity that traditionally has been considered to be non-neoplastic in nature

Question 2

Are pyogenic granulomas related to infection?

Answer 2

Once through to be caused by pyogenic prganisms but now believed to be unrelated to infection

Question 3

pyogenic granulomas are a response to what?

Answer 3

Exuberant response to local irritation or trauma

Question 4

Are pyogenic granulomas a true granuloma?

Answer 4

NO

Question 5

Clinical presentation of pyogenic granulomas

Answer 5

Smooth or lobulated mass that is usually pedunculated though some are sessile

Surface is characteristically ulcerated and ranges from pink to red to purple depending on age of lesion

Question 6

How do young pyogenic granulomas appear?

Answer 6

highly vascularized appearance (red)

Question 7

How do collagenized pyogenic granuloma lesions appear?

Answer 7

collagenized and pink

Question 8

Are pyogenic granulomas painful?

Answer 8

Painless

Question 9

Do pyogenic granulomas bleed easily?

Answer 9

Yes because its extremely vascularity

Question 10

Where do pyogenic granulomas often occur in the mouth?

Answer 10

gingiva

Question 11

What population often develops pyogenic granulomas?

Answer 11

pregnant women

Question 12

What are epulis granulomatosis?

Answer 12

hyperplastic growths of granulation tissue that sometimes arise in healing extraction sockets

Lesion resembles pyogenic granulomas and usually represent a granulation tissue reactrion to bony sequestra in the pocket

Question 13

What is the histpathologic appearance of pyogenic granulomas?

Answer 13

Highly vascular proliferation that resembles granulation tissue

Contains numerous small and larger endothelium-lined channels engorged with RBCs

Vessels sometimes are organized in lobular aggregates

Exophytic mass of granulation like tissue with an ulcerated surface

Lobular endothelial proliferation in the deeper CT

Question 14

Tx for pyogenic granulomas

Answer 14

conservative surgical excision is usually curative

For gingival lesions, the excision should extend down to the periosteum and the adjacent teeth should be thoroughly scaled to remove any source of irritation

Question 15

Is there recurrence after pyogenic granuloma removals?

Answer 15

lesion can recur and re-excision is necessary

Question 16

What is a peripheral giant cell granuloma?

Answer 16

relatively common tumor-like growth in the oral cavity

Not a true neoplasm but a reactive lesion caused by local irritation or trauma

Question 17

Where in the oral cavity do peripheral giant cell granuloma exclusively occur?

Answer 17

gingiva and edentulous alveolar ridge

Question 18

What is the appearance of peripheral giant cell granuloma?

Answer 18

Red or red-blue nodular mass

Question 19

Histopathologic appearance of peripheral giant cell granuloma

Answer 19

Nodular proliferation of multinucleated giant cells within the gingiva

Giant cells reside within a hemorrhagic background of ovoid and spindle shaped mesenchymal cells

Question 20

Tx of peripheral giant cell granuloma

Answer 20

local surgical excision down to underlying bone

adjacent teeth should be carefully scaled down to remove any source of irritation and to minimize the ris kof recurrence

Question 21

what % of peripheral giant cell granuloma excisions undergo recurrence?

Answer 21

10%

Question 22

What is a lipoma?

Answer 22

Benign tumor of fat

Most common mesenchymal neoplasm

Question 23

What is the pathogenesis of lipoma?

Answer 23

Uncertain but appear more common in the obese

Question 24

Is metabolism of lipomas dependent of normal body fat?

Answer 24

No, metabolism of lipomas is completely independent of normal fat

Question 25

Do lipomas commonly occur in the oral and maxillofacial region?

Answer 25

No, less frequent

Question 26

Where do lipomas most often occur?

Answer 26

Trunk and proximal portion of the extremities

Question 27

Clinical appearance of oral lipomas?

Answer 27

Oral lipomas are usually soft, smooth-surfaced, yellow nodular masses that can be sessile or pedunculated

Question 28

When do some buccal lipomas not represent true tumors?

Answer 28

Some buccal cases may not represent true tumor but rather herniation of the buccal fat pad through the buccinator muscle which may occur after local trauma in young children or subsequent to surgical removal of 3rd molars in older pts

Question 29

What is the histopathologic appearance of lipomas?

Answer 29

Composed of mature fat cells that look like the surrounding normal fat

Tumor is well-circumscribed and may demonstrate a thing fibrous capsule

Distinct lobular arrangement of cells

Central cartilaginous oro sseous metaplasia may occur

Question 30

Tx for lipoma

Answer 30

Conservative local excision

Recurrence is rare