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Pathology I > Head and Neck Mesenchymal > Flashcards

Head and Neck Mesenchymal Flashcards

1
Q

what is the most common tumor of the oral cavity

A

fibroma

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2
Q

what is a fibroma

A

reactive response to local irritation and trauma
- hyperplasia of fibrous connective tissue

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3
Q

what are the clinical features of fibroma

A
  • most common on buccal mucosa along bite line
  • other site: labial mucosa, tongue, gingiva
  • smooth surface, pink nodule
  • may appear white from keratinization
  • asymptomatic
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4
Q

what is the treatment for a fibroma

A

conservative surgical excision

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5
Q

what does a fibroma feel like on palpation

A

firm

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6
Q

what does the histo slide of a fibroma look like

A

proliferation of CT with fibroblastic cells- purple cells

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7
Q

what is inflammatory papillary hyperplasia and what is it caused by

A

-reactive tissue growth that develops under a denture
- often caused by ill-fitting denture, poor denture hygiene, 24 hour denture wear

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8
Q

what are the clinical features of inflammatory papilary hyperplasia

A
  • usually occurs on hard palate, under denture
  • uncommonly develops on edentulous mandibular ridge
  • erythematous mucosa
  • pebbly, papillary surface
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9
Q

what is the treatment for inflammatory papillary hyperplasia

A
  • removal of denture to allow healing
  • antifungal therapy
  • surgical excision
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10
Q

describe oral focal mucinosis

A
  • uncommon, focal tumor like mass
  • overproduction of hyaluronic acid by fibroblasts
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11
Q

what are the clinical features of oral focal mucinosis

A
  • 2:1 female
  • gingiva: most common site in 2/3 of cases
  • may occur on hard palate, other sites rare
  • mucosal colored, nodular mass
  • asymptomatic
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12
Q

what is the treatment for oral focal mucinosis

A

surgical excision
- shouldnt recur

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13
Q

what is the histology of oral focal mucinosis

A

loose CT with fibroblastic cells
- over production of hyaluronic acid causing loose appearance
- mucin or hyaluronic acid will stain blue or purple on certain stains

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14
Q

what are the 3 P’s

A
  • pyogenic granuloma
  • peripheral giant cell granuloma
  • peripheral ossifying fibroma
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15
Q

what do the 3 P’s have in common

A

benign lesions occurring on the gingiva

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16
Q

what is a pyogenic granuloma

A

exuberant tissue response in response to local irritation or trauma

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17
Q

what is the most common of the 3 P’s

A

pyogenic granuloma

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18
Q

what are the clinical features of pyogenic granuloma

A
  • most common in females
  • 75% occur on gingiva
  • smooth, erythematous lobulated mass
  • “pregnancy tumor”
    asymptomatic
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19
Q

what is the treatment for pyogenic granuloma

A
  • surgical excision
  • pregnant patients- after delivery if possible
  • thorough scaling
  • encourage OHI
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20
Q

what does a pyogenic granuloma look like

A

smooth erythematous lobulated mass

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21
Q

what is the histology of pyogenic granuloma

A

proliferation of vascular tissues lined by endothelial cells

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22
Q

what is a peripheral giant cell granuloma caused by

A

likely a reactive lesion to local irritation and trauma

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23
Q

what are the clinical features of peripheral giant cell granuloma

A
  • occurs exclusively on gingiva/alveolar ridge
  • occurs at any age
  • red, red- blue nodular mass
  • cupping resorption of bone on xray
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24
Q

what is the treatment for peripheral giant cell granuloma

A
  • surgical excision
  • thorough scaling
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25
Q

what is the histology of peripheral giant cell granuloma

A
  • proliferation of giant cells in a background of small spindle shaped mesenchymal cells
  • hemorrhage
  • red cells- extravasated red blood cells in foreground
  • multinucleated giant cells are needed to make dx!!
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26
Q

what is peripheral ossifying fibroma caused by

A

a reactive lesion

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27
Q

what does peripheral ossifying fibroma contain

A

calcification/ossification

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28
Q

what are the clinical features of peripheral ossifying fibroma

A
  • most common in young adults
  • exclusively on the gingiva
  • nodular mass, red/pink
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29
Q

what is the treatment for peripheral ossifying fibroma

A
  • surgical excision
  • thorough scaling
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30
Q

what is the histology for peripheral ossifying fibroma

A
  • numerous fragments of calcified tissue- calcification or ossification is necessary for dx
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31
Q

what is a lipoma

A
  • benign tumor of fat
  • most common mesenchymal neoplasm
  • most occur on trunk and extremities
32
Q

what are the clinical features of lipoma

A
  • observed mainly in adults
  • buccal mucosa and vestibule: 50% cases
  • soft, smooth surfaced, nodular mass
  • yellow tint may be observed
33
Q

what is the treatment for lipoma

A

surgical excision
- unlikely to reoccur

34
Q

what does a lipoma feel like on palpation

A

soft

35
Q

what does the histology for a lipoma look like

A

sheets of mature fat cells
- looks like “chicken wire”

36
Q

what is a neurofibroma

A
  • most common peripheral nerve neoplasm
  • schwann cells, perineural fibroblasts
37
Q

what are the clinical features of neurofibroma

A
  • most common on tongue and buccal mucosa
  • pink, slow- growing nodule
  • may occur in jaws- radiolucency
  • may be a component of neurofibromatosis
38
Q

what is the treatment for neurofibroma/NFI

A
  • solitary neurofibroma: surgical excision, recurrence is rare
  • NFI: Tx directed towards management of complications such as neurofibrosarcoma
39
Q

how often does neurofibrosarcoma occur as a complication of neurofibroma/NFI

A

5% of cases

40
Q

what is the histology for neurofibroma

A

loose appearance from perineural fibroblasts and schwann cells- wavy appearance

41
Q

what is a schwannoma

A
  • benign neural neoplasm of schwann cell origin
  • 25% cases occur in head and neck
  • neurofibromatosis II: bilateral schwannomas of CN VIII
42
Q

what is neurofibromatosis II (NF2)

A
  • “acoustic neuromas”
  • deafness, dizziness, tinnitus
43
Q

what is another name for schwannoma

A

neurilemoma

44
Q

what are the clinical features of schwannoma

A
  • most common in young to middle aged adults
  • slow- growing encapsulated nodule
  • oral most common on tonuge
  • may occur in jaws as a radiolucency
45
Q

what are the histology patterns for schwannomas and describe each

A
  • antoni A: characterized by streaming fascicles of spindle shaped schwann cells and nuclei are lined up
  • Antoni B: nuclei are not lined up
46
Q

what are the clinical features of congenital epulis

A
  • occurs in newborns
  • 90% female
  • almost exclusively on alveolar ridge: maxillary&raquo_space; mandibular
  • pink-red, polypoid mass on alveolar ridge
47
Q

what is the treatment for congenital epulis

A
  • surgical excision
  • may regress on its own
48
Q

what is the histology for congenital epulis

A
  • CT full of granular cells
  • cells have granularity in cytoplasm and small nuclei
49
Q

what are the clinical features of a granular cell tumor

A
  • most common on tongue - 1/3 of cases
  • 2:1 female prediliction
  • 4th-6th decade of life
  • pink- yellow nodule
50
Q

what is the treatment for granular cell tumor

A

surgical excision
- shouldnt recur

51
Q

what is the histology for granular cell tumor

A

granular cells with granular cytoplasm

52
Q

what is the most common tumor of infancy

A

hemangioma

53
Q

what are the clinical features of hemangioma

A
  • 3:1 female
  • head and neck: 60% of cases
  • may appear raised and firm
  • red, blue, purple hue
  • often demonstrates rapid development
  • 90% resolve by age 9 - may result in permanent scarring
54
Q

what are the treatments for hemangioma

A
  • observation, likely to regress
  • surgical removal in some cases
55
Q

what is a lymphangioma

A

benign growth of lymphatic vessels

56
Q

what are the clinical features of lymphangioma

A
  • head and neck: 50-75% of cases
  • 90% develop by 2 years of age
  • cervical malformation: soft, fluctuant masses
  • oral: most common on anterior tongue -> macroglossia
  • pebbly surface, vesicle appearance
57
Q

what is the treatment for lymphangioma

A
  • depends on size, location- surgery may be indicated
  • non enlarging lesions of the tongue- may observe
58
Q

what is the histology for lymphangioma

A
  • dilated vascular channels
  • lymph fluid
59
Q

what is a leiomyoma

A
  • benign tumor of smooth muscle
  • most common in the uterus, GI tract, skin
60
Q

what are the clinical features of leiomyoma

A
  • rare in the oral cavity, most common subtype: angiomyoma
  • slow growing mucosal nodule
  • common sites: lips, tongue, palate, cheek
  • usually asymptomatic
61
Q

what is the treatment for leiomyoma

A

surgical excision

62
Q

what is the histology for leiomyoma

A

smooth muscle cells spindle shaped and arranged in vesicular pattern
- need to see vessel

63
Q

what is kaposi sarcoma and what is it caused by

A
  • vascular endothelial malignancy
  • caused by human herpesvirsus HHV-8
  • observed primarily in HIV infected adults
64
Q

what are the four clinical presentations of kaposi sarcoma

A
  • classic type
  • endemic (African)
  • iatrogenic (transplant associated)
  • epidemic (AIDS related)
65
Q

what is the clinical presentation of classic type kaposi sarcoma

A
  • older adults 70-95% men
  • italian, jewish ancestry
  • blue/purple macules and plaques -> tumor nodules
66
Q

what is the clinical presentation of endemic kaposi sarcoma

A
  • younger adults, children
  • indolent skin lesions, or aggressive tumors
67
Q

what is the clinical presentation of iatrogenic kaposi sarcoma

A
  • recipients of solid organ transplant
  • loss of cellular immunity from immunosuppressive therapy
68
Q

what is the clinical presentation of epidemic kaposi sarcoma

A
  • AIDS related, most common type observed in USA
  • less common after cART therapy
  • sexual transmission
  • appx 70% demonstrate oral lesions
  • most common locations: hard palate, gingiva, tongue
69
Q

what is the treatment for kaposi sarcoma

A
  • dependent on clinical subtype and stage
  • radiation therapy for skin lesions
  • surgical excision for isolated lesions
  • AIDS- related cases: may regress with cART therapy
70
Q

what is the presentation of kaposi sarcoma in the mouth

A

buccal and lingual aspect on alveolar ridge

71
Q

what is the histology of kaposi’a sarcoma

A

vascular proliferation- proliferation of spindle cells with extravasated erythrocytes surrounded vessel

72
Q

what is rhabdomyosarcoma

A
  • malignant neoplasm of skeletal muscle differentiation
  • most common soft tissue sarcoma in children
73
Q

what are the clinical features of rhabdomyosarcoma

A
  • most common head and neck area- 35% of cases
  • most common 1st decade of life, rare above 45 years old
  • infiltrative mass that often grows rapidly
  • oral cavity: most common in palate
74
Q

what is the treatment for rhabdomyosarcoma

A

local surgical excision, radiation, and chemotherapy

75
Q

what is the histology for rhabdomyosarcoma

A

small spindle and rounded cells but all are malignant
- to make dx you need to see rounded pink cells called pink bellies

Pathology I (24 decks)

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