Mesenchymal Tumors Flashcards
1
Q
Fibroma
A
- Most are due to irritation, but irritation is not always present
- Most common “tumor” of the oral cavity
- True “tumor’ of fibrous tissue is rare
- Reactive hyperplasia of fibrous CT
- Smooth-surfaced, sessile, pink nodule
- Tx: Surgical excision
2
Q
Peripheral vs. Central
A
-
Indication of location
- Central:Inside the bone (jaw)
- Peripheral: Specifically on the gingiva (outside the bone)
- Distinction is important for tx purposes
- Typically peripheral tx’d w/ local excision
- Some central lesions req extensive excision or resection
Note: Salivary gland lesions & rhabdomyoma never on gingiva
3
Q
Peripheral Ossifying Fibroma
A
- Relatively common lesion that is also considered to be reactive
- Occurs exclusively on the gingiva, usually on interdental papilla
- Nodular, red to pink, firm may become ulcerated
- Look like a fibroma but it’s making bone for some reason
- Tx: Excisional biopsy
- Px: Good px, but higher recurrence rate than typical benign tumor
- If recurs, then re-excise
4
Q
Fibrosarcoma
A
Malignant tumor of fibroblasts
5
Q
Pyogenic Granuloma
A
- Tumorlike growth of the oral cavity, generally non-neoplastic
- Cause most likely reactive lesion to irritation or injury
- Some categorize it as a vascular tumor: lobular capillary hemangioma
- Common during pregnancy & puberty - “Pregnancy tumor”
- Anyone can get this
- Not a peripheral lesion
- Can appear anywhere there is vasculature
- NOT PYOGENIC
- NOT A GRANULOMA
- Clinical Features
- Rapid growth initially
- Well circumscribed
-
Vascular: Red-blue, bleeds easily, blanches
- Most common on gingiva, but can happen anywhere
- Often ulcerated and covered w/ pseudomembrane
- Tx:
- Surgical excision, usually curative
- Gingival lesions: excision should extend down to periosteum
- Adjacent teeth should be scaled to remove irritation sources
- Px:
- Recurrence is not uncommon
- May recur if irritants are not removed or pt is pregnant or in puberty
-
Pregnancy lesions: May resolve spontaneously after birth
- We usually wait until after pregnancy to excise lesions so they will not recur
6
Q
Peripheral Giant Cell Lesion
A
- Another clinically vascular tumor-like growth that is reactive to local irritation or trauma
- Seen exclusively in the gingiva or edentulous alveolar ridge
- Arises from PDL or periosteum
- Clinical Features
- Peripheral = only on gingiva
- Firm
- Vascular
- May be ulcerated
- Tx: Excision
7
Q
The 5 P’s
A
The 5 P’s
Gingival masses:
- Pyogenic granuloma
- Peripheral ossifying fibroma
- Peripheral giant cell granuloma
- “Plain” fibroma
- Parulis
8
Q
Lymphagioma
A
- Benign growth of lymphatic vessels
- Does not blanch under pressure b/c the vessels do not contain blood
- Thought to be congenital
- Half of all lesions noted at birth; 90% before age 2
- Cystic usually found in the head & neck (more surrounding space)
- Clinical Features
- Usually diffuse & compressible
- Oral lesions: Dorsum of tongue; causing macroglossia
- Cluster of translucent vesicles: frog eggs appearance
- Tx: Excision. Recurrence is common b/c it’s hard to get every little one, but once one is excised, they do not come back
9
Q
Angiosarcoma
A
Malignant vascular tissue
10
Q
Traumatic Neuroma
A
- Painful traumatic lesion
- Rxn proliferation of neural tissue after transection or trauma
-
Proliferation of axons
- Trying to find the severed end if the nerve was cut and it starts to proliferate
- Mental foramen, tongue, lower lip areas
- H/o trauma (tooth extraction)
- Clinical Features
- Anesthesia or dysthesia
- Pain upon palpation
- Tx: Surgical excision
11
Q
Schwannoma
A
- Anywhere where neural tissue is
- Benign neural neoplasm of Schwann cell
- AKA neurilemoma
- Not painful on palpation
- Most common oral location is the tongue
- Tx: Excision
- Cannot be a pyogenic granuloma b/c it won’t blanch and is not vascular and red
12
Q
Neurofibroma
A
- Most common type of peripheral nerve neoplasm
- Mixture of cell types (Schwann cells & perineural fibroblasts)
- Solitary or part of a syndrome (neurofibromatoses)
- Oral: Tongue & buccal mucosa
- All pts should be evaluated for NF
13
Q
Neurofibromatosis
A
- Not vascular, but has a vascular supply
- Hereditary condition (1:3000)
- Most common form: NF1: von Recklinghausen’s disease of the skin
- Autosomal dominant (85-97% of cases)
- NF1 gene mutation (chromosome 17q11.2)
- 50% no family hx (new mutation
14
Q
Granular Cell Tumor
A
- Benign neoplasm that shows a predilection for the oral cavity
- Studies point to a neural origin: Schwann cells
- ~50% of the cases on the tongue
- Tx’d by surgical excision
15
Q
Malignant Peripheral Nerve Sheath Tumor
A
- ~10-15% seen in head/neck, most common in young adults
- Oral: MN, lips & buccal mucosa
- Intrabony: Widening or MN canal or mental foramen
- Surgical tx (+/- CT/RT); poor px
18
Q
Rhabdomyoma
A
- Benign tumor of skeletal muscle
- Will never be on the hard palate or gingiva
- Adult type
- Middle aged & older adults, 70% men
- Pharynx, oral cavity, larynx
- Fetal type
- Typically occurs in young children, male predilection
- Most on face and periauricular regions
20
Q
Lipoma
A
- Benign tumor of fat tissue
- Most cases on trunk & proximal extremities
- Appear to be more common in obese people
- Oral: 50% buccal mucosa & buccal vestibule
- Clinical Features: Yellow or pink hue
22
Q
Congenital Epulis
A
- Occurs @ birth only on the MX alveolar ridge tissue
- Pink-red, smooth-surfaced single or polypoid mass
- 90% of cases are female
