Non Neoplastic

Question 1

Fibroma

Answer 1

Hyperplasia of fibrous connective tissue

most common tumor of the oral mucosa

usually sessile, smooth surfaced, normal color, asymptomatic

↑↑ cheek but occurs almost anywhere

Question 2

Fibroma

Giant Cell Fibroma

Answer 2

Giant cell fibroma (not to be confused with giant cell granuloma)

“papillary” tumor of fibrous connective tissue containing plump,

stellate and often bi or trinucleated fibroblasts

↑ children

↑↑ gingiva, ↑ tongue

often confused clinically with papillomas (see neoplasm)

Question 3

Fibroma

Peripheral odontogenic (ossifying) fibroma

Answer 3

Reactive fibroblastic lesion of PDL

↑↑ 1-3 decades, occurs only on gingiva, asymptomatic; pedunculated or

sessile mass ± red ± ulceration

Histology: Cellular fibroblastic lesion with bone and/or cementum and/or

dystrophic calcification

Treatment Excision including superficial PDL

recurrence rate 15-20%, highest recurrence of any of the reactive gingival lesions

Question 4

Inflammatory Fibrous Hyperplasia

Answer 4

(Epulis Fissuratum)

Reactive folds of hyperplastic fibrous connective tissue along border of ill-fitting, over extend denture

Histology: Fibrous hyperplasia ± inflammation

Treatment: Excision and remake/reline denture

Question 5

Inflammatory Papillary Hyperplasia

Answer 5

Papillomatosis

Hyperplastic response of palatal mucosa to ill-fitting denture

Histology: Papillary hyperplasia + inflammation ± pseudoepitheliomatous

Hyperplasia (PEH)

Treatment: Excise + remake/reline denture

Question 6

Peripheral Giant Cell Granuloma

Answer 6

Tumor of well vascularized fibrous connective tissue containing numerous multinucleated giant cells

questionable histogenesis but occurs only on gingiva (↑ anterior)

any age, asymptomatic

usually reddish-brown-purple pedunculated or sessile mass

female:male; 2:1

may produce cupping resorption of underlying bone

Treatment: Excision and removal of irritants, may recur

Question 7

Pyogenic granuloma

Answer 7

Pyo – pus genic – produces (misnomer)

reactive lesion representing hyperplasia of body’s basic reparative tissue –

granulation tissue

reddish, ulcerated pedunculated or sessile mass

↑ 2-4 decades, ↑↑ gingiva but occurs anywhere including skin

Asymptomatic but may bleed easily

↑ females, often in pregnancy “pregnancy tumor”

not uncommon in extraction sockets – epulis granulomatosa

Histology: Hyperplastic granulation tissue, fibroblasts with delicate

collagen, endothelial cells + capillaries and dilated larger vessels

Treatment: Excision and removal of irritants, may recur

Question 8

Parulis “Gum boil”

Answer 8

Can occur anywhere but on gingiva, it represents draining from a source of odontogenic

infection of either pulpal or periodontal origin

pus (purulence, suppuration) = bacterial infection

Question 9

Localized juvenile spongiotic gingival hyperplasia

Answer 9

Localized hyperplasia presumably from externalized sulcular epithelium on gingiva

Almost exclusively 1-2 decades, female 2:1,

Almost all anterior gingiva, Max 5:1,

Clinical: red often papillary gingival lesions

Histology: Papillary proliferation of inflamed epithelium with intercellular edema (spongiosis)

Treatment: Excision

Question 10

Hemangioma

Answer 10

Overgrowth of blood vessels (hamartoma – localized overgrowth of tissues native to the part, often developmental)

rapid proliferation of endothelial cells at birth or shortly thereafter,

characteristically involute

most common tumor of infancy (5-10% incidence)

↑ females 3:1

60% H&N

↑↑↑ 0-5 years, rarely congenital, 90% complete but slow involution by age 10

reddish to purple mass lesions that tend to blanch with pressure

oral ones often later and don’t involute

can occur in bone, often multilocular or soap bubble appearance (why you aspirate before bone biopsy)

Histology: Endothelial cell proliferation with formation of small capillaries

(capillary) or larger dilated vascular spaces (cavernous)

Treatment: Natural history is involution

laser pulse, excision, sclerosing agents, steroids both intralesional and systemic propanolol

Question 11

Sturge-Weber Angiomatosis

Answer 11

(Encephalotrigeminal angiomatosis)

Nonhereditary developmental, congenital condition characterized by vascular

proliferation of brain and face usually along distribution of ophthalmic branch of the trigeminal nerve

Sturge-Weber and port wine stains are due to somatic activation mutation in GNAQ which

encodes Gαq, a member of the q class of G-protein alpha subunits that mediates

signals between G-protein–coupled receptors and downstream effectors. The difference is when and where the mutation occurs

Large purplish lesions –identical clinically to port-wine stains,

ipsilateral oral mucosal involvement common

leptomingeal angiomas of cerebral cortex

Question 12

Lymphangiomas

Answer 12

Developmental overgrowth of lymphatic vessels

↑↑ H&N, ↑↑ 0-5 years of age

Orally: ↑↑ tongue (may produce macroglossia)

Superficial ones – pebbly surface covered by translucent vesicles

Deeper ones – more diffuse

Cystic hygroma: variant that infiltrates and becomes very large

(↑ neck)

Histology: Proliferation of thin walled lymphatic vessels capillary sized,

Dilated (cavernous) or cystically dilated (cystic hygroma)

Treatment: Lesions don’t involute

Excision

Deeper ones often recur

Sclerosing agents