Oral mucosa: benign neoplasms and reactive lesions Flashcards
TABLE IN LECTURE - RED MORE IMPORTANT
RED MORE IMPORTANT
Swellings of gingival tissues = Epulis/epulides - local causes?
Fibrous hyperplasia Pyogenic granuloma Peripheral giant cell granuloma Gingival cysts Bohns nodules
Swellings of gingival tissues = Epulis/epulides - generalised causes?
Chronic hyperplastic gingivitis - inflam Leukaemic infiltration Endocrine related (puberty, pregnancy) Crohn's disease Gingival fibromatosis Drug induced hyperplasia
Fibrous epulus features?
Same colour as oral mucosa
Firm
Painless unless traumatised
Caused by trauma - dentures, teeth, ortho apliances
Overgrowth of fibrous CT covered by hyperkeratinised SS epithelium
Fibrous epulus/fibro-epithelial polpy management?
Excision, remove cause
Send for histopathological examination
Pyogenic granuloma features?
Red/purple/blue vascular growth Sessile = flat base or pedunculated = on a stalk Rapid growth Soft, bleeds easily Usually <40yrs Common in pregnancy/puberty
Caused by trauma e.g. plaque, calculus, denture, ortho appliances
Overgrowth of very vascular granulation tissue = red colour
Pyogenic granuloma management?
Excision and remove cause
If pt pregnant improve OH and excise but may recur
Lesions may mature into dense fibrous tissue (fibrous epulis)
Also found at other sites in oral mucosa
Peripheral giant cell granuloma?
Soft red/blue sessile or pedunculated swelling
Usually anterior teeth, mandible>maxilla
Average age <40yrs
Similar to a pyogenic granuloma clinically
May cause superficial bone resorption
Only found on gingiva
Vascular fibrous tissue
Numerous multinucleate giant cells
Haemorrhage
Giant cell lesion on histology
Management of peripheral giant cell granuloma?
Important to determine whether lesion has arisen on gingiva or arisen within bone and burst through cortical plate. Radiographs - large radiolucency = central one
If arisen in bone = diff diagnosis = central giant cell granuloma and hyperparathyroidism
Excision. curettage of underlying bone to prevent recurrence and send lesion for histopathological examination
Bohn’s nodules and epstein pearls?
Usually in babies - will disappear on own, very rare
Differential diagnosis of epulides?
Firm, mucosa coloured = fibrous epulis
Soft, red, red/blue - pyogenic granuloma, giant cell granuloma
If pt pregnant/puberty then more likely pyogenic granuloma
Definitive diagnosis by excisional biopsy
Remember to exclude an abscess from tooth or gum- red/yellow/soft/fluctuant
How to know something is an abscess?
Adjacent to broken down tooth - looks yellow
Vitality testing and radiographs
Painful on pressure
Generalised gingival swellings?
Hereditary: Gingival fibromatosis
Inflammatory: Chronic hyperplastic gingivitis
Hormonal: Endocrine related (puberty, pregnancy)
Diet related: scurvy
Drug related: drug induced hyperplasia
Neoplastic - Leukaemic infiltration: Wegners granulomatosis
Associated with GI tract disease: Crohn’s disease
Gingival fibromatosis features?
Hereditary (Autosomal Dominant) Lifelong Pale pink, firm overgrowth May cover and submerge teeth May regrow after removal
Chronic hyperplastic gingivitis?
Associated with poor oral hygiene
Erythematous gingivae, BOP
Hormonal related gingival hyperplasia?
Puberty and pregnancy
Exaggerated response to plaque - OHI, will settle down once baby is born
Red, erythematous, bleeds easily on probing
Diet related gingival hyperplasia in scurvy?
Diet poor in vitamin C Failure to synthesise collagen Loss of teeth Inflammatory type hyperplasia V rare in UK
Neoplastic - gingival hyperplasia associated with leukaemia?
Be vary with children with gingival hyperplasia complaining of tiredness, easy bruising, not sleeping
Red, swollen gingivae, yellow pus
May exude pus
Ulceration
Response in excess of amount of plaque
May be associated with petechial haemorrhages, tiredness
Drug induced gingival hyperplasia?
Associated with cyclosporin (immunosuppressant), nifedipine (antihypertensive) and phenytoin (anticonvulsant)
Gingivae pale, lobulated surface, little inflammation
Dense fibrous tissue, little inflammation, long epithelial rete ridges
Drug induced gingival hyperplasia management?
Surgical reduction (gingivectomy), improve OH, change drug regime if possible
Crohn’s related gingival hyperplasia?
Maybe labial swelling, ulcers, mucosal tags, fissures in lips
Differential diagnosis generalised gingival hyperplasia?
Pale, un-inflamed gingivae: gingival fibromatosis or drug induced. Distinguish on duration and drug history
Red inflamed gingivae: inflammatory hyperplasia or hormonal induced. Distinguish by history
Red, inflamed, pus, ulceration - Leukaemia. Further investigations
Swellings affecting the oral mucosa features?
Derived from any tissues in the oral mucosa
Most are reactive or inflammatory in nature
A few are benign neoplasms or developmental
Squamous cell papilloma features?
Benign neoplasm HPV driven - HPV6 and 11
White cauliflower like growth
Pendunculated or sessile
Common on palate, often junction of hard and soft palate
Squamous cell papilloma histology and management?
Overgrowth of epithelium which is hyperkeratinised - hence white colour
Surface thrown into fronds
Vascular CT core
Management: excision with a margin
Heck’s disease (focal epithelial hyperplasia)?
Multiple papillomas Caused by HPV 13 and 32 Multiple flat viral warts May resolve spontaneously/excise Inuit/central America
Fibrous hyperplasia - fibro-epithelial polyp?
Continued trauma
Common on cheeks, tongue, lip
Mucosal coloured, firm nodule
Histology of fibrous hyperplasia?
SS epi
Fibrous CT
Pyogenic granuloma?
Caused by trauma
Red/white-red
Overgrowth of vascular granulation tissue
Usually ulcerated
Traumatic neuroma?
Haphazard overgrowth of nerve fibres
Usually caused by trauma
Mental foramen region
Frequently painful
Lipoma?
Benign neoplasm Composed of fat Yellow/pink Smooth surface Common on cheek and tongue
Management: Excision
Histology - lipoma?
Mature fat cells
Haemangioma?
- Hamartoma = proliferation of tissue which is normal for that site e.g. BVs in mouth
- Choristoma = proliferation of tissue which is not normal for the site e.g. cartilage in your tongue
Excess BVs Put thumb over it - it may blanch Blue/blue-purple colour Localised or diffuse May bleed excessively
Sturge-weber syndrome?
Present from birth (congenital) Has characteristic features: - Port wine stain - Varying degrees of mental retardation - Seizures - Glaucoma
Mucocele?
Collections of mucin or saliva under the mucosa - pearly, translucent look to them and are fluctuant
Not painful
Most common on lower lip
Lymphangioma?
Similar to haemangioma but an overgrowth of lymphatic vessels. Paler colour clinically
Cystic hygroma
Neural tumour - neurofibroma or neurilemmoma?
More deep seated, relatively rare
Firm
Mucosal coloured
Granular cell tumour?
Common on tongue - neural origin?
Congenital epulis?
Similar to granular cell tumour histologically but occurs in neonates
Differential diagnosis of mucosal swellings?
Cauliflower like and white - ss papilloma
Smooth, mucosal coloured, related to denture or other source of trauma - fibrous hyperplasia
Smooth, yellow - lipoma
Red/red-white, related to trauma - pyogenic granuloma
Red/blue - haemangioma, mucocoele
Deep seated/normal mucosa - neuroma, neural tumour, salivary gland tumour
