Oral mucosa: benign neoplasms and reactive lesions Flashcards

1
Q

TABLE IN LECTURE - RED MORE IMPORTANT

A

RED MORE IMPORTANT

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2
Q

Swellings of gingival tissues = Epulis/epulides - local causes?

A
Fibrous hyperplasia 
Pyogenic granuloma
Peripheral giant cell granuloma
Gingival cysts
Bohns nodules
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3
Q

Swellings of gingival tissues = Epulis/epulides - generalised causes?

A
Chronic hyperplastic gingivitis - inflam
Leukaemic infiltration
Endocrine related (puberty, pregnancy)
Crohn's disease
Gingival fibromatosis 
Drug induced hyperplasia
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4
Q

Fibrous epulus features?

A

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

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5
Q

Fibrous epulus/fibro-epithelial polpy management?

A

Excision, remove cause

Send for histopathological examination

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6
Q

Pyogenic granuloma features?

A
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

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7
Q

Pyogenic granuloma management?

A

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

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8
Q

Peripheral giant cell granuloma?

A

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

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9
Q

Management of peripheral giant cell granuloma?

A

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

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10
Q

Bohn’s nodules and epstein pearls?

A

Usually in babies - will disappear on own, very rare

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11
Q

Differential diagnosis of epulides?

A

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

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12
Q

How to know something is an abscess?

A

Adjacent to broken down tooth - looks yellow
Vitality testing and radiographs
Painful on pressure

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13
Q

Generalised gingival swellings?

A

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

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14
Q

Gingival fibromatosis features?

A
Hereditary (Autosomal Dominant)
Lifelong
Pale pink, firm overgrowth 
May cover and submerge teeth 
May regrow after removal
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15
Q

Chronic hyperplastic gingivitis?

A

Associated with poor oral hygiene

Erythematous gingivae, BOP

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16
Q

Hormonal related gingival hyperplasia?

A

Puberty and pregnancy
Exaggerated response to plaque - OHI, will settle down once baby is born
Red, erythematous, bleeds easily on probing

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17
Q

Diet related gingival hyperplasia in scurvy?

A
Diet poor in vitamin C
Failure to synthesise collagen
Loss of teeth 
Inflammatory type hyperplasia
V rare in UK
18
Q

Neoplastic - gingival hyperplasia associated with leukaemia?

A

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

19
Q

Drug induced gingival hyperplasia?

A

Associated with cyclosporin (immunosuppressant), nifedipine (antihypertensive) and phenytoin (anticonvulsant)
Gingivae pale, lobulated surface, little inflammation

Dense fibrous tissue, little inflammation, long epithelial rete ridges

20
Q

Drug induced gingival hyperplasia management?

A

Surgical reduction (gingivectomy), improve OH, change drug regime if possible

21
Q

Crohn’s related gingival hyperplasia?

A

Maybe labial swelling, ulcers, mucosal tags, fissures in lips

22
Q

Differential diagnosis generalised gingival hyperplasia?

A

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

23
Q

Swellings affecting the oral mucosa features?

A

Derived from any tissues in the oral mucosa
Most are reactive or inflammatory in nature
A few are benign neoplasms or developmental

24
Q

Squamous cell papilloma features?

A

Benign neoplasm HPV driven - HPV6 and 11
White cauliflower like growth
Pendunculated or sessile
Common on palate, often junction of hard and soft palate

25
Q

Squamous cell papilloma histology and management?

A

Overgrowth of epithelium which is hyperkeratinised - hence white colour
Surface thrown into fronds
Vascular CT core
Management: excision with a margin

26
Q

Heck’s disease (focal epithelial hyperplasia)?

A
Multiple papillomas
Caused by HPV 13 and 32
Multiple flat viral warts
May resolve spontaneously/excise
Inuit/central America
27
Q

Fibrous hyperplasia - fibro-epithelial polyp?

A

Continued trauma
Common on cheeks, tongue, lip
Mucosal coloured, firm nodule

28
Q

Histology of fibrous hyperplasia?

A

SS epi

Fibrous CT

29
Q

Pyogenic granuloma?

A

Caused by trauma
Red/white-red
Overgrowth of vascular granulation tissue
Usually ulcerated

30
Q

Traumatic neuroma?

A

Haphazard overgrowth of nerve fibres
Usually caused by trauma
Mental foramen region
Frequently painful

31
Q

Lipoma?

A
Benign neoplasm
Composed of fat
Yellow/pink
Smooth surface
Common on cheek and tongue 

Management: Excision

32
Q

Histology - lipoma?

A

Mature fat cells

33
Q

Haemangioma?

A
  • 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
34
Q

Sturge-weber syndrome?

A
Present from birth (congenital)
Has characteristic features:
- Port wine stain
- Varying degrees of mental retardation
- Seizures
- Glaucoma
35
Q

Mucocele?

A

Collections of mucin or saliva under the mucosa - pearly, translucent look to them and are fluctuant
Not painful
Most common on lower lip

36
Q

Lymphangioma?

A

Similar to haemangioma but an overgrowth of lymphatic vessels. Paler colour clinically
Cystic hygroma

37
Q

Neural tumour - neurofibroma or neurilemmoma?

A

More deep seated, relatively rare
Firm
Mucosal coloured

38
Q

Granular cell tumour?

A

Common on tongue - neural origin?

39
Q

Congenital epulis?

A

Similar to granular cell tumour histologically but occurs in neonates

40
Q

Differential diagnosis of mucosal swellings?

A

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