ORAL PATH soft tissue hyperplastic lesions Flashcards
what are soft tissue hyperplastic lesions usually a response to?
trauma/ inflammation
where can you find soft tissue hyperplastic lesions?
anywhere in the oral cavity
what are soft tissue hyperplastic lesions known as when located on the gingiva?
epulis
list the types of localised soft tissue hyperplastic lesions?
epulides
pyogenic granuloma
fibroepithelial polyp (giant cell fibroma)
denture irritation hyperplasia
papillary hyperplasia of the palate
what are the 3 types of epulides (soft tissue hyperplastic lesions)?
fibrous epulis
pyogenic granuloma/ pregnancy epulis
giant cell epulis (peripheral giant cell granuloma)
what are the clinical features of fibrous epulis?
pedunculated or sessile firm mass on gingiva, often between 2 teeth
pink in colour
wide age range
describe the histopathology of a fibrous epulis?
nodular lesion
hyperplastic surface epithelium
cellular fibroblastic granulation tissue + collagen bundles
variable inflammation
calcification or metaplastic bone formation can be seen
treatment for a fibrous epulis?
excision
remove source of irritation
what are the clinical features of a pyogenic granuloma/ pregnancy epulis?
soft red/ purple swelling
often ulcerated
wide age range
describe the histopathology of a pyogenic granuloma/ pregnancy epulis?
nodular lesion
surface epithelium often ulcerated
underlying vascular proliferation
oedematous fibrous stroma
variable inflammation (acute and chronic)
treatment for pyogenic granuloma?
local excision
remove source of irritation
treatment for pregnancy epulis?
good OH and perio treatment
lesions typically regress post-partum
clinical features of giant cell epulis/ peripheral giant cell granuloma?
soft purplish gingival swelling
mostly on gum of teeth anterior to molar
F>M
wide age range esp 30-40 years
what is the cause of giant-cell epulis/ peripheral giant cell granuloma?
local irritation by dental calculus, plaque deposits, retained tooth roots or other chronic irritation
reactive proliferation of mononuclear cells and osteoclasts in a vascular stroma located in the soft tissues of gingiva or alveolar ridge mucosa
where would you find a giant-cell epulis/ peripheral giant cell granuloma?
gingiva/ alveolar ridge mucosa
histopathology of giant-cell epulis/ peripheral giant cell granuloma?
collections of lots of multinucleated osteoclast-like giant cells in rich vascular and cellular stroma
narrow zone of fibrous tissue with dilated blood vessels separates lesion from overlying epithelium
what must a giant cell epulis/ peripheral giant cell granuloma be distinguished from?
central giant cell lesion perforating bone e.g., central giant cell granuloma, hyperparathyroidism
treatment for giant cell epulis/ peripheral giant cell granuloma?
excision of lesion and remove source of irritation
curettage of underlying bone to reduce chance of recurrence
clinical features of fibroepithelial polyp?
pink smooth mucosal polyp
very common
wide age range
located on buccal mucosa, lip, tongue
if found under denture = leaf fibroma
histopathology of fibroepithelial polyp?
polypoid lesion with core of dense scar-like fibrous tissue
overlying stratified squamous epithelium may be hyperplastic
typically little inflammation
treatment for fibroepithelial polyp?
excision of lesion
what is a variant of fibroepithelial polyp often seen on the gingivae and tongue?
giant cell fibroma
clinical features of denture irritation hyperplasia?
broad-based leaf like folds of tissue related to periphery of badly fitting denture
typically pale, fibrous swelling
may be ulcerated
histopathology of denture irritation hyperplasia?
hyperplastic fibrous connective tissue
hyperplasia of the overlying epithelium
may show focal ulceration
variable inflammation, often acute and chronic
may be superadded candida infection
