ORAL PATH soft tissue hyperplastic lesions

Question 1

what are soft tissue hyperplastic lesions usually a response to?

Answer 1

trauma/ inflammation

Question 2

where can you find soft tissue hyperplastic lesions?

Answer 2

anywhere in the oral cavity

Question 3

what are soft tissue hyperplastic lesions known as when located on the gingiva?

Answer 3

epulis

Question 4

list the types of localised soft tissue hyperplastic lesions?

Answer 4

epulides
pyogenic granuloma
fibroepithelial polyp (giant cell fibroma)
denture irritation hyperplasia
papillary hyperplasia of the palate

Question 5

what are the 3 types of epulides (soft tissue hyperplastic lesions)?

Answer 5

fibrous epulis
pyogenic granuloma/ pregnancy epulis
giant cell epulis (peripheral giant cell granuloma)

Question 6

what are the clinical features of fibrous epulis?

Answer 6

pedunculated or sessile firm mass on gingiva, often between 2 teeth
pink in colour
wide age range

Question 7

describe the histopathology of a fibrous epulis?

Answer 7

nodular lesion
hyperplastic surface epithelium
cellular fibroblastic granulation tissue + collagen bundles
variable inflammation
calcification or metaplastic bone formation can be seen

Question 8

treatment for a fibrous epulis?

Answer 8

excision
remove source of irritation

Question 9

what are the clinical features of a pyogenic granuloma/ pregnancy epulis?

Answer 9

soft red/ purple swelling
often ulcerated
wide age range

Question 10

describe the histopathology of a pyogenic granuloma/ pregnancy epulis?

Answer 10

nodular lesion
surface epithelium often ulcerated
underlying vascular proliferation
oedematous fibrous stroma
variable inflammation (acute and chronic)

Question 11

treatment for pyogenic granuloma?

Answer 11

local excision
remove source of irritation

Question 12

treatment for pregnancy epulis?

Answer 12

good OH and perio treatment
lesions typically regress post-partum

Question 13

clinical features of giant cell epulis/ peripheral giant cell granuloma?

Answer 13

soft purplish gingival swelling
mostly on gum of teeth anterior to molar
F>M
wide age range esp 30-40 years

Question 14

what is the cause of giant-cell epulis/ peripheral giant cell granuloma?

Answer 14

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

Question 15

where would you find a giant-cell epulis/ peripheral giant cell granuloma?

Answer 15

gingiva/ alveolar ridge mucosa

Question 16

histopathology of giant-cell epulis/ peripheral giant cell granuloma?

Answer 16

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

Question 17

what must a giant cell epulis/ peripheral giant cell granuloma be distinguished from?

Answer 17

central giant cell lesion perforating bone e.g., central giant cell granuloma, hyperparathyroidism

Question 18

treatment for giant cell epulis/ peripheral giant cell granuloma?

Answer 18

excision of lesion and remove source of irritation
curettage of underlying bone to reduce chance of recurrence

Question 19

clinical features of fibroepithelial polyp?

Answer 19

pink smooth mucosal polyp
very common
wide age range
located on buccal mucosa, lip, tongue
if found under denture = leaf fibroma

Question 20

histopathology of fibroepithelial polyp?

Answer 20

polypoid lesion with core of dense scar-like fibrous tissue
overlying stratified squamous epithelium may be hyperplastic
typically little inflammation

Question 21

treatment for fibroepithelial polyp?

Answer 21

excision of lesion

Question 22

what is a variant of fibroepithelial polyp often seen on the gingivae and tongue?

Answer 22

giant cell fibroma

Question 23

clinical features of denture irritation hyperplasia?

Answer 23

broad-based leaf like folds of tissue related to periphery of badly fitting denture
typically pale, fibrous swelling
may be ulcerated

Question 24

histopathology of denture irritation hyperplasia?

Answer 24

hyperplastic fibrous connective tissue
hyperplasia of the overlying epithelium
may show focal ulceration
variable inflammation, often acute and chronic
may be superadded candida infection

Question 25

treatment for denture irritation hyperplasia?

Answer 25

excision (and new dentures)

Question 26

clinical features of papillary hyperplasia of the palate?

Answer 26

numerous small tightly packed nodular lesions
involves all or part of denture bearing area of palate
typically in older patients, ill-fitting dentures
can also be seen in non-denture wearers
may be superadded candidal infection (not causative)

Question 27

histopathology of papillary hyperplasia of the palate?

Answer 27

papillary/ nodular projections
underlying hyperplastic, chronically-inflamed vascular fibrous tissue
hyperplastic overlying epithelium
fungal organisms with acute inflammation may be seen

Question 28

what is periodic acid schiff (PAS)?

Answer 28

A special stain to highlight fungi - can be seen in papillary hyperplasia

Question 29

treatment of papillary hyperplasia of the palate?

Answer 29

good denture hygiene
antifungals if indicated
rarely surgery