ORAL PATH soft tissue neoplasms

Question 1

list the types of soft tissue neoplasms?

Answer 1

tumours of fibrous tissue
tumours of adipose tissue
tumours of vascular tissue
tumours of peripheral nerves
tumours of muscle

Question 2

how would you classify majority of intraoral fibrous lesions?

Answer 2

benign overgrowths

Question 3

what is a fibrosarcoma?

Answer 3

malignant tumour of fibrous tissue
neoplastic fibroblasts with variable amount of collagen
rare in oral cavity
rarely metastasises

Question 4

fibrosarcoma treatment?

Answer 4

radical excision
can recur

Question 5

what are the 2 types of tumours of adipose tissue?

Answer 5

lipoma (benign)
liposarcoma (malignant)

Question 6

clinical features of lipoma?

Answer 6

soft smooth swelling
pedunculated or sessile
asymptomatic
can be yellowish or pink
buccal mucosa most common intraoral site
pt typically adults 40+

Question 7

histopathology of lipoma?

Answer 7

well-circumscribed lesion
thin capsule
lobules of mature fat cells
bands (septa) or fibrous tissue

Question 8

lipoma treatment?

Answer 8

excision

Question 9

treatment for liposarcoma?

Answer 9

radical excision

Question 10

list the types of tumours of vascular tissue?

Answer 10

haemangioma
lymphangioma
kaposi sarcoma
angiosarcoma

Question 11

haemangioma clinical features?

Answer 11

vascular hamartomatous lesion/ developmental lesions/ benign neoplasm
wide age range
common in children esp females
dark red/ purple swelling
blanch on pressure

Question 12

what angiomatous syndrome may haemangioma be apart of?

Answer 12

sturge-weber syndrome

Question 13

histopathology of haemangioma?

Answer 13

juvenile - very cellular endothelial proliferation
capillary and cavernous depending on size of vascular spaces:
capillary - lots of small blood vessels
cavernous - large blood filled spaces

Question 14

what may oral haemangiomas involve?

Answer 14

muscle, bone and salivary glands

Question 15

treatment for haemangiomas?

Answer 15

haemangiomas in infants/ young children often regress
hamartomatous lesions removal by cryosurgery

Question 16

clinical features of lymphangioma?

Answer 16

rare
pale swelling
often present in childhood
malformation of lymphatic vessels
may be bleeding into lesion
can be localised or diffuse lesion
may present in neck (cystic hygroma)

Question 17

histopatholgy of lymphangioma?

Answer 17

subepithelial collection of dilated lymphatic channels
vessels contain lymph

Question 18

treatment of lymphangioma?

Answer 18

excision

Question 19

what is Kaposi sarcoma?

Answer 19

locally aggressive (intermediate grade) tumour of endothelial cells
associated with HHV-8 infection

Question 20

what are the 4 variants of kaposis sarcoma?

Answer 20

classic
endemic
AIDS-associated
iatrogenic (immunosuppression associated)

Question 21

clinical features of kaposis sarcoma?

Answer 21

palate and gingivae most common IO sites
purplish/ red lesion
becomes increasingly nodular
lesions frequently bleed

Question 22

treatment for kaposis sarcoma?

Answer 22

antiretroviral therapy/ chemotherapy

Question 23

what is an angiosarcoma?

Answer 23

malignant tumour of vascular endothelium
very rare in oral cavity
forehead and scalp of older pts

Question 24

treatment of angiosarcoma?

Answer 24

excision +/- radiotherapy
has poor prognosis

Question 25

list the types of tumours of peripheral nerves?

Answer 25

neurofibroma neurilemmoma 'traumatic neuroma' malignant peripheral nerve sheath tumours (MPNST)

Question 26

clinical features of neurofibroma?

Answer 26

benign peripheral nerve sheath tumour rare in the mouth smooth painless swelling affects tongue, gingivae, salivary glands or rarely intraosseous solitary or multiple associated with neurofibromatosis-1

Question 27

what disease poses significant risk for malignant transformation of neurofibroma?

Answer 27

NF-1

Question 28

histopathology of neurofibroma?

Answer 28

mixed cellular components including Schwann cells and intraneural fibroblasts spindle cells with wavy, dark-staining nuclei and scanty cytoplasm background of collagen fibres, myxoid stroma and occasional mast cells

Question 29

treatment of neurofibroma?

Answer 29

excision rarely recur

Question 30

clinical features of neurilemmoma (schwannoma)?

Answer 30

benign peripheral nerve sheath tumour schwann cell origin smooth painless swelling slow growing tongue most common site

Question 31

histopathology of neurilemmoma (schwannoma)?

Answer 31

encapsulated tumour spindled cells with palisaded nuclei (antoni A areas) loose, less cellular connective tissue (antoni B areas)

Question 32

treatment of neurilemmoma (schwannoma)?

Answer 32

excision unlikely to recur

Question 33

clinical features of traumatic neuroma?

Answer 33

reactive lesion after nerve damage - NOT a tumour smooth nodule tongue, lower lip, salivary gland history of trauma/ surgery uncommon may be painful

Question 34

histopathology of traumatic neuroma?

Answer 34

proliferation of nerve bundles random arrangment

Question 35

treatment of traumatic neuroma?

Answer 35

excision

Question 36

what genetic disease are malignant peripheral nerve sheath tumours associated with?

Answer 36

NF-1

Question 37

clinical features of malignant peripheral nerve sheath tumours?

Answer 37

painful quickly growing mass mandible, lips, buccal mucosa

Question 38

treatment for malignant peripheral nerve sheath tumours?

Answer 38

radical excision +/- adjuvant therapy

Question 39

what are the 2 types of tumours of smooth muscle?

Answer 39

leiomyoma (benign) leiomyosarcoma (malignant)

Question 40

clinical features of leiomyoma?

Answer 40

rare in oral cavity most arise from vascular smooth muscle slow growing nodule sometimes painful lips, tongue, palate, buccal mucosa

Question 41

histopathology of leiomyoma?

Answer 41

well-circumscribed proliferation of smooth muscle cells may be multiple vessels with thickened walls (angioleimyoma)

Question 42

treatment for leiomyoma?

Answer 42

local excision shouldnt recur

Question 43

clinical features of leiomyosarcoma?

Answer 43

very rare in oral cavity older pts enlarging mass which may be painful can metastasise

Question 44

treatment for leiomyosarcoma?

Answer 44

radical excision +/- adjuvant therapy

Question 45

what are the 2 types of tumours of skeletal muscle?

Answer 45

rhabdomyoma (benign) rhabdomyosarcoma (malignant)

Question 46

what are the 2 types of rhabdomyoma?

Answer 46

feotal adult

Question 47

clinical features of foetal rhabdomyoma?

Answer 47

young children (some adults) very rare male swelling face and ear region proliferation of immature muscle cells

Question 48

what must you distinguish rhabdomyoma from?

Answer 48

rhabdomyosarcoma

Question 49

foetal rhabdomyoma treatment?

Answer 49

local excision

Question 50

clinical features of adult rhabdomyoma?

Answer 50

older male patients FOM, tongue, soft palate often large slow growing mass

Question 51

adult rhabdomyoma treatment?

Answer 51

local excision can recur

Question 52

rhabdomyosarcoma clinical features?

Answer 52

more frequent in young children often painless rapidly growing mass head and neck most common site

Question 53

treatment for rhabdomyosarcoma?

Answer 53

radical excision +/- adjuvant therapy

Question 54

what histological patterns are found in rhabdomyosarcoma?

Answer 54

embryonal and alveolar

Question 55

granular cell tumour aetiology?

Answer 55

unknown it is a benign neuroectodermal tumour

Question 56

granular cell tumour clinical features?

Answer 56

tongue, buccal mucosa, FOM, palate wide age range, rare in children f>m submucosal, smooth painless swelling

Question 57

granular cell tumour histopathology?

Answer 57

large eosinophillic cells with granular cytoplasm in subepithelial tissue unencapsulated tend to merge with underlying skeletal muscle fibres marked hyperplasia of overlying epithelium

Question 58

granular cell tumour treatment?

Answer 58

excision

Question 59

congenital epulis/ congenital granular cell epulis aetiology?

Answer 59

unknown

Question 60

congenital epulis/ congenital granular cell epulis clinical features?

Answer 60

pink polypoid mass on alveolar of newborns anterior maxilla most frequent site f>m

Question 61

congenital epulis histopathology?

Answer 61

mass of large eosinophillic granular cells similar to those seen in granular cell tumour hyperplasia of overlying epithelium not seen immunohistochemistry different from granular cell tumour

Question 62

congenital epulis treatment?

Answer 62

excision, esp if breathing or feeding difficulties