Reactive lesions of Oral Mucosa Flashcards
What is an epulis?
Soft tissue swelling on gingiva only
Called a polyp if located anywhere else
Exaggerated response to irritation and inflammation causing hyperplasia (perhaps from gingivitis/periodontitis)
Easy to remove, but if stimulus is not removed they reoccur
Bleeds sometimes
What are the other causes of soft swellings on gingivae?
Odontogenic tumours
Cysts
What malignancy is most likely to arise from gingivae?
SSC
What are the histological features of fibrous epulis?
Fibrous tissue forms bulk of swelling
Keratinised epithelium SSE as on gingiva
Hyperplastic areas- thicker than normal
On part with no epithelium- this is due to ulceration (occurs because of trauma from food and toothbrushing)
Fibrin- appears pink
Granulation tissue under fibrous layer
Bone may form within- due to metaplasia (dycastic bone- stem cells are reprogrammed to produce bone)
Plasma cells (chronic inflammatory cells)- form immunoglobulins (may be present due to ulceration- as pathogens will be trying to get into tissue or due to periodontal disease)
What cells are generally responsible for phagocytosis?
Macrophages
How is a fibrous epulis/polyps treated?
Excision biopsy
What are the histological features of Granulation tissue? (first stage in healing)
Many blood vessels (appear red on stain)
Fibroblasts (form collagen)
Inflammatory cells- mostly macrophages (remove debris, prevent against inflammation)
Neutrophils
-> Chronic inflammation subsides giving fibrous tissue
What are the features of giant cell epulis?
Peripheral giant cell granuloma- deep red/purple colour
Bleeds
Tends to happen anterior to molars
What are the histological characteristics of GC epulis?
Multi nucleated Giant cells (formed by fusion of macrophages)
No capsule (obviously different from healthy tissues)
Granulation tissue
Presence of capillaries and BV- bleeding into tissues
Hourglass appearance
How are giant cell epulides treated?
Excision biopsy
What are the types of giant cells?
Osteoclasts- bone resorption
Langherans giant cells- respond to trauma and inflammation
What do giant cells left at margin of lesion suggest?
That it has not been fully excised and may recur
What are the histological features of granulomatous inflammation?
Multi-nucleated giant cells
Lymphocytes
Macrophages (epithelioid cells appear like epithelium)
What condition is a central giant cell granuloma associated with? (central lesion that presents as epulis)
Hyperparathyroidism
What conditions is granulomatous inflammation associated with?
OFG
Crohns
Sarcoidosis
What are the features of a vascular epulis?
Yellow fibrinous surface- ulceration
Bleeds easily
Soft mass
Exaggerated repose to tissue insult
Can be caused by hormonal changes in pregnancy or OCP use
Occurs at any age
Presence of connective tissue- fibroblasts and collagen
Why is it better to leave a pregnancy epulis until baby is born?
Tend to become more fibrous and shrink when hormones go back to normal
-> if not exisional biopsy
What causes bubbles to be present in fibrous tissue?
Oedema
What is a pyogenic granuloma?
Failure of normal healing at wound site
-> overgrowth of granulation tissue
-> appears red
-> may have pus
“vascular epulis not on gingiva”
What is vascular hamartoma?
Developmental vascular malformation (appear when skin thins)
-> Exophytic blood filled lesions
What is a vascular hamartoma in new-born child called?
Hameangioma- bunch of grapes appearance
What is a hamartoma of the dental tissues?
Odontome
What are the types of haemangioma?
Capillary type- lots of capillaries
Cavernous type- large blood filled space
What is lymphangioma?
Benign mass of lymphatic tissue/vessels
What is a Haematoma?
Bleeding into tissues- can be associated with fracture
-> gradually disappears
How are haemangiomas treated?
Cryotherapy
Excision biopsy
What are the histological features of fibroepithelial polyp?
Collagen- pink wavy structures
Fibroblasts
Lacking BVs/inflammatory cells
Keratin layer- thicker this is means polyp appears paler
How are fibrous polyps under dentures managed?
Tissue conditioner
Excision biopsy (especially if it persists for 3 weeks)
What special stain is used for melanin?
Silver satin- has affinity for melanin (appears black)
H and E- appears brown
What are the exogenous sources of pigementations?
Amalgam
-> giant cell lesions around these as it is dealt with as foreign object- foreign body giant cell granuloma
Smoking (irritates melanocytes),
Increased lead/bismuth (appears as black line on gingivae)
Tattoos
What is occurring histologically in reactive melanosis?
Keratosis of NK epithelium
Acanthosis
Melanocytes- no desmosomes
What is meant by para-keratosis?
Nuclei are present in keratin
What are desmosomes/hemidesmosomes?
Desmosomes- attach epithelium together- appear as prickles
Hemi- attaches epithelial cells to BM
What may reactive melanosis occur as a result of?
Smoking
Inflammation
LP
Drugs- antimalarials
Addisons
Following surgery
What is a lipoma?
Benign neoplasm of fat
How is lipoma treated?
Excisonal biopsy
What is squamous cell papilloma?
A viral wart caused by HPV 6/11 (pendunculated)
-> benign neoplasm
-> exophytic, cauliflower appearance
-> may get lesions on fingers
What are the oncogenic types of HPV?
16/18
-> OPC, oral cancer, cervical cancer
What are the histological characteristics of SCP?
Finger like projections
Has stalk
Epithelium on outside
Core- BV, fibroblasts, inflammatory cells due to viral infection of epithelium
Keratin on surface- thicker the lesion the more keratin
koilocytes- means virus present within epithelial cells (clear cytoplasm and dark nucleus)
How is SCP treated?
Exisional biopsy
What is denture hyperplasia?
Roll of excessive tissue between denture periphery and residual ridge
-> caused by chronic irritation/trauma due to poor fitting denture
How is denture hyperplasia treated?
Remove excess tissue
Reduce denture flange
What is a leaf fibroma? How is it treated?
FE polyp that has been squashed by denture
-> excision biopsy
What is a mucocele?
Mucous extravasation cyst
-> caused by damage to salivary glands
-> saliva leaks into submucosal area
What is a mucocele in floor of mouth called?
Ranula
What is a plunging ranula?
Mucocele occurring below mylohyoid muscle in submandibular/lingual space
How are mucoceles treated?
Excision
-> whole gland may have to be removed
What are the features of SSC?
Persisting non-healing ulcer type lesion
-> uneven rolled margins
-> exophytic
-> fixed
-> indurated
-> may have speckled appearance
How is SSC treated?
Incisional biopsy
-> urgent cancel referral pathway
