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BDS4 CDS Oral Surgery > SCR - Oral Surgery/Histology > Flashcards

SCR - Oral Surgery/Histology Flashcards

1
Q

FIBROUS EPULIS - what location of the mouth do they affect ?

A

Gingivae ONLY (peripheral lesion, no central involvement).

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2
Q

FIBROUS EPULIS - what is the cause ?

A

Hyperplastic response to irritation - overhangs or subgingival calculus.
Therefore, high recurrence if cause is not removed.

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3
Q

FIBROUS EPULIS - describe the clinical characteristics.

A

Smooth surface, round swelling, pink, pedunculated, posterior gingivae affected most, firm.

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4
Q

FIBROUS EPULIS - how should they be managed ?

A

Excisional biopsy with Coe pack dressing.
Removal of cause.

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5
Q

FIBROUS EPULIS - what are some differential diagnoses ?

A

Benign odontogenic tumour (rare).
SSC (rare).
Lateral periodontal or gingival cyst.
Pyogenic granuloma - vascular epulis.
Peripheral giant cell lesion.

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6
Q

FIBROUS EPULIS - what are some histopathological features ?

A

Keratinised stratified squamous epithelium.
Hyperplastic epithelium covering granulation tissue.
Metaplastic bone formation.
Fibroblasts, plasma cells, macrophages, fibrin.
Blood vessels.
Ulceration.

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7
Q

What is granulation tissue ?

A

New CT and microscopic blood vessels formed during tissue healing.
Grows from base of a lesion - wound healing by secondary intention.
Sign of cellular developmental and MMPs.

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8
Q

What stain is used for histopathological analysis ?

A

Haematoxylin and eosin staining (H&E).

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9
Q

PYOGENIC GRANULOMA - what are the two types affecting gingivae ?

A

Pregnancy epulis. Vascular epulis.

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10
Q

PYOGENIC GRANULOMA - has same histological appearance as what lesion ?

A

Fibrous epulis.
- Granulation tissue.
- Capillaries and blood vessels.
- Fibroblasts and neutrophils.
- Ulceration.

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11
Q

PYOGENIC GRANULOMA - where are they most commonly found ?

A

Tongue and lip - can be found on gingivae too.

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12
Q

PERIPHERAL GIANT CELL GRANULOMA - where are they most commonly found ?

A

Gingivae.

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13
Q

PERIPHERAL GIANT CELL GRANULOMA - what medical conditions are most commonly associated ?

A

Increased PTH - low vit D, malabsorption, renal disease.
TB.
Sarcoidosis.
Chronic inflammatory conditions.

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14
Q

PYOGENIC GRANULOMA - how should they be managed ?

A

Surgical excision and curettage.

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15
Q

PERIPHERAL GIANT CELL GRANULOMA - what is the clinical characteristics ?

A

Deep red or purple, chronic irritation, broad base.

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16
Q

PERIPHERAL GIANT CELL GRANULOMA - what age range are most commonly affected ?

A

Children and teenagers.

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17
Q

PERIPHERAL GIANT CELL GRANULOMA - how should they be managed ?

A

Rule out high PTH.
X-ray to rule out central giant cell granuloma.
Surgical excision and curettage of base + Coe pack dressing.

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18
Q

CENTRAL GIANT CELL GRANULOMA - how would they appear on an OPT ?

A

Radiolucency at alveolar bone level.
Can cause root resorption of teeth.

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19
Q

PERIPHERAL GIANT CELL GRANULOMA - what are the histological features ?

A

Multinucleated giant cells present.
Red blood cells and vascular stroma.
Fibroblasts.
Haemosiderin.

20
Q

PERIPHERAL GIANT CELL GRANULOMA - what are multinucleated giant cells ?

A

Fused macrophages due to unphagocytosable material.

21
Q

FIBROEPITHLIAL POLY (TRAUMATIC FIBROMA) - what locations of the mouth do they commonly affect ?

A

Cheek, lip, tongue.

22
Q

FIBROEPITHLIAL POLYP (TRAUMATIC FIBROMA) - what is the clinical appearance ?

A

Semi pedunculated/sessile, pink, smooth surface.

23
Q

FIBROEPITHLIAL POLY (TRAUMATIC FIBROMA) - how should they be managed ?

A

Remove and address cause.
Can shrink in size or remove.

24
Q

FIBROEPITHLIAL POLY (TRAUMATIC FIBROMA) - what are the histopathological features ?

A

Fibrous tissue covered by thick epithelium.
Keratinised stratified squamous epithelium.
Collagen fibres.

25
Q

DENTURE INDUCED HYPERPLASIA - what is the cause ?

A

Ill-fitting denture.
Can be seen with ulceration and trauma.
Can be problematic in denture construction.

26
Q

DENTURE INDUCED HYPERPLASIA - how should this be managed ?

A

Denture with soft lining to let settle.
New denture construction.
If persists for >4 weeks - refer for biopsy.

27
Q

LEAF FIBROMA - is what lesion but compressed by denture ?

A

Fibroepithelial polyp.

28
Q

LEAF FIBROMA - how should they be managed ?

A

Remove and address cause - new denture.

29
Q

PAPILLARY HYPERPLASIA OF PALATE - what is a differential diagnosis ?

A

Invasive squamous cell carcinoma.

30
Q

PAPILLARY HYPERPLASIA OF PALATE - what are the histopathological features ?

A

Pseudoepithlialmatous hyperplasia.
Extending to CT.
Epithelial cells are normal and show no dysplastic change.
Candida can be present.

31
Q

HAEMANGIOMA - what are the two types ?

A

Capillary and cavernous.

32
Q

HAEMANGIOMA - what are the clinical features ?

A

Blue, soft, bleeds easily, can become more fibrotic, can shrink, leaves birth mark.

33
Q

HAEMANGIOMA - how can they be managed ?

A

Surgical removal.
Cryotherapy.

34
Q

HAEMANGIOMA - what is the disadvantage of cryotherapy ?

A

Lesion cannot be biopsied - be sure of diagnosis.

35
Q

SQUAMOUS CELL PAPILLOMA - what are the clinical features ?

A

Pedunculated, white surface, cauliflower appearance, benign neoplasm, can look like viral warts.

36
Q

SQUAMOUS CELL PAPILLOMA - how should they be managed ?

A

Excision.

37
Q

SQUAMOUS CELL CARCINOMA - what is the classic appearance ?

A

Non-healing ulcer/lump, rolled margin, induration, bleeds easily, fixed to surrounding tissue, red or white in colour.

38
Q

SQUAMOUS CELL CARCINOMA - how should they be managed ?

A

Incisional biopsy via rapid access pathway (2 week urgent referral).

39
Q

POTENTIAL MALIGNANT DISORDERS - Define potentially malignant disorder.

A

Altered tissue which makes cancer more likely AND generalised state with increased cancer risk.

40
Q

POTENTIAL MALIGNANT DISORDERS - What are some predictors of malignancy ?

A

Age, smoking status, HPV status, gender, site, non-homogenous (mixed or verrucous), proliferative verrucous leukoplakia, molecular markers (p53), non-cohesive front.

41
Q

POTENTIAL MALIGNANT DISORDERS - What HPV status is more likely to be potentially malignant ?

A

HPV-

42
Q

POTENTIAL MALIGNANT DISORDERS - what areas of the mouth are high risk ?

A

Floor of mouth and tongue.

43
Q

POTENTIAL MALIGNANT DISORDERS - what architectural atypia is most commonly associated with lymph node involvement ?

A

Non-cohesive front.
Perineural spread.
Haematogenous spread.

44
Q

POTENTIAL MALIGNANT DISORDERS - what are histopathological signs of chronic hyperplastic candidasis ?

A

Irregular hyperplastic epithelium - acanthosis.
Excessive keratin.
Candida hyphae in epithelium.
Inflammatory infiltrate at lamina propria.
Dysplasia - mitotic figures - loss of polarity of basal cells.
Neutrophils in epithelium causing microabscesses.

45
Q

POTENTIAL MALIGNANT DISORDERS - what type of staining helps visualise candida hyphae in chronic hyperplastic candidasis ?

A

Periodic Schiff staining - removes carbohydrate and then stain.
Better visualisation.

46
Q

POTENTIAL MALIGNANT DISORDERS - how should chronic hyperplastic candidasis be managed ?

A

Systemic antifungals - 50mg 1x daily 14 days fluconazole.
Incisional biopsy.
Smoking cessation.
Active observation with clinical photographs.

BDS4 CDS Oral Surgery (18 decks)

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