SCR - Oral Surgery/Histology Flashcards
FIBROUS EPULIS - what location of the mouth do they affect ?
Gingivae ONLY (peripheral lesion, no central involvement).
FIBROUS EPULIS - what is the cause ?
Hyperplastic response to irritation - overhangs or subgingival calculus.
Therefore, high recurrence if cause is not removed.
FIBROUS EPULIS - describe the clinical characteristics.
Smooth surface, round swelling, pink, pedunculated, posterior gingivae affected most, firm.
FIBROUS EPULIS - how should they be managed ?
Excisional biopsy with Coe pack dressing.
Removal of cause.
FIBROUS EPULIS - what are some differential diagnoses ?
Benign odontogenic tumour (rare).
SSC (rare).
Lateral periodontal or gingival cyst.
Pyogenic granuloma - vascular epulis.
Peripheral giant cell lesion.
FIBROUS EPULIS - what are some histopathological features ?
Keratinised stratified squamous epithelium.
Hyperplastic epithelium covering granulation tissue.
Metaplastic bone formation.
Fibroblasts, plasma cells, macrophages, fibrin.
Blood vessels.
Ulceration.
What is granulation tissue ?
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.
What stain is used for histopathological analysis ?
Haematoxylin and eosin staining (H&E).
PYOGENIC GRANULOMA - what are the two types affecting gingivae ?
Pregnancy epulis. Vascular epulis.
PYOGENIC GRANULOMA - has same histological appearance as what lesion ?
Fibrous epulis.
- Granulation tissue.
- Capillaries and blood vessels.
- Fibroblasts and neutrophils.
- Ulceration.
PYOGENIC GRANULOMA - where are they most commonly found ?
Tongue and lip - can be found on gingivae too.
PERIPHERAL GIANT CELL GRANULOMA - where are they most commonly found ?
Gingivae.
PERIPHERAL GIANT CELL GRANULOMA - what medical conditions are most commonly associated ?
Increased PTH - low vit D, malabsorption, renal disease.
TB.
Sarcoidosis.
Chronic inflammatory conditions.
PYOGENIC GRANULOMA - how should they be managed ?
Surgical excision and curettage.
PERIPHERAL GIANT CELL GRANULOMA - what is the clinical characteristics ?
Deep red or purple, chronic irritation, broad base.
PERIPHERAL GIANT CELL GRANULOMA - what age range are most commonly affected ?
Children and teenagers.
PERIPHERAL GIANT CELL GRANULOMA - how should they be managed ?
Rule out high PTH.
X-ray to rule out central giant cell granuloma.
Surgical excision and curettage of base + Coe pack dressing.
CENTRAL GIANT CELL GRANULOMA - how would they appear on an OPT ?
Radiolucency at alveolar bone level.
Can cause root resorption of teeth.
PERIPHERAL GIANT CELL GRANULOMA - what are the histological features ?
Multinucleated giant cells present.
Red blood cells and vascular stroma.
Fibroblasts.
Haemosiderin.
PERIPHERAL GIANT CELL GRANULOMA - what are multinucleated giant cells ?
Fused macrophages due to unphagocytosable material.
FIBROEPITHLIAL POLY (TRAUMATIC FIBROMA) - what locations of the mouth do they commonly affect ?
Cheek, lip, tongue.
FIBROEPITHLIAL POLYP (TRAUMATIC FIBROMA) - what is the clinical appearance ?
Semi pedunculated/sessile, pink, smooth surface.
FIBROEPITHLIAL POLY (TRAUMATIC FIBROMA) - how should they be managed ?
Remove and address cause.
Can shrink in size or remove.
FIBROEPITHLIAL POLY (TRAUMATIC FIBROMA) - what are the histopathological features ?
Fibrous tissue covered by thick epithelium.
Keratinised stratified squamous epithelium.
Collagen fibres.
DENTURE INDUCED HYPERPLASIA - what is the cause ?
Ill-fitting denture.
Can be seen with ulceration and trauma.
Can be problematic in denture construction.
DENTURE INDUCED HYPERPLASIA - how should this be managed ?
Denture with soft lining to let settle.
New denture construction.
If persists for >4 weeks - refer for biopsy.
LEAF FIBROMA - is what lesion but compressed by denture ?
Fibroepithelial polyp.
LEAF FIBROMA - how should they be managed ?
Remove and address cause - new denture.
PAPILLARY HYPERPLASIA OF PALATE - what is a differential diagnosis ?
Invasive squamous cell carcinoma.
PAPILLARY HYPERPLASIA OF PALATE - what are the histopathological features ?
Pseudoepithlialmatous hyperplasia.
Extending to CT.
Epithelial cells are normal and show no dysplastic change.
Candida can be present.
HAEMANGIOMA - what are the two types ?
Capillary and cavernous.
HAEMANGIOMA - what are the clinical features ?
Blue, soft, bleeds easily, can become more fibrotic, can shrink, leaves birth mark.
HAEMANGIOMA - how can they be managed ?
Surgical removal.
Cryotherapy.
HAEMANGIOMA - what is the disadvantage of cryotherapy ?
Lesion cannot be biopsied - be sure of diagnosis.
SQUAMOUS CELL PAPILLOMA - what are the clinical features ?
Pedunculated, white surface, cauliflower appearance, benign neoplasm, can look like viral warts.
SQUAMOUS CELL PAPILLOMA - how should they be managed ?
Excision.
SQUAMOUS CELL CARCINOMA - what is the classic appearance ?
Non-healing ulcer/lump, rolled margin, induration, bleeds easily, fixed to surrounding tissue, red or white in colour.
SQUAMOUS CELL CARCINOMA - how should they be managed ?
Incisional biopsy via rapid access pathway (2 week urgent referral).
POTENTIAL MALIGNANT DISORDERS - Define potentially malignant disorder.
Altered tissue which makes cancer more likely AND generalised state with increased cancer risk.
POTENTIAL MALIGNANT DISORDERS - What are some predictors of malignancy ?
Age, smoking status, HPV status, gender, site, non-homogenous (mixed or verrucous), proliferative verrucous leukoplakia, molecular markers (p53), non-cohesive front.
POTENTIAL MALIGNANT DISORDERS - What HPV status is more likely to be potentially malignant ?
HPV-
POTENTIAL MALIGNANT DISORDERS - what areas of the mouth are high risk ?
Floor of mouth and tongue.
POTENTIAL MALIGNANT DISORDERS - what architectural atypia is most commonly associated with lymph node involvement ?
Non-cohesive front.
Perineural spread.
Haematogenous spread.
POTENTIAL MALIGNANT DISORDERS - what are histopathological signs of chronic hyperplastic candidasis ?
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.
POTENTIAL MALIGNANT DISORDERS - what type of staining helps visualise candida hyphae in chronic hyperplastic candidasis ?
Periodic Schiff staining - removes carbohydrate and then stain.
Better visualisation.
POTENTIAL MALIGNANT DISORDERS - how should chronic hyperplastic candidasis be managed ?
Systemic antifungals - 50mg 1x daily 14 days fluconazole.
Incisional biopsy.
Smoking cessation.
Active observation with clinical photographs.
