Soft lesions & salivary tumors and variant of normal combined-kerr Flashcards
Irritation Fibromas
Composed of
Etiology
Clinical features ;Color
Location
Treatment
- AKA – Fibroma, Traumatic Fibroma
- Composed of dense, scar-like, fibrous connective tissue
- Occurs as a result of chronic trauma
- Clinical Features: Exophytic lesion
- Usually less than a centimeter in diameter
- Color: lighter pink than surrounding mucosa,the surface can be white sometimes bc it’s rubbing and bumping into other oral structures (like teeth), so they get surface keratinization
- Locations: buccal mucosa, tongue, lips, gingiva
- Very common; totally benign soft lesion
- Treatment: You don’t have to remove them, but the surgical Tx = to excise them bc pts will stop biting them and they’ll heal and stop the irritation
What is this clinical finding?
Irritation Fibromas
What is this clinical finding?
Irritation Fibromas
What is this clinical finding?
Chronic Hyperplastic Pulpitis (pulp polyp)
Giant Cell Fibroma
Chronic Hyperplastic Pulpitis
What is it?
Location?
Age?
Clinical Appearance?
Treatment?
• AKA: pulp polyp
• An e_xcessive proliferation of chronically inflamed dental pulp tissue_ – granulation tissue/ fibrous tissue with inflammatory cells (like a little fibroma that
occurs from pulp tissue) ( benign soft tissue leasion)
• Location:
• Teeth with large, open carious lesions
• Primary or permanent molars
• Age: Children & young adults
• Clinical Appearance: A red or pink nodule of soft tissue protruding from the
pulp chamber and fills the entire cavity of the tooth
• Treatment: RCT or extraction of tooth
Giant Cell Fibroma
- Very small form of fibrous tumour that show giant cells
- Age: relatively rare in paediatric patients.
- Clinically it is presented as a painless, sessile, or pedunculated growth which is usually confused with other fibrous lesions like irritation fibromas or Retrocuspid papilla
- Location: Largely occur on lower gingivae and on palate\
What are these clinical findings (what is the name of the syndrome or complex?)
Tuberous sclerosis complex
we see A lot of gingival enlargement – is this overgrowth from disease or from seizure medication? Multi organ system involvement
What is this clinical finding?
Epulis Fissuratum
Cowden Syndrome
- (multiple hamartoma and neoplasia syndrome)
- • Autosomal dominant disorder affecting multiple organ systems
- • Caused by mutations in the phosphatase and tensin homolog gene (PTEN, a tumor suppressor gene)
- • Oral and perioral findings include
- *multiple papules on the lips and gingivae,**
- papillomatosis (benign fibromatosis) of the buccal, palatal, faucial, and oropharyngeal
- mucosae often producing a “cobblestone” effect, and the tongue may also present as pebbly or fissured.
- • Multiple papillomatous nodules (histologically inverted follicular keratoses or
- trichilemmomas) are often present on the perioral, periorbital, and perinasal skin, the pinnae of the ears, and neck.
- • These nodules are often accompanied by lipomas, hemangiomas, neuromas, vitiligo, café au lait spots, and acromelanosis .
- • A variety of neoplastic changes occur in the organs exhibiting hamartomatous lesions,with an increased rate of breast and thyroid carcinoma and gastrointestinal malignancy.
- Squamous cell carcinoma of the tongue and basal cell tumors of the perioral skin have also been reported.
- Incredibly rare ( board loves it)
What is this clinical finding?
Inflammatory Papillary Hyperplasia of the Palate
What is these clinical findings? (what is the name of the syndrome or complex?)
Cowden Syndrome
Very rare!
Tuberous sclerosis complex
• is an inherited disorder caused by mutations in the tuberous sclerosis complex (TSC1 or TSC2) genes
• Characterized by seizures and mental retardation associated with hamartomatous glial proliferations and neuronal deformity in the central nervous system.
• Fine wart-like lesions (adenoma sebaceum) occur in a butterfly distribution over the cheeks and forehead, and histologically similar lesions (vascular fibromas) have been described intraorally.
• Characteristic hypoplastic enamel defects (pitted enamel hypoplasia)
occur in 40 to 100% of those affected.
• Rhabdomyoma of the heart and other hamartomas of the kidney,
Epulis Fissuratum
AKA
Cause
Location
Clinical presentation
Composed of
Treatment
• AKA: denture-induced fibrous hyperplasia, fibrous inflammatory hyperplasia
• Cause: ill-fitting denture
• Location: vestibule (maxilla or mandible), along the
denture border
•Clinical presentation: Arranged in elongated folds of tissue into which the
denture flange fits; • Surface ulceration within the folds is common
• Composed of dense fibrous connective tissue
• Treatment: surgical excision (scalpel vs CO2 laser -laser is better)
and reline then remake of denture
What is the clinical finding?
Pyogenic Granuloma
We can see the corresponding radiograph;
-although the radiograph suggests generalized bone loss, there is a lot of calculus on
the distal of #16 > it makes sense that this is a pyogenic granuloma
What is this clinical finding?
Pyogenic Granuloma:
Pyogenic Granuloma
Histology
They are filled with blood vessels so they’re very very rich
in vascularization > they tend to bleed easily
What is this clinical finding?
A parulis
It is not a pyogenic granuloma
A parulis is a proliferation of granulation tissue at the opening of a sinus tract
When the infection breaks through the alveolar bone and presents itself,
it will sometimes cause this proliferation of granulation tissue
Inflammatory Papillary Hyperplasia of the Palate
Majority occur with what disease?
Associated with what?
Clinical appearance
Treatment
- Majority occur with denture stomatitis
- Associated with a removable full or partial denture or orthodontic
- appliance (Something you see in patients who wear denture all the time, don’t take it out, chronic denture wear)
-
Clinical Appearance: Palatal vault is covered by multiple erythematous papillary projections (fibrous connective tissue surfaced by epithelium) –(papillary but no papilla, instead it’s bumpy and bosselated)
- Granular or cobblestone appearance
- Erythema is usually due to superinfection with candida
- Treatment:Treat underlying candidiasis, fix denture. These bumps can be removed, take electrosurgery loop, and scrape off the bumps – heals well
What is this clinical finding?
Peripheral Ossifying or Cementifying Fibroma
Lesion in the image is pedunculated – put a periodontal probe on normal gingiva and glide along underneath it, there’s a stalk
Peripheral Ossifying Fibroma
Histology
- When sessile, when removing it, take scalpel blade and just cut into it
- If has a little bone or cementum formation inside it, you can feel the bone with the scalpel
What is this clinical finding?
Peripheral Giant Cell Granuloma
Peripheral Giant Cell Granuloma
Histology
Giant cells inside the lesion
What are the 3P
or 4P?
• Pyogenic granuloma/pregnancy tumor
• Peripheral ossifying**_or_**cementifying fibroma
• Peripheral giant cell granuloma
• Peripheral fibroma (4P)
Memorize these well!
All benign soft tissue lesions
Pyogenic Granuloma
What a differential diagonsis to consider if we see it
- if it’s on the gingival tissues, take a radiograph
- always consider SCC as a differential diagnosis
What is this clinical finding?
Inflammatory Gingival Enlargement
Example of someone with true hyperplastic gingivitis
Maybe related to very poor plaque control
In this case, either porcelain or porcelain fused to metal full coverage restorations that have very
bulky margins, and that may play a role for food to pick up
Pyogenic Granuloma
What is it?
Etiology
Assossiated with which demographics?
Location?
Treatment?
- What is it? Reactive connective tissue hyperplasia - exuberant granulation tissue; Misnomer – not pyogenic and not a true granuloma
- Etiology: Response to injury - calculus or overhang restoration
- Assosiated with? Often occurs in pregnant women (“pregnancy tumor”), also associated with puberty
- Treatment: Excision and removal of irritant (eg calculus, overhanging restorations)
What is the Differential diagnosis of gingival enlargement
Acute Myelogenous Leukemia (AML)
Wegener’s Granulomatosis
Kaposi Sarcoma
Plasma Cell Gingivitis
Generalized gingival enlargement – all different cases and diseases
How to differentiate Pyogenic Granuloma from the other 2Ps ?
(Peripheral ossifying or cementifying fibroma & Peripheral giant cell granuloma)
- They often occur in the gingival, but can occur in multiple areas
- that’s the one thing that distinguishes this from the other 2 P’s: pyogenic granuloma can occur on ANY oral site, most commonly on the gingival tissues
What is this clinical finding?
Hereditary Gingivofibromatosis
Infantile
Hemangioma
(“strawberry” hemangioma).
Infant with two red, nodular masses on
the posterior scalp and neck
Neville Cr
Pyogenic Granuloma
Clinical appearance
Location
Size
Developing rate
Age:
- Clinical appearance
- Usually ulcerated
- Soft exophytic lesion, either sessile or pedunculated
- Deep red to purple in color, bleeds easily
-
Location:
- Most common – gingiva
- Also occurs in other areas of the oral mucosa ( can happen anywhere)
- Size: small to large (millimeters to centimeters)
- Develop rapidly and then remain static
- Age: Any age
How to recogonize a capillary Malformation?
When you apply pressure to it, it evacuates the lesion (disappears!), when you pull away, it refills and you see it again – that tells you it’s a vascular lesion
What is this clinical finding?
Capillary
Malformation (Low
flow)
How to differentiate between
Venous
malformation (low
flow)
from
Arteriovenous or
arteriolar malformations
(High flow)
Venous malformation
(Low flow)
No bruit, non-pulsatile
vs
Arteriovenous or
arteriolar malformations
(High flow)
Bruit and pulsatile
In other word, Venous lesion = Does not have pulse
Histopathologically they look different too
Treatment:
-Don’t biopsy this unless it’s rapidly growing, if it is rapidly growing then suspect ► angiosarcoma? ( unlikely)
-can be surgically treated by oral surgeons -clamping off the blood vessel and dissecting it out, or putting a sclerosis agent
What is this clinical finding?
Venous
malformation (low
flow)
Many pts can live with this without treatment
What are these clinical findings ( which syndrome or complex is this)?
Osler-Weber-Rendu
Syndrome
What are these clinical findings? (What is the syndrome or complex)?
Sturge-Weber
Angiomatosis
Sturge-Weber syndrome
What are these clinical findings (What is the syndrome or complex)?
Sturge-Weber
Angiomatosis
Sturge-Weber syndrome
Notice how the vascular malformation is only one side..
Remember: Vascular changes follow trigeminal nerve, so it doesn’t cross midline
What is this clinical finding?
Lymphangioma
What is this clinical finding?
Cystic Hygroma
a type of Lymphangioma
Peripheral Ossifying or Cementifying Fibroma
What is it?
Clinical appearance
Derived from
Age
Sex
Reccurance rate
Treatment
- a reactive benign soft tissue lesion
- Clinical appearance: Well-demarcated, sessile or pedunculated lesion that appears to originate from the gingival interdental papilla
- Derived from: cells of the periodontal ligament
- Age: children and young adults
- Sex: females more than males
- Recurrence rate – about 16%
- Treatment: Surgical excision
What is this clinical finding?
Neuroma
(Traumatic Neuroma)
Not a benign true neoplasm, it’s reactive lesion
This is an edentulous patient, so resorbed bone, so flange of denture is impinging in the area of mental foramen – develop from repeated trauma
Sometimes have to cut into nerve, peel the neuroma from nerve, careful not to sever nerve
What are these clinical findings (Which syndrome or complex)?
Multiple Endocrine
Neoplasia (MEN)
Syndrome
What is this clinical finding?
neurofibroma
-it looks like lymphoepithelial cyst, but this is further anterior and not where you would get
lymphoid tissue – so it’s not lymphoepithelial cyst, it’s neurofibroma
Yellow – nerves typically yellow
What is this clinical finding?
neurofibroma
Peripheral Giant Cell Granuloma
What is it?
Location?
Age?
Clinical appearance:
Radiographic finding?
- What is it? Probably a reactive lesion due to local irritating factors (giant cells develop inside the lesion which is a benign soft tissue lesion)
- Location: Gingiva, usually anterior to the molars
- Age: Most frequently seen between 40-60 years old
- Clinical appearance: dusky purple, sessile or pedunculated, smooth-surfaced, dome-shaped papule or nodule. Most lesions are less than 1.5 cm in diameter, though infrequently, may grow as large as 5 cm in greatest dimension
- Radiographic Features: Usually none, but superficial destruction of the alveolar bone may occur
What are these clinical findings (which syndrome or complex)?
Neurofibromatosis syndrome
von Recklinghausen’s Disease
- Lisch nodules on iris, pigmented (eye picture)
- Neurofibromatosis in mouth (bottom left picture)
- Café au lait (bottom right picture)
What is the clinical finding?
Schwannoma/ Neurilemoma
What is this clinical finding?
Schwannoma/ Neurilemoma
Schwannoma/ Neurilemoma
Histology
Antoni A and Antoni B.
Streaming fascicles of spindle-shaped Schwann cells characterize Antoni A tissue.
These cells
often form a palisaded arrangement around central acellular, eosinophilic areas known as Verocay bodies. Antoni B
tissue is less cellular and less organized; the spindle cells are randomly arranged within a loose, myxomatous stroma.
What is this clinical finding?
Granular Cell Tumor
What is this clinical finding?
Granular Cell Tumor
Granular Cell Tumor
Histology
Has pseudoepitheliomatus hyperplasia of epithelium (seen on left picture)
Characteristic feature are the granular cells on the right picture
Infiltrate down into the muscle layers, that’s when pathologist confirms granular cell tumor
Diagnosis and Treatment
of the 3Ps
•Diagnosis: All 3 “P” lesions usually occur on gingival interdental papillae ( however pyogenic granuloma can occur anywhere)
• Since they can look similar clinically, excisional biopsy necessary to
determine diagnosis
• Treatment: complete excision and removal of local irritant (scaling
and root planing)
What is this clinical finding?
Congenital Epulis
Gingival Enlargement
Etiology
- Response to chronic inflammation
- Hormonal changes (pregnancy/puberty)
- Immune-mediated/plasma cell gingivitis
- Drug induced
- Genetic/ Inherited
NOTE: Gingival enlargement is not always hyperplastic tissue
What is this clinical finding?
Neuroectodermal tumor of infancy
look how they removed it here surgically
is rare, rapidly growing, pigmented neoplasm of neural crest origin. It is generally accepted as a benign tumour despite of its rapid and locally destructive growth.
Lipoma
What is it?
Location?
Cliniclly?
Histologically?
Treatment?
- What is it: Benign tumor of mature fat cells; Relatively rare
- Location:Won’t see on gingival tissue, will see on buccal mucosa, on the tongue, and floor of the mouth
- Clinically appears as a yellowish mass surfaced by thin overlying epithelium, When you feel it, it’s soft
- Histologically: a well-delineated tumor composed of mature fat cells with a thin capsule
- Treatment: surgical excision,does not recur
What is this clinical finding?
Lipoma
Usually very orange looking lesion in site where there’s adipose tissue
Very obvious, nothing as orange as lipoma
Drug Induced Gingival
Enlargement
What are the famous drugs that are known to cause it?
- Phenytoin: (or Dilantin) – the drug that used to be given to every single
- person that had seizures
- Calcium-channel blockers
- Nifedipine not as prescribed anymore
- Dilitiazem still prescribe
- Amlodipine: is prescribed as one of the first line therapy for hypertension (very commonly prescribed); it doesn’t typically cause gingival overgrowth except in some selected patients, usually
those with pretty poor oral hygiene
- Cyclosporine A (used for for bone marrow transplant, graft vs
host disease, solid organ transplant)- Cyclosporine is universally recognized as causing gingival hyperplasia
- Cyclosporine is largely replaced with Tacrolimus, which typically doesn’t cause gingival overgrowth
- Cyclosporine A is largely replaced with Tacrolimus, which typically doesn’t cause gingival overgrowth
Some drugs have more connective tissue component, others have more epithelial component
Not all identical under the microscope - Cyclosporine provides more epithelial change, Dilantin causes more of a connective tissue change
What is this clinical finding?
Vascular leiomyoma
High-power view showing spindle-shaped cells with bluntended
nuclei. Immunohistochemical analysis shows
strong positivity for smooth muscle actin (inset).
What is this clinical finding?
Rhabdomyoma
Will see the striated muscle
Differential diagnosis… looks like granular cell tumor – don’t know til you remove it
If patient presents with relatively slow growing tumor like this, will I get incisional biopsy or
excisional biopsy? Hard to say
If confident benign tumor and it’s this size and I don’t think it’s vascular (no pulse, can do
aspiration), feels firm – try to excise it
If it looks different, like you think it’s malignant minor salivary gland neoplasm (won’t find it in this
site, but if it’s on hard palate) – incision?
What is this clinical finding?
Leiomyosarcoma
Hereditary Gingivofibromatosis
What causes it?
How common?
what effects on oral cavity?
Treatment?
What causes it?
- Various genes that are implicate (Putative inherited mutations are in the SOS1 or CAMK4 genes.) Linked to both autosomal dominant and recessive patterns of inheritance
How common?
- Very rare
what effects on oral cavity?
- Sometimes gingival overgrowth will completely obliterate the teeth, grow around entire tooth
- Enlargement may be present at birth or may become apparent only with
the eruption of the deciduous or permanent dentitions. - Tooth migration, prolonged retention of the primary dentition, and
diastemata are common, and enlargement may completely cover the
crowns of the teeth, resulting in compromised oral function.
Treatment
- Need surgical (usually laser) treatment – just grows back, so have to get it done periodically
What are these clinical findings?
Rhabdomyosarcoma
In this case, hasn’t broken through epithelium
They don’t all break through
Infantile
Hemangioma
When do they appear?
Rate of Development
Clinical presentation
Treatment
- When do they appear? They are rarely present at birth, infants are Born with this in place.
- Rate of development: the tumor will demonstrate rapid development that occurs at a faster pace than the infant’s overall growth in the first few weeks of life,
-
Clinical presentation: Either superficial or deeper tumors
- Superficial tumors of the skin appear raised and bosselated with a bright-red color (“strawberry” hemangioma); They are firm and rubbery to palpation, and the blood, cannot be evacuated by applying pressure.
- Deeper tumors may appear only slightly raised with a bluish hue.
- May be left with a pink or magenta macule in site where hemangioma occurred after its involute
- Treatment: Typically will involute with time, Some cases don’t involute, so need to be removed
- It is a vascular Anomaly
What is this clinical finding?
Fibrosarcoma
Capillary
Malformation (Low
flow)
- a type of vascular anomaly
- CMs are commonly known as port wine stains.
- They look like a pink, red or purple patch of skin
- occur in 1 in 300 newborns.
What is this clinical finding?
Kaposi Sarcoma
Solitary vascular lesion on hard palate – it was so small so he decided to just excise it in this case^
What are these clinical findings?
Kaposi Sarcoma
- Widespread Kaposi, can see cutaneous lesions
- Oral images of this patient: on palate, starts with macule on patient’s left posterior palate –macular stage
- Then in becomes proliferative – exophytic nodular stage (seen on patient’s right anterior palate,surrounding canine and some incisors)
- Can see engorged blood vessels in area on histology slide
What is this clinical finding?
Plasmacytoma in Multiple Myeloma
- They already had multiple myeloma then developed plasmacytoma
- When you biopsy this, it’s filled with plasma cells bc they’re producing the abnormal immunoglobulins, which are the cause of the devastating issues of multiple myeloma
Acute myelogenous
leukemiawith
granulocytic
sarcoma
- *Complaining of lump inside of her cheek**
- *Notsomuch worried about her gingiva**, despite her overgrowth – leukemic infiltrates that got into gingival tissues
- *Left buccal mucosa**, kept biting on it, feeling incredibly fatigued though she was always working out
- *Oral surgeon biopsied** her buccal mucosa and read by pathologist as pyogenic granuloma
- *Physician** sent her for bloodwork, dental school sent her for bloodwork too
What is this clinical finding?
Lymphoma
- Well circumscribed ulceration in area
- Associated swelling in periphery
- White change in the patient’s left area
- Been there for 3 weeks
- It’s lymphoma
What is this clinical finding?
Looks like it could be a salivary gland neoplasm, but it’s not
It was another lymphoma
Manifest in a number of different ways
Case
40 year old male
Completely healthy otherwise
Not taking any medications
Presents with bump on the tongue
First question: did you do anything that might have led to this? Bite your tongue?
“possible I bit my tongue, or it could be when I had a dental procedure, maybe they accidentally
cut into the side of my tongue” – then it developed
This tells us, is this a reactive lesion?
Is it pedunculated or sessile? It’s pedunculated, larger at the top than the base
Let’s look at the surface: it’s ulcerated
When palpating, it’s only on the surface - don’t feel any submucosal presentation
Tongue underneath feels relatively normal
This bump is kind of firm and it bleeds like crazy when you touch it
When you look at teeth, no area where they’re too sharp
Do you think it’s a fibroma? No. Why?
Fibroma is covered with normal coloring epithelium – sometimes see a little white change on surface or see tiny traumatic ulcer on surface This is not like that, this is completely ulcerated
Not fibroma; fibroma is a chronic bump that patient is aware of
Is it squamous cell carcinoma? Interesting, it is indeed very friable; but no
Sometimes SCC can develop and can be exophytic and don’t have deep invasion, But this is pedunculated, SCC would not be pedunculated
History says there could be some kind of trauma, biting, or nick with bur – not squamous cell
Mucocele? No
Would you typically develop mucocele on lateral border of tongue? No
Not going to be as many mucoceles in this area, but there are the glands of Blandin and Nuhn, so it’s possible to develop on ventral surface of tongue
This bump doesn’t look like a fluid filled bump though, it has surface ulceration, redness ;Mucoceles have intact surface, would not bleed, or be red
Granular cell tumor? No
Granular cell tumor would have normal overlying epithelium (it’s pushing up from underneath)
This does not have normal overlying epithelium
Hemangioma reserved for congenital; not a vascular malformation either
Neurofibroma? No, not the same surface
Salivary gland neoplasms? Possible, there are salivary glands in that area; keep this in differential
The one that this is is pyogenic granuloma: usually red, ulcerated, and bleeds easily
Osler-Weber-Rendu
Syndrome
AKA
What is it and its clinical appearance
Type of Herditary and Etiology
What can it cause?
Location?
AKA
• Hereditary Hemorrhagic Telangiectasia
What is it and its clinical appearance
• disorder of development of the vasculature characterized by telangiectases and
arteriovenous malformations in specific locations. These are essentially endothelial cell issue – get tafted area of abnormal blood vessels multiple different organ systems – causes complications
Type of Herditary and Etiology
•Autosomal dominant with mutations i_n at least five gene_s but mutations in two genes (ENG and ACVRL1/ALK1) cause approximately 85% of cases.
What can it cause?
• Can cause hemorrhage
Location?
often on fingers, lips,tongue, but always look at the fingers!
Sturge-Weber
Angiomatosis
Sturge-Weber syndrome
- Rare, non-hereditary developmental condition
- Vascular proliferation involving tissues of the brain and face
- Face: Unilateral distribution along one or more segments of the trigeminal nerve ( unilateral means don’t cross the midline) known as port wine stain/ nevus flammeus – they are deep-purple color.
- Intracranial calcifications; neurological disorders
- Intraoral involvement is common
What is this clinical finding?
PLEOMORPHIC ADENOMA
(MIXED TUMOR)
What is this clinical finding?
PLEOMORPHIC ADENOMA
Classic presentation: includes swelling in the parotid region
(MIXED TUMOR)
What is this clinical finding?
PLEOMORPHIC ADENOMA
Palatal presentation: since salivary glands are only in lateral sides of the palate, usually
swellings are in one side and not the midline. Lateral swelling is a clue that you are
looking at a salivary gland lesion (left pics)
On the right pic, it involved midline and crossed over to other side, so there are
exceptions. But more commonly found in lateral side of the palate.
(MIXED TUMOR)
What is this clinical finding?
PLEOMORPHIC ADENOMA
- Upper lip presentation: sometimes swelling can be seen extra orally and intraorally.
- Remember the swelling will be movable, not tender, not fixed to underlying structures.
(MIXED TUMOR)
What is this clinical finding?
Untreated pleomorphic adenoma
slow growing, but can grow to enormous sizes
Pleomorphic adenoma
histology
This is a mixed tumor with myxoid component (right) and
fibrous/epithelial component(left)
This type of tumor can produce a lot of different tissues, since the origin is from myoepithelial cells aka plasmacytoid cells, which are pluripotent cells which means they can differentiate into many different lineages of cells such as
What is this clinical finding?
Canalicular Adenoma
What is this clinical finding?
Canalicular Adenoma
- Mucocele might look this way, but what would make it lower on
- differential diagnosis is the location of the swelling. Mucocele is mostly seen on lower lip and this pic shows upper lip. Salivary gland tumors and mucoceles
- can have the same clinical presentation, so always do a biopsy for formal histopathology diagnosis.
Basal Cell Adenoma
- Basaloid appearance of the tumor cells
- Primarily parotid lesion
- predominantly in women over 50 years of age. It is uncommon in young adults.
(Basal cells are located in epithelium that is adjacent to interface with the connective tissue and they are separated from the CT by a basement membrane, stem cells of epithelium are located in basal cell layer)
Basal cells are typically Blue in appearance and cuboidal,
What is this clinical finding?
Basal Cell Adenoma
What is this clinical finding?
PAPILLARY
CYSTADENOMA
LYMPHOMATOSUM
(WARTHIN TUMOR)
MUCOEPIDERMOID
CARCINOMA
Charcterstics?
Location
Clinical appearance in minor gland
Can be mistaken for
Histopahtology
Most common malignancy of salivary glands
Most common malignant SG tumor in children
Locations
Palate, most common intraoral site
Rare primary intrabony (jaws) tumors
Most common in parotid
Minor SG: palate 2nd
Clinical appearance in minor gland: asymptomatic fluctuant swelling; blue or red colored
Can be mistaken for mucocele
Histopathology: note the cells growing into adjacent tissue, showing infiltration
What is this clinical finding?
MUCOEPIDERMOID
CARCINOMA
What is this clinical finding?
MUCOEPIDERMOID
CARCINOMA
Request all for biopsies!
What is this radiographical finding?
CENTRAL
MUCOEPIDERMOID
CARCINOMA
- Intrabony presentations, may have extraoral swelling depending on the stage
- Started as small swelling and progressed rapidly:, need to pick it up early!
- Patient recovered, but might need radiation, lost salivary glands, needed reconstruction of palate
What is the clinical finding?
ACINIC CELL
ADENOCARCINOMA
What is the clinical finding?
ACINIC CELL
ADENOCARCINOMA
blue‐ish tint
What is this clinical finding?
Untreated acinic cell adenocarcinoma
Because it is slow growing, and a low grade tumor, the
patient is alive and not dead with a tumor this size.
Similar presentation to pleomorphic adenomas, but there is a lot of ulceration on the surface and prominent vascularization in acinic cell
adenocarcinoma.
Adenoid Cystic Carcinoma
High grade salivary gland malignancy ( very bad cancer to get)
Adults
Palatal mass; ulcerations
Spread through perineural invasion ‐ tumor wraps itself around nerves and spreads through perineural spaces
Grows slowly in the beginning and then picks up speed
Histology: Duct like proliferation with cystic spaces
What is this clinical finding?
Adenoid Cystic Carcinoma
What are these clinical findings?
Adenoid Cystic Carcinoma
What are these clinical findings?
Adenoid Cystic Carcinoma
Adenoid Cystic Carcinoma
Swiss cheese appearance, cribriform pattern (full of holes aka cystic spaces)
Perineural invasion Histology
Perineural invasion: nerve nuble in the
center and is wrapped by tumor
What is this clinical presentation?
Polymorphous
Adenocarcinoma
What is this clinical presentation?
Polymorphous
Adenocarcinoma
What is this clinical finding?
Carcinoma Ex Pleomorphic
Adenoma
What is this clinical finding?
Palatine Torus/Torus Palatinus
What is this clinical finding?
Palatine Torus/Torus Palatinus
What is this clinical finding?
Mandibular Torus:
Torus Mandibularis
What is this clinical finding?
Mandibular Torus:
Torus Mandibularis
What is this clinical finding?
Buccal Exostoses
What is this clinical finding?
Unencapsulated Lymphoid Aggregates
What is this clinical finding?
Lymphoepithelial
cyst
we see a tiny yellowish cyst. we see the blood vessels on the surface; this is quite characteristic.
What is this clinical finding?
Unencapsulated
Lymphoid
Aggregates
Post-tonsillectomy
Can even develop these on area of tonsils.
(left pic) Red/salmon is a lymphoid aggregate (unencapsulated lymphoid tissue). This is someone
who had a tonsillectomy , and you can see these
lymphoid aggregates on posterior pharyngeal wall (salmon color).They move around the area.
(right pic) It grew back even in post-tonsillectomy patients.
What is this clinical finding?
Fordyce Granules
What is this clinical finding?
Fordyce Granules
What is this clinical finding?
Fimbriated
fold/Plica
semiluminaris
What is this clinical finding?
Frenal tag
What is this clinical finding?
Sublingual Varices
What is this clinical finding?
Sublingual Varices
What is this clinical finding?
Sublingual Varices
What is this clinical finding?
Circumvallate papillae
What is this clinical finding?
Parotid Papillia (Stenson duct)
What is this clinical finding?
Parotid Papillia (Stenson duct)
What is this clinical finding?
Linea Alba
What is this clinical finding?
Leukoedema
What is this clinical finding?
Palatal Rugae
Mucocele
Definition
Clinical features
Location
Histological features
Treatment
• definition: a lesion that forms when a salivary gland duct is severed & secretion spills into the adjacent CT
• a pseudocyst (not lined by epithelium) — mucous builds up in the CT & causes a bump
• clinical features:
- swelling in the tissue that may increase & decrease in size
- may have a bluish hue, fluctuant on palpation — fluid filled, soft, compressible
• location: lower lip most common site, but may form in any area where there are minor salivary glands
• histologic features:
- a cyst-like space in soft tissue
- lined by compressed granulation tissue
- lumen filled with mucin, foamy macrophages & inflammatory cells
• treatment: surgical excision, removal of associated minor salivary glands
• may recur if don’t remove all associated injured minor salivary glands
What is this clinical finding?
Mucocele
What is this clinical finding?
Mucous Cyst
What is this clinical finding?
Ranula
Notice how it’s unilateral
on the floor of the mouth
What is this clinical finding?
Ranula
- Notice how it’s unilateral*
- on the floor of the mouth*
Necrotizing Sialometaplasia
Definition
Predisposing factors
Clinical features
Histologic features
Treatment
• Definition: locally destructive inflammatory condition — looks malignant but is benign
• salivary gland ischemia — “heart attack of the palate”; blood flow is interrupted
• predisposing factors:
- local trauma
- palatal injection of local anesthesia
- previous surgery
- many are idiopathic..
• usually a clinical diagnosis based on history & how fast — palate uncommon for SCC
• clinical features:
- initially appears as a non-ulcerated swelling of the palate
- often associated with pain or paresthesia
- within 2-3 weeks, necrotic tissue sloughs off & becomes a crater-like ulcer
- patient may say: “a chunk of the roof of my mouth fell out”
• histologic features:
- necrosis of the salivary glands — coagulative necrosis (green circles in histology —>)
- salivary gland duct epithelium is replaced by squamous epithelium — appear as islands of squamous epithelium deep in the CT & resembles SCC (arrows in histology —>)
• Treatment: no treatment, spontaneously resolves within 6 to 10 weeks
• irrigating & debriding the area can reintroduce vascularity & help healing
What is this clinical finding?
Necrotizing Sialometaplasia
Sialolithiasis
Definition
Location
Origin
Clinical features
Radiological features
Histological features
Treatment
Definition: lith = stone ;; sialolith: a salivary gland stone
Location: occur in both major & minor salivary glands
• floor of the mouth is most common location (Wharton’s duct is a common place)
• often causes obstruction of the duct
Origin: arise from desposition of calcium salts around nidus of debris within the duct lumen
- *clinical features:**- minor glands: hard yellowish structure in soft tissue
- may be visible on a radiograph
- recurrent swelling (due to the obstruction)
- episodic pain & swelling during times of increased salivation
- can be palpated if the stone is located toward the terminal portion of the duct
- *Radiological features** : may be viewed as a radiopacity on an occlusal x-ray–well defined radiopacity
- *Histological features-** concentric rings of calcification, color of it in stain depends on level of calcificatio
- *Treatment**: promote passage of stone (massage, sialogogues, increase fluid intake) or surgical removal
What is this clinical finding?
Sialolithiasis
What is this clinical finding?
Sialolithiasis
Notice how it can appear radiographically as a well defined radiolucency
What is this Radiographical finding?
Sialolithiasis
What is this clinical finding?
Sialadenitis
Acute: parotid papilla purulent discharge
What is this clinical finding?
Sialadenitis
Chronic: caused fibrosis
Summery
of inflmattory salivaory conditions
Mucocele
- fluctuant swelling
- bluish hue
- lower lip most common
Ranula
- fluctuant swelling
- floor of mouth
Sialolithisis
• major glands: episodic pain &
swelling of affected gland
• minor glands: asymptomatic/
local swelling or tenderness
• if superficial - firm to palpation
& yellowish color
Necrotizing
Sialometaplasia
• initial painful swelling
• later necrotic ulcer
• posterior lateral hard
palate & soft palate
Sialadenitis
• painful swelling of
affected gland
• purulent discharge if
acute infection
