Soft Tissue Flashcards
3 types of soft tissue tumors and what makes it a soft tissue tumor?
They originate from under the top layers of the epithelium.
- Reactive Gingival swellings
- Benign soft tissue neoplasms
- Malignant soft tissue neoplasms
Basics on reactive gingival swellings?
They develop in response to a local irritant
They grow rapidly, simulating a sarcoma
They shrink if irritant removed
Lesion will recur if the irritant is left behind
There is always an inflammatory component
Parulis (gumboil, gingival abscess)
Etiology- Intraoral opening of a periapical apex or periodontal abscess.
Site- Buccal Gingiva usually sometimes lingual (some molars)
Age- Any
Gender- Any
Appearance-Exophytic yellowish-red smooth surfaced nodule on the gingiva
Frequency- Common
Two types of Inflammatory Fibrous Hyperplasia
Denture Related Hyperplasia and Inflammatory Papillary Hyperplasia
Denture Hyperplasia (Inflammatory Fibrous Hyperplasia)
Called Denture Hyperplasia or epulis fissuratum when it is a denture. IFH when the irritant is something else.
Etiology- From any irritant usually a denture, sometimes something else like calculus or a sharp tooth.
Site- Usually the alveolar ridge and gingiva but palate too when a denture.
Age- Any
Gender- Any
Appearance- Well demarcated, pink, white or red raised nodules. Can be irregular in shape and sometimes ulcerated. Smooth or rough surface that is thickened keratin or acanthotic tissue.
Frequency- Semi common among denture wearers
Inflammatory Papillary Hyperplasia
Etiology- Ill-fitting denture worn constantly or other irritant such as mouth breathing, palate licking or high vaulted palates
Site- Palate most common,
Age- Any
Gender- Any
Appearance- Pink to red with a pebbly surface and asymptomatic. Candida found in some of them but not all
Frequency- Semi-common
Pyogenic Granuloma
Etiology- Reaction to a habitual irritant, develop over weeks
Site- Anywhere in mouth or skin with gingiva being most common
Age- Any
Gender- Any but slight predilection for young females
Appearance- It presents as a rapidly growing well-demarcated hemorrhagic, ulcerated nodule. It becomes pinkish as the lesion heals. Can have white pseudomembrane if ulcerated. Vascular granulation tissue with inflammatory cells. Can be tender and bleed.
Frequency- Most common reactive gingival swelling
POF- Peripheral Ossifying Fibroma
Etiology- Reactive originating from the periodontal ligament, develop over 1-36 month
Site- Exclusively on the Gingiva, usually molars but not always, slightly more on the maxilla, rarely but has been reported on edentulous alveolar mucosa
Age- Usually younger 10-19
Gender- Predilection for females ⅔rd of cases
Appearance-Sessile nodules, can be lobulated, firm or hard, pink or red if ulcerated (often), well demarcated, Histology shows fibrous connective tissue and ossification, usual asymptomatic, average ~1.5 cm size
Frequency- 10% of all reactive gingival swelling
PGCG- Peripheral Giant Cell Granuloma
Etiology- Most likely originates from the PDL or periosteum and is reactive in nature, develop over 1 month to years
Site- Occurs exclusively on the gingiva both edentulous and dentate, anterior to molars
Age- Average age of 30
Gender- 2 to 1 Female
Appearance- Single, broad based, sessile, red, red-blue nodule lesions, irregular in shape. Sometimes resorbs the underlying bone ‘saucer-like”, average .5-1.5 cm
Frequency- Medium not uncommon and not rare- 24.4% of reactive lesions in young patients and 7% at all ages.
Fibroma
Etiology- Benign tumor, possibly reactive to trauma or irritation but not necessarily- they think those may be fibrous hyperplasia, develop over weeks to months
Site- Most common buccal mucosa then lip and tongue but can occur anywhere
Age- Any but 30-50 most common
Gender- Any
Appearance- Dome shaped smooth surface, pink or whitish, can ulcerate, fibrous tissue lined by surface mucosa, average ~1 cm
Frequency- Most common oral soft tissue tumor
Lipoma
Etiology- Benign neoplasm of adipose origin, slow growth over months to years
Site- FOM, tongue and buccal mucosa are common locations
Age- Adults
Gender- Any
Appearance- Single, smooth surfaced, soft, lobulated, painless, yellowish, sessile nodule, lined by thin epithelium with visible blood vessels. Because of its softness it can be mistaken for a cyst
Frequency- Rare orally 0.1-5% of benign neoplasms
Choristoma
Etiology- Normal tissue in abnormal areas, Chondroid and osseous choristomas, slow growing
Site- Chondroid choristoma tongue, Osseous choristoma buccal mucosa
Age- Usually under 40
Gender- Women more often
Appearance- Round whitish nodules, can be exophytic, contain cartilage or bone, hard to touch, usually asymptomatic
Frequency- Rare
Leiomyoma
Etiology- Benign neoplasm smooth muscle origin, slow growing
Site- Not common in oral cavity but if they do most common on the posterior tongue, palate, cheeks and lips
Age- Over 30
Gender- Mostly male
Appearance- Painless, pedunculated, smooth-surfaced, normal color or slightly bluish nodule, Angiomyoma (vascular and painful) account for 75% of oral leiomyomas, average ~1 cm
Frequency- Rare in oral cavity
Hemangioma
Etiology- Benign proliferation of blood vessels, often appear at birth and develop in weeks to a few months
Site- Head and Neck- Tongue most common site; followed by buccal mucosa, lips, can occur anywhere
Age- More common in kids
Gender- Slightly more common in females
Appearance- Flat or elevated, purplish-red in color. They blanch on pressure, unless there is a thrombus, can be big or small
Frequency- Common in kids 5-10% estimated prevalence
Sturge Weber Syndrome
Etiology- Rare disease complex, not inherited, developmental vascular malformation
Site- Face with oral involvement
Age- Any
Gender- Any
Appearance- Port wine stain or nevus flammeus on the face, usually unilateral, also have leptomeningeal angiomas, gyriform calcifications (“tramline” calcifications), ocular involvement and occasional mental retardation. Gingival and other oral hyperplasia and hemangiomas can occur
Frequency- Rare
Hereditary Hemorrhagic Telangiectasia
Etiology- Autosomal dominant disease complex
Site- Mucosa, oral and nasopharyngeal, Spider veins on hands, feet, GI tract, conjunctiva
Age- Inherited
Gender- Any
Appearance- Lots of small red papules 1-2 mm
Frequency- Rare
Lymphangioma
Etiology- Benign tumor, proliferation of lymph vessels, fast growing at first then slow
Site- Most common dorsal tongue, occurs in soft tissue, lip, can occur in bone and max sinuses
Age- Mainly kids-90%, develops in first 2 yrs and babies
Gender- Any
Appearance- lip it resembles angioedema, if on the tongue is “cobblestone“ causing macroglossia, can be around ~2 cm but can bigger
Frequency- Rare 4% of tumors in kids
Cystic Hygroma
Etiology- Benign developmental malformation of the lymph vessels- version of lymphangioma, keep growing and can get very large
Site- 75% occur in head and neck, affects the posterior triangle, can cross the midline, may extend into the oral cavity to include the tongue and soft palate, can also extend into the maxilla, mediastinum, thorax
Age- Usually occurs at birth, survival is 10%
Gender- Any
Appearance- Large tumor/swelling deep in neck and lymph vessels, can look solid on a CT scan
Frequency- Rare
Traumatic Neuroma
Etiology- Reactive benign tumor/lesion resulting from an episode of repair of a damaged nerve, slow growing
Site- Mental foramen, tongue and lips, more in edentulous patients resorbed ridge & ill-fitting dentures most common but anywhere in oral cavity
Age- Any but more likely in middle age
Gender- Slight predilection for females
Appearance- Small smooth surfaced nodule, painful (around 25%) to palpation, usual pink or no color change, central lesions may occur. It is usually small. Hyperplastic nerve bundle surrounded by fibrous tissue
Frequency- Rare but can happen due to trauma from 3rd molar or anesthetic
Multiple Endocrine Syndrome
Etiology- Some inherited as autosomal dominant, 50% mutation, Three types described, affecting the endocrine system, MEN2B has most dental implications
Site- anterior tongue, lower lip, bilateral corner of mouth, eyelids, conjuctiva, etc
Age- Inherited
Gender- Any inherited
Appearance- Multiple small nodules/Neuromas, pink to white in color. Patients have marfanoid features, thick lower lip, everted upper eyelid, pheochromocytoma, medullary carcinoma at around 18-25 years of age
Frequency- Very Rare
Neurofibroma
Etiology- Benign peripheral nerve origin, slow growing
Site- Orally most common sites buccal mucosa, tongue, palate, but they can appear anywhere on body
Age- Any but often show up in kids
Gender- Small female predilection
Appearance- Non-tender, smooth surface, soft (sometimes firm) nodule, can be well circumscribed or diffuse, pink or white, When multiple it is usually neurofibromatosis
Frequency- Common
Neurofibromatosis
Etiology- Hereditary, 8 types, NF1 most common
Site- all over body and oral cavity
Age- Any usually shows up in childhood- hereditary
Gender- Any
Appearance- Multiple neurofibromas, café au lait spots. Axilary freckling (Crowe’s sign), Lisch nodules on the iris, seizures, scoliosis, etc. 5-8% transformation
Frequency- 1:3000 so common
Neurilemmoma/ Schwannoma
Etiology- Benign, encapsulated neoplasm of Schwann cell origin, Usually slow growing- years but some can develop in months
Site- Tongue most common, lips, buccal mucosa and floor of mouth, jaw bones, 48% in head and neck, palate- rare
Age- Young and middle age
Gender- Any
Appearance- Encapsulated, firm, rubbery, smooth-surfaced nodule, irregular at times, pink or no color change, slightly vascular, mobile except in tongue
Frequency- Rare
Granular Cell Tumor
Etiology- Benign neoplasm uncertain origin- neural crest cells? slow growing
Site- Dorsal or lateral of tongue 50% then buccal mucosa, FOM
Age- Any but often around 40
Gender- Predilection for females
Appearance- Small elevated but deeper nodule on the dorsal or lateral surface of tongue, pinkish or white and asymptomatic. Histology pseudoepithelium hyperplasia can be mistaken for SCC
Frequency- Uncommon
Congenital epulis of the Newborn/Congenital granular cell tumor
Etiology- Congenital
Site- More in the anterior maxilla, can affect both the maxilla and the mandible
Age- At birth
Gender- Female
Appearance- Pedunculated, sometimes hemorrhagic masses, sometime huge
Frequency- Very rare
Fibrosarcoma
Etiology- Malignant neoplasm of fibroblasts, growth rate variable, usually rapid but can be slower
Site- 10% in the head and neck, Cheeks, maxillary sinus, palate, lips and periosteum mandible and maxilla, jaw
Age- 20-40 most common or infants
Gender- Slightly more in Males
Appearance- fleshly, polypoid, rapidly growing, ulcerated, vascular lesions
Frequency- Very rare, 1 in 1-2 mil people
Rhabdomyosarcoma
Etiology- Malignant neoplasm of skeletal muscle cells, rapidly growing,
Site- Orbit, nasal cavity, palate most common in mouth, 40% in Head and Neck (Embryonal & alveolar more common in H&N area)
Age- Children, First decade, teenage, rare after 45,
Gender- more in males
Appearance- exophytic, polypoid, ulcerated
Frequency- Rare but devastating
