Soft Tissue Flashcards
The most common tumor of the oral cavity; probably not a true neoplasm; reactive lesion, secondary to trauma or chronic irritation
Fibroma
F>M, 4th-6th decade; commonly located along the bite line of the buccal mucosa; sessile, smooth-surfaced pink nodule
fibroma
variant of fibroma that feature both clinically and histologically unique features; unassociated with trauma or irritation
giant cell fibroma
F>M, first 3 decades; most occur on gingiva, followed by tongue; sessile, often papillary nodule; features large, stellate-shaped or multinucleated fibroblasts
Giant cell fibroma
reactive lesion that occurs secondary to irritation from an ill-fitting denture
epulis fissuratum
any tumor of the gingiva or alveolar mucosa
epulis
F>M, middle aged and older; single or multiple folds of firm, fibrous tissue located in the alveolar vestibule (usually anterior)
epulis fissuratum
lesions can achieve large size; may be ulcerated; fibroepithelial polyp- pedunculated lesion of palate beneath maxillary denture
epulis fissuratum
reactive process of the palate underneath a maxillary denture; associated with: ill-fitting denture, poor hygiene, wearing denture 24 hr/day; superimposed candidiasis
inflammatory papillary hyperplasia
variable involvement of the hard palate; aymptomatic, erythematous lesion with a pebbly surface; had been seen on edentulous mandibular ridge or on epulis
inflammatory papillary hyperplasia
may see pseudoepitheliomatous hyperplasia
inflammatory papillary hyperplasia
common non-neoplastic proliferation of granulation tissue; not a true granuloma; response to local irritation or trauma; F>M, children and young adults; common during pregnancy
pyogenic granuloma
rapidly growing, smooth or lobulated ulcerated mass; easily bleeds; any mucosal surface with most involving the gingiva
pyogenic granuloma
relatively common reactive lesion of the gingiva; histologically identical to the central giant cell granuloma
peripheral giant cell granuloma
F>M, 5th and 6th decades; bluish-purple lesion, exclusively on the gingiva or alveolar ridge; radiographic- may cause “cupping” resorption (saucerization)
peripheral giant cell granuloma
relatively common reactive lesion, probably arising from periodontal ligament; this lesion is unrelated to the central ossifying fibroma; teenagers and young adults; maxilla>mandible; exclusively on the gingiva; frequently ulcerated
peripheral ossifying fibroma
mineralization, consisting of bone, cementum-like, or dystrophic calcifications; ulcerated surface; 16% recurrence rate
peripheral ossifying fibroma
benign tumor of fat; although rare in the oral/maxillofacial area, the lipoma is the most common mesenchymal neoplasm; unrelated to metabolism/body fat
lipoma
F>M; soft nodule, most commonly involving the buccal mucosa; normal or yellow in color; well circumscribed, lobular arrangement of mature adipose tissue
lipoma
reactive proliferation of neural tissue; not necessarily a true neoplasm; secondary to disruption of Schwann cell tube
Traumatic neuroma
F>M, middle-aged adults; smooth surfaced, submucosal nodule; commonly involve the mental foramen area; may be symptomatic
traumatic neuroma
benign neural tumor of schwann cell origin; uncommon, but often involve the head and neck
schwannoma
oral tumors most commonly involve the tongue; may arise within bone, causing an expansile, unilocular radiolucency
schwannoma
Schwannoma: Antoni _ tissue: Spindle-shaped schwann cells palisaded around central acellular areas (Verocay bodies)
A
Schwannoma: Antoni _ tissue: Randomly arranged spindle cells against a myxomatous background; Ancient schwannoma
B
the most common peripheral nerve neoplasm; tumor cells are a mixture of Schwann cells and fibroblasts
neurofibroma
typically solitary, involving the tongue or buccal mucosa; may occur in bone; multiple lesions associated with neurofibromatosis
neurofibroma
circumscribed proliferation of spindle-shaped (comma-shaped) cells against a background of delicate collagen fibers; variable numbers of mast cells
neurofibroma
Relatively common autosomal dominant syndrome (50% new mutations) with variable expressivity
Neurofibromatosis (Von Recklinghausen’s Disease of Skin)
Type _ neurofibromatosis: bilateral acoustic neuroma (schwannoma of auditory nerve)
2
multiple neurofibromas: small papules to large pendulous masses; plexiform neurofibroma; cafe au lait pigmentation (6 or more, smooth-edged, yellow-tan to brown macules)
neurofibromatosis
crowe’s sign (axillary freckling); lish nodules (pigment spots on the iris); CNS tumors, mental deficiency, seizures
neurofibromatosis
oral lesions: enlargement of the fungiform papillae, neurofibromas; radiograph: enlargement of the mandibular foramen
neurofibromatosis
5% or NF patients will develop _ or other tumors
neurofibrosarcoma
Rare hereditary condition characterized by tumors or hyperplasias of neuroendocrine origin; inherited as an autosomal dominant trait or spontaneous mutation
Multiple endocrine neoplasia type 2B
MEN type _: pancreatic islets, adrenal cortex, parathyroid glands, pituitary gland
1
MEN type _: adrenal pheochromocytoma, medullary thyroid carcinoma
2
MEN 2B: Mutation in the RET oncogene on chromosome _
10
in addition to MEN type 2, MEN type 2B will present with multiple _ _
mucosal neuromas
Marfanoid habitus; narrow face with thick, protruberant lips; small neuromas may involve the eyelid, conjunctiva, or cornea
MEN 2B
Mucosal neuromas involving predominantly the lips or anterior tongue; sweating, hypertension, heart palpitations secondary to catecholamine production by pheochromocytoma
MEN 2B
Urinary or serum calcitonin secondary to thyroid carcinoma; Epi/NE or VMA secondary to pheochromocytoma; Mucosal neuromas show hyperplasia of nerve bundles
MEN 2B
MEN 2B: prophylactic thyroidectomy due to poor prognosis of _ _ _
medullary thyroid carcinoma
Rare pigmented neoplasm of neural crest origin; it is typically a tumor of the first year of life
Melanotic neuroectodermal tumor of infancy
most involved the anterior maxilla; rapidly expansile, blue to black lesion; destruction of underlying bone
melanotic neuroectodermal tumor of infancy
High VMA, which return to normal after removal
melanotic neuroectodermal tumor of infancy
Biphasic cell population: small round cell, epithelioid cells with dark brown melanin pigment
melanotic neuroectodermal tumor of infancy
uncommon tumor that appears to be of schwann cell origin; significant predilection for the oral cavity; F>M; 4th to 6th decade; solitary lesion, primarily involving the dorsal tongue; asymptomatic sessile nodule
granular cell tumor
large polygonal cells with granular cytoplasm; often show overlying pseudoepitheliomatous hyperplasia; S-100 positivity
Granular cell tumor
Rare tumor of the alveolar ridge in newborns; unknown histogenesis; striking resemblance to granular cell tumor
congenital epulis (of the newborn)
Females; pink to red, polypoid mass; most commonly found in the anterior maxilla
congenital epulis
Histo similar to granular cell tumor except: No pseudoepitheliomatous hyperplasia, No S-100 positivity
congenital epulis
benign proliferation of blood vessels; the most common tumor of infancy; rarely present at birth; 5-10% of 1 yr olds, F>M; raised nodular masses of skin; may be seen intraorally
hemangioma
present at birth and persist throughout life; “port-wine stains”; venous vs arteriovenous; may occur in bone; mandible>maxilla
vascular malformation
non-hereditary developmental condition characterized by vascular proliferations of the skin and brain; secondary to persistence of the vascular plexus around the cephalic portion of the neural tube
Sturge-weber angiomatosis
nevus flammeus (port wine stain); may be seen intraorally; mental retardation, hemiplegia, convulsions; leptomeningeal angiomas; gyriform “tram-line” calcifications
sturge-weber angiomatosis
port wine stain- dilated blood vessels within the dermis (capillary vascular malformation); gingival lesions may resemble pyogenic granuloma
sturge-weber angiomatosis
benign tumor of lymphatic channels; 75% occur in the head and neck; cervical _ most commonly involve the posterior tongue
lymphangiomas
Oral lesions of _: tongue is most common site; “Frog’s eggs;” deeper tumors- Ill defined masses; alveolar _
lymphangiomas
benign tumor of smooth muscle; typically a tumor of the uterus; any age; firm submucosal nodule; lips, palate, tongue, cheek; vascular lesions may appear bluish
leiomyoma
solid- well circumscribed bundles of spindle-shaped nuclei with blunt-ended nuclei (cigar-shaped)
leiomyoma
benign tumor of skeletal muscle; rare, but most involve the head and neck
rhabdomyoma
_ rhabdomyoma: nodule or mass; floor of mouth, palate, base of tongue
adult
_ rhabdomyoma: M>F, young children; face and preauricular region; haphazard arrangement of less mature, spindle-shaped cells
fetal
malignant tumor of fibroblastic origin; typically a tumor of the extremities; children and young adults; slow-growing, initially painless mass; most commonly involve the nose and sinuses; “herring-bone pattern”
fibrosarcoma
malignant tumor; 50% associated with neurofibromatosis; rare tumor of the head and neck area; young adults, sometimes rapidly growing mass; pain or paresthesia; may occur within bone
Malignant peripheral nerve sheath tumor
fascicles of atypical spindle-shaped cells; wavy nuclei; triton tumor
malignant peripheral nerve sheath tumor
vascular neoplasm that has become more common with the AIDS epidemic; associated with HHV-8;
kaposi’s sarcoma
_ Kaposi’s: elderly adults; tumor of the lower extremities; slowly progressive, indolent tumor
classic
_ kaposi’s: benign nodular; aggressive; florid; lymphadenopathic
endemic (african)
_ kaposi’s: associated w/ organ transplant, especially renal; more aggressive
iatrogenic
_ kaposi’s: usually in homosexual males; decreasing in frequency; oral lesions common
AIDS-related
malignant tumor of skeletal muscle; M>F, 1st decade (embryonal); potentially rapidly growing, infiltrative mass; orbit, nasal cavity, nasopharynx
rhabdomyosarcoma
_ variant of rhabdomyosarcoma: polypoid growth; “grape-like”
botryoid
