Soft tissue differential diagnosis Flashcards
case 1
pseuomembraneous candidiasis
-multiple white plaques
-wipes off leaving erythematous area
-commonly found in immunocompromised patients
6 weeks, burning sensation, wide spectum antiboditc
case 2
-bump on gums
-location: lingual gingiva
-has not displaced teeth
-no radiographic calcifications
-sessile, nodule, ulceration, erythema
-firm
-middle-aged female
- not pregant
BUMP ON GUMS DIFFERENTIAL DIAGNOSIS
- Pyogenic granuloma
- Peripheral ossifying fibroma
- Peripheral giant cell granuloma
hyperplastic meschycmal cells with formation of hard tissue -POF
case 3
- location: buccal mucosa & vestibule
- white plaque
- wipes off
- not d/t trauma
- no tobacco use
- frequent use of aspirin due to bombed out molar
- slough off
This is a chemical burn
- intraorally chemical burns look white & oral mucosa sloughs off
case 4
- location: hard palate
- nodule with some redness
- soft tissue firm/ fixed
- female patient
- painful - not an indicator
- pt noticed a fast growing
- been there a year
Differential diagnosis:
- polymorphous low grade adenocarcinoma (PLGA)
- pleomorphic adenoma
- mucoepidermoid carcinoma
histo- mucus cells, intermediate cell( clear cell) - MC
case 5
Describe this lesion & give a differential diagnosis:
- sessile, ulcerated nodule located on dorsal of tongue
- painful yes
- slow growing
- hx of trauma
- bit
- male age 45
- Differential diagnosis:
1. tramatic fibroma
2. giant cell fibroma
3. pyogenic granuloma
4. peripheral giant cell granuloma
histo - ulceration of the overlyring starum granulation tissue
DX- pyogenic granuloma
case 6
Describe this lesion & give a differential diagnosis:
- submucosal amass, yellow, located on dorsal of tongue
- firm
- few years
- stable growth
- Differential diagnosis:
1. lipoma
2. lyphoepithlial cyst - Histology:
- overlying stratified squamous epithelium
- proliferation of pseudomembranous hyperplasia
- large pinkish cells that have granular cytoplasm
- S100 stain = diffusely positive
- this is NOT a mucocele because no salivary glands on dorsal of tongue
- NOT fordyce granules because they are small & multiple (although they are yellow)
- malignancy of muscle - sarcoma bc the tongue is a muscle
- benign growth of skeletal muscle - arabdomyoma
- benign growth of connective tissue - fibroma
- nerve tissue benign tumor - neuroma, schwanoma, neurofibroma
Actual diagnosis: granular cell tumor - most common on dorsal of tongue & a yellow-ish submucosal mass
not invasion
sesslie pic side of check
DDX:
1. fibroma
2. giant cell fibroma
3. mucocle
4. pyogenic
5. neurofibroma
histo:
spindle shaped cells
wavy nucli
postive for S100
Dx: neurofibroma wavy nucli
sesslise tip tongue
DDX:
1. pyogenic granuloma
2. tramatic fibroma
3. tramatic neroma
histo:
fiboblasts
DX: Fibroma
tongue side white
- non-smoker
- unknown duration
- no pain
- no trauma
- HIV positive
- bilateral
- can’t wipe off
- mulitifocal
DDX:
1.Oral Hairly Leukoplaia
2.hyperplastic candidias
Histo
DDX
erythema of gums
- positive nikosky
- not punched out
- no fever
- no skin lesion
- NKA
- no new tooth paste
- painful
- desquatmative gingivitis
- couple years
DDX:
1. Pemphingus
2. Pemphigoid
3. Erosive Lichen Planus
Histo:
subephileal split
linear line IgG
DX:Pemphigoid
end of lecture
What is the histology of a peripheral giant cell granuloma?
Chocolate chip cookies (multinucleated giant cells)
atrophic candidiasis
-aka erythematous candidiasis
-clinically appears erythematous
-can be seen with central papillary atrophy or median rhomboid glossitis or denture stomatitis (due to poor hygiene)
-will cause a red outline on the mucosa
Hyperplastic candidiasis
-does NOT wipe off
-leukoplakia appearance
The histology of a pyogenic granuloma would have:
granulation tissue (NOT granulomatous tissue)
granulation tissue= endothelial cells, fibroblasts, myofibroblasts
Describe a peripheral ossifying fibroma:
- reactive lesion NOT a neoplasm
- teens + young adults
- EXCLUSIVELY on gingiva
- fibrous hyperplasia with OSSEOUS metaplasia (may appear radiopaque)
Peripheral ossifying fibroma
Peripheral ossifying fibroma
-may appear radiopaque due to fibrous hyperplasia with osseous metaplasia
Describe a peripheral giant cell granuloma:
- reactive lesion NOT a neoplasm
- older adults
- exclusively on gingiva & edentulous alveolar ridge
- bluish/purple due to containing hemosideran
- may recur
Peripheral giant cell granuloma
-bluish/purple due to containing hemosideran
On the hard palate there is a ton of minor salivary gland tissue, so if you have a bump/swelling/etc. there is a ____ chance that it is malignant
Another thing to consider when you have an enlargement of the hard palate is a ____
50/50
lymphoma
Most common salivary gland tumor:
pleomorphic adenoma (AKA benign mixed tumor)
- middle aged females
- painless
- slow growing
- mix of myoepithelial & ductal elementd
- ENCAPSULATED
Differential diagnosis for bump on gum:
- pyogenic granuloma (can occur on tongue)
- peripheral ossifying granuloma (exclusive to gingiva)
- peripheral giant cell granuloma (exclusive to gingiva)
How would you describe this type of inflammation?
What are some differential diagnosis that present with this type of inflammation?
Granulomatous inflammation
-pattern of chronic inflammation
-aggregates of epithelioid macrophages
- multinucleated giant cells
- mononuclear leukocytes
- principal lymphocytes
- occasionally plasma cells (peripherally)
- fibrosis variable
Differential diagnosis
1. Crohn’s disease
2. Deep fungal infections (example: coccidiomycosis)
3. Tuberculosis (caseous necrosis)
How would you describe this histological slide?
What disease is seen with this type of presentation?
Granulation tissue
- pyogenic granuloma
List the differential diagnosis to the following presentation:
- chemical burn (aspirin)
- toothpaste allergy (SLS)
- cheek biting (trauma)
- pseudomembranous candidiasis
Where is the most common intraoral- extranodal area for lymphomas?
hard palate
You see a bump on the hard palate & upon palpating you note that it is squishy & bogging. What is a good diagnosis?
lymphoma
Most common salivary gland tumor:
What is its comprised of histologically?
Pleomorphic adenoma
(MC location palate)
Myopeithelial & ductal cells
Describe how this appears histologically:
What is a likely diagnosis?
Monomorphic adenoma
(MC location upper lip)
Histology
- uniform pattern
- single layered cords of columnar or cuboidal epithelium
A malignant salivary gland tumor (the low grade version of this mimics a mucocele):
mucoepidermoid carcinoma
- most common MALIGNANT salivary gland tumor
- middle-aged females
- clinically mistaken for mucocele
Histology
- mucus producing cells
- epidermoid (squamous) cells
- may be cystic and/or solid
You note this Swiss cheese histological appearance, automatically consider:
Adenoid cystic carcinoma
- best recognized salivary gland tumor
- malignant salivary gland tumor
- middle aged females
- painful
- slow growing
Histology
- peri neural & peri vascular invasion
- myoepithelial & ductal cells
- cribriform pattern
Histology
- deceptive uniform appearance
- different growth patterns
- perineurial & perivascular invasion
- Indian filing
Polymorphous Low-grade Adenocarcinoma (PLGA)
- common malignant minor salivary gland neoplasm
- middle-aged females
- favors palate
If you see a salivary gland tumor in a kid (rare) it is most likely:
mucoepidermoid carcinoma
- most common malignant salivary gland neoplasm
- middle-aged females
- clinically mistaken for a mucocele
You can see perineural & perivascular invasion in any tumor, but in the oral cavity its most commonly seen in:
- adenoid cystic carcinoma
- PLGA
Nodular blue-ish bump on tongue rather than yellow, location = dorsal of tongue:
lymphangioma
If a white lesion is bilateral, it will never be a ____ but ca be ___ or ____
leukoplakia; lichen planus or oral hairy leukoplakia
If a white lesion is unilateral, it can be:
- leukoplakia
- hyperplastic candidiasis
- squamous cell carcinoma
- epithelial dysplasia
- carcinoma in-situ
If you notice an erythroplakia, the diagnosis options may be:
- squamous cell carcinoma
- epithelial dysplasia
- carcinoma in situ
Case 1:
-ulcerated nodule located on dorsal of tongue
-been present for around 7 months
- painful
- only lesion present
Differential diagnosis
1. erythrematous multiforme
2. pyogenic granuloma
3. peripheral giant cell granuloma (ruled out bc these are not found on tongue)
Histology shows granulation tissue- what is this?
Pyogenic granuloma
lecture two slide 1
whitish red ucleration on the tongue
- painful
- 6months
- does not wipe off
- isolated
DDX:
Squamous Cell Carcinoma
Carcinoma insitu
Epitheial Displaisa
deep fungal
tuberculosis lesion
Histo:
squamous pearl island island
DX: Squamous Cell Carcinoma
Tongue blood under it
- bilateral red uclers of the ventcal tongue
- painful
- couple of years
- medications : lisonpril (just for fun)
- no habits of piercings
- gets better and gert worse
- on back hard palate too
- nikolsky +
- hx of blisters in mouth
DDX:
Pemphigous Vulgars
Mucus membrane Pemphgoid
Eorsive Lichen Planus
Histo
breaking off of epi cells
basal layer broken away
immonflurence :Ig
DX: Pemphigous Vulgars
submucosal nodule located in the mandibular vestibule
- no history of trauma
- 5 years
- stayed about the same
- no pain
- isolated
- movable
DDX:
Pleomorphic Adenoma
Mucoepdermal Carcinoma
Muccocle
Histo:
mature adiposites
DX: lipoma
Bump on lip submocosa nodule lower lip
- 4-5 months
- hx of trauma
- no pain
- isolated
DDX:
mucocle
tramatic fibroma
hemangioma
Histo
changes sizes
granulation tissue wall
filled mucin
DX: mucocle
purplish pigmentation on palate
- no pain
- unknown duration
- no other pigmentation
- pt does not know of trauma
- medication: hydrochlophine
DDX:
Malanotic Nevi
Melanoma
Post Inflammatory Pigmentation
Histo:
DX: medicated indicuded pigmentation
hydroxychloroquine- anti malataria
ulceration on cheek and upper lip
*nikolsky +
* fever :no
* age: 17
* 5 days
* HIV : no
* infection recently : fever and malasia sore mouth
* no habits
* no systemic disease
* no changed in OH
DDX:
Erythema multiform - duration
cant be Primary Herpes (no fever/systemic)
bump on hard palate
- no pain
- soft tissue firm
- no trauma
- gender:female
- age: 55
- isolate
- no dental pain
DDX:
PGLA
Pleomorphic Adenoma
Mucoepidermal
Histo
something that resemble cartilage
DX:Pleomorphic Adenoma
bump on gums
DDX
Pyogenic Granuloma
Peripheral Ossifying Fibroma
Peripheral Giant cell granuloma
histo
osseous
DX
Peripheral Ossifying Fibroma
macule on alveolar crest
- had silver filling before
- no symptoms
- chew on pencils
DDX:
Amalgam tattoo
Melanoma
Lead Tattoo
XRAY
radiobque flecks = amalana tattoo
Histo:
see chuncks of amalgam
amalgam tattoo
on the floor of the mouth rasied white border with red center ( picture from test)
- other lesions : dorsal surface of tongue
- come and go
- painful for foods and on their own
- no fever
DDX:
DX: geo tongue
