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BDS4 Oral Surgery > Soft Tissue Lesions and Biopsy > Flashcards

Soft Tissue Lesions and Biopsy Flashcards

1
Q

What is a biopsy?

A

Sample for histopathological analysis
- Helps confirm or establish diagnosis (not necessarily of malignancy)
- Determines prognosis and treatment required

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2
Q

When would you consider referral for biopsy?

A

If lesion prone to bleeding

If suspected cancer

Lumps in upper lip (always presumed cancer until proven different- common site for minor gland lesions)

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3
Q

When may a patient choose to not biopsy a growth?

A

If it is a traumatic polyp

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4
Q

Why do we biopsy lesions?

A
  • To remove it- ending disease process
  • To identify lesion
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5
Q

Why are aspirates from abscesses preferred over swab?

A
  • Avoids contamination
  • Protection of anaerobic species
  • If keratocyst- white cheesy material
  • Radicular/dentigerous cyst- straw coloured fluid
  • Determines whether solid or fluid filled
  • If blood- may be haemangioma
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6
Q

What other aspirates may be taken?

A

Blood sample
* Venous blood
* eg. FBC, U&E, haematinics, glucose etc

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7
Q

What is a fine needle aspirate and its uses?

A

Aspirate cells from solid lesions, sent to cytology
- Neck swellings
- Breast lesions
- Salivary gland

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8
Q

What is done in an excision biopsy?

A
  • Remove all of clinically abnormal tissue
  • You must be fairly confident of provisional diagnosis
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9
Q

What are the indications for excisional biopsy?

A

Usually benign lesions-fibrous overgrowths, denture hyperplasia, mucoceles (well-known clinical appearance)

Must be discrete lesion

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10
Q

What is an incisional biopsy?

A

Don’t remove lesion but take representiitve sample of it

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11
Q

What are the instances may an incisional biopsy be opted for?

A

 Larger lesions that may be spread
 Uncertain diagnosis- leukoplakia, LP, SCC (sometimes a discrete lesion- but leave some evidence to help guide surgeons)

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12
Q

What are the features of a punch biopsy?

A

Type of incisional biopsy
- Uses Hollow trephine- 4, 6, 8mm diameter
- Removes core of tissue- would be difficult to remove with scalpel
- Minimal damage
- May not require suture or minimal suturing

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13
Q

How is an area for incisional biopsy selected?

A
  • Must be large enough
  • Must be representative (may need to take more than one)
  • If an ulcer- take peri-lesional biopsy (tissue next to ulcer)
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14
Q

How is a sample sent to pathology lab?

A
  • Put into 10% formalin (be careful with handling as it is carcinogenic)
  • Don’t place on damp swab- distorts
  • Suture to help pathologist orientate (if that is important)
  • Include relevant clinical info (description, include diagrams or pictures)
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15
Q

What can a specimen be put onto if gauze is not allowed?

A

Filter paper

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16
Q

What damage can occur to specimens if handled incorrectly?

A

Crushing can occur when taking biopsy
-> Distorts flat samples

Tear- surface of epithelium is ripped off from underlying tissue (can look like different disease)

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17
Q

What information is provided on pathology form?

A
  • All information possible about patient- name, DoB, gender, address, who to contact-number, where the report is to go to, hospital number, department (ensure this is filled out properly)
  • Tick histopathology
  • When you collected- time and date
  • What sample is (nature)- basic description
  • Clinical details- MH, provisional diagnosis
  • Risk of infection- specify
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18
Q

How does cytopathology specimen differ from histopathology? (rare in dentistry)

A
  • Goes on slide
  • Is fresh sample not fixed
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19
Q

What information may we want to include when describing a lesion?

A
  • Location
  • Colour- white, red, mixed etc
  • Pattern/texture- striated, ulceration
  • Size
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20
Q

What should be done when putting specimen in the pathology pot?

A
  • label as fully as possible
  • correct usage should ensure no leaks
  • do not confuse with the tooth collection pots

-> Package and send to pathology at QE, by courier (may not be possible in GDP)

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21
Q

What should we avoid when choosing area to sample with biopsy?

A

Try to avoid:
salivary gland duct orifices
tip of tongue
areas close to nerves
larger blood vessels

** Not required to take normal tissue margin

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22
Q

What are fordyce spots?

A

Fordyce spots- ectopic sebaceous glands
-> Does not require biopsy

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23
Q

What is a fibrous epulis?

A

Swelling arising from the gingivae caused by hyperplastic response to irritation
-> Overhanging restorations
-> Subgingival calculus

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24
Q

How does a fibrous epulis appear clincially?

A

Smooth surface

Rounded swelling

Pink

Pedunculated

25
Q

How is a fibrous epulis treated?

A
  • Excisional biopsy
  • Coe pack dressing
  • Removal of source of irritation (prevent recurrence)
26
Q

What causes fibrous overgrowth or polyp?

A

Frictional irritation

Trauma

27
Q

How does a fibrous overgrowth appear clinically?

A

Can be semi-pendunculated or sessile

Pink

Smooth surface

Commonly seen on inner surface of lower lip or buccal mucosa

28
Q

How is fibrous polyp treated?

A

Surgical excision- no need for deep excision or normal margin
- Stabilise lesion with suture
- Cut around with scalpel

29
Q

What is a giant cell epulis?

A

Peripheral giant cell granuloma
-> Multi nucleated giant cells in vascular stroma

30
Q

How do giant cell epulides present?

A

In Teenagers

Anterior regions of mouth

Deep red or purple lesion with broad base

31
Q

Why do we need a radiograph when we see a giant cell epulis?

A

To check it is not a central epulis arising from bone

32
Q

How is a giant cell epulis treated?

A

Surgical excision with curettage of base (may bleed)
-> Coe pack dressing

33
Q

What is a haemangioma?

A

Developmental overgrowth of BVs
-> form of hamartoma

34
Q

How does a haemangioma present clincially?

A

Bunch of grape apeearance

Exophytic

Blue in colour

Pressing on it causes blanching

35
Q

How is a haemangioma treated?

A

Cryotherapy/freezing- 3 cycles for a minute each (leave to thaw- this causes damage)
-> no confirmed diagnosis required as appearance is classic

Surgical removal

36
Q

What is a lipoma?

A

Benign neoplasm of fat

37
Q

How does a lipoma appear?

A

Soft swelling

Pale yellow

Sessile

38
Q

How is a lipoma treated?

A

Excision

39
Q

What lesion is a pregnancy epulis histologically identical to?

A

Pyogenic granuloma

40
Q

What causes a pregnancy epulis?

A

Hormonal changes enhance response to irritation
-> calculus

41
Q

How are pregnancy epulides treated?

A

Small lesions- may not require removal, and can regress after baby is born

Larger lesions- excise

*** source of irritation must be removed

42
Q

What is a pyogenic granuloma?

A

Arises from failure of normal healing- Overgrowth of granulation tissue
-> May be related to extraction sockets or traumatic soft tissue injuries

43
Q

How is a pyogenic granuloma treated?

A

Surgical excision

Curettage of base

44
Q

What is a squamous cell papilloma?

A

Being neoplasms that commonly occurs on palate, buccal mucosa, lips, uvula

45
Q

How does a squamous cell papilloma appear?

A

Pendunculated

White surface

Cauliflower appearance

Similar to viral warts

46
Q

How is squamous cell papilloma treated?

A

Excision at base

Test for HPV

47
Q

What is denture hyperplasia?

A

Hyperplastic reaction to poorly fitting dentures

48
Q

How does denture hyperplasia present?

A

Roll of excess tissue on outer aspect of denture flange or between flange and alveolar ridge
-> most common in lower labial sulcus

49
Q

How is denture hyperplasia treated?

A

Trim flange of denture (make new denture)

Remove excess tissue
-> If very large area Coe pack dressing to ensure sulcus depth maintained

50
Q

What is a leaf fibroma

A
  • Polyp caused by chronic irritation by denture
  • Squashed by denture so looks flat like a leaf (pedunculated)
51
Q

How is leaf fibroma treated?

A

Excision

52
Q

What is a mucocele?

A

Mucous extravasation cyst
- Damage to minor salivary gland duct causes leaking into submucosal layer
- Disappear on trauma then recur

53
Q

How do mucoceles present?

A

Soft bluish swelling fluid filled
-> recurrent

54
Q

What happens if the mucocele as ruptured when you plan to remove it?

A

You must wait until it returns

55
Q

Why do we remove any other minor glands we see on dissection of a mucocele?

A
  • Removing mucocele often damages another salivary gland
56
Q

What is a ranula?

A

Big blue swelling in floor of mouth
- Dissecting is problematic due to salivary gland ducts and lingual nerve
- Associated with sublingual gland
- Can plunge off the back of mylohyoid

57
Q

How is a mucocele excised?

A
  • LA
  • Incise around- elliptical opening (vertical not horizontal- reduces risk of nerve damage)
  • Blunt dissection to remove it
  • Ensure tissue bed is clear
  • Suture
58
Q

How does squamous cell carcinoma present?

A
  • Non-healing ulcer with raised rolled margins which is indurated
  • Bleed easily
  • Red and white patches
  • Fixed to surrounding tissue- Difficulty moving tissue around it
  • Painful
59
Q

How is SSC managed?

A

Need histological diagnosis before treatment plan
 Refer via rapid access pathway- via scigateway on urgent suspicion of cancer pathway (consider following up with a phone call)
 Patients need to be seen within 2 weeks
 Treatment must be started in 62 days

BDS4 Oral Surgery (19 decks)

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