Soft tissue lesions and biopsy Flashcards
What is a biopsy ?
- Sample of tissue for histopathological analysis
- Allows us to confirm or establish a diagnosis
- Determine prognosis
What questions should you ask when thinking about a biopsy?
- Should I biopsy this?
- Why am I biopsying this?
- What question am I asking the pathologist?
What type of biopsy is a blood sample?
- Aspiration biopsy
- e.g. FBC, U&E, haematinics, glucose etc
What types of biopsy can be taken from aspiration?
- Blood sample
- Lesion e.g. abscess or cystic lesion
- Solid lesion e.g. salivary gland lesion
Why is aspiration useful in biopsy for a abscess for example?
- Avoids contamination by oral commensals
- Protection of anaerobic species
- Determines whether a lesion is solid or fluid filled
What type of lesion may yield blood, that isn’t a blood sample?
- Haemangioma
What is a cystic lesion that can be aspirated?
- Keratocytes -aspirate keratin
- Radicular cyst
- Dentigerous cyst
What is a fine needle aspiration biopsy?
- Aspiration of cells from solid lesion
- Goes to cytology not histology
- Not done commonly in dental hospital
- But can be done for enck swelling, salivary gland lesions
What is an excisional biopsy and what would you do this for?
- Removal of all clinically abnormal tissues
- Have to be fairly confident of provisional diagnosis to excise all teh tissue
- Done for Benign lesions e.g. fibrous overgrowths, denture hyperplasia, mucoceles
- Done only if it is a discrete lesion (in one place, not all over the mouth)
What is an incisional biopsy and when would you do this?
- Representative tissue sample
- Usually done for larger lesions or uncertain diagnosis
- e.g. leukoplakia , lichen planus, squamous cell carcinoma
What is a punch biopsy? Describe the instrument and what is does
- Type of incisional biopsy
- Hollow trephine 4, 6 or 8mm diameter
- Removes core of tissue with minimal damage
- May not require suture or only minimal number of sutures
What questions do you need to answer when selecting the area to biopsy?
- Must be large enough
- Must be representative
- Maybe more than one biopsy
- Don’t just biopsy ulcers, include perilesional tissue
- Refer?
* suspicious lesions
* lumps within the upper lip (common site for malignant salivary gland lesions)
What should the biopsy sample be placed in before sent to pathology lab?
- Place immediately into 10% formalin
- Don’t place on guaze swab
- Sometimes if you place suture in mesial or distal aspect then helps the orientation for lab
- Include all relevant clinical info on pathology form to aid diagnosis
Why do you not use gauze on the sample?
- Distorts the sample
Why do you use filter paper on the sample?
- to reduce sample distortion
What injury is this an example of?
- Crush injury from a flat sample
What injury is this an example of?
- Tear injury from flat sample
- Epithelium been torn away
What info do you need to include on the pathology form?
- Name
- CHI
- DOB
- Dentist
- Address
- Your name and address
- Contact number
- Tick histopathology
- Details of specimen - time and date of collection
- Nature of specimen
- provisional diagnosis
- Clinical details (PMH)
- Risk of infection tick yes or no
Describe this lesion
- Buccal mucosa in edentulous arch
- Mixed red and white lesion white with striated areas (White areas)
- Some areas of ulceration in the middle lesion
- Extensive lesion
Where should the specimen be sent to?
- The pathology dept Queen Elizabeth University hospital
When choosing areas to biopsy what are the 3 things you need to consider?
- Chose a representative sample
- Don’t need to include normal tissue margin
- Try to avoid salivary gland duct orifices, tip of tongue, areas close to nerves and larger blood vessels
What are Fibrous epulis? Describe the lesion
- Swelling arising from gingivae
- Hyperplastic response to irritation (usually due to overhanging restoration, subgingival calculus)
- Has smooth surface, rounded swelling
- Pink and pedunculated
What is the txt of fibrous epulis?
- Excisional biopsy
- Coe pack dressing
- removal of source of irritation or will just return
What is a fibrous overgrowth? Describe what you would see?
- Fibroepithelial polyp
- Benign
- Due to Frictional irritation or trauma
- Semi pedunculated or sessile
- Pink
- Smooth surface
- Most common on buccal mucosa and inner surface of lip
What is the txt of a fibroepithelial polyp?
- Surgical excision if bothering pt
- No need for deep excision
What is a Giant cell epulis? Describe what you might see?
- Peripheral giant cell granuloma
- Multi nucleated giant cells in vascular stroma
- Deep red or purple with broad base
Where are Giant cell epulis found commonly?
- Teenagers, anterior regions of mouth
What is the txt for Giant cell epulis?
- X-ray to ensure it is not centrally originating (this would appear as radiolucency)
- Surgical excision with curettage of base
- Coe pack dressing
What is a Haemangioma? Describe the lesion
- Developmental overgowths
- Hamartomata
- Exophytic
- Blue in colour
- Pressure will cause loss of colour
What is the txt of Haemangioma?
- Surgical removal
- More commonly cryotherapy (but this option has no histological diagnosis)
What does Exophytic mean?
- Growth of a tumour outwards from surface epithelium
What is a Lipoma? Describe the lesion? How would you treat one?
- Benign neoplasm of fat
- Soft swelling
- Pale yellow
- Sessile
- Excision
What is a pregnancy epulis? What might it be due to?
- Overgrowth of granulation tissue which arises from failure of normal healing
- May be due to calculus
- Hormonal changes enhance response to tissue irritation
- Bleeds easily
What is the txt of a pregnancy epulis?
- Small lesions may not need excision and can be kept until after baby is born (may even regress on their own)
- Larger lesions should be excised
What is a Pyogenic granuloma? Describe this lesion. What is the txt?
- Overgrowth of granulation tissue which arises from failure of normal healing
- May be related to XLA sockets ir traumatic soft tissue injuries
- Red in colour
- Surgical excision
- Curettage of base
What is a squamous cell papilloma? Describe the lesion. What is the txt?
- Benign neoplasm
- Usually pedunculated
- White surface
- Cauliflower appearance
- Most common palate, bucal mucosa or lips
- Excision at base
- Get tested for HPV as similar to viral warts
What is denture hyperplasia? What is it due to? Where is it most common? What is the txt?
- Hyperplastic reaction leading to roll of excess tissue of outer aspect of denture flange or between flange and alevolar ridge
- Due to poorly fitting denture
- Most common lower labial sulcus
- Trim flange of denture
- remove XS tissue
- If very larger area Coe Pack dressing to ensure sulcus depth maintained
What is a leaf fibroma? Describe the lesion. What is the txt?
- Chronic iritation due to denture
- Round polyp that becomes flattened due to denture
- Pedunculated (attached at one point)
- Benign
- Excision
What is a mucocele? What is it due to?
- Mucous extravasation cyst
- Most common minor salivary gland problem
- Damage to minor gland duct occurs
- Saliva leaks into submucosal layer
- Soft bluish swelling fluid filled
- Recurrent issue
- When they occur in the floor of the mouth they are called ‘Floor of mouth Ranula’
What is the txt of mucocele?
- if pt presents with mucocele we can see then surgical excision vertically using blunt dissection
- Often rupture
- Pt should be warned about recurrence
What is this image showing?
- Floor of the mouth ranula
- Mostly associated with sublingual gland
- Need to be careful, wouldn’t excise this
What does this image show? Describe this image
- Squamous cell carcinoma
- May present as lump, red or white patch, non healing ulcer
- Ulcer
- Raised Rolled margin
- Induration (hard)
- Lesion may bless easily and be fixed to surrounding tissue
- Often not painful at the start but may get painful as they grow
- Refer rapidly via the Rapid access pathway - urgent suspicion
