Soft Tissue Lesions and Biopsy

Question 1

What is a biopsy?

Answer 1

Sample of tissue for histopathological analysis
Confirm or establish a diagnosis
Determine prognosis

Question 2

What tissue sampling techniques can be used?

Answer 2

Aspiration
Aspiration from lesion
Fine needle aspiration biopsy

Question 3

What is an aspiration sampling technique?

Answer 3

Blood sample - venous blood
E.g. FBC, U&E, haematinics, glucose etc
Also a type of biopsy

Question 4

What is an aspiration from lesion tissue sampling technique?

Answer 4

Aspiration will determine whether a lesion is solid or fluid filled
Occasionally an aspiration may yield blood e.g. haemangioma
Protection of anaerobic species
Aspiration avoids contamination by oral commensals

Question 5

What is a fine needle aspiration biopsy?

Answer 5

Aspiration of cells from solid lesions
Neck swellings, salivary gland lesions
Cytology instead of pathology

Question 6

What types of surgical biopsy can you do?

Answer 6

Excisional biopsy
Incisional biopsy

Question 7

What is an excisional biopsy?
For what lesions?

Answer 7

Removal of all clinically abnormal tissue
Usually fairly confident of provisional diagnosis
Usually for benign lesions e.g. fibrous overgrowths, denture hyperplasia, mucoceles

Question 8

What is an incisional biopsy?
For what lesions?

Answer 8

Representative tissue sample
For larger lesions of uncertain diagnosis
E.g. leukoplakia, lichen planus, squamous cell carcinoma

Question 9

What is a punch biopsy?

Answer 9

Type of incisional biopsy
Removes the core of tissue
Minimal damage
May not require sutures or only a minimal number of sutures

Question 10

What do you look for when selecting an area to biopsy?
What must you include in ulcers?

Answer 10

Area must be large enough
Must be representative
Maybe more than one biopsy - if differences in appearance between presenting areas
Include the perilesional tissue around ulcers

Question 11

What is sample placed immediately into for the pathology lab?

Answer 11

10% formalin

Question 12

What are some issues that can arise when you are not careful with sample tissues?

Answer 12

Crush- distorts anatomy of the sample
Tear- surface of epithelium has been ripped off from the underlying tissue (can occur in other disease processes so can lead to incorrect diagnosis)

Question 13

What is a fibrous epulis?
What biopsy is used?
How to treat?

Answer 13

Swelling arising from the gingivae
Hyperplastic response to irritation
–overhanging restoration, subgingival calculus
Smooth surface, rounded swelling
Pink and pedunculated
Excisional biopsy
TREATMENT;
Coe pack dressing
Removal of source of irritation

Question 14

What is a fibrous overgrowth?
What biopsy is used?

Answer 14

Fibroepithalial polyp
Frictional irritation or trauma
Semi-pedunculated or sessile
Pink
Smooth surface
Most common site is the buccal mucosa and inner surface of the lip
Surgical excision
No need for deep excision or normal margin

Question 15

What is a giant cell epulis?
Biopsy used?
Treatment?

Answer 15

Peripheral giant cell granuloma
Multinucleated giant cells in vascular stroma
Most common in teenagers in anterior regions of the mouth
Deep red or purple with a broad base
TREATMENT;
Surgical Excision with curettage of the base
Coe pack dressing

Question 16

What is a Haemangioma?
Treatment?

Answer 16

Hamartoma
Developmental overgrowths
Exophytic
Blue in colour
Pressure will cause loss of colour
TREATMENT;
Surgical removal or cryotherapy (no histological diagnosis with cryotherapy)

Question 17

What is a lipoma?
Treatment?

Answer 17

Benign neoplasm of fat
Soft swelling
Pale yellow
Sessile
TREATMENT;
Excision

Question 18

What is a pregnancy epulis?
Treatment?

Answer 18

Histologically same as pyogenic granuloma
May be related to calculus as they often bleed easily
Hormonal changes enhance response to tissue irritation
TREATMENT;
Small lesions may not require excision and may regress after birth of baby
Larger lesions should be excised especially if they are getting in the patients way
Remove the source of irritation

Question 19

What is a pyogenic granuloma?
Treatment?

Answer 19

Arises from failure of normal healing
Overgrowth of granulation tissue
May be related to extraction sockets or traumatic soft tissue injuries
Red
TREATMENT;
Surgical excision
Curettage of base

Question 20

What is a squamous cell papilloma?
Treatment?

Answer 20

Benign neoplasm
Usually pedunculated
White surface
Cauliflower appearance
TREATMENT;
Excision at base
Test for HPV now too

Question 21

What is Denture Hyperplasia?
Treatment?

Answer 21

Hyperplastic reaction from a poorly fitting denture (that is moving all the time)
Roll of excess tissue on outer aspect of denture flange or between flange and alveolar ridge
TREATMENT;
Trim flange of the denture
Remove excess tissue
If very large area Coe pack dressing to ensure sulcus depth is maintained

Question 22

What is a Leaf Fibroma?
Treatment?

Answer 22

Chronic irritation from denture
Would be round if not covered by denture but becomes flattened
Pedunculated- just attached at one point
TREATMENT;
Excision

Question 23

What is a Mucocele?

Answer 23

Mucous extravasation cyst
Damage to minor gland and duct
Saliva leaks into submucosal layer
Soft bluish swelling fluid filled
Recurrent
TREATMENT;
Diagnosis usually from history
Surgical excision
Blunt dissection
Often rupture

Question 24

What is the name for a mucocele on the floor of the mouth?

Answer 24

Ranula
More difficult to remove

Question 25

What is a squamous cell carcinoma?
What biopsy is used?

Answer 25

Cancer
May present a lump, red or white patch, non-healing ulcer
Classic description
–ulcer, rolled margin, induration (hard)
Lesion may bleed easily and be fixed to surrounding tissue
BIOPSY- incisional
urgent referral if suspected