soft tissue lesions and biopsy Flashcards
purpose of biopsy
3
- Sample of tissue for histopathological analysis
- Confirm or establish a diagnosis
- Determine prognosis
any abnormal tissue removed should be sent for biopsy
purpose of biopsy
3
- Sample of tissue for histopathological analysis
- Confirm or establish a diagnosis
- Determine prognosis
any abnormal tissue removed should be sent for biopsy
aspiration biopsy
e.g.. Abscess (better than swab)
Aspiration avoids contamination by oral commensals
* Protection of anaerobic species
May also aspirate cystic lesions
* Keratocysts-keratin (cheesy, semi solid); straw liquid from dentigerous cyst
Aspiration will determine whether a lesion is solid or fluid filled
* Ameloblastoma would be solid on aspiration attempt
* Occasionally aspiration may yield blood e.g. haemangioma (good as don’t want to cut into it)
Fine needle aspiration biopsy
* Aspiration of cells from solid lesions - Neck swellings, salivary gland lesions
* Cytology
surgical biopsy types
3
excisional biopsy
incisional biopsy
punch biopsy
excisional biopsy
Removal of all clinically abnormal tissue
Usually fairly confident of provisional diagnosis
Usually benign lesions e.g. fibrous overgrowths, denture hyperplasia, mucocoeles
Discrete lesions
incisional biopsy
Representative tissue sample – so can confirm dx
Larger lesions
Uncertain diagnosis
E.g. Leukoplakia, lichen planus, squamous cell carcinoma
punch biopsy
Type of incisional biopsy
Hollow trephine 4, 6 or 8mm diameter
Removes core of tissue
Minimal damage
May not require suture or only minimal number of sutures
selecting area to biopsy
Must be large enough
Must be representative
Maybe more than one biopsy
Don’t just biopsy ulcers! – not useful for dx
include perilesional tissue
* dont need normal tissue margin around
* try to avoid salivary gland duct orifices, tip of tongue, areas close to nerves and larger blood vessels
Refer?
* Suspicious lesions
* e.g. lumps within the upper lip (cancer until proven otherwise – common minor salivary gland cancer; whereas lowerlip more likely to have mucocele)
sending sample to pathology lab
Sample should be placed immediately into 10% formalin, don’t place on gauze swab
Suture may help the pathologist to orientate the sample – label mesial to distal
Include relevant clinical information on the pathology form to aid in diagnosis.
Diagrams are helpful (more info better)
Pathology form- in GDH now electronic (Trakcare)
ensure use pot correctly and package to guidelines
sent to pathology dept QUEH
care of specimen
- a biopsy is fragile
- Sutures - can be useful for orientation; otherwise, be careful
- Gauze - distorts the sample so don’t use
- Filter paper - to reduce sample distortion
describe this lesion
Left buccal mucosa – mixed erythroleukoplakia (red and white) with striated areas, with areas of ulceration in the centre. Pt is edentulous. Lesion covers full buccal mucosa
what is this
Fordryce spots
DO NOT NEED BIOPSY
Sebaceous gland in underlying mucosa
fibrous epulis
describe
Swelling arising from the gingivae
Hyperplastic response to irritation
Overhanging restoration
Subgingival calculus
Smooth surface, rounded swelling
Pink and pedunculated
Excisional biopsy
Coe pack dressing
Removal of source of irritation
* Possibility to recur
fibrous overgrowth/fibroepithelial polyp
Frictional irritation or trauma (e.g. bit cheek)
Semi pedunculated or sessile (more common)
Pink
Smooth surface
Most common buccal mucosa and inner surface of lip
Surgical excision* if pt not bothered by it can remain – realistic medicine*
* Very unlikely to develop malignancy
* No need for deep excision or normal margin; Suture to stabilise lesion, excise around border scalpel, then suture
giant cell epulis
Peripheral giant cell granuloma
Multi nucleated giant cells in vascular stroma
Teenagers, anterior regions of mouth
Deep red or purple, broad base
Need
* x-ray to ensure not centrally originating (would appear as radiolucency)
* blood tests as well to exclude systemic disease (PTH)
tx
* Surgical excision with curettage of base (likely bleed)
* Coe pack dressing
haemangioma
describe
Hamartomata
Developmental overgrowths
Exophytic - commonly looks like a bunch of grapes
Blue in colour
Pressure will cause loss of colour
Surgical removal or more commonly cryotherapy (3 cycles of min each, thawing which cause damage and make lesion to disappear – will regress over time)
* Only drawback of cryotherapy is no histological diagnosis – but not necessary often due to classic appearance
pregnancy epulis
describe
Histologically same as pyogenic granuloma
May be related to calculus often bleed easily
Hormonal changes enhance response to tissue irritation
Small lesions may not require excision and may regress after birth of baby
Larger lesions should be excised
But also need to remove source of irritation
pyogenic granuloma
Arises from failure of normal healing
Overgrowth of granulation tissue
May be related to extraction sockets or traumatic soft tissue injuries
Red in colour
Surgical excision
Curettage of base
squamous cell papilloma
Most common palate, buccal mucosa or lips
Benign neoplasm
usually pedunculated
White surface
Cauliflower appearance
Test for HPV – as can be associated, then oral cancer risk
Excision at base
Similar to viral warts
denture hyperplasia
describe
Poorly fitting denture
* hyperplastic reaction – sausage shaped rolls of tissue
Roll of excess tissue on outer aspect of denture flange or between flange and alveolar ridge
* Most common lower labial sulcus
Trim flange of denture or make new denture
Remove excess tissue
* If very large area Coe pack dressing to ensure sulcus depth maintained
leaf fibroma
describe
benign
Chronic irritation from denture
* Would be round if not covered by denture but becomes flattened (polyp)
Pedunculate
Excision
mucocele
describe
*a.k.a. Mucus extravasation cyst *
Most common minor salivary gland problem
* Damage to minor gland duct
* Saliva leaks into submucosal layer
Soft bluish swelling fluid filled
Recurrent – warn pt
Floor of mouth ranula
Diagnosis usually from history
Surgical excision - remove when present
* Blunt dissection; Often rupture in process – can damage another minor salivary gland next to it – elliptical incision should be vertical not horizontal (greater chance of damage)
BUT swellings in upper lip are usually neoplastic NOT simple mucocele
squamous cell carcinoma descrive
May present as a lump, red or white patch, nonhealing ulcer
Classical description
* Ulcer
* Rolled margin
* Induration
* Lesion may bleed easily and may be ‘fixed’ to surrounding tissue
* mixed erythroleukoplakia
Need a histological diagnosis
* Incisional biopsy
Should be referred urgently via the rapid access pathway
* By phone followed up by a faxed referral
* Now SKYGATEWAY electronic
State Urgent suspicion of cancer
Cancer seen within 2 weeks, tx started in 62 days
what is this
what needs done
Leukoplakia – can be PMD – take a biopsy from each separate area
classical description of squamous cell carcinoma
6
- Ulcer
- Rolled margin
- Induration
- Lesion may bleed easily
- may be ‘fixed’ to surrounding tissue (firm)
- mixed erytholeukoplakia
