Soft tissue lesions and biopsy Flashcards
What is a biopsy
it is a sample of tissue for histopathological analysis , it can confirm or establish a diagnosis - determines prognosis
What is the advantages of aspirational biopsy?
- avoids contamination by oral commensals
- protection of anaerobic species
- may also aspirate cystic lesions (keratocysts)
What is fine needle aspiration biopsy?
- aspiration from cells from solid lesions
- neck swellings or salivary glands lesions
- for cytology
What is excisional biopsy?
- remove all clinically abnormal tissue
- when you are confident about the diagnosis
- Usually benign lesions such as fibrous overgrowths and denture hyperplasia
- Discrete lesions
What is incisional biopsy?
- for larger lesions
- if diagnosis is not certain
e.g. - lichen planus , squamous cell carcinoma, leukoplakia
What is punch biopsy?
- it is a type of incisional biopsy
- hollow trephine 4,6,8,mm diameter
- minimal damage
- may not require suturing or minimal suturing
How to select the area for biopsy?
- must be large enough
- must be representative
- may take more than one biopsy
- for ulcers : include perilesional tissue
How to send biopsy to the lab?
- it should be placed immediately into 10% formalin
- suture may help pathologist to orientate the sample
- include relevant clinical information on the pathology form to aid diagnosis
- fill pathology form
How to care of biopsy?
- suturing the biopsy can be useful for orientation
How does gauze damage the biopsy?
it can distort the sample
What is filtered paper used for in biopsy?
it can reduce the sample distortion
What two types of injuries can happen to a biopsy?
Crushing and tearing
What to include in biopsy form?
- type of biopsy carried out
- history of biopsied sample : ex present for 6 months with gradual increase in size
- Past medical history
- differential diagnosis
What kind of pot is biopsy stored in?
Yellow lid pot
- need to label as fully as possible
- do not confuse with tooth collection pots
Where to send the specimen to ?
The pathology department in QEUH
What areas should you avoid when taking a biopsy?
- salivary gland ducts orifices
- areas close to nerves and larger blood vessels
Soft tissue lesions examples
Carcinoma
denture hyperplasia
Fibrous epulis
Fibrous overgrowth
Giant cell epulis
Pregnancy epulis
Haemangioma/lymphangioma
Lipoma
pyogenic granuloma
squamous cell papilloma
Salivary glands lesions
What is fibrous epulis
- swelling arising from the gingivae
- hyperplastic response to irritation (overhanging restorations or calculus)
- smooth surface rounded swelling
- pink and pedunculated
- excisional biopsy
- coe pack dressing
- remove source of irritation
What is fibroepithelial polyp
- fibroepithelial polyp
- caused by frictional irritation to trauma
- semi pedunculated
- pink
most common buccal mucosa and inner surface of lip - surgical excision
- no need for deep excision or normal margin
What is a giant cell epulis?
- a peripheral giant cell granuloma
- multi nucleated giant cells in vascular stroma
- mostly affects teenagers and affect anterior regions of the mouth
- red or purple, with broad base
- need radiograph to check its not centrally originating
- Surgical excision with curettage of base
- Coe pack dressing
What is haemangioma?
- hamartoma
- developmental overgrowths
- Exophytic
- Blue in color
- Pressure will cause loss of colour
- surgical removal or cryotherapy
What is the disadvantages of cryotherapy?
there is no histological analysis as the lesion is frozen by liquid nitrogen
What is a lipoma?
- benign neoplasm of fat
- soft swelling
- pale yellow
- sessile
- excision
What is pregnancy epulis?
- same as pyogenic granuloma histologically
- 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
What is pyogenic granuloma?
- 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
- curretage of base
What is squamous cell papilloma?
- most common in palate, buccal mucosa or lips
- benign neoplasm
- usually pedunculated
- white surface
- Cauliflower appearance
- excision at base
- similar to viral warts
What is denture hyperplasia
- hyperplastic reaction due to poorly fitting denture
- Roll of excess tissue on outer aspect of denture flange and alveolar ridge
- most common lower labial sulcus
- Trim flange of denture
- remove excess tissue
- If large area coe pack dressing to ensure sulcus depth is maintained
What is leaf fibroma?
- chronic irritation from denture
- would be round if not covered by denture but becomes flattened
- pedunculated
- excision
What is a mucocele?
- mucous filled cyst
- most common minor salivary gland problem to damage to duct
- Saliva leaks into submucosal layer
- Soft bluish swelling fluid filled
- recurrent
- called ranula at the floor of the mouth
swellings in the upper lip are mostly ______?
neoplastic rather than mucoceles
What is squamous cell carcinoma?
- may present as a lump, red white patch or non healing ulcer
What is the Classical description of squamous cell carcinoma?
- Ulcer
- Rolled margin
- induration
- lesion may bleed easily and may be fixed to surrounding tissue
What to do if suspected squamous cell carcinoma?
- Need a histological diagnosis
- incisional biopsy
- Should be referred urgently via the rapid access pathway
- by phone and then followed by a faxed referral
