Soft Tissue Lesions And Biopsy Flashcards
What is a ‘biopsy’
Sample of tissue for histopathological analysis
To confirm or establish a diagnosis and determine prognosis
What are advantages of aspiration biopsy?
Prevents contamination of oral commensals
Protects anaerobic species’
Can be used to tell if lesion is solid or liquid
What is a fine needle aspiration biopsy?
Fine needle inserted into lesion and suctions a few cells and occasionally fluid
Often used on solid lesions - neck swellings, salivary gland lesions
What is a surgical excisional biopsy? When might it be done?
What lesion would it typically be done for?
Removal of all clinically abnormal tissue
Done when usually fairly confident of provisional diagnosis
Usually done on benign lesions such as fibrous overgrowths or denture hyperplasia etc
What is a surgical incisional biopsy?
When used?
What type of pathology would be good for this?
Incision made and small sample of tissue taken
Used for when diagnosis is uncertain
Good form larger lesions
Leukoplakia or lichen planes
What is a punch biopsy?
Why is it good?
Sample of tissue punched out by a hollow trephine 4,6 or 8mm in diameter
Minimal damage and may not even require a suture, or minimal number of sutures
How should the biopsy be sent to a lab?
Immediately place biopsy in 10% formalin
Include relevant clinical information to aid in diagnosis
What area should i choose to biopsy?
Choose a representative area
‘Normal’ tissue margin is not needed
Avoid areas in close proximity to vessels, nerves, salivary gland orifices, tip of tongue
What is a fibrous epulis?
What biopsy would i take?
Pedunculate Swelling arising from gingiva
Hyperplasticity response to irritation e.g. calculus or overhanging restoration
Smooth surface and round
Take excisional biopsy and remove source of irritation
What is a fibrous overgrowth? What type of biopsy?
Fibroepithelial polyp
Pedunculated or sessile
Pink and smooth surface
Caused by irritation or trauma
Surgical excision needed
What is a giant cell epulis? What biopsy?
Peripheral giant cell granuloma found often in teenagers in the anterior region of the mouth
Deep red or purple broad base
Idiopathic however believed local irritation factors contribute
Surgical excision after x ray of area
What is a haemangioma? What biopsy take?
Benign tumour arising from proliferation of endothelial cells
- blueish in colour
Surgical excisional biopsy
What are pregnancy epulis?
What type of biopsy?
Same as Pyogenic granuloma
- failure of normal healing and overgrowth of granulation tissue
Often cause by hormonal changes enhancing response to tissue irritation
Larger lesions should be excised, smaller ones may regress after baby delivered
What is pyogenic granuloma?
What biopsy?
Failure of normal healing causing overgrowth of granulation tissue
- hyperplasia of capillaries
May be related to extraction sockets or traumatic soft tissue injuries
Red colour
Surgical excision
What is squamous cell papilloma? What biopsy?
Benign neoplasm which is usually pedunculated
Cauliflower appearance
Excision at the base of the lesion
What is denture hyperplasia?
Where is it most commonly found?
What type of biopsy?
Hyperplasticity reaction to a poorly fitting denture
Often a roll of excess tissue at outer aspect of denture flange, or between flange and ridge
Trim flange and excise excess tissue
What is a leaf fibroma? What biopsy?
Chronic irritation with denture
Would be round if not flattened by denture
Becomes flattened
Pedunculated
Excision
What is a mucocele? What type of biopsy?
Damage to minor salivary duct causing saliva to leak into submucosa
Causes soft bluish swelling that is fluid filled
Often recurrent
Surgical excision or blunt dissection
What is a squamous cell carcinoma?
What biopsy?
Cancer arising from the epithelium
- Lump, red or white patch
- Non healing ulcer with rolled margin, induration of tissue
- Lesion may bleed easy
Incisional biopsy and urgent referral
What is fibrosarcoma?
Malignant proliferation of fibroblasts
