soft tissue lesions and biopsy techniques Flashcards
- why is aspiration from lesion good?
- what is reticular cyst?
- Aspiration avoids contamination by oral commensals
Protection of anaerobic species
May also aspirate cystic lesions
> Keratocysts-keratin
Aspiration will determine whether a lesion is solid or
fluid filled
Occasionally aspiration may yield blood e.g.
haemangioma - stall coloured fluid
- when do you do excisional biopsy?
- Usually fairly confident of provisional diagnosis
Usually benign lesions e.g. fibrous overgrowths, denture
hyperplasia, mucocoeles
Discrete lesions
- when do you do incisional biopsy?
- Representative tissue sample
Larger lesions
Uncertain diagnosis
E.g. Leukoplakia, lichen planus, squamous cell
carcinoma
what is a 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
- how do you send samples to lab?
- why not place in gauze?
- what is best thing to put sample on and why?
- Sample should be placed immediately into 10% formalin, don’t place on gauze swab
Suture may help the pathologist to orientate the sample
Include relevant clinical information on the pathology form to aid in diagnosis. Diagrams are helpful
Pathology form- in GDH now electronic (Trakcare)
- gauze can distort it
- filter paper to reduce sample distortion
what is this an example of?
crushed specimen
what is this an example of?
tear in specimen
how would you describe this?
mixed red and white lesion with striated areas and has some areas of ulceration on buccal mucosa of edentulous patient. Size - extensive whole buccal mucosa
what area should you avoid biopsying?
Try to avoid salivary gland duct orifices, tip of tongue, areas close to nerves and larger blood vessels
what is this?
fordyce’s spots
what is fibrous epulis?
- 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
what is this and describe it?
fibrous overgrowth
Fibroepithelial polyp
Frictional irritation or trauma
Semi pedunculated or sessile
Pink
Smooth surface
Most common buccal mucosa and inner surface of lip
Surgical excision
No need for deep excision or normal margin
why do you use suture for excising polyp?
to stabilise lesion
what is 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)
Surgical excision with curettage of base
Coe pack dressing
what is this and describe it?
heamangioma
Hamartomata
Developmental overgrowths
Exophytic
Blue in colour
Pressure will cause loss of colour
Surgical removal or more commonly cryotherapy
Only drawback of cryotherapy is no histological diagnosis
what is lipoma?
Benign neoplasm of fat
Soft swelling
Pale yellow
Sessile
Excision
what is this and describe it?
Pregnancy epulis
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
what is 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
what is this and describe it?
squamous cell papilloma
Most common palate, buccal mucosa or lips
Benign neoplasm
Usually pedunculated
White surface
Cauliflower appearance
Excision at base
Similar to viral warts
what is this and describe it?
denture hyperplasia
Poorly fitting denture
> hyperplastic reaction
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
Remove excess tissue
If very large area Coe pack dressing to ensure sulcus
depth maintained
what is this and describe it?
leaf fibroma
Chronic irritation from denture
Would be round if not covered by denture but
becomes flattened
Pedunculated
Excision
what is this and describe it?
mucocoele
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 - if bite and burst it can come back
Floor of mouth ranula
how to diagnose a mucocoele?
Diagnosis usually from history
Surgical excision
Blunt dissection
Often rupture
Patients should be warned about recurrence
Remember swellings in upper lip are usually neoplastic rather than simple mucocoeles
what is this? what must you be careful from?
ranula
- need to treat with care because of close relation to sub lingual gland
what is this and describe it?
squamous cell carcinoma
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
what must you do with a squamous cell carcinoma?
Need a histological diagnosis
Incisional biopsy
Should be referred urgently via the rapid access pathway
By phone followed up by a faxed referral
