soft tissue lesions + biopsy Flashcards

1
Q

What is a biopsy and what are they used for?

A

A sample of tissue usually for histopathological analysis
Can confirm or establish a diagnosis and determine the prognosis of a patients condition

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2
Q

What questions should be asked when thinking of biopsy?

A

Should i biopsy this?
Why am i biopsying this?
What questions am i asking the pathologist? - usually send the pathologist a differential diagnosis list

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3
Q

Name 4 tissue sampling techniques

A

Aspiration
Aspiration from lesions eg - abscess
Fine needle aspiration biopsy
Surgical biopsy

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4
Q

Give an example of aspiration sampling

A

Blood sample eg - for FBC, U&E and haematinics

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5
Q

What are the benefits of aspirating lesions?

A

Avoids contamination by oral bacteria
Protects anaerobic species
Will determine whether a lesion is solid or fluid filled

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6
Q

How is fine needle aspiration carried out and when is it used?

A

Aspiration of cells from solid lesions
Used in neck swellings and SG lesions
Sample sent to cytology, not histopathology
Commonly used to diagnose breast cancer

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7
Q

What are the 3 types of surgical biopsy?

A

Incisional biopsy
Punch biopsy
Excisional biopsy

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8
Q

Describe an excisional biopsy and when its used

A

Removal of all clinically abnormal tissue
Used when fairly confident of provisional diagnosis
Usually on benign lesions eg - fibrous overgrowths, denture hyperplasia and mucoceles
Used on discrete lesions

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9
Q

Describe an incisional biopsy and when its used

A

A representative tissue sample
Used on larger lesions with uncertain diagnosis eg - leukoplakia, lichen planus and SSC
Don’t want to remove all signs of the lesion

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10
Q

Describe a punch biopsy and when it is used

A

Type of incisional biopsy
Uses hollow trephine 4, 6 or 8mm diameter
Removes core of tissue with minimal damage
May not require of suture or only minimal number of sutures

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11
Q

What should be considered when selecting an area to biopsy?

A

Must be large enough
Must be representative
Maybe more than one biopsy is needed
Include perilesional tissue
Refer if lesions are suspicious or lumps in the upper lip (these are often SG neoplasm)

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12
Q

How should samples be sent to the pathology lab?

A

Sample placed into 10% formalin
Suture may help pathologist orientate the sample (label mesial and distal)
Include relevant clinical info on pathology form to aid diagnosis, diagrams are helpful
Don’t use gauze, it distorts the sample
May use filter paper to reduce sample distortion - most of the time you don’t need anything

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13
Q

What is a crushed sample?

A

Sample is rolled on instead of flat
This distorts the anatomy

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14
Q

Why does a teared sample affect the histopathology analysis?

A

Can give the impression of a different disease process

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15
Q

What is a pregnancy epulis?

A

Histologically the same as a pyogenic granuloma
May be related to calculus and often bleeds
Hormonal changes enhance the response to tissue irritation

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16
Q

How is a pregnancy epulis managed?

A

Small lesions may not require excision and may regress after birth of baby
Larger lesions should be excised

17
Q

What is a pyogenic granuloma?

A

Overgrowth of granulation tissue arising from failure of normal healing
May be related to extraction sockets or traumatic soft tissue injuries
Red in colour

18
Q

How is a pyogenic granuloma managed?

A

Surgical excision needed
Curettage of base

19
Q

What is a squamous cell papilloma?

A

A benign neoplasm most common in the palate, buccal mucosa or lips
Usually pedunculated
White surface
Cauliflower appearance
Similar to viral warts

20
Q

How is a squamous cell papilloma managed?

A

Excision at base

21
Q

What is denture hyperplasia?

A

Poorly fitting denture causing a hyperplastic reaction
Roll of excess tissue on outer aspect of denture flange or between flange and alveolar ridge
Most common on the lower labial sulcus

22
Q

How is denture hyperplasia managed?

A

Flange of denture needs trimmed drastically
Remove excess tissue
If very large are, pack with Coe pack dressing placed to ensure sulcus depth is maintained

23
Q

What is a leaf fibroma?

A

Chronic irritation from denture
Essentially a polyp
Usually found on palate
Would be round if not covered by a denture, but becomes flattened
Pedunculated

24
Q

How is a leaf fibroma managed?

A

Excision

25
Q

What is a mucocele?

A

A mucus extravasion cyst
Most common minor salivary gland problem
Damage to minor gland duct and saliva leaks into submucosal layer
Soft bluish, fluid filled swelling
Recurring

26
Q

What is a ranula?

A

A mucocele found on the floor of the mouth

27
Q

How are mucoceles managed?

A

Surgical excision

28
Q

How may a squamous cell carcinoma present?

A

As a lump, red or white patch or non-healing ulcer
Classically an ulcer with rolled margins and induratied (hard)
May bleed easily and may be fixed to surrounding tissue
Often not painful to start with but may get painful as it gets bigger

29
Q

How should a squamous cell carcinoma be managed?

A

Need a histological diagnosis
Incisional biopsy taken
Should be referred urgently via the rapid access pathway by phone followed up by a fax referral