Soft Tissue Lesions & Biopsy Techniques

Question 1

What is a biopsy?

Answer 1

• sample of tissue for histopathological analysis
• confirm or establish a diagnosis
• determine prognosis

Question 2

What types of biopsies are there?

Answer 2

• aspiration biopsy
• excisional biopsy
• incisional biopsy
• punch biopsy

Question 3

What types of surgical biopsies are there?

Answer 3

• excisional
• incisional
• punch

Question 4

what are the positives of doing aspirational biopsies?

Answer 4

• avoids contamination by oral commensals
• protection of anaerobic species
• helps to determine if a lesion is solid or fluid filled

Question 5

When are fine needle aspiration biopsies used?

Answer 5

• aspiration of cells from solid lesions
• neck swellings, salivary gland lesions
• cytology

Question 6

What is an excisional biopsy?

Answer 6

• removal of all clinically abnormal tissue
• usually benign lesions

Question 7

What is an incisional biopsy?

Answer 7

• removal of part of a lesion (larger lesions)
• uncertain diagnosis

Question 8

give an example of a type of incisional biopsy:

Answer 8

punch biopsy

Question 9

What are punch biopsies?

Answer 9

• type of incisional biopsy
• 4, 6, or 8mm diamete
• removes core of tissue
• minimal damage

Question 10

What determines the area you choose to biopsy?

Answer 10

• must be large enough
• must be representative
• maybe more than one biopsy

Question 11

how should samples be sent to lab?

Answer 11

• sample placed immediately into 10% formalin
• include relevant clinical info on form

Question 12

What is fibrous epulis?

Answer 12

• swelling arising from the gingivae
• hyperplastic response to irritation

Question 13

how does fibrous epulis present?

Answer 13

• smooth surface
• rounded swelling
• pink & pedunculated

Question 14

what type of biopsy should be used to test for fibrous epulis?

Answer 14

excisional biopsy with coe pack dressing

Question 15

what is giant cell epulis?

Answer 15

• peripheral giant cell granuloma
• multi nucleated giant cells in vascular stroma

Question 16

how does giant cell epulis present?

Answer 16

• deep red or purple
• broad base

Question 17

how is giant cell epulis treated?

Answer 17

surgical excision with curettage of base

Question 18

what is a haemangioma?

Answer 18

• hamartoma
• developmental overgrowth

Question 19

how does a haemangioma present?

Answer 19

• blue in colour
• pressure will cause loss of colour

Question 20

what is lipoma?

Answer 20

benign neoplasm of fat
- soft swelling
- pale yellow
- sessile

Question 21

what is pregnancy epulis?

Answer 21

• hormonal changes enhance response to tissue irritation
• histologically same as pyogenic granuloma

Question 22

what is pyogenic granuloma?

Answer 22

• overgrowth of granulation tissue
• arises from failure of normal healing
• red in colour and must be surgically excised

Question 23

what is a squamous cell papilloma?

Answer 23

• benign neoplasm
• usually pedunculated
• white surface
• cauliflower appearance

Question 24

where are common sites for squamous cell papillomas?

Answer 24

• palate
• buccal mucosa
• lips

Question 25

what is denture induced hyperplasia?

Answer 25

• hyperplastic reaction of tissue due to poorly fitting denture

Question 26

what is a leaf fibroma?

Answer 26

• chronic irritation from denture
• would be round if not covered by denture
• becomes flattened
• excision

Question 27

what is a mucocele?

Answer 27

A mucous extravasation cyst
- soft bluish swelling fluid filled
- damage to minor gland duct

Question 28

How are mucoceles treated?

Answer 28

• surgical excision
• blunt dissection
• patients should be warned about recurrence

Question 29

what is the classic description of a squamous cell carcinoma?

Answer 29

• ulcer
• rolled margin
• induration

Question 30

how should potential squamous cell carcinomas be biopsied?

Answer 30

incisional biopsy
- should be referred urgently