Soft Tissue Masses Part 3

Question 1

Fordyce Granules
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx

Answer 1

Category:
-Developmental

Etiology:
-Ectopic sebaceous glands

Demographics:
-Present in over 80% of the population

Clinical Presentation:
-Multiple yellow-white papules
-Buccal mucosa and vermillion of the upper lip most common

Diagnosis:
-Clinical diagnosis

Tx:
-No tx necessary (variation of normal)

Question 2

Varix/Varicosities
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx

Answer 2

Category:
-Developmental

Etiology:
-Superficial dilated and tortuous veins
-Weakening of blood vessel walls and loss of tone in supporting connective tissues

Demographics:
-Rare in children
-Occurs in 2/3rds of people over 60

Clinical Presentation:
-Blue-purple nodules
-May be solitary or multiple
-Common on ventral and lateral surfaces of the tongue
-Common on lips or buccal mucosa
-Can become thrombosed (firm)

Diagnosis:
-Usually a clinical diagnosis can be made
-Biopsy for solitary varicosities of the lip and buccal mucosa may be indicated

Tx:
-No tx necessary

Question 3

Gingival Cyst of the Adult
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx

Answer 3

Category:
-Developmental

Etiology:
-Derived from rests of dental lamina
-Soft tissue counterpart to lateral periodontal cyst (will be covered later)

Demographics:
-Adults

Clinical Presentaion:
-Painless, domelike swellings
-Bluish-gray color
-May cause “cupping out” of alveolar bone
-Predilection for mandibular canine and premolar area
-Always on facial gingiva/alveolar mucosa

Diagnosis:
-Biopsy

Tx:
-Excisional biopsy

Question 4

Epidermoid Cyst
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx

Answer 4

Category:
-Developmental

Etiology:
-Keratin-filled cyst arising from hair follicle

Demographics:
-Unusual before puberty

Clinical Presentation:
-Nodular, fluctuant subcutaneous lesion
-White or yellow (red if inflamed)
-Common in acne-prone areas of head, neck and back
-NOT found intraorally

Diagnosis:
-Biopsy

Tx:
-Excisional biopsy

Question 5

Lymphoepithelial Cyst
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx

Answer 5

Category:
-Developmental

Etiology:
-Occlusion and dilation of a crypt of lymphoid tissue

Demographics:
-Most common in young adults

Clinical Presentation:
-Small submucosal mass
-Firm or soft to palpation
-Typically white or yellow
-Common locations:
1. floor of mouth
2. ventral tongue
3. posterior lateral border of tongue
4. palatine tonsil
5. soft palate

Diagnosis:
-Clinical diagnosis
-Biopsy

Tx:
-Do nothing
-Excisional biopsy

Question 6

Lingual Thyroid
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx

Answer 6

Category:
-Developmental

Etiology:
-Ectopic thyroid tissue
-Failure of thyroid bud to descend normally into neck

Demographics:
-More common in females

Clinical Presentation:
-Nodular mass on the posterior dorsal tongue
-May be accompanied by dysphagia, dysphonia, and dyspnea
-72% accompanied by hypothyroidism

Diagnosis:
-Thyroid scan
-Avoid biopsy (risk of hemorrhage and may be patient’s only functioning thyroid tissue)

Tx:
-Follow-up
-Hormone therapy if necessary (may reduce size of symptomatic lesions)

Question 7

Multiple Endocrine Neoplasia Type 2B (MEN2B)
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx

Answer 7

Category:
-Developmental

Etiology:
-RET gene mutation
-Autosomal dominant inheritance pattern

Clinical Presentation:
-Mucosal neuromas (often first sign)
1. tend to involve oral cavity
2. soft, painless papules or nodules
3. primarily on lips and anterior tongue
4. also seen on buccal mucosa, gingiva, and palate
-Medullary thyroid carcinoma
-Pheochromocytoma (adrenal gland tumor)

Diagnosis:
-Biopsy of oral lesions
-Genetic testing

Tx:
-Preventative thyroidectomy
-Observation for development of pheochromocytoma

Question 8

Neurofibromatosis Type 1 (NF1)
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx

Answer 8

Category:
-Developmental

Etiology:
-NF1 gene mutation
-Autosomal dominant inheritance pattern

Clinical Presentation:
-Multiple neurofibromas of skin and mucosa (potential to become malignant peripheral nerve sheath tumor)
-Cafe au lait macules (light brown skin pigmentation)
-Axillary and inguinal freckling
-Lisch nodules (pigmentary defect of iris)

Diagnosis:
-Biopsy
-Genetic testing

Tx:
-Cosmetic excision of neurofibromas (if possible)
-Monitoring for signs of malignant peripheral nerve sheath tumor