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Oral Pathology > Soft Tissue Presentation > Flashcards

Soft Tissue Presentation Flashcards

1
Q

Define Incisional biopsy

A

Removal of only a part of the lesion

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2
Q

Define Excisional Biopsy

A

Removal of the entire lesion

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3
Q

Define Surgical Excision

A

Removal of the entire lesion +/- border of non-lesional tissue

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4
Q

What does a surgical excision not specify?

A

If only the lesion itself is removed or the lesion and a border of normal/non-lesional tissue is removed

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5
Q

What is typically removed with malignant lesions or locally invasive lesions?

A

Border of non-lesional tissue

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6
Q

Define marginal excision

A

A margin of non-lesional tissue

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7
Q

Define wide excision

A

A large circumference (as compared to marginal excision) of normal-appearing tissue removed circumferentially around a lesion.

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8
Q

Benign Reactive Lesions AKA _____ ____

A

Non-neoplastic

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9
Q

Define Benign Reactive Lesions

A

A lesion that occurs from local trauma or other irritant

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10
Q

What are the types of benign reactive lesions?

A 
Fibroma
3 P's
Verruciform xanthoma
Epulis Fissuratum 
Inflammatory Papillary hyperplasia 
Amalgam Tattoo
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11
Q

What are the 3 P’s?

A

Pyogenic Granuloma
Peripheral Ossifying FIbroma
Peripheral Giant Cell Granuloma

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12
Q

Fibroma: Etiology

A

Reactive hyperplasia of fibrous connective tissue as a result of chronic irritation

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13
Q

Fibroma: Clinical Features

A
  • Asymptomatic, soft, tan/pink, smooth-surfaced nodule
  • Sessile or pedunculated
  • Usually small (<1 cm) but may increase in size overtime if continually traumatized
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14
Q

Fibroma: Site

A

Buccal Mucosa» labial mucosa, tongue, gingiva

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15
Q

Fibroma: Histology

A

Nodular mass of dense fibrous connective tissue

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16
Q

Fibroma: Treatment

A

Excisional Biopsy

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17
Q

Why do we lump the 3 P’s together?

A

Each lesion has some unique features however we usually consider all of these on our DDX for a “bump on the gingiva” as they share many of the same clinical characteristics

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18
Q

Two other names for Pyogenic Granuloma

A
  • Granuloma Gravidarum

- Epulis Granulomatosa

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19
Q

When is granuloma gravidarum used?

A

In pregnant patients

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20
Q

When is Epulis Granulomatosa used?

A

When occurring in an extraction site

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21
Q

Pyogenic Granuloma: Etiology

A

Reactive Proliferation from chronic irritation/trauma

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22
Q

Pyogenic Granoluma: Population Presented In

A

Predominantly children and young adults, but can occur at any age

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23
Q

Pyogenic Granulomas are common in _____

A

Pregnancy

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24
Q

Pyogenic Granuloma: Clinical Features

A

-Bright red, frequenly ulcreated, bleeds easily on manipulation, friable

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25
Q

Pyogenic Granuloma Site

A

Gingiva&raquo_space; buccal mucosa, tongue, labial mucosa

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26
Q

Pyogenic Granuloma Histology

A

Resembles granulation tissue

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27
Q

Define Granulation Tissue

A

Tissue formed in ulcers and in early wound healing and repair, composed largely of newly growing capillaries

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28
Q

Pyogenic Granuloma Treatment

A

Excisional Biopsy

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29
Q

Pyogenic Granuloma Treatment for Pregnant Women

A

Wait until after the patient gives birth and monitor for potential self-resolution

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30
Q

Peripheral Ossifying FIbroma: Etiology

A

Reactive proliferation from chronic irritation/trauma

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31
Q

Peripheral Ossifying Fibroma: Site

A

Gingiva Only

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32
Q

Peripheral Ossifying Fibroma: Clinical Features

A
  • Raised, smooth-surfaced (unless traumatized and secondarily ulcerated) pink/tan nodule
  • More firm and less friable compared to PG
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33
Q

Peripheral Ossifying Fibroma: Population

A

Predominantly teens and young adults

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34
Q

Peripheral Giant Cell Granuloma: Etiology

A

Reactive proliferation from chronic irritation/trauma

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35
Q

Peripheral Giant Cell Granuloma: Clinical Features

A
  • On palpation, lesion is somewhere between PG and POF in firmness
  • Frequenly bluish in color
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36
Q

Peripheral Giant Cell Granuloma: Population

A

Slightly older patient population

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37
Q

Peripheral Giant Cell Granuloma Site

A

Gingiva or edentulous ridge only

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38
Q

Peripheral Giant Cell Granuloma Histology

A

Multinucleated giant cells

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39
Q

Peripheral Giant Cell Granuloma Treatment

A

Excisional Biopsy

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40
Q

Verruciform Xanthoma: Etiology

A

Reactive proliferation thought to be a response to local inflammation

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41
Q

Verruciform Xanthoma Clinical Features

A

-Well-demarcated, soft, painless, raised lesion with papillary surface architecture

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42
Q

Verruciform Xanthoma Color

A

Range in color from white to orange to yellow to red

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43
Q

Verruciform Xanthoma Site

A

Most common on gingiva and hard palate

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44
Q

Verruciform Xanthoma can look similar to what?

A

Papilloma

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45
Q

Verruciform Xanthoma Histology

A

Papillary Surface, parakeratin plugging

-Xanthoma cells (foamy histocytes) in superficial connective tissue papillae

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46
Q

Verruciform Xanthoma Treatment

A

Excisional Biopsy (unless large lesin and then may consider incisional for diagnosis, followed by excision)

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47
Q

Epulis Fissuratum: Etiology

A
  • Tumor-like hyperplasia of fibrous CT resulting from an ill-fitting denture
  • Folds of tissue complement the denture
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48
Q

Epulis Fissuratum Clinical Features

A
  • Single or multiple folds of hyperplastic tissue in the alveolar vestibule
  • Most often there are two folds of tissue and the denture flange will fit between them
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49
Q

Epulis Fissuratum Population

A

More common in females; older patients; denture wearers

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50
Q

Epulis Fissuratum Treatment

A

Excisional Biopsy

Reline of current denture of fabrication of a new denture

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51
Q

Leaflike Denture Fibroma Cause and Histology

A

Identical to Epulis Fissuratum -> ill fitting denture

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52
Q

Leaflike Denture Fibroma Treatment

A

Excisional Biopsy

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53
Q

Inflammatory Papillary Hyperplasia: Cause

A
  • Ill fitting denture, poor denture hygiene, wearing the denture 24/7
  • Can occur in a non-denture wearer that habitually mouth breathes or has a high palatal vault
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54
Q

Inflammatory Papillary Hyperplasia: Clinical Features

A

Erythematous, pebbly appearance of the palatal vault

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55
Q

Inflammatory Papillary Hyperplasia: Treatment

A
  • Improved denture hygiene and fabrication of new well-fitted prosthesis
  • Can consider excision of hyperplastic tissue before new prosthesis if does not self resolve
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56
Q

Inflammatory Papillary Hyperplasia: Treatment for Superimposed candidia infection

A

Topical and systemic antifungal

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57
Q

Amalgam Tattoo: Etiology

A

Implantation of amalgam filling particles into the soft tissue

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58
Q

Amalgam Tattoo: Clinical Features

A

Blue-black macule which varies in size

  • Should be adjacent to or in the place where there used to be a metal restoration
  • Can be visualized on radiology
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59
Q

Amalgam Tattoo: Treatment

A
  • Classic examples can be monitored

- Biopsy may be indicated in cases where the etiology is less clear

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60
Q

Basic soft tissue tumor naming: Myo-

A

Muscle

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61
Q

Basic soft tissue tumor naming: neur/schwann-

A

Neural

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62
Q

Basic soft tissue tumor naming: Lipo-

A

Fat

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63
Q

Basic soft tissue tumor naming: Fib-

A

Fibrous tissue

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64
Q

Basic soft tissue tumor naming: Leiomyo-

A

Smooth muscle

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65
Q

Basic soft tissue tumor naming: rhabdomyo-

A

Striated muscle

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66
Q

Basic soft tissue tumor naming: hemangio-

A

Blood vessel

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67
Q

Basic soft tissue tumor naming: -oma

A

Benign

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68
Q

Basic soft tissue tumor naming: -carcinoma; -sarcoma

A

Malignant

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69
Q

-carcinoma etiology

A

Epithelial

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70
Q

-sarcoma etiology

A

Connective tissue/non-epithelial origin

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71
Q

Define Neoplasia

A

The formation or presence of a new, abnormal growth of tissue

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72
Q

Schwannoma: Etiology

A

benign tumor (-oma) of schwann cell origin

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73
Q

Schwannoma: Clinical Features

A

-Painless, slow-growing, submucosal nodule, ranging from 1 mm- 3 cm in size

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74
Q

Schwannoma: Population

A

Young to middle-aged adults

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75
Q

Schwannoma: Site

A
  • Almost anywhere
  • Tongue is most common soft tissue site
  • Intrabony: Radiolucency, most common in posterior mandible
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76
Q

Schwannoma Cause

A

Can occur sporadically or as part of a syndrome

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77
Q

Schwannoma: Associated Syndromes

A
  • Neurofibromatosis type 2

- Schwannomatosis

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78
Q

Schwannoma Treatment

A

Sometimes excisional biopsy, sometimes incisional biopsy due to size

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79
Q

Schwannoma Histology Buzz terms: Antoni A

A

Hypercellular areas

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80
Q

Schwannoma Histology Buzz terms: Antoni B

A

Hypocellular, aka less cellular areas

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81
Q

Schwannoma Histology Buzz Terms: Verocay Bodies

A

Areas within Antoni A composed of basement membrane and neuronal proesses

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82
Q

Neurofibromatosis Type 2: Inheritance Pattern

A

Autosomal dominant inheritance

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83
Q

Neurofibromatosis Type 2: Cause

A

NF2 Gene

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84
Q

Neurofibroma: Etiology

A

Benign tumor (-oma) with a mixture of cell types (schwann cells, fibroblasts)

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85
Q

Neurofibroma: Clinical Features

A
  • Painless, slow-growing, soft lesion

- Range in size from a small nodule to large masses

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86
Q

Neurofibroma: Population

A

Most common in young adults

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87
Q

Neurofibroma: Site

A

Tongue and buccal mucosa

Rarely can arise within bone

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88
Q

Neurofibroma: Associated Syndromes

A

Neurofibromatosis type 1

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89
Q

Neurofibroma Treatment

A

Sometimes excisional biopsy, sometimes incisional biopsy due to size

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90
Q

Neurofibromatosis Type 1: Inheritance Pattern

A

Autosomal Dominant; mutation of NF1 gene

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91
Q

Neurofibromatosis Type 1: Clinical Features

A

Enlargement of the fungiform papillae

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92
Q

What is the most common oral leasion of NF1?

A

Neurofibromatosis type 1

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93
Q

Neurofibromatosis Type 1 Complications

A

Greater risk for development of malignant peripheral nerve sheath tumor

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94
Q

Multiple Endocrine Neoplasia Type 2B (MEN 2B): Why do we only focus on Type 2?

A

Only type with oral manifestations

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95
Q

Multiple Endocrine Neoplasia Type 2B (MEN2B): Etiology

A

Rare, autosomal dominant inherited condition

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96
Q

Multiple Endocrine Neoplasia Type 2B: Clinical Features

A
  • Multiple Endocrine Neoplasms
  • Mucosal Neuromas
  • Marfanoid Body Habitus
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97
Q

Granular Cell Tumor: Etiology

A

Benign tumor of schwann cell differentiation

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98
Q

Granular Cell Tumor: Clinical Features

A

Non-tender, rubbery-firm, slow-growing, sessile submucosal nodule
Color varies from normal mucosal coloring to a white-yellowish hue

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99
Q

Granular Cell Tumor Site

A

Tongue, buccal mucosa

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100
Q

Granular Cell Tumor Treatment

A

Biopsy for diagnosis followed by conservative excision or just excisional biopy (depending on the size of the lesion)

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101
Q

Granular Cell Tumor Reoccurence

A

Rare

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102
Q

Granular Cell Tumor Histology

A

Pseudoepitheliomatous hyperplasia

Granular cells in the CT that are positive for neural markers

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103
Q

Define Pseudoepitheliomatous hyperplasia

A

Benign proliferation of the epithelium in reaction to certain stimuli

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104
Q

What can Pseudoepitheliomatous Hyperplasia mimic?

A

Squamous cell carcinoma

105
Q

Congenital (granular cell) Epulis: Define

A

Benign tumor almost exclusive to the alveolar ridges of newborns

106
Q

Congenital Granular Cell Epulis is not what origin

A

Neural origin

107
Q

Congenital Granular Cell Epulis: Clinical Features

A
  • Smooth surfaced, pink to red, polypoid mass

- Maxillary alveolar ridge> mandibular ridge

108
Q

Congential Granular Cell Epulis

A

Strong female predilection (nearly 90%)

109
Q

Congenital Granular Cell Epulis Treatment

A

Conservative surgical excision (aka excisional biopsy).

Can spontaneously regress in some patients, but often poses difficulty for feeding and requires removal

110
Q

Congenital Epulis: Histology

A

Flat epithelial connective tissue interface

Similar appearing granular cells in the connective tissue as a granular cell tumor

111
Q

Lipoma, Leiomyoma, Myofibroma, Rhabdomyoma: What characteristics do they share?

A

Asymptomatic, firm, painless, slow-growing nodules

112
Q

Lipoma: Define

A

Benign tumor of adipose tissue

113
Q

Lipoma: Color

A

Yellow-gold huge

114
Q

Lipoma: Location

A

Buccal, buccal vestibule

115
Q

Leiomyoma: Define

A

Benign tumor of smooth muscle

116
Q

Leiomyoma: Location

A

Lips, tongue, palate and cheeck

117
Q

Leiomyoma: Color

A

Vascular variant has a bluish hue

118
Q

Myofibroma: Define

A

Benign tumor of myofibroblasts (cells with both smooth muscle and fibroblastic features)

119
Q

Myofibroma: Population

A

Average age 22

120
Q

What is the most common fibrous tumor of infancy?

A

Myofibroma

121
Q

Rhabdomyoma: Define

A

Benign tumor of skeletal muscle

122
Q

Rhabdomyoma: Special Characteristic

A

Spider cell

123
Q

Choristoma: Define

A

Benign tumor-like growth of microscopically normal tissue in an abnormal location.

124
Q

Choristoma: Clinical Features

A
  • Firm, smooth surfaced nodule
  • 0.5-2 cm
  • Osseous and cartilaginous types
125
Q

Choristoma: Histology

A

Destermine whether it is osseous or cartilaginous

126
Q

Choristoma Treatment

A

Excisional Biopsy

127
Q

What is the most common tumor of infancy?

A

Hemangioma

128
Q

Hemangioma: Population

A

Female predilection

129
Q

Hemangioma: Clinical Characteristics

A

FIrm, rubbery to palpation, do not blanch

130
Q

Hemangioma: Growth Pattern

A

Rapid Development during first few months of life -> Stabilize -> Up to 90% spontaneously resolve by age 9

131
Q

Hemangioma Treatment

A

Observe for resolution if not of functional concern.
First line treatment: beta blocker (propranolol).
Some lesions may be surgically excised.

132
Q

In cases of large cevicofacial hemangioma, what treatment is indicated?

A

Clinical workup to rule out well-recognized hemangioma syndrome: Phaces

133
Q

P in Phaces

A

Posterior Fossa Brain Anomalies; also called dandy-walker malformation

134
Q

H in Phaces

A

Hemangioma

135
Q

A in Phaces

A

Arterial Anomalies

136
Q

C in Phaces

A

Cardiac Defects

137
Q

E in Phaces

A

Eye anomalies

138
Q

S in Phaces

A

Sternal Cleft; supraumbilical raphae

139
Q

Define Borderline/Intermediate Malignant Potential

A

Locally aggressive & Destructive, do not metastasize.

140
Q

Example of Borderline/Intermediate Malignant Potential

A

Soft Tissue Fibromatosis

141
Q

Soft Tissue Fibromatosis is also known as

A

Juvenille Aggressive Fibromatosis

142
Q

Soft Tissue FIbromatosis: Define

A

Fibrous proliferation with biologic behavior intermediate between a benign fibrous proliferation and fibrosarcoma

143
Q

Soft Tissue Fibromatosis: Clinical Features

A

-Firm, painless mass
-Growth potential: Slow and rapid
-

144
Q

Soft Tissue Fibromatosis: Population

A

Any age, but typically young patients

145
Q

Branchial Cleft Cyst Clinical Features

A
  • Upper lateral neck mass anterior or deep to the SCM (2nd branchial arch origin)
  • Cyst itself is soft, fluctuant mass ranging from 1-10 cm
146
Q

Branchial Cleft Cyst Population

A

Typically develops in children and young adults (ages 10-40)

147
Q

Branchial Cleft Cyst Treatment

A

Surgical Excision

148
Q

Oral Lymphoepithelial Cyst: Define

A

Uncommon benign cyst that may form in areas of lymphoid tissue

149
Q

Oral Lymphoepithelial Cyst: What is this histologically identical to?

A

Branchial cystic lesion

150
Q

Oral Lymphoepithelial Cyst: Clinical Features

A
  • Well circumscribed yellow-white cystic lesion usually less than 1 cm
  • Asymptomatic unless traumatized
151
Q

Oral Lymphoepitelial Cyst: Sites

A

Floor of mouth, ventral tongue, posterior lateral border of tongue, palatine tonsil and soft palate

152
Q

Oral Lympepithelial Cyst Treatment

A

Excisional biopsy or clinical monitoring if asymptomatic and characteristic enough for clinical diagnosis

153
Q

Thyroglossal Duct Cyst: Etiology

A

Developmental cyst arising from remnants of the thyroglossal tract (A structure that normally atrophies after thyroid gland descends to the neck in development)

154
Q

Thyroglossal Duct Cyst: Clinical Features

A

Midline neck mass that can occur anywhere from the foramen cecum area of the tongue to the suprasternal notch (anywhere along the descending tract).
Painless, fluctuant, moveabel swelling
Cysts attached to the hyoid bone or tongue will move vertically with swallowing

155
Q

Thyroglossal Duct Cyst: Population

A

1-2nd decade of life

156
Q

Thyroglossal Duct Cyst Treatment

A

Referral to head and neck surgeon or ENT -> Sistrunk procedure

157
Q

Thyroglossal Duct Cyst Treatment

A

Referral to head and neck surgeon or ENT -> Sistrunk procedure

158
Q

Define Sistrunk Procedure

A

Specific type of excision that removed some adjacent tissue and structures to lessen recurrence rate

159
Q

Epidermoid & Dermoid Cysts: Etiology/Background

A

Benign, epithelial-lined, keratin filled, developmental cysts

160
Q

Epidermoid & Dermoid Cysts: Clinical Features

A

-Midline, yellow-white, soft, compressible, doughy submucosal mass
Rare intraoral lesions

161
Q

Epidermoid & Dermoid Cysts: Site

A

Rare intraoral lesions. More common on the skin.

162
Q

Epidermoid & Dermoid Cysts: Treatment

A

Surgical excision

163
Q

Malignant Soft Tissue Neoplasms in Children

A

Rhabdomyosarcoma

164
Q

Malignant Soft Tissue neoplasms in Teens/Young Adults (4)

A
  1. Malignant peripheral nerve sheath tumor
  2. Fibrosarcoma
  3. Synovial sarcoma
  4. Alvolar Soft Part Sarcoma
165
Q

Malignant Soft Tissue neoplasms in Middle Aged Adults

A
  1. Liposarcoma
  2. Olfactory neuroblastoma
  3. Leiomyosarcoma
  4. Undifferentiated pleomorphic sarcoma
166
Q

Malignant Soft Tissue Neoplasms in Older Adults

A

Angiosarcoma

167
Q

Key Features of Rhabdomyosarcoma

A

Most common soft tissue sarcoma in children

168
Q

Key Features of MPNST

A
  1. 50% of cases occur in patients with NF1

2. Patients with NF1 develops MPNST’s in first decade earlier than non-NF1 patients

169
Q

Key Features of Synovidal Sarcoma

A

Translocation X; 18

170
Q

Key Features of Alveolar Soft Part Sarcoma

A

Translocation X; 17

171
Q

Kaposi Sarcoma Etiology

A

Human herpesvirus 8

172
Q

Kaposi Sarcoma Clinical Features

A

Blue/brown macules that do not blanch
Macules develop into blue/purple plaques or nodules
Can become a diffuse, exophytic mass

173
Q

Kaposi Sarcoma: Four different clinical presentations

A

Classic, endemic, iatrogenic and epidemic

174
Q

What is usually associated with Kaposi Sarcoma?

A

Aids

175
Q

Treatment of Kaposi Sarcoma (HIV Associated)

A

Initiation of cART therapy

Chemotherapy, immunotherapy

176
Q

Metastatic Disease of Oral Soft Tissue: Etiology

A

Hematogenous spread of malignancy via the Batson plexus

177
Q

Metastatic Disease to Oral Soft Tissue: Clinical Features

A

Nodular mass resembling pyogenic granuloma

Nodular mass with non-ulcerated smooth surface

178
Q

Metastatic Disease to Oral Soft Tissue: Site

A

Metastases can occur to the jaws or soft tissue

Soft Tissue: Gingiva > tongue

179
Q

Metastatic Disease to Oral Soft Tissue: Treatment

A
  • Metastatic disease always constitutes stage IV cancer
  • Chemo/radiation
  • Surgical management in some cases
180
Q

malformations and anomalies (non-neoplastic)

A 
Lymphangioma
Variscosity 
Caliber persistent artery
Vascular malformations
Sturge-Weber Syndrome
181
Q

Lymphangioma/Lymphatic Malformation: Etiology

A

Developmental Anomaly

182
Q

Lymphangioma/Lymphatic Malformation: Clinical Features

A

Cystic hygroma
Oral Cavity lymphatic malformation
Pebbly “Vessicle-like” appearance “Frog Eggs” on anterior 2/3 of tongue

183
Q

When do lesions occur in lymphangioma?

A

Around age 2

184
Q

Define Cystic hygroma

A

Macrocystic lymphatic malformation that often occurs in the neck

185
Q

Lymphangioma Histology

A

Dilated lymphatic vessels beneath the epithelium

186
Q

Lymphangioma Treatment

A

Small Lesion -> Observation only or biopsied if unsure

Larger lesions or lesions of cosmetic concern -> surgical excision and sclerotherapy

187
Q

Variscosity Etiology

A

Abnormally dilated veins

188
Q

Variscosity Clinical Features

A

Blue-purple, painless nodule
Diascopy positive
May become thrombosed and feel firm to palpation

189
Q

Variscosity Population

A

Older adults

190
Q

Variscosity Treatment

A

Excisional biopsy for small lesions if uncertain of diagnosis or desired by patient for esthetics.
Large and clinically characteristic lesions not of esthetic concern: Monitor

191
Q

Caliber Persistent Artery: Etiology

A

Vascular anomaly

Main arterial branch extends up into superficial submucosa

192
Q

Caliber Persistent Artery location

A

Almost exclusively on lip

193
Q

Caliber Persistent Artery Population

A

Older adults

194
Q

Caliber Persistent Artery Clinical Features

A

Linear or popular elevation ranging from typical mucosal coloration to blueish in color.
Pulsation of lesion

195
Q

Caliber Persistent Artery Treatment

A

No treatment indicated

196
Q

Vascular malformation: etiology

A

Present at birth, persistent throughout life

197
Q

Vascular malformation: Location

A

Occur in both soft tissue and intrabony

198
Q

Three clinical features of vascular malformation

A
  • Venous malformation
  • Arteriovenous malformation
  • Intrabony lesions
199
Q

Describe clinical features of venous malformation

A
  • Low flow
  • Bluish, easily compressible
  • Grow with the patient
200
Q

Describe clinical features of arteriovenous malformation

A
  • High flow, may be able to feel a thrill/pulse

- Present at birth but often become noticeable later in childhood or adulthood

201
Q

Describe clinical features of intrabony lesions

A
  • Usually miltiocular radiolucency

- Can cause sunburst periosteal reaction resembling osteosarcoma

202
Q

Vascular malformation Treatment

A
  • Small stable soft tissue lesions do not require treatment.
  • Large problematic lesions -> sclerotherapy +/- surgical resection
  • Intrabony lesions: need aspiration of any undiagnosed intrabony lesions before biopsy is a wise precaution to rule out the possibility of a vascular malformation. Lesions are typically embolized before surgical resection
203
Q

Port Wine Stain: Etiology

A

Congenital dermal capillary vascular malformation.

Caused by specific genetic mutation (GNAQ)

204
Q

Port Wine Stain aka

A

Nevus flammeus

205
Q

Port Wine Stain Clinical Features

A
  • Pink or purple macular lesions
  • Grow commensurately with the patient
  • Lesion may darken and become nodular with age
206
Q

Port Wine Stain Treatment

A

Laser treatment for esthetic purposes with functional difficulty due to the size of the lesion

207
Q

Port Wine Stain can occur independently or as a component of _______

A

Sturge-Weber Syndrome

208
Q

Sturge-Weber Syndrome Etiology

A 
Development Condition (not hereditary)
GNAQ Mutation
209
Q

Sturge-Weber Syndrome: Site

A

Affects skin, brain, and eyes

210
Q

Sturge-Weber Syndrome Treatment

A

Lasers for port wine stain and potential oral lesions.

Neurosurgery in some cases for intractable epilepsy with progressive ID

211
Q

Granulomatosis with polyangiitis: Etiology

A
  • Disorder characterized by necrotizing granulomatous inflammation and systemic vasculitis of small arteries and veins
  • Thought to be caused by an abnormal immune reaction to an inhaled environmental antigen or infectious agent
212
Q

Granulomatosis with polyangiitis: Age and Sex

A

40 years old; no sex predilection

213
Q

Granulomatosis with polyangiitis: Initial Clinical Features

A
  • Related to upper and lower respiratory tract involvement
  • Chronic sinus pain, nasal discharge, congestion
  • Dry cough, hemoptysis, dyspnea
214
Q

Granulomatosis with polyangiitis: What can occur without treatment

A

Progress to renal involvement

215
Q

Granulomatosis with polyangiitis: Oral clinical characteristics

A

Strawberry gingivitis

216
Q

Granulomatosis with polyangiitis: Diagnosis

A

Clinical features + microscopic findings

Indirect immunofluorescence for serum antibodies against PR3-ANCA

217
Q

Granulomatosis with polyangiitis: Histology

A

Necrotizing granulomas, leukocytoclastic vasculitis

218
Q

Granulomatosis with polyangiitis: Treatment

A

Systemic steroids+ cyclophosphamide

219
Q

Granulomatosis with polyangiitis: Prognosis

A

If untreated and with systemic involvement-> mortality at 2 years is 90%.
With treatment and with systemic involvement prolonged remission in 75% and many patients can be cured

220
Q

Palatal perforation: Differential Diagnosis

A
  • Granulomatosis with polyangiitis
  • Cocaine abuse
  • Extranodal NK-T cell lymphoma
  • Gumma
  • Tuberculosis
221
Q

Saddle Nose Deformity Differential Diagnosis

A

Granulomatosis with polyangiitis
Cocaine Snorting
Congenital Syphilis

222
Q

Granulomatous Inflammation: Define

A

Specific type of inflammatory reaction to antigen

223
Q

Granulomatous Inflammation: histology

A

Collections of histiocytes (macrophages) trying to wall off the intruder

224
Q

Granulomatous inflammation: Causes

A
  • Immune mediated diseases like sarcoidosis, granulomatosis with polyangiitis, crohn disease
  • Some infections: Tuberculosis (and other mycobacteria), cat scratch disease, other fungal infections
  • Foreign body reaction
225
Q

Sarcoidosis: Etiology

A

Multisystem granulomatous disorder

Thought to be a result of improper degradation of antigenic material

226
Q

Sarcoidosis: Acute Clinical Features

A

Fever, fatigue, anorexia, weight loss+ respiratory symptoms polyarthritis, vision problems, skin lesions

227
Q

Sarcoidosis: Specific Acute syndromes

A

Lofgren syndrome and Heerfordt syndrome

228
Q

Sarcoidosis: Chronic Clinical Features

A

-Dry cough, dyspnea, chest pain

229
Q

Sarcoidosis: Head and Neck Manifestations

A

Submucosal mass, isolated papule or an area of granularity or ulceration
Intraosseous lesions: ill-defined radiolucency
Salivary glands can be infiltrated by granulomatosis inflammation

230
Q

Sarcoidosis: Characteristic skin manifestation:

A

Lupus pernio

231
Q

Sarcoidosis: Diagnosis

A
  • Combination: clinical features+ radiology+ biopsy of lung lesions or of the parotid gland showing granulomas
  • Elevated serum ACE in 60% of patients
232
Q

Sarcoidosis: Histology

A

Non-necrotizing granulomas, asteroid bodies and shaumann bodies

233
Q

Sarcoidosis: Treatment

A
  • 60% of cases resolve spontaneously

- If progressive -> corticosteroids

234
Q

Sarcoidosis: Prognosis

A

4-10% mortality

235
Q

Oral Lesions associated with cosmetic fillers: Etiology

A

Oral lesion as a result of a foreign body type reaction to cosmetic filler

236
Q

Biodegradable filler materials

A

Collagen, fat transfer, dextran, hyaluronic acid, poly-Llactic acid

237
Q

Permanent/non-degrading fillers

A

Liquid silicone, polyacrylamid, hydroxyapatite

238
Q

Oral Lesions associated with cosmetic fillers: Acute Mild Characteristics

A

Brusing, erythema, pain, localized infection

239
Q

Oral Lesions associated with cosmetic fillers: Acute Severe Characteristics

A

Local allergic response (anaphylaxis), arthralgia, myalgia, facial paralysis, retinal artery thrombosis

240
Q

Oral Lesions associated with cosmetic fillers: Chronic Clinical Characteristics

A

Latent tumor-like nodules in the soft tissue within vestibules and lips
If hydroxyapatite is used you may see radiopaque material on PAN or cone beam

241
Q

Oral Lesions associated with cosmetic fillers: Diagnosis

A

Biopsy; intralesional or systemic steroids

242
Q

Cervicofacial Emphysema: Etiology

A

Introduction of air into subcutaneous or fascial spaces of the face and neck

243
Q

What puts a patient at higher risk for cervicofacial emphysema?

A

Surgical extractions, endodontic procedures, osteotomies, significant traumas

244
Q

Cervicofacial Emphysema Other Causes

A

Use of compressed air, difficult or prolonged extractions, increased intraoral pressure after extraction

245
Q

When do 90% of cervicofacial emphysema cases occur?

A

During surgery or within 1 hour post-op

246
Q

Initial Signs of cervicofacial emphysema

A

Soft tissue enlarges, crepitus is detected easily with palpation

247
Q

What helps differentiate between angioedema and cervicofacial emphysema?

A

Crepitus

248
Q

Why do symptoms progress in cervicofacial emphysema? What are those symptoms?

A

Due to secondary inflammation and edema.

Symptoms: Variable pain, facial erythema, dysphagia, dysphonia, visual difficulty, mild fever

249
Q

Cervicofacial Emphysema: What occurs if it spread to mediastinum?

A

Pneumomediastium

250
Q

Cervicofacial Emphysema: Symptoms of Pneumomediastium

A

Harsh voice, dyspnea and respiratory distress, hamman’s crunch/sign

251
Q

Define Hamman’s crunch/sign

A

A sound hearde on cardiac ausculatation in a patient with pneumomediastinum

252
Q

Treatment of Cervicofacial Emphysema for Mild to Moderate Cases

A
  • Observation for self-resolution (2-5 days)
  • Prophylaxis with broad-spectrum antibiotic
  • Body gradually removes air over 2-5 day period
253
Q

Treatment for Cervicofacial Emphysema for severe cases

A
  • Immediate emergency medical attention

- Possibility of airway compromise and other serious complications

254
Q

Pneumoparotid is very similar to what disease

A

Cervicofacial emphysema

255
Q

Describe Penumoparotid

A

Air enters parotid duct and causes enlargement of the parotid gland

256
Q

What population is affected by pneumoparotid

A

Occupation based (trumpet players, or other similar instruments)

257
Q

Clinical manifestations of pneumoparotid

A

Saliva from parotid duct is frothy from mixing with air

Crepitus over parotid gland region

258
Q

Pneumoparotid Treatment

A

Prophylactic antibiotics, massage, hydration, warm compresses, sialagogues

Oral Pathology (7 decks)

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