Soft Tissue Tumors

Question 1

irritation / traumatic fibroma

Answer 1

most common “tumor” of the oral cavity

Question 2

common locations of irritation / traumatic fibroma

Answer 2

buccal mucosa > labial mucosa, tongue, gingiva

Question 3

etiology of irritation / traumatic fibroma

Answer 3

happens along lines that teeth contact soft tissue

Question 4

clinical features of giant cell fibroma

Answer 4

-not associated with trauma or irritation
-asymptomatic, sessile, or pedunculate nodules
-younger age than fibroma (50% less than 30)

Question 5

location of giant cell fibroma

Answer 5

-mandibular gingiva, tongue, palate
-papillar surface common

Question 6

microscopic appearance of giant cell fibroma

Answer 6

-thin, atrophic epithelium
-loose fibrous CT
-large multinuclear stellate fibroblasts

Question 7

retrocuspid papilla

Answer 7

anatomical structure, part of normal oral anatomy!

resembles giant cell fibroma histopathologically

Question 8

location of retrocuspid papilla

Answer 8

-common (25-99%) in children and adolescents
-only 6-19% of adults

Question 9

histology of retrocuspid papilla

Answer 9

resembles giant cell fibroma histopathologically

Question 10

epulis fissuratum (other names)

Answer 10

inflammatory fibrous hyperplasia
denture injury tumor
denture epulis
denture granuloma

Question 11

etiology of epulis fissuratum

Answer 11

associated with the flange of an ill fitting denture

Question 12

demographics of epulis fissuratum

Answer 12

-middle aged or older adults
-maxilla = mandible
-anterior&raquo_space; posterior
-F&raquo_space; M (2-3:1)

Question 13

clinical appearance of epulis fissuratum

Answer 13

-single or multiple folds in vestibular tissue (usually labial or buccal)
-denture flange fits in between the folds
-variable inflammation and ulceration
-variable size
-chronic inflammation and ulceration (due to chronic trauma)
-occasional osseous and chrondromatous metaplasia

Question 14

management of epulis fissuratum

Answer 14

surgical removal
denture reline / remake
good prongosis

Question 15

another name ofr inflammatory papillary hyperplasia

Answer 15

denture papillomatosis

Question 16

location of inflammatory papillary hyperplasia

Answer 16

-multiple papillary growths on hard palate
-usually asymptomatic

Question 17

etiology of inflammatory papillary hyperplasia

Answer 17

-ill fitting denture
-poor denture hygiene (contsant wear)
-mouth breathing

Question 18

treatment of inflammatory papillary hyperplasia

Answer 18

1. surgical excision
2. denture reline
3. leave denture out at night

Question 19

3 Ps of benign gingival mass

Answer 19

periperal ossifying fibroma
peripheral giant cell granuloma
pyogenic granuloma

Question 20

clinical features of peripheral ossifying fibroma

Answer 20

-thought to arise form the PDL
-gingival growth, young adults, anterior jaws, females, often ulcerated

Question 21

histopathological features of peripheral ossifying fibroma

Answer 21

spindle cell proliferation with variable calcificaitons

Question 22

treatment of peripheral ossifying fibroma

Answer 22

1. excision, removal of local irritants
2. full thickness flap to remove

Question 23

rate of recurrence of peripheral ossifying fibroma

Answer 23

15%

Question 24

clinical features of peripheral giant cell granuloma

Answer 24

1. alveolar or gingival mass, adults (40-50)
2. blush-red mass, may be ulcerated, may cause “cupping” of ulderlying bone
3. soft consistencly
4. arise from PDL space

Question 25

histopathological features of perihperal giant cell granuloma

Answer 25

1. abundant multinucleate giant cells 2.marked hemorrhages -> hemosiderin 3. acute and chronic inflammation 4. occasional reactive bone or dystrophic calcification

Question 26

treatment of peripheral giant cell granuloma

Answer 26

1. local surgical excision 2. aggressive SRP

Question 27

rate of recurrence of peripheral giant cell granuloma

Answer 27

10-18%

Question 28

clinical features of pyogenic granuloma

Answer 28

1. rapidly growing, painless, reddish mass 2. children and young adults 3. any body surface; bleeds easily 4. gingiva, lipds, tongue 5. frequently during prengancy

Question 29

histopathological features of pyogenic granuloma

Answer 29

granulation tissue

Question 30

treatment of pyogenic granuloma

Answer 30

excise remove irritants

Question 31

rate of recurrence of pyogenic granuloma

Answer 31

15%

Question 32

lipoma

Answer 32

benign tumor of adipose (fatty tissue)

Question 33

features of lipoma

Answer 33

1. adult patients 2. slow growing, non-tender, soft, doughy, usually encapsulated 3. common in head and neck; occassionally found intraorally 4. yellow if clsoe to the surface 5. tend to float in formalin 6. demarcated or encapsulated collection of mature fat cells

Question 34

treatment of lipoma

Answer 34

excisional biopsy no recurrence

Question 35

traumatic neuroma

Answer 35

uncommon reaction to sectioning of a nerve (amputation neuroma)

Question 36

clinical features of traumatic neuroma

Answer 36

1. smooth surfaced, dome shaped papules, usually less than 1cm 2. tongue, buccal vestibule (mental foramen region common affected) 3. may be tender on palpation

Question 37

histology of traumatic neuroma

Answer 37

1. microscopically, a tangled mass of peripheral nerve fibers is seen 2. usually set in a collagenous background

Question 38

management of traumatic neuroma

Answer 38

surgical excision -lack of sensation in supplied areas -revent resurrected ends from meeting

Question 39

neurilemmoma / schwannoma

Answer 39

benign tumor of schwann cell origin (myelin)

Question 40

clinical features of neurilemoma

Answer 40

1. most identified in adults 2. slow growing, solitary, encapsulated, fubbery-firm, nontender mass 3. 25-48% in head and neck including oral cavity 4. lips, tongue, buccal mucosa 5. may be seen within the mandible

Question 41

histology of neurilemoma

Answer 41

1. well developed connective tissue capsule 2. benign proliferaiton of spindle shaped schwann cells 3. antoni a and antoni B patterns seen

Question 42

management and prognosis of neurilemoma

Answer 42

conservative exision

Question 43

neurofirboma

Answer 43

benign tumor of neural fibroblast origin -over 90% are solitary; remainder are multiple and associated with neurofibromatosis -soft dome shaped nontender superficial nodule affecting skin or mucosa -demarcated but encapsulated

Question 44

neurofibromatosis

Answer 44

one of the most common autosomal genetic problems that affect humans -approximatley half are transmitted as autosomal dominant trait; other half appear to be new mutations

Question 45

clinical features of neurofibromatosis

Answer 45

-highly variable gene expression -variety of manifestations, both cutaneous and oral -skin lesions -lisch nodules (benign pigmented nodule of iris) -oral lesions consist of neurofbiromas that may affect the tongue, gingiva, or bone -multiple comorbidities

Question 46

skin lesiosn of neurofibromatosis

Answer 46

cafe aulait spots multiple neurofibromas axillary freckinling (crowe sign)

Question 47

lisch nodules

Answer 47

benign pigmented nodules of iris

Question 48

comorbidities of neurofibromatosis

Answer 48

hypertension CNS tumors macrocephaly mental defect seizures

Question 49

malignant transformation of neurofibromatosis

Answer 49

-treatment consist of removing traumatized neurofibromas or disfiguring lesions -genetic counseling -decreased longevity -follow for potential malignant transofmraiotn -potential to beome malignant peripheral nerve sheath tumor

Question 50

MEN

Answer 50

multiple endocrine neoplasia syndromes

Question 51

MEN1

Answer 51

parathyroid, pancreatic tumors, phaeochromocytoma, pituitary tumors -ajority of tumors in people with MEN1 are benign -however, approximatley 1/3 pancreatic neuroendocrine tumors and mediastinal neuroendocrine tumors are malignant -all benign tumors

Question 52

MEN2a

Answer 52

men1 and medullary carcinoma of thyroid

Question 53

MEN2b

Answer 53

men 2a and neuromas

Question 54

features of type 2b

Answer 54

autosomal dominant