Soft Tissue Tumors; Reactive and Neioplastic Flashcards
Parulis (Gumboil)
Pus surrounded by a mass of hyperplastic granulation tissue
present on the buccal gingiva - exophytic mass = swelling
Where does parulis originate?
The apex ofnon-vital teeth or deep perio pockets
sinus tract swellling - gutta percha assist in determining origin
How do you treat Parulis? s
surgical removal of lesion
Inflammatory Fibrous hyperplasia overview.
simmilar to dentrue IFH
benign soft tissue response to a local irritant
What type of irritants cause IFH?
calculus, sharp tooth
What are the clinical features of IFH?
any age; no sex predilection
well demarcated nodule, white, pink or reddish in color
can be ulcerated and/or kerotic
soft upon palpation
What is an epulis fissuratum?
redundant hyperplastic tissue in the alveolar vestibule
occurs because of alveolar ridge resorption leading to ill fitting denture
Describe the histology of IFH.
mass of dense and hyperplastic fibrous connective tissue
dilated vlood vessels
inflammatory cells
acanthotic, ulcerated, keratotic,
How do you treat IFH?
remove or reduce denture
possible excision
Inflammatory papillary hyperplasia (denture papillomatosis)
reactive response to irritant (denture)
What are the clinical features of IPH?
pink/red, pebbly, asymptomatic
dentures will poor OH
24% who do not ever take it out
turns into candida infection
What is the most common location of IPH?
hard palate
licking, high palate, mouth breather
Describe the histology of IPH.
Papillary mass of dense and hyperplastic fibrous connective tissue with diilated blood vessels and inflammatory cells
How do you treat IPH?
removal of stimulus and antifungals
Pyogenic Granuloma
most common reactive swelling of the gingiva
exuberant mass of granulation tissue
anywhere in the oral cavity
not a true granuloma
What are the clinical features of PG?
occur at any age/sex (slightly young females)
“pregnancy tumors”
What is the most common location of PG?
Gingiva
What does PG present as?
Rapidly growing, well-demarcated, hemorrhagic, ulcerated nodule
pinkish as the lesion heals (White as ulcer is covered with pseudomembrane)
2-4CM
Describe the histology of PG?
Mass of granulation tissue
vascular and ulerated
Inflammatory cells are present
What is the treatment for PG?
Removal of irritant
Scaling and polishing prior to surgical removal shrinks lesion
Pregnancy Tumor Characteristics.
pyogenic granuloma during pregnancy (mid to late stages)
Gingivitis likely to be present as well
Hormonally induced
How do you treat a pregnancy tumor?
Wait post partum
reduction occurs within 2-4 months
treatment during pregnancy - recurrence
Peripheral Ossifying Fibroma Overview;
tumor exclusively on the gingiva (10% of all reactive gingival swelling)
reare reports on edentulous mucosa
arises from PDL or periosteum
What are clinical features of peripheral ossifying firbroma?
exclusively on the gingiva
anterior to molar and maxillary
well demarcated sessile nodules
frim
pink and red if ulcerated
Describe the histology of peripheral ossifying fibroma.
cellular fibrous connective tissue with calcified bone or osteoid; some cementum like tissue
ulcerated surface
vascularity not prominent
What is the treatment for peripheral ossifying fibroma?
excision deep to the PDL
extract tooth if it recurs >2 times (16-20%)
What age and gender is peripheral ossifying fibroma more commonly found in?
10-19 years of age
females (2/3)
Peripheral Giant Cell Granuloma Overview:
reactive in nature
originates from pdl or periosteum
What are the clinical features of peripheral giant cell granuloma?
occurs exclusively on the gingiva, edentulous and dentat
mainly anterior to molars
sessile = red or red/blue lesion
sometimes resorbs underlying bone in uniform “saucer-like” appearance
What are the radiographic features of peripheral giant cell granuloma
“cuffing” effect with slight bone resorption as described
not common
Describe the histology of peripheral giant cell granuloma
fibrovascular stroma with numberous multinucleated gian cells and hemosiderin pigment
What is the treatment for peripheral giant cell granuloma?
complete excision including curetage of underlying bone
remove local irritants
prognosis good
Fibroma (traumatic or irritation)
most common soft tissue tumor in te oral cavity
difficult clinically and histologically to differentiate between benign and hyperplasia
What is the most common cause of fibroma?
cheek chewing
What are the clinical features of fibroma?
most common on the buccal mucosa and lip
occurs anywhere
presents as dome shaped, smooth, pink or white nodule
Who is most commonly effected by fibroma?
30-50 with no sex predilection
Describe the histology of fibroma.
fibrous connective tissue nodule lined by surface mucosa (keratotic and maybe thick)
What are the treatment options for fibroma?
Surgical removal
remove irritant (habits)
Lipoma Overview
Benign neoplasm of adipose origin tissue
uncommon orally
What are the clinical features of lipoma?
Floor of the mouth, tongue, and buccal mucosa are most common
lipomatous nodule on buccal mucosa = fat herniation
What is the appearance of a lipoma?
single, smooth surfaced, soft, lobulated, painless yellowis, sessile nodule
lined by thin epithelium
visible blood vessel
soft (mistaken for a cyst)
what is the treatment for lipoma?
excision
Who is more commonly affected by lipoma’s?
Oral: adults with equal sex predilection
skin: females 2x more common
Leiomyoma Characteristics
a binign neoplasm of smooth muscle origin
more common in the GI, uterus and skin
oral cavity = originates from vascular smooth muscle
angiomyoma = 75% of oral leiomyomas
What are the clinical feature of leiomyoma?
Slow growing painless pedunculated, smooth surfaced, normal color or slighlty buish nodule
central leiomyoma vry rare
What are the common locations of leiomyoma?
posterior tongue, palate, cheeks and lips
Who is commonly effected by leiomyoma?
> 30 years old
Predominantly male
Describe the histopathology of leiomyoma.
well-circumscribed nodule made up of smooth muscle cells
Treatment options for leiomyoma.
simple & conservative excision
Hemangioma characteristics.
benign proliferation of blood vessels (most are hemartomas)
What are the clinical features of hemangioma?
flat or elevated and purplish-red
blanch on pressure (unless thrombus)
present centrally (aspirate before surgery)
Where does hemangioma commonly occur?
head and neck
oral cavity: tongue, buccal mucosa, and lips
Whos is commonly effected by hemangioma?
equally in sexes (some say more in females)
children mainly (even at birth) on the lips (no treatment except to improve scar cosmeics)
What are hemangiomas commonly associate with?
Sturg-Weber
Hereditary Hemorrhagic Telangiectasia
Describe the histology of hemangiomas?
proliferation of vascular spaces lined by endothelial cells
Treatment options for hemangioma?
depends on size and relationship to other anatomical sructure, blood flow
injecting sclerosing agents, surgical debulking; complete excision
