warts, polyps, epulides and vascular anomalies Flashcards
what descriptive features must you comment on when examining a soft tissue lesion?
site
size
shape
consistency
colour
anatomical relationships
what is the most common soft tissue lesion?
Fibrous nodules
what is a fibrous nodule?
fibrous hyperplastic nodule
what is the aetiology of a fibrous nodule?
- chronic minor trauma
- chronic low grade infection
what is the pathology of a fibrous nodule?
- initially inflamed fibrous tissue
- once mature become dense collagenous tissue
what are the clinical features of a fibrous nodule?
- usually well circumscribed
- sold and raised
- can form on mucosa close to line of occlusion
- denture induced
what are the presentations of fibrous nodules?
- FIBROEPITHELIAL POLYP (FEP)
- FIBROUS EPULIS (GINGIVA)
- DENTURE INDUCED HYPERPLASIA (associated with denture trauma)
what is the management of a fibrous nodule?
- remove stimulus
- excisional biopsy
(can recur if causative factor not removed)
is a papilloma common or uncommon oral lesion?
common
what is the aetiology of a papilloma?
- viral = HPV 6 and 11
- can be transmitted from cutaneous or genital warts
what are the clinical features of a papilloma?
- usually painless
- single or multiple
- occur at any oral site
- exophytic (grow outwards)
- cauliflower like appearance
what is the pathology of a papilloma?
- stratified squamous epithelium
- supported by vascular connective tissue
- keratinised
- may be evidence of virus but not minority
what is the management of a papilloma?
- not considered to be premalignant
- excision
- cryotherapy
- if multiple consider potential underlying immunodeficiency (eg HIV)
- management of skin lesion elsewhere if present
what is the clinical appearance of a pyogenic granuloma?
-painless
-pedunculated (on a stalk)
-red and inflamed
- commonly on the gingiva
- in pregnancy often associated with pregnancy gingivitis
what are the causes of a pyogenic Granuloma?
- local low-grade irritation
- hormonal changes
- trauma
what is the pathology of a Pyogenic Granuloma?
-hyperplastic lesion
-dilated capillaries in loose connective tissue stroma
-mature lesions are more fibrous with variable inflammation
what is the management of a Pyogenic Granuloma?
- excision
- remove causative factors
- Pregnancy epulis - delay where possible until postpartum (prior recurrence is likely)
- improve oral hygiene (often calculus/ plaque is causative)
is a giant cell granuloma common?
no, its an uncommon lesion
is a giant cell granuloma benign or malignant?
benign
what is the most common age range to get a giant cell granuloma?
20-40
where is a giant cell granuloma commonly found in the mouth?
tooth bearing areas, commonly anterior mandible
is a giant cell granuloma more common in males or females?
2F: 1M
what is the classification of giant cell granulomas?
1> Central (within bone) - aka reparative granuloma
2> Peripheral (on gingiva) - aka giant cell epulis
what are the clinical features of a central giant cell granuloma?
- may be asymptomatic
- bony swelling
- can erode through the cortical plate
- loosing of teeth
- purple gingival swelling
- ulceration/ inflammation of overlying mucosa
what are the radiographic features of a central giant cell granuloma?
- Extent - may be large/ rounded
- Quality - radiolucent, may have areas of trabeculation
- margin - localised but often ill defined edges
- adjacent anatomy - may perforate alveolar bone and extend into the mouth, may resorb/ displace adjacent roots
what is the his-pathology of a giant cell granuloma?
- multiple multinucleate giant cells
- storm of plump spindle shaped cells
- often highly vascular
- areas of old and new haemorrhage
- large cystic blood filled spaces
- new bone deposits at margins
what is a central giant cell granuloma similar in appearance to?
- brown tumour of hyperparathyroidism
- aneurysmal bone cyst
what is the management of a Central giant cell granuloma?
> Excision of soft tissue lesion and curettage underlying bone
> need can be retained If possible
> recurrence approximately 15%
> in larger lesions resection may be required
> corticosteroids, calcitonin, interferon alpha and bisphosphonates may be used in treatment
(children are unable to have surgery, and residual surgery may be necessary)
what are central giant cell granulomas linked to?
Noonan syndrome - cardiac abnormlaities, learning disabilities, short stature
what is the difference between peripheral and central GCG?
- Peripheral - CAUSED BY LOCAL IRRITANTS, non neoplastic, GINGIVA AND ALVEOLAR RIDGE, LITTLE AGGRESSIVE, SLOW, RARE BONE RESORPTION, RARE DENTAL INVOLVEMENT, SURIGICAL TREATMENT
- CENTRAL - uncertain cause, non neoplastic, intra osseous, more agressive, rapid growth, bone resorption present, dental involvement present, pharmacological and or surgical treatment
what does hyperparathyroidism cause in the mouth?
browns tumour
granulomata
what is hyperparathyroidism?
- parathyroid hormone overproduction
- mobilises calcium from the skeleton and raises plasma calcium
> its uncommon and occurs more in females, usually elderly and an incidental finding
xerostomia or granulomata present
what are the radiographic features of hyperparathyroidism?
- minimal bony change
in advanced cases -
> reduced bone density
> loss of trabecular density
> loss of lamina dura
> may develop a brown tumour
how does a brown tumour appear on a radiograph?
- cyst like radiolucency
- uni or multilocular
what is the treatment of a browns tumour?
- correction of underlying lesion
what is a vascular malformation?
a composition of seemingly disorganised vessels
what is the aetiology of vascular malformation?
- defect in vasculargenisis/ angiogenesis
- structural defect in blood vessels
- congenital
- present at birth but many go unnoticed
- equal in males and females, and grows at a rate proportional to the body
what are the clinical features of a vascular malformation?
- raised or flat
- soft (can become firm with time due to thrombus or calcification)
- deep red/ bluish colour
- size varies
- usually blanch with pressure
- if affecting tongue may impact movement
what is the management of vascular malformations?
- excision only if small
- laser surgery
- cryotherapy
- radiation therapy
- corticosteroids (topical, intralesional, oral)
what syndromes are associated with vascular malformations?
- sturge weber - aka encephalotrigeminal angiomatosis (haemangiomas of the face affecting the trigeminal divisions)
- Osler rendu weber - hereditary haemorrhagic telangiectasia (HHT)
what is at the aetiology of haemanginioma?
> benign vascular tumour
abnormal endothelial cell proliferation
- similar clinical features to VM
- not congenital
- usually presents in the first few months of life
what is the management of a haemangioma?
- the same as vascular malformations
- can regress with time
what is the classification of haemangioma?
> central - in bone
> capillary - intercommunicating capillary vessels (strawberry angioma/ port wine stain)
> cavernous - dilated blood containing spaced lined by endothelium
> arterial
what is an example of a malignant vascular lesion?
- kaposi’s sarcoma (AIDS related)
what is purpura?
> bleeding into the skin or mucous membranes
results in petechia or ecchymoses
- spont gingival bleeding
- purple can form at any site of trauma
- indicates underlying platelet disorder
