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Oral Pathology > 12 Soft tissue tumors > Flashcards

12 Soft tissue tumors Flashcards

1
Q

Fibroma

A
  • Can occur anywhere
  • most common buccal mucosa labial mucosa, tongue and gingiva
  • smoothed-surface, pink nodule
  • May be keratinized (trauma)
  • usually sessile
  • Tx-excision, rare recurrence
  • sessile or pedunculated
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2
Q
  • Younger age than traditional fibroma
  • variant of fibroma, looks the same
  • 50% of cases on gingiva
  • Histology shows large stellate and multinucleated fibroblasts
A

Giant cell fibroma

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3
Q
  • Unilateral or bilateral papular lesions on the gingiva lingual to the canines
  • Seen mainly in children
  • Normal anatomic variation that disappears with age
A

retrocuspid papilla

  • mandibular canines
  • from the picture know that it’s SOFT TISSUE lesion, to distinguish from tori
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4
Q
  • Tumor-like hyperplasia of fibrous connective tissue that develops in association with the flange of an ill-fitting complete or partial denture
  • Inflammatory hyperplasia
  • Denture injury tumor
  • Denture epulis
A

epulis fissuratum

  • usually more anterior
  • txt: surgical removal
  • more of a clinical term than histologic term
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5
Q

-Reactive tissue growth that usually develops beneath a denture
-Clinical Features
–usually on hard palate beneath denture
base
–edentulous mandibular alveolar ridge
–can occur on palate due to mouth breathing
–Appears as small pebbles or cobblestones

A

inflammatory papillary hyperplasia

-txt: remove denture, allow to heal, surgical intervention, remake denture

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6
Q
  • Exhibit fibrous and histiocytic differentiation
  • Unlike other fibrous growths discussed, this represents a true neoplasm
  • On the skin known as a dermatofibroma
A

Fibrous Histiocytoma

  • Surgical excision and recurrence uncommon
  • he got rid of this slide in his lecture and didn’t talk about it
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7
Q
  • Histologic pattern intermediate between benign fibrous lesions and a fibrosarcoma
  • Locally aggressive and high recurrence rate
  • AKA Desmoplastic fibroma and juvenile aggressive fibromatosis
  • can cause a limitation of opening (painless, no numbness, thrill or bruit, no hx of trauma, neg medial hx)
A

fibromatosis

-txt: partial mandibular resection, placement of bone plate

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8
Q

what are the “3 P’s?”

-KNOW THESE

A
  • pyogenic granuloma
  • peripheral ossifying fibroma
  • peripheral giant cell granuloma
  • when they give you one of the three p’s, when looking at the histo, look for giant cells and bone cells
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9
Q
  • Common tumor-like growth of the oral cavity considered non-neoplastic
  • Unrelated to infection
  • Response to local irritant or trauma
  • Any age and most common in children and young adults
  • Develop in pregnant women so much so that the terms pregnancy tumor or granuloma gravidarum are often used
  • reaction to local irritant or trauma
  • 75% occur on gingiva
A

Pyogenic granuloma

-txt: conservative surgical excision down to periosteum and remove any irritants (calculus)

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10
Q
  • Hyperplastic growth of granulation tissue that sometimes arise in healing extraction sockets
  • Resemble pyogenic granuloma and represent a granulation tissue response to bony sequestra in the socket
A

epulis granulomatosa

-I think this may be on the test, it’s very similar to a pyogenic granuloma

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11
Q

-relatively common tumor-like growth of the oral cavity
-reactive lesion caused by local irritation or trauma
-Clinical Features
-ONLY on the gingiva or
edentulous alveolar ridge
-31-41 and 60% female
-redorreddish-bluenodularmass
-“cupping resorption”of underlying bone

A

peripheral giant cell granuloma

  • txt: local surgical excision, 10% recurrence
  • no association with hyperparathyroidism and osteoclastic “brown tumors” unless intraosseous
  • histologically look for the giant cells
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12
Q
  • This tumor-like mass occurs only on the gingiva and is most common in 10-19 YEAR OLDS. 2/3 of all cases occur in females.
  • ONLY on gingiva
  • origination from PDL,
A

peripheral ossifying fibroma

  • txt: excision down to periosteum, can recur about 16%
  • look for calcification (esp on radiographs)
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13
Q

benign tumor of fat cell origin

-most common mesenchymal neoplasm, usually on the trunk

A

lipoma

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14
Q

-Not a true neoplasm
-Proliferation of neural tissue due to
transection or other trauma (nerve gets cut)
-Clinical Features
-smooth-surfaced nonulcerated nodule
-mental foramen area, tongue, lower lip
-25-30% are painful
-often Hx of trauma, extraction, other surgery

A

traumatic neuroma

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15
Q

-Benign neural neoplasm of Schwann cell origin
-Relatively uncommon
-25-50% of all cases in H&N
region
-Tongue is most common location
-Asymptomatic
-can occur in vestibular schwann cells and ususally causes total deafness

A 
neurilemoma
-txt: excision, 
histopathology:
-Antoni A: streaming fascicles of spindle shaped Schwann cells and form a palisaded arrangement around a central accelular area (Verocay bodies)
-Antoni B: randomly arranged
-S-100 positive
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16
Q

what is the most common type of peripheral nerve neoplasm? and what are its’ features?

A

neurofibroma

  • Mixture of Schwann cells and perineural fibroblasts
  • Clinical Features
  • slow growing, soft, painless
  • skin most common site
  • solitary or component of neurofibromatosis
  • most common intraoral–tongue and buccal mucosa
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17
Q

Spindle shaped cells with wavy nuclei

A

neurofibroma

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18
Q

-Von Recklinghausen’s Disease of the Skin
-relatively common hereditary
condition
-1/3000 births (50% new mutation)
-type I is most common–85-90% of cases
-Mutation of NF1 gene on chromosome 17q11.2 and responsible for a tumor suppressor protein know as neurofibromin
-cafe au lait pigmentation

A

neurofibromatosis (NF1)

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19
Q

what is the stain for nerve

A

S100

20
Q

what is the histology of a neurilemoma?

A
  • Antoni A tissue (): streaming fascicles of spindle shaped schwann cells and form a palisaded arrangement around a central accelular area (verocay bodies)
  • Antoni B: randomly arranged
  • S-100 positive
21
Q

-cafe au lait pigmentation
-axillary feckling (crowes sign)
Lisch nodules (brown pigmented spots on iris in nearly all affected individuals)
-oral lesions in 72-92% of cases

A

Neurofibromatosis (NF1) or Von recklinghausen’s disease of the skin

22
Q

A group of rare conditions characterized by tumors or hyperplasias of neuroendocrine origin

A

MULTIPLE ENDOCRINE NEOPLASIAS
-Type 1–pancreatic islet, adrenal cortex, parathyroid, pituitary
n Type 2A–pheochromocytoma, medullary thyroid carcinoma
n Type 2B same as type 2A plus mucosal neuromas (this is the one that concerns dentistry the most)

23
Q

most patients have a marfanoid habitus (thin
elongated limbs with muscle wasting)
n oral mucosal neuromas (usually 1st sign)
n soft, painless papules or nodules
n lips and anterior tongue, buccal mucosa, gingiva, palate
n bilateral neuromas of the commissural mucosa are highly characteristic
n pheochromocytomas in 50% of all patients
n medullary carcinoma of the thyroid–90% of cases–marked propensity for metastasis— arise 18-25

A

MEN type 2B (MULTIPLE ENDOCRINE NEOPLASIAS)

24
Q

-Calcitonin – thyroid carcinoma
**Increased vanillylmandelic acid - pheochromocytoma
**Increased epinephrine- norepinephrine ratios
n Life-threatening hypertension

A

MEN type 2B

25
Q

Rare pigmented neoplasm that usually occurs during first year of life
n Neural crest origin
n Clinical features
n 65-70% maxilla
n rapidly expanding mass, frequently blue or black
n may destroy underlying bone and displace teeth
n elevated vanillylmandelic acid
n small percent are malignan

A

MELANOTIC NEUROECTODERMAL TUMOR OF INFANCY

26
Q

what two diseases have elevated vanillymandelic acid?

A

MEN 2B and MELANOTIC NEUROECTODERMAL TUMOR OF INFANCY

27
Q

-specialized tissue of neural crest origin associated with autonomic nerve and ganglia throughout the body

A

0paraganglioma (carotid body tumor

28
Q

most common paraganglioma
n bifurcation of internal and external carotids
n slowly enlarging painless mass
n upper lateral neck below angle of ja

A

carotid body tumor

-txt: surgery and/or radiation depending on extent and location

29
Q

benign soft tissue neoplasm that shows a predilection for the oral cavity
n Probably origin from Schwann cells or neuroendocrine cells
n Most common location tongue/dorsal followed by buccal mucosa
n 4th to 6th decades; females 2X
n Color–pink, yellow and sometimes whit

A

granular cell tumor (**)

30
Q

Pseudoepitheliomatous hyperplasia is found in…

A

Squamous cell carcinoma and/or granular cell tumor

31
Q
  • Rare soft tissue tumor that occurs exclusively on the alveolar ridges of newborns.
  • S-100 positive, GCT S-100 negative
A

congenital epulis

-90% female

32
Q

Currently considered benign tumors of infancy that display rapid growth phase with endothelial proliferation, followed by gradual involution
-blanches on pressure

A

hemangioma

  • arise by at least the first 8 weeks of life
  • vascular malformations are anomalies of blood vessels without endothelial proliferation
33
Q

examples of vascular malformations

A
  • capillary hemangioma
  • juvenile hemangioma
  • cavernous hemangioma
  • arteriovenous malformation
34
Q
  • In contrast to hemangiomas are present at birth and persist through life
  • Typically blue and compressible and grow proportionally with patient
  • Secondary thrombosis and phlebolith formation can occur
A

low-flow vascular malformations

35
Q
  • Result from direct arterial and venous communication
  • Present at birth but not noticed until later
  • Fast vascular flow causes thrill or bruit
A

high flow vascular malformations

36
Q

Rare, non-hereditary developmental condition characterized by hamartomatous vascular proliferations, involving the brain and face

A

Sturge-Weber syndrome

37
Q

-

A

-

38
Q
  • port-wine stain or nevus-flammeus
  • unilateral distribution along one or more segments of the trigeminal nerve
  • not all patients with port-wine nevi have Sturge-Weber Syndrome (only a small %)
  • leptomeningeal angiomatosis
  • ocular involvement may include glaucoma, and vascular malformations of the conjunctiva, episclera
A

sturge-weber angiomatosis

-encephalo-trigeminal angiomatosis

39
Q
  • Rare tumor of the nasopharynx
  • Exclusively males between 10-17
  • Nasal obstruction and epistaxis
  • Vascular malformation rather than true neoplasm
  • Surgery with 20-40% recurrence rates
  • Can be destructive
A

Nasopharyngeal Angiofibroma

-“I probably won’t ask you this)

40
Q

-Oral common – 75% buccal mucosa
-Histology—staghorn appearance of blood
vessels surrounded by pericytes
-IH CD34 positive—rare in children
-4 or more mitoses per 10 high power fields suggests a possibly malignant lesion
-Treatment—Surgery and more aggressive for tumors of malignant characteristics
-86% 5 year survival–follow-up

A

Hemangiopericytoma–Solitary fibrous tumor

-“I think I will leave this one out too”

41
Q

Benign hamartomatous tumors of lymphatic vessels—arbitrary classification because all three sizes of vessels found in the same lesion

  • Do not communicate with the rest of the lymphatic system
  • Cystic L neck and axilla
  • Cavernous in the mouth
A 
Lymphangioma
-capillary lymphangioma (L simplex)
-cavernous lymphangioma
-cystic lymphangioma (cystic hygroma) 
    the cystic L can interfere with the airway
42
Q

-marked predilection for the head and
neck (50-75%)
-90% develop by two years of age
-anterior 2/3 of tongue - macroglossia
-usually superficial with pebbly appearance
-deeper tumors present as soft, ill- defined masses
-cervical lymphangiomas can cause dysphagia and/or respiratory difficult

A

Lymphangioma

-histo, looks just like a hemangioma, but no RBCs

43
Q
  • benign neoplasms of smooth muscle
  • rare in oral cavity
  • vascular know as angiomyoma
A

Leiomyoma

44
Q
  • benign neoplasms of skeletal muscle
  • floor of mouth, soft palate, base of tongue
  • histology: Rounded and polygonal cells with focal vacuolization
A

Rhabdomyoma

45
Q
  • normal tissue in an abnormal location

- striking predilection for the tongue

A

Choristoma

46
Q

hamartoma

A

just means its not a true neoplasm (tumor) it’s just mal-formed

47
Q

port-wine stain

A

sturge-weber angiomatosis or encephalo-trigeminal angiomatosis (two names for the same thing)

Oral Pathology (16 decks)

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