12 Soft tissue tumors Flashcards
(47 cards)
Fibroma
- 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
- Younger age than traditional fibroma
- variant of fibroma, looks the same
- 50% of cases on gingiva
- Histology shows large stellate and multinucleated fibroblasts
Giant cell fibroma
- Unilateral or bilateral papular lesions on the gingiva lingual to the canines
- Seen mainly in children
- Normal anatomic variation that disappears with age
retrocuspid papilla
- mandibular canines
- from the picture know that it’s SOFT TISSUE lesion, to distinguish from tori
- 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
epulis fissuratum
- usually more anterior
- txt: surgical removal
- more of a clinical term than histologic term
-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
inflammatory papillary hyperplasia
-txt: remove denture, allow to heal, surgical intervention, remake denture
- Exhibit fibrous and histiocytic differentiation
- Unlike other fibrous growths discussed, this represents a true neoplasm
- On the skin known as a dermatofibroma
Fibrous Histiocytoma
- Surgical excision and recurrence uncommon
- he got rid of this slide in his lecture and didn’t talk about it
- 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)
fibromatosis
-txt: partial mandibular resection, placement of bone plate
what are the “3 P’s?”
-KNOW THESE
- 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
- 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
Pyogenic granuloma
-txt: conservative surgical excision down to periosteum and remove any irritants (calculus)
- 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
epulis granulomatosa
-I think this may be on the test, it’s very similar to a pyogenic granuloma
-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
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
- 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,
peripheral ossifying fibroma
- txt: excision down to periosteum, can recur about 16%
- look for calcification (esp on radiographs)
benign tumor of fat cell origin
-most common mesenchymal neoplasm, usually on the trunk
lipoma
-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
traumatic neuroma
-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
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
what is the most common type of peripheral nerve neoplasm? and what are its’ features?
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
Spindle shaped cells with wavy nuclei
neurofibroma
-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
neurofibromatosis (NF1)
what is the stain for nerve
S100
what is the histology of a neurilemoma?
- 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
-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
Neurofibromatosis (NF1) or Von recklinghausen’s disease of the skin
A group of rare conditions characterized by tumors or hyperplasias of neuroendocrine origin
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)
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
MEN type 2B (MULTIPLE ENDOCRINE NEOPLASIAS)
-Calcitonin – thyroid carcinoma
**Increased vanillylmandelic acid - pheochromocytoma
**Increased epinephrine- norepinephrine ratios
n Life-threatening hypertension
MEN type 2B
