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osomop 4th > warts, polyps, epulides and vascular anomalies > Flashcards

warts, polyps, epulides and vascular anomalies Flashcards

1
Q

what descriptive features must you comment on when examining a soft tissue lesion?

A

site
size
shape
consistency
colour
anatomical relationships

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2
Q

what is the most common soft tissue lesion?

A

Fibrous nodules

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3
Q

what is a fibrous nodule?

A

fibrous hyperplastic nodule

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4
Q

what is the aetiology of a fibrous nodule?

A
  • chronic minor trauma
  • chronic low grade infection
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5
Q

what is the pathology of a fibrous nodule?

A
  • initially inflamed fibrous tissue
  • once mature become dense collagenous tissue
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6
Q

what are the clinical features of a fibrous nodule?

A
  • usually well circumscribed
  • sold and raised
  • can form on mucosa close to line of occlusion
  • denture induced
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7
Q

what are the presentations of fibrous nodules?

A
  • FIBROEPITHELIAL POLYP (FEP)
  • FIBROUS EPULIS (GINGIVA)
  • DENTURE INDUCED HYPERPLASIA (associated with denture trauma)
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8
Q

what is the management of a fibrous nodule?

A
  • remove stimulus
  • excisional biopsy

(can recur if causative factor not removed)

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9
Q

is a papilloma common or uncommon oral lesion?

A

common

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10
Q

what is the aetiology of a papilloma?

A
  • viral = HPV 6 and 11
  • can be transmitted from cutaneous or genital warts
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11
Q

what are the clinical features of a papilloma?

A
  • usually painless
  • single or multiple
  • occur at any oral site
  • exophytic (grow outwards)
  • cauliflower like appearance
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12
Q

what is the pathology of a papilloma?

A
  • stratified squamous epithelium
  • supported by vascular connective tissue
  • keratinised
  • may be evidence of virus but not minority
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13
Q

what is the management of a papilloma?

A
  • not considered to be premalignant
  • excision
  • cryotherapy
  • if multiple consider potential underlying immunodeficiency (eg HIV)
  • management of skin lesion elsewhere if present
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14
Q

what is the clinical appearance of a pyogenic granuloma?

A

-painless
-pedunculated (on a stalk)
-red and inflamed
- commonly on the gingiva
- in pregnancy often associated with pregnancy gingivitis

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15
Q

what are the causes of a pyogenic Granuloma?

A
  • local low-grade irritation
  • hormonal changes
  • trauma
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16
Q

what is the pathology of a Pyogenic Granuloma?

A

-hyperplastic lesion
-dilated capillaries in loose connective tissue stroma
-mature lesions are more fibrous with variable inflammation

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17
Q

what is the management of a Pyogenic Granuloma?

A
  • excision
  • remove causative factors
  • Pregnancy epulis - delay where possible until postpartum (prior recurrence is likely)
  • improve oral hygiene (often calculus/ plaque is causative)
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18
Q

is a giant cell granuloma common?

A

no, its an uncommon lesion

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19
Q

is a giant cell granuloma benign or malignant?

A

benign

20
Q

what is the most common age range to get a giant cell granuloma?

A

20-40

21
Q

where is a giant cell granuloma commonly found in the mouth?

A

tooth bearing areas, commonly anterior mandible

22
Q

is a giant cell granuloma more common in males or females?

A

2F: 1M

23
Q

what is the classification of giant cell granulomas?

A

1> Central (within bone) - aka reparative granuloma

2> Peripheral (on gingiva) - aka giant cell epulis

24
Q

what are the clinical features of a central giant cell granuloma?

A
  • may be asymptomatic
  • bony swelling
  • can erode through the cortical plate
  • loosing of teeth
  • purple gingival swelling
  • ulceration/ inflammation of overlying mucosa
25
Q

what are the radiographic features of a central giant cell granuloma?

A
  1. Extent - may be large/ rounded
  2. Quality - radiolucent, may have areas of trabeculation
  3. margin - localised but often ill defined edges
  4. adjacent anatomy - may perforate alveolar bone and extend into the mouth, may resorb/ displace adjacent roots
26
Q

what is the his-pathology of a giant cell granuloma?

A
  • 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
27
Q

what is a central giant cell granuloma similar in appearance to?

A
  • brown tumour of hyperparathyroidism
  • aneurysmal bone cyst
28
Q

what is the management of a Central giant cell granuloma?

A

> 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)

29
Q

what are central giant cell granulomas linked to?

A

Noonan syndrome - cardiac abnormlaities, learning disabilities, short stature

30
Q

what is the difference between peripheral and central GCG?

A
  1. Peripheral - CAUSED BY LOCAL IRRITANTS, non neoplastic, GINGIVA AND ALVEOLAR RIDGE, LITTLE AGGRESSIVE, SLOW, RARE BONE RESORPTION, RARE DENTAL INVOLVEMENT, SURIGICAL TREATMENT
  2. CENTRAL - uncertain cause, non neoplastic, intra osseous, more agressive, rapid growth, bone resorption present, dental involvement present, pharmacological and or surgical treatment
31
Q

what does hyperparathyroidism cause in the mouth?

A

browns tumour

granulomata

32
Q

what is hyperparathyroidism?

A
  • 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

33
Q

what are the radiographic features of hyperparathyroidism?

A
  • minimal bony change

in advanced cases -
> reduced bone density
> loss of trabecular density
> loss of lamina dura
> may develop a brown tumour

34
Q

how does a brown tumour appear on a radiograph?

A
  • cyst like radiolucency
  • uni or multilocular
35
Q

what is the treatment of a browns tumour?

A
  • correction of underlying lesion
36
Q

what is a vascular malformation?

A

a composition of seemingly disorganised vessels

37
Q

what is the aetiology of vascular malformation?

A
  • 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
38
Q

what are the clinical features of a vascular malformation?

A
  • 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
39
Q

what is the management of vascular malformations?

A
  • excision only if small
  • laser surgery
  • cryotherapy
  • radiation therapy
  • corticosteroids (topical, intralesional, oral)
40
Q

what syndromes are associated with vascular malformations?

A
  1. sturge weber - aka encephalotrigeminal angiomatosis (haemangiomas of the face affecting the trigeminal divisions)
  2. Osler rendu weber - hereditary haemorrhagic telangiectasia (HHT)
41
Q

what is at the aetiology of haemanginioma?

A

> benign vascular tumour
abnormal endothelial cell proliferation

  • similar clinical features to VM
  • not congenital
  • usually presents in the first few months of life
42
Q

what is the management of a haemangioma?

A
  • the same as vascular malformations
  • can regress with time
43
Q

what is the classification of haemangioma?

A

> central - in bone

> capillary - intercommunicating capillary vessels (strawberry angioma/ port wine stain)

> cavernous - dilated blood containing spaced lined by endothelium

> arterial

44
Q

what is an example of a malignant vascular lesion?

A
  • kaposi’s sarcoma (AIDS related)
45
Q

what is purpura?

A

> 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

osomop 4th (18 decks)

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