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BDS4 Oral surgery > Soft tissue lesions and biopsy > Flashcards

Soft tissue lesions and biopsy Flashcards

1
Q

What is a biopsy ?

A
  • Sample of tissue for histopathological analysis
  • Allows us to confirm or establish a diagnosis
  • Determine prognosis
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2
Q

What questions should you ask when thinking about a biopsy?

A
  • Should I biopsy this?
  • Why am I biopsying this?
  • What question am I asking the pathologist?
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3
Q

What type of biopsy is a blood sample?

A
  • Aspiration biopsy
  • e.g. FBC, U&E, haematinics, glucose etc
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4
Q

What types of biopsy can be taken from aspiration?

A
  • Blood sample
  • Lesion e.g. abscess or cystic lesion
  • Solid lesion e.g. salivary gland lesion
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5
Q

Why is aspiration useful in biopsy for a abscess for example?

A
  • Avoids contamination by oral commensals
  • Protection of anaerobic species
  • Determines whether a lesion is solid or fluid filled
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6
Q

What type of lesion may yield blood, that isn’t a blood sample?

A
  • Haemangioma
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7
Q

What is a cystic lesion that can be aspirated?

A
  • Keratocytes -aspirate keratin
  • Radicular cyst
  • Dentigerous cyst
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8
Q

What is a fine needle aspiration biopsy?

A
  • Aspiration of cells from solid lesion
  • Goes to cytology not histology
  • Not done commonly in dental hospital
  • But can be done for enck swelling, salivary gland lesions
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9
Q

What is an excisional biopsy and what would you do this for?

A
  • Removal of all clinically abnormal tissues
  • Have to be fairly confident of provisional diagnosis to excise all teh tissue
  • Done for Benign lesions e.g. fibrous overgrowths, denture hyperplasia, mucoceles
  • Done only if it is a discrete lesion (in one place, not all over the mouth)
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10
Q

What is an incisional biopsy and when would you do this?

A
  • Representative tissue sample
  • Usually done for larger lesions or uncertain diagnosis
  • e.g. leukoplakia , lichen planus, squamous cell carcinoma
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11
Q

What is a punch biopsy? Describe the instrument and what is does

A
  • Type of incisional biopsy
  • Hollow trephine 4, 6 or 8mm diameter
  • Removes core of tissue with minimal damage
  • May not require suture or only minimal number of sutures
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12
Q

What questions do you need to answer when selecting the area to biopsy?

A
  • Must be large enough
  • Must be representative
  • Maybe more than one biopsy
  • Don’t just biopsy ulcers, include perilesional tissue
  • Refer?
    * suspicious lesions
    * lumps within the upper lip (common site for malignant salivary gland lesions)
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13
Q

What should the biopsy sample be placed in before sent to pathology lab?

A
  • Place immediately into 10% formalin
  • Don’t place on guaze swab
  • Sometimes if you place suture in mesial or distal aspect then helps the orientation for lab
  • Include all relevant clinical info on pathology form to aid diagnosis
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14
Q

Why do you not use gauze on the sample?

A
  • Distorts the sample
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15
Q

Why do you use filter paper on the sample?

A
  • to reduce sample distortion
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16
Q

What injury is this an example of?

A
  • Crush injury from a flat sample
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17
Q

What injury is this an example of?

A
  • Tear injury from flat sample
  • Epithelium been torn away
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18
Q

What info do you need to include on the pathology form?

A
  • Name
  • CHI
  • DOB
  • Dentist
  • Address
  • Your name and address
  • Contact number
  • Tick histopathology
  • Details of specimen - time and date of collection
  • Nature of specimen
  • provisional diagnosis
  • Clinical details (PMH)
  • Risk of infection tick yes or no
19
Q

Describe this lesion

A
  • Buccal mucosa in edentulous arch
  • Mixed red and white lesion white with striated areas (White areas)
  • Some areas of ulceration in the middle lesion
  • Extensive lesion
20
Q

Where should the specimen be sent to?

A
  • The pathology dept Queen Elizabeth University hospital
21
Q

When choosing areas to biopsy what are the 3 things you need to consider?

A
  • Chose a representative sample
  • Don’t need to include normal tissue margin
  • Try to avoid salivary gland duct orifices, tip of tongue, areas close to nerves and larger blood vessels
22
Q

What are Fibrous epulis? Describe the lesion

A
  • Swelling arising from gingivae
  • Hyperplastic response to irritation (usually due to overhanging restoration, subgingival calculus)
  • Has smooth surface, rounded swelling
  • Pink and pedunculated
23
Q

What is the txt of fibrous epulis?

A
  • Excisional biopsy
  • Coe pack dressing
  • removal of source of irritation or will just return
24
Q

What is a fibrous overgrowth? Describe what you would see?

A
  • Fibroepithelial polyp
  • Benign
  • Due to Frictional irritation or trauma
  • Semi pedunculated or sessile
  • Pink
  • Smooth surface
  • Most common on buccal mucosa and inner surface of lip
25
Q

What is the txt of a fibroepithelial polyp?

A
  • Surgical excision if bothering pt
  • No need for deep excision
26
Q

What is a Giant cell epulis? Describe what you might see?

A
  • Peripheral giant cell granuloma
  • Multi nucleated giant cells in vascular stroma
  • Deep red or purple with broad base
27
Q

Where are Giant cell epulis found commonly?

A
  • Teenagers, anterior regions of mouth
28
Q

What is the txt for Giant cell epulis?

A
  • X-ray to ensure it is not centrally originating (this would appear as radiolucency)
  • Surgical excision with curettage of base
  • Coe pack dressing
29
Q

What is a Haemangioma? Describe the lesion

A
  • Developmental overgowths
  • Hamartomata
  • Exophytic
  • Blue in colour
  • Pressure will cause loss of colour
30
Q

What is the txt of Haemangioma?

A
  • Surgical removal
  • More commonly cryotherapy (but this option has no histological diagnosis)
31
Q

What does Exophytic mean?

A
  • Growth of a tumour outwards from surface epithelium
32
Q

What is a Lipoma? Describe the lesion? How would you treat one?

A
  • Benign neoplasm of fat
  • Soft swelling
  • Pale yellow
  • Sessile
  • Excision
33
Q

What is a pregnancy epulis? What might it be due to?

A
  • Overgrowth of granulation tissue which arises from failure of normal healing
  • May be due to calculus
  • Hormonal changes enhance response to tissue irritation
  • Bleeds easily
34
Q

What is the txt of a pregnancy epulis?

A
  • Small lesions may not need excision and can be kept until after baby is born (may even regress on their own)
  • Larger lesions should be excised
35
Q

What is a Pyogenic granuloma? Describe this lesion. What is the txt?

A
  • Overgrowth of granulation tissue which arises from failure of normal healing
  • May be related to XLA sockets ir traumatic soft tissue injuries
  • Red in colour
  • Surgical excision
  • Curettage of base
36
Q

What is a squamous cell papilloma? Describe the lesion. What is the txt?

A
  • Benign neoplasm
  • Usually pedunculated
  • White surface
  • Cauliflower appearance
  • Most common palate, bucal mucosa or lips
  • Excision at base
  • Get tested for HPV as similar to viral warts
37
Q

What is denture hyperplasia? What is it due to? Where is it most common? What is the txt?

A
  • Hyperplastic reaction leading to roll of excess tissue of outer aspect of denture flange or between flange and alevolar ridge
  • Due to poorly fitting denture
  • Most common lower labial sulcus
  • Trim flange of denture
  • remove XS tissue
  • If very larger area Coe Pack dressing to ensure sulcus depth maintained
38
Q

What is a leaf fibroma? Describe the lesion. What is the txt?

A
  • Chronic iritation due to denture
  • Round polyp that becomes flattened due to denture
  • Pedunculated (attached at one point)
  • Benign
  • Excision
39
Q

What is a mucocele? What is it due to?

A
  • Mucous extravasation cyst
  • Most common minor salivary gland problem
  • Damage to minor gland duct occurs
  • Saliva leaks into submucosal layer
  • Soft bluish swelling fluid filled
  • Recurrent issue
  • When they occur in the floor of the mouth they are called ‘Floor of mouth Ranula’
40
Q

What is the txt of mucocele?

A
  • if pt presents with mucocele we can see then surgical excision vertically using blunt dissection
  • Often rupture
  • Pt should be warned about recurrence
41
Q

What is this image showing?

A
  • Floor of the mouth ranula
  • Mostly associated with sublingual gland
  • Need to be careful, wouldn’t excise this
42
Q

What does this image show? Describe this image

A
  • Squamous cell carcinoma
  • May present as lump, red or white patch, non healing ulcer
  • Ulcer
  • Raised Rolled margin
  • Induration (hard)
  • Lesion may bless easily and be fixed to surrounding tissue
  • Often not painful at the start but may get painful as they grow
  • Refer rapidly via the Rapid access pathway - urgent suspicion
43
Q
A

BDS4 Oral surgery (15 decks)

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