midterm3 Flashcards
most common benign “tumor” of oral cavity. Reactive hyperplasia (not neoplasia) of fibrous CT in response to local irritation or trauma. Most commonly seen along bite line. Grows as long as you keep trauma on it. Normal colored, sessile (non-mobile), bump. TX: cut it out, get it biopsied
Fibroma
Fibrous CT tumor, not associated with chronic irritation. Predilection for gingiva. (retrocuspid papilla: is bilateral and behind mandibular canines). Have a papillary surface. Occurs at younger age
Giant cell fibroma
tumor-like hyperplasia of fibrous CT. Epulis Fissuratum is name for IFH associated with flange of ill-fitting denture. Usually develops on facial aspect of alveolar ridge. TX: surgical excision and remake denture
Inflammatory Fibrous Hyperplasia
reactive tissue growth that develops under a denture (from bacteria: wearing the denture 24/7). Typically occurs on hard palate. Asymptomatic erythemous tissue with a pebbly or papillary surface. TX: remove denture, antifungal, excision
Inflammatory Papillary Hyperplasia
not a true granuloma. Reactive lesion to local irritation or trauma (poor oral hygiene). Most common on gingiva (75%), then lips, tongue, buccal mucosa. Children and young adults. Typically pedunculated, lobular mass, that is red, ulcerated, and bleeds easily. Frequently in pregnant women (pregnancy tumor).
Pyogenic Granuloma
reactive lesion cause by local irritation or trauma. Occurs exclusively on gingiva or edentulous alveolar ridge. Blue, purple, red. May produce “cupping” resorption of underlying bone. 10% recur after excision. Average age is 35
Peripheral Giant Cell Granuloma
exclusively on gingiva. Pink (normal color), or pale and hard. Average age is 15. 2/3 in females.50% in incisor/cuspids area. 15% recur
Peripheral Ossifying Fibroma
benign tumor of fat. Most common mesenchymal (non-epithelial) neoplasm. Soft smooth nodular mass. Yellow or mucosal colored. 50% in buccal mucosa. Older than 40. Floats in formalin.
Lipoma
Traumatic neuroma (proliferation of neural tissue after injury [not neoplasm], common in mental foramen area, 1/3 is painful. TX surgical excision) Palisading encapsulated neuroma (benign neural tumor)
Neuroma
benign neural tumor of Schwann cell origin. Slow growing encapsulated nerve tumor. Tongue is the most common origin. Bilateral Schwannoma is characteristic of neurofibromatosis type 2(chromosome 22, AD) Antoni A: spindle shaped Schwann cells organized (palisading) around verocay bodies- eosinophils. Antoni B: disorganized
Schwannoma
most common type of peripheral nerve neoplasm. Can arise as solitary tumor or be a component in neurofibromatosis. Slow growing, soft, painless lesion. Tongue and buccal mucosa. Evaluate for neurofibromatosis.
Neurofibroma
- Type 1: hereditary condition, termed von Recklinghausen’s disease of skin. Plexiform variant of NF is pathognomonic (feels like a bag of worms), most common NF. DX (2 or more) 1) six or more café au lait macules (big milk colored coffee macules. “c
Neurofibromatosis (Types 1 & 2):
narrow face with thick lips, marfinoid limb structure. Bilateral neuromas of the commissural mucosa. 50% develop pheochromocytoma (adrenal gland tumor), 90% get medullary carcinoma of the thyroid gland. Also tumors of parathyroid, pituitary, pancreas.
Multiple Endocrine Neoplasia, Type 2B
rare pigmented lesion, usually occurs in first year of life. More common in anterior maxilla. Black/blue. High urinary levels of vannillylmandelic acid. Benign.
Melanotic Neuroectodermal Tumor of Infancy
most common tumor of infancy. More common in white females. 60% on head or neck. Capillary (red and does not blanch) or cavernous (red to purple, blanches)
Hemangioma
not genetic developmental condition. Born with a dermal capillary vascular malformation known as “port wine stain” or “nevus flammeus”. Unilateral distribution along segments of the trigimenal nerve (not all that have this have disease). Involvement of opthalamic segment more likely to have the disease. Pts have leptomeningeal angiomas. Typically associated with a convulsive disorder (think phenytoin-drug induced gingival hyperplasia). May result in retardation and contralateral hemiplegia.
Sturge-Weber-Angiomatosis
benign tumor of lymphatic vessels. Capillary, cavernous (mouth), or cystic (neck). Younger patients get diagnosed (under 2) common on anterior 2/3 of tongue (macroglossia) resembles frog eggs or tapioca pudding.
Lymphangioma
benign smooth muscle tumor. Common in uterus, GI, skin. 75% of oral cases are vascular variant. Asymptomatic, firm mucosal nodule. TX: Excision
Leiomyoma
(malignant counterpart): 60% of soft tissue sarcomas of childhood. Skeletal muscle. Face and orbit and males common. Painless, infiltrative mass that grows rapidly. Tx. Surgery and chemo
Rhabdomyoma
may spread by lymphatics, from lower part of body is probably blood borne. Bratson’s plexus: valve-less vertebral venous plexus that allows retrograde spread bypassing lungs. Gingiva is most common site for soft tissue (50%), then tongue (25%). Nodular hyperplastic growth. Carcinomas rather than sarcomas.
Metastases to oral soft tissues
decreased in volume of RBCs. Often a sign of underlying disease. Symptoms: tired, headache, fainting/lightheadedness, pallor. Oral symptoms: pallor, bald tongue, burning/pain on tongue.
Anemia
decreased platelet count. Decreased production, increased destruction of sequestration in spleen. No clinical symptoms until under 100k, small capillaries leak (small=petechiae, ecchymosis, hematoma)- Thrombotic Thrombocytopenia pupura (ttp): endothelial damage causes a serious coagulation disorder. Bad news- refer to physician- Idiopathic thrombocytopenia pupura (itp): classically after a viral infection, resolves in 6 months
Thrombocytopenia
enlargement of tissue due to infection. Lymph nodes, weldeyer’s ring, or any lymphatic tissue. Acute: enlarged, tender, soft, freely movable nodules. Chronic: enlarged, non-tender, firm, freely movable nodules. Look for symmetry (might be normal). Posterior lateral tongue is commonly bilateral.
Lymphoid Hyperplasia
hematopoietic stem cell derivation: proliferated in bone marrow. Acute: aggressive and lead to death in a few months if untreated. Chronic is more indolent. Myeloid or lymphoid. CML associated with 9/22 translocation (Philadelphia). Environmental factors like: pesticides, benzene, ionizing radiation, HTLV-1 virus. ALL more common in children. CLL most common. Pts have decreased 02 carrying capacity, bruise easily. Boggy, ton-tender pus filled swelling in mouth.
Leukemia
antigen presenting cells- dendritic mononuclear cells found in epidermis, mucosa, lymph nodes, and bone marrow. Eosinophilic granuloma of bone: one or multiple lesions, no visceral involvement. Acute disseminate histiocytosis: visceral involvement, mostly in infants, (letterer-siwe disease). Chronic disseminate histiocytosis: bone skin and viscera (hand-schuller-christian disease). Pain and tender bone lesions in skull, ribs, vertebrae, and mandible (15%). XRAY: sharply demarcated punched out radiolucency, mandibular lesions appear scooped out, teeth look like they are “floating in air”.
Langerhan’s Cell Histiocytosis
malignant lymphoproliferative disorder. Neoplastic cells are reed-sternberg cells (typically binucleated). Linked to EBV. 75% occur in cervical or supraclavicular nodes. Bimodal age (15-35 and 50+). Persistently enlarging, nontender, discrete mass, in lymph node region, early they are movable but late are more secure. Nodular lymphocyte is more dominant and Classical has 5 histio subtypes. 15 years post tx mortality likely due to complications of tx.
Hodgkin’s Lymhoma
malignancy of plasma cell origin. If metastatic disease is excluded this accounts for 50% of malignancies. Symptoms result from uncontrolled proliferation of cells and protein products- bone pain, most common is spine) Average age is 65. Most common hematologic malignancy in African Americans. XRAYS: multiple well defined punched out RL, may be ragged, may be evident on skull film. Renal failure from excess proteins: termed bence jones proteins. Bisphosphonates given to reduce fractures
Multiple Myeloma
“marble bone disease” increased density of bone, defect in remodeling caused by a failure of normal osteoclast function. Marrow failure (infantile), frequent fractures (nutrients go away). Really white radiograph. Adult is mild and have long term survival. Infantile does not
Osteopetrosis
clavicle hypoplasia. Short stature, frontal bossing, ocular hypertelorism, broad nose, supernumerary teeth, prolonged retention of primary teeth.
Cleidocranial Dysplasia
area of hematopoietic marrow that produces a radiolucency. NOT pathology but looks like one. Typically asymptomatic, ill-defined borders with central trabeculations. Most common in adult females
Focal Osteoporotic Bone Marrow Defect
Hardening of bone with no known cause (not by a massive restoration). Arise in teenage years and stays static. XRAY: well definied, elliptical/round RO, usually associated with root apex, NO RL rim, 2-3mm. Biopsey only if continued growth , symptoms, expansion.
Idiopathic Osteosclerosis
abnormal resorption and deposition of bone, bone pain common, weakened bones. Older people, more males. Forms near joints and promotes osteoarthritic changes (joint immobility). Increases circumference of skull (hat/denture doesn’t fit anymore). More common in max (enlargement of middle 1/3) than mand. XRAY: patchy sclerotic areas, cotton roll appearance, hypercementosis. Pts have elevated serum alkaline phosphatase with normal calcium and phosphorus levels. Tx: NSAIDs and bisphosphonates. Can cause an osteosarcoma.
Paget’s Disease of bone
considered non-neoplastic lesion (plateaus). Most common in anterior jaw and crosses midline. Most are asymptomatic. XRAY: not diagnostic, RL multi or unilocular, well delineated, non-corticated margins. Tx: curettage with 20% chance of regrowth. Good long term prognosis, no chance of metastasis
Central Giant Cell Granuloma
AD. Bilateral involvement of posterior mandible (chubby cheeks), eyes turned up to heaven (wide rim and stretched skin). Ages 2-5. After puberty it slowly recedes. XRAY: multilocular, expansile, RL, usually bilateral. Unpredictable prognosis: may go away, may have complications.
Cherubism
