Benign Mesenchymal Tumors Part 2

Question 1

Benign tumor of adipose tissue

Answer 1

Lipoma

Question 2

What color are lipomas if they are close to the surface?

Answer 2

Yellow

Question 3

Histology of lipomas: demarcated or ___ collection of mature ___ cells (____)

Answer 3

Encapsulated
Fat
Adipocytes

Question 4

Treatment of lipoma

Answer 4

Enucleation or conservative surgical excision

Question 5

Prognosis for lipoma

Answer 5

Good - no recurrence or transformation

Question 6

5 types of nerve benign mesenchymal tumors

Answer 6

1. Traumatic neuroma
2. Neurilemoma (Schwannoma)
3. Neurofibroma (Neurofibromatosis)
4. Melanotic Neuroectodermal Tumor of Infancy
5. Granular Cell Tumor

Question 7

“Amputation neuroma”

Answer 7

Traumatic neuroma

Question 8

Traumatic neuroma

Answer 8

Reactive proliferation of nerve tissue after damage of the nerve bundle

Question 9

How does a traumatic neuroma happen?

Answer 9

Attempts to regenerate innervation of the distal segment and encounters scar tissue

Question 10

True/False: most oral traumatic neuromas are painful

Answer 10

False

Question 11

Common intraoral sites for traumatic neuroma

Answer 11

Tongue, buccal vestibule (esp. mental foramen area)

Question 12

Histology of traumatic neuroma

Answer 12

Tangled mass of peripheral nerve fibers in a collagenous background

Question 13

Treatment for traumatic neuroma

Answer 13

Surgical excision, including a small portion of the proximal nerve bundle

Question 14

Benign tumor of Schwann cell origin

Answer 14

Neurilemoma

Question 15

Most common intraoral locations for neurilemoma

Answer 15

Lips, tongue, buccal mucosa

Question 16

Neurilemoma may cause ___

Answer 16

Expansion

Question 17

Radiographically, neurilemomas may be ___ or ____

Answer 17

Unilocular or multilocular

Question 18

Neurilemoma shows benign proliferation of ____-shaped Schwann cells

Answer 18

Spindle

Question 19

2 patterns seen microscopically in neurilimoma

Answer 19

Antoni A and Antoni B

Question 20

Antoni A shows palisaded nuclei arranged around ___ bodies

Answer 20

Verocay

Question 21

Antoni B is less ___ and sometimes ___

Answer 21

Organized, myxoid

Question 22

Why does a neurilemoma usually “shell out”?

Answer 22

Due to dense connective tissue capsule

Question 23

Benign tumor of neural fibroblast origin

Answer 23

Neurofibroma

Question 24

Most neurofibromas are ____

Answer 24

Solitary

Question 25

Are neurofibromas encapsulated?

Answer 25

No

Question 26

Most common location for neurofibromas

Answer 26

Skin

Question 27

Histology of neurofibroma shows a collection of spindle-shaped cells with _____ nuclei and ___ cells

Answer 27

Wavy, Mast

Question 28

What protein highlights mast cells?

Answer 28

S-100

Question 29

Common hereditary condition with a variable number of neurofibromas/schwannomas

Answer 29

Neurofibromatosis

Question 30

3 types of Neurofibromatosis

Answer 30

1. NF1 - mainly neurofibromas 2. NF2 - mainly schwannomas 3. Schwannomatosis - mainly schwannomas

Question 31

NF1 can also be called

Answer 31

Von Recklinghausen disease of the skin

Question 32

NF1 is autosomal ___

Answer 32

Dominant

Question 33

3 types of NF1 manifestations

Answer 33

Cutaneous, Oral, Ocular

Question 34

Cutaneous manifestations of NF1 also called ____ ___. How many must an adult have? What size?

Answer 34

Cafe-au-lait spots. 6 or more, greater than 1.5 cm

Question 35

What is pathognomonic for NF1

Answer 35

Plexiform neurofibroma

Question 36

What is another cutaneous manifestation for NF1

Answer 36

Axillary and inguinal freckling

Question 37

Oral findings of NF1

Answer 37

Neurofibromas on tongue, gingiva, bone. Enlargement of fungiform papilla

Question 38

Ocular manifestations of NF1

Answer 38

Lisch nodules of the iris

Question 39

What are lisch nodules

Answer 39

Clear, yellow to brown aggregates of dendritic melanocytes within iris

Question 40

Diagnosing NF1

Answer 40

1. Six or more cafe-au-lait spots measuring > 5mm in children and > 15mm in adults 2. Two or more neurofibromas, or one plexiform 3. Freckling in the armpit or groin 4. Two or more Lisch nodules 5. Tumor on the optic nerve (optic nerve glioma) 6. Abnormal spine, temple, or tibia development 7. Partent, sibling, or child with NF1

Question 41

Treatment for NF1

Answer 41

Remove traumatized neurofibromas, genetic counseling, follow up (malignant transformation)

Question 42

Prognosis for NF1

Answer 42

Poor of malignant transformation occurs

Question 43

Melanotic neuroectodermal tumor of infancy (MNTI) has ___ ___ origin

Answer 43

Neural crest

Question 44

MNTI usually develops:

Answer 44

In the first year of life

Question 45

Where is MNTI typically seen

Answer 45

Anterior maxilla

Question 46

What color is MNTI

Answer 46

Brown/Black

Question 47

Are most MNTIs benign or malignant?

Answer 47

Benign

Question 48

Characteristic radiographic feature of MNTI

Answer 48

Radiolucency in the anterior maxilla pushes the deciduous maxillary incisor labially and appears as a "tooth floating in space"

Question 49

What is prudent in regards to MNTI

Answer 49

Follow up

Question 50

Previously called "myoblastoma", but immunohistochemistry shows neural differentiation

Answer 50

Granular Cell Tumor

Question 51

Many granular cell tumors occur on the ____

Answer 51

Tongue

Question 52

Granular cell tumors often have ___ ___ present, which makes them similar to SCC

Answer 52

Pseudoepitheliomatous hyperplasia

Question 53

____ ___ can be found at birth on the maxillary ridge in females

Answer 53

Congenital epulis

Question 54

Histologicallky, a congenital epulis shows proliferation of ____ cytoplasm and atrophy of ___ ___ with no ___

Answer 54

Granular Rete Ridges PEH

Question 55

Congenital epulis is S-100 (____), while granular cell tumors are S-100 (_____)

Answer 55

(-) - doesn't stain for neural differentiation | (+) - stains for neural differentiation

Question 56

2 blood benign mesenchymal tumors

Answer 56

Hemangioma | Vascular malformations

Question 57

Vascular malformations are also called:

Answer 57

``` Port wine stain Encephalotrigeminal angiomatosis (Sturge-Weber syndrome) ```

Question 58

A hemangioma may be a ___ ____

Answer 58

Vascular hamartoma (overgrowth of tissue normally present in the site)

Question 59

Most common tumor of childhood

Answer 59

Hemangioma (what Toby had)

Question 60

Are most hemangiomas obvious at birth? What is the exception?

Answer 60

No - arise by 8 weeks | Exception is non-involuting congenital hemangioma (developed fully at birth)

Question 61

Most common intraoral site for a hemangioma

Answer 61

Tongue

Question 62

Hemangioma treatment

Answer 62

Watch and do nothing (most will resolve) unless problematic or life-threatening unless is impairs vision (otherwise wait until 6 yo)