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Oral Pathology > Chapter 12 > Flashcards

Chapter 12 Flashcards

1
Q
A

Fibroma

* Most common “tumor” of the oral cavity *

Hyperplasia of FIBROUS connective tissue in response to local irriant or trauma

Most common location –> BUCCAL mucosa along the bite ling

Asymptomatic, sessile, smooth-surfaced nodule

Similar to mucosal coloring

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2
Q

Most common location for a fibroma?

A

Buccal mucosa along the occlusal plane (bite line)

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3
Q

Treatment for Fibroma?

A

Surgical excision

MUST submit to biopsy

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4
Q
A

Retrocuspid Papilla

“Giant Cell Fibroma”

Fibrous tumor with distinctive features - not associated with chronic irritation

YOUNGER patients

Gingiva - lingual to mandibular cuspids

BILATERAL

Normal anatomic variation – regresses with age

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5
Q

Treatment for Retrocuspid papilla

A

NO biopsy is needed

Can leave alone – may regress with age

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6
Q

Inflammatory Fibrous Hyperplasia (IFH)

A

Tumor like hyperplasia – FIBROUS connective tissue

* Tumor –> fibrous CT and inflammatory cells*

Epulis Fissuratum

Predominately found on GINGIVA

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7
Q
A

Epulis Fissuratum

“Inflammatory Fibroous Hyperplasia”

Associated with flange on ill fitting DENTURES

Facial aspect of alveolar ridge

Treatment –> Surgical removal and remake denture

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8
Q
A

Inflammatory Papillary Hyperplasia (IPH)

Reactive tissue growth that develops under a denture

Due to:

Ill fitting denture

Poor denture hygiene

Wearing a denture 24 hours a day (20% of denture patients)

Asymptomatic

Erythematous tissue

Pebbly or papillary surface

May also have a CANDIDAL infection

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9
Q

Treatment of Inflammatory Papillary Hyperplasia

A

Relieve tissue of dentures

Surgical extraction

Anti-fungals

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10
Q

Fibrous Histiocytoma

A

Occurs mostly on SKIN –> DERMATOFIBROMA

Painless nodular mass

Treatment –> surgicl excisions

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11
Q

Oral Focal Mucinosis

A

Overproduction of hyaluronic acid by fibroblasts

YOUNG FEMALES

Most common location – gingiva

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12
Q

4 differential of lesions that occcur on GINGIVA

A

IFH - Inflammatory fibrous hyperplasia

Pyogenic granuloma

Peripheral Giant Cell Carcinoma

Peripheral Ossifying Fibroma

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13
Q
A

Pyogenic Granuloma

Reactive lesion to local irritant or trauma (poor oral hygiene)

RAPID growth

Predilection for GINGIVA

PREGNANT women (defer treatment)

Smooth lobulated mass - pedunculated

Ulcerated and lesion bleeds easily - hyperplasia of capillaries

Treatment –> Surgical excision

Should extend down to periosteum and adjacent teeth scaled

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14
Q
A

Peripheral Ossifying Fibroma (POF)

Occures eclusively –> on gingiva

**INCISOR CUSPID REGION **

Nodular mass - originating from dental papilla

Treatment — excision down to periosteum and scall teeth

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15
Q
A

Peripheral Giant Cell Granuloma (PGCG)

Occures exclusively on GINGIVA or edentulous alveolar ridge

May produce a “CUPPING” resorption of the underlying alveolar bone

Erythematous mass –> BLUE or PURPLE

Treatment – excision down to underlying bone

Histology –> GIANT CELLS

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16
Q
A

LIPOMA

Benigna tumor of fate

Most common MESENCHYMAL NEOPLASM

Soft, fluctuant

Smooth surfaced nodular mass

Yellow or mucosal colored

50% on BUCCAL MUCOSA

**FLOAT in FORMALIN**

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17
Q
A

Neuroma

Traumatic neuroma or palisaded encapsulated neuroma

Proliferation of neural tissue after injury

1/3 are painful

MENTAL FORAMEN

Treatment – surgical removal

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18
Q

Schwannoma

A

“Neurilemoma”

Benign neural neoplasm of schwann cell origin

Half of cases occur in Head and Neck

Slow growing

Encapsulated tumor

Association with a nerve trunk

Typically Asymptomatic

Most common location: Tongue

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19
Q

Histology of Schwannoma

A

Antoni A –> organized: streaming fasicles of spindle-shaped schwann cells. Surround eosinophilc areas known as Verocay bodies

Antoni B –> unorganized

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20
Q

Neurofibroma

A

Most common peripheral nerve neoplasms

Young adults

slow growing

Soft

Painless

Most common location: Skin, Tongue, buccal mucosa

Treatment –> surgical excision

** CHECK PATIENT FOR NEUROFIBROMATOSIS **

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21
Q

Neurofibromatosis Type I

A

Hereditary

Most common form of the 8 types

NF1 –> von Recklinghausen’s disease of the skin

Pathognomonic –> Plexiform variant of NF

2/3 of patients have a milde disease.

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22
Q

Plexiform Variant of Nuerofibroma

A

“Bag of worms”

Pathognomonic for Neurofibromatosis Type I

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23
Q

Neurofibromatosis Type I Diagnositc critera (6)

A

Six or more cafe au lait macules (coast of california - smooth borders)

2 or more Neurofibroma OR 1 plexiform Neurofibroma

Crowe’s Disease (axillary region)

Optic glioma

2 or more iris hamartomas (LISH NODULES)

Osseous lesion

First degree relative with NF1

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24
Q
A

Cafe au lait macule

“Coast of California” – smooth borders

Diagnostic criterea for Neurofibromatosis (six or more)

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Crowe's Sign \*\* freckling in the axillary region \*\* Diagnostic sign of Neurofibromatosis
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Lisch nodules Diagnostic for neurofibromatosis type I
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Recklinghausen's Disease of the skin Neurofibromatosis type I
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Oral Manifestations Neurofibromatosis Type I (3) \*\* 90% of patients \*\*
Enlargement of the fungiform papilla Intraoral neurofibromas Enlargment of mandibular forament or canal
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Up to 5% have malignant peripheral nerve sheath tumors -- Nuerofibromatosis Type I
.Malignant peripheral nerve sheath tumor
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Multiple Endocrine Neoplasia Type 2B
MEN 2B System complex -- involves many organs \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Pheochromocytoma** --\> adrenal gland tumors **Medullar carcinoma** ---\> thyroid tumors **Mucosal neuromas** --\> multiple (usually only one) --***_FIRST SIGN!_*** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Marfanoid build -- thin and elongated limbs** **Narrow face with thick protuberant lips** Bilateral neuromas of commissural mucosa Diagnosed by 18 - 25 Die around 21
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Phoechromocytoma
Adrenal gland tumors ## Footnote **Multiple endocrine neoplasia Type 2B**
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Medullary Carcinoma
Thyroid Tumors ## Footnote **Multiple endocrine neoplasia, Type 2B**
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Marfinoid build Narrow face Proturberant lips Bilateral nuerofibromas in commisures
Multiple endocrine neoplasia type 2B
34
Melanotic Neuroectodermal Tumor of infancy Rare - pigmented tumor **Congenital** - occur during 1st year **Anterior Maxilla** Diagnose using --\> using urinary test. Detect **_Vanillylmandelic Acid (VMA)_** Mostly benign
35
Diagnostic test for Melanotic Neuroectodermal Tumor
Elevated urinary levels of **Vanillylmandelic Acid** (VMA)
36
**Granular Cell Tumor** ***_Benign_*** soft tissue neoplasm (be suspicious if biopsy indicates otherwise) _Most common site_ --\> TONGUE (dorsal surface) Appears yellow or mucosal colored Asymptomatic nodule (deep tissue) Exhibit **Pseudoepitheliomatous Hyperplasia (PEH)** **Positive S-100 immuno stain** Surgical excision
37
Pseudoepitheliomatous hyperplasia (2 disease)
Blastomycosis Granular cell tumor
38
**Congenital Epilus** \*\*Alveolar Ridge of newborns\*\* Appears --\> mucosal colored, smooth, polypoid mass Location --\> lateral incisor canine area **S-100 NEGATIVE** Surgical Excision
39
Histologically similar except for S-100 results \* Granular Cell Tumor --\> ? \* Congenital Epulis --\> ?
Granular Tumor --\> **S-100 POSITIVE** Congenital Epulis --\> **S-100 NEGATIVE**
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**Hemangioma** Most common tumor of infancy Most common location --\> HEAD AND NECK Types: \* **_Cavernous_** --\> Typically blanches, DARK RED - PURPLE \* **_Capillary_** --\> May not blanch, RED
42
Sturge-Weber Angiomatosis
Rare **NONHEREDITARY DEVELOPMENTAL condition** **_*Port Wine Stain***_ -- _***NEVUS FLAMMEUS*_** (Dermal capillary vascular malformation) Unilateral distribution along one or more segments of the trigeminal nerve. May be associated with: **Convulsive disorder** **Mental retardation** **Contralateral hemiplagia** **Intraoral involvement --\> hypervascular changes in ipsilateral mucosa** (Lesions may hemorrhage)
43
Nevus Flammeus "port wine stain" Associated with **Sturge-Weber Angiomatosis** -- not all patients with a port wine stain have Sturge-Weber Angiomatosis
44
**Lymphangioma** _Benign tumor of LYMPHATIC VESSELS_ Types: Capillary, Cavernous, Cystic Cavernous --\> frequently found in the mouth Cystic --\> occur on the neck **Oral lymphangioma --\> Frequently on the anterior two thirds of the TONGUE can cause \*\*_MACROGLOSSIA\*\*_** Looks like "frog eggs"
45
Cystic Hygroma
Cystic lymphangioma Often occur in the **neck**
46
Lateral neck mass differential:
Dermoid Cyst Epidermoid cyst Cervical lymphoepithelial cyst Thyroid duct cyst Cystic hygroma (cystic lymphangioma)
47
Leiomyoma
Benign tumors of **smooth muscle** Cured by surgical excision
48
Rhabdomyoma
Benign neoplasm of **SKELETAL MUSCLE** Typically affects CARDIAC & Head and Neck Head and Neck region --\> **Adult:** pharynx and FOM **Children:** Predilection for face Surgical Excision
49
Soft Tissue Sarcomas
Rare in **oral and maxillofacial region** --\> 1% Fibrosarcomas (H&N) Malignant fibrous histocytoma Liposarcoma Leiomyosarcoma (uterus, GI) Angiosarcoma (scalp and forehead) Malignant peripheral nerve sheath tumor (MPNST) -- (benign: neurofibroma, schwannoma)
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Sarcoma --\> Carcinoma --\>
Sarcoma --\> cancer of **MESNCHYMAL** origin (rare in H&N) Carcinoma --\> cancer of **EPITHELIAL** origin
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**Kaposi's Sarcoma**-- HSV 8 _Four clinical presentations:_ Classic, Endemic, Iatrogenic immunocomprimised, AIDS Treatment: depends on type, stage, location \* radiation, surgery, and chemo\*
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Classic Kaposi Sarcoma
Older men **Italina, Jewish, Slavic** Multiple, asymptomatic blue purple macules on lower extremities -- may turn into nodules Good prognosis: 90% survival
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Endemic Kaposi's Sarcoma
Has 4 subtypes Poor prognosis
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Iatrogenic Kaposi's Sarcoma
Organ transplant recipients
55
Rhabdomyosarcoma
Malignancy of **SKELETAL muscle** Common in children --\> 60% of soft tissue sarcomas Large portion occur in the H&N--\> Face and neck **_Painless_** **_Rapid growth_** **_Infiltrative mass_** Try all treatments: Sugery, chemo, radiation
56
Metastases to the **ORAL SOFT TISSUE**
\*\* LYMPHATICS\*\* Metastes to lower body are more likely _blood-borne_: would be found in the lungs Found in: **_2/3 --\> Soft Tissue_** (50% gingiva, 25% tongue) **_1/3 --\> Bone_** **_Lesions appears as nodular mass with hyperplastic growth_** (most cases represent CARCINOMA rather than sarcoma) Poor prognosis
57
H&N mets in _absence_ of lung mets:
**Batson's Plexus** Valvless vertebral venous plexus -- might allow retrograde spread of tumor cells and bypass the lungs
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Batson's Plexus
Valveless vertebral venous plexus -- might allow retrograde spread of
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Neurofibromatosis type II
Bilateral schwannomas of auditory vestibular nerve Symptoms: Deafness, Dizzines, and Tinnitus Mutation of tumor suppressor gene on chromosome 22

Oral Pathology (17 decks)

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