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Flashcards in Chapter 12 Deck (105):
1

What is the most common tumor of the oral cavity?

Fibroma

2

Why is it that fibromas aren't "true" tumors?

It is more of an inflammatory reactive response. Fibroblasts are stimulated to produce more collagen.

3

Where is the most common location of a fibroma?

Buccal mucosa along the bite line

4

What is the appearance of a fibroma?

Asymptomatic

Sessile

Smooth-surfaced

Similar color to surrounding mucosa

5

What is the treatment for a fibroma?

Conservative surgical excision is curative

MUST submit the excised tissue for microscopic examination

6

What is a giant cell fibroma?

Fibrous tumor with distinctive features (plump fibroblasts); not associated with chronic irritation like a normal fibroma

Typically has a papillary surface

7

Which occurs at a younger age, fibromas or giant cell fibromas?

Giant cell fibromas occur at a younger age

8

Where is the most common location for giant cell fibromas?

Gingiva

9

What is a retrocuspid papilla?

Microscopically similar lesion to giant cell fibromas. Lingual to mandibular canine.

Typically bilateral and present in up to 99% of children

Normal anatomical variation that regresses with age

10

What is inflammatory fibrous hyperplasia?

Tumor-like hyperplasia of fibrous CT

11

What is an epulis fissuratum?

Name given for inflammatory fibrous hyperplasia in association with the flange of an ill-fitting denture

Epulis fissuratum = clinical diagnosis

Histological diagnosis = inflammatory fibrous hyperplasia

12

Where does inflammatory fibrous hyperplasia typically occur?

On the facial aspect of the alveolar ridge

13

What is inflammatory papillary hyperplasia?

Reactive tissue growth that develops under a denture (typically on hard palate)

Asymptomatic

Erythematous

Pebbly (papillary) surface

14

Inflammatory papillary hyperplasia is a condition relating to what three things?

Ill-fitting denture

Poor denture hygiene

Wearing denture 24hrs a day


(Also note that most patients also have a candidal infection. Condition may show improvement after antifungal therapy)

15

True or false... for early inflammatory papillary hyperplasia lesions, removal of the denture may allow healing

True

16

__% of patients who continuously wear their denture have IPH (inflammatory papillary hyperplasia)

20%

17

When you see a bump on the gums, it is usually one of four things. What is the differential?

IFH (inflammatory fibrous hyperplasia)

Pyogenic granuloma

Peripheral giant cell granuloma

Peripheral ossifying fibroma

18

What is considered the oral counterpart of cutaneous focal mucinosis?

Oral focal mucinosis

19

Oral focal mucinosis results from overproduction of ____ by fibroblasts. It most commonly occurs in the ___ population. 2/3s of lesions occur on the ___ and 1/3rd occur on the ___.

Hyaluronic acid

Young female

Gingiva

Hard palate

20

True or false.. surgical excision of oral focal mucinosis is curative

True

21

Why is a pyogenic granuloma considered a misnomer?

It is not a true granuloma (TB, sarcoidosis, foreign body), but a reactive lesion to local irritation or trauma or *poor oral hygiene.

22

True or false... pyogenic granulomas are typically slow growing

False, they exhibit rapid growth

23

75% of cases of pyogenic granulomas occur on the ___, followed by __, ___, and ___. Pyogenic is most common in what population?

Gingiva

Lips

Tongue

Buccal mucosa

Children/young adults

24

What does a pyogenic granuloma look like?

Red due to capillary blood (oxygen) (older lesions are more collagenized and pink)

Ulcerative and bleeds easily

Smooth/lobulated mass typically pedunculated

25

___% of the time, pyogenic granulomas are ulcerative.

75%

26

What are two other names for pyogenic granulomas? Why are they given these names?

Pregnancy tumor - frequently occurs in pregnant women in 1st trimester

Granuloma gravidarum

27

What is the treatment for pyogenic granulomas?

Surgical excision (make sure that for gingival lesions the excision extends to periosteum)

Lesions occasionally recur

28

If you are looking at the histology of a bump on the gums and it has blood vessels, what is the most probable diagnosis?

Pyogenic granuloma

29

What "bump on the gums" lesion is characterized by a purple-ish hue, cupping resorption of underlying alveolar bone, is caused by local irritation or trauma, and has big purple cells in histology?

Peripheral giant cell granuloma

30

What is it called when cupping resorption goes through bone into the medullary bone?

Central giant cell granuloma

31

Peripheral giant cell granulomas occur exclusively on the ___. Treatment is surgical excision down to underlying bone and you should also ___. __% recur.

Gingiva or edentulous alveolar ridge

Scale adjacent teeth

10%

32

Peripheral ossifying fibromas occur exclusively on the ___. It appears as a modular mass originating from the ___. 50% of cases occur in the ___ region.

Gingiva

Dental papilla

Incisor-cuspid region

33

What is the most common mesenchymal neoplasm? (It most commonly occurs on the trunk)

Lipoma (a benign tumor of fat)

34

True or false... lipomas are more commonly found in skinny patients

False. It is most common in obese patients, but the metabolism is independent of normal body fat

35

Most lipomas of the oral cavity occur in the __

Buccal mucosa

36

Once a lipoma is removed, what is a diagnostic test to ensure that it is a lipoma?

It will float in formalin

37

What are the two types of neuromas?

Traumatic neuroma

Palisaded encapsulated neuroma (PEN)

38

Traumatic neuromas are not true neoplasms, why?

Where is the most common location for a neuroma?

About 1/__ cases are painful upon palpation.

It is a proliferation of neural tissue after nerve injury

Mental foramen area

1/3 cases

39

What is a Schwannoma?

A benign neural neoplasm of Schwann cell origin

40

What is another name for a schwannoma?

Neurilemoma

41

A schwannoma is a __-growing, encapsulated tumor which arises in association with a ___. They are typically symptomatic/asymptomatic.

Slow-growing

Nerve trunk

Asymptomatic

42

Bilateral schwannoma of auditory-vestibular nerves are a characteristic feature of ___

Neurofibromatosis type 2 (NF2)

43

Neurofibromatosis type 2 is autosomal ___. It results from a mutation of a ___ gene (called __) on chromosome ___.
It causes acoustic neuromas and causes symptoms of ___, __, and ___

Dominant

Tumor suppressor gene (called Merlin)

22

Deafness, dizziness, tinnitus

44

Where is the most frequent location for oral schwannomas?

Tongue

45

Schwannoma histopathologic features include Antoni A and Antoni B. Describe them.

Antoni A - streaming fascicles of spindle-shaped Schwann cells which form a palisaded arrangement around central acellular, eosinophilic areas known as Verocay bodies.

Antoni B - basically everything that's not Antoni A

46

In which, Antoni A or Antoni B, will you find Verocay bodies?

Antoni A

47

What is the most common type of peripheral nerve neoplasm?

Neurofibroma

48

Describe neurofibromas

Can arise as solitary tumors or be a component of neurofibromatosis

Most common in young adults and present as slow-growing, soft, painless lesions

49

Where are the most common locations for neurofibromas?

Skin

Tongue and buccal mucosa are the most common intraoral sites

50

Neurofibromatosis is a hereditary condition (autosomal __) affecting 1 in ___ people

Dominant

3000

51

What is another name for NF1 (neurofibromatosis type 1)

Von recklinghausen's disease

52

___ variant of neurofibromatosis type 1 is pathognomonic. What does this feel like?

Plexiform

Plexiform NF feels like a bag of worms because it has a bunch of thick nerves in it that move around as you palpate it.

53

In order to be diagnosed with neurofibromatosis type 1, you must meet __ or more diagnostic criteria. Name all 7 of the diagnostic criteria

2

Six or more cafe au lait macules

2 or more NF or one plexiform NF

Optic glioma

Two or more iris hamartomas (Lisch nodules)

Freckling of the axillary region (Crowe's sign)

Osseous lesion such as sphenoid dysplasia

First degree relative with NF1

54

What are lisch nodules?

Associated with neurofibromatosis type 1

Increased proliferation or collection of multiple normal tissue types

55

Oral manifestations of neurofibromatosis occurs ___% of the time

90%

56

Name three oral manifestations associated with neurofibromatosis type 1.

Enlargement of fungiform papilla (occur in 50%)

Intraoral neurofibromas (occur in 25%)

Enlargement of the mandibular foramen or canal

57

Up to __% of pts with NF1 have MPNST with an associated 5 year survival of 15%. What is MPNST?

5

Malignant peripheral nerve sheath tumors

58

What does MEN2B stand for?

Multiple endocrine neoplasia type 2B

59

Multiple endocrine neoplasia type 2B is a system complex characterized by what 6 things?

Pheocrhomocytoma (Adrenal gland tumors)

Thyroid tumors (medullary carcinoma)

Mucosal neuromas with a predilection for the oral cavity

Parathyroid tumors

Pituitary tumors

Pancreatic tumors

60

Patients with MEN2B have a ___ build which means...

Marfanoid

Thin, elongated limbs

Narrow face with characteristically thick protuberant lips

61

What is the first typical sign of MEN2B?

Oral mucosal neuromas

62

bilateral neuromas of the commissary mucosa is highly characteristic of ___?

Multiple endocrine neoplasia Type 2B

63

___% of patients with multiple endocrine neoplasia develop pheochromocytoma, which is...

50%

Adrenal gland tumors

64

___% of patients with multiple endocrine neoplasia type 2B develop medullary carcinoma of the thyroid gland

90%

65

Multiple endocrine neoplasia type 2B is usually diagnosed between the ages of __-__ and has marked propensity for metastasis. The average age of death for these patients is __

18-25

21 because it isn't caught early enough

66

What soft tissue tumor has a rare pigmented tumor (black/blue/purple) and usually occurs during the first year of life. The mass is rapidly expanding yet benign.

Melanotic neuroectodemal tumor of infancy

67

Melonatic neuroectodermal tumor of infancy has a striking predilection for the ___ (__%).

Anterior maxilla. 61%

68

What is a diagnostic tool to diagnose melanotic neuroectodermal tumor of infancy?

High urinary levels of vanillymandelic acid

69

Granular cell tumors are benign soft tissue neoplasms that show a predilection for the oral cavity. The most common is the __ surface of the ___ (__%). It occurs twice as often in females. It may be ___-colored.

Dorsal

Tongue (50%)

Yellow or mucosal

70

What race may experience multiple granular cell tumors?

African Americans

71

Which tumors exhibit significant pseudoepithelimatous hyperplasia? What does it kind of look like under a microscope?

Granular cell tumors

Looks similar to squamous cell carcinoma

72

Granular cell tumors are S-100 positive or negative?

Positive

73

Congenital epulis occurs almost exclusively on ___

The alveolar ridges of newborns

74

Congenital epulis appears as a mucosal-colored, smooth-surfaced, polyploid mass that's typically less than 2cm. It appears 3xs more commonly in the ___ ridge, and more specifically in the ___ area

Maxillary

Developing lateral incisor-canine area

75

90% of congenital epulis cases occur in males or females?

Females

76

Since both granular cell tumors and congenital epulis are both composed of granular cells, how do you tell the difference?

Congenital epulis has no PEH (pseudoepitheliomatous hyperplasia) and is S-100 negative

77

What is the most common tumor of infancy?

Hemangioma

78

What is the most common location for hemangioma?

In the head and neck (60% of cases)

79

Name and describe the two types of hemangiomas

Capillary: may not blanch clinically, usually red in color

Cavernous: typically blanches, darker red to purple.

80

Puts with sturge-Weber antiomatosis are born with a dermal capillary vascular malformation known as __ or ___. It is a rare, nonhereditary developmental condition. What is it caused by?

Port wine stain

Nevus flammeus

Persistence of a vascular plexus around the cephalic portion of the neural tube

81

Patients with sturge-Weber angiomatosis, in addition to nevus flammeus, have ___. What are these? Describe their relationship to intraoral lesions.

Leptomeningeal angiomas

They over lie the ipsilateral cerebral cortex possibly causing MR or contralateral hemiplagia (one side paralysis)

82

Sturge-Weber angiomatosis is typically associated with a __ disorder.

Convulsive

83

Describe the intraoral lesions associated with sturge-Weber angiomatosis

Intraoral involvement is common and results in hypervascular changes to the ipsilateral mucosa

84

What is a lymphangioma? What are the different types?

Benign tumor of lymphatic vessels

Capillary, cavernous, cystic

85

Cavernous lymphangiomas are most frequently found where?

In the mouth

86

Cystic lympangiomas most often occur where?

Neck

87

True or false.. half of all lymphangioma lesions are noted at birth and 90% develop by 2 years of age

True

88

Where is the most common location for lymphangiomas?

Anterior two-thirds of the tongue

89

Which soft tissue tumor looks like frog eggs or tapioca pudding?

Lymphangioma

90

What is a leiomyoma? Where are the most common locations?

Benign tumor of smooth muscle. Typically asymptomatic, slow growing, firm, mucosal nodule.

uterus, GI tract, skin

91

What are rhabdomyomas?

Benign neoplasm of skeletal muscle (usually occur in the heart, but if they occur elsewhere they usually occur in the head and neck)

92

What are the two types of rhabdomyomas?

Adult - 70% in adult men(in pharynx and FOM)

Fetal - young male patients (predilection for the face)

93

What are six types of soft tissue sarcomas?

Fibrosarcomas (head and neck)
Malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma)

Liposarcoma (thigh, retroperitoneum)

Leiomyosarcoma (uterus, GI)

Angiosarcoma (scalp and forehead)

Malignant peripheral nerve sheath tumor

94

True or false... soft tissue sarcomas are common in the oral and maxillofacial region

False, they are rare.

95

Koposi's sarcoma is caused by HHV-__. What are its four clinical presentations?

8

Classic (hereditary)

Endemic (African)

Iatrogenic immunosuprssion associated

AIDS related

96

The classic type of koposis sarcoma is 80% of the time found in older __, specifically of ___ descent. What does the appearance look like?

Men

Italian/Jewish/Slavic

Multiple, asymptomatic blue-purple macules on the lower extremities which grow into nodules

97

What are the four types of endemic koposis sarcoma?

Benign nodular

Aggressive

Florid

Lymphadenopathic

98

Iatrogenic koposis sarcoma is most common in ___.

Organ transplant recipients

0.5% of renal transplant patients

99

What is the prognosis for classic, endemic and for transplant patients for kaposis sarcoma?

Classic - 90% survival

Endemic - poor prognosis

Transplant patients - prognosis somewhere between classic and endemic

100

What is rhabdomyosarcoma?

Malignancy of skeletal muscles

101

What makes up 60% of soft tissue sarcomas of childhood?

Rhabdomyosarcoma

35% are found in the head and neck region

102

True or false... metastasis of the oral soft tissues are likely blood-bone and therefore would be expected to be found in the lungs

True

103

Describe one possible explanation of metastases in the head and neck in the absence of mestastses in the lung.

Batson's plexus

This is a valveless vertebral venous plexus that might allow retrograde spread of tumor cells and bypass of the lungs

104

Where is the most common location for mestastes in the oral soft tissues?

Gingiva (50%)

Then tongue (25%)

105

True or false... most cases of metastases in the oral soft tissues are sarcomas rather than carcinomas

False. Most cases represent carcinomas rather than sarcomas