Chapter 12: Soft Tissue Tumors Flashcards by Maggie Rodriguez

what is the treatment of a palisaded encaspulated neuroma?

surgical excision

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are most melanotic neuroectodermal tumors of infancy benign or malignant?

benign

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inflammatory papillary hyperplasia is a condition related to what 3 things?

ill-fitting denture
poor denture hygiene
wearing a denture 24 hours/day

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what is the appearance of peripheral ossifying fibroma?

nodular mass, usually originating from the dental papilla

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inflammatory papillary hyperplasia

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___% of peripheral ossifying fibromas recur. why?

15%, usually because the base of the lesion was not removed

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giant cell fibroma

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multiple endocrine neoplasia type 2B

notice the multiple mucosal neromas on the tongue and the bilateral neuromas of the commissural mucosa

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palisaded encapsulated neuroma

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___ of neurofibromatosis type I is pathognomonic

plexiform variant

feels like a bag of worms

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sturge-weber angiomatosis

ipsilateral hypervascular changes

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are pyogenic granulomas more common in males or females?

females
frequently occurs in pregnant women, most commonly in the 1st trimester
some regress after pregnancy

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leptomeningeal angiomas are typically associated with a ___, and may result in mental retardation or ___

convulsive disorder
contralateral hemiplagia (one-sided paralysis)

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lipomas are the most common ___ neoplasm

mesenchymal

more common on the trunk

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is the mechanism by which tumors can spread to the oral cavity well understood?

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peripheral giant cell granuloma

notice the bluish color

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what are the two types of rhabdomyomas?

adult
- 70% in adult men
- nodular mass most commonly occurring int he pharynx and floor of mouth
fetal
- young male patients
- predilection for the face

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endemic (african) kaposi’s sarcoma has 4 subtypes. what are they?

benign nodular (similar to classic)
aggressive
florid
lymphadenopathic (children)

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what are the diagnostic criteria for neurofibromatosis type I and how many do you need for a positive diagnosis?

need 2 or more for a positive diagnosis

six or more cafe au lait macules
- “coast of california”
two or more neurofibromas or one plexiform neurofibroma
freckling in the axillary region (crowe’s sign)
optic glioma
two or more iris hamartomas (lisch nodules)
osseous lesion such as sphenoid dysplasia
first degree relative with neurofibromatosis type I

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what is the treatment for fibromas?

conservative surgical exision

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port wine stain aka nevus flammeus characteristic of sturge-weber angiomatosis

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describe the classic type of kaposi’s sarcoma

80% in older men
italian, jewish, or slavic descent
multiple, asymptomatic blue-purple macules on the lower extremities which grow into nodules

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___ is reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma

fibroma

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what is the treatment of peripheral ossifying fibroma?

excision down to periosteum and scale adjacent teeth

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what is the clinical presentation of lymphangiomas?

frog eggs or tapioca pudding

granular cell tumor

pyogenic granulomas may exhibit ___ growth

rapid

50-75% of lymphangiomas are in what location?

head and neck

what is the treatment of lipomas?

surgical excision

\_\_\_ is a reactive tissue growth that develops under a denture

inflammatory papillary hyperplasia

patients with sturge-weber angiomatosis have what two characteristic features?

* port wine stain (aka nevus flammeus) * leptomeningeal angiomas

congenital epulis' are 3x more common in the maxillary or mandibular alveolar ridge? what specific location is most frequent?

* maxillary * most frequently where the developing lateral incisor-canine area

neurofibroma

what is the treatment for a granular cell tumor?

conservative excision is typically curative

\_\_\_ is a benign tumor of lymphatic vessels

lymphangioma

primary malignancies from adjacent tissues may spread via \_\_\_

lymphatics

leptomeningeal angiomas overly the ipsilateral or contralateral cerebral cortex?

ipsilateral

describe a possible explanation of head and neck metastases in the absence of lung metastases

batson's plexus * this is a valveless vertebral venous plexus that might allow retrograde spread of tumor cells and bypass the lungs

what is the most common location of neurofibromas? what about intraoral sites?

* skin is the most common overall * intraoral lesions are common on the tongue and buccal mucosa

most patients with inflammatory papillary hyperplasia also have \_\_\_

a candidal infection

\_\_\_ neuromas of the ___ mucosa are highly characteristic of multiple endocrine neoplasia type 2B

bilateral neuromas of the commissural mucosa

melanotic neuroectodermal tumor of infancy

how many recognized forms of neurofibromatosis are there, and what is the most common form?

* 8 forms * neurofibromatosis type I

are schwannomas typically symptomatic or asymptomatic?

asymptomatic

inflammatory papillary hyperplasia typically occurs where?

on the hard palate

what is the average age of someone with a palisaded encapsulated neuroma?

50yo

retrocuspid papilla

\_\_\_ is the most common type of peripheral nerve neoplasm

neurofibroma

what is the treatment for inflammatory fibrous hyperplasia?

surgical removal and remake the denture

rhabdomyosarcomas make up \_\_\_% of soft tissue sarcomas of childhood, and \_\_\_% are found in the head and neck

* 60% * 35%

what are the histologic features of a schwannoma?

* 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

what is the treatment for rhabdomyomas?

excision is curative

describe traumatic neuromas

* not a true neoplasm; it is a proliferation of neural tissue after nerve injury * most common in mental foramen area * 1/3 are painful * surgical removal is typically curative

intraoral involvement of sturge-weber angiomatosis is common and results in \_\_\_. this lesion may ___ when manipulated

* hypervascular changes to the ipsilateral mucosa * hemmorhage

do all patients with a port wine stain have sturge-weber angiomatosis?

what is the presentation of pyogenic granulomas?

* smooth or lobulated mass that is typically pedunculated * surface is characteristically ulcerated and lesion bleeds easily * young lesions appear red; older lesions are more collagenized and pink

peripheral ossifying fibroma

in histology photos, what would you see that would indicate a peripheral ossifying fibroma?

bone

50% of lipomas are in what location?

buccal mucosa

giant cell fibromas typically have a ___ surface

papillary

what is another name for a schwannoma?

neurilemoma

inflammatory papillary hyperplasia

what is a retrocuspid papilla?

* it is microscopically similar to a giant cell fibroma, located lingual to the mandibular cuspid * typically bilateral, present in up to 99% of children * normal anatomic variation that regresses with age

what is the prognosis of metastases to oral soft tissues?

poor

neurofibroma

what is typically the first sign of multiple endocrine neoplasia type 2B?

oral mucosal neuromas, present as soft, painless papules or nodules

what population are hemangiomas more common?

* more common in females (3:1, 5:1) * more common in caucasians vs other racial groups

what are the 4 clinical presentations of kaposi's sarcoma?

* classic * endemic (african) * iatrogenic immunosuppression associated * AIDS related

inflammatory papillary hyperplasia may show improvement after ___ therapy

antifungal

giant cell fibroma

floats in formalin

lipoma

\_\_\_ is a rare, nonhereditary developmental condition caused by the persistence of a vascular plexus around the cephalic portion of the neural tube

sturge-weber angiomatosis

what age patient are lipomas most common?

\>40

rhabdomyosarcoma

up to half of schwannoma cases occur in what location?

head and neck

what are the syptoms of neurofibromatosis type II?

deafness, dizziness, tinnitus

what is the treatment of neurofibromatosis type I?

directed toward prevention or management of complications

\_\_\_ occurs almost exclusively on the alveolar ridges of newborns and appears as a mucosal-colored, smooth-surfaced, polypoid mass typically less than 2cm

congenital epulis

neurofibromas can arise as ___ tumors or be a component of \_\_\_

* solitary * neurofibromatosis

what is the prognosis of classic kaposi's sarcoma?

90% survival

how do rhabdomyosarcomas present?

painless, infiltrative mass that grows rapidly

how should pyogenic granulomas that develop during pregnancy be treated?

treatment should be deferred unless functional or esthetic problems develop

what is the treatment of neurofibromas?

surgical excision

what population with granular cell tumors might experience multiple tumors?

african americans

pyogenic granuloma

\_\_\_ is a benign neural neoplasm of schwann cell origin; it is a slow-growing, encapsulated tumor which arises in associated with a nerve trunk

schwannoma

palisaded encapsulated neuromas are benign neural tumors that are typically found in what location?

on the face (90%)

what do lesions look like that have metastasized to the oral soft tissues?

nodular mass that resembles a hyperplastic growth, such as a pyogenic granuloma

sturge-weber angiomatosis has a \_(unilateral/bilateral)\_ distribution along one or more segments of the ___ nerve

* unilateral * trigeminal nerve

describe the iatrogenic type of kaposi's sarcoma

* most common in organ transplant recipients * 0.5% of renal transplant patients

what is the most common location of fibromas?

buccal mucosa along the bite line

granular cell tumors typically occur around what age? male to female ratio?

* age 40; rare in kids * 2:1 F:M

what are the common locations of pyogenic granulomas?

most common on gingiva (75%) \> lips, tongue, buccal mucosa

what is the treatment of rhabdomyosarcoma?

surgery and chemotherapy with radiation

what are two types of neuromas?

can be either traumatic neuroma or palisaded encapsulated neuroma

\_\_\_ may produce a "cupping" resorption of the undelrying alveolar bone

peripheral giant cell granuloma

what is the treatment for pyogenic granulomas?

surgical excision

\_\_\_ is a malignancy of skeletal muscles

rhabdomyosarcoma

are congenital epulis' more common in males or females?

90% occur in females

\_\_\_ typically appears as an asymptomatic, sessile, smooth-surfaced nodule that is similar in color to the surrounding mucosa

fibroma

lymphangioma

what is another name for a palisaded encapsulated neuroma?

solitary circumscribed neuroma

which type of lymphangioma is more commonly found in the mouth?

cavernous

what are the 3 types of lympangioma?

capillary, cavernous, cystic

what are the 3 oral manifestations of neurofibromatosis type I?

* nelargement of the fungiform papilla in 50% * intraoral neurofibromas in 25% * enlargement of the mandibular foramen or canal

what physical characteristics do patients with multiple endocrine neoplasia type 2B have?

* marfanoid build with thin, elongated limbs * narrow face with characteristically thick and protuberant lips

\_\_\_ is a benign tumor of fat

lipoma

50% of patients with multiple endocrine neoplasia type 2B develop \_\_\_, and 90% develop \_\_\_

* pheochromocytoma * medullar carcinoma of the thyroid gland

pyogenic granuloma

lymphangioma

75% of leiomyoma oral cases are a ___ variant

vascular

fibroma

which type of hemangioma typically blanches, and is darker red to purple?

cavernous

\_\_\_ is the most common "tumor" of the oral cavity

fibroma

50% of peripheral ossifying fibromas occur in the ___ region

incisor-cuspid region

what is the clinical color of melanotic neuroectodermal tumor of infancy?

black and/or blue

oral focal mucinosis is most common in what population?

young females

what is the average age patient that peripheral ossifying fibromas are most common in? male or female predilection?

* average age is 15yo (teenagers and young adults 10-19) * 2/3 occur in females

hemangioma

most cases of metastases to oral soft tissues represent ___ rather than \_\_\_

carcinomas rather than sarcomas

what is the survival of someone with rhabdomyosarcoma?

ranges from 50-95% depending on histologic subtype

up to 5% of patients with neurofibromatosis type I have ___ tumors with an associated 5-year survival of \_\_\_%

* malignant peripheral nerve sheath tumors (MPSNT) * 15%

lipoma

what is the treatment for more advanced inflammatory papillary hyperplasia lesions?

surgical removal

what age patient are schwannomas common in?

young and middle-aged adults

will a congenital epulis be S-100 positive or negative?

negative - no pseudopeitheliomatous hyperplasia (different from granular cell tumor)

melanotic neuroectodermal tumor of infancy

\_\_\_ is extremely important in the management of neurofibromatosis type I

genetic counseling

inflammatory fibrous hyperplasia (epulis fissuratum)

what is the most common location of a schwannoma?

tongue

giant cell fibromas have a predilection for what location?

gingiva

treatment of kaposi's sarcoma depends on what? what are the treatment types?

* type, stage, and location * radiation, surgery, and chemotherapy are used

what does the tissue look like in inflammatory papillary hyperplasia?

asymptomatic, erythematous tissue with a pebbly or papillary surface

what is the most common location in the oral cavity of fibrous histiocytomas?

buccal mucosa

oral manifestations of neurofibromatosis type I occur in what percent of patients with NF1?

90%

floats in formalin

lipoma

fibrous histiocytoma

\_\_\_% of patients who continuously wear their denture have inflammatory papillary hyperplasia

20%

peripheral ossifying fibromas occur exclusively on what location?

gingiva

granular cell tumor

oral focal mucinosis

which type of hemangioma may not blanch clinically, and is usually red in color?

capillary

what fraction of patients with neurofibromatosis type I have mild disease?

2/3

do pyogenic granuloma lesions recur?

occasionally

what is the treatment of a congenital epulis?

surgical excision is curative, even with incomplete removal

congenital epulis

neurofibromatosis is a ___ condition affecting 1 in ___ people

* hereditary * 1/3000

is a pyogenic granuloma a true granuloma?

do giant cell fibromas occur at younger or older ages than other fibromas?

younger

leiomyomas are most common in what 3 locations?

uterus, GI tract, skin (smooth muscle from vasculature)

pyogenic granuloma

\_\_\_ is the most common site for metastases to the oral soft tissues. __ is the second most common site.

* gingiva (50%) * tongue (25%)

what are common locations of rhabdomyosarcomas? male or female predilection?

face and orbit male predilection

what is the treatment of giant cell fibromas?

conservative surgical excision

neurofibromatosis type I

patients with sturge-weber angiomatosis that have involvement along the distribution of the ___ are at risk for the full condition

ophthalmic branch

\_\_\_ is a reactive lesion caused by local irritation or trauma, that occurs exclusively on the gingiva or edentulous alveolar ridge

peripheral giant cell granuloma

what is the most common location of hemangiomas?

head and neck, which accounts for 60% of all cases

the histological diagnosis of tumor-like hyperplasia of fibrous connective tissue on association with the flange of an ill-fitting denture is \_\_\_, while the clinical diagnosis is \_\_\_

* inflammatory fibrous hyperplasia * epulis fissuratum

\_\_\_ is a benign neoplasm of skeletal muscle

rhabdomyoma

\_\_\_ is the name for inflammatory fibrous hyperplasia in association with the flange of an ill-fitting denture

epulis fissuratum

\_\_\_ is a rare pigmented tumor that usually occurs during the first year of life

melanotic neuroectodermal tumor of infancy

\_\_\_ rhabdomyomas are very rare but have a predilection for the head and neck

extracardiac in other words, cardiac rhabdomyomas are the most common

schwannoma

what is multiple endocrine neoplasia type 2B characterized by?

* parathyroid tumors * pituitary tumors * pancreatic tumors * adrenal gland tumors (pheochromocytoma) * thyroid tumors (medullary carcinoma) * mucosal neuromas with a predilenction for the oral cavity

what location is oral focal mucinosis most common in? second most common?

* gingiva - 2/3 * hard palate - 1/3

fibroma

granular cell tumors exhibit significant \_\_\_; why is it significant?

* pseudoepitheliomatous hyperplasia * if you submit a small dorsal tongue lesion for microscopic review and get back a reply of "squamous cell carcinoma" ask for a second opinion

soft tissue sarcomas account for \_\_\_% of cancers

\<1%

lipomas are more common in what type of patient?

obese patients, but the metabolism is independent of normal body fat

peripheral ossifying fibroma

how do leiomyomas typically present?

asymptomatic, slow-growing, firm, mucosal nodule

neurofibromatosis type I is autosomal \_\_\_

dominant

\_\_\_ is a true neoplasm exhibiting fibroblastic and histiocytic differentiation

fibrous histiocytoma

what are 2 other names for pyogenic granulomas?

pregnancy tumor or granuloma gravidarum

fibrous histiocytomas occur most commonly on what location?

the skin (termed a dermatofibroma)

neurofibromatosis type I is also termed \_\_\_

von recklinghausen's disease of the skin

\_\_\_% of peripheral giant cell granuloma lesions recur

10%

what is the treatment for leiomyomas?

excision is curative

do melanotic neuroectodermal tumor of infancy expand rapidly or slowly?

rapidly

describe the presentation of granular cell tumors

* asymptomatic, sessile nodule that is less than 2cm * may be yellow or mucosal colored

should excised tissue from a fibroma be submitted for microscopic examination?

yes

what is the average age patient that peripheral giant cell granulomas are seen in? male or female predilection?

35yo, 60% occur in females

which type of lymphangioma is more common on the neck?

cystic lymphangioma (cystic hygroma)

fibroma

traumatic neuroma

what is the presentation of a peripheral giant cell granuloma?

appears as an erythematous mass similar to pyogenic granuloma, although peripheral giant cell granulomas are more often blue or purple compared to the bright red presentation of pyogenic granulomas

are soft tissue sarcomas common in the oral and maxillofacial region?

what is the most common site of granular cell tumors?

* tongue (up to 50%) * dorsal surface is the most common site

oral lymphangiomas occur most frequently on the \_\_\_, where they often result in \_\_\_

* anterior 2/3 of the tongue * macroglossia

inflammatory fibrous hyperplasia (epulis fissuratum)

what are the features of neurofibromatosis type II?

"acoustic neuromas" of vestibular nerve, meningiomas and ependymomas of the central nervous system

\_\_\_ is diagnosed between the ages of 18-25 and has a marked propensity for metastasis, with an average age of death of 21

multiple endocrine neoplasia type 2B

\_\_\_ are a characteristic feature of the neurofibromatosis type II

bilateral schwannomas of auditory-vestibular nerve

what is the treatment of retrocuspid papillas?

it should be recognized clinically, and no biopsy or treatment is needed

what is the most common tumor of infancy?

hemangioma

what is the prognosis of endemic kaposi's sarcoma (other than benign nodular)?

poor prognosis

peripheral giant cell granuloma notice the blueish color

what are the two types of hemangiomas?

capillary and cavernous

what is the treatment of oral focal mucinosis?

surgical excision

what may heal very early inflammatory papillary hyperplasia lesions?

removal of the denture

\_\_\_ is a fibrous tumor with distinctive features and is not associated with chronic irritation

giant cell fibroma

pyogenic granuloma

fibroma

what is the S-100 stain? for a granular cell tumor, will the test be positive or negative?

tests for neural tissue and will be positive if it is a granular cell tumor

what is the prognosis of kaposi's sarcoma in transplant patients?

survival somewhere between classic (90% survival) and endemic (poor prognosis)

what is a trick used to help diagnose a lipoma?

it will float in formalin

port wine stain aka nevus flammeus characteristic of **sturge-weber angiomatosis**

what is the differential for a nodule on the gingiva (4 things)?

* peripheral ossifying fibroma * peripheral giant cell granuloma * pyogenic granuloma * inflammatory fibrous hyperplasia

fibrous histiocytomas appear as a \_\_\_

painless nodular mass

\_\_\_ is a reactive lesion to local irritation or trauma (poor oral hygiene)

pyogenic granuloma

giant cell fibroma

oral focal mucinosis results from overproduction of \_\_\_

overproduction of hyaluronic acid by fibroblasts

for gingival pyogenic granuloma lesions, where should the excision extend to?

periosteum and adjacent teeth should be scaled

kaposi's sarcoma is caused by what virus?

HHV-8

granular cell tumors are a ___ soft tissue neoplasm that shows a predilection for the \_\_\_

* benign * oral cavity

inflammatory fibrous hyperplasia usually develops in what location?

facial aspect of the alveolar ridge

what is the treatment of peripheral giant cell granuloma?

local surgical excision down to underlying bone, scaling of adjacent teeth

what age patient are pyogenic granulomas most common?

children and young adults

\_\_\_ is a tumor-like hyperplasia of fibrous connective tissue

inflammatory fibrous hyperplasia

metastases to the oral soft tissues from lower parts of the body are likely ___ and therefore would be expected to be found in the \_\_\_

* blood-borne * lungs

what age patients do cutaneous fibrous histiocytomas commonly occur in? what about oral lesions?

* cutaneous - young patients * oral lesions - older patients

patients with sturge-weber angiomatosis are born with a dermal capillary vascular malformation known as ___ or \_\_\_

port wine stain or nevus flammeus

what is the treatment for fibrous histiocytoma?

surgical excision

any patient with a lesion diagnosed as a neurofibroma must be evaluated for \_\_\_

neurofibromatosis

describe neurofibromatosis type II

* autosomal dominant * mutation of a tumor suppressor gene on chromsome 22 (merlin)

melanotic neuroectodermal tumor of infancy has a striking predilection for what location?

anterior maxilla (61%)

half of all lymphangioma lesions are noted at what age?

at birth 90% develop by 2 years of age

oral focal mucinosis

congenital epulis

\_\_\_ represents the oral counterpart of cutaneous focal mucinosis

oral focal mucinosis

inflammatory fibrous hyperplasia (epulis fissuratum)

\_\_\_ are benign tumors of smooth muscle

leiomyoma

what is the presentation of lipomas?

appear as soft, smooth-surfaced nodular masses lesion may be yellow or mucosal-colored

what are 6 types of soft tissue sarcomas?

* fibrosarcomas (head and neck) * malignant fibrous histiocytoma (now termed undifferentiated pleomorphic sarcoma) * liposarcoma (thigh, retroperitoneum) * leiomyosarcoma (uterus, GI) * angiosarcoma (scalp and forehead) * malignant peripheral nerve sheath tumor (MPNST)

melanotic neuroectodermal tumor of infancy has characteristically high urinary levels of \_\_\_

vanillymandelic acid (VMA)

neurofibromas are most common in what what age patient? what is the presentation?

* young adults * slow-growing, soft, painless lesions

Chapter 12: Soft Tissue Tumors Flashcards

(237 cards)