Chapter 12: Soft Tissue Tumors Flashcards
(237 cards)
1
Q
what is the treatment of a palisaded encaspulated neuroma?
A
surgical excision
2
Q
are most melanotic neuroectodermal tumors of infancy benign or malignant?
A
benign
3
Q
inflammatory papillary hyperplasia is a condition related to what 3 things?
A
- ill-fitting denture
- poor denture hygiene
- wearing a denture 24 hours/day
4
Q
what is the appearance of peripheral ossifying fibroma?
A
nodular mass, usually originating from the dental papilla
5
Q
A
inflammatory papillary hyperplasia
6
Q
___% of peripheral ossifying fibromas recur. why?
A
15%, usually because the base of the lesion was not removed
7
Q
A
giant cell fibroma
8
Q
A
multiple endocrine neoplasia type 2B
notice the multiple mucosal neromas on the tongue and the bilateral neuromas of the commissural mucosa
9
Q
A
palisaded encapsulated neuroma
10
Q
___ of neurofibromatosis type I is pathognomonic
A
plexiform variant
feels like a bag of worms
11
Q
A
sturge-weber angiomatosis
ipsilateral hypervascular changes
12
Q
are pyogenic granulomas more common in males or females?
A
- females
- frequently occurs in pregnant women, most commonly in the 1st trimester
- some regress after pregnancy
13
Q
leptomeningeal angiomas are typically associated with a ___, and may result in mental retardation or ___
A
- convulsive disorder
- contralateral hemiplagia (one-sided paralysis)
14
Q
lipomas are the most common ___ neoplasm
A
mesenchymal
more common on the trunk
15
Q
is the mechanism by which tumors can spread to the oral cavity well understood?
A
no
16
Q
A
peripheral giant cell granuloma
notice the bluish color
17
Q
what are the two types of rhabdomyomas?
A
- 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
18
Q
endemic (african) kaposi’s sarcoma has 4 subtypes. what are they?
A
- benign nodular (similar to classic)
- aggressive
- florid
- lymphadenopathic (children)
19
Q
what are the diagnostic criteria for neurofibromatosis type I and how many do you need for a positive diagnosis?
A
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
20
Q
what is the treatment for fibromas?
A
conservative surgical exision
21
Q
A
port wine stain aka nevus flammeus characteristic of sturge-weber angiomatosis
22
Q
describe the classic type of kaposi’s sarcoma
A
- 80% in older men
- italian, jewish, or slavic descent
- multiple, asymptomatic blue-purple macules on the lower extremities which grow into nodules
23
Q
___ is reactive hyperplasia of fibrous connective tissue in response to local irritation or trauma
A
fibroma
24
Q
what is the treatment of peripheral ossifying fibroma?
A
excision down to periosteum and scale adjacent teeth
25
what is the clinical presentation of lymphangiomas?
frog eggs or tapioca pudding
26
granular cell tumor
27
pyogenic granulomas may exhibit ___ growth
rapid
28
50-75% of lymphangiomas are in what location?
head and neck
29
what is the treatment of lipomas?
surgical excision
30
\_\_\_ is a reactive tissue growth that develops under a denture
inflammatory papillary hyperplasia
31
patients with sturge-weber angiomatosis have what two characteristic features?
* port wine stain (aka nevus flammeus)
* leptomeningeal angiomas
32
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
33
neurofibroma
34
what is the treatment for a granular cell tumor?
conservative excision is typically curative
35
\_\_\_ is a benign tumor of lymphatic vessels
lymphangioma
36
primary malignancies from adjacent tissues may spread via \_\_\_
lymphatics
37
leptomeningeal angiomas overly the ipsilateral or contralateral cerebral cortex?
ipsilateral
38
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
39
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
40
most patients with inflammatory papillary hyperplasia also have \_\_\_
a candidal infection
41
\_\_\_ neuromas of the ___ mucosa are highly characteristic of multiple endocrine neoplasia type 2B
bilateral neuromas of the commissural mucosa
42
melanotic neuroectodermal tumor of infancy
43
how many recognized forms of neurofibromatosis are there, and what is the most common form?
* 8 forms
* neurofibromatosis type I
44
are schwannomas typically symptomatic or asymptomatic?
asymptomatic
45
inflammatory papillary hyperplasia typically occurs where?
on the hard palate
46
what is the average age of someone with a palisaded encapsulated neuroma?
50yo
47
retrocuspid papilla
48
\_\_\_ is the most common type of peripheral nerve neoplasm
neurofibroma
49
what is the treatment for inflammatory fibrous hyperplasia?
surgical removal and remake the denture
50
rhabdomyosarcomas make up \_\_\_% of soft tissue sarcomas of childhood, and \_\_\_% are found in the head and neck
* 60%
* 35%
51
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
52
what is the treatment for rhabdomyomas?
excision is curative
53
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
54
intraoral involvement of sturge-weber angiomatosis is common and results in \_\_\_. this lesion may ___ when manipulated
* hypervascular changes to the ipsilateral mucosa
* hemmorhage
55
do all patients with a port wine stain have sturge-weber angiomatosis?
no
56
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
57
peripheral ossifying fibroma
58
in histology photos, what would you see that would indicate a peripheral ossifying fibroma?
bone
59
50% of lipomas are in what location?
buccal mucosa
60
giant cell fibromas typically have a ___ surface
papillary
61
what is another name for a schwannoma?
neurilemoma
62
inflammatory papillary hyperplasia
63
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
64
what is the prognosis of metastases to oral soft tissues?
poor
65
neurofibroma
66
what is typically the first sign of multiple endocrine neoplasia type 2B?
oral mucosal neuromas, present as soft, painless papules or nodules
67
what population are hemangiomas more common?
* more common in females (3:1, 5:1)
* more common in caucasians vs other racial groups
68
what are the 4 clinical presentations of kaposi's sarcoma?
* classic
* endemic (african)
* iatrogenic immunosuppression associated
* AIDS related
69
inflammatory papillary hyperplasia may show improvement after ___ therapy
antifungal
70
giant cell fibroma
71
floats in formalin
lipoma
72
\_\_\_ 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
73
what age patient are lipomas most common?
\>40
74
rhabdomyosarcoma
75
up to half of schwannoma cases occur in what location?
head and neck
76
what are the syptoms of neurofibromatosis type II?
deafness, dizziness, tinnitus
77
what is the treatment of neurofibromatosis type I?
directed toward prevention or management of complications
78
\_\_\_ 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
79
neurofibromas can arise as ___ tumors or be a component of \_\_\_
* solitary
* neurofibromatosis
80
what is the prognosis of classic kaposi's sarcoma?
90% survival
81
how do rhabdomyosarcomas present?
painless, infiltrative mass that grows rapidly
82
how should pyogenic granulomas that develop during pregnancy be treated?
treatment should be deferred unless functional or esthetic problems develop
83
what is the treatment of neurofibromas?
surgical excision
84
what population with granular cell tumors might experience multiple tumors?
african americans
85
pyogenic granuloma
86
\_\_\_ 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
87
palisaded encapsulated neuromas are benign neural tumors that are typically found in what location?
on the face (90%)
88
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
89
sturge-weber angiomatosis has a \_(unilateral/bilateral)\_ distribution along one or more segments of the ___ nerve
* unilateral
* trigeminal nerve
90
describe the iatrogenic type of kaposi's sarcoma
* most common in organ transplant recipients
* 0.5% of renal transplant patients
91
what is the most common location of fibromas?
buccal mucosa along the bite line
92
granular cell tumors typically occur around what age? male to female ratio?
* age 40; rare in kids
* 2:1 F:M
93
what are the common locations of pyogenic granulomas?
most common on gingiva (75%) \> lips, tongue, buccal mucosa
94
what is the treatment of rhabdomyosarcoma?
surgery and chemotherapy with radiation
95
what are two types of neuromas?
can be either traumatic neuroma or palisaded encapsulated neuroma
96
\_\_\_ may produce a "cupping" resorption of the undelrying alveolar bone
peripheral giant cell granuloma
97
what is the treatment for pyogenic granulomas?
surgical excision
98
\_\_\_ is a malignancy of skeletal muscles
rhabdomyosarcoma
99
are congenital epulis' more common in males or females?
90% occur in females
100
\_\_\_ typically appears as an asymptomatic, sessile, smooth-surfaced nodule that is similar in color to the surrounding mucosa
fibroma
101
lymphangioma
102
what is another name for a palisaded encapsulated neuroma?
solitary circumscribed neuroma
103
which type of lymphangioma is more commonly found in the mouth?
cavernous
104
what are the 3 types of lympangioma?
capillary, cavernous, cystic
105
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
106
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
107
\_\_\_ is a benign tumor of fat
lipoma
108
50% of patients with multiple endocrine neoplasia type 2B develop \_\_\_, and 90% develop \_\_\_
* pheochromocytoma
* medullar carcinoma of the thyroid gland
109
pyogenic granuloma
110
lymphangioma
111
75% of leiomyoma oral cases are a ___ variant
vascular
112
fibroma
113
which type of hemangioma typically blanches, and is darker red to purple?
cavernous
114
\_\_\_ is the most common "tumor" of the oral cavity
fibroma
115
50% of peripheral ossifying fibromas occur in the ___ region
incisor-cuspid region
116
what is the clinical color of melanotic neuroectodermal tumor of infancy?
black and/or blue
117
oral focal mucinosis is most common in what population?
young females
118
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
119
hemangioma
120
most cases of metastases to oral soft tissues represent ___ rather than \_\_\_
carcinomas rather than sarcomas
121
what is the survival of someone with rhabdomyosarcoma?
ranges from 50-95% depending on histologic subtype
122
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%
123
lipoma
124
what is the treatment for more advanced inflammatory papillary hyperplasia lesions?
surgical removal
125
what age patient are schwannomas common in?
young and middle-aged adults
126
will a congenital epulis be S-100 positive or negative?
negative - no pseudopeitheliomatous hyperplasia (different from granular cell tumor)
127
melanotic neuroectodermal tumor of infancy
128
\_\_\_ is extremely important in the management of neurofibromatosis type I
genetic counseling
129
inflammatory fibrous hyperplasia (epulis fissuratum)
130
what is the most common location of a schwannoma?
tongue
131
giant cell fibromas have a predilection for what location?
gingiva
132
treatment of kaposi's sarcoma depends on what? what are the treatment types?
* type, stage, and location
* radiation, surgery, and chemotherapy are used
133
what does the tissue look like in inflammatory papillary hyperplasia?
asymptomatic, erythematous tissue with a pebbly or papillary surface
134
what is the most common location in the oral cavity of fibrous histiocytomas?
buccal mucosa
135
oral manifestations of neurofibromatosis type I occur in what percent of patients with NF1?
90%
136
floats in formalin
lipoma
137
fibrous histiocytoma
138
\_\_\_% of patients who continuously wear their denture have inflammatory papillary hyperplasia
20%
139
peripheral ossifying fibromas occur exclusively on what location?
gingiva
140
granular cell tumor
141
oral focal mucinosis
142
which type of hemangioma may not blanch clinically, and is usually red in color?
capillary
143
what fraction of patients with neurofibromatosis type I have mild disease?
2/3
144
do pyogenic granuloma lesions recur?
occasionally
145
what is the treatment of a congenital epulis?
surgical excision is curative, even with incomplete removal
146
congenital epulis
147
neurofibromatosis is a ___ condition affecting 1 in ___ people
* hereditary
* 1/3000
148
is a pyogenic granuloma a true granuloma?
no
149
do giant cell fibromas occur at younger or older ages than other fibromas?
younger
150
leiomyomas are most common in what 3 locations?
uterus, GI tract, skin (smooth muscle from vasculature)
151
pyogenic granuloma
152
\_\_\_ is the most common site for metastases to the oral soft tissues. __ is the second most common site.
* gingiva (50%)
* tongue (25%)
153
what are common locations of rhabdomyosarcomas? male or female predilection?
face and orbit
male predilection
154
what is the treatment of giant cell fibromas?
conservative surgical excision
155
neurofibromatosis type I
156
patients with sturge-weber angiomatosis that have involvement along the distribution of the ___ are at risk for the full condition
ophthalmic branch
157
\_\_\_ is a reactive lesion caused by local irritation or trauma, that occurs exclusively on the gingiva or edentulous alveolar ridge
peripheral giant cell granuloma
158
what is the most common location of hemangiomas?
head and neck, which accounts for 60% of all cases
159
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
160
\_\_\_ is a benign neoplasm of skeletal muscle
rhabdomyoma
161
\_\_\_ is the name for inflammatory fibrous hyperplasia in association with the flange of an ill-fitting denture
epulis fissuratum
162
\_\_\_ is a rare pigmented tumor that usually occurs during the first year of life
melanotic neuroectodermal tumor of infancy
163
\_\_\_ rhabdomyomas are very rare but have a predilection for the head and neck
extracardiac
in other words, cardiac rhabdomyomas are the most common
164
schwannoma
165
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
166
what location is oral focal mucinosis most common in? second most common?
* gingiva - 2/3
* hard palate - 1/3
167
fibroma
168
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
169
soft tissue sarcomas account for \_\_\_% of cancers
\<1%
170
lipomas are more common in what type of patient?
obese patients, but the metabolism is independent of normal body fat
171
peripheral ossifying fibroma
172
how do leiomyomas typically present?
asymptomatic, slow-growing, firm, mucosal nodule
173
neurofibromatosis type I is autosomal \_\_\_
dominant
174
\_\_\_ is a true neoplasm exhibiting fibroblastic and histiocytic differentiation
fibrous histiocytoma
175
what are 2 other names for pyogenic granulomas?
pregnancy tumor or granuloma gravidarum
176
fibrous histiocytomas occur most commonly on what location?
the skin (termed a dermatofibroma)
177
neurofibromatosis type I is also termed \_\_\_
von recklinghausen's disease of the skin
178
\_\_\_% of peripheral giant cell granuloma lesions recur
10%
179
what is the treatment for leiomyomas?
excision is curative
180
do melanotic neuroectodermal tumor of infancy expand rapidly or slowly?
rapidly
181
describe the presentation of granular cell tumors
* asymptomatic, sessile nodule that is less than 2cm
* may be yellow or mucosal colored
182
should excised tissue from a fibroma be submitted for microscopic examination?
yes
183
what is the average age patient that peripheral giant cell granulomas are seen in? male or female predilection?
35yo, 60% occur in females
184
which type of lymphangioma is more common on the neck?
cystic lymphangioma (cystic hygroma)
185
fibroma
186
traumatic neuroma
187
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
188
are soft tissue sarcomas common in the oral and maxillofacial region?
no
189
what is the most common site of granular cell tumors?
* tongue (up to 50%)
* dorsal surface is the most common site
190
oral lymphangiomas occur most frequently on the \_\_\_, where they often result in \_\_\_
* anterior 2/3 of the tongue
* macroglossia
191
inflammatory fibrous hyperplasia (epulis fissuratum)
192
what are the features of neurofibromatosis type II?
"acoustic neuromas" of vestibular nerve, meningiomas and ependymomas of the central nervous system
193
\_\_\_ 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
194
\_\_\_ are a characteristic feature of the neurofibromatosis type II
bilateral schwannomas of auditory-vestibular nerve
195
what is the treatment of retrocuspid papillas?
it should be recognized clinically, and no biopsy or treatment is needed
196
what is the most common tumor of infancy?
hemangioma
197
what is the prognosis of endemic kaposi's sarcoma (other than benign nodular)?
poor prognosis
198
peripheral giant cell granuloma
notice the blueish color
199
what are the two types of hemangiomas?
capillary and cavernous
200
what is the treatment of oral focal mucinosis?
surgical excision
201
what may heal very early inflammatory papillary hyperplasia lesions?
removal of the denture
202
\_\_\_ is a fibrous tumor with distinctive features and is not associated with chronic irritation
giant cell fibroma
203
pyogenic granuloma
204
fibroma
205
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
206
what is the prognosis of kaposi's sarcoma in transplant patients?
survival somewhere between classic (90% survival) and endemic (poor prognosis)
207
what is a trick used to help diagnose a lipoma?
it will float in formalin
208
port wine stain aka nevus flammeus characteristic of **sturge-weber angiomatosis**
209
what is the differential for a nodule on the gingiva (4 things)?
* peripheral ossifying fibroma
* peripheral giant cell granuloma
* pyogenic granuloma
* inflammatory fibrous hyperplasia
210
fibrous histiocytomas appear as a \_\_\_
painless nodular mass
211
\_\_\_ is a reactive lesion to local irritation or trauma (poor oral hygiene)
pyogenic granuloma
212
giant cell fibroma
213
oral focal mucinosis results from overproduction of \_\_\_
overproduction of hyaluronic acid by fibroblasts
214
for gingival pyogenic granuloma lesions, where should the excision extend to?
periosteum and adjacent teeth should be scaled
215
kaposi's sarcoma is caused by what virus?
HHV-8
216
granular cell tumors are a ___ soft tissue neoplasm that shows a predilection for the \_\_\_
* benign
* oral cavity
217
inflammatory fibrous hyperplasia usually develops in what location?
facial aspect of the alveolar ridge
218
what is the treatment of peripheral giant cell granuloma?
local surgical excision down to underlying bone, scaling of adjacent teeth
219
what age patient are pyogenic granulomas most common?
children and young adults
220
\_\_\_ is a tumor-like hyperplasia of fibrous connective tissue
inflammatory fibrous hyperplasia
221
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
222
what age patients do cutaneous fibrous histiocytomas commonly occur in? what about oral lesions?
* cutaneous - young patients
* oral lesions - older patients
223
patients with sturge-weber angiomatosis are born with a dermal capillary vascular malformation known as ___ or \_\_\_
port wine stain or nevus flammeus
224
what is the treatment for fibrous histiocytoma?
surgical excision
225
any patient with a lesion diagnosed as a neurofibroma must be evaluated for \_\_\_
neurofibromatosis
226
describe neurofibromatosis type II
* autosomal dominant
* mutation of a tumor suppressor gene on chromsome 22 (merlin)
227
melanotic neuroectodermal tumor of infancy has a striking predilection for what location?
anterior maxilla (61%)
228
half of all lymphangioma lesions are noted at what age?
at birth
90% develop by 2 years of age
229
oral focal mucinosis
230
congenital epulis
231
\_\_\_ represents the oral counterpart of cutaneous focal mucinosis
oral focal mucinosis
232
inflammatory fibrous hyperplasia (epulis fissuratum)
233
\_\_\_ are benign tumors of smooth muscle
leiomyoma
234
what is the presentation of lipomas?
appear as soft, smooth-surfaced nodular masses
lesion may be yellow or mucosal-colored
235
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)
236
melanotic neuroectodermal tumor of infancy has characteristically high urinary levels of \_\_\_
vanillymandelic acid (VMA)
237
neurofibromas are most common in what what age patient? what is the presentation?
* young adults
* slow-growing, soft, painless lesions
