Oral Pathology Flashcards
(411 cards)
1
Q
What is incisional biopsy? And what does it allow for?
A
Where a small piece of a tissue is taken from a representative area of a lesion
It allows for diagnosis and future treatment planning.
2
Q
After what type of biopsy is a specimen resection often carried out?
A
After incisional biopsy
3
Q
In what two ways can a specimen be sent to pathology for investigation?
A
Fixed or fresh
4
Q
In what way are most specimens sent to pathology for further investigation?
A
As fixed specimens
5
Q
What is meant by a “fixed” specimen?
A
The specimen has been placed in a 10% neutral buffered formalin solution to stop the tissue from breaking down and to cross link the proteins to preserve the tissue histology.
6
Q
What is meant by a “fresh” specimen? And in what situation is it likely used?
A
Where specimen comes as it is, patient may be in theatre and requires urgent diagnosis.
7
Q
How are fixed specimens processed in the laboratory?
A
Tissue is placed within a cassette, which is placed into an automatic tissue processor, where further fixation then dehydration of tissue in ethanol takes place.
8
Q
After processing of fixed specimen, what is the next step the pathology laboratory takes?
A
Embedding of tissue in hot paraffin wax to form tissue blocks
9
Q
What instrument is used to precisely cut tissue blocks to a 4um thickness?
A
Microtome
10
Q
What stains are most commonly used for tissue that is to be made into a slide and examined by pathologists?
A
Haematoxylin and Eosin stains (H&E stains)
11
Q
Define, “the abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue.”
A
Hyperplasia
12
Q
Define, “the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells.”
A
Hypertrophy
13
Q
Define, “a decrease in cell size by loss of cell substance.”
A
Atrophy
14
Q
Define, “a reversible change in which one adult cell type is replaced by another adult cell type.”
A
Metaplasia
15
Q
Define, “a thickening of the stratum corneum”
A
Hyperkeratosis
16
Q
What is the stratum corneum?
A
The outermost layer of the epidermis
17
Q
Define, “the formation of an anuclear keratin layer, as in normal keratinised stratified squamous epithelium.”
A
Orthokeratosis
18
Q
Define, “ the persistence of nuclei in the cells of a keratin layer”
A
Parakeratosis
19
Q
Define, “premature keratinisation of epithelial cells that have not reached the keratinising surface layer.”
A
Dyskeratosis
20
Q
Define, “ an increased thickness of the prickle cell layer”
A
Acanthosis
21
Q
Define, “ the loss of intra cellular adhesion between keratinocytes.”
A
Acantholysis
22
Q
Define, “alteration in differentiation, maturation and architecture of adult epithelial cells.”
A
Epithelial dysplasia
23
Q
Define, “mucosal/skin defect with complete loss of surface epithelium”
A
Ulceration
24
Q
Give an example of a developmental white lesion.
A
Fordyce granules
25
Give an example of a white lesion of normal variation.
Leukoedema
26
Give an example of a white lesion which is hereditary.
White sponge naevus
27
Give two examples of dermatological white lesions.
1. Lichen planus
2. Lupus erythematosus
28
Give an example of an infective white lesion.
Candidosis
29
Give an example of an idiopathic white lesion.
Leukoplakia
30
Give an example of a neoplastic white lesion.
Squamous cell carcinoma
31
What type of white lesion is described?:
-autosomal dominant
- may be apparent in infants or not until adolescence
- ill-defined
- shaggy surface
- often bilateral
- buccal mucosa most commonly affected
- mutations in keratins 4/13
White sponge naevus
32
What treatment is required for white sponge naevus?
None
33
What are the two most characteristic histopathalogical signs of white sponge naevus?
1. Thickened epithelium with marked hyperparakeratosis
2. Basket weave appearance of upper prickle cells and parakeratinised cells
34
What white lesion is due to EBV infection? And is strongly associated with HIV infection in many cases?
Oral hairy leukoplakia
35
What are the clinical features of oral hairy leukoplakia?
- white, shaggy appearance on lateral tongue
- asymptomatic
36
What is the treatment for oral hairy leukoplakia?
None
37
What is the pathogenesis of lichen planus?
T cell-mediated immunological damage to the basal cells of epithelium.
38
Which sites in the oral cavity are more commonly affected by lichen planus?
- buccal mucosa
- tongue
- gingivae
- lips
39
Which sites in the oral cavity are LEAST commonly affected by lichen planus?
FOM and palate
40
Where on the body is the most common site for lichen planus skin lesions?
Flexor surface of the wrist
41
What are the 6 presentations of lichen planus?
1. Reticular
2. Atrophic
3. Plaque-like
4. Papular
5. erosive
6. Bullous
42
What can lead to the formation of subepithelial bullae (blisters) in bullous lichen planus?
Lack of cohesion between epithelium and lamina propria as a result of basal cell degeneration and oedema
43
What are “civatte” bodies? When are they present?
Degenerating cells appearing as hyaline, shrunken bodies, they are present when basal cells are undergoing apoptosis. Often seen histopathologically in patients with lichen planus.
44
What is the common treatmnet for lichen planus?
Steroids
45
Name 3 oral potentially malignant disorders dentists should be very aware of?
1. Oral lichen planus
2. Leukoplakia
3. Proliferative verrucous leukoplakia
46
Define, “ a clinical term used to describe a white plaque of questionable risk after having excluded other known diseases.”
Leukoplakia
47
Define, “ a clinico-pathological variant of oral leukoplakia that is multi-focal, persistent and regressive with a high rate of recurrence, and a high risk of progression to SCC.”
*WHO 2024
Proliferative Verrucous leukoplakia
48
What are 3 examples of infective red patches?
1. Periodontal disease
2. Median rhomboid glossitis
3. HIV gingivitis
49
What type of lichen planus is classified as a red patch?
Erosive lichen planus
50
Give two examples of idiopathic red patches.
1. Geographic tongue
2. Erythroplakia
51
What is median rhomboid glossitis?
“Rhomboid red patch on midline of posterior aspect of anterior 2/3rds of dorsal tongue”
52
What oral infection if medium rhomboid glossitis associated with in most cases?
Candida infection
53
Is median rhomboid glossitis symptomatic or asymptomatic?
Asymptomatic
54
What are the 4 key histopathlogical signs of median rhomboid glossitis?
1. Loss of lingual papillae
2. Parakeratosis and acanthosis of the squamous epithelium
3. Candidal hyphae in parakeratin and associated neutrophils
4. Chronic inflammatory infiltrate in connective tissue
55
What is the treatment for median rhomboid glossitis if associated candida is involved?
Anti-fungal medication
56
Which type of stain will highlight Candida on histopathlogical examination?
PAS (periodic acid-Schiff) stain
57
Define, “ a red patch that cannot be characterised clinically or pathologically as another definable lesion.”
Erythroplakia
58
What are the typical clinical features of erythroplakia?
Red, “velvety” appearance
Smooth or nodular
59
On what three areas of the oral cavity is erythroplakia most frequently seen?
Palate, FOM and buccal mucosa
60
What two red patches are classified as oral potentially malignant disorders?
1. Erythroplakia
2. Erythroleukoplakia
61
What clinically characterises erythroleukoplakia?
It has both leukoplakia and erythroplakia components (both red and white).
62
Why might you worry if you spot an erythroplakia or erythroleukoplakia in the oral cavity?
They have a high likelihood of malignant transformation
(On biopsy, >90% are severe dysplasia or carcinoma)
63
What 5 exogenous factors can cause oral pigmentation?
1. Superficial staining (e.g. foods/drinks, tobacco)
2. Black hairy tongue
3. Foreign bodies (e.g. amalgam tattoo)
4. Heavy metal poisoning
5. Drugs (e.g. NSAIDs, antimalarials, chlorohexidine)
64
Define, a condition characterised by papillary hyperplasia and overgrowth of pigment-producing bacteria.
Black hairy tongue
65
Define, a benign,well-defined small flat brown/black lesion that presents in the oral cavity due to an increased activity of melanocytes.
Melanotic Macule
66
What 2 histopathological changes would you expect to see in a Melanotic Macule?
1. Increased melanin pigment in basal keratinocytes
2. Melanin pigmentary incontinence in underlying connective tissue
67
Define, a malignant neoplasm of mucosal melanocytes which can vary in presentation from dark brown or black to non-pigmented or red. It is very invasive and metastasises early.
Mucosal melanoma
68
What is the treatment for mucosal melanoma?
Surgical resection, adjuvant radiotherapy and immunotherapy.
69
Describe the presentation of Melanotic neuroectodermal tumour of Infancy.
- very rare, most <1years old
- males> females
-locally aggressive, rapidly grows
- most frequently affects the anterior maxillary alveolus
70
What causes Melanotic neuroectodermal tumour of infancy?
Might be neural crest cell origin, however pathogenesis is unknown.
71
What two cell populations comprise a Melanotic neuroectodermal tumour of infancy?
Neuroblastic cells and pigmented epithelial cells
72
What is the treatment for Melanotic neuroectodermal tumour of Infancy?
Complete local excision
73
What is an ulcer?
“Localised surface defect with loss of epithelium exposing underlying inflamed connective tissue”
74
Give two examples of drugs/drug class that can often cause oral ulceration.
1. Nicorandil
2. NSAIDs
75
Define a vesicle.
Small blister
76
Define a bulla.
A blister >10mm
77
What is an immunobullous disorder?
“Autoimmune diseases in which autoantibodies against components of skin and mucosa produce blisters.”
78
How can disorders which result in vesicles/bullae be classified histologically?
Depending on the location of the bulla:
1. Intra epithelial
2. Subepithelial
79
What are the further classifications of intra epithelial vesicles/bullae?
1. Non-acantholytic (death and rupture of cells)
2. Acantholytic (desmosomal breakdown)
80
Give an example of intra-epithelial non-acantholytic vesicles/bullae?
Herpes simplex virus in primary herpetic stomatitis and herpes labialis
81
Describe in 4 steps, how herpes simplex viral infection leads to ulceration.
1. Virus targets and replicates within epithelial cells
2. Leads to cell lysis
3. Groups of infected cells breakdown to form vesicles within the epithelium
4. Infected cells infect nearby normal cells and an ulcer forms when the full thickness of the epithelium is involved and is destroyed.
82
Give an example of intra-epithelial acantholytic vesicles/bulla.
Pemphigus vulgaris
83
What sex and age group is most frequently affected by Pemphigus vulgaris?
Females, 40-60 years old.
84
What is the treatment for Pemphigus vulgaris?
Steroids
85
What are the 3 main histopathological features of Pemphigus vulgaris?
1. Bullae just above basal cells forming base of lesion (tombstones)
2. Acantholytic (Tzanck) cells lie free within bulla fluid
3. Little inflammation until lesion ruptures
86
What type of specimen is mandatory for direct immunofluorescence studies?
Fresh specimen
87
What study is used in conjunction with routine histopathology to confirm diagnosis of vesiculobullous disorders?
Direct immunofluorescence (DIF) studies
88
Give 4 examples of subepithelial vesicles/bulla.
1. Pemphigoid
2. Erythema multiforme
3. Dermatitis herpetiformis
4. Epidermolysis bullosa acquisita
89
What sex and age range is mostly affected by the autoimmune condition, mucous membrane pemphigoid?
Females, 50-80 years old.
90
What clinical description is used for gingival lesions present in mucous membrane pemphigoid?
Desquamative gingivitis
91
What site is usually first affected by mucous membrane pemphigoid? And what other sites mat be involved?
Oral mucosa usually first affected.
Other sites:
1. Eyes
2. Nose
3. Larynx
4. Pharynx
5. Oesophagus
6. Genitalia
92
How does mucous membrane pemphigoid differ in bullae presentation to Pemphigus vulgaris?
Mucous membrane pemphigoid bullae tend to be relatively tough and involve full thickness of epithelium. Whereas, Pemphigus vulgaris bulla is much thinner.
93
What is the treatment for mucous membrane pemphigoid?
Steroids
94
What are the three histopathological features of mucous membrane pemphigoid?
1. Separation of full thickness epithelium from connective tissue producing sub epithelial bulla with thick roof
2. Infiltration of neutrophils and eosinophils around bulla
3. Base of bulla comprised of inflamed connective tissue
95
Define, acquired autoimmune blistering dermatosis with subepithelial bullae.
Epidermolysis Bullosa Acquisita
96
What are the 3 variants of Epidermolysis bullosa?
1. Simplex
2. Junctional
3. Dystrophic
97
Describe simplex Epidermolysis bullosa?
Intra-epithelial blistering, mutations in keratins 5/14.
98
Describe junctional Epidermolysis bullosa?
Subepithelial blistering, separation in lamina Lucinda, laminin mutations.
99
Describe dystrophic Epidermolysis bullosa?
Most severe form: Subepithelial blistering, separation beneath basal lamina, mutation in type VII collagen gene.
100
What is mean by angina bullosa Haemorrhagica?
Oral blood blistering , where blood-filled bullae burst to form ulcers and heal uneventfully.
101
Where does angina bullosa haemorrhagica most commonly occur in oral cavity?
On soft palate
102
Name a chronic, progressive, oral potentially malignant disorder associated with betel quid/areca nut chewing.
Oral submucous fibrosis
103
What are the clinical signs of oral submucous fibrosis?
1. Clinically pale mucosa
2. Firm to palpate
3. Marked trismus
104
What are the three key histopathological features of oral submucous fibrosis?
1. Dense collagenous tissue deposition in submucosa
2. Loss of vascularity
3. Marked epithelial atrophy
105
Define, atypical epithelial alterations limited to the surface squamous epithelium.
Epithelial dysplasia
106
What 4 sites in the mouth are associated with higher risk of malignant transformation if epithelial dysplasia is present?
1. Lateral border of tongue
2. Ventral tongue
3. Retromolar area
4. FOM
107
What grade of epithelial dysplasia is described:
Disorganisation, increased proliferation and atypia of basal cells.
Mild epithelial dysplasia
108
What grade of epithelial dysplasia is described:
More layers of disorganised basaloid cells, atypia, suprabasal mitoses.
Moderate epithelial dysplasia
109
What grade of epithelial dysplasia is described:
Very abnormal, affects full thickness of epithelium.
Severe epithelial dysplasia
110
According to WHO classifications, what are moderate and severe ED classified as?
High grade dysplastic lesions
111
What is the key histopathological difference between dysplasia and SCC?
In Dysplasia, atypical cells are confined to the surface epithelium.
In SCC, the atypical cells invade into the underlying connective tissue.
112
In the UK, what is the current incidence of mouth and oropharyngeal cancer?
8,500 cancers per year
113
Name the 11 variations in signs and symptoms for oral cancer.
1. Lumps and bumps
2. Ulcers
3. White patches
4. Red patched
5. Speckled patches
6. Non-healing socket
7. Tooth mobility not associated with perio disease
8. Induration/fixation of mucosa
9. Dysphagia
10. Pain/parasthesia
11. Bleeding
114
Who should suspected oral cancer be referred to?
Oral and Maxillofacial surgery
115
When is a lesion/lump sent for referral as suspected oral cancer?
If it is persistent, unexplained and has been present for >3 weeks
116
What is the treatment for SCC?
Surgery, adjuvant therapy (chemotherapy or radiotherapy), monoclonal antibodies.
117
What is the importance of staging cancer?
Major determinant of appropriate treatment and prognosis
118
What staging is used for most cancers including external lip and oral cavity carcinomas?
TNM classification of malignant tumours staging
119
What do TNM staging components stand for?
T = extent of primary tumour
N = absence or presence and extent of regional lymph node metastasis
M = category described the absence or presence of distant metastasis
120
What would indicate a TNM staging suggests more extensive disease and poorer prognosis?
If the given numbers are high
121
Why is there usually no “M” stage in pathological staging using TNM classification?
Because we don’t receive tissue from distant sites so we cant test for distant metastases.
122
What are the 4 most significant prognostic factors for oral cancer?
1. Tumour size
2. Depth of invasion
3. Nodal status
4. Distant metastases
123
What is the most common cause of periradicular/periapical inflammation?
Due to bacterial infection following pulpal necrosis
124
What is the potential sequelae of acute periradicular periodontitis?
Acute abscess
Which can lead to:
Cellultis or chronic abscess
Periapical granuloma/radicular cyst
125
What is the potential sequelae of chronic periradicular periodontitis?
Periapical granuloma which can become:
A radicular cyst
An acute abscess, chronic abscess or lead to cellulitis.
126
What is a periapical granuloma?
Localised mass of inflamed granulation tissue at the apex of a non-vital tooth
127
A tooth has a history of trauma and pain, it is grossly carious into pulp/heavily restored, however not much is seen on the radiograph periapically. What is your diagnosis from these clinical features?
Acute periradicular periodontitis
128
What are the treatment options for acute periradicular periodontitis?
- extraction
- RCT
129
What are the clinical features of an acute periapical abscess?
Pain
Swelling/sinus
130
What are the treatment options for an acute periapical abscess?
- drainage and extraction
- RCT
131
A tooth has minimal symptoms, appears non-vital when tested but shows an apical radiolucency on radiograph. What is your diagnosis according to these clinical features?
Chronic periradicular periodontitis
132
What cells predominantly cause inflammation of granulation tissue?
Lymphocytes and plasma cells
133
What are the treatment options for chronic periradicular periodontitis?
- extraction
- RCT/endodontic re-treatment
- periradicular surgery
134
Why is periapical granuloma not considered a “true” granuloma?
Because it does not contain granulomatous tissue (i.e. not a collection of macrophages)
135
What are the clinical features of periapical granuloma?
Similar to those of chronic periradicular periodontitis, initially usually asymptomatic.
If there’s inflammation patient can experience sensitivity/pain, swelling and sensitivity to percussive tests.
136
What histopathological feature of periapical granuloma may ultimately lead to inflammatory radicular cyst formation?
Proliferation of cell rests of Malassez
137
What are the histopathological features of periapical granuloma?
1. Haemosiderin and cholesterol deposits from RBC/inflammatory cell breakdown
2. Associated multinucleate foreign body giant cells
3. Resorption of adjacent bone +/- tooth
4. Inflamed granulation tissue
5. Proliferation of cell rests of Malassez
138
What are the treatment options for periapical granuloma?
- extraction
- RCT/re-treatment RCT
- periradicular suregry
139
Define pericoronitis?
Inflammation of soft tissues around a partially erupted tooth.
140
What are the 4 key clinical features of pericoronitis?
1. Pain
2. Swelling/tenderness of operculum
3. Bad taste
4. Trismus
141
What type of Odontogenic cyst might arise in chronic pericoronitis?
Paradental cyst
142
What are the treatment options for pericoronitis?
- irrigation
- extraction of opposing tooth
- antibiotics (if systemically unwell)
143
What is a cyst?
A pathological cavity having fluid or semi-fluid content, lined wholly or in part by epithelium, not due to accumulation of pus.
144
Define this class of cyst:
Derived from epithelial residues of tooth-forming organ
Odontogenic cyst
145
Define this class of cyst:
Derived from sources other than toot-forming organ
Non-Odontogenic cyst
146
What two structures do teeth develop from?
Odontogenic epithelium and neural crest derived ectomesenchyme
147
What are the two subtypes of inflammatory odontogenic cysts?
1. Radicular cyst
2. Inflammatory collateral cysts
148
What is the most common type of jaw cyst, making up 55% of all odontogenic cysts?
Radicular cyst
149
How do radicular cysts arise?
From epithelial proliferation and cyst formation within some periapical granulomas
150
Where is the most frequent location of a radicular cyst in the oral cavity?
Anterior maxilla
151
What are the clinical features of a radicular cyst?
- most common in anterior maxilla
- Slow growing swelling
- often no symptoms unless very large
- associated with non-vital teeth
- well circumscribed unilocular radiolucent lesion
152
What is the pathogenesis of a radicular cyst?
Proliferation of epithelium (cell rests of Malassez) in response to inflammation
153
What cysts do these histopathological features suggest could be present?
- chronically inflamed fibrous capsule
- wholly/partly lined by no-keratinised squamous epithelium
- hyperplasia of epithelium common
- mucous metaplasia and cilliated cells
- hyaline/rushton bodies
- cholesterol clefts and Haemosiderin
1. Radicular cyst
2. Paradental cyst
3. Mandibular buccal bifurcation cyst
154
What are the three treatment options for a radicular cyst?
1. Small cysts may resolve after RCT/extraction/periradicular surgery
2. Enucleation
3. Marsupialisation (very large lesions)
155
What is meant by ‘Enucleation’?
The removal of a cyst in such a way that it comes out whole, without rupture.
156
What is meant by Marsupialisation?
Cyst opened with a cut and fluid drained out, edges of skin stitched to create small pouch which allows further fluid drainage.
157
What is meant by a residual cyst?
A radicular cyst that persist after extraction of the associated non-vital tooth.
158
What are the 2 variants of inflammatory collateral cysts?
1. Paradental cyst
2. Mandibular buccal bifurcation cyst
159
What is the aetiology of inflammatory collateral cysts?
1. Inflammation associated with pericoronitis
2. Enamel spur on buccal aspect of involved tooth
3. Proliferation of sulcular or junctional epithelium derived from reduced enamel epithelium
160
What exacerbates inflammatory collateral cysts?
Food impaction
161
Out of the two variants, which variant of inflammatory collateral cysts is more common (>60%)?
Paradental cyst
162
What are the clinical features of a Paradental cyst?
- arise from chronic pericoronitis of lower 3rd molars
- associated with vital tooth
- well-demarcated radiolucency
163
What are the clinical features of a mandibular buccal bifurcation cyst?
- often located at lower 1st or 2nd molars
- painless swelling
- associated tooth usually tilted buccaly with deep perio pocket
- well-demarcated buccal radiolucency
164
What are the treatment options for inflammatory collateral cysts?
1. Enucleation
2. Removal of associated tooth and cyst
165
What are the 7 types of developmental odontogenic cysts?
1. Odontogenic keratocyst
2. Dentigerous cyst/eruption cyst
3. Lateral periodontal cyst and botryoid odontogenic cyst
4. Glandular odontogenic cyst
5. Gingival cysts
6. Calcifying odontogenic cyst
7. Orthokeratinised odontogenic cyst
166
What is the third most common cysts of the jaw?
Odontogenic keratocyst (OKC)
167
What are the clinical features of an Odontogenic keratocyst?
1. Majority arise in posterior mandible
2. Symptomless unless infected or where there is cortical bony expansion
3. Well-defined uni or multilocular radiolucent lesion
168
In what direction to Odontogenic keratocysts tend to enlarge?
In an anterior-posterior direction
169
How do odontogenic keratocysts arise?
From remnants of the dental lamina (glands of serres), they are associated with mutation or inactivation of PTCH1 gene.
170
What syndrome is associated with multiple odontogenic keratocysts at a younger age than expected?
Naevoid basal cell carcinoma syndrome (Gorlin Syndrome)
171
What cyst could be identified from these histopathological features?
- keratinised stratified squamous epithelial lining
- corrugated appearance of surface of parakeratin layer
- well defined, palisaded basal cell layer
- keratin debris in lumen
- Thin fibrous cyst wall with no inflammation, unless secondary infection
- may be daughter cysts in wall
Odontogenic keratocyst
172
What is important to note if there is a suspected odontogenic keratocyst with secondary infection?
That the characteristic histopathological features will typically be lost
173
Is an odontogenic keratocyst benign or malignant?
Benign
174
Why do Odontogenic keratocysts have a high recurrence rate of incompletely removed?
Due to thin capsule/ daughter cysts in wall
175
What are the 6 treatment options for an odontogenic keratocyst?
1. Marsupialisation
2. Enucleation
3. Marsupialisation & Enucleation
4. Enucleation + Carnoy’s solution
5. Enucleation + cryotherapy
6. Resection
176
What is the purpose for carnoy’s solution in the treatment of odontogenic keratocysts?
Used as a complementary treatment. The application of this solution promotes superficial chemical necrosis and is intended to reduce recurrence rates by removing any daughter cells from walls.
177
What is the 2nd most common odontogenic cyst?
Dentigerous cyst
178
What cyst is suggested by these clinical features:
- encloses all or part of crown of an unerupted tooth
- attached to the ACJ
- most commonly seen in unerupted 3’s,5’s,8’s.
- more prevalent in the mandible compared to the maxilla
- symptom free until significant swelling or if infected
- well circumscribed unilocular radiolucency
- ballooning expansion
Dentigerous cyst
179
What cysts are suggested by these histopathological features?
- thin non-keratinised stratified squamous epithelial lining
- mucous metaplasia common
- fibrous capsule
- no inflammation, unless secondary infection
1. Dentigerous cyst
2. Eruption cyst
180
What are the treatment options for Dentigerous cyst?
1. Enucleation
2. Exposure/transplantation/extraction of associated tooth
181
What is an eruption cyst?
A Dentigerous cyst arising in an extra-alveolar location
182
What cyst do these clinical features suggest?
- typically seen in children
- typically seen associated with deciduous and permanent molars
-presents as bluish swelling
eruption cyst
183
What are the treatment options for an eruption cyst?
1. Do nothing, allow spontaneous eruption
2. Exposure of erupting tooth
184
What cyst do these clinical features suggest?
- uncommon
- arise adjacent to vital teeth
- canine and premolar region of mandible most common
- usually symptom free
- well-circumscribed radiolucency in PDL
Lateral periodontal cyst
185
What cyst is suggested by these histopathological features?
- thin, non-keratinised squamous or cuboidal epithelium
- focal thickening’s/ plaques
- uninflamed fibrous wall
Lateral periodontal cyst
186
What is the treatment for a lateral periodontal cyst?
Enucleation
187
Name the cyst that is a very rare multi cystic variant of lateral periodontal cyst?
Botryoid odontogenic cyst
188
What cyst is suggested by these clinical features?
- very rare
- anterior mandible most common site
- multi-lobular radiolucency
- strong tendency to recur
Glandular odontogenic cyst
189
What is the treatment for glandular odontogenic cysts?
Enucleation (but high recurrence rate- up to 50%)
190
What is a key histopathological feature of glandular Odontogenic cysts?
Cyst-like spaces in the epithelial lining
191
What superficial keratin-filled cysts are often seen in infants, presenting as white nodules on the gingivae (Bohn’s nodules)?
Gingiva cysts
192
What is the treatment for gingival cysts in a) infants and b) adults?
A) None, usually disappear in a few weeks
B) simple excision
193
Gingival cysts are very rare in adults. If present where are the most likely found in the oral cavity?
In mandibular canine/premolar region
194
What cyst is suggested by these clinical features?
- rare
- painless swelling of jaw
- well-defined radiolucency
- associated tooth displacement and resorption common
- often anterior jaw
Calcifying odontogenic cyst (COC)
195
Where does a calcifying Odontogenic cyst arise from?
Dental lamina
196
What cyst is suggested by these histopathological features?
- unicystic
- lined by epithelium which is ameloblastoma like
- palisaded basal layer with overlying Stellate reticulum like layer
- focal ‘ ghost cells’ which may calcify
Calcifying odontogenic cyst (COC)
197
What is the treatment for calcifying Odontogenic cyst?
Enucleation
198
What cyst is suggested by these clinical features?
- rare
- male predilection
- 90% in mandible
- painless swelling of jaw
- well-defined unilocular radiolucency
Orthokeratinised odontogenic cyst
199
What cyst is suggested by these histopathological features?
- uninflamed fibrous wall
- lined by stratified squamous epithelium
- prominent granular cell layer and Orthokeratinised
- no basal palisading, no corrugated parakeratin
Orthokeratinised Odontogenic cyst
200
What is the treatment for Orthokeratinised Odontogenic cyst? And recurrence rate?
Enucleation + recurrence rare
201
What are the three main types of non-odontogenic cysts?
1. Nasopalatine duct cyst
2. Surgical ciliated cyst
3. Nasolabial cyst
202
What type of non-odontogenic cyst do these clinical features suggest?
- uncommon
-originates from epithelium of nasopalatine duct in incisive canal
- slow growing
- presents as swelling in midline of anterior palate
- pt may complain of a salty taste
Nasopalatine duct cyst
203
In what part of the nasopalatine canal does a nasopalatine duct cyst most frequently occur?
Palatal end of the canal
204
How does a nasopalatine duct cyst tend to present on a radiograph?
As a rounded or heart-shaped radiolucency in midline of anterior hard palate
205
What are three cysts now considered to represent different presentations of nasopalatine duct cysts?
1. Median palatine cyst
2. Incisive canal cyst
3. Median alveolar cyst
206
What type of non-odontogenic cyst do these clinical features suggest?
- Rare
- more prevalent in females
- most found in posterior maxilla
- may be asymptomatic or present with pain/swelling
- develop after sinus/nasal mucosa implanted into jaw following trauma or surgery
Surgical ciliated cyst
207
What type of non-odontogenic cyst do these clinical features suggest?
- very rare
- more prevalent in females
- arise in upper lip below nose, lateral to midline
- slowly growing, distorts nostril
- painless unless infected
- 10% are bilateral
Nasolabial cyst
208
What is the treatment for a nasopalatine duct cyst?
Enucleation
209
What is the treatment for a surgical ciliated cyst?
Enucleation
210
What is the treatment for a Nasolabial cyst?
Excision
211
What are the 5 types of soft tissue cysts?
1. Salivary mucocoele
2. Epidermoid cyst
3. Dermoid cyst
4. Lymphoepithelial cyst
5. Thyroglossal duct cyst
212
What type of soft tissue cyst is described by these clincial features?
- painless swelling
- often following trauma or surgery
- more common on skin
Epidermoid cyst
213
What cyst is described by these histopathological features?
- cystic lesion with thin cyst wall
- keratinising stratified squamous epithelium lining
- abundant keratin debris in lumen
- no skin appendages in cyst wall
Epidermoid cyst
214
What is the treatment for an epidermoid cyst?
Excision
215
What type of soft tissue cyst is described by these clinical features?
- developmental lesion
- various locations in head and neck
- FOM is common oral site
- presents as painless swelling in midline
Dermoid cyst
216
What type of soft tissue cyst is suggested from these histopathological features?
- keratinised stratified squamous lining
- keratin debris within cyst lumen
- must have skin appendages in cyst wall
Dermoid cyst
217
What is the treatment for a Dermoid cyst?
Excision
218
What type of soft tissue cyst is described by these clincial features?
- developmental lesions
- uncommon but do occur in oral cavity
- FOM and tongue most commonly affected
- painless small swelling
- may be yellowish in colour
Lymphoepithelial cyst
219
What type of soft tissue cyst is suggested from these histopathological features?
- thin keratinised stratified squamous epithelium lining
- keratin debris in cyst lumen
- lymphoid tissue in cyst wall
Lymphoepithelial cyst
220
What is the treatment for a Lymphoepithelial cyst?
Excision
221
What type of soft tissue cyst is described by these clincial features?
- developmental cyst derived from embryonic Thyroglossal duct
- intra-oral lesions rare
- most arise near hyoid bone
- presents as midline swelling
- usually painless/ symptoms if infected
- may have functioning thyroid issues
Thyroglossal duct cyst
222
What type of soft tissue cyst is suggested from these histopathological features?
- cystic lesion lined by stratified squamous/ciliated/nonciliated columnar epithelium
- fibrous wall which typically contains thyroid tissue
- can find incidental thyroid carcinoma
Thyroglossal duct cyst
223
What is the treatment for Thyroglossal duct cyst?
Complete excision involving removal of mid third of hyoid bone (sistrunk procedure)
224
What is the advantage of using a sistrunk procedure for treatment of a Thyroglossal duct cyst?
Lower chance of recurrence with this procedure
225
What are the two types of non-epithelialised primary bone cysts?
1. Simple/solitary bone cyst
2. Aneurysmal bone cyst
226
What type of cysts almost exclusively involves the mandible?
Non-epithelialised primary bone cysts
227
Why are non-epithelialised primary bone cysts not considered to be true cysts?
They are not lined by epithelium
228
What type of bone cyst is described by these clinical features?
- peak incidence 2nd decade
- premolar/molar regions of the mandible
- may be asymptomatic swelling or often incidental finding
- large radiolucency on radiograph
- not a true cyst
Simple (solitary) bone cyst
229
What type of bone cyst is suggested from these histopathological features?
- bony cavity with no epithelial lining
- may be thin fibrovascular tissue lining with haemosiderin, RBC’s or giant cells covering bony walls
- usually no cyst contents
Simple (solitary) bone cyst
230
What are the two treatment options for a simple (solitary) bone cyst?
1. Resolve spontaneously
2. Resolve after opening of cavity
231
What type of bone cyst is described by these clinical features?
- very rare in jaws
- usually mandible
- usually presents in young people
- painless swelling
- radiolucency on radiograph
Aneurysmal bone cyst
232
What type of bone cyst is suggested from these histopathological features?
- blood-filled spaces separated by cellular fibrous tissue
- no lining of spaces
- multi-nucleated giant cells in fibrous band
Aneurysmal bone cyst
233
What is the treatment required for an Aneurysmal bone cyst?
Curettage
234
What is Stafne’s Defect/Stafne’s idiopathic bone cavity? What is its aetiology? And radiographic presentation?
- A developmental anomaly
- aetiology: due to part of the submandibular gland indenting the lingual part of the mandible.
- presentation: appears cyst-like on radiograph and may be mistaken for a cyst
235
Is Stafne’s defect a true lesion or not?
NOT a true lesion
236
Name 4 benign mixed epithelial and mesenchymal odontogenic tumours?
1. Odontoma
2. Primordial Odontogenic tumour
3. Ameloblastic fibroma
4. Dentinogenic ghost cell tumour
237
Name 4 benign mesechnymal odontogenic tumours
1. Odontogenic fibroma
2. Cementoblastoma
3. Cement-ossifying fibroma
4. Odontogenic myxoma
238
What benign epithelial odontogenic tumour is described by these clinical features?
- 2nd most common odontogenic tumour
- usually located in the posterior mandible
- swelling
- radiolucent lesion on imaging
- slow growing, locally aggressive
Ameloblastoma
239
Describe the histopathology of ameloblastoma according to the two types of tumour cells present, and the two patterns of presentation.
Two types:
1. Well organised peripheral single layer of tall, columnar, pre-ameloblast like cells
2. Core of loosely arranged cells resembling Stellate reticulum
Two patterns:
- follicular (islands of epithelial cells) OR plexiform (long strands of epithelial cells)
240
What is the treatment/management for ameloblastoma?
Complete excision with margin of uninvolved tissue + long term follow up
241
What benign epithelial odontogenic tumour is described by these clinical features?
- most in 2nd decade, 90% before 30 years old
- greater prevalence in females compared to males
- more common in maxilla
- majority present in canine region
- often associated with unerupted permanent tooth
- unilocular radiolucency
- most asymptomatic
Adenomatoid odontogenic tumour
242
What cyst can an adenomatoid odontogenic tumour appear to mimic?
Dentigerous cyst
243
What is the treatment for an adenomatoid odontogenic tumour?
Local excision
244
What is an Odontoma?
Developmental malformation of dental tissue (contains enamel dentine and sometimes cementum)
245
What is the most common odontogenic tumour?
Compound Odontoma
246
Where is the most common place to find a compound Odontoma?
Anterior maxilla
247
Where is the most common place to find a complex Odontoma?
Posterior mandible
248
What is the treatment for an Odontoma?
Enucleation
249
What benign mesenchymal odontogenic tumour is described by these clinical features?
- formation of cementum-like tissue in connection with root of tooth
- more common in mandible, especially associated with 6’s
- painful swelling
- tooth remains vital
- well defined radiopaque or mixed density lesion
Cementoblastoma
250
What is the treatment for Cementoblastoma?
Complete excision and removal of tooth
251
Serum levels of what 3 substances is principal for biochemical investigations in the diagnosis of bone diseases?
Calcium, phosphorus and alkaline phosphotase
252
Name 5 lesions/cysts that comprise giant cell lesions and bone cysts?
1. Central giant cell granuloma
2. Peripheral giant cell granuloma
3. Cherubism
4. Aneurysmal bone cyst
5. Simple bone cyst
253
What giant cell lesion is described by these clinical features?
- localised benign lesion (can be aggressive)
- more prevalent in mandible
- more prevalent in females
- often asymptomatic
- if cortical plate perforates lesion can present as peripheral
Central giant cell granuloma
254
What giant cell lesion disorder is described by these clinical features?
- rare inherited autosomal dominant disorder
- causes distension of jaws
- more common in males
-painless swelling usually bilateral
- may regress by adulthood
- may be associated dental anomalies
Cherubism
255
What are fibro-osseous lesions histologically characterised by?
Replacement of normal bone by cellular fibrous tissue within which islands and trabeculae of meta plastic bone develop
256
Name 4 key fibro-osseous lesions
1. Cemento-osseous dysplasia
2. Fibrous dysplasia
3. Ossifying fibroma (3 types)
4. Familial gigantiform cementoma
257
What fibro-osseous lesion is described by these clinical features?
- occurs in tooth-bearing areas of jaw
- most common fibro-osseous lesion of jaw
- often asymptomatic
- involved teeth remain vital
- characterised by replacement of normal bone by fibrous tissue and varying amounts of meta plastic bone and cementum like material
- predilection for middle aged African-American females
Cemento-osseous dysplasia
258
What are the 4 forms of cemento-osseous dysplasia?
1. Periapical cemento-osseous dysplasia
2. Focal cemento-osseous dysplasia
3. Florid cemento-osseous dysplasia
4. Familial florid cemento-osseous dysplasia
259
What type of cemento-osseous dysplasia involves apical incisor region of the mandible, where several teeth are usually involved?
Periapical cemento-osseous dysplasia
260
What type of cemento-osseous dysplasia is associated with a single tooth?
Focal cemento-osseous dysplasia
261
What types of cemento-osseous dysplasia is multi focal/multiquadrant?
Florid cemento-osseous dysplasia and familial florid cemento-osseous dysplasia
262
What is the treatment of cemento-osseous dysplasia?
Surgery but only if symptomatic
263
What fibro-osseous lesion is described by these clinical features?
- involves one bone
- gives rise to painless bony swelling
- usually starts in childhood and arrests in adulthood
- jaws are the most frequent head and neck site
- more common in maxilla
Monostotic fibrous dysplasia
264
What is meant by Craniofacial fibrous dysplasia?
Monostotic fibrous dysplasia in the region of the maxilla, where lesions often involves adjacent bones.
265
What fibro-osseous lesion is described by these clinical features?
- rare
- more common in females
- affects several bones
- skin pigmentation and endocrine abnormalities associated
- head and neck involve in 50% of cases
Polyostotic fibrous dysplasia
266
What syndrome comprises polyostotic fibrous dysplasia, skin pigmentation and sexual precocity?
Albright’s syndrome
267
What is the treatmnet for fibrous dysplasia?
Aesthetic surgery
268
What are the three types of ossifying fibroma?
1. Cemento-ossifying fibroma
2. Juvenile trabecular ossifying fibroma
3. Psammomatoid ossifying fibroma
269
What ossifying fibroma is described by these clinical features?
- almost exclusively occurs in tooth bearing areas of jaw
-slow, painless expansion of jaw
- higher prevalence in females
- more common in mandible
Cemento-ossifying fibroma
270
What important histopathological features distinguishes cemento-ossifying fibroma from fibrous dysplasia?
Demarcated nature
271
What are the treatment options for cemento-ossifying fibroma?
1. Enucleation and curettage
2. Resection
272
What ossifying fibroma is described by these clinical features?
- painless rapid expansion of jaw
- occurs in children and adolescents
- more common in females
- more common in mandible
Juvenile trabecular ossifying fibroma
273
What ossifying fibroma is described by these clinical features?
- usually painless fast bone expansion
- most arise in Craniofacial bones especially around paransal sinuses and orbit
-more common in males
Psammomatoid ossifying fibroma
274
What is a rare form of fibro-osseous lesion of the jaw which may be massive with facial deformity?
Familial gigantiform cementoma
275
Name a rare development disorder, which is characterised by segmental maxillary and soft tissue enlargement with dental-osseous abnormalities.
Segmental odontomaxillary dysplasia
276
What are the two main benign Maxillofacial bone and cartilage tumours to be aware of?
1. Osteoma
2. Osteochondroma
277
Name a benign slow-growing Maxillofacial bone and cartilage tumour that consists of well-differentiated mature bone, is usually a solitary lesion unless in the case of Gardner syndrome where multiple lesions occur.
Osteoma
278
What is Gardner syndrome and its key features?
A rare autosomal dominant disorder and features include multiple osteoma, polyposis coli (which show marked tendency to undergo malignant change) and multiple fibrous tumours and cysts of skin.
279
What are the two types of osteoma histologically?
1. Compact type
2. Cancellous type
280
What type of osteoma is described by these histological features?
Mass of dense lamellar bone with few marrow spaces
Compact type
281
What type of osteoma is described by these histological features?
Interconnecting trabeculae enclosing fatty or fibrous marrow
Cancellous type
282
What is the treatment or osteoma?
Lesions removed if symptomatic or causing probelms with fit of denture
283
Name the benign Maxillofacial bone and cartilage Tumour which presents as a bony projection with a cap of cartilage and appears continuous with the underlying bone.
Osteochondroma
284
What is the treatment for Osteochondroma?
Complete excision
285
Define the benign Maxillofacial bone and cartilage tumour:
Benign but aggressive bone forming tumour
Osteoblastoma
286
Define the benign Maxillofacial bone and cartilage tumour:
Benign tumour of bone composed of chondroblasts
Chondroblastoma
287
Define the benign Maxillofacial bone and cartilage tumour:
Benign chondroid tumour
Chondromyxoid fibroma
288
Define the benign Maxillofacial bone and cartilage tumour:
Benign chondroid tumour
Chondromyxoid fibroma
289
Locally aggressive fibroblastic/myofibroblastic tumour
Desmoplastic fibroma of bone
290
Define, a rare group of malignant bone neoplasms in which the cells produce immature bone.
Osteosarcoma of the jaw
291
Define, a rare malignant bone neoplasm that produces cartilaginous matrix.
Chondrosarcoma
292
Define, a rare high-grade, biphasic malignant cartilaginous neoplasm
Mesenchymal Chondrosarcoma
293
Name 4 inherited disorders of bone.
1. Osteogenesis imperfecta
2. Osteopetrosis (marble bone disease)
3. Cleidocranial dysplasia
4. Achondroplasia
294
Define the inherited bone disorder:
Characterised by impairment of collagen matrix. There are several different types, type 1 being most common and mild.
Osteogenesis imperfecta
295
What are the clinical features of osteogenesis imperfecta?
1. Easily fractured, osteoporotic bone
2. Affected teeth appear as in Dentinogenesis imperfecta
3. Malocclusion
296
Define the inherited bone disorder:
Group of rare genetic diseases in which there is a marked increase in bone density due to failure of osteoclastic activity and absence of normal modelling resorption. Corticles are thickened and there is sclerosis of cancellous bone.
Osteopetrosis
297
Why is anaemia often associated with Osteopetrosis?
Due to marrow space deficiency
298
What recognised complication of Osteopetrosis makes prevention of dental infections of great importance?
Osteomyelitis
299
Define the inherited bone disorder:
A rare genetic disorder characterised by abnormalities of many bones, but most notably there is defective formation of the clavicles, delayed closure of fontanelles and sometimes retrusion of the maxilla. Dental anomalies common.
Cleidocranial dysplasia
300
What are the oral features of someone with Cleidocranial dysplasia?
1. Delayed eruption of permanent dentition
2. Supernumerary teeth
3. Narrow, high arched palate
301
Define the inherited bone disorder:
Associated with an abnormality in endochondral ossification, so limbs appear excessively short with head and trunk of body appearing normal.
Achondroplasia
302
Why is severe malocclusion often associated with achondroplasia?
Defective growth of base of skull leads to a retrusive maxilla, often resulting in severe malocclusion
303
What metabolic disorder results when bone loss is excessive or when apposition of bone is reduced, but bone composition is normal.
Osteoporosis
304
What group of individuals is osteoporosis most commonly found?
Postmenopausal women
305
How does osteoporotic bone appear on radiograph?
1. Increased radiolucency of bone
2. Cortex is thinned
3. More marrow spaces in the cancellous bone associated with thin trabeculae
306
What endocrine disorder is characterised by overproduction of parathormone (PTH)?
Hyperparathyroidism
307
What is the result of overproduction of PTH in hyperparathyroidism?
Mobilises calcium and raises plasma calcium levels
308
What is often the cause of primary hyperparathyroidism?
Either hyperplasia or adenoma of the parathyroids
309
What is often the cause of Secondary hyperparathyroidism? And what disease is it usually associated with?
Develops when PTH produced in response to chronic low calcium levels.
Often seen in chronic renal disease
310
What are the three key features of hyperparathyroidism?
‘Stones, bones and abdominal groans’
1. Stones- renal calculi and other calcifications
2. Bones - various bone lesions including ‘brown tumour’ of hyperparathyroidism
3. Abdominal groans- tendency to develop duodenal ulcers
311
How might hyperparathyroidism present in dental patients?
As a cyst-like swelling of the jaw which displays the histological features of a giant-cell lesion
312
True or false?
It is histologically impossible to distinguish ‘brown tumour’ of hyperparathyroidism from other giant-cell lesions of bone.
True.
Clinical, radiological and biochemical investigations also required for diagnosis.
313
What causes rickets/osteomalacia?
Deficiency of, or resistance to the action of, vitamin D.
314
What oral findings can be associated with rickets/osteomalacia?
1. Delay in tooth eruption
2. Rare- hypocalcification of dentine and enamel hypoplasia
315
What metabolic/endocrine disorder is caused by prolonged and excessive secretion of growth hormone?
Acromegaly
316
What are the facial/oral features of acromegaly?
1. Jaw enlarged
2. Jaw protruded
3. Increased spacing between teeth
4. Thickening of facial soft tissues
317
What inflammatory disease of the bone is characterised by a spectrum of inflammatory and reactive changes in bone and periosteum?
Osteomyelitis
318
How does radiation affect the vascularity of bone?
By causing proliferation of the intima (innermost layer) of the blood vessels
319
What is the action of bisphosphonates?
Inhibit osteoclasts, thus inhibiting bone resorption.
320
What is Paget’s disease of bone?
Form of osteodystrophy characterised by disorganised formation and remodelling of bone unrelated to functional requirements.
321
What 5 key dental considerations are there for patients with Paget’s disease of bone (osteitis deformans)?
1. Maxilla more often affected than mandible
2. More prone to pathological fracture due to thickened but weaker bone
3. Progressive enlargement of skull and facial bones- dentures don’t fit.
4. Malocclusion and spacing of teeth can occur
5. Hypercementosis and ankylosis of teeth leading to extraction difficulties
322
What is the characteristic radiograohic appearance of Paget’s disease of bone?
Cotton wool appearance
323
What are the three progressive and overlapping phases of Paget’s disease of bone?
1. Initial predominantly osteolytic phase
2. Active stage of mixed osteolysis and osteogenesis
3. Predominantly osteoblastic or sclerotic phase
324
What are the main histopathological features of Paget’s disease of bone?
1. Irregular pattern of reversal liens
2. Many osteoblasts and osteoclasts
3. Fibrosis of marrow spaces
4. increased vascularity
325
What is a mosaic appearance of bone histopathologically a sign of?
Paget’s disease of bone
326
In terms of serum calcium, phosphorus and alkaline phosphotase levels, what would you expect to see in serum biochemistry tests of someone with Paget’s disease of bone?
Normal calcium and phosphorus levels
Increased alkaline phosphatase levels
327
What are the two most common places in the oral cavity to find tori/exostoses?
Midline of palate or lingual surface of the mandible
328
Name the 5 locations for primary tumours which are most likely to metastasise to bone (including bone in the jaw)?
1. Breast
2. Bronchus
3. Prostate
4. Thyroid
5. Kidney
329
What are jaw metastases indicative of?
Life-threatening disease
330
What can jaw metastases look like radiographically?
Have a moth-eaten appearance, although some can appear radiopaque
331
What are the three most common sites for metastases to the oral mucosa?
1. Gingiva
2. Alveolar mucosa
3. Tongue
332
What benign odontogenic tumour commonly presents at the angle of the mandible?
Ameloblastoma
333
What developmental cysts is most commonly found at the angle of the mandible?
Odontogenic keratocyst
334
On CT scan, what would buccal expansion of a radiolucency suggest?
Ameloblastoma
335
On CT scan, what would anterior-posterior expansion of a radiolucency suggest?
Odontogenic keratocyst
336
What is the presence of a soft tissue hyperplastic lesion usually a response to?
Chronic trauma/inflammation
337
What is a soft tissue hyperplastic lesion located on the gingiva referred to as?
Epulis
338
From these clinical feature, name the localised soft tissue hyperplastic lesion:
- pedunculated or sessile firm mass on gingiva, often between 2 teeth
- pink in colour
Fibrous epulis
339
What is the treatment required for fibrous epulis?
Excision and remove source of irritation
340
From these clinical feature, name the localised soft tissue hyperplastic lesion:
- soft red/purple swelling
- often ulcerated
- a form of this lesion tends to present in women who are pregnant
Pyogenic granuloma (pregnancy epulis)
341
What is the treatment for pyogenic granuloma?
Local excision and remove source of irritation
342
What is the treatment for pregnancy epulis?
Good OH and periodontal treatment, lesions typically regress post-partum
343
From these clinical feature, name the localised soft tissue hyperplastic lesion:
- soft purplish gingival swelling
- mostly on gum of teeth anterior to molars
- F>M
Giant cell epulis/peripheral giant-cell granuloma
344
What causes giant cell epulis/ peripheral giant-cell granuloma?
Local irritation by dental calculus, plaque deposits, retained tooth roots or other chronic irritation
345
From these histological features, name the localised soft tissue hyperplastic lesion:
Collections of lots of multinucleated osteoclast-like giant cells in rich vascular and cellular stroma
Peripheral giant cell granuloma
346
What is the treatment for giant-cell epulis/peripheral giant cell granuloma?
1. Excision of lesion and remove source of irritation
2. Curettage of underlying bone to reduce chance of recurrence
347
From these clinical feature, name the localised soft tissue hyperplastic lesion:
- pink smooth mucosal polyp
- very common
- buccal mucosa, lip and tongue most commonly affected
Fibroepithelial polyp
348
If a fibroepithelial polyp becomes flatten under denture what is it then referred to as?
Leaf fibroma
349
What is the treatment for fibroepithelial polyp?
Excision of lesion
350
What is the variant of fibroepithelial polyp called which is often seen on the gingivae and tongue?
Giant cell fibroma
351
From these clinical feature, name the localised soft tissue hyperplastic lesion:
- broad based, leaf-like folds of tissue related to periphery of badly fitting denture.
- typically pale, fibrous swelling which may be ulcerated
Denture irritation hyperplasia
352
From these clinical feature, name the localised soft tissue hyperplastic lesion:
- numerous small tightly packed nodular lesions
- involves all or part of denture bearing area of palate
- typically older patients with ill-fitting dentures
- can be seen in non-denture wearers
- may be superadded candidia infection
Papillary hyperplasia
353
What is the periodic acid schiff (PAS) special stain used for?
To highlight fungi
354
What are the five categories of soft tissue neoplasms?
- tumours of fibrous tissue
- tumours of adipose tissue
- tumours of vascular tissue
- tumours of peripheral nerves
- tumours of muscle
355
Name the malignant tumour of fibrous tissue.
Fibrosarcoma
356
Name the two tumours of adipose tissue and state which is benign and which is malignant.
Lipoma (benign)
Liposarcoma (malignant)
357
What tumours does these clinical features suggest?
- soft, smooth swelling
- pedunculated or sessile
- asymptomatic
- can be yellowish or pink
- buccal mucosa most common intra-oral site
- patients typically adults 40+
Lipoma
358
What is the treatment for lipoma?
Excision
359
What is the treatment for liposarcoma?
Radical excision
360
Name the 4 tumours of vascular tissue
1. Haemangioma
2. Lymphangioma
3. Kaposi’s sarcoma
4. Angiosarcoma
361
What vascular tissue tumour does these clinical features suggest?
-benign
-common in children especially females
- dark red/purple swelling
- blanches on pressure
- usually solitary
- can be part of an angiomatous syndrome (sturge-Weber syndrome)
Haemangioma
362
What is the difference between a capillary Haemangioma and a cavernous Haemangioma?
Capillary- lots os small blood vessels
Cavernous- large blood filled spaces
363
What is the treatment for Haemangioma in adults?
1. Do nothing as can regress
OR
2. Cryosurgery/therapy
364
What vascular tissue tumour is suggested by these clinical features?
- pale swelling
- rare
- often present in childhood
- malformation of lymphatic vessels
- can be localised or diffuse
- may present in neck
Lymphangioma
365
What is the treatment for Lymphangioma?
Excision
366
What vascular tissue lesion is locally aggressive and associated with HHV-8 infection?
Kaposi’s sarcoma
367
What are the 4 variants of kaposi sarcoma?
1. Classic
2. Endemic
3. AIDS-associated
4. Iatrogenic (immunosuppression associated)
368
What vascular tissue lesion is suggested from these clinical findings?
- palate and gingiva most commonly affected sites
- purplish/red lesions
- comes increasingly nodular
- lesions frequently bleed
Kaposi’s sarcoma
369
What is the treatment for kaposi’s sarcoma?
Antiretroviral therapy/chemotherapy
370
What vascular tissue tumour is malignant, very rare in oral cavity, of poor prognosis and tends to present on the forehead and scalp of older male patients?
Angiosarcoma
371
What is the treatment for Angiosarcoma?
Excision +/- radiotherapy
372
Name 4 tumours of peripheral nerves.
1. Neurofibroma
2. Neurilemmoma
3. Traumatic neuroma
4. Malignant peripheral nerve sheath tumours (MPNST)
373
What peripheral nerve tumour is suggested by these clinical features?
- benign
- rare
- smooth painless swelling
- solitary or multiple
- associated with NF-1
Neurofibroma
374
What is the concern if neurofibroma is NF-1 type?
Significant risk of malignant transformation
375
What peripheral nerve tumour is suggested by these clinical features?
- benign
- Schwann cell origin
- smooth painless swelling
- slow growing
- tongue most common site
Neurilemmoma (schwannoma)
376
What peripheral nerve lesion is suggested by these clinical features?
- reactive lesion after nerve damage, not a tumour
- smooth nodule
- tongue, lower lip, salivary gland
- history of trauma/surgery
- may be painful
Traumatic neuroma
377
What peripheral nerve tumour is suggested by these clinical features?
- 2-4% of head and neck sarcomas
- may be associated with NF-1
- painful quickly growing mass
- requires radical excision +/- adjuvant therapy
Malignant peripheral nerve sheath tumour
378
Name two tumours of muscle and describe if they are benign or malignant.
1. Leiomyoma (benign)
2. Leiomyosarcoma (malignant)
379
Which muscle tumour is suggested by these clinical features?
- rare in oral cavity
- most arise from vascular smooth muscle
- slow growing nodule
- sometimes painful
Leiomyoma
380
What is the treatment required for all tumours of peripheral nerves?
Excision
381
What is Leiomyoma referred to if it involves multiple vessels with thickened walls?
Angioleiomyoma
382
Name two tumours of skeletal muscle, stating which is benign or malignant.
1. Rhabdomyoma (benign)
2. Rhabdomyosarcoma (malignant)
383
What are the two types of Rhabdomyoma?
1. Foetal
2. Adult
384
How does foetal Rhabdomyoma tend to present?
Young males, swelling around face and ear region.
385
What malignant tumour is described by these clinical features?
- More frequently seen in young children
- often painless rapidly growing mass
- head and neck most common site
- specific genetic alterations identified
Rhabdomyosarcoma
386
What are the two tumours of uncertain histogenesis?
1. Granular cell tumour
2. Congenital epulis/congenital granular cell epulis
387
Name the benign neuroectodermal tumour that has unknown aetiology, presents more commonly in females and is a sub mucosal smooth painless swelling.
Granular cell tumour
388
What lesion is suggested by these clinical features?
- uncommon
- pink polyploid mass on alveolus of newborns
- can be quite large
- anterior maxilla most frequent site
- females >males
Congenital epulis/ congenital granular cell epulis
389
90% of major salivary gland tumours occur in which major salivary gland?
Parotid
390
Is malignancy more likely in the minor or major salivary glands?
Minor salivary glands
391
Definitive Diagnosis of salivary gland tumours can be confirmed by various methods of obtaining tissue. Name these 4 methods.
1. Fine needle aspiration (FNA)
2. Core biopsy
3. Open biopsy
4. Excision
392
Describe FNA.
A needle is used to aspirate cells from lesion and the cell features examined under microscope
393
Describe core biopsy.
A larger hollow needle is used to remove a core of tissue
394
Describe open biopsy.
A surgical incision is made then an incisional biopsy of the lesion taken
395
What are the 4 categories of salivary gland tumours under the current WHO classification?
1. Non-neoplastic epithelial lesions
2. Benign epithelial tumours
3. Malignant epithelial tumours
4. Mesenchymal tumours specific to the salivary glands
396
Name three key benign epithelial salivary tumours to be aware of.
1. Pleomorphic adenoma
2. Warthin tumour
3. Canalicular adenoma
397
What is the most common type of salivary gland tumour?
Pleomoprhic adenoma
398
What gene rearrangements are most pleomorphic adenomas associated with?
PLAG1 and HMGA2
399
What lesion is described by this histopathology?
- well-circumscribed
- incomplete fibrous capsule
- may be cystic
- complex intermingling of epithelial and myoepithelial components
Pleomorphic adenoma
400
What is the treatment for pleomorphic adenoma?
Complete excision
401
What is the risk of pleomorphic adenoma is not completely excised?
It has higher recurrence rate
402
If pleomorphic adenoma becomes malignant, what is it referred to as?
Carcinoma ex pleomorphic adenoma
403
What benign epithelial tumour is described?
- almost exclusively in the parotid
- bilateral lesions in 5-17% cases
- painless swelling
- strong link with cigarette smoking
- radiation
Warthin tumour
404
What type of benign epithelial tumour is described?
- almost exclusively (80%) in the upper lip
- can be multi focal
- typically painless slow growing nodule
Canalicular adenoma
405
Name three key malignant epithelial tumours to be aware of?
1. Mucoepidermoid carcinoma
2. Adenoid cystic carcinoma
3. Acinic cell carcinoma
406
What is the most common malignant primary epithelial salivary gland tumour?
Mucoepidermoid carcinoma
407
What gland does mucoepidermoid carcinoma most frequently affect?
Parotid glands
408
Mucoepidermoid carcinoma has varying proportions of 3 types of tumour cells. What are these cells?
1. Mucous-secreting cells
2. Epidermoid (squamous) cells
3. Intermediate cells
409
How do tumours with high mucous cell numbers compare to tumours with mainly Epidermoid cells?
High mucous cell number tumours = more cystic
Epidermoid cell tumours = more soluble and often more aggressive
410
What malignant tumour has a predilection to infiltrate and spread along nerve sheaths?
Adenoid cystic carcinoma
411
What is the characteristic histopathological feature of adenoid cystic carcinoma?
Numerous microscopic cyst-like spaces (produces cribiform, lace-like or “Swiss cheese” pattern)
