Red-Blue Lesions

Question 1

Congenital Hemangioma/Malformation etiology

Answer 1

2 types, capillary and cavernous
typically blanch when compressed (as opposed to hemorrhagic lesions in soft tissue (ecchymoses))
usually occur at birth. Only vascular malformation grows with the patient
Need to differentiate blue rubber bleb nevus syndrome, as the multiple nevuses can cause GI bleeds

Question 2

Congenital Hemangioma/Malformation histopathology

Answer 2

hemangiomas have abundant capillary spaces without muscular support
Congenital vascular malformations consist not only of capillaries, but also venous, arteriolar, and lymphatic channels, with frequent direct artero-venous communication

Question 3

Congenital Hemangioma/Malformation Diagnosis and treatment

Answer 3

when they affect the maxilla or mandible a radiolucent honeycomb pattern with distinct margins is expected. The two lesions can be impossible to differentiate clinically, but could be by MRI
These often involute in childhood. If not Propanolol can be effective. They can be surgically excised if eradication is the goal. Laser therapy or selective arterial embolization can be used.

Question 4

Encephalotrigeminal Angiomatosis

Answer 4

Non-inherited neurocutaneous syndrome that includes vascular malformations
port-wine stain facial lesions
these follow the trigeminal nerve, and may follow into the buccal mucosa.

DD: Parkes-Weber symdrome
Angio-osteohyperprophy
Varices
Limb hypertrpophy

Question 5

Varix

Answer 5

a trivial but common vascular malformation, dilation of a single vein
typically blue lesions that blanch with compression.
No treatment required unless it is frequently traumatized or cosmetically objectionable
thrombosis can cause them to be firm texture

Question 6

Pyogenic granuloma etiology

Answer 6

A response to tissue injury, containing hyperplastic granulation tissue
most commonly occur in the attached gingiva, and are reactive to biofilm/foreign material
Hormonal changes in pregnancy or puberty modify the tissue response to injury making them more likely
Typically red and smooth or lobulated with hemorrhagic and compressible features. They can have an ulcerated surface. The older lesions become collagenized.

Question 7

Pyogenic granuloma histology

Answer 7

lobular masses of hyperplastic granulation tissue.
Chronic inflammatory cells are frequenly seen, with neutrophils common in ulcerated lesions

Question 8

pyogenic granuloma differential

Answer 8

peripheral giant cell granuloma
peripheral odontogenic or ossifying fibroma
Less common
Kaposi Sarcoma
Bacillary Angiomatosis
Non-Hodgkin’s Lymphoma

Question 9

Pyogenic Granuloma treatment

Answer 9

Can be surgically excised, requiring removal of the connective tissue from where the lesion arises, as well as the local factors.
Recurrence is infrequent and usually related to incomplete removal of the lesion/local factors

Question 10

Peripheral Giant Cell Granuloma Etiology

Answer 10

A hyperplastic connective tissue response to injury of gingival tissues, differentiated by the presence of multinucleated giant cells.
Seen exclusively in gingiva, presumably arising from the PDL or periosteum, and occasionally cause bone resorption.
Appear as red to blue broad-based masses. Secondary ulceration caused by trauma can be see

Question 11

Peripheral Giant Cell Granuloma Histopathology

Answer 11

Fibroblasts are the basic element, with multinucleated giant cells scattered throughout

Question 12

Peripheral Giant Cell Granuloma Differential

Answer 12

clinically indistinguishable from pyogenic granuloma, although more likely to cause bone resorption.
Histologically identical to a central giant cell granuloma

Question 13

Peripheral Giant Cell Granuloma treatment

Answer 13

surgical excision is the preferred treatment
Removal of local factors or irritants required.
Recurrences are related to the lack of inclusion of periosteum or PDL in the excised specimen

Question 14

Scarlet Fever Etiology

Answer 14

Caused by Streotococcal strains A B or C
Usually occurs at age 1-10
Skin rash that starts on the chest
The palate may show nonspecific inflammatory changes
Treated by penicillin to prevent rheumatic fever or glomerulonephritis

Question 15

Erythroplakia Etiology

Answer 15

red patch on oral mucous membranes. Not a specific diagnosis, but biopsy usually finds dysplasia or carcinoma
much less common than leukoplakia
It should be viewed as much more serious than leukoplakia due to higher rate of malignancy.
Appears as a velvety red patch with well defined margins. Focal white patches can be seen in erythroleukoplakia lesions
Invasive lesions can feel indurated

Question 16

Erythroplakia histopathology

Answer 16

40% are severe dysplastic change
50% are SSC
9% are mild or moderate dysplasia
A reduction in keratin and increase in vascularity account for the clinical changes

Question 17

Erythroplakia Differential Diagnosis

Answer 17

Kaopsi Sarcoma
Ecchymosis
contact allergic reaction
vascular malformation
psoriasis
biopsy provides definitive diagnosis

Question 18

Erythroplakia treatment

Answer 18

surgical excision. Generally it is more important to excise widely than deeply in dysplastic and in situ lesions as the dysplastic cells tend to be superficial and beyond the margin of the lesion. However salivary ducts can contain dysplastic cells so it cannot be too shallow
it is generally accepted that dysplastic lesions eventually become invasive

Question 19

Kaposi’s sarcoma Etiology

Answer 19

Neoplastic proliferation of endothelial cell origin with dermal/submucosal dendrocytes, lymphocytes, or mast cells having a minor role
It is related to HHV8 with AIDS patients or organ transplant patients
Skin lesions are not limited to the extremities, and may be multifocal. Oral lesions may be the only site of involvement.
They appear as trivial-appearing flat lesions to late, nodular, exophytic lesions, that may be single or multifocal. Colour is red/blue

Question 20

Kaposi’s sarcoma histopathology

Answer 20

early lesions can be subtle, with hypercellular foci containing bland-appearing spindle cells, and an increase in capillary channels
Later they can resemble pyogenic granulomas. Late stage has spindle cell proliferation and bizarre capillaries

Question 21

Kaposi’s sarcoma differnetial diagnosis

Answer 21

Hemangioma
Erythroplakia
Malanoma
Pyogenic Granuloma

Question 22

Kaposi’s sarcoma treatment

Answer 22

Highly active antiretroviral therapy has the greatest effect (treating AIDS)
Chemotherapy directed against angiogenesis and cytokine pathways may also be beneficial
Surgery on localized lesions or low-dose radiation and intralesional chemotherapy can be done

Question 23

Plasma Cell Gingivitis Etiology

Answer 23

frequently found as an allergy to chewing gum or other irritants.
burning mouth, tongue, or lips is the chief complaint
sudden onset is expected, and accompanied by distinctive clinical changes, the attached gingiva fiery red and edematous but not ulcerated.

Question 24

Plasma Cell Gingivitis Histopathology

Answer 24

epithelium is spongiotic and infiltrated by inflammatory cells. Langerhans cells are prominent. Apoptotic keratinocytes may occasionally be seen
lamina propria displays prominent capillaries and infiltrated by plasma cells

Question 25

Plasma Cell Gingivitis Treatment

Answer 25

most patients respond quickly to cessation of chewing gum or toothpaste containing cinnamic-aldehyde-containing flavoring agent

Question 26

Petechiae and Ecchymoses Etiology

Answer 26

Petechiae (pinpoint size) or Ecchymoses (larger than pinpoint size) appear intraorally from trauma to blood vessels, resulting in leakage of blood into connective tissue, producing red to purple lesions.
If no traumatic cause can be discerned, pt should be referred to hematologist due to possible leukemia or platelet coagulation defects

Question 27

Petechiae and ecchymoses Diagnosis

Answer 27

inability to explain the appearance o these should suspect blood dyscrasias
Gingivitis that is refractory to standard therapy should be viewed as potential dyscrasia