SCR - Oral Surgery/Histology

Question 1

FIBROUS EPULIS - what location of the mouth do they affect ?

Answer 1

Gingivae ONLY (peripheral lesion, no central involvement).

Question 2

FIBROUS EPULIS - what is the cause ?

Answer 2

Hyperplastic response to irritation - overhangs or subgingival calculus.
Therefore, high recurrence if cause is not removed.

Question 3

FIBROUS EPULIS - describe the clinical characteristics.

Answer 3

Smooth surface, round swelling, pink, pedunculated, posterior gingivae affected most, firm.

Question 4

FIBROUS EPULIS - how should they be managed ?

Answer 4

Excisional biopsy with Coe pack dressing.
Removal of cause.

Question 5

FIBROUS EPULIS - what are some differential diagnoses ?

Answer 5

Benign odontogenic tumour (rare).
SSC (rare).
Lateral periodontal or gingival cyst.
Pyogenic granuloma - vascular epulis.
Peripheral giant cell lesion.

Question 6

FIBROUS EPULIS - what are some histopathological features ?

Answer 6

Keratinised stratified squamous epithelium.
Hyperplastic epithelium covering granulation tissue.
Metaplastic bone formation.
Fibroblasts, plasma cells, macrophages, fibrin.
Blood vessels.
Ulceration.

Question 7

What is granulation tissue ?

Answer 7

New CT and microscopic blood vessels formed during tissue healing.
Grows from base of a lesion - wound healing by secondary intention.
Sign of cellular developmental and MMPs.

Question 8

What stain is used for histopathological analysis ?

Answer 8

Haematoxylin and eosin staining (H&E).

Question 9

PYOGENIC GRANULOMA - what are the two types affecting gingivae ?

Answer 9

Pregnancy epulis. Vascular epulis.

Question 10

PYOGENIC GRANULOMA - has same histological appearance as what lesion ?

Answer 10

Fibrous epulis.
- Granulation tissue.
- Capillaries and blood vessels.
- Fibroblasts and neutrophils.
- Ulceration.

Question 11

PYOGENIC GRANULOMA - where are they most commonly found ?

Answer 11

Tongue and lip - can be found on gingivae too.

Question 12

PERIPHERAL GIANT CELL GRANULOMA - where are they most commonly found ?

Answer 12

Gingivae.

Question 13

PERIPHERAL GIANT CELL GRANULOMA - what medical conditions are most commonly associated ?

Answer 13

Increased PTH - low vit D, malabsorption, renal disease.
TB.
Sarcoidosis.
Chronic inflammatory conditions.

Question 14

PYOGENIC GRANULOMA - how should they be managed ?

Answer 14

Surgical excision and curettage.

Question 15

PERIPHERAL GIANT CELL GRANULOMA - what is the clinical characteristics ?

Answer 15

Deep red or purple, chronic irritation, broad base.

Question 16

PERIPHERAL GIANT CELL GRANULOMA - what age range are most commonly affected ?

Answer 16

Children and teenagers.

Question 17

PERIPHERAL GIANT CELL GRANULOMA - how should they be managed ?

Answer 17

Rule out high PTH.
X-ray to rule out central giant cell granuloma.
Surgical excision and curettage of base + Coe pack dressing.

Question 18

CENTRAL GIANT CELL GRANULOMA - how would they appear on an OPT ?

Answer 18

Radiolucency at alveolar bone level.
Can cause root resorption of teeth.

Question 19

PERIPHERAL GIANT CELL GRANULOMA - what are the histological features ?

Answer 19

Multinucleated giant cells present.
Red blood cells and vascular stroma.
Fibroblasts.
Haemosiderin.

Question 20

PERIPHERAL GIANT CELL GRANULOMA - what are multinucleated giant cells ?

Answer 20

Fused macrophages due to unphagocytosable material.

Question 21

FIBROEPITHLIAL POLY (TRAUMATIC FIBROMA) - what locations of the mouth do they commonly affect ?

Answer 21

Cheek, lip, tongue.

Question 22

FIBROEPITHLIAL POLYP (TRAUMATIC FIBROMA) - what is the clinical appearance ?

Answer 22

Semi pedunculated/sessile, pink, smooth surface.

Question 23

FIBROEPITHLIAL POLY (TRAUMATIC FIBROMA) - how should they be managed ?

Answer 23

Remove and address cause.
Can shrink in size or remove.

Question 24

FIBROEPITHLIAL POLY (TRAUMATIC FIBROMA) - what are the histopathological features ?

Answer 24

Fibrous tissue covered by thick epithelium.
Keratinised stratified squamous epithelium.
Collagen fibres.

Question 25

DENTURE INDUCED HYPERPLASIA - what is the cause ?

Answer 25

Ill-fitting denture. Can be seen with ulceration and trauma. Can be problematic in denture construction.

Question 26

DENTURE INDUCED HYPERPLASIA - how should this be managed ?

Answer 26

Denture with soft lining to let settle. New denture construction. If persists for >4 weeks - refer for biopsy.

Question 27

LEAF FIBROMA - is what lesion but compressed by denture ?

Answer 27

Fibroepithelial polyp.

Question 28

LEAF FIBROMA - how should they be managed ?

Answer 28

Remove and address cause - new denture.

Question 29

PAPILLARY HYPERPLASIA OF PALATE - what is a differential diagnosis ?

Answer 29

Invasive squamous cell carcinoma.

Question 30

PAPILLARY HYPERPLASIA OF PALATE - what are the histopathological features ?

Answer 30

Pseudoepithlialmatous hyperplasia. Extending to CT. Epithelial cells are normal and show no dysplastic change. Candida can be present.

Question 31

HAEMANGIOMA - what are the two types ?

Answer 31

Capillary and cavernous.

Question 32

HAEMANGIOMA - what are the clinical features ?

Answer 32

Blue, soft, bleeds easily, can become more fibrotic, can shrink, leaves birth mark.

Question 33

HAEMANGIOMA - how can they be managed ?

Answer 33

Surgical removal. Cryotherapy.

Question 34

HAEMANGIOMA - what is the disadvantage of cryotherapy ?

Answer 34

Lesion cannot be biopsied - be sure of diagnosis.

Question 35

SQUAMOUS CELL PAPILLOMA - what are the clinical features ?

Answer 35

Pedunculated, white surface, cauliflower appearance, benign neoplasm, can look like viral warts.

Question 36

SQUAMOUS CELL PAPILLOMA - how should they be managed ?

Answer 36

Excision.

Question 37

SQUAMOUS CELL CARCINOMA - what is the classic appearance ?

Answer 37

Non-healing ulcer/lump, rolled margin, induration, bleeds easily, fixed to surrounding tissue, red or white in colour.

Question 38

SQUAMOUS CELL CARCINOMA - how should they be managed ?

Answer 38

Incisional biopsy via rapid access pathway (2 week urgent referral).

Question 39

POTENTIAL MALIGNANT DISORDERS - Define potentially malignant disorder.

Answer 39

Altered tissue which makes cancer more likely AND generalised state with increased cancer risk.

Question 40

POTENTIAL MALIGNANT DISORDERS - What are some predictors of malignancy ?

Answer 40

Age, smoking status, HPV status, gender, site, non-homogenous (mixed or verrucous), proliferative verrucous leukoplakia, molecular markers (p53), non-cohesive front.

Question 41

POTENTIAL MALIGNANT DISORDERS - What HPV status is more likely to be potentially malignant ?

Answer 41

HPV-

Question 42

POTENTIAL MALIGNANT DISORDERS - what areas of the mouth are high risk ?

Answer 42

Floor of mouth and tongue.

Question 43

POTENTIAL MALIGNANT DISORDERS - what architectural atypia is most commonly associated with lymph node involvement ?

Answer 43

Non-cohesive front. Perineural spread. Haematogenous spread.

Question 44

POTENTIAL MALIGNANT DISORDERS - what are histopathological signs of chronic hyperplastic candidasis ?

Answer 44

Irregular hyperplastic epithelium - acanthosis. Excessive keratin. Candida hyphae in epithelium. Inflammatory infiltrate at lamina propria. Dysplasia - mitotic figures - loss of polarity of basal cells. Neutrophils in epithelium causing microabscesses.

Question 45

POTENTIAL MALIGNANT DISORDERS - what type of staining helps visualise candida hyphae in chronic hyperplastic candidasis ?

Answer 45

Periodic Schiff staining - removes carbohydrate and then stain. Better visualisation.

Question 46

POTENTIAL MALIGNANT DISORDERS - how should chronic hyperplastic candidasis be managed ?

Answer 46

Systemic antifungals - 50mg 1x daily 14 days fluconazole. Incisional biopsy. Smoking cessation. Active observation with clinical photographs.