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Pathology II > Soft tissue differential diagnosis > Flashcards

Soft tissue differential diagnosis Flashcards

1
Q
A

pseuomembraneous candidiasis

-multiple white plaques
-wipes off leaving erythematous area
-commonly found in immunocompromised patients

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2
Q
A

Hyperplastic candidiasis

-does NOT wipe off
-leukoplakia appearance

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3
Q
A

atrophic candidiasis

-aka erythematous candidiasis
-clinically appears erythematous
-can be seen with central papillary atrophy or median rhomboid glossitis or denture stomatitis (due to poor hygiene)
-will cause a red outline on the mucosa

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4
Q
A

-bump on gums
-location: lingual gingiva
-has not displaced teeth
-no radiographic calcifications
-sessile, nodule, ulceration, erythema
-firm
-middle-aged female

BUMP ON GUMS DIFFERENTIAL DIAGNOSIS

  1. Pyogenic granuloma
  2. Peripheral ossifying fibroma
  3. Peripheral giant cell granuloma
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5
Q

What is the histology of a peripheral giant cell granuloma?

A

Chocolate chip cookies (multinucleated giant cells)

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6
Q

The histology of a pyogenic granuloma would have:

A

granulation tissue (NOT granulomatous tissue)

granulation tissue= endothelial cells, fibroblasts, myofibroblasts

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7
Q

Describe a peripheral ossifying fibroma:

A
  • reactive lesion NOT a neoplasm
  • teens + young adults
  • EXCLUSIVELY on gingiva
  • fibrous hyperplasia with OSSEOUS metaplasia (may appear radiopaque)
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8
Q
A

Peripheral ossifying fibroma

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9
Q
A

Peripheral ossifying fibroma

-may appear radiopaque due to fibrous hyperplasia with osseous metaplasia

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10
Q

Describe a peripheral giant cell granuloma:

A
  • reactive lesion NOT a neoplasm
  • older adults
  • exclusively on gingiva & edentulous alveolar ridge
  • bluish/purple due to containing hemosideran
  • may recur
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11
Q
A

Peripheral giant cell granuloma

-bluish/purple due to containing hemosideran

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12
Q
A
  • location: buccal mucosa & vestibule
  • white plaque
  • wipes off
  • not d/t trauma
  • no tobacco use
  • frequent use of aspirin due to bombed out molar

This is a chemical burn
- intraorally chemical burns look white & oral mucosa sloughs off

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13
Q
A
  • location: hard palate
  • nodule with some redness
  • soft tissue firm
  • female patient
  • not painful
  • slow growing

Differential diagnosis:
- polymorphous low grade adenocarcinoma (PLGA)
- pleomorphic adenoma
- mucoepidermoid carcinoma

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14
Q

On the hard palate there is a ton of minor salivary gland tissue, so if you have a bump/swelling/etc. there is a ____ chance that it is malignant

Another thing to consider when you have an enlargement of the hard palate is a ____

A

50/50

lymphoma

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15
Q

Most common salivary gland tumor:

A

pleomorphic adenoma (AKA benign mixed tumor)

  • middle aged females
  • painless
  • slow growing
  • mix of myoepithelial & ductal elementd
  • ENCAPSULATED
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16
Q

Differential diagnosis for bump on gum:

A
  1. pyogenic granuloma (can occur on tongue)
  2. peripheral ossifying granuloma (exclusive to gingiva)
  3. peripheral giant cell granuloma (exclusive to gingiva)
17
Q

How would you describe this type of inflammation?

What are some differential diagnosis that present with this type of inflammation?

A

Granulomatous inflammation
-pattern of chronic inflammation
-aggregates of epithelioid macrophages
- multinucleated giant cells
- mononuclear leukocytes
- principal lymphocytes
- occasionally plasma cells (peripherally)
- fibrosis variable

Differential diagnosis
1. Crohn’s disease
2. Deep fungal infections (example: coccidiomycosis)
3. Tuberculosis (caseous necrosis)

18
Q

How would you describe this histological slide?

What disease is seen with this type of presentation?

A

Granulation tissue

  1. pyogenic granuloma
19
Q

List the differential diagnosis to the following presentation:

A
  1. chemical burn (aspirin)
  2. toothpaste allergy (SLS)
  3. cheek biting (trauma)
  4. pseudomembranous candidiasis
20
Q

Where is the most common intraoral- extranodal area for lymphomas?

A

hard palate

21
Q

You see a bump on the hard palate & upon palpating you note that it is squishy & bogging. What is a good diagnosis?

A

lymphoma

22
Q

Most common salivary gland tumor:

What is its comprised of histologically?

A

Pleomorphic adenoma
(MC location palate)

Myopeithelial & ductal cells

23
Q

Describe how this appears histologically:

What is a likely diagnosis?

A

Monomorphic adenoma
(MC location upper lip)

Histology
- uniform pattern
- single layered cords of columnar or cuboidal epithelium

24
Q

A malignant salivary gland tumor (the low grade version of this mimics a mucocele):

A

mucoepidermoid carcinoma

  • most common MALIGNANT salivary gland tumor
  • middle-aged females
  • clinically mistaken for mucocele

Histology
- mucus producing cells
- epidermoid (squamous) cells
- may be cystic and/or solid

25
Q

You note this Swiss cheese histological appearance, automatically consider:

A

Adenoid cystic carcinoma

  • best recognized salivary gland tumor
  • malignant salivary gland tumor
  • middle aged females
  • painful
  • slow growing

Histology
- peri neural & peri vascular invasion
- myoepithelial & ductal cells
- cribriform pattern

26
Q

Histology
- deceptive uniform appearance
- different growth patterns
- perineurial & perivascular invasion
- Indian filing

A

Polymorphous Low-grade Adenocarcinoma (PLGA)

  • common malignant minor salivary gland neoplasm
  • middle-aged females
  • favors palate
27
Q

If you see a salivary gland tumor in a kid (rare) it is most likely:

A

mucoepidermoid carcinoma
- most common malignant salivary gland neoplasm
- middle-aged females
- clinically mistaken for a mucocele

28
Q

You can see perineural & perivascular invasion in any tumor, but in the oral cavity its most commonly seen in:

A
  1. adenoid cystic carcinoma
  2. PLGA
29
Q

Describe this lesion & give a differential diagnosis:

A
  • sessile, ulcerated nodule located on dorsal of tongue
  • Differential diagnosis:
    1. pyogenic granuloma
    2. peripheral giant cell granuloma
30
Q

Describe this lesion & give a differential diagnosis:

A
  • submucosal amass, yellow, located on dorsal of tongue
  • Differential diagnosis:
    1. fordyce granules
    2. mucoele
    3. squamous cell carcinoma (extremely rare to see on dorsal of tongue- MC on ventral or lateral border)
  • Histology:
  • overlying stratified squamous epithelium
  • proliferation of pseudomembranous hyperplasia
  • large pinkish cells that have granular cytoplasm
  • S100 stain = diffusely positive
  • this is NOT a mucocele because no salivary glands on dorsal of tongue
  • NOT fordyce granules because they are small & multiple (although they are yellow)
  • malignancy of muscle - sarcoma bc the tongue is a muscle
  • benign growth of skeletal muscle - arabdomyoma
  • benign growth of connective tissue - fibroma
  • nerve tissue benign tumor - neuroma, schwanoma, neurofibroma

Actual diagnosis: granular cell tumor - most common on dorsal of tongue & a yellow-ish submucosal mass

31
Q

Nodular blue-ish bump on tongue rather than yellow, location = dorsal of tongue:

A

lymphangioma

32
Q

If a white lesion is bilateral, it will never be a ____ but ca be ___ or ____

A

leukoplakia; lichen planus or oral hairy leukoplakia

33
Q

If a white lesion is unilateral, it can be:

A
  1. leukoplakia
  2. hyperplastic candidiasis
  3. squamous cell carcinoma
  4. epithelial dysplasia
  5. carcinoma in-situ
34
Q

If you notice an erythroplakia, the diagnosis options may be:

A
  1. squamous cell carcinoma
  2. epithelial dysplasia
  3. carcinoma in situ
35
Q

Case 1:

-ulcerated nodule located on dorsal of tongue
-been present for around 7 months
- painful
- only lesion present

Differential diagnosis
1. erythrematous multiforme
2. pyogenic granuloma
3. peripheral giant cell granuloma (ruled out bc these are not found on tongue)

Histology shows granulation tissue- what is this?

A

Pyogenic granuloma

36
Q
A

Pathology II (17 decks)

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