Soft tissue differential diagnosis Flashcards
(50 cards)
case 1
pseuomembraneous candidiasis
-multiple white plaques
-wipes off leaving erythematous area
-commonly found in immunocompromised patients
6 weeks, burning sensation, wide spectum antiboditc
case 2
-bump on gums
-location: lingual gingiva
-has not displaced teeth
-no radiographic calcifications
-sessile, nodule, ulceration, erythema
-firm
-middle-aged female
- not pregant
BUMP ON GUMS DIFFERENTIAL DIAGNOSIS
- Pyogenic granuloma
- Peripheral ossifying fibroma
- Peripheral giant cell granuloma
hyperplastic meschycmal cells with formation of hard tissue -POF
case 3
- location: buccal mucosa & vestibule
- white plaque
- wipes off
- not d/t trauma
- no tobacco use
- frequent use of aspirin due to bombed out molar
- slough off
This is a chemical burn
- intraorally chemical burns look white & oral mucosa sloughs off
case 4
- location: hard palate
- nodule with some redness
- soft tissue firm/ fixed
- female patient
- painful - not an indicator
- pt noticed a fast growing
- been there a year
Differential diagnosis:
- polymorphous low grade adenocarcinoma (PLGA)
- pleomorphic adenoma
- mucoepidermoid carcinoma
histo- mucus cells, intermediate cell( clear cell) - MC
case 5
Describe this lesion & give a differential diagnosis:
- sessile, ulcerated nodule located on dorsal of tongue
- painful yes
- slow growing
- hx of trauma
- bit
- male age 45
- Differential diagnosis:
1. tramatic fibroma
2. giant cell fibroma
3. pyogenic granuloma
4. peripheral giant cell granuloma
histo - ulceration of the overlyring starum granulation tissue
DX- pyogenic granuloma
case 6
Describe this lesion & give a differential diagnosis:
- submucosal amass, yellow, located on dorsal of tongue
- firm
- few years
- stable growth
- Differential diagnosis:
1. lipoma
2. lyphoepithlial cyst - 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
not invasion
sesslie pic side of check
DDX:
1. fibroma
2. giant cell fibroma
3. mucocle
4. pyogenic
5. neurofibroma
histo:
spindle shaped cells
wavy nucli
postive for S100
Dx: neurofibroma wavy nucli
sesslise tip tongue
DDX:
1. pyogenic granuloma
2. tramatic fibroma
3. tramatic neroma
histo:
fiboblasts
DX: Fibroma
tongue side white
- non-smoker
- unknown duration
- no pain
- no trauma
- HIV positive
- bilateral
- can’t wipe off
- mulitifocal
DDX:
1.Oral Hairly Leukoplaia
2.hyperplastic candidias
Histo
DDX
erythema of gums
- positive nikosky
- not punched out
- no fever
- no skin lesion
- NKA
- no new tooth paste
- painful
- desquatmative gingivitis
- couple years
DDX:
1. Pemphingus
2. Pemphigoid
3. Erosive Lichen Planus
Histo:
subephileal split
linear line IgG
DX:Pemphigoid
end of lecture
What is the histology of a peripheral giant cell granuloma?
Chocolate chip cookies (multinucleated giant cells)
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
Hyperplastic candidiasis
-does NOT wipe off
-leukoplakia appearance
The histology of a pyogenic granuloma would have:
granulation tissue (NOT granulomatous tissue)
granulation tissue= endothelial cells, fibroblasts, myofibroblasts
Describe a peripheral ossifying fibroma:
- reactive lesion NOT a neoplasm
- teens + young adults
- EXCLUSIVELY on gingiva
- fibrous hyperplasia with OSSEOUS metaplasia (may appear radiopaque)
Peripheral ossifying fibroma
Peripheral ossifying fibroma
-may appear radiopaque due to fibrous hyperplasia with osseous metaplasia
Describe a peripheral giant cell granuloma:
- reactive lesion NOT a neoplasm
- older adults
- exclusively on gingiva & edentulous alveolar ridge
- bluish/purple due to containing hemosideran
- may recur
Peripheral giant cell granuloma
-bluish/purple due to containing hemosideran
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 ____
50/50
lymphoma
Most common salivary gland tumor:
pleomorphic adenoma (AKA benign mixed tumor)
- middle aged females
- painless
- slow growing
- mix of myoepithelial & ductal elementd
- ENCAPSULATED
Differential diagnosis for bump on gum:
- pyogenic granuloma (can occur on tongue)
- peripheral ossifying granuloma (exclusive to gingiva)
- peripheral giant cell granuloma (exclusive to gingiva)
How would you describe this type of inflammation?
What are some differential diagnosis that present with this type of inflammation?
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)
