Soft Tissue Lesions and Biopsy Flashcards
(59 cards)
What is a biopsy?
Sample for histopathological analysis
- Helps confirm or establish diagnosis (not necessarily of malignancy)
- Determines prognosis and treatment required
When would you consider referral for biopsy?
If lesion prone to bleeding
If suspected cancer
Lumps in upper lip (always presumed cancer until proven different- common site for minor gland lesions)
When may a patient choose to not biopsy a growth?
If it is a traumatic polyp
Why do we biopsy lesions?
- To remove it- ending disease process
- To identify lesion
Why are aspirates from abscesses preferred over swab?
- Avoids contamination
- Protection of anaerobic species
- If keratocyst- white cheesy material
- Radicular/dentigerous cyst- straw coloured fluid
- Determines whether solid or fluid filled
- If blood- may be haemangioma
What other aspirates may be taken?
Blood sample
* Venous blood
* eg. FBC, U&E, haematinics, glucose etc
What is a fine needle aspirate and its uses?
Aspirate cells from solid lesions, sent to cytology
- Neck swellings
- Breast lesions
- Salivary gland
What is done in an excision biopsy?
- Remove all of clinically abnormal tissue
- You must be fairly confident of provisional diagnosis
What are the indications for excisional biopsy?
Usually benign lesions-fibrous overgrowths, denture hyperplasia, mucoceles (well-known clinical appearance)
Must be discrete lesion
What is an incisional biopsy?
Don’t remove lesion but take representiitve sample of it
What are the instances may an incisional biopsy be opted for?
Larger lesions that may be spread
Uncertain diagnosis- leukoplakia, LP, SCC (sometimes a discrete lesion- but leave some evidence to help guide surgeons)
What are the features of a punch biopsy?
Type of incisional biopsy
- Uses Hollow trephine- 4, 6, 8mm diameter
- Removes core of tissue- would be difficult to remove with scalpel
- Minimal damage
- May not require suture or minimal suturing
How is an area for incisional biopsy selected?
- Must be large enough
- Must be representative (may need to take more than one)
- If an ulcer- take peri-lesional biopsy (tissue next to ulcer)
How is a sample sent to pathology lab?
- Put into 10% formalin (be careful with handling as it is carcinogenic)
- Don’t place on damp swab- distorts
- Suture to help pathologist orientate (if that is important)
- Include relevant clinical info (description, include diagrams or pictures)
What can a specimen be put onto if gauze is not allowed?
Filter paper
What damage can occur to specimens if handled incorrectly?
Crushing can occur when taking biopsy
-> Distorts flat samples
Tear- surface of epithelium is ripped off from underlying tissue (can look like different disease)
What information is provided on pathology form?
- All information possible about patient- name, DoB, gender, address, who to contact-number, where the report is to go to, hospital number, department (ensure this is filled out properly)
- Tick histopathology
- When you collected- time and date
- What sample is (nature)- basic description
- Clinical details- MH, provisional diagnosis
- Risk of infection- specify
How does cytopathology specimen differ from histopathology? (rare in dentistry)
- Goes on slide
- Is fresh sample not fixed
What information may we want to include when describing a lesion?
- Location
- Colour- white, red, mixed etc
- Pattern/texture- striated, ulceration
- Size
What should be done when putting specimen in the pathology pot?
- label as fully as possible
- correct usage should ensure no leaks
- do not confuse with the tooth collection pots
-> Package and send to pathology at QE, by courier (may not be possible in GDP)
What should we avoid when choosing area to sample with biopsy?
Try to avoid:
salivary gland duct orifices
tip of tongue
areas close to nerves
larger blood vessels
** Not required to take normal tissue margin
What are fordyce spots?
Fordyce spots- ectopic sebaceous glands
-> Does not require biopsy
What is a fibrous epulis?
Swelling arising from the gingivae caused by hyperplastic response to irritation
-> Overhanging restorations
-> Subgingival calculus
How does a fibrous epulis appear clincially?
Smooth surface
Rounded swelling
Pink
Pedunculated
