Soft Tissue Lesions

Front 1

most common lesion of the oral cavity

Back 1

Irritation Fibroma (traumatic Fibroma)
- sessile nonvascular soft, smooth mass made up of dense collagenous tissue with minimum inflammatory cells.
- 1 to 2 cm.

Front 2

Back 2

Epulis Fissuratum (Denture-Induced or Inflammatory Fibrous Hyperplasia, Denture Epulis)
- Long folds of dense connective tissue in the vestibule
- Irritation by flange of loos denture over a long period of time. Often not inflamed, but may be ulcerated.
- Similar lesion on hard palate beneath maxillary denture is called a FIBROEPITHELIAL POLYP or leaf-like denture fibroma.

Front 3

Visually looks like fibroma, the only difference is microscopic.
- Vascular fibrous tissue
- Large stellate fibroblasts
- usually less than 1 cm in diameter
- first three decade of life

Back 3

Giant cell Fibroma.
- Does NOT appear to be associated with irritation.
- 50% appear on gingiva (twice as common on mandible than maxilla)
-

Front 4

numerous vertical projections each composed of orthokeratotic or parakeratotic squamous epithelium with connective tissue core.

Back 4

Papillary Hyperplasia (Inflammatory papillary hyperplasia, Palatal Papillomatosis)
- Often due to wearing denture or flipper 24 hrs a day.
- Chronic atrophic candidiasis
- poor denture hygiene
For complete regression must do surgery or electosurgey
- treat w/ scalpel, fluted bur, electro- or laser surgery.

Front 5

"3 p's"

Back 5

Pyogenic granuloma (pregnancy tumor)
- Usually on gingiva (interdental area), red, elevated adn pedunculated. Soft, bleeds easily, often ulcerated
- exuberant tissue response to irritation (b/c of hormones)
- excise, may have high rate of recurrence during pregnancy

Front 6

Probably arise from periodontal ligament or mucoperiosteum.
"3 p's"

Back 6

Peripheral Giant Cell Granuloma (Tumor)
-Occurs exclusively on gingiva
- Dark and red usually or blue purple, but may be mucosal color (more pink than pyogenic granuloma, not as red)
- more aggressive, can move teeth

Front 7

Back 7

Peripheral Giant Cell Granuloma (Tumor) again
- Delicate C.T. stroma w/ multinucleated gian cells.

Front 8

Back 8

Peripheral Giant Cell Granuloma (Tumor) again
- Delicate C.T. stroma w/ multinucleated gian cells.

Front 9

"3 p's"

Back 9

Peripheral (ossifying) Fibroma
- clinically can't distinguish from giant cell.
- more common in young adults and children, twice as common in females
- ONLY found on gingiva, usually anterior to molar region and less than 2 cm.
- May be irritation or odontogenic in origin.
- Dense connective tissue (very cellular like fibroma, but may have calcification or ossification)
- may show radiopaque foci.

Front 10

Back 10

Epulis granulomatosa

Front 11

Which of the " 3 p's" is more aggressive and can move teeth?

Back 11

Peripheral Giant Cell Granuloma (Tumor)

Front 12

Which of the the "3 p's" occurs exclusively on the gingiva?

Back 12

Peripheral Giant Cell Granuloma (Tumor)
&
Peripheral (ossifying) Fibroma

Front 13

red vascular tissu growing out of a recent extraction site or socket ( may mimic a pyogenic granuloma)

Back 13

Epulis Granulomatosa
- Made up of granulation tissue
- metastatic carcinomas occasionally masquerade as this.
Etiology = irritation
- Calculus tooth fragment, bony sequestra in socket
Treatment - excise

Front 14

Hyperplastic growth of granulation tissue that at times arise in healing extraction sockets.
- usually represent a granulation tissue reaction to bony sequestra in the socket

Back 14

Epulis granulomatosa.

Front 15

Usually can see blood vessels on surface

Back 15

Lipoma
- Benign neoplasm of Fat
- uncommon orally
- possible reaction of fat to trauma
- 30+ years of age

Front 16

Most common mesenchymal neoplasm, but uncommon orally

Back 16

Lipoma

Front 17

Malignant neoplasm of fatty origin

Back 17

LIposarcoma
- considered the most common soft tissue sarcoma and account for 20% of all soft tissue malignancies in adults. The most common sites are the thigh, retroperitoneum, and inguinal region.
- They are rare in the head and neck regions.

Front 18

Back 18

Neurilemoma (Schwannoma)
-Black arrow (left) = Antoni A; Blue arrow (right) = Antoni B
- The Schwann cells of the Antoni A tissue form a palisaded arrangement around acellular zones known as Verocay Bodies

Front 19

slow growing nodular painless mass that can occur at any age.

Back 19

Neurilemoma (Schwannoma)
- Uncommon orally but 25-50% occur in head and neck
- Tongu is the most common intra-oral site
- Can occur in bone (usually mandible)
- Tumor of sheath of Schwann
- Excise (well encapsulated)

Front 20

The most common type of peripheral nerve neoplasm.

Back 20

Neurofibromas
- can arise as a solitary mass or be a component of neurofibromatosis.

Front 21

Back 21

Neurofibroma
- skin is the most frequent location, but not uncommon orally.
- Can arise centrally w/in bone.

Front 22

Probably arises from schwann cells, fibroblasts and perineural cells.

Back 22

Neurofibromatosis type 1. AKA Von Recklinghausen's Disease of the skin.
Skin is the most common site, 72-92% have oral lesions
majority of pt.s show cafe-au-lait spots
may have small to large nodules to baggy pendulous masses (elephatitis neuromatosa)

Front 23

Not a true neoplasm

Back 23

Traumatic (amputation) Neuroma
- attemped repair of damaged nerve. Often after tooth extraction
- usually appears a small nodule less than .5 cm.
- Mental nerve area common location (also tongu and lower lip)

Front 24

Proliferation of blood vessels that is often congenital and common in the head and neck regions (60%)
- 3:1 female predilection.

Back 24

Hemangioma
- will blanch, diascope.
- common oral regions are lips, tongue, buccal mucosa and palate.
- A unilateral hemangioma on the face following the division of the trigeminal nerve is called a port-wine stain.
may also occur in bone.

Front 25

Methods of treatment for hemanioma?

Back 25

Surgery
radiation
cryosurgery
steroids
interferon-?-2A
lasers
NEVER do incisional biopsy

Front 26

Back 26

Hereditary Hemorrhagic Telangiectasia (Rendu-Osler-Weber Disease)
- Autosomal dominant
- tend to undergo repeated hemorrhage
- Epistaxis may be an early sign
- Pt. may suffer from anemia, but not usually life threatening.

Front 27

present at birth, but not hereditary.

Back 27

Sturge-Weber Syndrome (Variant of hemangioma)
- "Portwine Nevi" Unilateral areas provided by trigeminal
- May have vascular hyperplasia orally.
- Neurological manifestations related to leptomeningeal angiomas and calcifications
-a. may have convulsive disorders
-b. may have mental retardations.

Front 28

Back 28

Lymphangioma (most present at birth, 95% arise before age 10).
- commonly in the head and neck
- Oral - most commonly occurs in tongue (may be papillary in appearance in superficial area)

Front 29

Back 29

Lymphangioma
Histo - numerous spaces lined by endothelium containing lymph. Some may also have blood = mixed hemangiolymphanioma.
- surgery only treatment of choice, tend to recur.

Front 30

Back 30

Leiomyoma - benign neoplasm of SMOOTH muscle.
- uncommon orally - usually on poster of tongue
- ecapsulated, painless, firm and may be multinodular.

Front 31

Back 31

Rhabdomyoma - Benign lesion of SKELETAL muscle.
- Rare
- most common location is tongue

Front 32

Occurs anywhere, especially tongue (50%+), all ages

Back 32

Granular Cell Tumor
Benign soft tissue neoplasm, 2:1 female predilection
asypmtomatic sessile nodule up to 2 cm in diameter.
Controversial origin most likely Schwann cells or undifferentiated mesenchymal cell.
Histo: large granular cells w/ eiosinophilic cytoplasm
- may display pseudoepitheliomatous hyperplasia.

Front 33

Back 33

Congenital Granular Cell Epulis (congenital epulis of the newborn)- present and birth...
Usually in Maxillary anterior gingiva
90% female predilections
-excise - recurrence uncommon.

Front 34

What disease is similar to Granular cell tumor, but does NOT display pseudoepitheliomatous hyperplasia; and is seen in the new born?

Back 34

Congenital Granular Cell Epulis (congenital epulis of the newborn)

Front 35

Probably of neural crest origin

Back 35

Melanotic Neuroectodermal Tumor of Infancy
- usually occurs in anterior maxilla
-usually occurs as rapidly growing dark pigmented lesion
- Pts. have high levels of vanilmadelic acid in urine.
HISTO: infiltrating tumor mass of cells arranged in a patter of alveolus-like spaces lined by cuboidal cells.