Oral Pathology Week 7 Ppt - Soft Tissue Enlargements

Origination of Lesions: What 8 sources can these come from?

Vocab Terms for Neoplastic-type lesions:

Lesion comprised of an excessive abnormally arranged mass of normal tissue at any given site.

Vocab Terms for Neoplastic-type lesions:

Lesion occurring as a well-formed entity in anarea where it would NOT be expected to be found.

Size and Shape and Palpation:

How are larger lesions detected and diagnosed?

Size and Shape and Palpation:

How are smaller lesions detected and diagnosed?

Inflammatory Growths:

From trauma that severs nerve tissue orfibers.

Appear as small firm nodules covered bynormal mucosa.

Usually painful when palpated.

Found in areas most common to injury on thetongue, around the mental foramen, and mandibular incisors.

Surgically removeto treat

Inflammatory Growths:

aka. Focal Fibrous Hyperplasia, IrritationFibroma, Traumatic Fibroma.

Reactive response to chronic trauma.

Most common tumors found in the oral cavity.

Trauma causes reactive hyperplasia resultingin fibrous connective tissue enlargement.

Growths are usually nodular and exophitic.Usually found on the tongue, buccal mucosaand lips.

Surgically removeto treat.

Will recur if trauma occurs again.

Inflammatory Growths:

Sometimes called “epulis fissuratum”.

Resulting from wearing an ill-fittingdenture.Patients should have their dentures examinedregularly and replaced or relined for optimum fit.

Inflammatory Growths:

Multiple hamartoma syndrome.

Rare geneticdisorder.

Patients develop facial papules 1 to 5millimeters, with 80% developing oral lesions.

Many patientsdevelop malignancies.

Inflammatory Growths:

Reactive hyperplastic lesion on the gingivathought to originate from submucosal connective tissue or the PDL.

Often seen in women in their 20’s.

Often displaces adjacent teeth.

Contains bone and deposits of cementum withinthe tissue and variable amounts of inflammatory cells.

Biopsy needed for a definitive diagnosisbetween the three types: POF, Giant cell and Peripheral odontogenic.

Excise to treat.

Inflammatory Growths:

Overgrowth of gingival tissues.

Can be from exuberant response to biofilm,calculus, hormone changes, meds such as phenytoin for epilepsy, calcium channelblockers for CVD, or cyclosporine for organ transplants.

Treat by discontinuing the meds orgingivectomy.

Inflammatory Growths:

Proliferation of lymph cells within lymph tissues.

Reactive response of the immune system caused by infectious agents or foreign substances that invade the body.

May require biopsy to diagnose and distinguish from a malignancy.

May appear bulbous, have a papillary or smooth surface usually the same color or slightly lighter than surrounding tissues.

Inflammatory Growths:

Inflammatory disease of unknown etiologyresulting in granulomas developing in organs and tissues.

Affects skin, salivary glands, lymph nodes,lungs, and eyes.

Prevalence is higher in African Americans andfemales more than males.

Lesions often resolve on their own, but orallesions can be treated with topical steroids.

Mycobacterium and Epstein-Barr virus has beensuggested as possibly associated with this disease.

May have genetic and environmental factors.Seen here is a maculopapular rash on theface.

Inflammatory Growths:

Descriptive term for a swelling in the floorof the mouth that resembles a frog's belly.

Usually caused by an obstruction of thesubmandibular or sublingual salivary gland.

Infections:

Caused by the paramyxo virus.

Patient may experience swelling of salivaryglands, usually the parotid which is known as parotitis.

Infections:

Bacterial infection due to xerostomia.

Patient may also have fever, malaise, andheadache.

Painful swelling of the gland ischaracteristic and trismusis common as well as painful chewing.

Pus is common at theduct.

Treat with analgesics, moist compresses, andstimulation of salivary flow.

Immune System Disorders:

Autoimmunedisorder.

2nd most common connective tissuedisorder next to Lupus.

Destruction of the exocrine glands especiallythe salivary and lacrimal glands.

Principal oral symptom is xerostomia.

Saliva may appear frothy with the lack ofpooling in the floor of the mouth.

Most common triad is rheumatoid arthritis,xerostomia, and kerato conjunctivitis.

Xerostomia will cause tissue atrophy andfissured tongue as well as altered taste and difficulty swallowing.

Soft Tissue Neoplasms:

Neoplastic Growth Characteristics

–Encapsulated.

–Do not metastasize.

–Local destruction.

Soft Tissue Neoplasms:

Neoplastic Growth Characteristics

–Not encapsulated.

–Replace normal functioning cells which result in cell death.

–Metastasize.

Soft Tissue Neoplasms:

Broad group of fibrous proliferations.

Occur more frequently under age 40 with young children and young adults affected most often and females more than males.

Lesions can be aggressive and are more destructive than benign neoplasms.

Lesions are firm when found in the soft tissues and can be found within bone and cause cortical bone to expand.

Biopsy needed to rule out fibrosarcoma.

Surgically excise to treat.

Soft Tissue Neoplasms:

Malignant tumor of fibroblasts that can occurin soft tissues or within bone.

Can occur after radiation therapy or burninjury.

Common in children and young adults.

Surgical excisionto treat.

Slow growing and may become quite largebefore they become painful.

Surgically exciseto treat.

Soft Tissue Neoplasms:

aka. Schwannoma.

From proliferation of the Schwann cells of the nerve sheath.

Slow-growing tumor that can occur in soft tissues or bone.

Mass of spindle-shaped cells surrounded by a fibrous capsule.

Surgical excision to treat.

Soft Tissue Neoplasms:

Benign neoplasm originating from Schwanncells that support peripheral nerves.

Average age is 45years.

Can be found onany nerve.

Slow-growing painless mass.

Most common on the tongue.

Surgical excisionto treat.

Soft Tissue Neoplasms: Two Types

Benign neoplasm of smooth muscle.

Rare in oralcavity.

Most often on the tongue, hard palate, andbuccal mucosa.

Painless.

Surgical removal.

The latter is a malignant lesion of smooth muscle.

Soft Tissue Neoplasms:

Benign neoplastic growth of striated muscle cells.

Painless submucosal swellings of the floor, tongue and soft palate.

Surgical removal to treat.

Soft Tissue Neoplasms:

Malignant tumor of striated muscle withunknown etiology.

Most often seen in children under age 15.

Rapidly growing mass.

Surgical excisionand chemo and radiation therapy.

Soft Tissue Neoplasms:

Benign neoplasm of adiposecells.

Most common soft tissuetumor of the body.

Rarein the oral cavity.

Palpable, smooth yellowishmass.

Found more often in adultsage 50+.

Surgicalremoval to treat.

Malignant counterpart of the Lipoma

Salivary Gland Neoplasms:

aka. mixed tumor.

Common benign neoplasm from the proliferationof salivary gland cells.

Slow-growing, firm masses that are slightlycompressible.

May be found as an enlargement of thesalivary gland.

Intraorally, it usually occurs on the palate.

Surgical removalto treat.

Salivary Gland Neoplasms:

aka. Warthin’s tumor.

Parotid glandtumor.

Etiology unknown but relationship withsmoking.

May be entrapment of salivary gland cellswithin lymph nodes as nodes are developing.

2nd most common benign parotidtumor.

Usually found ages40 to 70.Surgical removalto treat.

Salivary Gland Neoplasms:

Most common malignant salivary gland tumor inthe US.

Etiology unknown but thought to arise from proliferation of stem cells.

Also can occur within the bone of the maxilla or mandible.

Can be present for several years before noticed by patient.

Surgical removal to treat.

Salivary Gland Neoplasms:

Etiology unknown but may arise from serouscells within the major salivary glands.

Parotid gland is affected most often.

Slow-growing hard masses.

May cause facial nerve paralysis.

Surgical removal to treat may also involveremoval of the gland.

Minor Salivary Gland Malignancy:

Salivary neoplasm.

Appears most frequently at age 60.

Proliferation of salivary duct cells resulting in slow-growing, submucosal mass.

Palate most common site - might be source of ill-fitting denture.

Surgical removal to treat.

Minor Salivary Gland Malignancy:

Etiology unknown but may be genetic mutation.

Seen most often in ages 40 to 60.

High-grade malignant tumor arising most frequently within the minor salivary glands.

Slow-growing and may be tender to palpation. Surface may be ulcerated.

Surgical removal and radiation and immunotherapy to treat.

Genetic and Congenital Disorders:

aka. Recklinghausen’s disease of the skin.

Inherited disorder causing decreased production of neurofibromin (a substance that functions as a tumor suppressor).

Estimated to affect 1 out of 3000 people.

Intraoral neuromas appear in 25% of patients.

Well defined, painless, submucosal nodules.

Tongue can appear as macroglossia.

No treatment but patient should be monitored for changes to malignancy.

Genetic and Congenital Disorders:

Genetic disorder causing hyperplasia of target cells located in the thyroid and adrenal glands and in mucosal tissues leading to tumor formation.

Most people have a tall, slender body with long arms.

Oral lesions appear on lips, tongue, and any other mucosal surface.

Surgical removal of thyroid and adrenal gland tumors.

Genetic and Congenital Disorders:

Etiology unknown.

Congenital malformation of lymphatic vessels. They grow as the child grows and may be superficial or deep.

Painless nodules that may be translucent or bluish and have a pebbly surface.

Palpation of deeper lesion may produce a cracking sound (crepitus).

Tongue and buccal mucosa are most common areas.

Surgical or laser therapy to control growth.

Soft Developmental Cysts:

Branchial cleft cyst.

May arise from parotid gland epithelium becoming entrapped within the cervical lymph nodes.

Seen in young adults from 10 to 40 years.

Located along the anterior border of the SCM. Soft and fluctuant when palpated.

More often seen on the left side.

Intraoral counterpart is the lymphoepithelial cyst found on the floor and posterior border of the tongue.

Soft Developmental Cysts:

Proliferation of remnants of epithelial cells that lined the thyroglossal tract during embryonic development.

Seen more often in children.

Midline of the neck.

Well-circumscribed, non-tender, mobile mass. May cause dysphagia and dysphonia.

Have a tendency to become infected.

Surgical removal to treat.

Soft Developmental Cysts:

Entrapment of epithelial cells along the lines of embryonic closure or fusion so they are located in the midline in the head and neck region.

Uncommon oral cyst appearing between ages of 10 and 30.

Epithelial lined cavity containing sebaceous glands, sweat glands, hair follicles, and sometimes tooth-like structures.

Surgically remove to treat.