soft tissue enlargement lab ( slide for lab # 1)

8/3/2019 Soft Tissue Enlargement Lab ( slide for Lab # 1)

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Hyperplastic, NeoplasticHyperplastic, Neoplasticand Related Disorders of and Related Disorders of

Oral MucosaOral MucosaLABLAB

Dr. Rima SafadiDr. Rima Safadi

Giant cell fibroma

Multinucleated fibroblasts

Tongue dorsum

Papillary palatal hyperplasiaPapillary palatal hyperplasia

Psuedoepitheiomatous hyperplasia

13 year old female13 year old female

This 13 yearThis 13 year--oldoldf emale is ref erred forf emale is ref erred forevaluation of anevaluation of anasymptomatiasymptomatic, 1 x 1.5c, 1 x 1.5

mm mass in the right mm mass in the right buccal mucosa in the buccal mucosa in the premolar area at the premolar area at the level of the occlusal level of the occlusal planeplane. The patient . The patient wears f ull wears f ull orthodontic orthodontic

appliancesappliances. She . She believes that the believes that the lesion was present lesion was present before she started the before she started the orthodontic treatment orthodontic treatment one year ago.one year ago.

Courtesy of Dr. Hellstein, UIowa

Differential DiagnosisDifferential Diagnosis

ListList

±± 11

±± 22

±± 33

±± 44

±± 55

Granular cells

Hyperplasticepithelium

Granular Cell Tumor Granular Cell Tumor

Microscopic f eaturesMicroscopic f eatures±± PseudoepitheliomatouPseudoepitheliomatou

s hyperplasia of s hyperplasia of

overlying stratifiedoverlying stratifiedsquamous epitheliumsquamous epithelium

±± Large cells with Large cells with granular, eosinophilic granular, eosinophilic cytoplasmcytoplasmGranules: lysosomesGranules: lysosomes

Pseudo EpitheliomatousPseudo Epitheliomatous

HyperplasiaHyperplasia

PEHPEH

Patient: 17 year old femalePatient: 17 year old female

Chief Complaint:Chief Complaint:NonNon--tendertenderswelling of the swelling of the lef t posteriorlef t posteriorbuccal mucosabuccal mucosaof 2 monthsof 2 months

duration.duration.

What is your ClinicalWhat is your ClinicalDiagnosis andDiagnosis and

Management?Management?

Clinical Diff erential Diagnosis of Clinical Diff erential Diagnosis of Localized Sof t Tissue EnlargementsLocalized Sof t Tissue Enlargementswith a normal mucosawith a normal mucosa::

Benign mesenchymal tumorsBenign mesenchymal tumors(irritation fibroma, schwannoma, (irritation fibroma, schwannoma, neurofibroma, lipoma««)neurofibroma, lipoma««)

Benign salivary gland tumorsBenign salivary gland tumorsLow grade salivary adenocarcinomasLow grade salivary adenocarcinomas

Management in thisManagement in thiscase: Excisional case: Excisional biopsy.biopsy.

Irritation fibromaIrritation fibroma

HistopathologyHistopathology

cellular fibro

Patient:19Patient:19--year year --old maleold male

Chief Complaint:Chief Complaint:Ref erred by Ref erred by Internal Medicine Internal Medicine

to evaluate forto evaluate forpossible possible odontogenic cause odontogenic cause of right of right

submandibularsubmandibularswelling.swelling.

Hodgkins lymphomaHodgkins lymphoma

Reed Sternberg cell

lymphocytes

Histopathologic FindingsHistopathologic Findings

Hodgkins lymphomaHodgkins lymphoma

26 year old woman26 year old woman

Clinical Findings: AClinical Findings: Adiff use, diff use, compressible, noncompressible, non--

tender, purple tender, purple surface lesion issurface lesion ispresent on the lef t present on the lef t sof t palate.sof t palate.

What is your ClinicalWhat is your ClinicalDiagnosis andDiagnosis and

Diff erential DiagnosisDiff erential Diagnosisof Intravascularof IntravascularBlood LesionsBlood Lesions²²

Surface Lesions:Surface Lesions:

HemangiomaHemangioma

VarixVarixKaposi¶s sarcomaKaposi¶s sarcoma

Clinical Diagnosis:Clinical Diagnosis:HemangiomaHemangioma

Management: NoManagement: Notreatmenttreatment

Kaposi SarcomaKaposi Sarcoma

Cellular hemangiomaCellular hemangioma

Endothelial cells

AVM AVM

Thin walled vein

Thick walled

Sublingual varicositiesSublingual varicosities

Sturge Weber SyndromeSturge Weber Syndrome

Hereditary hemorrhagicHereditary hemorrhagic

telangiectasiatelangiectasia ADAD

Multiple dilatedMultiple dilatedmalformed capillariesmalformed capillaries

±± Skin and mucousSkin and mucousmembranes and organsmembranes and organs

Nose bleedingNose bleeding

AA diff use, diff use, compressible, compressible, nontendernontender

enlargement isenlargement ispresent in the present in the anterior dorsum of anterior dorsum of the tongue. Nothe tongue. Nothrill or bruit thrill or bruit

evident.evident.

LymphangiomaLymphangioma

Lymphatic f luid

Cystic HygromaCystic Hygroma

Early inEarly indevelopment of development of lymphatic changeslymphatic changes

Large f luctuant Large f luctuant swellingswelling

10 cm in diameter10 cm in diameter May extend toMay extend to

base of the tongue base of the tongue and f loor of the and f loor of the

mouthmouth

HemangiomaHemangioma

Patient: 18 year old femalePatient: 18 year old female

Third recurrence Third recurrence of non tenderof non tendergingival swelling.gingival swelling.

What is your

Clinical

What is your

ClinicalDiagnosis andDiagnosis and

EpulidesEpulides

Types:Types: Fibrous epulis, chronic hyperplastic Fibrous epulis, chronic hyperplastic

gingivitisgingivitis

pyogenic granulomapyogenic granuloma

Peripheral giant cell granulomaPeripheral giant cell granuloma

Peripheral ossif ying fibromaPeripheral ossif ying fibroma

Peripheral odontogenic fibromaPeripheral odontogenic fibromaManagement: Excisional biopsy.Management: Excisional biopsy.

Peripheral giant cellPeripheral giant cell granulomagranuloma

Peripheral ossifying fibromaPeripheral ossifying fibromaBone formation

Cellular fibrous stroma

Pyogenic granulomaPyogenic granulomaVascular spaces

Clinical findingsClinical findings

Area is firm but

movable, somewhat

pedunculated and

located about 5mmfrom Stenson¶s duct.

It is of unknown

duration and non-

painful to palpation.

SchwannomaSchwannoma

NeurofibromaNeurofibroma

Wavy spindeledcells

NeurofibromatosisNeurofibromatosis

CaféCafé--au lait spotsau lait spots

Other findings:Other findings:axillary freckelingaxillary freckeling

Malignant Malignant transformationtransformation

In 5In 5--15% of cases15% of cases

Traumatic neuromaTraumatic neuroma

Nerve bundels

LipomaLipoma

liposarcomaliposarcoma

Lipoblasts with pleomorphic nuclei

Ulcerative enlargement of the hardUlcerative enlargement of the hard

palatepalate

NonNon--Hodgkin's lymphomaHodgkin's lymphoma

Starry Sky patternStarry Sky pattern

in Burkitt`s lymphomain Burkitt`s lymphoma

Macrophages are not neoplasticMacrophages are not neoplastic

Small closely packed malignant cellsSmall closely packed malignant cells

Aggressive fibromatosis Aggressive fibromatosis

FibrosarcomaFibrosarcoma

Lethal midline granulomaLethal midline granuloma

Tcell lymphomaTcell lymphoma

soft tissue enlargement lab ( slide for lab # 1)

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