oral & maxillofacial pathology - soft tissue tumors 2
TRANSCRIPT
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Oral & Maxillofacial Pathology IIOral & Maxillofacial Pathology IIDB 3702DB 3702
Thursdays, 10:00 – 11:50 amRoom DB 132
Course Director: Dr. J. E. BouquotCourse Director: Dr. J. E. BouquotRoom 3.094b; 713Room 3.094b; [email protected]@uth.tmc.edu
Topic: Soft Tissue TumorsTopic: Soft Tissue Tumors
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This presentation is intended for students of Dr. Jerry Bouquot. Designated owners of the photographic images in this lecture retain the copyrights for those images but have agreed to allow their photos to be used for teaching. You are welcome to use this presentation for your learning, alone or with other dental students, but permission is not given for the publication of these photos in electronic or any other format.
This presentation created by This presentation created by Dr. J. E. BouquotDr. J. E. Bouquot
Disclaimer: Dr. Bouquot is Professor & Chair,Department of Diagnostic Sciences,
University of Texas Dental Branch at Houston.The information and opinions provided herein are,
however, his own and do not represent official opinion or policy of the University of Texas.
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FibrosarcomaFibrosarcoma
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FibrosarcomaFibrosarcoma
Malignant neoplasm of fibroblastsEtiology = unknown
GALP:– None– Children, teenagers, young adults– Palate > tongue > buccal– 10% of all are in H&N
Painless, firm massOften lobulatedMay have surface ulcerationSlow-growing in beginningModerate growth speed-- May be rapid
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FibrosarcomaFibrosarcomaHistopathologyHistopathology
Spindle cells in collagenSpindle cells may be dysplasticGrade is important for prognosis-- Grades I - IVNot encapsulatedMitotic figuresHerring bone pattern
Grade IGrade I
Grade IIIGrade III
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FibrosarcomaFibrosarcomaPathophysiology, TreatmentPathophysiology, Treatment
Can grow rapidly toward end--Especially high grade lesionsDestroys underlying boneFibrosarcoma of bone-- Perforates through cortex
Treatment:-- Radical surgical removal-- Including affected bone5-year survival = 50%
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Malignant Fibrous Malignant Fibrous HistiocytomaHistiocytoma
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Malignant Fibrous HistiocytomaMalignant Fibrous HistiocytomaFibroxanthoma; DermatofibromaFibroxanthoma; Dermatofibroma
Malignant neoplasm of histiocytes-- With fibrous differentiation
GALP:– None– Middle-age and older (but skin lesions: young adults)– Buccal< vestibule-- Rare in mouth
Painless, firm massMay be lobulatedMay be ulcerated
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Malignant Fibrous HistiocytomaMalignant Fibrous HistiocytomaHistopathologyHistopathology
Numerous spindle cellsOpen nuclei (like histiocytes)Storiform patternMaybe rounded histiocytic cellsMay look benign!
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Pyogenic Pyogenic GranulomaGranuloma
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Pyogenic GranulomaPyogenic GranulomaPyogenic Granuloma Type HemangiomaPyogenic Granuloma Type Hemangioma
Lack of reduction of granulation tissueduring normal healing process-- Not an infection, no pus
but “pyogenic” = pus producing-- Not a granulomatous infection
GALP:– None (although strong female predilection in biopsied cases)– Children & young adults– Gingiva (75%), lips, tongue, buccal– 50th most common mucosal lesion-- Prevalence = 1/10,000 adults
“Proud flesh”
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Pyogenic GranulomaPyogenic Granuloma
Edematous granulation tissueNeovascularityChronic inflammatory cellsAcute inflammatory cellsSurface ulceration, oftenLobular (locular) capillary hemangioma
Lobular hemangiomaLobular hemangioma
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Pyogenic GranulomaPyogenic Granuloma
Painless erythematous massOften hemorrhagicOften lobulated surfaceOften ulceratedOften pedunculated
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Pyogenic GranulomaPyogenic GranulomaSpecial VariantsSpecial Variants
Pregnancy tumor:-- PG of gingiva-- In pregnant woman-- Papilla involved-- May be multiple-- Poor oral hygiene
Epulis granulomatosum:-- PG within poorly healed
extraction socket-- Curette thoroughly
Parulis (gum boil):-- PG at opening of dental fistula -- Check for abscess in bone-- Treat the tooth
Parulis
Epulis granulomatosum
Pregnancy tumor
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Pyogenic GranulomaPyogenic Granuloma
May shrink over timeMay become irritation fibroma-- Fibrotic pyogenic granuloma
Pregnancy tumor:-- Often disappears after
birth of babyTreat: Surgical excision-- Remove cause
For pregnancy tumor:-- Wait until after birth
May recur -- If original cause
is not removed-- More infection, trauma
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LookLook--Alike: Traumatic Eosinophilic UlcerAlike: Traumatic Eosinophilic UlcerTraumatic Ulcer with Stomal EosinophiliaTraumatic Ulcer with Stomal Eosinophilia
May mimic pyogenic
granuloma
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Peripheral Peripheral Ossifying FibromaOssifying Fibroma
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Peripheral Ossifying FibromaPeripheral Ossifying FibromaPeripheral Cementifying/Ossifying FibromaPeripheral Cementifying/Ossifying Fibroma
Inflammatory proliferation of fibrous tissue
From periodontal fibersPrimitive stromaBone or cementum
GAL:– 2/3 females– Teenagers and young adults– Gingival papilla
(must be in this location)-- Edentulous alveolus also
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Peripheral Ossifying Peripheral Ossifying FibromaFibroma
HistopathologyHistopathology
Primitive spindle cellsin fibrous stromaImmature bone formation-- Often with active osteoblastsMaybe cementoid globules-- Few cementoblasts-- Almost no cementocytes
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Peripheral Ossifying Peripheral Ossifying FibromaFibroma
Painless mass of papillaFirm, red/pink May be lobulatedMay be ulceratedMay show radiopacitiesCan separate teethMay develop in socket
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Peripheral Ossifying FibromaPeripheral Ossifying FibromaCan Spread Teeth ApartCan Spread Teeth Apart
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Peripheral Ossifying FibromaPeripheral Ossifying Fibroma
Usually < 2 cm.-- Occasionally up to 3 cm.Treat:
-- Conservative surgical excision-- With curettage of base– Cleaning/scaling adjacent teeth15% recur
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Peripheral Ossifying Fibroma (In Socket)Peripheral Ossifying Fibroma (In Socket)Epulis GranulomatosumEpulis Granulomatosum
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Peripheral Ossifying FibromaPeripheral Ossifying FibromaCan (Rarely) Produce Massive Sclerosis Above the CrestCan (Rarely) Produce Massive Sclerosis Above the Crest
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Peripheral Ossifying FibromaPeripheral Ossifying FibromaCan Occur on Edentulous Ridge (From Residual Periodontal Fibers)Can Occur on Edentulous Ridge (From Residual Periodontal Fibers)
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Peripheral Giant Peripheral Giant Cell GranulomaCell Granuloma
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Peripheral Giant Cell GranulomaPeripheral Giant Cell GranulomaPeripheral Giant Cell Lesion; Giant Cell EpulisPeripheral Giant Cell Lesion; Giant Cell Epulis
Inflammatory proliferation of phagocyticcells from:– Irritation-- Trauma-- Infection
GAL:– 60% in females– Fifth-sixth decades– Gingiva-- Alveolar mucosa
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Peripheral Giant Cell GranulomaPeripheral Giant Cell GranulomaHistopathologyHistopathology
Immature fibrous stroma Multinucleated giant cellsExtravasated erythrocytesSpindled, oval mesenchymal cells
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Peripheral Giant Cell GranulomaPeripheral Giant Cell GranulomaClinical FeaturesClinical Features
Painless massPerhaps hemorrhagicOften red/bluish/brownSomewhat soft to palpationMay cup out underlying bony cortex-- Saucerization (from pressure)Maybe calcifications on radiograph-- Near lower borderOften ulcerated In socket = epulis granulomatosum
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Peripheral Giant Cell GranulomaPeripheral Giant Cell GranulomaPathophysiology; TreatmentPathophysiology; Treatment
Generally remain less than 2 cm.May become more than 4 cm.No malignant transformationTreat: Conservative surgical excision--With curettage of base– And cleaning/scaling of adjacent teeth10% recurCaution: large or multiple or recurring lesionsmight be brown tumor of hyperparathyroidism
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HyperparathyroidismHyperparathyroidism
↑ PTH >> ↑ calcium taken from bonePrimary: ↑PTH from tumor-- 90%: from parathyroid adenoma-- 10% from parathyroid hyperplasia-- Rare: from parathyroid carcinomaSecondary: chronic ↓ calcium >> ↑PTH-- Usually: chronic renal disease-- ↓ vitamin D made by kidney >>-- ↓ calcium GI absorption >>-- ↓ serum calcium (hypocalcaemia)-- Severe: renal osteodystrophy
GALP: -- 1:4 male:female ratio-- >60 y/o -- Kidneys, bone
Ground glass skullGround glass skull
Osteitis Osteitis fibrosa fibrosa cysticacystica
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HyperparathyroidismHyperparathyroidism
“Bones, moans and abdominal groans”Renal calculi (kidney stones, nephrolithiasis)-- From ↑ serum calciumMetastatic calcification-- Dystrophic calcification of soft tissues-- From ↑ serum calciumSubperiosteal resorption of phalanges-- Index & middle fingersGround glass bone-- ↓ trabeculae-- Blurred radiographLoss of lamina dura (early sign)Brown tumorOsteitis fibrosa cystica-- Severe variant of bone change-- Marrow degeneration-- Fibrosis of brown tumors
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HyperparathyroidismHyperparathyroidism
Duodenal ulcers (painful)WeaknessLethargyConfusionDementia
Brown tumor-- Multinucleated giant cells-- Extravasated RBCs-- Hemosiderin deposits-- Radiolucency
(often multilocular)-- Bony expansion-- May be multiple-- Like central giant cell
granuloma of jaws
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HyperparathyroidismHyperparathyroidismGround Glass Bone; Loss of Lamina DuraGround Glass Bone; Loss of Lamina Dura
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HemangiomaHemangioma
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HemangiomaHemangiomaCavernous Hemangioma; Capillary HemangiomaCavernous Hemangioma; Capillary Hemangioma
Benign developmental growth of vesselsBenign neoplasm of blood vessels
GALP:– 3x females– Children and teenagers– Seldom congenital, but develop shortly after birth– Tongue > buccal > lips– 6th most common mucosal lesion– Prevalence = 6/1,000 adults– Head and neck:
most common location
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HemangiomaHemangiomaHistopathologyHistopathology
Dilated vessels: cavernous hemangiomaSmall vessels:capillary hemangiomaEndothelium-lined channelsEndothelial nuclei are enlarged-- Plump; bulge into lumen-- If flat: inactive lesionBlood-filled luminaWithout blood:lymphangiomaNo encapsulationPort wine stain = capillary hemangioma
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Capillary & Cavernous Capillary & Cavernous HemangiomaHemangioma
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HemangiomaHemangiomaClinical CharacteristicsClinical Characteristics
Sessile, lobulated Soft red mass
Often lobulatedPainlessSmooth-surfaceFluctuates and blanchesBlue color if venous bloodRed if arterialDeep lesions: no surface colorOn skin: port wine stain, -- Berry angioma-- Sturge-Weber syndrome
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Deep HemangiomaDeep HemangiomaDeep lesions may only discolor surfaceDeep lesions may only discolor surface
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HemangiomaHemangiomaPathophysiologyPathophysiology
Infancy lesions:-- Often spontaneously regress-- Later lesions do notSome lesions continue to enlarge-- Until adulthood-- Perhaps even after– No cancer developmentProblems:-- Hemorrhage-- Clots (from stagnant blood)
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Intramedullary HemangiomaIntramedullary HemangiomaEndosteal HemangiomaEndosteal Hemangioma
Central sunburst pattern
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HemangiomaHemangiomaTreatmentTreatment
Often left aloneChildhood lesions:-- Corticosteroids-- Interferon-α-2aLaser therapy can be effectiveInjection of sclerosing solutions-- Sodium morulate-- 95% ethanol
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Mucoepidermoid Carcinoma Mucoepidermoid Carcinoma (Blue Color from Mucus)(Blue Color from Mucus)
Hemangioma LookHemangioma Look--Alike LesionsAlike Lesions
KaposiKaposi’’s Sarcomas Sarcoma(AIDS)(AIDS)
Lingual VaricositiesLingual Varicosities HematomaHematoma(Does not Blanch)(Does not Blanch)
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Traumatic Traumatic Angiomatous LesionAngiomatous Lesion
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Traumatic Angiomatous LesionTraumatic Angiomatous LesionVenous Pool; Venous Lake; Venous Pool; Venous Lake;
Venous AneurysmVenous Aneurysm
Acute trauma to subepithelial vein-- With focal dilation or “aneurysm”GAL: – None-- Middle-aged and older-- Lips, buccalSmall, painless red bleb– BlanchesMicro: single dilated venous structurePerhaps with thrombus (may calcify)Remains indefinitely– Usually remains less than 4 mm– No malignant developmentTreat: conservative surgical removalOK to leave alone, except for esthetics
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SturgeSturge--WeberWeberAngiomatosisAngiomatosis
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Sturge-Weber AngiomatosisSturge-Weber Syndrome,
Encephalotrigeminal Angiomatosis
Vascular plexus forms around cephalicpart of neural tube at six weeks-- Regresses after the ninth week-- Doesn’t regress with S-W syndrome– Not inheritedGALP:– None– Congenital– Face, buccal, maxilla-- Rare
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Sturge-Weber AngiomatosisSturge-Weber Syndrome,
Encephalotrigeminal Angiomatosis
Purple/red macule(s) of face-- Port wine stain-- Nevus flammeus-- Trigeminal nerve distribution, usually
Often with involvement of oral mucosaAngiomas of ipsilateral leptomeninges-- May cause seizures--May cause mental retardationCalcifications of gyri
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AngiosarcomaAngiosarcoma
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AngiosarcomaMalignant
Hemangioendothelioma
Vascular neoplasm of endotheliumLooks like hemangioma-- More rapid growthNo painDestroys adjacent structuresMets via blood (to lungs)Poor prognosis-- 10-year survival = 21%Hemangioendothelioma
-- Histology may look OK-- Can’t predict from micro.
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Kaposi SarcomaKaposi Sarcoma
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Kaposi SarcomaKaposi SarcomaIn AIDSIn AIDS
Vascular proliferation (neoplasm?)-- Usually in AIDS-- Non-AIDS cases usually in old meStimulated by herpesvirus 8-- Kaposi’s sarcoma-associated herpesvirusGAL:– Strong male predilection– Young adults and middle-aged– Tongue, lips, gingivaSoft-to-firm red or purple nodule-- May be macular– Painless– Nonhemorrhagic-- May be multiple-- May be lobulated or granular
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Kaposi SarcomaKaposi SarcomaHistopathology, Pathophysiology, Histopathology, Pathophysiology,
TreatmentTreatment
Combination of proliferating spindled &endothelial cells– Extravasated erythrocytes– Staghorn clefts (veins)Slowly enlargeNew lesions developing over timeTreat: lesions disappear withsuccessful AIDS treatment-- Protease inhibitors, antivirals, etc.
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Kaposi SarcomaKaposi Sarcoma
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LymphangiomaLymphangioma
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LymphangiomaLymphangioma
Benign neoplasm of lymph vesselsHamartoma of lymph vesselsGAL:– None– Children and teenagers– Tongue (produces macroglossia)Soft painless cluster of clear blebsOften with outlying or satellite blebs-- Several mm from main massMay be scattered clear blebs
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LymphangiomaLymphangiomaHistopathologyHistopathology
Same appearance as hemangioma,but without blood in the luminaCavernous type, usuallyPlump endothelial nuclei-- If flat: inactive lesionMay be admixed with blood vesselsNo encapsulation
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LymphangiomaLymphangiomaPathophysiology, TreatmentPathophysiology, Treatment
Slowly enlarges with body growthNo spontaneous regression-- As with hemangiomaNo cancer developmentTreat: conservative surgical removal– Usually deliberately leave tumor behind(debulking)
Repeat surgery is not uncommon-- Congenital cases: average = 4
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Cystic HygromaCystic HygromaDevelopmental Cavernous LymphangiomaDevelopmental Cavernous Lymphangioma
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Developmental LymphangiomaDevelopmental Lymphangioma
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LymphangiomaLymphangiomaLookLook--Alike LesionsAlike Lesions
Inflammatory Papillary HyperplasiaInflammatory Papillary Hyperplasia(Early, Edematous Lesions)(Early, Edematous Lesions)
Benign Lymphoid AggregatesBenign Lymphoid Aggregates
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LymphangiosarcomaLymphangiosarcoma
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LymphangiosarcomaLymphangiosarcoma
Malignant neoplasm of lymph vesselsVery rareDysplastic endothelial cellsNo blood in vesselsTreat: radical surgeryPoor prognosis
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LipomaLipoma
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LipomaLipoma
Benign neoplasm of fat cellsSome are developmental GALP:–None– Middle-aged– Buccal, vestibule– Most common soft tissue tumor in the body,
but not so common in the mouth– 38th most common mucosal lesion in adults– Prevalence = 3/10,000
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LipomaLipomaClinical FeaturesClinical Features
Sessile, yellowish massVery softPainlessEncapsulated: freely movable
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LipomaLipomaHistopathologyHistopathology
Micro: mature adipocytes-- With collagen trabeculaeMay or may not be encapsulatedMay “infiltrate” great distancesinto surrounding stromaSometimes admixed with fibrous tissue (fibrolipoma) Problem: herniated buccal fat pad
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LipomaLipomaPathophysiology, TreatmentPathophysiology, Treatment
Slowly enlargeUsually remain < 3 cm.No malignant transformationTreat: conservative surgical excision– Usually do not recur, except the infiltrating types
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Familial LipomatosisFamilial Lipomatosis
Photo: Dr. J. Bouquot, University of Texas, Houston, Texas
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Traumatic NeuromaTraumatic Neuroma
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Traumatic NeuromaTraumatic Neuroma
Reactive proliferation of neural tissue-- After nerve injury
GAL:-- None-- Middle-aged-- Mental foramen
Smooth-surfaced noduleSoft, nonulceratedLess than half are tender or painful, may be burningMicro: Intertwining, tortuous nerve fibers in a fibrous stromaUsually remain less than 1 cm.; no malignant transformationTreat: conservative surgical excision-- With small part of affected nerveMay lead to paresthesia and painMay recur
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NeurofibromaNeurofibroma
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NeurofibromaNeurofibroma
Benign neoplasm of Schwann cells-- And perineural fibroblastsGALP:– None– Young adults– Tongue, buccal– The most common peripheral nerve tumor-- 1/1,000 adultsSmooth-surfaced soft, nonulcerated nodulePainlessMay be huge and pendulous
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NeurofibromaNeurofibromaIn Inferior Alveolar CanalIn Inferior Alveolar Canal
Photo: Dr. J. Bouquot, University of Texas, Houston, Texas
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NeurofibromaNeurofibroma
Well circumscribed interlacing bundlesof spindle-shaped cells with wavy nuclei-- In a fibrous stromaUsually < 2 cm.-- May become hugeOral lesions seldom become malignant-- Less likely than skin lesionsTreat: conservative surgical excision– Recurrence is rare
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SchwannomaSchwannoma
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SchwannomaSchwannomaNeurilemmomaNeurilemmoma
Benign neoplasm of Schwann cellsGALP:– None– Young adults and middle-aged– Tongue, hard palate– Up to half occur in head and neck areaSmooth, soft noduleNonulceratedPainlessMoveableNormal color or yellowish white
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SchwannomaSchwannomaHistopathologyHistopathology
EncapsulatedTwo tissue types: – Antoni A: streaming fascicles of spindle
Schwann cells forming Verocay bodies– Antoni B: disorganized neurites in
loose fibrous stroma
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SchwannomaSchwannomaPathophysiology, TreatmentPathophysiology, Treatment
Usually remain less than 2 cmOral lesions seldom become malignantSkin lesions can but it is uncommonTreat: conservative surgical excision– Recurrence is rare
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NeurofibrosarcomaNeurofibrosarcoma
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NeurofibrosarcomaNeurofibrosarcomaMalignant Peripheral Nerve Sheath TumorMalignant Peripheral Nerve Sheath Tumor
Dysplastic spindle cellsFew recognizable nervesTreat: radical surgery5-year survival = 40-50%
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NeurofibromatosisNeurofibromatosis
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von Recklinghausen Neurofibromatosisvon Recklinghausen NeurofibromatosisMultiple Endocrine Neoplasia I (MEN I)Multiple Endocrine Neoplasia I (MEN I)
Multiple neurofibromas-- Some schwannomas-- Throughout body-- Maybe hundreds-- Oral lesions in 1/4 of casesAutosomal dominant inheritance-- Gene is on chromosome 17
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von Recklinghausen Neurofibromatosisvon Recklinghausen NeurofibromatosisMultiple Endocrine Neoplasia I (MEN I)Multiple Endocrine Neoplasia I (MEN I)
Café au lait spots (brown skin patches)Abnormal bone developmentLisch nodules (brown spots on iris)5-10% chance of malignant development-- Usually neurofibrosarcoma
(malignant peripheral nerve sheath tumor)
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Multiple Mucosal Multiple Mucosal Neuroma SyndromeNeuroma Syndrome
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Multiple Endocrine Neoplasia IIBMultiple Endocrine Neoplasia IIBMultiple Mucosal Neuroma Syndrome; MEN IIIMultiple Mucosal Neuroma Syndrome; MEN III
Autosomal dominant inherited disease-- Multiple tumors or hyperplasias of
neuroendocrine tissues
Mutation of RET protooncogene-- On chromosome 10
GALP:– None– Teenagers and young adults– Tongue, lips-- Rare
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Multiple Endocrine Neoplasia IIBMultiple Endocrine Neoplasia IIBClinical FeaturesClinical Features
Sessile, soft nodules-- Smooth-surfaced-- Painless-- Yellowish white-- MoveableOral signs: often first evidence of diseaseNarrow face
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Multiple Endocrine Neoplasia IIBMultiple Endocrine Neoplasia IIBClinical FeaturesClinical Features
Long extremitiesAbraham Lincoln appearanceWeak musclesPheochromocytomas (50%)Medullary thyroid carcinomas (90%)Elevated serum and urinary calcitonin-- From thyroid tumorElevated urinary vanillylmandelic acid (VMA)Increased epinephrine-to-norepinephrine ratio-- From adrenal tumor
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Multiple Endocrine Neoplasia IIBMultiple Endocrine Neoplasia IIBHistopathology, Pathophysiology, TreatmentHistopathology, Pathophysiology, Treatment
Micro: intertwining, tortuous nerve fibers-- Thick perineurium-- Spaces (artifactual) around nervesOral neuromas remain small-- Less than 5 mmOral neuromas do not become malignantTreat: no treatment needed for oral lesions-- Except for estheticsTreat systemic problems and tumors prn
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Neuroectodermal Neuroectodermal Tumor of InfancyTumor of Infancy
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Neuroectodermal Tumor of InfancyNeuroectodermal Tumor of InfancyProgonoma; Retinal Anlage TumorProgonoma; Retinal Anlage Tumor
Neoplasm of neural crest cells
GALP:– None– Infancy; newborns– Anterior maxillary alveolus– Very rare
Rapidly expanding blue/black painless mass
Usually destroys underlying bone
Elevated urinary vanillylmandelic acid (VMA)-- From oral tumor
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Neuroectodermal Tumor of InfancyNeuroectodermal Tumor of InfancyHistopathologyHistopathology
Micro: two cell types: – Small dark round neuroblastic cells– Large epithelioid cells with melanin
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Neuroectodermal Tumor of InfancyNeuroectodermal Tumor of InfancyPathophysiology, TreatmentPathophysiology, Treatment
May reach alarming sizeMay destroy anterior alveolar boneMalignant variants (very rare)Treat: Moderately severe surgical excision– 15% recurrence
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Granular Cell Granular Cell TumorTumor
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Granular Cell TumorGranular Cell TumorGranular Cell MyoblastomaGranular Cell Myoblastoma
Benign neoplasm of Schwann cellsOriginally thought to be from striated muscle cells
GALP:– 2x females– Fourth-sixth decades– Tongue-- 50% of all body cases
are oral
Sessile mass-- Painless-- Firm-- Pale
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Granular Cell TumorGranular Cell TumorGranular Cell Myoblastoma (Schwann Cell Origin)Granular Cell Myoblastoma (Schwann Cell Origin)
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Granular Cell TumorGranular Cell TumorHistopathologyHistopathology
Large, polygonal cells-- Like histiocytes-- Granular cytoplasm-- Small nucleiIn sheets and globulesMay be spindled cellsNot encapsulated
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Granular Cell TumorGranular Cell TumorHistopathologyHistopathology
May infiltrate between muscle fibersProblem: -- Pseudoepitheliomatous hyperplasia-- Mimics squamous cell carcinoma
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Granular Cell TumorGranular Cell TumorPathophysiology, TreatmentPathophysiology, Treatment
Usually remain 1-2 cm.Seldom enlarge after initial noticeNo malignant transformation riskTreat: conservative surgical excision-- Recurrence is very rare
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Granular Cell EpulisGranular Cell Epulis
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Granular Cell EpulisGranular Cell EpulisCongenital EpulisCongenital Epulis
Developmental tumor of unknown histogenesisGAL:
– 90% females– Newborn– Anterior maxillary alveolus
Pedunculated, soft, noduleSmooth-surfacedPink or pale
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Granular Cell EpulisGranular Cell EpulisHistopathologyHistopathology
Large, polygonal cells-- Granular cytoplasmLike cells in granular cell tumor-- But different immunohistochemistryAtrophic epithelium-- No pseudoepitheliomatous hyperplasia
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Granular Cell EpulisGranular Cell EpulisPathophysiology, TreatmentPathophysiology, Treatment
Usually remains less than 2 cm-- May become up to 9 cmTreat: conservative surgical excision-- As soon as baby can tolerate surgery– Does not recurIf left untreated: small lesions shrink-- Often disappear-- Does not interfere with tooth eruption
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LeiomyomaLeiomyoma
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LeiomyomaLeiomyoma
Benign neoplasms of smooth muscleGALP: – None– Infancy or childhood– Tongue, lips– Very rareUsually sessile, firm, painless massNormal surface color and smooth surfaceMicro: cellular proliferations of smooth muscle cellsUsually encapsulatedUsually remain less than 2 cm.No cancer transformationTreat: conservative surgical removal– Few recurrences
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LeiomyosarcomaLeiomyosarcoma
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LeiomyosarcomaLeiomyosarcoma
Malignant neoplasm of smooth muscleEtiology: unknownGALP:-- None-- Young adults & middle age-- No location predilection-- Rare
Lobulated massRelatively firmMay be ulcerated
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LeiomyosarcomaLeiomyosarcomaHistopathology, TreatmentHistopathology, Treatment
Dysplastic spindle cells-- blunt, cigar-shaped nuclei
Treat: radical surgeryOverall: poor prognosisHigh grade = worse prognosis
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RhabdomyomaRhabdomyoma
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RhabdomyomaRhabdomyoma
Benign neoplasmof striated muscleEtiology: unknownGAL:– None– Infancy or childhood– Tongue, lips– Very rareUsually sessile, firm, painless massNormal surface color and smooth surface
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RhabdomyomaRhabdomyoma
Micro: cellular proliferationsof striated muscle cells-- Usually encapsulatedUsually remain less than 2 cm.No cancer transformationTreat: conservative surgical removal– Few recurrences
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RhabdomyosarcomaRhabdomyosarcoma
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RhabdomyosarcomaRhabdomyosarcoma
Malignant neoplasm of striated muscle
GALP:-- None-- Childhood/young adults-- Tongue-- Rare
Firm massOften lobulatedSometimes ulcerated
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RhabdomyosarcomaRhabdomyosarcomaHistopathologyHistopathology
Dysplastic striate muscle cellsEmbryonal typeAlveolar typeTreat: radical surgery70% 5-year survival
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ChoristomaChoristoma
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Cartilaginous ChoristomaCartilaginous ChoristomaSoft Tissue ChondromaSoft Tissue Chondroma
Tumor-like proliferation of normal cartilage-- But in wrong place GAL: – None– Teens and young adults (probably started much earlier)– TongueSessile, firm, painless mass with normal surface color or pallorMicro: Normal cartilage (hyaline or fibrous) in a fibrous stroma
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Cartilaginous ChoristomaCartilaginous ChoristomaSoft Tissue ChondromaSoft Tissue Chondroma
Usually remain 1-2 cmNo cancer transformationTreat: conservative surgical removal– No recurrenceSpecial variant: Cutright tumor:– Presumably secondary to continuing, low-level trauma– Older persons– Anterior maxillary alveolar midline– Firm, sessile nodule under denture– Treat: conservative surgical removal and fix denture
(seldom recurs)
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Osseous ChoristomaOsseous ChoristomaSoft Tissue OsteomaSoft Tissue Osteoma
Tumor-like proliferation of normal bone-- But in wrong place GALP:– None– Teens and young adults (probably started much earlier)– Tongue-- RareSessile, firm massNormal surface color or pallorPainlessMicro: Normal but immature bone-- Perhaps with marrow-- In fibrous stromaUsually remain 1-2 cmNo cancer transformationTreat: conservative surgical removal– No recurrence
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MetastasisMetastasisto the Mouthto the Mouth
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Metastasis to the MouthMetastasis to the Mouth
Metastatic spread from extraoral source-- Almost always carcinomaUsually from lung, breast and GIGALP:– Moderate male predilection– Middle-aged and older– Gingiva, tongue-- 1-2% of all oral cancersFirm, smooth-surface nodule-- Often with normal colorOften ulceratedMay be painfulMay destroy bone
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Metastasis to the MouthMetastasis to the Mouth
Micro: same appearance as primary cancerEnlarge rapidlyEventually with surface ulceration, painTreat: -- Radical surgical excision-- Radiotherapy-- Chemotherapy– Depends on condition of the primary tumor-- Depends on other metastases
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