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

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

Hypo

cellular fibro

us

tiss

ue



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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