Soft Tissue Masses Part 2

Etiology:

• Benign Neoplasm derived from Schwann cells

Granular Cell tumor

Clinical presentation:

• Sessile submucosal nodule

• Pink, sometimes yellow hue

• Dorsal tongue most common site

  

Granular Cell tumor

Etiology:

• Benign tumor of fat

Lipoma

Clinical presentation:

• Soft, smooth surfaced nodule

• Usually Yellow, sometimes pink

• Buccal mucosa and buccal vestibule most common oral sites

Lipoma

Lipoma

How to differentiate Lipoma from Fibroma?

Yellow tissue in Lipoma (fat tissue)

Where is the most common oral location for a Lipoma

Buccal mucosa and buccal vestibule

After biopsy / excision how can you determine a lipoma?

The fat will float in formalin

Etiology:

• Benign Vascular tumor

Hemangioma

Clinical Presentation:

• Seen in children, but will spontaneously go away

• Bright red to dull blue/purple nodule

Hemangioma

What is unique about Hemangioma?

They will rapidly grow for 6-12 months, then involute (go away). 90% resolve by age 9

Etiology:

• Structural anomaly of blood vessels

Vascular Malformation

Clinical presentation:

• Pink/red macule to blue/purple mass

• Presentation can vary based on vasculature involved

• Port wine stains common on face

Vascular Malformation

Common type of Vascular malformation seen on the face?

Port wine stain

Helpful clinical test to determine if a lesion is vascular?

Diascopy: take a glass slide to compress lesion, if it blanches it is vascular.

Demographic of Hemangioma vs Vascular malformation?

• Hemangioma: Kids <9 y/o

• Vascular Malformation: any age

Neurofibroma and Schwannoma are what type of tumor?

Mesenchymal tumors

For a salivary gland tumor is a larger or smaller gland more likely to be MALIGNANT?

Smaller the gland, more likely to be malignant. Minor glands 50% chance to be malignant

T/f Salivary gland tumors can be benign or malignant?

True, can be either

Common sites for minor Salivary gland neoplasm?

• Hard palate

• Soft palate

• Upper lip

Most common salivary gland benign NEOPLASM

Pleomorphic adenoma

Most common salivary gland MALIGNANCY

Mucoepidermoid carcinoma

Malignancy not found in MAJOR salivary glands

Polymorphous Adenocarcinoma

Malignant and more aggressive Salivary gland tumor that shows Perineural Invasion

Adenoid Cyst Carcinoma

Which is more likely to be malignant? Salivary gland tumor on the parotid gland or the sublingual gland?

Sublingual is more likely to me malignant since it is smaller

What is the most common site for a minor salivary gland neoplasm?

Hard palate

Etiology:

• Group of malignancies characterized by overproduction of Neoplastic WBCs

• Originates in bone marrow then spills into circulation

Leukemia

Where does Leukemia originate?

Bone marrow

Oral manifestation of Leukemia?

Diffuse, boggy, non-tender swelling of gingiva. With or without ulceration

Leukemia

Is Acute or Chronic Leukemia more common in children?

Acute (ALL of us have been children, not all adults)

Etiology:

• Group of malignant tumors of lymph nodes

• Originates in lymph nodes then can become more widely disseminated

Lymphoma

Where does lymphoma originate?

Lymph nodes

Clinical Presentation:

• Enlarging, nontender discrete mass in lymph node region

• Pruritis (itchiness)

• Oral nontender diffuse soft tissue swelling

Lymphoma

Most common oral sites for lymphoma lesions?

Buccal vestibule, posterior hard palate, gingiva

Oral lesions from lymphoma are most commonly due to what?

Diffuse Large B cell lymphoma

Lymphoma

Kaposi sarcoma is associated with what HHV?

HHV-8

Kaposi Sarcoma is commonly seen in what patient demographic?

HIV/AIDS

Etiology:

• Vascular Malignancy

• Infection with HHV-8

Kaposi Sarcoma

Clinical Presentation:

• Multiple, Blue / purple macules, plaques and nodules on face and oral mucosa

Kaposi Sarcoma

Most common locations to see Kaposi Sarcoma

Hard palate, gingiva, tongue.

Kaposi Sarcoma

Treatment for Kaposi Sarcoma?

Underlying AIDS management

Most common Metastatic tumor types in MEN?

Lung, Kidney, Melanoma

Most common Metastatic tumor types in WOMEN?

Breast, Genital, Kidney, Lung

Clincial Presentation:

• Nodular soft tissue mass, resembling hyperplastic or reactive growth.

• 50% on gingiva

• 25% of pts, primary malign. not diagnosed when seen in the mouth

Metastatic Cancer

Most common location to see metastatic cancer in the mouth?

50% on Gingiva

What categories can a Thyroid enlargement be?

• Metabolic

• Immune-mediated

• Neoplastic

What are common causes of Thyroid enlargement

• Goiter

• Thyroid Adenoma (benign)

• Thyroid Carcinoma (malignant)

• Graves

• Hashimoto

Of all the thyroid enlargment casues, which are most likely to be symptomatic?

Graves and Hashimoto

Clinical Presentation:

• Diffuse thyroid enlargement

• Weight loss despite increased appetite

• Tachycardia

• Sweating

• Warm skin

• Exopthalmos

Graves (hyperthyroidism)

Clincial Presentation:

• Lethargy

• Dry skin

• swelling of face and extremities

• Huskiness of voice

• Bradycardia

• Hypothermia

Hashimoto (Hypothyroidism

Three diagnostic techniques for Thyroid Englargement

• Fine needle Aspiration

• Imaging

• Bloodwork

Odontogenic Neoplasms that can cause Peripheral Odontogenic Cysts / tumors

• Peripheral Ameloblastoma

• Peripheral Calcifying Epithelial Odontogenic Tumor