Benign Soft Tissue Pathology

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1
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soft tissue tumors are derived from .... tissues

mesenchymal

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which type of benign soft tissue pathology:

• Most common benign soft

tissue mass

• Results from irritation or trauma

• Reactive lesion

• Well-localized

• Dome-shaped

• Asymptomatic (unless secondary

ulceration)

• Smooth surface

• Often pink but may be ulcerated

if traumatized

• Sessile or pedunculated

fibroma

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which type of benign soft tissue histopathology:

• Nodular mass of fibrous connective tissue covered by stratified

squamous epithelium

• Surface may exhibit hyperkeratosis from secondary trauma

fibroma

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fibroma

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fibroma histology

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which type of benign soft tissue pathology:

• Fibrous hyperplasia

• Most common on the maxillary

labial frenum

• Small, asymptomatic, exophytic

growths

• Can be diagnosed clinically so no

treatment is necessary

frenal tag

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frenal tag

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treatment for which type of benign soft tissue pathology:

◦ Surgical excision

◦ Important to submit ANY tissue

removed for histopathologic

examination

◦ Malignancies can mimic

benign entities!

fibroma

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which type of benign soft tissue pathology:

• Reactive hyperplasia due to an

ill-fitting denture or alveolar

resorption

• Found in the vestibules

• Redundant folds

• Rubbery

• May be ulcerated

• Overgrowth of tissue along the

border of a denture

Epulis fissuratum

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Epulis fissuratum

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treatment for which type of benign soft tissue pathology:

• Excision (with histopathologic examination of the tissue)

• Remake or reline the denture

Epulis fissuratum

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which type of benign soft tissue pathology:

• Reactive tissue growth related to:

-An ill-fitting denture

-Poor denture hygiene

-24-hour denture wearing

• Usually occurs on the hard

palate beneath a denture base

• Usually asymptomatic

• Mucosa is erythematous and has

a pebbly or papillary surface

Inflammatory papillary hyperplasia

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treatment for which type of benign soft tissue pathology:

• Proper denture hygiene and

removal of dentures at night

• Fabrication of new dentures

• Excise excessive tissue if

necessary

Inflammatory papillary hyperplasia

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Inflammatory papillary hyperplasia

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which type of benign soft tissue pathology:

• May be hereditary

• May be medication related:

-Dilantin (Phenytoin)

-Cyclosporine

-Nifedipine

• Begins in the interdental

papillae

• Gingiva may cover the crowns

• Firm

gingival hyperplasia

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treatment for which type of benign soft tissue pathology:

• Discontinuation of the offending medication

• Improved oral hygiene with frequent recall visits

• Gingivectomy

• Recurrence is common

gingival hyperplasia

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gingival hyperplasia

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which type of benign soft tissue pathology:

• Common

• Cause: local irritation or trauma,

poor hygiene, or hormonal

factors

• 75% on the gingiva

• Sometimes called the

"pregnancy tumor"

• May grow rapidly

• Smooth or lobulated vascular

mass

pyogenic granuloma

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treatment for which type of benign soft tissue pathology:

• Surgical excision with submission for histopathologic examination

• Excise to periosteum and scale adjacent teeth

• In pregnant patients defer treatment until after delivery when

possible (high recurrence rate)

pyogenic granuloma

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which type of benign soft tissue histopathology:

• Ulcerated stratified squamous epithelium

• Vascularized fibrous connective tissue

• Mixed inflammatory infiltrate

pyogenic granuloma

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pyogenic granuloma

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pyogenic granuloma histopathology

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which type of benign soft tissue pathology:

• Common

• Reactive lesion caused by local

irritation or trauma

• Occurs exclusively on the gingiva

or edentulous alveolar ridge

• Red or red-blue nodular mass

• Frequently ulcerated

• "Cupping" resorption of the

underlying alveolar bone may be

noted

Peripheral Giant Cell Granuloma

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treatment for which type of benign soft tissue pathology:

• Local surgical excision down to the underlying bone with submission

of the specimen for histopathologic examination

• Adjacent teeth should be carefully scaled

Peripheral Giant Cell Granuloma

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Peripheral Giant Cell Granuloma

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Peripheral Giant Cell Granuloma histopathology

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which type of benign soft tissue pathology:

• Common

• Reactive lesion caused by local

irritation or trauma

• Occurs exclusively on the gingiva

• Nodular mass

• Frequently ulcerated

• Red to pink

• Seen most commonly in teens

and young adults

Peripheral Ossifying Fibroma

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treatment for which type of benign soft tissue pathology:

• Local surgical excision down to periosteum with submission of the

specimen for histopathologic examination

• Adjacent teeth should be thoroughly scaled

Peripheral Ossifying Fibroma

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Peripheral Ossifying Fibroma

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Peripheral Ossifying Fibroma histopathology

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which type of benign soft tissue pathology:

• Fibrous tumor

• Unlike the traumatic fibroma, it

does not appear to be

associated with chronic irritation

• Common

• Asymptomatic

• The surface of the mass often

appears papillary

• More common in young patients

• Approximately 50% of all cases

occur on the gingiva

• Tongue and palate also are

common sites

giant cell fibroma

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treatment for which type of benign soft tissue pathology:

• Conservative surgical excision with submission of tissue for

histopathologic examination

• Recurrence is rare

giant cell fibroma

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giant cell fibroma

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giant cell fibroma histopathology

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which type of benign soft tissue pathology:

• Papillary-like growth

• Mandibular gingiva lingual to

canine

• Frequently bilateral

• 25-99% of children/YA

• Involutes with age

• Should be recognized clinically

as a normal anatomic variation

retrocuspic papilla

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retrocuspic papilla

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which type of benign soft tissue pathology:

• Uncommon

• Derived for Schwann cells

• Cytoplasm is granular because of

lysosomes

• Most commonly found on the

dorsal tongue

• Asymptomatic sessile nodule

• Pink to yellowish in color

granular cell tumor

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treatment for which type of benign soft tissue pathology:

• Conservative local excision with

submission of tissue for

histopathologic examination

• Recurrence is rare

granular cell tumor

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granular cell tumor

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granular cell tumor histopathology

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which type of benign soft tissue pathology:

• Uncommon

• Occurs almost exclusively on the

alveolar ridges of newborns

• Bears a microscopic

resemblance to the granular cell

tumor

• Pink-to-red, smooth-surfaced,

polypoid mass on the alveolar

ridge of a newborn

• More common on the maxilla

than the mandible

• 90% occur in females

Congenital epulis

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treatment for which type of benign soft tissue pathology:

• Surgical excision with submission of tissue for histopathologic

examination

• No reports of recurrence, ever

Congenital epulis

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Congenital epulis

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Congenital epulis histopathology

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which type of benign soft tissue pathology:

• Benign tumor of fat

• 4% of mesenchymal tumors of

oral cavity

• Soft, doughy, smooth-surfaced

nodular

• Asymptomatic

• Pink to yellow in color

Lipoma

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treatment for which type of benign soft tissue pathology:

• Conservative local excision with submission of tissue for

histopathologic examination

• Recurrence is rare

lipoma

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lipoma

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lipoma histopathology

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which type of benign soft tissue pathology:

• Congenital lesion

• Most common tumor of infancy

• Vascular proliferation

• Often red/blue

• Early rapid growth, followed by

slow involution

hemangioma

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hemangioma

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which type of benign soft tissue pathology:

◦ Most common sites in the head

and neck:

◦ Lips, tongue, buccal mucosa, or

palate

◦ Deep red or blue compressible

lesion

◦ Lesions can in the soft tissue or

central (intraosseous) in location

vascular malformation

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vascular malformation

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treatment for which type of benign soft tissue pathology:

• Can undergo spontaneous

remission

• Surgery

• Embolization

• Sclerosing agents

• Cryotherapy

• Laser

vascular malformation

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which type of benign soft tissue pathology:

• Benign, hamartomatous

tumorlike growths of lymphatic

vessels

• Likely represent developmental

anomalies that arise from

sequestrations of lymphatic

tissue that do not communicate

normally with the rest of the

lymphatic system

• Predilection for the head and

neck

• Oral lymphatic malformations

are most frequent on the

anterior two thirds of the

tongue, where they often result

in macroglossia

• Demonstrates a pebbly surface

that resembles a cluster of

translucent vesicles

lymphangioma

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treatment for which type of benign soft tissue pathology:

• Surgical excision

• Sclerotherapy

• May recur

lymphangioma

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lymphangioma

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which type of benign soft tissue pathology:

• Most common peripheral nerve

neoplasm

• Can be a solitary tumor or be a

component of

neurofibromatosis*

• Slow-growing, soft, painless

lesions that vary in size from

small nodules to larger masses

• Can be in the soft tissue or

central (in bone)

neurofibroma

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treatment for which type of benign soft tissue pathology:

• Surgical excision

neurofibroma (and schwannoma and traumatic neuroma)

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neurofibroma

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neurofibroma histopathology

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which type of benign soft tissue pathology:

• Common hereditary condition

• One of every 2,500-3,000 births

• Autosomal dominant trait

Neurofibromatosis Type I

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Neurofibromatosis Type I

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which type of benign soft tissue pathology:

• Benign neural neoplasm of

Schwann cell origin

• Uncommon

• Slow-growing, encapsulated

tumor that typically arises in

association with a nerve trunk

• Asymptomatic

• The tongue is the most common

location for oral schwannomas

• Can arise centrally

schwannoma

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schwannoma

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schwannoma histopathology

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which type of benign soft tissue pathology:

• Reactive proliferation of neural

tissue after transection or other

damage of a nerve bundle

• Smooth-surfaced, nonulcerated

nodules

• Most common in the mental

foramen area, tongue, and lower

lip

• A history of trauma often can be

elicited

• May be intraosseous

• About 1/3 are painful

traumatic neuroma

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traumatic neuroma

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which type of benign soft tissue pathology:

• Benign neural lesion

• Associated with Multiple

Endocrine Neoplasia type 2B

(MEN2B)*

• Soft, painless papules or nodules

Locations:

-Lips, anterior tongue

-BM, gingiva, palate

mucosal neuroma

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mucosal neuroma

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treatment for which type of benign soft tissue pathology:

• Surgical excision

• Multiple lesions should be evaluated for MEN 2B

mucosal neuroma