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2013-01-13 16:54:16
soft tissue christensen osd4

osd4 opath4 soft tissue
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  1. Fibroma
    • • Most common “tumor” of the oral cavity. Not a true neoplasm. Instead, it is a reactive hyperplasia of fibrous CT in response to local irritation or trauma.
    • • Clinical Features
    • o Can occur anywhere in the mouth, but the most common location is buccal mucosa along the bite line.
    • o Consequence of trauma from biting the cheek.
    • o Likely that many gingival fibromas represent fibrous maturation of the preexisting pyogenic granuloma.
    • o Typically appears as a smooth-surfaced pink nodule that is similar in color to the surrounding mucosa [may be gray-brown in black patients].
    • o Surface may appear white as a result of hyperkeratotis from continued irritation.
    • o Most are sessile [no stalks], but some are pedunculated [stalks]. Range in size.
    • o Frenal tag – occurs on the maxillary labial frenum.
    • • Histo
    • o Nodular mass of fibrous connective tissue covered by stratified squamous epithelium.
    • o CT is usually dense and collagenized, but in some cases, it is looser in nature.
    • o Lesion is not encapsulated; the fibrous tissue instead blends gradually into the surrounding connective tissues.
    • • Tx and Prognosis
    • o Conservative surgical excision. Recurrence is rare.
    • o Important to examine excised tissue to make sure it is not a malignant tumor.
    • o No tx for frenal tags.
  2. Giant Cell Fibroma
    • • Clinical features
    • o Retrocuspid papilla – occurs on the gingiva lingual to the mandibular cuspid. Frequently bilateral, and appears as a small, pink papule that measures less than 5 mm in diameter.
    • o Normal anatomic variation that disappears with age.
    • • Histo
    • o Nodular mass of fibrous connective tissue covered by stratified squamous epithelium.
    • o Rete ridges are elongated.
    • o Multiple large stellate-shaped and multinucleated fibroblasts.
    • • Tx and Prognosis
    • o Do not need to be excised. Should be recognized clinically.
  3. Epulis Fissuratum
    • • Tumor-like hyperplasia of fibrous CT that develops in association w/ the flange of an ill-fitting complete or partial denture.
    • • Clinical
    • o Fibroepithelial Polyp/leaflike denture fibroma – occurs on the hard palate beneath a maxillary denture.
    • • Flattened pink mass that is attached to the palate by a narrow stalk.
    • • Usually the flattened mass is closely applied to the palate, and sits in a slightly cupped-out depression.
    • • Easily lifted up with a probe, which demonstrates its pedunculated nature.
    • • Edge of the lesion is often serrated and resembles a leaf.
    • • Histo
    • o Hyperplasia of the fibrous CT.
    • o Multiple folds and grooves occur where the denture impinges on the tissue.
    • o Overlying epithelium is frequently hyperparakeratotic and demonstrates irregular hyperplasia of the rete ridges.
    • o Epithelium shows inflammatory papillary hyperplasia or pseudoepitheliomatous hyperplasia.
    • • Tx and Prognosis
    • o Surgical removal w/ microscopic examination of excised tissue.
    • o Ill-fitting denture should be remade or relined to prevent a recurrence of the lesion.
  4. Inflammatory Papillary Hyperplasia
    • • Reactive tissue growth that usually develops beneath a denture. Related to the following:
    • o Ill-fitting denture
    • o Poor denture hygiene
    • o Wearing the denture 24 hrs/day
    • • Also could be caused by Candida organisms
    • • Clinical
    • o Occurs on the hard palate beneath a denture base. Associated w/ denture stomatitis.
    • o Early lesions may involve only the palatal vault, although advanced cases cover most of the palate.
    • o Hyperplasia may also develop on the edentulous mandibular alveolar ridge or on the surface of an epulis fissurataum [less frequently].
    • o Rarely, it occurs on the palate of a patient w/out a denture, especially in people who habitually mouth breathe or have a high palatal vault.
    • o If HIV pt, then candida-associated palatal papillary hyperplasia occurs.
    • o Condition is usually asymptomatic; erythematous mucosa w/ pebbly or papillary surface.
    • • Histo
    • o Fibrous and epithelial hyperplasia resulting in papillary surface projections.
    • o Heavy chronic inflammation is present.
    • o Pseudoepitheliomatous hyperplasia of the epithelium occurs. Epithelium has a bland appearance [not carcinoma].
    • • Tx and Prognosis
    • o If early lesion, removal of the denture may allow the erythema and edema to subside, and the tissues may resume a more normal appearance.
    • o Condition may also improve after topical or systemic antifungal therapy.
    • o For more advanced and collagenized lesions, excision of the hyperplastic tissue before fabricating a new denture is an option.
    • o After surgery, the existing denture can be lined w/ a temporary tissue conditioner that acts as a palatal dressing and promotes greater comfort.
    • o After healing, the pt should be encouraged to leave the new denture out at night and to keep it clean.
  5. Pyogenic Granuloma
    • • Common tumorlike growth of the oral cavity that is considered non-neoplastic in nature.
    • • Now believed to be unrelated to infection.
    • • Thought to represent an exuberant tissue response to local irritation or trauma. Not a true granuloma.
    • • Clinical
    • o Smooth or lobulated mass that is usually pedunculated [on a stalk], but some lesions are sessile [no stalk].
    • o Surface is ulcerated and ranges from pink to red to purple, depending on age of lesion.
    • • Young are highly vascularized [red]
    • • Older are more collagenized and pink
    • o Vary in size. May grow rapidly.
    • o Painless mass, but bleeds easily b/c of vascularity.
    • o Show a striking predilection for the gingiva.
    • o Frequently develop in pregnant women [pregnancy tumor].
    • • May begin developing during the first trimester, and their incidence increases up through the 7th month of pregnancy.
    • • Gradual rise in development of these lesions throughout pregnancy may be related to the increasing levels of estrogen and progesterone as the pregnancy progresses.
    • • After pregnancy, these granulomas resolve w/out treatment or undergo fibrous maturation and resemble a fibroma.
    • • Histo
    • o Exophytic mass of granulation-like tissue w/ an ulcerated surface.
    • o Lobular endothelial proliferation in the deeper CT.
    • o Capillary blood vessels and scattered inflammation.
    • • Tx and Prognosis
    • o Conservative surgical excision – usually curative. Should examine specimen for cancer.
    • o Occasionally, the lesion recurs and reexcision is necessary.
    • o If pregnant, no tx unless significant functional or aesthetic problems develop.
    • o Recurrence rate is higher for pyogenic granulomas removed during pregnancy, and some lesions will resolve spontaneously after parturition.
  6. Peripheral Giant Cell Granuloma
    • • Common tumorlike growth of the oral cavity.
    • • Does not represent a true neoplasm but rather is a reactive lesion caused by local irritation or trauma.
    • • Clinical
    • o Occurs on the gingiva presenting as a nodular mass
    • • Histo
    • o Nodular proliferation of multinucleated giant cells w/in the gingiva
    • o Scattered multinucleated giant cells w/in a hemorrhagic background of ovoid and spindle-shapde mesenchymal cells.
    • • Tx and Prognosis
    • o Local surgical excision down to the underlying bone.
    • o Adjacent teeth should be carefully scaled to remove any source of irritation and to minimize the risk of recurrence.
    • o 10% of lesions recur, and reexcision must be performed.
  7. Peripheral Ossifying Fibroma
    • • Common gingival growth that is considered to be reactive rather than neoplastic in nature.
    • • Some peripheral ossifying fibromas develop initially as pyogenic granulomas that undergo fibrous maturation and subsequent calcification.
    • • Does not represent the soft tissue counterpart of the central ossifying fibroma.
    • • Clinical
    • o Occurs exclusively on the gingiva.
    • • Histo
    • o Focal early mineralization.
    • o Central bone formation. Trabeculae of bone found w/ adjacent fibrous CT.
    • • Tx and Prognosis
    • o Local surgical excision w/ examination of specimen.
    • o Mass should be excised down to the periosteum b/c recurrence is more likely if the base of the lesion is allowed to remain.
    • o Adjacent teeth should be thoroughly scaled to eliminate any possible irritants.
    • o Excision is usually curative, but recurrence occurs at a rate of 8-16%.
  8. Lipoma
    • • Benign tumor of fat.
    • • Most common mesenchymal neoplasm, and most examples occur on the trunk and proximal portions of the extremities.
    • • Occur less frequently in the oral and maxillofacial region.
    • • More common in obese people.
    • • Clinical
    • o Usually soft, smooth-surfaced nodular masses that can be sessile or pedunculated.
    • o Less common sites: tongue, floor of the mouth, lips.
    • • Histo
    • o Mass of mature adipose tissue
    • o Tumor cells are very similar to normal fat cells.
    • • Tx and Prognosis
    • o Conservative local excision; recurrence is rare.
  9. Traumatic Neuroma
    • • Not a true neoplasm, but a reactive proliferation of neural tissue after transaction or other damage of a nerve bundle.
    • • After a nerve has been damaged or severed, the proximal portion attempts to regenerate and reestablish innervations of the distal segment by the growth of axons through tubes of proliferating Schwann cells.
    • • If these regenerating elements encounter scar tissue or otherwise cannot reestablish innervations, then a tumor-like mass may develop at the site of injury.
    • • Clinical
    • o Associated w/ altered nerve sensations that can range from anesthesia to dysesthesia to overt pain.
    • o Only ¼-1/3 are painful.
    • o Neuromas of the mental nerve are frequently painful, especially when impinged on by a denture.
    • • Histo
    • o Haphazard arrangement of nerve bundles within the background fibrous connective tissue.
    • o Cross-sectioned nerve bundles w/in dense fibrous CT.
    • • Tx and Prognosis
    • o Surgical excision, including a small portion of the involved nerve bundle.
    • o Most lesions do not recur; sometimes the pain persists or returns later.
  10. Schwannoma
    • • Benign neural neoplasm of Schwann cell origin. Relatively uncommon.
    • • Clinical
    • o Slow-growing, encapsulated tumor that typically arises in association w/ a nerve trunk.
    • o Mass is usually asymptomatic, although tenderness or pain may occur in some instances.
    • • Histo
    • o Well-organized Antoni A tissue w/ adjacent myxoid and less organized Antoni B tissue.
    • o Schwann cells of the Antoni A tissue form a palisaded arrangement around acellular zones known as Verocay bodies.
    • • Tx and Prognosis
    • o Surgical excision and the lesion should not recur.
  11. Neurofibroma
    • • Most common type of peripheral nerve neoplasm.
    • • Arises from a mixture of cell types [Schwann cells and perineural fibroblasts].
    • • Clinical
    • o Arise as solitary tumors or are a component of neurofibromatosis.
    • • Histo
    • o Cellular tumor mass below epithelial surface
    • o Spindle-shaped cells w/ wavy nuclei.
    • • Tx and Prognosis
    • o Local surgical excision; recurrence is rare.
    • o Pts w/ this should be evaluated for possibility of neurofibromatosis.
  12. Neurofibromatosis
    • • Common hereditary condition. 8 forms recognized. Caused by mutations in NF1 gene [responsible for a tumor suppressor protein product known as neurofibromin].
    • • Clinical
    • o Diagnostic criteria [pt has to have 2+ of the following]
    • • 6+ café au lait macules
    • • 2+ neurofibromas of any type
    • • Freckling in the axillary or inguinal regions
    • • Optic glioma
    • • 2+ Lisch nodules
    • • Distinctive osseous lesion [sphenoid dysplasia or thinning of long bone cortex]
    • • First degree relative w/ NF1
    • o Multiple neurofibromas that occur anywhere in the body but are most common on the skin.
    • o Can vary from small papules to larger soft nodules to massive baggy, pendulous masses.
    • o May be present at birth, but often begin to appear during puberty and continue to develop slowly throughout adulthood.
    • o Accelerated growth during pregnancy.
    • o Presence of café au lait pigmentation on the skin
    • • Smooth-edged, yellow-tan to dark-brown macules that vary in diameter from 1 to 2 mm to several centimeters.
    • • Usually present at birth or may develop during the first year of life.
    • o Axillary freckling [crowe’s sign] is highly suggestive
    • o Lisch Nodules – translucent brown-pigmented spots on the iris. Found in nearly all affected individuals.
    • o Most common general medical problem = hypertension, which may develop 2ndary to coarctation of the aorta, pheochromocytoma, or renal artery stenosis.
    • o Other abnormalities: CNS tumors, macrocephaly, mental deficiency, seizures, short stature, scoliosis.
    • o Oral manifestations occur in many cases.
    • • Most common: enlargement of the Fungiform papillae
    • • Enlargement of the mandibular foramen
    • • Enlargement or branching of the mandibular canal
    • • Increased bone density
    • • Concavity of the medial surface of the ramus
    • • Increase in dimension of the coronoid notch
    • • Tx and Prognosis
    • o Tx directed toward prevention or management of complications.
    • o Facial neurofibromas may be removed for cosmetic purposes.
    • • CO2 laser and dermabrasion have been used successfully for extensive lesions.
    • o Cancer is one of the most feared complications [malignant peripheral nerve sheath tumor].
    • o Avg lifespan is 15 years less than the general population, due to vascular disease and malignant neoplasms.
    • o Should not be called “Elephant Man Disease.”
    • Multiple Endocrine Neoplasia Type 2B
    • • Group of rare conditions characterized by tumors or hyperplasias of the neuroendocrine tissues.
    • • Pts w/ 2B have mucosal neuromas that involve the oral mucous membranes.
    • • Clinical
    • o Marfanoid body build characterized by thin, elongated limbs w/ muscle wasting.
    • o Face is narrow, but the lips are characteristically thick and protuberant b/c of the diffuse proliferation of nerve bundles.
    • o Pheochromocytomas of the adrenal glands develop in these pts and become more prevalent w/ increasing age. Frequently bilateral or multifocal. Tumor cells secrete catecholamines, which result in symptoms such as profuse sweating, intractable diarrhea, headaches, flushing, heart palpitations, and severe hypertension.
    • o Most significant aspect: development of medullary carcinoma of the thyroid gland [90% of cases]. This tumor arises from the parafollicular cells [responsible for calcitonin production].
    • o Avg age at death for this disease is 21 yo.
    • • Lab Values
    • o Serum or urinary calcitonin levels are elevated.
    • o Also VMA in urine may be elevated, and increased epi:norepi ratio.
    • • Tx and Prognosis
    • o Prophylactic removal of the thyroid gland at an early age b/c medullary carcinoma is almost certain to occur w/ this disease.
    • o Once it has developed, this tumor is very aggressive and has a poor prognosis.
    • o Should also observe for development of pheochromocytomas b/c they result in a life-threatening hypertensive crisis, especially if surgery w/ general anesthesia is performed.
  13. Melanotic Neuroectodermal Tumor of Infancy
    • • Rare pigmented neoplasm that occurs during the first year of life.
    • • Lesion is of neural crest origin.
    • • Clinical
    • o Striking predilection for the maxilla [61%].
    • o Other sites: skull, epididymis, testis, mandible, brain.
    • o Slight male predilection.
    • • Lab
    • o High urinary levels of VMA.
    • • Neural crest origin b/c other tumors from this tissue often secrete norepinephrine-like hormones that are metabolized to VMA and excreted in the urine.
    • • Tx and Prognosis
    • o Most are benign, despite their rapid growth and potential to destroy bone. Surgical removal.
  14. Paraganglioma
    • • Paraganglia = specialized tissues of neural crest origin that are associated w/ autonomic nerves and ganglia throughout the body.
    • o Some of these cells act as chemoreceptors [carotid body] – can detect changes in blood pH or oxygen tension and cause changes in respiration and heart rate.
    • • This disease is when tumors occur in these structures.
    • • Clinical
    • o Rare, but the head and neck area is the most common site.
    • • Tx and Prognosis
    • o Surgery, radiation therapy, or both [depending on extent and location of the tumor].
  15. Granular Cell Tumor
    • • Uncommon benign soft tissue neoplasm that shows a predilection for the oral cavity.
    • • Originally, believed to be of skeletal muscle origin.
    • • Now, it has been shown to be derived from Schwann cells or neuroendocrine cells.
    • • Clinical
    • o Most common in the oral cavity and on the skin.
    • o Single most common site = tongue [1/3-1/2 of all cases].
    • • Histo
    • o Composed of large, polygonal cells w/ abundant pale eosinophilic, granular cytoplasm and small, vesicular nuclei.
    • o Lesion is not encapsulated and sometimes appears to infiltrate the adjacent connective tissues.
    • o Positivity for S-100 protein within the cells [neural origin].
    • o Unusual finding: presence of acanthosis or pseudoepitheliomatous hyperplasia of the overlying epithelium.
    • • Usually minor in degree, but in some cases may be so striking that it results in a mistaken diagnosis of SCC and unnecessary cancer surgery.
    • • Tx and Prognosis
    • o Conservative local excision; recurrence is uncommon.
  16. Congenital Epulis
    • • Uncommon soft tissue tumor that occurs almost exclusively on the alveolar ridges of newborns.
    • • Histogenesis is uncertain.
    • • Clinical
    • o Polypoid mass of the anterior maxillary alveolar ridge.
    • o Nodular mass on the maxillary alveolar ridge.
    • • Histo
    • o Nodular tumor mass w/ atrophy of rete ridges.
    • o Rounded cells w/ abundant granular cytoplasm.
    • • Tx and Prognosis
    • o Surgical excision; lesion never recurs.
    • o After birth, tumor stops growing and may even diminish in size. Eventual complete regression has been reported in a few pts, even w/out treatment.
  17. • Hemangioma
    • o Used to describe a variety of developmental vascular anomalies.
    • o Currently considered to be benign tumors of infancy that display a rapid growth phase w/ endothelial cell proliferation, followed by gradual involution.
    • o Most cannot be recognized at birth, but arise subsequently during the first 8 weeks of life.
    • • Vascular malformations
    • o Structural anomalies of blood vessels w/out endothelial proliferation.
    • o Present at birth and persist throughout life.
    • o Can be categorized according to the type of vessel involved and to hemodynamic features.
    • • Clinical
    • o Hemangioma of Infancy
    • • Most common tumors of infancy; more common in females, and in whites.
    • • Most common location: head and neck. Most occur as single lesions.
    • • Fully developed lesions are rarely present at birth; during the first few weeks of life, the tumor will demonstrate rapid development that occurs at a faster pace than the infant’s overall growth.
    • • Superficial tumors of the skin appear raised and bosselated w/ bright red color.
    • • Firm and rubbery to palpation, and the blood cannot be evacuated by applying pressure.
    • • Deeper tumors may appear only slightly raised w/ a bluish hue.
    • • Proliferative phase lasts 6-10 months, after which the tumor slows in growth and begins to involute. Color gradually changes to a dull-purple hue, and the lesion feels less firm to palpation.
  18. o Vascular Malformations
    • • Present at birth, persist throughout life. Port wine stains are common.
    • • Most common on the face, along the distribution of the trigeminal nerve.
    • • Typically pink or purple macular lesions that grow commensurately w/ the patient.
    • • As the pt gets older, the lesion often darkens and becomes nodular b/c of vascular ectasia.
    • • Venous malformations – low flow, encompass a wide spectrum of lesions, from small isolated ectasias to complex growths that involve multiple tissues and organs.
    • • Present at birth, may not always be immediately apparent.
    • • Are typically blue and easily compressible.
    • • Often grow proportionately w/ the patient, but may swell when dependent or w/ increased venous pressure.
    • • Arteriovenous malformations – high flow lesions that result from persistent direct arterial and venous communication.
    • • Present at birth, but may not become noticeable until later on.
    • • Palpable thrill or bruit is noticeable. Overlying skin feels warmer. May have pain, bleeding, and skin ulcerations.
  19. o Intrabony Vascular Malformations
    • • Probably represent either venous or arteriovenous malformations.
    • • Radiographic appearance is variable. Large ones may cause cortical expansion [sunburst radiographic pattern].
    • • Histo
    • o Circumscribed cellular mass of vascular endothelial cells arranged in lobular aggregates.
    • o Highly cellular endothelial proliferation forming occasional indistinct vascular lumina.
    • o Well-formed capillary sized vessels.
    • o Vascular proliferation forming multiple capillary blood vessels.
    • o Multiple, large dilated blood vessels.
    • • Tx and Prognosis
    • o Watchful neglect – most undergo involution.
    • o Even though rapid growth is seen, regression occurs.
    • o Surgical resection is rarely warranted during infancy.
    • o Methods
    • • Flashlamp pulsed dye lasers – treat port wine stains
    • • Sclerotherapy – larger lesions
    • • Injection of sclerosing agents [95% ethanol] directly into the lesion to induce fibrosis
    • • Surgical resection
    • • Combined w/ sclerotherapy, less risk of bleeding
    • o Tx of arteriovenous malformations
    • • Radiographic embolization before the surgery to minimize blood loss
    • o Vascular malformations of the jaws
    • • Dangerous b/c of the risk of severe bleeding, which may occur spontaneously or during surgical manipulation.
    • • Needle aspiration of undiagnosed intrabony lesion before biopsy is a precaution to rule out the possibility of a vascular malformation.
  20. Sturge-Weber Angiomatosis
    • • Rare, nonhereditary developmental condition that is characterized by a hamartomatous vascular proliferation involving the tissues of the brain and face.
    • • Clinical
    • o Pts are born w/ a dermal capillary vascular malformation of the face known as port wine stain.
    • • Unilateral distribution along one or more segments of the trigeminal nerve.
    • • Occasional bilateral involvement or more lesions elsewhere on the body.
    • • Only pts w/ involvement along the distribution of the ophthalmic branch of the trigeminal nerve were at risk for full disease condition (Sturge-Weber)
    • o Affected individuals also have leptomeningeal angiomas that overlie the ipsilateral cerebral cortex. Usually associated w/ a convulsive disorder and often results in mental retardation or contralateral hemiplegia.
    • o Ocular involvement may be manifested by glaucoma and vascular malformations of the conjunctiva, episclera, choroid, and retina.
    • o Intraoral involvement is common, resulting in hypervascular changes to the ipsilateral mucosa.
    • o Gingiva may exhibit slight vascular hyperplasia or a more massive hemangiomatous proliferation that can resemble a pyogenic granuloma.
    • • May be attributable to the increased vascular component, Phenytoin therapy used to control the seizures, or both.
    • o Rare: destruction of the underlying alveolar bone.
    • • Histo
    • o Excessive numbers of dilated blood vessels in the middle and deep dermis.
    • o Intraoral lesions show a similar vascular dilatation.
    • o Proliferative gingival lesions may resemble a pyogenic granuloma.
    • • Tx and Prognosis
    • o Depends on the nature and severity of the possible clinical features.
    • o Newer flashlamp pulsed dye lasers – can improve facial port wine nevi.
    • o Some cases – cortical excision of angiomatous meningeal lesions.
    • o Pts w/ intractable epilepsy and progressive mental retardation eventually may require more extensive neurosurgical tx [lobectomy or hemispherectomy].
    • o Take greater care when performing surgical procedures in the mouth b/c severe hemorrhage is possible.
  21. Nasopharyngeal Angiofibroma
    • • Rare vascular and fibrous tumorlike lesion that occurs only in the nasopharynx.
    • • Microscopically benign, but exhibits locally destructive and aggressive behavior.
    • • May represent a vascular malformation rather than a true neoplasm.
    • • Clinical
    • o Occur almost exclusively in males. Predilection for age 10-17 pts.
    • o Nasal obstruction and epistaxis are common early symptoms.
    • o Anterior bowing of the posterior wall of the maxillary sinus is characteristic.
    • o Angiograms can be used to confirm the vascular nature of the lesion.
  22. Lymphangioma
    • • Benign, hamartomatous tumors of lymphatic vessels. Not true neoplasms.
    • • Most likely represent developmental malformations that arise from sequestrations of lymphatic tissue that do not communicate normally w/ the rest of the lymphatic system.
    • • Clinical
    • o Marked predilection for the head and neck [50-75% of all cases].
    • o ½ of lesions noted at birth, 90% by 2 yo.
    • o Pebbly, vesicle-like appearance of a tumor of the right lateral tongue
    • o Dorsal tongue lesions demonstrate a purple color, which can be caused by 2ndary hemorrhage or an associated hemangiomatous component.
    • • Histo
    • o Dilated lymphatic vessels beneath the epithelium and the deeper connective tissues.
    • o Dilated, lymph-filled vessels immediately below the atrophic surface epithelium.
    • o Markedly dilated lymphatic vessels.
    • • Tx and prognosis
    • o Surgical excision, although total removal may not be possible in all cases b/c of the large size or involvement of vital structures.
    • o Do not respond to sclerosing agents [like hemangiomas do].
    • o Prognosis is good for most patients, but large tumors of the neck or tongue may result in airway obstruction and death. Mortality is 2-5%.
  23. Leiomyoma
    • • Benign tumors of smooth muscle that occur in the uterus, GI tract, and skin.
    • • Rare in the oral cavity.
    • • Clinical
    • o Occur at any age
    • o Usually a slow-growing, firm, mucosal nodule.
    • • Histo
    • o Bundles of smooth muscle w/ adjacent normal collagen
    • • Tx and Prognosis
    • o Treated by local surgical excision. Lesion should not recur.
  24. Rhabdomyoma
    • • Benign neoplasms of skeletal muscle. Also describes hamartomatous lesions of the heart that are associated w/ tuberous sclerosis.
    • • Rare, but show a predilection for the head and neck.
    • o 2 categories:
    • • Adult rhabdomyomas
    • • Fetal
    • • Histo
    • o Uniform tumor composed of rounded and polygonal cells w/ focal vacuolization
    • o Focal cross striations occur in some cells.
  25. Osseous and Cartilaginous Choristomas
    • • Tumorlike growth of microscopically normal tissue in an abnormal location.
    • • May occur in several different tissue types.
    • o Gastric mucosa, glial tissue, sebaceous gland tissue
    • o Most frequent: bone, cartilage, or both
    • • Not true neoplasms.
    • • Clinical
    • o Striking predilection for the tongue [85% of cases].
    • • Histo
    • o Mass of dense lamellar bone beneath the surface epithelium
    • • Tx and Prognosis
    • o Best treated by local surgical excision. No recurrence.
  26. Liposarcoma
    • Malignant neoplasm of fatty origin.
    • Most common soft tissue sarcoma
    • 20% of all soft tissue malignancies in adults.
    • Most common sites: thigh, retroperitoneum, inguinal region.
    • Rare in the head and neck.¬†•
    • Histo
    • o 3 major categories:¬†
    • Well-differentiated liposarcoma/atypical ¬†lipomatous tumor
    • Myxoid/round cell liposarcoma
    • Pleomorphic liposarcoma
    • Tx and Prognosis
    • o Radial excision, but 50% of all tumors recur.
    • 10 year survival = 50%.
  27. Fibrosarcoma
    • • Malignant tumor of fibroblasts.
    • • Histo
    • o Cellular mass of spindle-shaped cells demonstrating mild pleomorphism.
    • • Tx and Prognosis
    • o Surgical excision, including a wide margin of adjacent normal tissue.
    • o Recurrence in ½ of cases. 5 year survival: 40-70%.
  28. Malignant Peripheral Nerve Sheath Tumor
    • • Half seen in NF-1 Patients [neurofibromatosis]
    • • Tx and Prognosis
    • o Radical surgical excision, possibly along with adjuvant radiation therapy and chemotherapy.
    • o Prognosis is poor, especially in pts w/ Neurofibromatosis.
  29. Kaposi’s Sarcoma
    • • Unusual vascular neoplasm. Became common in the 80s b/c of propensity to develop in AIDS pts.
    • • Declined w/ advent of HAART therapy for AIDS.
    • • Caused by HHV-8. Arises from endothelial cells, maybe lymphatic origin.
  30. Leiomyosarcoma
    • • Malignant neoplasm of smooth muscle differentiation.
    • • Most common sites: uterine wall and GI tract. Rare in oral cavity.
  31. Rhabdomyosarcoma
    • • Malignant neoplasm that is characterized by skeletal muscle differentiation.
    • • Tumors are more common in young children. Rare in adults.
    • • Most frequent site = head and neck [35%].
    • • Clinical
    • o Primarily occur during the first decade of life but may also occur in teens and young adults.
    • o Painless tumor. Infiltrative mass that grows rapidly.
    • • Tx and Prognosis
    • o Multimodal therapy has helped improve prognosis for patients.
    • o Surgery and chemotherapy are main methods.
  32. Metastases to the Oral Soft Tissues
    • • Metastatic tumors to the oral cavity are uncommon and represent approx 1% of all oral malignancies.
    • • Metastases can occur to bone or oral soft tissues.
    • • Spreading routes
    • o Lymphatic
    • o Blood borne – via batson’s plexus [valveless vertebral venous plexus that might allow retrograde spread of tumor cells, bypassing filtration through the lungs].
    • • Clinical
    • o Most common oral site: gingiva [50%], tongue [25%]
    • o Lesion is a nodular mass that resembles a hyperplastic or reactive growth [pyogenic granuloma]
    • o Lesion may appear as a surface ulceration.
    • o Adjacent teeth may become loosened by an underlying destruction of the alveolar bone.
    • o Presence of teeth may play an important role in the preference of metastases for the gingiva.
    • o Once malignant cells reach the oral cavity, the rich vascular network of inflamed gingival tissues may serve as a fertile site for further growth.
    • o Most common sites: lung, kidney, melanoma, prostate, breast
    • • Tx and Prognosis
    • o Prognosis is poor b/c other metastatic sites are also frequently present.
    • o Management is palliative and should be coordinated w/ pts overall treatment.