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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.
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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.
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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.
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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.
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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.
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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.
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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%.
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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.
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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.
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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.
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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.
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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.
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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.
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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].
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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.
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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.
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• 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.
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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.
-
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.
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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.
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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.
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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%.
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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.
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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.
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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.
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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%.
-
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%.
-
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.
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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.
-
Leiomyosarcoma
- • Malignant neoplasm of smooth muscle differentiation.
- • Most common sites: uterine wall and GI tract. Rare in oral cavity.
-
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.
-
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.
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