this ppt describes about benign connective tissue tumors arising from fibroblasts, fat cells, nerves, bone and cartilage. clinical & histological features of all tumors are discussed with pictures.

2. Reactive and Benign lesions of Fibroblastic and Histiocytic Origin
Irritation Fibroma
Giant Cell fibroma
Inflammatory Fibrous Hyperplasia
Inflammatory Papillary Hyperplasia
Fibrous Histiocytoma
Fibromatosis and Myofibromatosis
Oral Focal Mucinosis
Pyogenic Granuloma
Peripheral Giant Cell Granuloma
Peripheral Ossifying Fibroma
Benign Tunors of Fat tissue origin
Lipoma
Benign Tumors of Neural Origin
Traumatic Neuroma
Palisaded Encapsulated Neuroma
Schwannoma
Neurofibroma
Granular Cell Tumor
Congenital Epulis
Melanotic Neuroectodermal Tumor of Infancy

3. Benign Tumors of Vascular Origin
Hemangioma
Lymphangioma
Benign Tumors of Muscle Origin
Leiomyoma
Rhabdomyoma
Osseous and Cartilaginous Choristomas
Malignant Tumors of Connective Tissue
Fibrosarcoma
Malignant Fibrous Histiocytoma
Liposarcoma
Neurofibrosarcoma
Angiosarcoma
Kaposi’s Sarcoma
Leiomyosarcoma
Rhabdomyosarcoma
Metastases to Oral Soft Tissues

4. • Most common benign tumor of oral cavity
• Reactive focal fibrous hyperplasia
• due to trauma or local irritation
Clinical Features:
• Age- occurs at any age, most commonly in 3rd , 4th & 5th
decades
• Sex predilection- Female : Male 2 : 1
• buccal mucosa along plane of occlusion
• gingiva, buccal mucosa, tongue, lips & palate
• may be small, or several cm in diam.

5. • Elevated nodule of normal color,
• Smooth surface, sessile or pedunculated base
• Surface may be inflamed, ulcerated or show hyperkeratosis
• Well-defined, slowly growing lesion
Clinical Differential Diagnosis
• Giant cell fibroma,
• Neurofibroma,
• Peripheral giant cell granuloma,
• Mucocele,
• Benign & Malignant salivary gland tumours

6. • Histologic Features-
• Bundles of interlacing collagen fibers interspersed with
fibroblasts or fibrocytes & small blood vessels
• layer of stratified squamous epithelium, frequently
stretched,
• Shortening & flattening of rete ridges
• Trauma- vasodilatation, edema & inflammatory cell
infiltration
• Diffuse or focal calcification or even ossification Fibroma

8. • Pathogenesis :- Pyogenic Granuloma if left untreated
healing by sclerosis resembles to fibroma histologically
• Treatment-
• Conservative surgical excision
• Recurrence very rare/No recurrence

9. • Represent a group of infiltrating fibrous proliferations
• Biologic behavior & Microscopic appearance intermediate
between Benign lesions & Fibrosarcomas
• Clinical Features:
• Head & Neck region, particular Submandibular area
• Intraoral lesions –rare
• Age- 0-51 years of age,
• Commonly diagnosed before age of 10 years
• No significant gender predilection
• Intraosseous counterpart of soft-tissue fibromatosis---
Desmoplastic Fibroma

10. • Histopathological Features
• Poorly demarcated, infiltrating cellular proliferation of
mature spindle cells arranged in streaming & interlacing
fascicles
• prominent collagen production
• Infiltration into adjacent structures at periphery
• Cellular atypia absent

11. • Clinical Differential Diagnosis
• Low-grade fibrosarcoma,
• Nodular fasciitis,
• Reactive fibrous hyperplasia,
• Fibrous histiocytoma,
• Treatment-
• Wide surgical excision
• Recurrence rate- 24% for intraoral fibromatoses

12. • Clinical Features:
• Age- 10-30 years, No gender predilection
• Site- most common- mandibular gingiva -maxillary
gingiva, tongue, palate
• Asymptomatic, sessile or pedunculated nodule,
• Less than 1 cm in diam.
• Often has a papillary surface Giant Cell Fibroma
• Clinical Differential Diagnosis :- Squamous papilloma,
Irritation fibroma, pyogenic granuloma, Peripheral giant
cell granuloma, Giant Cell Fibroma

13. • Histopathlogic Features-
• Unencapsulated mass of loose fibrous C.T.
• In peripheral areas of lesion:- Numerous characteristic
large, plump, spindle-shaped and stellate fibroblasts,
Some fibroblasts multinucleated
• In central areas - typical fusiform fibroblasts
• Surface epithelium- corrugated & atrophic, thin elongated
rete ridges
• Origin of stellate & multinucleate cells- not known
• Show positive immunostaining for vimentin -suggests
fibroblast phenotype

14. • Treatment & Prognosis-
• Conservative Excisional Biopsy
• Rare recurrence

15. • A common gingival lesion
• Characterized by high degree of cellularity
• Showing bone formation
• Occasionally cementum like material
• rarely dystrophic calcification

16. • Clinical Features:
• Age- can occur at any age, - more common in children & young
adults
• Female sex predilection- F:M 2:1 to 3:2
• Equal distribution in maxilla & mandible
• Anterior to molar area
• Well demarcated focal mass of tissue on gingiva
• Sessile or pedunculated base
• Color- same as that of normal mucosa or slightly reddened
• Surface- intact or ulcerated
• Commonly originates from interdental papilla
• Radiographic Features-
• No apparent underlying bone involvement
• Rarely superficial erosion of bone

17. • Histopathlogic Features-
• Surface- ulcerated SSE or intact
• exceedingly cellular mass of C.T.
• Large nos. of plump proliferating fibroblasts intermingled
throughout very delicate fibrillar stroma
• Characteristic high degree of cellularity
• Vascularity not prominent
• Calcifications- several forms, varying in amount from Single or
multiple interconnecting trabeculae of bone or osteiod OR
Globules of calcification resembling acellular cementum OR
Diffuse granular dystrophic calcification
• Occasional multinucleated giant cells
• Treatment & Prognosis- Surgical excision
• Lesions recur sometimes

20. • intraosseous Neoplasm
• They are two separate benign tumors, identical in nature, Except for
the cell undergoing proliferation------
• Osteoblast with bone formation -Central ossi. F. AND
• Cementoblast with cementum formation –Central C. F.
• They represent simply two facets of the same basic tumor Central
Ossifying Fibroma
Clinical Features:
• Age predilection- Young adults, mean age- 33 years
• predilection for mandible,
• Female sex predilection, High incidence in Blacks
• Generally asymptomatic, swelling & mild deformity
• Displacement of teeth an early clinical feature
• Relatively slow growing tumor Central Ossi. Fibroma

21. • Radiographic Features-
• Variable appearance depending upon stage of
development
• Well circumscribed & demarcated
• Early stages- radiolucent with no evidence of radio-
opacities as tumor bone matures- flecks of radio-
opacities appear late stages- lesion appears as uniform
radiopaque mass
• Displacement of adjacent teeth
• Impingement upon other adjacent structures

22. Histopathologic Features-
• Many delicate interlacing collagen fibers rarely in bundles
interspersed by numerous active, proliferating fibroblasts
• Many small foci of irregular bony trabeculae
• As the lesion matures, islands of ossification increase in
number, enlarge & ultimately coalesce
• Treatment & Prognosis- Conservative excision & Rare
recurrence

23. • Etiology- unknown
• local irritation due to dental plaque or calculus,
periodontal disease, poor dental restorations, ill-fitting
dental appliances, dental extractions
• Clinical Features:
• Age :- 4th to 6th decades, Female : Male 2:1
• Generally asymptomatic, relatively rapid growth rate
• Gingiva or alveolar process, anterior to molars
• Slight predilection for mandible
• Pedunculated or sessile mass, Size- variable
• Dark red, vascular or hemorrhagic in appearance,
Surface ulceration common

24. • In edentulous patient- Lesion- vascular, ovoid or fusiform
swelling of crest of alveolar ridge 1-2 cm in diam.
• Granular mass of tissue growing from tissue covering
slope of alveolar ridge
• Dark red, vascular or hemorrhagic in appearance
• Ulceration less common

25. Histopathologic Features-
• Nonencapsulated mass of tissue
• Delicate reticular & fibrillar C.T. stroma
• Large nos. of ovoid or spindle shaped young C.T. cells
• Multinucleated giant cells-
• Numerous capillaries particularly around periphery of
lesion
• Foci of hemorrhage, with liberation of hemosiderin
pigment, subsequent ingestion by mononuclear
phagocytes

26. • Radiographic Features-
• In edentulous areas- superficial erosion of bone with
pathognomonic peripheral ‘cuffing’ of bone In dentulous
areas-
• superficial destruction of alveolar margin or crest of
interdental bone
• Treatment & Prognosis- Complete surgical removal-
curative
• Excellent prognosis
• Recurrence rate of 10-15%

27. • Clinical Features-
• Young patients under 30 yrs,
• Female : Male = 2:1
• Mandible, Ant. parts, commonly crossing midline
• No sign & symptoms, accidental finding
• May cause expansion of cortex & perforation
• Mobility, displacement & root resorption of associated tooth
• Borders of lesion may be regular or diffuse
• Depending upon Clinical & Radiographic features-
• Non-aggressive- slow growing, no root resorption or cortical
perforation, new bone formation
• Aggressive- grows quickly, cortical perforation, root resorption
& pain

28. Radiographic Features-
• Radiolucent area with ragged or relatively smooth border
• Often multilocular
• Cortical plates often thin & expanded & may be
perforated
• Displacement of adjacent teeth
• Appearance not pathognomonic

29. • Histopathologic Features-
• Loose fibrillar C.T. stroma interspersed with proliferating
fibroblasts & small capillaries
• Multinucleated giant cells- throughout the C.T. vary in
size from case to case ◦ contain only few or several
dozen nuclei
• Numerous foci of extravasated blood & hemosiderin
• Foci of new trabeculae of osteoid or bone at periphery of
lesion
• Treatment & Prognosis-
• Curettage or surgical excision
• Occasional recurrence

30. • Pseudocyst, Solitary lesion of bone
• Not classified as a neoplasm since it regresses after
incomplete removal
• Etiology- ◦ Unknown
• Several cases arise after trauma or fracture
• May arise de novo in bone without a definite preexisting
lesion
• Rarely malignant tumors of bone may contain benign
areas similar to ABC

31. • Clinical Features-
• Under 20 years, No gender predilection
• History of trauma prior to development of lesion
• seen in every part of skeleton, rarely skull & bones of
hands & feet
• Tender or painful particularly upon motion
• Affected bone movement limited,
• Swelling over the area of bone involvement

32. Gross findings at the time of surgery-
• Excessive bleeding upon opening the bony lesion (‘Blood
welling up’ from the tissue)
• Tissue resembles a blood-soaked sponge
• Large pores representing cavernous spaces of lesion
• Some studies show A.B.Cysts with elevated vascular
pressure as high as arteriolar levels
Oral Manifestations-
• Age range- 6-69 years, average age 18 years
• slight predilection for females

33. • 4 phases of Pathogenesis-
• Osteolytic - initial phase
• Active growth phase- rapid destruction of bone &
subperiosteal blow out pattern
• Mature stage (Stage of Stabilization)-formation of distinct
peripheral bony shell & internal bony septae & trabeculae
to give soap-bubble appearance
• Healing phase- showing progressive calcification &
ossification dense bony mass

34. Radiographic Features-
• Expansion of bone
• Cyst with a soap-bubble appearance
• Cortical bone may be destroyed
• Periosteal reaction may be present

35. Histopathlogic Features-
• Fibrous C.T. stroma
• Many cavernous or sinusoidal blood-filled spaces
• Blood spaces may show thrombosis
• Numerous young fibroblasts
• Many multinucleated giant cells in a patchy distribution
• Varying amounts of hemosiderin
• New osteoid & bone formation

36. • Pathogenesis-
• Persistent local alteration in hemodynamics- leads to
increased venous pressure development of dilated &
engorged vascular bed resorption of bone replaced by
C.T., osteoid & new bone
• Exuberant attempt at repair of a hematoma of bone, but
the hematoma maintains a circulatory connection with
damaged vessel
• Primary lesions- solitary bone cyst, osteoclastoma,
trauma etc
• primary lesion of initiates an arteriovenous fistula due to
its hemodynamic forces creates secondary reactive
lesion of bone i.e. ABC
• Hillerup & Hjrting-Hansen- ABC, CGCG & solitary bone
cyst have common dysvascular etio. & local factors diff.
Treatment & Prognosis- Surgical curettement or excision
• Irradiation may lead to radiation sarcoma

37. • Benign neoplasm of adipose tissue composed of
mature fat cells
• Age predilection- adults, No gender predilection
• Buccal mucosa & buccal vestibule, Tongue, floor of
mouth, gingiva
• Sessile or pedunculated, Soft, smooth-surfaced nodular
• Typically asymptomatic, <3 cm, occasionally larger
• More superficial lipomas look yellow

38. • Histopathlogic Features-
• Gross pathology- Yellow coloured, Float in aqueous
solutions
• Usually well circumscribed, may show a thin capsule
• Mature fat cells, lobules of fat cells separated by fibrous
septae
• Treatment & Prognosis- Conservative local excision
• Rare recurrence
• Infiltrating lipomas- high recurrence rate,
• but rare in orofacial region Lipoma

39. • Abundant myxoid ground substance
(mucopolysaccharides, mainly hyaluronic acid)
• True neoplasm made of tissue resembling primitive
mesenchyme
• Benign lesion, does not metastasize
• Frequently infiltrates adjacent tissues
• Intraoral soft tissue myxoma- extremely rare
• Cases occurring in jaw bones- commonly are
odontogenic myxomas

40. Histopathlogical Features-
• Loose-textured tissue with delicate reticulin fibers
• Mucoid material probably hyaluronic acid
• Varying nos. of stellate cells & occasional spindle cells
interspersed throughout
• No encapsulation
• May invade into surrounding tissue
Treatment & Prognosis- Surgical excision & Recurrence
common

41. • Benign tumor of nerve tissue origin derived from cells
that form nerve sheath
• Seen either ◦ As a solitary lesion- similar except absence
of hereditary factors, unknown etiology
• ◦ As a part of Neurofibromatosis- Autosomal Dominant
trait

42. Clinical Features-
• Hereditary disease, Autosomal dominant trait,
• No gender predilection, cosmetic problems,
• Risk of malignant transformation
• Discrete, non-ulcerated nodules or Diffuse masses of
tissue
• Buccal mucosa, palate, alveolar ridge, tongue
• Macroglossia due to diffuse involvement of tongue
• Occasionally located centrally within jaw bones

43. • Histopathological Features-
• May or may not be well circumscribed
• Interlacing bundles of spindle-shaped cells often with
wavy nuclei
• Cells are associated with delicate collagen bundles
• variable amounts of myxoid matrix
• Numerous mast cells
• In plexiform neurofibroma- distorted masses of
myxomatous peripheral nerve tissue still within perineural
sheath
• Treatment-
• Solitary neurofibroma- surgical excision
• For neurofibromas associated with Neurofibromatosis-
surgical removal only for functional or cosmetic purpose

45. • Benign neural neoplasm of Schwann cell origin
• Neurites are not a component of tumor as in
neurofibroma
• Clinical Features-
• Occurs at any age, no gender predilection
• Slow growing lesion, arises in association with a nerve
trunk
• Usually painless unless causes pressure on adjacent
nerve
• Few mm to several cm in size

46. • Oral Manifestations-
• Tongue- most common site for oral neurilemomas
• Can occur anywhere in mouth
• Single circumscribed nodule of varying size
• Can occur centrally within jaw bones
• ◦ commonly in mandible- arising from mandibular nerve
• ◦ May cause destruction of bone with cortical plate
expansion

47. • Histopathological Features-
• Usually encapsulated
• 2 microscopic patterns in varying amounts
• Antoni type A
• ◦ Streaming fascicles of spindle-shaped Schwann cells
• ◦ Cells often form a palisaded arrangement around central
acellular,
• ◦ eosinophilic areas called verocay bodies
• ◦ Verocay bodies consist of reduplicated basement membrane
& cytoplasmic processes
• Antoni type B-
• ◦ Less cellular & less organized
• ◦ Spindle cells arranged randomly within a loose myxomatous
stroma
• No neurites, but degenerative changes can be seen

49. • Benign tumor composed of mature cartilage
• Clinical Features-
• AGE- 3rd & 4th decades of life.
• No gender predilection
• Lesion- Painless, slowly progressive swelling of jaws, may
cause loosening of teeth
• SITE- ◦ anterior part of maxilla, particularly midline
• ◦ Mandible, posterior to canine
• ◦ Nasal septum
Radiographic features-
• Destructive lesion
• Irregular radiolucent or mottled appearance
• Root resorption of adjacent teeth Chondroma

50. Histopathological Features-
• Circumscribed mass of mature hyaline cartilage
• Well formed lacunae containing small chondrocytes with
pale cytoplasm & small, round nuclei
• May show areas of calcification or necrosis
• Treatment- Total surgical excision

51. • Benign tumor composed of mature compact or cancellous
bone in an endosteal or periosteal location
Clinical Features-
• Not common in oral cavity
• Age- common in young adults
• If Periosteal in origin- circumscribed swelling on the jaw,
asymmetry of face
• If endosteal in origin- slower to present manifestations
• Pain not common
• Multiple osteomas of jaws & skull in Gardner’s syndrome
• Rarely soft tissue osteomas in tongue Radiographic features-
• Well circumscribed radiopaque mass

52. Histopathologic Features-
• Well circumscribed lesion
• Either composed of extremely dense, compact bone with
minimal marrow tissue (compact osteoma) OR
• Coarse cancellous bony trabeculae & fibrofatty marrow
(cancellous osteoma)
• Sometimes foci of cartilage present- osteochondroma
• Treatment- Total surgical excision if causes cosmetic
deformity No recurrence compact bone with minimal
marrow tissue

54. • Benign tumor bone
• True nature of the lesion unknown ◦ True neoplasm of
osteoblastic derivation OR ◦ Lesion as result of trauma or
inflammation Clinical Features-
• Age- young persons, Gender- M>F 2:1
• Site- femur, tibia, rarely in the jaws
• Severe pain- sharp, worse at night, relieved by aspirin
• Localized swelling of soft tissue over involved area

55. Radiographic features- Lesion rarely larger than 1 cm
• Small round or oval radiolucency surrounded by sclerotic
border
Histopathologic Features-
• Central nidus composed of compact osteoid tissue
• Interspersed by vascular CT
• Formation of definite trabeculae outlined by active
osteoblasts,
• Osteoclasts & foci of bone resorption
• Treatment-
• Conservative surgical excision

56. • Benign neoplasm of bone arising from osteoblasts
• Histologically similar to osteoid osteoma
• More growth potential than osteoid osteoma
• Lacks the characteristic pain of osteoid osteoma
• Lacks the halo of sclerotic bone as in osteoid osteoma
• Some authorities consider osteoblastoma &
cementoblastoma as identical lesions

57. • Histopathologic Features-
• Actively proliferating osteoblasts which pave the irregular
bony trabeculae
• Many dilated capillaries scattered throughout the lesion
• Moderate no. of multinucleated giant cells scattered
throughout the lesion
• Treatment- Conservative surgical excision
• Recurrence rare

58. • A common exostosis occurring in midline of the vault of hard
palate (Bony protuberance)
• Pathogenesis- unclear
• ◦ Hereditary condition
• ◦ Local environmental factors
• ◦ masticatory stress
• ◦ multifactorial
• Clinical Features-
• F>M 2:1, Age- may occur at any age,
• Racial predilection- American Indians & Eskimos
• Outgrowth in the midline of palate

59. • Classified clinically according to shape- ◦ Flat ◦ Spindle-
shaped ◦ Nodular ◦ Lobular
• Overlying mucosa may be normal, blanched or ulcerated
• Histopathological Features-
• Dense compact bone OR Shell of compact bone with a
center of cancellous bone
• Treatment- May be removed to accommodate denture
base or if it interferes with oral function

60. • Exostosis found on lingual aspect of mandible
• Etiology- unknown, Hereditary condition, Local
environmental factors, masticatory stress, Multifactorial
• Clinical Features-
• Variable size & shape
• Lingual surface of mandible above mylohyoid ridge
• Usually bilateral, may be unilateral
• Single or multiple lobed

61. Histopathologic Features-
• Dense compact bone OR Shell of compact bone with a
center of cancellous bone
• Treatment- May be removed to accommodate denture
base or if it interferes with oral function

62. • Less common, Unknown etiology
• On buccal surface of maxilla below mucobuccal fold in
molar region
• Small nodular protuberances,
• Asymptomatic, overlying mucosa may be blanched
• May interfere with preparation or insertion of prosthetic
appliances