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Benign Connective Tissue Tumours.pptx
- 2. Reactive and Benignlesions 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 ofVascular 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 commonbenign 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 noduleof 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 agroup 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 DifferentialDiagnosis • 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 commongingival 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- • Manydelicate 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 edentulouspatient- 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- • Nonencapsulatedmass 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- • Radiolucentarea 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, Solitarylesion 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 atthe 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 phasesof 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- • Expansionof bone • Cyst with a soap-bubble appearance • Cortical bone may be destroyed • Periosteal reaction may be present
- 35. Histopathlogic Features- • FibrousC.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- • Persistentlocal 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 neoplasmof 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 myxoidground 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-texturedtissue 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 tumorof 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- • Hereditarydisease, 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 neuralneoplasm 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 tumorcomposed 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- • Circumscribedmass 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 tumorcomposed 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- • Wellcircumscribed 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 tumorbone • 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- Lesionrarely 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 neoplasmof 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 commonexostosis 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 clinicallyaccording 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 foundon 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- • Densecompact 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
Editor's Notes
- #28 Jaffe ‘central giant cell reparative granuloma’ to distinguish it from ‘giant cell tumor’ of long bones Reparative response -rare, most lesions were destructive, So the word ‘reparative’ was removed from the term