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Oral Pathology - 07 - Connective Tissue Benign Tumors

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Oral Pathology1

Table Of Contents

Clinical Categories and Disease Classifications2

  • Developmental Conditions
  • Mucosal Lesions—Reactive
  • Mucosal Lesions—Infections
  • Mucosal Lesions—Immunologic Diseases
  • Mucosal Lesions—Premalignant
  • Mucosal Lesions—Malignant
  • CT Tumors—Benign

Connective Tissue Tumors

Connective tissue tumors are located within the submucosal layer and typically manifest as "lumps or bumps." These tumors generally fall into two categories:

  • ==Reactive: Reacting to trauma or another stimulus.==
  • ==Neoplastic: Referring to new, abnormal growth.==

These lesions are further divided by tissue type, including fibrous, neural, vascular, muscular, and fat tissue.

  • CT Tumors—Malignant
  • Salivary Gland Diseases—Reactive
  • Salivary Gland Diseases—Benign
  • Salivary Gland Diseases—Malignant
  • Lymphoid Neoplasms
  • Odontogenic Cysts
  • Odontogenic Tumors
  • Bone Lesions—Fibro-Osseous
  • Bone Lesions—Giant Cell
  • Bone Lesions—Inflammatory
  • Bone Lesions—Malignant
  • Hereditary Conditions

Reactive Mucosal Lesions

Clinical Concepts3

  • Also known as traumatic fibroma, irritation fibroma, and hyperplastic scar.
  • Caused by chronic trauma or irritation.
  • Characterized as fibrous hyperplasia of the oral mucosa.
  • It is a very benign and common connective tissue tumor, often found on the buccal mucosa.

Fibroma

Gingival Hyperplasia

Drug-Induced Etiology4

  • Calcium channel blockers
  • Dilantin (anticonvulsant)
  • Cyclosporine (immunosuppressant)

Treatment and Clinical Notes

  • Treatment: Gingivectomy and discontinue drug if possible.
  • CDC is concerned about gingival hyperplasia.

CDC Mnemonic

A helpful mnemonic for drug-induced gingival hyperplasia is CDC:

  • C - Calcium Channel Blockers (e.g., verapamil, nifedipine, amlodipine)
  • D - Dilantin (phenytoin)
  • C - Cyclosporine

Denture Induced Fibrous Hyperplasia

Clinical Variants5

  • Epulis fissuratum: Located in the vestibule.
  • Papillary hyperplasia: Located on the palate
    • ==Associated Condition: Angular Cheilitis is often grouped with these as part of a “triad” of denture-associated lesions. It occurs at the corners of the mouth and is linked to fungal infections (candidiasis) when the corners of the mouth fold in due to poor denture fit.==

Traumatic Neuroma

Pathophysiology and Location6

  • Entangled submucosal mass of neural tissue and scar.
  • Caused by injury to a nerve.
  • Most common at the mental foramen.
    • The mental foramen is located near the mandibular canine and premolar area.

Associated Syndromes

  • Multiple Endocrine Neoplasia (MEN 2B): Characterized by multiple neuromas, medullary thyroid cancer, and pheochromocytoma of the adrenal gland.
    • A mnemonic to remember the association is that "MEN" is short for "mental," as in the mental foramen.

Pyogenic Granuloma

Clinical Features7

  • Hyperplasia of capillaries (appears red).
    • Presentation: Usually a bright, vividly red lesion.
  • Caused by chronic trauma or irritation.
  • Common in the gingiva.

Benign Connective Tissue Tumors

Clinical Characteristics8

  • Neoplasm of fibroblasts.
  • Easy to eradicate and rarely recurs.
  • Treatment: Surgical excision.

Nodular Fasciitis

  • Pathophysiology: A neoplasm of fibroblasts (cells that secrete collagen).
  • Clinical Characteristics: Easy to eradicate and rarely recurs after surgical excision.

Fibromatosis

Clinical Characteristics9

  • Neoplasm of fibroblasts.
  • Difficult to eradicate and often recurs.
    • Pathophysiology: Also a neoplasm of fibroblasts.

Granular Cell Tumor

Pathophysiology10

  • Neoplasm of Schwann cells.
  • Named for tumor cells containing granular cytoplasm.
    • Cell Type: A neoplasm of Schwann cells (responsible for myelin).
  • Pseudoepitheliomatous hyperplasia (PEH) in this tumor mimics Squamous Cell Carcinoma (SCC).
    • PEH features a proliferative epithelium that mimics the appearance of squamous cell carcinoma under a microscope.

Clinical Presentation

  • Most common on the dorsal tongue.
  • Congenital epulis of newborn: A variant found on the gingiva (does not exhibit PEH).

Schwannoma

  • Terminology: Also known as a neurolemoma.
  • Pathophysiology: A neoplasm of Schwann cells.

Histologic Features11

  • Neoplasm of Schwann cells.
  • Characterized by acellular Verocay bodies in Antoni A tissue (resembling a “line of scrimmage”).
    • These form a pattern described as a "line of scrimmage," appearing as two distinct lines in the histology.

Neurofibroma

Pathophysiology12

  • Neoplasm of Schwann cells and fibroblasts.

Neurofibromatosis Type I (Von Recklinghausen’s Disease)

  • Characterized by multiple neurofibromas.
  • Skin manifestations: Multiple skin freckles (café au lait spots) and axillary freckles (Crowe’s sign).
  • Ocular manifestations: Iris freckles (Lisch spots).
  • Complications: Neurofibromas can transform into neurofibrosarcomas in this condition.

Muscle And Fat Tumors

Leiomyoma

  • Neoplasm of smooth muscle cells.

Rhabdomyoma

  • Neoplasm of skeletal muscle cells.

Leiomyoma13

Lipoma

  • Neoplasm of fat cells.
  • Most common on the buccal mucosa.
    • Typically presents with a yellowish nature due to its fatty composition.

Footnotes

  1. Original PDF page 1: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.1 ↩

  2. Original PDF page 2: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.2 ↩

  3. Original PDF page 3: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.3 ↩

  4. Original PDF page 4: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.4 ↩

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  6. Original PDF page 6: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.6 ↩

  7. Original PDF page 7: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.7 ↩

  8. Original PDF page 8: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.8 ↩

  9. Original PDF page 9: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.9 ↩

  10. Original PDF page 10: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.10 ↩

  11. Original PDF page 11: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.11 ↩

  12. Original PDF page 12: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.12 ↩

  13. Original PDF page 13: Oral Pathology - 07 - Connective Tissue Benign Tumors, p.13 ↩

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