Oral Pathology - 07 - Connective Tissue Benign Tumors

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

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