Soft Tissue Tumors

1. Soft Tissue Tumors

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. Irritation Fibroma (Traumatic Fibroma) • Clinical Features • Reactive hyperplasia of fibrous connective tissue • Can occur anywhere in the oral cavity that is susceptible to constant • trauma – like buccal mucosa and tongue due to biting • Color is similar to surrounding mucosa and is pedunculated or sessile • Symptoms present only if ulcerated • 4th to 6th decades of life • Treatment: Conservative surgical excision

10. Giant Cell Fibroma • Clinical Features • Occurs at a much younger age compared to fibroma and • presents as asymptomatic sessile/pedunculated nodule <1cm • Not associated with trauma • More than half the cases occurs on the gingiva and has a • papillary surface; Mandible>Maxilla • Similar to retrocuspid papilla • Treatment: Conservative surgical excision • Recurrence is rare

13. Histology • Vascular and loosely arranged • fibrous connective tissue • Hallmark is the presence of • large, stellate shaped fibroblasts • which are multinucelated • Rete ridges are narrow and • elongated

14. Epulis Fissuratum (Inflammatory Fibrous hyperplasia; Denture Injury Tumor) • Clinical Features • Tumor-like hyperplasia of fibrous connective tissue that • develops in association with the flange of an ill-fitting denture • Presents as single or multiple folds of tissue in the alveolar • mucosa; usually presents as two folds with denture flanges • in between • The size varies from < 1 cm to large lesions involving the entire • length of the vestibule • Appears as firm, fibrous tissue with variable ulcerations and • erythema • Most common location is facial aspect of alveolar ridges;anterior • portions of jaws and older adults with female predilection

18. Epulis Fissuratum • Histology: • Fibrous connective tissue hyperplasia • Overlying epithelium is • hyperkeratotic and shows • hyperplasia of rete ridges • Pseudoepitheliomatous • hyperplasia • Ulceration and chronic inflammation is also seen frequently Treatment: Surgical removal and denture should be relined or remade

19. Inflammatory Papillary Hyperplasia • Reactive lesion that most commonly develops under a denture • an ill-fitting denture • poor oral hygiene • wearing the denture 24 hours • Usually occurs on the hard palate beneath a denture base • Starts at the palatal vault but advanced lesions can cover • the entire palate • Candidiasis can also be seen associated with the lesion • Mucosa is pebbly or papillary and appears erythematous • Treatment: Removal of denture • Surgical removal with altering the denture

22. Inflammatory Papillary Hyperplasia • Histology • Papillary growths surfaced by • hyperplastic startified • squamous epithelium • Pseudoepitheliomatous • hyperplasia • Chronic inflammation

23. Fibrous Histiocytoma • Group of tumors which have both fibroblastic and histiocytic • differentiation • Most common in the skin called dermatofibroma • Oral cavity – rare; buccal mucosa and vestibule • Middle aged and older adults • Painless nodular mass of varying size • Treatment: Local surgical excision

26. Fibromatosis and Myofibromatosis • Group of fibrous proliferations that have intermediate • biologic behavior • Named based on clinicopathologic features: juvenile • aggressive fibromatoses, extrabdominal desmoids • Myofibromatosis is similar but less aggressive • Painless mass occurring in children or young adults • Most common site: Paramandibular soft tissues • Tumor can grow to considerable size and can cause significant • facial disfigurement • Destruction of adjacent bone can be seen in radiographs

29. Fibromatosis and Myofibromatosis • Histology: • Cellular proliferation of spindle-shaped cells arranged in • fascicles • Poorly circumscribed and infiltrates adjacent tissues • Cells should be uniform with NO pleomorphism and • hyperchromatism • Treatment: Wide excision • 23% recurrence rate • Metastasis does not occur

31. Myofibroma (Myofibromatosis) • Rare spindle cell neoplasm that consists of myofibroblasts • The multicentric disease affects infants and young children • and this is called myofibromatosis • Predilection to the head and neck; occurs in the first 4 decades • of life with most lesions occurring in neonates and infants • Most common oral site is the mandible followed by lips, cheek, • and tongue • Painless mass in dermis or subcutaneous tissue and • intrabony cases are radiolucent • Treatment: Local excision; can spontaneously regress; lesions • affecting vital or visceral organs are aggressive and can be fatal

32. Oral Focal Mucinosis • Uncommon tumor-like mass of unknown cause. • Maybe due to overproduction of hyaluronic acid • Commonly seen in young adults with a 2:1 female-to-male ratio • Most commonly seen in the gingiva followed by hard palate • Sessile painless nodule of normal color • Size varies from a few mm to 2 cm • Histology: Well-demarcated loose myxomatous tissue • surrounded by dense collagenous tissue • Treatment: Surgical excision and recurrence is rare

33. Pyogenic Granuloma • Common tumor-like growth of the oral cavity • Exuberant response to irritation or trauma; periodontal irritation • could be a major source • Smooth or lobulated pedunculated mass which appears pink • to red in color and is commonly ulcerated • Range from a few mm to several cm – hormone dependent • GINGIVA however other sites also affected • Most common in children and young adults with females>males • Develops in pregnant women during first trimester and increases • through 7th months - Pregnancy tumors; Some will resolve • after delivery

38. Pyogenic Granuloma • Histology • In spite of name, not a true granuloma • Vascular proliferation that resembles granulation tissue • Surface is usually ulcerated • Mixed inflammatory infiltrate • Younger lesions are very vascular, but older lesions mature and are fibrous • Treatment: Conservative surgical excision. • Recurs if incompletely excised; Irritation also has to be removed.

40. Peripheral Giant Cell Granuloma • Reactive lesion due to local irritation or trauma • Resembles central giant cell granuloma • GINGIVA or edentulous alveolar ridge • Red or reddish-blue nodular mass which is usually < 2 cm • Appearance similar to pyogenic granuloma • 5th to 6th decades; F > M (60% occurs in females) • Mandible > Maxilla • Although occurs in soft tissues a “cupping” resorption of bone

43. Peripheral Giant Cell Granuloma • Histology: • Proliferation of multinucleated giant cells in a background of • plump ovoid and spindle-shaped cells • Abundant hemorrhage is observed • Treatment: • Local surgical excision down to the underlying bone • Scaling of the adjacent teeth of any source of irritation • Rarely, lesions similar to this are seen in hyperparathyroidism • (however these are mostly intraosseous)

44. Peripheral Giant Cell Granuloma

45. Peripheral Ossifying Fibroma • Reactive growth of the gingiva with uncertain histogenesis • Believed to be a matured pyogenic granuloma that ultimately • undergoes calcifications • It does not represent central ossifying fibroma • Occurs exclusively on the GINGIVA • Nodular mass that is either pedunculated or sessile usually of • the interdental papillae and appears red to pink and frequently • ulcerated • Younger adults and teens with F > M • Maxilla > Mandible; >50% cases occur in the incisor/canine area

49. Peripheral Ossifying Fibroma • Histology: • Fibrous proliferation associated with formation of mineralized • product • The surface if ulcerated, shows a fibrinopurulent membrane • The mineralized component varies from bone, cementum-like • material or dystrophic calcifications • Treatment: • Local surgical excision down to the periosteum • Scaling of the adjacent teeth to remove irritants • Recurrence rate of 16%

50. Peripheral Ossifying Fibroma