Soft Tissue Tumor for Rafdain

7/30/2019 Soft Tissue Tumor for Rafdain

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Oral Pathology

. Connective tissue neoplasms and

allied conditions


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Reactive hyperplasias comprise a group of

fibrous connective tissue lesions that

commonly occurs in oral mucosa as a result of

injury. They represent a chronic process in

which granulation tissue and scar follows

injury. As a group these lesions present as

submucosal masses that may becomesecondarily ulcerated when-traumatized

during mastication.


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A - Hyperplastic lesions

Peripheral fibroma:-

Clinical features

It's a reactive hyperplastic mass that occurs on the gingiva

and is believed to be derived from connective tissue of thesubmucosa or periodontal ligament. It may occur, at anyage, although young aged groups are mostly affected.Females more commonly affected than do males, thegingiva anterior to the permanent molars.

Fibroma, present clinically, as either a pedunculated or asessile mass that is similar in color to the surroundingconnective tissue, ulceration may be noted.


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Fibroma

Fibroma. Lesion on lateral border of tongue


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Histopathology

Fibroma (Traumatic fibroma): Is a focal

fibrous hyperplasia "hyperplastic scar". It's

highly collagenous and relatively avascular,

and it may contain a mild to moderate chronic

inflammatory cell infiltrate. This lesion is

basically the gingival counterpart to traumaticfibroma occurring in other mucosa,


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Fibroma


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Fibroma


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Peripheral ossifying fibroma: Is a gingival

mass in which islands of woven "immature

bone" bone and osteoid are seen. The bone

formed is surrounded by a lobular

proliferation of plump benign fibroblasts.

Chronic inflammatory cells tend to be seen

around the margins of the lesion. The surfaceis ulcerated


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Peripheral ossifying fibroma


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Peripheral (ossifying) fibroma.

Peripheral (ossifying) fibroma.


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Peripheral ossifying fibroma. Note cellular fibroblastic proliferation with islands of

new bone.


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Peripheral fibroma with stellate-shaped fibroblasts.


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Peripheral odontogenic fibroma: Is a gingival

mass composed of well-vascularized, non-

encapsulated fibrous connective tissue. The

distinguishing feature of this variant is the

presence of strands of odontogenic

epithelium, often abundant, throughout the

connective tissue amorphous hard tissueresembling tertiary dentine "dentinoid"

maybe seen. It's usually non-ulcerated.


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Giant cell fibroma: Is a focal fibrous hyperplasia in which

connective tissue cells, many of which are multinucleated,

assume a stellate shape. It has been shown by immuno-

histochemical studies that most of these cells are

fibroblast.unlike the traumatic fibroma, its not associated

with trauma. Its asymptomatic sessile or pedunculated

with papillary surface. Gingiva affected in 50% , Tongueand palate are also can be involved (non traumatized

sites). Histologically is a mass of vascular connective tissue

with numerous large stellate fibroblast (with several

nuclei) in the superficial connective tissue. The retrocuspidpapilla is a developmental anomly with similar

histopathological features. It affect lower gingiva behind

the lower canine, unilateral or bilaterally. No treatment is

required.


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Giant cell fibroma


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Giant cell fibroma


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Differential diagnosis

Pyogenic granuloma and peripheral giant cell

granuloma


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Treatment

By local excision that include periodontal

ligament if involved and any other possible

etiologic agent such as calculus or other

foreign material. Recurrence may occasionally

be seen in peripheral ossifying fibroma. He-

excision to the periosteum or periodontalligament prevent further recurrence


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2- Focal fibrous hyperplasia:-

Is a reactive lesion usually caused by chronic

trauma to oral mucous membranes, outer-

production of fibrous connective tissue results ina clinically evident submucosal mass. Although

the terms traumatic fibroma and oral fibroma are

applied to these entities, they are misnomers,since these lesion's are not benign tumors of

fibroblasts, as term fibroma implies.


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Clinical features

No gender or racial predilection, for the developmentof this intraoral lesion. It's a very common reactivehyperplasia that is typically found in frequently

traumatized areas, such as the buccal mucosa, lateralboarder of the tongue and lower lip. It's a painless,broad swelling that is paler than the surrounding tissuebecause of its relative lock of vascular channels. The

surface may occasionally be ulcerated traumatically,particularly in larger lesions, they usually don't exceed1-2 cm in diameter.


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Focal fibrous hyperplasia, buccal mucosa.


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Focal fibrous hyperplasia.


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Histopathoiogy

Collagen overproduction is the basic process

that dominates the microscopy of this lesion.

Fibroblasts are mature and widely scattered in

a dense collagen matrix. Occasional chronic

inflammatory cells may be seen overlying

epithelium is often hyperkeratotic because ofchronic irritation.


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Focal fibrous hyperplasia.


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In tongue Neurofibroma, neurilemmoma,and granular cell tumor.

In lower lip + buccal mucosa lipoma,mucocele and salivary gland tumor.


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Treatment

By surgical excision

The term fibrous hyperplasia is synonymouswith peripheral fibroma, traumatic fibroma,

irritation fibroma, hyperplastic srar;inflammatory fibrous hyperplasia


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3- Denture-induced fibrous hyperplasia

Denture-induced fibrous hyperplasia is related to

chronic trauma produced by an ill-fitting denture.

The process is essentially the same as the onethat leads to traumatic fibroma, except that a

denture is specifically identified as the causative

agent, this lesion has been named by severalsynonyms: inflammatory hyperplasia, denture

hyperplasia, epulis fissuratum.


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Clinical feature

It is a common lesion that occurs in the vestibular

mucosa and less commonly along the mandibular

lingual sulcus where the denture flange contactstissue-chronic trauma and irritation may cause

fibrous connective tissue reparative response,

which resulted in the appearance of painlessfolds of fibrous tissue surrounding the

overextended denture flanges.


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Denture-induced fibrous hyperplasia.


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Denture-induced fibrous hyperplasia.


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Epulis fissuratum


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Fibroepithelial polyp


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Treatment

Removal of the denture, surgical excision of

the hyperplastic scar and construction of a

new denture.


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Treatment

Removal of the denture, surgical excision of

the hyperplastic scar and construction of a

new denture.


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B- Neoplasm of fibrous tissue

1-Myxoma:-

Clinical features

Is a soft tissue neoplasm composed of a

gelatinous material that has a myxoid

appearance histologically. Oral tumors are rare

and present as a slow growing asymptomatic

submucosal mass, usually in the palate.


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Odontogenic myxoma of the right mandible. Note

malpositioned third molar.


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Odontogenic myxoma showing characteristic multilocularity.


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Histopathology

The tumor is not encapsulated and may

exhibit infiltration into surrounding soft tissue.

Stellate and spindle shaped fibroblasts are

found in a loose myxoid stroma


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Odontogenic myxoma exhibiting typical bland myxoid

appearance.


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Odontogenic fibromyxoma with collagen bundles and residual

bony trabecula (center) evident.


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Treatment

Surgical excision, recurrence is not

uncommon.


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2- Nodular fasciitis, fibrous histocytoma and fibromatosis. Nodular fasciitis:-

Clinical features

Also known as pseudosarcomatous fasciitis in a well

recognized entity representing a fibrous connective tissuegrowth. The cause of their proliferation is unknown.Trauma is believed to be important in many cases becauseof the location of the lesions over bony prominence such asthe angle of the mandible and the zygoma. Althoughtraditionally considered a reactive condition, recentmolecular evidence suggests that the cells in nodularfasciitis are clonal, thus supporting the concept that thelesion is a benign neoplasm


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. Clinically they present as a firm mass in the

submucosa and exhibits rapid growth with

pain and tenderness, young adults and adults

are mainly affected, 10% of these lesionsappear in the head and neck region, usually in

the skin of the face, and the parotid sheath,

intra-orally the buccal mucosa is the mostcommon affected site, the lesion is benign.


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Histopathology

A nodular growth of plump fibroblast and

myofibroblasts with vesicular nuclei in a

haphazard to storiform arrangement.


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Nodular fasciitis. A and B, Lobular or nodular pattern

with foci of lymphocytes.


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Nodular fasciitis. A and B, Lobular or nodular

pattern with foci of lymphocytes.


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Fibromatosis, fibrohistocytoma and

Fibrosarcoma.


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FibromatosisMore infiltration, grow infascicles, produce more collagen and less cellular.

Fibrous histiocytoma More cellular with

storiform pattern.

FibrosarcomaIs infiltrative and exhibit a

herringbone pattern, with nuclear pleomorphism,hyperchromatism and abundant mitoses.


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fibromatosis


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Generalized gingival hyperplasia associated with local

factors and hormonal changes.(Fibromatosis)


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Generalized gingival hyperplasia associated with phenytoin

therapy for seizures.


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Generalized gingival hyperplasia associated with

chronic monocytic leukemia.


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fibromatosis


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Treatment

Nodular fasciitis and fibrous histocytorna by surgical excision

Fibromatosis by aggressive surgery


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3-Fibrosarcoma

Malignant spindle cell tumor showing a herringbone orinterlacing fascicular pattern and no expression ofother connective tissue ceil markers.

Clinical features

Rare soft tissue and bone malignancy results fromproliferation of malignant mesenchymal cells at thesite of origin, it may become secondarily ulceratedmainly affects young adults. The tumor is infiltrativelocally destructive more than a metastatic one.


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Fibrosarcoma


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Fibrosarcoma of the buccal mucosa.


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Histopathology

Malignant appearing fibroblasts, with

herringbone or interlacing fascicular pattern,

collagen may be sparse and mitotic figures

frequent. The margins are ill-defined.

Treatment

Wide surgical excision, with high recurrence

rate.


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Fibrosarcoma


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Fibrosarcoma composed of atypical spindle cells.


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3-Fibrohistocytic tumors

The original concept of these tumors is that

some show dual population of fibroblasts and

histocytes (macrophages). Now it's known

that this concept is incorrect and that the

tumors show no histocytic differentiation and

are of fibroblastic origin.


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Fibrous histiocytoma


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Benign and malignant fibrous histocytoma (B

& MFH )

BFH:-

Is a fibroblastic neoplasm that uncommonly

occur in oral soft tissues. Mainly affects adults

with fifth decade of life and prevents as a

painless masses that maybe ulcerated


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Histopathology

Well demarcated tumor, there is a storiform

(cartwheel or mat-like) growth pattern of

spindle cells "fibroblasts" with vesicular nuclei

admixed with some inflammatory cells, tumor

giant cells may be seen. No atypia, mitoses are

infrequent or not present


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Fibrous histiocytoma

Benign fibrous histiocytoma composed of plump


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Benign fibrous histiocytoma composed of plump

fibroblasts.


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Treatment Surgical excision


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MFH:-

A soft tissue malignant tumor with different

clinical and histological features.

Clinical features

It's an infrequently reported lesion in the head

and neck region. It has a significant recurrence

and metastatic potential. It occurs in late adult

life and is rare in children.


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Malignant fibrous histiocytoma


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Histopathoiogy

Proliferation of pleomorphic spindle cells

showing fibroblastic morphology, abnormal

and frequent mitotic figures, necrosis andextensive cellular atypia. The storiform

pattern is seen in some cases.


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Malignant fibrous histiocytoma


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Treatment

Wide surgical excision


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Vascular lesions:-

Pyogenic granuloma, vascular lesions,

Kaposi's sarcoma and angiosarcoma

Hemanigoma Vascular malformation


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Pyogenic granuloma: Represents an exuberant connective tissue

proliferation to a known stimulus or injury. It appearsas a red mass because it is composed predominantly ofhyperplastic granulation tissue in which

capillaries are very prominent, and hence the termlobular capillary hemangioma.

The original term pyogenic granuloma is a misnomer inthat it's not pus producing, and it does not represent

granulomatous inflammation. Hence the new term islobular capillary hemangioma and currently consideredas vascular tumor.


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Clinical features

Mostly seen on the gingiva, where they are presumablycaused by calculus or foreign material within thegingival cervice. Hormonal changes of puberty and

pregnancy may modify the gingival reparative responseto injury, producing what was called "pregnancytumor".

Other parts of oral mucosa may else be affected, such

as lower lip, buccal mucosa, and the tongue. Pyogenicgranuloma is typically red. Occasionally they maybecome ulcerated because of secondary trauma.

i l


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Pyogenic granuloma

P i l


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Pyogenic granuloma

l


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Pyogenic granuloma.

l


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Pyogenic granuloma.

P i l


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Pyogenic granuloma.

P i l


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Pyogenic granuloma.


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Histopathology

Microscopically, consist of lobular masses ofhyperplastic granulation tissue, some scarringmay be noted in some of these lesions,suggesting that occasionally there maymaturation of the connective tissue repairprocess. Numerous small and large endothelium-

lined channels are formed organized in lobularaggregate. Admixed inflammatory cellsinfiltration is evident

P i l


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Pyogenic granuloma

P i l


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Pyogenic granuloma

Pyogenic granuloma showing abundant


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y g g g

capillaries.


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Peripheral giant cell granuloma, ossifying

fibroma, rarely metastatic malignancy.

Treatment

Surgical excision, which includes the

connective tissue from which the lesion arises

as well as removal of local etiologic features,

some lesions have recurrence potential.

P i h l i t ll l


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Peripheral giant cell granuloma.

P i h l i t ll l


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Peripheral giant cell granuloma.

Peripheral giant cell granuloma showing fibroblastic


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p g g g

matrix and abundant multinucleated giant cells.


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2- Congenital hemangioma and vascularmalformations: The term congenital

hemangioma is used to identify benign

congenital neoplasms of proliferatingendothelial cells, congenital vascular

malformation includes lesions resulting from

abnormal vessels morphologies


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Vascular lesions:- Pyogenic granuloma.

Intravascular lesions

Congenital hemangioma & congenital vascularmalformations.

The term congenital hemangioma and congenitalvascular malformations have been used as a genericdesignation for many vascular proliferation and they

have also been used interchangeably. Because of thedifference in clinical as well as behavioral characteristicit is important to seperate one from another:-


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Clinical features Congenital hemangioma also called strawberry

nevus, usually appears around the time of birth, butmay not be apparent until early childhood. It exhibit a

rapid growth phase, which is followed several yearslater by an involution phase. While congenitalmalformation are persistent. Both types maybe flat,nodular or bosselated. Lesions are most commonly .

found on the lips, tongue, and buccal mucosa .Lesionsthat affect bone are probably congenital vascularmalformations rather than congenital hemangioma.

hemangioma


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hemangioma

hemangioma


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hemangioma

Congenital hemangioma


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Congenital hemangioma.

Hemangioma of bone showing honeycomb


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radiographic pattern with associated root resorption.

Hemangioma of bone


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Hemangioma of bone.

Oral vascular malformation causing slight facial


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asymmetry.

Vascular malformation of the palate


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Vascular malformation of the palate.

Vascular malformation of the buccal mucosa


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Vascular malformation of the buccal mucosa.

Vascular malformation


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Vascular malformation.

Oral vascular malformation causing slight facial


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asymmetry.


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Histopathology

Congenital hemangiomas are composed of

abundant capillary spaces lined by

endothelium without muscular support.Congenital vascular malformation may consist

not only of capillaries, but also of venous,

arteriolar and lymphatic channels

hemangioma


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hemangioma

hemangioma


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hemangioma

hemangioma


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hemangioma

Hemangioma of bone. Note numerous vascular

h l d d b b l f b


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channels surrounded by trabeculae of bone.

Vascular malformation composed of large tortuous

h l li d b d h li


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channels lined by endothelium.


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Treatment

Congenital hemangioma spontaneousinvolution during early childhood if not

surgery, arterial embolization, and sclerosanttherapy and laser therapy.

Congenital vascular malformation the

same difficult to eradicate


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Sturge-weber syndrome (EncephalotrigeminalAngiomatosis)

A condition that includes vascular malformations,venous malformation involves the leptomeninges of

the cerebral cortex, with similar vascularmalformations of the face. The associated face lesion iscalled as port-wine stain, which involves the skininnervated by one or more branches of the trigeminalnerve. The patient may complain from mentalretardation, hemiparalysis and seizure disorders, oralmucosal and eye lesions may also be present.

SturgeWeber angiomatosis


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Sturge Weber angiomatosis



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Lymphangioma

Regarded as a congenital lesion, usually

appears within the 1st 2 decades of life.

Involution doesn't occur.


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Clinically Presents as painless nodular vesicle-like swelling when

superficial as in a submucosal mass when located deeper.The color range, from lighter than the surrounding tissue tored-blue when capillaries, are part of the congenital

malformation. The tongue is the most common intraoralsite, and the lesion maybe responsible for macroglossiawhen diffusely distributed throughout the submucosa.

Lymphangioma of the lip cause a macrocheilia. Lymphangioma of the neck, known as cystic hygroma,

hygroma colli or cavernous Lymphangioma, which is adiffuse soft tissue swelling that may be life threateningbecause it involves vital structures of the neck.

lymphangioma


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lymphangioma

lymphangioma


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y p g

Lymphangioma of the buccal mucosa.


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lymphangioma


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y p g

Combined lymphangioma and hemangioma of the

tongue


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tongue.


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Histopathoiogy

Endothelial-lined lymphatic channels are

diffusely distributed in the submucosa. The

channels contain eosinophilic lymph thatoccasionally includes RBC s.

Treatment surgical removal

lymphangioma


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y p g

Lymphangioma composed of prominent lymphatic vessels. The vessels are

characteristically apposed to the

ith li


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epithelium.


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Malignant vascular lesions:-

1- Angiosarcoma.

2- Kaposis sarcoma.


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Angiosarcoma:- rare neoplam of endothelial ell origin arise from

either blood or lymphatic vesseles. More than50% occur in head and neck with scalp and

forehead being the most common site. Oralcavity may be involved in rare instances.

Hemagioendothelioma is a term used to describe

vascular tumors with microscopic featuresintermediate between those of hemagiomas andangiosarcoma.


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Clinical features

Angiosarcoma affect elderly patients, continue

to enlarge resulting a nodular lesion which

could be multifocal.

Angiosarcoma


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g


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Histopathology

An unencapsulated proliferation of anaplastic

endothelial cells enclosing irregular luminal

spaces.

Treatment

Aggressive clinical course leading to poor

diagnosis.

Angiosarcoma


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Kaposis sarcoma:-

It is a proliferation of endothelial cell origin.

Recently discovered herpesvirus known as

human herpesvirus 8 (HHV8) or Kaposissarcoma herpesvirus (KSHV) in all Kaposis

lesions, as well as in acquired

immmunodeficiency syndrome (AIDS).


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Clinical features

Three different clinical patterns of Kaposis sarcoma are described

Kaposis sarcoma in older men living in mediterranean basin appearas multifocal reddish brown nodules in skin and lower extremities,Oral lesions are rare.

Endemic kaposis sarcoma in africa which affect skin of extremitiesmostly of black people. Oral lesions also rarely seen.

Kaposis sarcoma in patients with immunodeficiency statesespecially (AIDS).skin lesions are not limited to the extremities, oral

and lymph node lesions are common, younger age group people isaffected

Kaposis sarcoma


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Kaposis sarcoma


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Kaposis sarcoma: early lesions


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Kaposi's sarcoma presenting as a dark macule in the right posterior

palate.


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Advanced Kaposi's sarcoma of the gingiva.


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Kaposi's sarcoma.


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Kaposi's sarcoma of the neck.


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Histopathology Hypercellular foci of bland-appearing spindle

cells with ill defined vascular channels and

extravasated red blood cells are seen inkaposis sarcoma.

Kaposis sarcoma


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Kaposis sarcoma


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Early Kaposi's sarcoma showing a subtle increase in the number of capillaries and

extravasated red blood

cells.


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Advanced Kaposi's sarcoma showing spindle cell proliferation and bizarre

capillaries.


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Kaposi's sarcoma. Positive immunohistochemical stain for CD34 of Kaposi's sarcoma,

confirming spindle

cells as endothelial cells.


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Treatment For localized lesions surgery with low dose

and intralesional chemotherapy could be

beneficial, while for larger and multifocallesions systemic chemotheraputic regimens

are being used.


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Neural lesions 1-Reactive lesions:-

Traumatic neuroma:

Caused by injury to a peripheral nerve, such as a tooth

extraction, from local anesthetic injection, or from anaccident. Transection of a sensory nerve can result ininflammation and scarring in the area of injury. As theproximal nerve segment proliferates in an attempt to

regenerate into to the distal segment, it becomesentangled and trapped in the developing scar, resultingin a mass of fibrous tissue, Schwann cells and axons.


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Clinical features Pain ranges from occasional tenderness to

constant, severe pain. Injection of localanesthesia relieves the pain. The mentalforamen is the most common location,followed by extraction site, in the anteriormaxilla and posterior mandible. The lower lip,

tongue, buccal mucosa and palate are alsorelative common soft tissue locations.

Traumatic neuroma


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Histopathoiogy Bundles of nerves in a haphazard or tortuous

arrangement are found admixed with dense

collagenous fibrous tissue. Treatment surgical removal.

Traumatic neuroma


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Traumatic neuroma


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Traumatic neuroma composed of fibrous tissue and nerve bundles.


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Traumatic neuroma presenting as a painful radiolucency

at the mental foramen in an edentulous mandible

(ramus to the right).


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2-Neoplasms:- Granular cell tumor:

Uncommon benign tumor of unknown cause.

It is believed to be of neural origin (Schwanncells). A related lesion of dispute origin is the

congenial epulis which is composed of cells

that are light microscopically identical to thoseof granular cell tumors with slight differences.


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a)Granular cell tumor: Clinical features

Benign tumor of neural sheath origin,

Any age, females slightly more than males, Any site, usually tongue.

Asymptomatic submucosal mass (1-2 cm).

Same or lighter than mucosal color. Intact overlying epithelium.

Granular-cell tumor of the newborn


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Granular cell tumor of the tongue.


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Histopathology Large, uniform cells with granular cytoplasm,

with indistinct cytoplasmic borders, overlying

pseudoeptheliomatous hyperplasia. Cells arepositive for neural-associated proteins and

negative for muscle protein. Treatment >excision, no recurrence.

Granular-cell tumor


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Granular-cell tumor


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Granular cell tumor. Note uniform cells with granular cytoplasm

found adjacent to skeletal muscle.


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Granular cell tumor with overlying pseudoepitheliomatous

hyperplasia.


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b)Congenital epulis: Clinical features

Benign tumor or disouted origin.

Infants only, gingiva only, usuallypedunculated, non ulcerated mass.

Congenital epulis


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Histopathology Large, uniform cells with granular cytoplasm

no overlying pseudoeptheliomatous

hyperplasia. Cells are negative for neural andmuscle proteins.

Congenital epulis


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Congenital epulis


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Treatment Excision no recurrence


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C)Schwannoma (neurilemmoma) andNeurofibroma:

Schwannoma: Is a benign neoplasm that isderived from a proliferation and Schwann

cells, or nerve sheath.

Clinical features

The lesion is an encapsulated submucosalmass. The tongue is the most common site

Schwannoma


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Schwannoma showing characteristic pattern of palisaded

schwannoma cells around eosinophilic bodies.


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Histopathology

Encapsulated tumor, spindle cells exhibiting twodifferent patterns: in one pattern, the so calledAntoni-A areas consist of spindle cells organizedin palisaded manner. These cells often surroundan acellular eosinophilic zone "verocay body",which represent reduplicated basementmembrane.

The other pattern is the so called Antoni-B tissueconsisting of spindle cells haphazardly distributedin a delicate fibrillar microcystic matrix.

Schwannoma


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Schwannoma showing characteristic pattern of palisaded

schwannoma cells around eosinophilic bodies.


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Treatment surgical excision


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d) Neurofibroma: May appear as a solitary lesion or as

multiple lesions as part of the syndrome

"neurofibromatosis" (von-Recklinghausen'sdisease of skin) which is inherited as an

autosomal-dominant trait.


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Clinically: 1.Solitary neurofibroma present at any

age as an uninflamed asymptomatic,submucosal mass. The tongue, buccal mucosa,

and vestibule are the oral regions mostcommonly affected.

2.In fibromatosisit includes multiple

neurofibromas cutaneous cafe-au-laitmacules, bone abnormalities, CNS changes.

Neurofibroma


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Neurofibroma of the left palate.


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Intramandibular neurofibroma.


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Neurofibromatosis


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Neurofibromatosis, oral lesions.


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Neurofibromatosis


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Caf-au-lait macule in patient with neurofibromatosis.


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Neurofibromatosis, cutaneous lesions.


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Histopathology Spindle shaped cells, with fusiform or wavy

nuclei found in a delicate connective tissue

matrix, the matrix maybe myxoid, mast cellsare characteristically scattered throughout the

lesion.


Neurofibroma


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e) Neurofibromatosis Common hereditary condition and at least

eight forms have been recognized but the

most common is neurofibromatosis type I(NFI)or von Recklinghausen disease of the skin


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Clinically 1- Six or more caf au lait macules with

variable size depend on puberty

2- Two or more neurofibromas of any type 3- Freckling in the axillary or lingual regions

4- Optic glioma

5- Two or more Lisch nodules


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Treatment No specific therapy for NFI, prevention of

complication which the development of

cancer, most often Neurofibrosarcoma andmalignant schwannoma


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f) Pigmented neuroectodermal tumor of infancy

It is rare benign neoplasm of primitive pigment-producing cells. Like melanocytes and nevus cells,

Clinically

it is found in infants usually younger than 6months of age and occurs typically in the maxilla,although the mandible and the skull have beeninvolved. This lesion usually presents as a nonulcerated and occasionally darkly pigmentedmass due to melanin production by tumor cells.

Melanotic neuroectodermal tumor of

infancy


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Histologically

This neoplasm exhibits an alveolar pattern (i.e.,nests of tumor cells with small amounts ofintervening connective tissue) . The variably sized

nests of round to oval cells are found within awell defined connective tissue margin. Cellslocated centrally within the neoplastic nests aredense and compact, resembling neuroendocrine

cells; peripheral cells are larger and often containmelanin.


infancy


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infancy


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Pigmented neuroectodermal tumor of infancy. A and B, Nests of round cells

with peripheral pigmented cells


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Pigmented neuroectodermal tumor of infancy as a radiolucency in the anterior

maxilla.


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g) Malignant peripheral nerve sheath tumor: Rare malignant tumor that develops, either

from a pre-existing neurofibroma or de novo.

Clinically appears as an expansible mass that is usually

asymptomatic, pain or paresthesia may

accompany the lesion in bone.


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Histopathology The lesion is composed of abundant spindle

cells with variable numbers of abnormal

mitotic figures. Streaming and palisading ofnuclei are often seen.

Treatment wide surgical excision,recurrence is common.

Muscle lesions


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Muscle lesions

(Rhabdomyoma and Rhabdomyosarcoma)Rhabdomyomas:

Are rare lesions, but they have a predilection for the softtissue of the head and neck. Orally, the floor of the mouth,soft palate, tongue and buccal mucosa.

Microscopically

The neoplastic cells closely mimic their normal counterpartin adult patients. The fetal type, the neoplastic cells are

elongated and less differentiated.


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Rhabdomyoma


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Rhabdomyoma


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Rhabdomyosarcoma of the palate.


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Rhabdomyosarcoma: have three principal microscopical forms,


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Rhabdomyosarcoma: have three principal microscopical forms,

(embryonal & alveolar) and pleomorphic

Children Adults

Embryonal type consists of primitive round cells, spindle cells.Botryoid

types Alveolar variant consists of round cells, but in compartments.

Pleomorphic type consists of sharp or spindle cells. When it occursin the head and neck region, Rhabdomyosarcoma is mainly found inchildren outside the head and neck, it is mainly found in adults.

Treatment surgery, radiation and chemotherapy.

Tumor of Adipose tissue


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Tumor of Adipose tissue

Lipoma

Liposarcoma

Lipoma

Uncommon neoplasm of oral cavity, tongue, buccal mucosaand floor of the mouth among common locations. Appearas asymptomatic, yellowish submucosal mass, overlyingepithelium is intact and superficial blood vesseles areevident over the tumor. Histologically it composed of a

well-circumscribed lobulated mass of adipocytes in variousdegree of maturation,


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Lipoma


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Lipoma


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Lipoma


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Liposarcoma


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p

Is a rare slow growin malignant neoplasm of soft tissue ofhead and neck, variation in its microscopic findings led tosubclassification of liposarcoma into four types:

Well differntiated

Myxoid Round cell pleomorphic

Treatment of liposarcoma is by surgery or radiation andprognosis is fair to good.

Liposarcoma showing irregular fat cells with atypical nuclei.


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Tumor of smooth muscle origin


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Leiomyoma Leiomyosarcoma

Leiomyoma and Leiomyosarcoma

In the oral cavity both are rare smooth muscle neoplasm, appear asa slow growing, asymptomatic sbumucosal masses, usually in thetongue, hard palate or buccal mucosa. Occur in all age groups.Histologically both composed of spindle cell proliferation sharesmany similarities with neurofibroma, fibromatosis, myofibroma andshwanoma. Treatment by surgical excision with unexpectedrecurrence.

Leiomyoma


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Leiomyoma


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Leiomyoma composed of bland spindle cells.


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Metastatic Tumors


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Metastatic disease to the jaws is unusual,approximately 80% of these metastases are tothe mandible and 14% to the maxilla.

Occasionally metastatic deposits are seen ingingiva simulate pyogenic granuloma. Occur inolder age groups (5th & 6th decades of life)associated with bone pain and swelling,

loosening of teeth, lip parasthesia, gingival massand pathologic fracture.

Metastatic tumors to the oral cavity


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Documents

Soft Tissue Tumor for Rafdain