Oral Pathology Quiz

Tumor-like Lesions (Fibrous Overgrowths)

• Definition: Any pathologic growth that projects above the normal contour of the oral surface

Pathophysiology

• Different mechanisms lead to development of soft tissue tumor-like lesions in the oral cavity
• Most common mechanism: Reactive hyperplasia due to inflammation

Inflammation

• Part of the body's defense mechanism to recognize and remove harmful foreign stimuli
• Acute inflammation: Rapid, severe, and short-term (e.g. acute pulpitis and acute periapical abscess)
• Chronic inflammation: Slow, long-term, and prolonged (e.g. chronic pulpitis and chronic periapical abscess)

General Features

• Submucosal and/or epithelial masses that may ulcerate when traumatized
• Color ranges: Lighter than normal (due to collagen or keratinization), reddish (due to epithelial atrophy or abundance of vascularized granulation tissue), or bleeds easily due to ulceration and increased vascularity
• Painless, as nerves do not proliferate with reactive tissue

Types of Tumor-like Lesions

• 1. Pyogenic granuloma
• 2. Peripheral fibroma and peripheral ossifying fibroma
• 3. Peripheral giant cell granuloma (PGCG)
• 4. Denture-induced fibrous hyperplasia (denture fissuratum)
• 5. Inflammatory papillary hyperplasia (palatal papillomatosis)
• 6. Fibro-epithelial polyp (leaf-like denture fibroma)
• 7. Generalized gingival hyperplasia (drug-induced) and fibromatosis
• 8. Tori and exostosis
• 9. Keratoacanthoma

Pyogenic Granuloma

• Etiology: Trauma → pathway to non-specific microbial invasion → oral mucous membrane
• Clinical: Elevated, smooth, lobulated, or warty mass, painless, soft, deep red or reddish purple, and easily hemorrhagic on slight touch
• Histology: Epithelium (thin, atrophic, eroded, or ulcerated), connective tissue mass (granulation tissue, endothelium-lined vascular spaces, and budding endothelial cells)

Pregnancy Tumor

• Etiology: Combination of dental plaque buildup, hormonal shifts, inadequate brushing, and poorly fitted fillings
• Clinical: Well-defined gingival mass, appears at about the third month of pregnancy or slightly later
• Histology: Similar to pyogenic granuloma

Tori and Exostosis

• Clinical: Exostosis (bony outgrowth), tori (bony protuberance on the palate or mandible)
• Histology: Dense lamellar, cortical bone with small amount of fibrofatty marrow
• Treatment: Surgical correction if exposed to trauma repeatedly or if ulcerated, surgical excision for denture construction

Keratoacanthoma

• Etiology: Unknown, but sun exposure is a common predisposing factor, virus-like intranuclear inclusions have been described in these lesions