Benign tumors of Epithelial tissue origin + Squamous papilloma + Keratoacanthoma womvincanetaceadonn com Squamous Papilloma Itis.a benign proliferation of stratified squamous epithelium, resulting in a papillary or verruciform mass. Caused by HPV (Human papilloma virus). HPV types 6 and 11. HPV comprises a large family (>100) of double stranded DNA viruses of papova virus subgroup —A. HPV can be identified by in situ hybridization, PCR and immuno-histochemical analysis. These viruses have a incubation period of 3 to 12 months. nu inctancetzeaon comPapill @ Papilloma Clinical features: ‘Tongue, lips, buccal mucosa, labial mucosa and rarely in tard palate Soff, painless, usually pedunculated, exophytic nodule with numerous finger like surface projections that impart a cauliflower of wartlike appearance. Atany age. Projections may be pointed or blunted. Lesions appear whitish, slightly red or normal depending on amount of surface keratinisation. Lesions are usually solitary and enlarges so rapidly+ ‘The common wart or verruca vulgaris, is a frequent tumor of the skin analogous to oral papilloma. + HPV 2, HPV 4 and HPV 40, Clinically pointed or verruciform surface projections, a very narrow stalk. White in colour. + Contagious. Oral lesions appear to arise through autoinoculation by finger sucking or fingernail biting, womvincanetaceadonn com ketatoacanthoma * Sclf healing carcinoma, molluscum pseudo- carcinomatosum, molluscum scbaccum, verrucoma. © Common low-grade malignancy that originates in the pilosebaceous glands. © Itclinically and histologically resembles epidermoid carcinoma and itis frequently mistaken as eancer. nu inctancetzeaon comEtiology * Genetic and viral — both etiological factors have been demonstrated. * HPV 9, 11, 13, 16, 18, 24, 25, 33, 37 and 57. * Trauma and chemicals such as coal tar and mineral oil. womvincanetaceadonn com Clinical features: © Age and sex: 50 to 0 year age and common in males. * Site : intraoral lesion is uncommon. If present, mostly on the lips. On sun-exposed areas. © Appearance: he lesion appears as an elevated umbilicated or crateriform with depressed central core, And appears as dome shaped. * Lipion the lower lip the tumor shows smooth, raised, rolled borders with a central plug of hard keratin, nu inctancetzeaon com* Color: It is yellowish brown in color. * Size : It grows to a size of 1 to 2.cms. © Signs: lesion appear fixed to the surrounding tissues. © Progress: it begins as a small, firm nodules that develop co full size over a period of 4 to 8 weeks and persist as static lesions for another 8 weeks. After that it undergoes spontancous regression over the next 6 to 8 weeks by expulsion of keratin core with resorption of the mass. womvincanetaceadonn com DD * Verruca vulgaris * Condyloma acuminatum nu inctancetzeaon comkeratoacanthoma Differential dignosis Keratinizing squamous cell carcinoma — cancerous lesion usually fails to exhibit a smooth, round, regularity which is present in keratoacanthoma. Actinic keratosis. Verrucous carcinoma. Warty dyskeratoma — are usually small ie, <0.5 cm as compared to keratoacanthomaBenign tumors of connective tissue origin © Oral fibromas * Giant cell fibroma * Myxofibroma + Peripheral ossifjing fibroma + Central ossifying fibroma + Central giant cell granuloma * Giant cell tumor of bone © Lipoma © Myxoma + Chondroma © Osteoma womvincanetaceadonn com Fibroma * Most common benign soft tissue tumor in the oral cavity. + Most of these lesions are infact hyperplasia or reactive proliferation of fibrous tissue, nu inctancetzeaon com( SY A (C Clinical features: * Tecan occur at any age but it is common in 3 4% and 5 decades. + Female predilection. * Site: it oceurs on gingiva, tongue, buecal mucosa and palate. * Appearance : it is most often sessile dome shaped or slightly pedunculaced with smooth contour. * Consistency : it can range from soft and myxomatous to firm and elastic, FibromaDifferential diagnosis + Myxofibroma — itis softer on palpation when compared to fibroma, * Neurofibroma * Neurilemoma * Giant cell fibroma. © Minor salivary gland rumors. omuincanetaceadonn com Giant cell fibroma * Itis a well described benign hyperplastic lesion of oral mucosa. * First described by Weathers and Callihan in 1974, Clinical features: * Itoccurs at any age * Iris common in gingiva followed by tongue, palate, buccal mucosa and lips + Asymtomatic. © Itappears usually small, raised, peduculated, papillary lesion less than 1em in diameter. nu inctancetzeaon combp © squamous papilloma * ieritation fibroma * pyogenic granuloma womvincanetaceadonn com Myxofibroma © Some areas of Fibroma undergo myxomatous degeneration Clinical features: © Iris most commonly seen on palate, lip and gingiva. * Itis softer than fibroma and appears less pale. nu inctancetzeaon comDifferential diagnosis: * Plexiform neurofibroma — itis spongy and fluctuant. ‘Treatment: + Complete excision womvincanetaceadonn com Peripheral Ossifying Fibroma * Ossifyjng fibroid epulis * Peripheral exophytic growths that exclusively occur in interdental gingiva, which appears pale pink to cherry red. * According to some, these develop from pyogenic granulomas that undergo fibrous maturation and subsequent calcification. + Predominently seen in young adults. © Most common in female population. © Most common in anterior region (Ingisor — Cuspid region).Peripheral ossifying fibromas Radiographic features © there is no apparent underlying bone involvement visible on the radiographs. * on rare ocassion, there may be superficial erosion of the bone.Differential diagnosis * Fibrous hyperplasia * Peripheral giant cell granuloma womvincanetaceadonn com Central ossifying fibroma * Itisa central neoplasm of bone. » There is considerable similarity and even overlap in the histologic features of central cementifying fibroma. © These two are separate benign tumors identical in nature except for the cell undergoing proliferation. * Ostcoblasts in the case of ossifying fibroma and cementoblasts in cementifying fibroma. nu inctancetzeaon comClinical features: It occurs in any age but, more common in young adults and females. Most common in the mandible. Itis relatively slow growing tumor, asymptomatic until the growth produces a noticeable swelling and mild deformity. Displacement of teeth may be an early C/F. As it is slow growing the cortical plates of bone and overlying mucosa or skin are invariably intact. COF - MandibleRadiographic features + The neoplasm presents extremely variable R/G appearance depending upon its stage of development. * The lesion is always well circumscribed and demarcated from the surrounding bone. * In carly stages, COF paradoxically appears as a radiolucent lesion, + As the tumor bone apparently matures, there is increasing calcification hence, radiolucent areas become flecked with opacities. ‘+ Ultimately the lesion appears as radiopaque mass womvincanetaceadonn com Differential diagnosis * Fibrous dysplasia * Other Fibro-osseous lesions at mixed stage. nu inctancetzeaon comFibrous dysplasia COEF © Diffuse and rectangular. © Round and localized. © Blends with surrounding normal bone. © Sharply defined margins * appears more fusiform, * Dome shaped and nodular. © 24 to 3 decade. © 3% to 5" decade. * more common in maxilla. * More common in mandible. * Ground glass/ orange ‘© Appears mottled with peel/finger print/ wispy mixed R/O & R/L. cotton. Central giant cell granuloma © Le was first described by Jaffein 1953. + Jaffe believed that the jaw lesions were not true aeoplasms and represented a local reparative reaction. * Because the clinical behavior of many of these lesions has been inconsistent with a reparative process, the term “reparative” has been omitted today. * Itis a Benign lesion that usually occurs in the Mandible and the Maxilla.WHO definition: “An Intraosseons lesion consisting of cellular fibrous tissue containing murbiple joi of Hemorrhage, aggregations of multinucleated giant cells and occasionally trabeculae of woven bone.” Classification: * The central giant cell granuloma was classified as a True Neoplasm and a reactive peoiltesits process at the same time because of its Histologic features, dynamic Biologic characteristics, and variable clinical patterns. + Based on its clinical behavior, CGCG has been classified as one of the following: 1 Nonaggressive. 2 Aggressive clinical features: © Age: Normally it appears before the age of 30. + CGCG occurs most commonly in young adults and has a female predilection * ‘The clinical behavior of CGCG ean vary from benign to rather aggressive. » ‘The clinical behavior of the lesion varies from an asymptomatic osteolytic lesion that grows slowly without expansion, to an aggressive, painful process accompanied by root resorption, cortical bone destruction, and extension into the soft tissues.Site: In 72.2% of the Male patients with CGCG, the, lesion was located in the mandible and in males 27.8% in the Maxilla, 2 In 61.7% of the Female Patients, the lesions appeared in the mandible. © Occurs twice as often in the Mandible than in the Maxilla and can be confined to the tooth-bearing areas of the jaws. Nonaggressive type Aggressive type characterized characterized by by * aslow * Pain, + asymptomatic growth Non * Rapid Growth, perforating » Expansion © Rarely causing Root © Perforation of cortical bone, resorption. * Radicular resorption. © low tendency to recur, high tendeney to recur. destroys bone, resorbs teeth, displace anatomical structures: Teeth, Mandibular canal, Floor of maxillary antrum,Central giant cell granuloma Radiographic Features : = CGCGs were small Apical Lesions and Large Multilocular Lesions with a diameter of more than 4 cm, Itappears as Unilocular radiolucency as often as with a Multilocular one ,the majority of CGCGs proved to be unilocular (67.7%) and only 42.3% multilocular, Root resorption as a sign of local aggressive biologic behavior was evident in 60% of the aggressive lesions, which is more frequent than in other reports.= ( (7) Differential diagnosis cCEOT Ossifying Fibroma Odontogenic myxoma Giant cell tumor of bone i © Synonym : Osteoclastoma. \\ * Itisa distinctive neoplasm of undifferentiated cells. * Multinucleated giant cells apparently result from fusion of the proliferating mononuclear cells.Clinical features: * Itis more common in females and mostly occurs in 3"! decade. © Pain of variable severity is a predominant symptom. * It occurs most commonly in long bones. © Swelling, weakness, limitation of the joint and pathologic fracture are common findings. womvincanetaceadonn com Lipoma © Benign tumor of the fat tissue. * Most common mesenchymal neoplasm, which occurs on the crunk and proximal portions of the extremities * Lipomas in the oral & maxillofacial region are less frequent. * Pathogenesis is uncertain, but more common in obese people. nu inctancetzeaon comClinical features: © Oral lipomas are usually soft, smooth-surfaced nodular masscs that can be sessile or pedunculated . ~ * A subtle or more obvious yellow hue often is detected clinically, deeper lesions may appear pink. * Buccal mucosa and buccal vestibule are most common sites in the oral cavity. || © Tongue, floor of the mouth and lips are less common sites. © Mostly they oceur in middle age and rare in children,Differential diagnosis © Traumatic fibroma * Mucocele + Lymphangioma * Neurofibroma womvincanetaceadonn com Myxoma * This is a heterogenous group of soft tisssue tumors which have H/A of abundant myxoid ground substance. * Myxoid consists of muco-polysaccharides, mainly hyaluronic acid. * Stout described myxoma as a true neoplasm made up of tissue resembling primitive mesenchyme. * Tumor rarely infiltrates adjacent tissues. nu inctancetzeaon coma i Clinical feature: © Most soft tissue myxomas are deep seated lesions occurring in the skin or the subcutaneous tissues, GI tract, GU tract, Liver, Spleen, Parotid gland. * Ircan occur at any age without sex predilection. * Intra oral soft-tissue myxomas are extreme rate lesions. + Some of the myxomas are nerve sheath myxoma arising from perincural cells of peripheral nerves. * Mostly occur in the oral cavity on the tongue buceal mucosa and retromolar area. MyxomaChondroma © Iris a benign central tumor composed of mature cartilage * Iris well recognized entity in certain areas of the bony skeleton. * Itis uncommon in maxilla and mandible. * Chondroma seldom develops in membrane bones, particularly if no vestigial cartilaginous rests are present. ¢ As maxilla and mandible rarely contain such remnants hence is uncommon, Clinical features: © This rumor can occur at any age with out any sex predilection. * They occur asa painless slowly progressive swelling of the jaw © Iccauses loosening of the teeth, © Overlying mucosa is rarely ulcerated. * Anterior maxilla b/n central incisors and posterior mandible, condylar or coronoid process are the most common sites © These may occur peripherally but they come under choristomas.Radiographic features + Roentgenogeam shows aa irregular radiolucent or mottled area in the bone. * Chondroma is a destructive lesion and causes root resorption of the teeth adjacent to it. womvincanetaceadonn com Osteoma * Benign neoplasm characterized by a proliferation of either compact or cancellous bone, usually in the endosteal or periosteal location. nu inctancetzeaon comClinical features: * Irisan uncommon lesion in the oral cavity. © Itean occur at any age mostly in young adults. + The tumor of periosteal origin manifests itself as a circumscribed swelling of the jaw. © Itisa slow growing tumor. © The tumor of endosteal origin is slower topresent clinical manifestations, since considerable growth must occur before there is expansion of the cortical plates. © Multiple osteomas of the jaws as well as long bones and skull are characteristic manifestations of Gardner's syndrome. + Rarely, pain is associated with this tumor. Radiographic features * The central lesion usually appears with in the jaw as a well- circumscribed radiopaque mass. * Sometimes, this may be diffuse,then it must be differentiated from chronic sclerosing osteomyelitis. * Periosteal form of the disease is manifested as a sclerotic mass.Benign tumors of Nerve tissue origin * Neurofibroma * Neurilemmoma * MEN syndrome womvincanetaceadonn com Neurilemmoma » Synonym : Schwannoma © Iris a benign neural neoplasm of schwann cell origin, * Itis relatively uncommon, although 25-48% cases occur in head and neck region. nu inctancetzeaon comNeurilemoma in the floor of the mouth Clinical and radiographic features: * Itis.a slow-growing, encapsulated tumor that typically arises in association with a nerve trunk. * As it grows it pushes the nerve aside. » Lesion is more common in young and middle aged adults. » Tongue is most common location for oral neurilemomas. © Rarerly, cumor arises centrally with in bone and may produce bony expansion. © Pain and paresthesia are usual for intrabony tumors.Neurofibroma * Iris a most common type of peripheral nerve neoplasm. © Irarises from a mixture of cell types, including schwann cells and perineural fibroblasts. womvincanetaceadonn com Clinical and radiographic features: ‘They arise as solitary tumors or be a component of neurofibromatosis. Most common in young adults. ‘They present as solitary, slow- growing, soft, painless lesions which vary in size from small aodules to larger masses. Skin is the most frequent location. Intraorally tongue and buccal mucosa are the most common sites Rarely, cumor arise centrally within bone, nu inctancetzeaon comNeurofibroma in the ventral surface (al of the tongueDifferential diagnosis * Traumatic fibroma * Neurilemoma * Traumatic neuroma * AmyloidosisMEN syndrome + Multiple endocrine neoplasia syndrome. * Itis characterised by tumors of neuroendocrine origin, * Synonym : MEN ILI or multiple mucosal neuroma syndrome. * Itwas initially deseribed by Wagemann in 1922. + The disease is associated with - 1.Adrenal pheochromocytoma 2.Medullary thyroid carcinomas 3.Diffuse alimentary tract ganglioneuromatosis| AMiple smal anbenuooeal aexroma nodolesothe nope 4 igestive tract. A The affected individual has a tall, lanky, martanoid body type, with a narrow face with muscle wasting, Adrenal and thyroid tumors do not present until puberty. OMEN syndromes are caused by mutations of the RET proto- oncogene, an imporatant regulator of neural crest development and the receptor of gliadelivered neurotrophic factor (GNAD)Clinical features: + The oral mucosal neuroma of this disease presents as a 2-7 mm yellowish white, sessile, painless nodule of the lips, antetior tongue and buccal commissures. * Usually there are 2-8 neuromas with deeper lesions having normal coloration * More neuromas in the lips and produce enlargement ~ “Bumpy lip” appearance. * Similar nodules are seen on the eyelids, producing eversion of the lid and also on sclera. womvincanetaceadonn com Lab — investigations * When a medullary thyroid carcinoma is present, serum and urinary calcitonin levels are clevated. * When a pheochromocytoma is present theremay be increase in the serum levels of vanillylmandelic acid (VMA) and altered epinephrine/nor-epinephrine ratios. nu inctancetzeaon comBenign tumors of Muscle tissue origin * Leiomyoma * Rhabdomyoma womvincanetaceadonn com Leiomyoma Leiomyomas are benign tumors of the smooth muscle that most commonly occur in the uterus, G.Ltract and skin, Leiomyomas of the oral cavity are rare, most of these probably have their origin from smooth muscle. The three types are: Solid leiomyomas Vascular leiomyomas Epithelioid leiomyomas Almost all the oral tumors are cither solid or vascular in type. nu inctancetzeaon comClinical & Radiographic features: * Ttcan occur at any age and is usually a slow growing firm mucosal nodule. © Solid type are typically normal in colour and angiomyomas may exhibit a blue hue. = Most common sites are lips, tongue, palate and cheek: which together account for 80% of cases. womvincanetaceadonn com Rhabdomyoma * Benign neoplasms of skeletal muscle are called “Rhabdomyomas”. * Rhabdomyomas of head and neck can be divided in to two categories: 1.Adult type 2. Fetal type nu inctancetzeaon comLAdult type ~ Most common in males and middle aged people. - Most common sites ate floor of the mouth, soft palate and ventral surface of the tongue. ~ Tumor appears as a nodular mass. — Laryngeal and pharyngeal tumors often lead to airway obstcuction. 2. Fetal type Usually occur in young children. ‘Most common locations are face and pre-auriculr region. womvincanetaceadonn com