6. Lesions of the oral mucosa (Péter Novák MD)
6.17. Benign tumours of the oral and maxillofacial region (Péter Novák MD)Novák MD)
Papilloma
Papilloma is a benign epithelial tumour, which frequently appears on the oral mucosa. Local irritation and infection, especially viral infection (human papilloma virus) may play a role in its development.
Symptoms: a pedunculated or sessile, white, or whitish-grey, papillary surfaced tissue growth, which does not cause any symtoms. A slowly proliferating, smaller or larger epithelial tumour may also develop. It occurs mostly in the palates, tongue, gingiva and lips.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
Papilloma Fibroma
Fibromas are benign, slow-growing tumours of the oral cavity composed of connective tissue. Fibroma is the most common tumour of the oral mucosa, which particularly occurs on the buccal mucosa and on the tongue. In the oral cavity, fibromas are reactive proliferative lesions, which develop secondarily to irritation (by sharp tooth edges, artificial teeth or calculus) or low grade infection. The lesion feels solid or soft on palpation. It is sessile or pedunculated, smooth-surfaced, reddish or pale and covered with intact mucosa, but as a result of mechanical irritation it may become whitish leukoplakia due to keratinisation or may become ulcerated. No other clinical sign or pain can be observed.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
PATHOLOGY
epulis, pyogenic granuloma, granuloma fissuratum and neurinoma.
Fibroma Lipoma
They are rare, painless and benign tumours in the oral cavity, which arise from the fat tissue and grow slowly.
Lesions mostly involve the bucca, the tongue and the floor of the mouth. The growth is mainly single, rounded or oval, mobile, pedunculated, soft, yellowish translucent and painless. The surface is vascularised.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
mucocele, ranula, dermoid cyst, lymphangioma and adenoma.
Pleomorphic adenoma
It is also called a ―mixed tumour‖. The epithelial tumour mainly originates from the small and large salivary glands, it is hard, springy and lobulated, and grows slowly without causing any pain. Extraorally, it mainly arises from the parotid gland. Small and large (giant and weighty) tumours occur alike. In the oral cavity, in addition to other localisations, the tumour predominantly appears on the hard palate, which occasionally interferes with eating and speaking.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
cystadenocarcinoma, epulis.
Papillary cystadenoma lymphomatosum (Warthin’s tumour)
Warthin‘s tumour or adenolymphoma is a rare and benign condition, which almost exclusively develops in the parotid glands. It rarely involves the submandibular glands or the intraoral small salivary glands. Usually men are affected.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
lymphoepithelial cyst (branchial cyst) and other benign and malignant tumours.
PATHOLOGY
Capillary haemangioma
The benign tumour develops as a result of vascular proliferation. The congenital form is considered to be rather a congenital disorder (malformation) than a real tumour, since it may regress spontaneously. The capillary form is composed of a capillary network, and is soft, small and bluish-red. Manual compression of the lesions expresses blood, leaving behind an empty sac (vitropression), thus temporarily they fade away.
Cavernous haemangioma
This type of haemangioma is a hamartoma (not a neoplasm), which histopathologically does not have a capsule.
It mostly involves the tongue, lips and the bucca, and reaches an extreme size (macrocheilia, macroglossia), thus hindering speech and swallowing. It occurs as a flat or exophytic, painless growth with a raspberry-like appearance. Its colour ranges from red to dark blue.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
haematoma, lymphangioma, pyogenic granuloma, malignant melanoma, mucocele.
Haemangioma TUMOUR-LIKE LESIONS
Pyogenic granuloma
The tumour-like reactive tissue proliferation may develop in response to trauma or infection, but it may also occur as a result of hormonal changes (pregnancy, menopause, or puberty), the administration of oral contraceptives, steroid drugs and anti-diabetics. Most frequently it develops on the gingiva, bucca, lips and tongue. It is a raised, pedunculated, flat or wart-like lesion with a dark red or pink colour depending on the vascularisation of the affected area. In case of ulceration, it is covered with yellowish fibrin. Its diameter ranges from a few millimetres to a centimetre. It is a painless tumour, which easily bleeds.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
epulis, papilloma, fibroma, haemangioma, granuloma gravidarum and malignant tumours.
PATHOLOGY
Pyogenic granuloma Granuloma gravidarum
After the first trimester of pregnancy, a single or rarely multiple, dark red, ulcerated tumour-like lesion which is prone to bleeding develops mostly on the gingiva. It mostly involves the vestibular gingiva at the level of the upper premolars, but it may also appear in other areas. During pregnancy, it may recur despite its removal, but after delivery it may spontaneously disappear. The clinical and pathological picture is similar to that of pyogenic granuloma.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
pyogenic granuloma, epulis and haemangioma.
Postextraction granuloma
This reactive, inflammatory tumour-like lesion develops after tooth extraction as a result of retained root, broken pieces of bones, amalgam or other foreign body.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
epulis and gingival tumour.
PATHOLOGY
Postextraction granuloma Epulis granulomatosa
It is not a real neoplasm, but a reparative tissue proliferation arising from the mucoperiosteum of the tooth socket or from the periodontal membrane. The diagnosis of ‖epulis‖ may be applied only clinically. The growth is a painless, red lesion, which is prone to bleeding and occurs mostly on the vestibular surface of the front and premolar teeth. It is mostly brought about by chronic inflammation (tartar, excess filling, or crown).
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
pyogenic granuloma and granuloma gravidarum.
PATHOLOGY
Epulis granulomatosa Fibrosus epulis
It is the most common type of epulis. It is a light red or yellowish-white, stiff tissue proliferation, which grows slowly.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
fibroma.
Peripheral giant cell epulis
It is a soft, bluish-red, often ulcerated growth covered with yellowish, fibrinous pseudomembrane, which may reach 2–3 cm in diameter. The teeth may loosen due to the destruction of the surrounding bones. In rare cases, the tumour becomes malignant. It develops less frequently than the granulomatous or the fibromatous forms.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
pyogenic granuloma, granuloma gravidarum, central haemangioma, gingival cancer, malignant melanoma.
Pigmented naevus (intradermalis)
Intradermal naevus is the most common lesion of the skin. It is usually elevated and as a result of fibrous tissue, stiff, brown or brownish-black, in rare cases colourless (amelanotic), occasionally papillary-surfaced or pedunculated develops. Malignant degeneration may result from irritants (collar, bras, or shaving) or insufficient treatment. It appears as a flat or slightly raised, brownish or brownish-black macule on the bucca or lips.
PATHOLOGY
Pigmented naevus BENIGN ODONTOGENIC AND NON-ODONTOGENIC TUMOURS Ameloblastoma
It is benign, locally aggressive and grows invasively. It is four times more frequent in the mandible than in the maxilla. Ameloblastoma may present in all ages, however, regarding the average age it is the most common in the fourth decade. The tumour grows slowly, and in 80% of the cases, it does not cause pain. A tumour in the jaw bone may cause facial deformation of various severity.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
follicular cyst, keratocyst.
Odontoma
Odontomas should be considered hamartomas rather than real tumours. This relatively common odontogenic tumour develops in the jaw bones mainly in children and young adults. The tumour has few symptoms and leads to swelling of the jaw bones, sometimes with a diameter of 5–6 centimetres.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
ameloblastoma, fibrous dysplasia.
Osteoma
Osteoid osteoma is a rare, benign, non-odontogenic tumor of the jaw bones. It occurs more frequently in women than in men, and it presents more commonly in the mandible than in the maxilla. It is a slowly-growing, usually painless, hard tumour that is bone-like to the touch and causes facial deformity.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
osteosarcoma, maxillary tumour, exostosis.
Exostosis
PATHOLOGY
The disease should be differentiated from osteoma, which is a real osteogenic tumour. The cause of exostosis is unknown. It is not a real neoplasm but a reactive lesion.
Torus palatinus
It is a developmental malformation of unknown origin, which presents as a slowly growing, bony growth (exostosis) in the middle of the hard palate, covered with intact mucosa. The growth is hard and feels like bone to the touch.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
palatal abscess, nasopalatine cyst.
Torus mandibularis
The disease can be manifested on the lingual surface of the mandible, unilaterally or bilaterally, at the site of the premolars, and may reach various sizes. The bony outgrowth is clearly visible in the radiogram.
Differential diagnosis: verruca vulgaris, condyloma acuminatum and verrucous carcinoma.
osteoma, mandibular cyst.
Torus mandibularis