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BENIGN AND MALIGNANT CONNECTIVE TISSUE TUMOURS

Learn about fibroma, giant cell fibroma, peripheral ossifying fibroma, central ossifying fibroma, myofibroma, and peripheral giant cell granuloma in oral soft tissues. Detailed information on clinical features, histopathology, differential diagnosis, and treatment options provided.

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BENIGN AND MALIGNANT CONNECTIVE TISSUE TUMOURS

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  1. BENIGN AND MALIGNANT CONNECTIVE TISSUE TUMOURS

  2. FIBROMA • MOST COMMON BENIGN SOFT TISSUE NEOPLASM • REACTIVE FIBROUS HYPERPLASIA TO TRAUMA OR IRRITATION

  3. C/F • ANY ORAL SITE • ALONG PLANE OF OCCLUSION • COMMON SITE: GINGIVA, B.M, TONGUE, LIPS, PALATE • ELEVATED NODULE • NORMAL COLOUR • SMOOTH SURFACE • SESSILE OR PEDUNCULATED • SMALL IN SIZE MOSTLY • WELL DEFINED

  4. C/F • TRAUMATIC SURFACE • ULCERATION • HYPERKERATOSIS • F:M = 2:1 • OCCURS AT ANY AGE Differential diagnosis: • GIANT CELL FIBROMA • NEUROFIBROMA • GIANT CELL GRANULOMA • MUCOCELE

  5. Fibroma..

  6. Fibroma..

  7. Fibroma..

  8. Histopathologhic/Features • BUNDLES OF INTERLACING COLLAGEN FIBRES • FEW FIBROBLASTS, FIBROCYTES OR SMALL BLOOD VESSLES • SURFACE EPITHELIUM – STRATIFIED SQUAMOUS • TRAUMA – VASODILATION, EDEMA • INFLAMMATORY CELL INFILTRATION SEEN PARTICULARLY LYMPHOCYTES

  9. Fibroma..

  10. Fibroma..

  11. TREATMENT & PROGNOSIS • SURGICAL EXCISION

  12. GIANT CELL FIBROMA • ORAL NEOPLASM FIRST DESCRIBED BY WEATHERS & CALLIHAN IN 1974

  13. C/F • ASYMPTOMATIC • SMALL AND RAISED • SESSILE OR PEDUNCULATED • 10 – 30 YRS • MANDIBULAR GINGIVA MOST COMMON • FOLLOWED BY TONGUE, PALATE, BUCCAL MUCOSA AND LIPS

  14. Giant cell fibroma..

  15. H/P • UNENCAPSULATED MASS OF LOOSE FIBROUS C/T • LARGE PLUMP, SPINDLE SHAPED & STELLATE FIBROBLASTS • SOME MULTINUCLEATED CELLS • PERIPHERALLY SUCH CELLS • SURFACE EPITHELIUM – CORRUGATED & ATROPHIC

  16. Giant cell fibroma..

  17. TREATMENT & PROGNOSIS • EXCISION BIOPSY IS CURATIVE • RECURRENCE RARE

  18. PERIPHERAL OSSIFYING FIBROMA • ANY AGE { COMMON IN CHILDREN & YOUNG ADULTS} • F : M – 2:1 • WELL DEMARCATED FOCAL MASS OF TISSUE ON GINGIVA • SESSILE OR PEDUNCULATED • COLOUR NORMAL OR REDDENED • SURFACE INTACT OR ULCERATED • APPEARS TO ORIGINATE FROM INTERDENTAL PAPILLA • MOST COMMON ANTERIOR TO MOLAR AREA

  19. Peripheral ossifying fibroma..

  20. R/F • SUPERFICIAL EROSION OF BONE ( FEW CASES)

  21. Peripheral ossifying fibroma..

  22. H/P • STRATIFIED SQUAMOUS EPITHELIUM • INTACT OR ULCEARTED • EXTREMELY CELLULAR WITH PROLIFERATING FIBROBLASTS • DELICATE FIBRILLAR STROMA • AREAS OF CALCIFICATION { MATURE LAMELLAR BONE OR IMMATURE CELLULAR BONE} • SINGLE OR MULTIPLE INTERCONNECTING TRABACULAE OF BONE • GLOBULES OF CALCIFICATIONS – ACELLULAR CEMENTUM • DYSTROPHIC CEMENTUM

  23. Peripheral ossifying fibroma..

  24. Peripheral ossifying fibroma..

  25. Peripheral ossifying fibroma..

  26. TREATMENT & PROGNOSIS • SURGICAL EXCISION

  27. CENTRAL OSSIFYING FIBROMA • CENTRAL NEOPLASM OF BONE • CONTROVERSY – CENTRAL CEMENTIFYING FIBROMA (OT) AND OTHER FIBRO OSSEOUS LESION

  28. C/F • AGE: 33 YRS • SITE: MANDIBLE MORE AFFECTED • ASYMPTOMATIC • NOTICEABLE SWELLING • MILD DEFORMITY • DISPLACEMENT OF TEETH • SLOW GROWING • OVERLYING MUCOSA INTACT

  29. Central ossifying fibroma..

  30. Central ossifying fibroma..

  31. R/F • R/F APPEARANCE DEPENDS UPON STAGE OF DEVELOPEMENT • INITIAL RADIOLUCENCY • MATURE LESION RADIOLUCENT WITH RADIO-OPAQUE FLECKS • LATER RADIO-OPAQUE MASSES • WELL DEFINED/CIRCUMSCRIBED AND DEMARCATED LESION FROM SURROUNDING • DISPLACEMENT OF TEETH

  32. Central ossifying fibroma..

  33. H/P • DELICATE INTERLACING COLLAGEN FIBRES • ACTIVE PROLIFERATING FIBROBLASTS • CELLULAR PLEOMORHISM – MILD • SMALL FOCI OF IRREGULAR BONY TRABECULAE • MATURE LESION WITH CALCIFICATION COALESCE

  34. Central ossifying fibroma..

  35. Central ossifying fibroma..

  36. TREATMENT & PROGNOSIS • CONSERVATIVE EXCISION

  37. MYOFIBROMA & MYOFIBROMATOSIS • PREDOMINANT MYOFIBROBLASTS • C/F – BENIGN & LESS AGGRESSIVE 26.6YRS H&N REGION • I.O – TONGUE, LIPS & B.M JAW LESIONS – MAND LESIONS UNILOC & MULTI LOC FIRM SUBMUCOSAL NODULES OR EXOPHYTIC

  38. H/P • BIPHASIC PATTERN • FASCICLES OF SPINDLE CELLS – EOSINOPHILIC CYTOPLASM – SMOOTH MUSCLE • PRIMITIVE SPINDLE CELLS

  39. Myofibroma..

  40. TREATMENT & PROGNOSIS • CONSERVATIVE EXCISION

  41. PERIPHERAL GIANT CELL GRANULOMA • REACTIVE LESION • LOCAL IRRITATION • RECENTLY ROLE OF TRAUMA

  42. C/F • DENTULOUS & EDENTULOUS • 4TH – 6TH DECADE • FEMALE • ASYMPTOMATIC • SIZE IS AROUND 1 CM IN DIAMETER • ORIGIN FROM PDL OR MUCOPERIOSTEUM • COLOR VARIES • SITE : MANDIBULAR GINGIVA , ALVEOLAR MUCOSA

  43. Peripheral giant cell granuloma..

  44. Peripheral giant cell granuloma..

  45. Peripheral giant cell granuloma..

  46. H/P • NON ENCAPSULATED • DELICATE RETICULAR & FIBRILLAR C/T • OVOID OR SPINDLE SHAPED C/T CELLS • MULTINUCLEATED GIANT CELLS • FOCI OF HEMORRHAGE • HEMOSIDERIN PIGMENTS • SPICULES OF OSTEOID OR BONE • INFLAMMATORY CELL INFILTRATION • STRATIFIED SQUAMOUS EPITHELIUM

  47. Peripheral giant cell granuloma..

  48. Peripheral giant cell granuloma..

  49. Peripheral giant cell granuloma..

  50. GIANT CELLS ? • OSTEOCLASTS • GIANT CELLS ASSOCIATED WITH RESORPTION OF DEC TEETH • ENDOTHELIAL CELLS

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