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BENIGN AND MALIGNANT CONNECTIVE TISSUE TUMOURS

BENIGN AND MALIGNANT CONNECTIVE TISSUE TUMOURS. FIBROMA. MOST COMMON BENIGN SOFT TISSUE NEOPLASM REACTIVE FIBROUS HYPERPLASIA TO TRAUMA OR IRRITATION. C/F. ANY ORAL SITE ALONG PLANE OF OCCLUSION COMMON SITE : GINGIVA, B.M, TONGUE, LIPS, PALATE ELEVATED NODULE NORMAL COLOUR SMOOTH SURFACE

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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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