Hyperplastic lesions

Question 1

What are TWO histological features of hyperplastic lesions?

Answer 1

• Hyperkeratosis

- Acanthosis (thickening of prickle cell layer)

Question 2

What feature would make a lesion harder or easier to excise?

Answer 2

Pedinculated (stalk) or sessile

Question 3

For lesions, what does papillary mean?

Answer 3

Any small growth projecting into a cavity

Question 4

What does Verrucous mean?

Answer 4

Warty surface appearance

Question 5

What is an epulis?

Answer 5

Lump on the gingiva (non-neoplastic)

Question 6

Is linea alba more commonly unilateral or bilateral?

Answer 6

bilateral

Question 7

Describe the appearance of smokers keratosis and why.

Answer 7

• White patches on palate (hyperkeratosis) with red dots (inflamed salivary ducts)

Question 8

Fibroepithelial hyperplasia:

• Most common cause
• Clinical presentation
• Main histological feature

Answer 8

• Mainly caused by chronic trauma
• Exophytic growth with normal mucosa colour +/- inflammation (e.g. due to biting on the growth)
• Reactive (due to trauma) collagen production (ie. fibrous tissue)

Question 9

What is a fibroepithelial polyp?

Answer 9

Very localised fibroepithelial hyperplasia

Question 10

Pyogenic granuloma:

• Most common cause/association
• Clinical presentation
• Histology
• Treatment
• Differences to epulis

Answer 10

• Increased incidence in puberty and pregnancy (can occur in males and females)
• Rapidly forming red, haemorrhagic, growth with ulcerated surface. Mainly seen on interdental papillae.
• Granulation tissue histology (essentially an atypical healing response to subgingival plaque)
• Treatment: excision and removed of irritating factors
• Way more rapid onset than epulis

Question 11

Peripheral giant cell granuloma:

• Clinical presentation
• Histology
• Cause

Answer 11

• Pyogenic granuloma + bony spicules (clinically or radiographically detected)
• Pyogenic granuloma + Giant cells + bone spicules
• Not mediated by hormones. Trauma possible cause.

Question 12

Calcifying fibroblastic granuloma:

• Clinical presentation
• Histology

Answer 12

• Fibroepithelial hyperplasia on gums. Rapid onset, faster than epulis but slower than pyogenic granuloma. Usually smaller than 1cm.
• Very cellular with calcifications

Question 13

One mechanism through which Phenytoin (Dilantin) may cause gingival hyperplasia

Answer 13

Impair collagen degradation through inhibition of MMP/TIMP pathway.