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Dental Tribune U.S. Edition

DENTAL TRIBUNE | January/February 2011 Pathology 9A AD e) All of the above 4) Which of the following is a rec- ommended form of treatment? a) Generally regresses on its own, especially the superficial one; so no treatment required. b) In some cases, a surgical treat- ment or lasers may be used to remove the small vessels. c) Cavernous hemangiomas are generally treated with steroid injec- tions or laser treatments or combina- tion treatment. d) All of the above are correct. DT (Answers are below.) until traumatized. Narrowing down the diagnosis a) Lymphangioma b) Hemangioma c) Amyloidosis Ruling out amyloidosis The tongue generally becomes smooth or may possess a variety of polypoid appendages that form as the tongue grows against gaps in the teeth. In addition to its large size, the tongue becomes adynamic, firm and friable and may cause problems with deglutition, speech and breathing. The tongue tissue may break down and haemorrhage due to the size. There are two types of amyloidosis: • Organ-limited amyloidosis rarely shows up in oral soft tissues. • Systemic amyloidosis show vari- ous other systemic signs and symp- toms. Thus, complete systemic examina- tion and probably a biopsy is required before making a diagnosis of amyloi- dosis. Ruling out lymphangioma When seen in the denser tissue such as the tongue, lymphangioma is con- fined and histologically it presents as a microcystic lesion unlike a macro- cystic lesion in the looser tissues. The tongue presents superficially as “pebbly” with a vesicle-like feature and a so-called “frog-egg” or “tapio- ca-pudding” appearance. If located deeper, lymphangioma may present as a submucosal mass. About 50 percent of the lesions are noted at birth and around 90 percent develop by 2 years of age. Other causes of macroglossia: a) Cretinism b) Downs Syndrome c) Mucopolysaccharidoses d) Neurofibromatosis e) Edentulous patients f) Myxedema g) Acromegaly h) Angioedema i) Carcinoma and other tumors Part II: Hemangiomas 2) Check your knowledge of heman- giomas by marking true or false next to each of the following. a) A hemangioma is a benign, self- involuting tumor of endothelial cells (the cells that line blood vessels) lead- ing to an abnormal proliferation of blood vessels that may occur in any vascularized tissue. b) Hemangiomas are one of the most common birthmarks in new- borns. c) The appearance depends on location. Superficials appear reddish; however, if they are just under the skin they present as a bluish swelling. d) Some are formed during gesta- tion while others (the most common) are not present at birth but appear during the first few weeks of life. e) Histologically, subclassified as capillary or cavernous depending on the size of the vascular channels. f) Show giant cell inflammatory reaction. The development cycle of heman- giomas includes three stages of devel- opment and decay. • In the proliferation stage, a hem- angioma grows very quickly. This stage can last up to 12 months. • In the rest stage, there is very lit- tle change in a hemangioma’s appear- ance. This usually lasts until the infant is 1 to 2 years old. • In the involution phase, a hem- angioma finally begins to diminish in size. Fifty percent of lesions will have disappeared by 5 years of age and the vast majority will have disappeared by 10 years of age. 3) Which of the following compli- cations can a hemangioma show? a) Bleeding b) Breathing and eating difficulties c) Secondary infections d) Vision problems 1)c(hemangioma) 2)a=true,b=true,c=true, d=true,e=true,f=false 3)e(alloftheabove) 4)d(alloftheabove) Dr. Monica Malhotra is an assistant profes- sor at the Sudha Rustagi Dental College in India and also main- tains a private practice. In 2008 she was presented with a national award for the best scien- tific study presentation by the Indian Association of Oral and Maxillofacial Pathology. Malhotra completed her master’s in oral pathology at the Manipal Insti- tute, India, in 2009. You may contact her at drmonicamalhotra@yahoo. com. About the author