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Chapter 12: Soft Tissue Tumors

front 1 What is the most common "tumor" of the oral cavity?	back 1 fibroma
front 2 Clinical Features associated with irritation or trauma occurs on buccal mucosa, tongue, and gingiva smooth-surfaced pink nodule similar in color to surrounding mucosa may appear white from hyperkeratosis most 1.5 cm or less no symptoms, unless due to secondary trauma most common in older patients (fourth to sixth decades) more common in females than males (2 : 1) Histopathologic Features nodular mass of fibrous connective tissue covered by stratified squamous epithelium not encapsulated collagen bundles in haphazard patterns	back 2 fibroma
front 3 Pink nodule of the posterior buccal mucosa near the level of the occlusal plane (along the "bite line").	back 3 fibroma
front 4 Black patient with a smooth-surfaced gray-brown pigmented nodule on the buccal mucosa near the commissure.	back 4 fibroma

front 5 A firm smooth-surfaced pink nodule on the lateral border of the tongue, similar in color to the surrounding tissue.	back 5 fibroma
front 6 A smooth-surfaced, pink nodular mass of the palatal gingiva between the cuspid and first bicuspid.	back 6 fibroma
front 7 A fibrous hyperplasia presenting as a small, asymptomatic, exophytic growth attached to the maxillary labial frenum.	back 7 frenal tag
front 8 Low-power view showing an exophytic nodular mass of dense fibrous connective tissue covered by stratified squamous epithelium. .	back 8 fibroma

front 9 High-power view demonstrating dense collagen bundles beneath the surface of stratified squamous epithelium.	back 9 fibroma
front 10 What is the treatment and prognosis for fibroma?	back 10 conservative surgical excision recurrence is extremely rare submit tissue - other tumors mimic clinical appearance
front 11 Clinical Features not associated with irritation or trauma asymptomatic sessile or pedunculated nodule usually less than 1 cm in size most often diagnosed in first three decades (60%) occur on ginviva (50%), tongue, or palate occur twice as often on the mandibular gingiva Histopathologic Features mass of vascular, loose fibrous connective tissue numerous large, stellate fibroblasts pebbly surface with thin and atrophic epithelium	back 11 giant cell fibroma
front 12 Exophytic nodule on the dorsum of the tongue. Compared with irritation fibroma, this lesion usually occurs at a younger age.	back 12 giant cell fibroma

front 13 Papillary growth on the lingual mandibular gingiva. Because of the rough surface, this lesion would be easily mistaken for a papilloma.	back 13 giant cell fibroma
front 14 Bilateral papular lesions on the gingiva lingual to the mandibular canines, which are microscopically similar to giant cell fibroma.	back 14 retrocuspid papilla
front 15 Low-power view showing a nodular mass of fibrous connective tissue covered by stratified squamous epithelium. Note the elongation of the rete ridges. High-power view showing multiple large stellate-shaped and multinucleated fibroblasts.	back 15 giant cell fibroma
front 16 What is the treatment and prognosis for giant cell fibroma?	back 16 conservative surgical excision recurrence is rare

front 17 Clinical Features associated with ill-fitting dentures folds of hyperplastic tissue in alveolar vestibule usually firm and fibrous, but may be ulcerated range from less than 1 cm to the entire vestibule usually on the facial aspect of the alveolar ridge most often occurs in middle-aged and older adults pronounced female predilection (66 to 75%) Histopathologic Features hyperplasia of the fibrous connective tissue grooves where denture impinges on tissue hyperparakeratotic epithelium irregular hyperplasia of the rete ridges variable chronic inflammatory infiltrate rare formation of osteoid or chondroid	back 17 epulis fissuratum
front 18 Hyperplastic folds of tissue in the anterior maxillary vestibule in a denture-wearing patient.	back 18 epulis fissuratum
front 19 Several folds of hyperplastic tissue in the maxillary vestibule. An ill-fitting denture fits into the fissure between two of the folds.	back 19 epulis fissuratum
front 20 Redundant folds of tissue arising in the floor of the mouth in association with a mandibular denture.	back 20 epulis fissuratum

front 21 Flattened mass of tissue arising on the hard palate beneath a maxillary denture; note its pedunculated nature.	back 21 fibroepithelial polyp ("leaflike" fibroma)
front 22 Low-power photomicrograph demonstrating folds of hyperplastic fibrovascular connective tissue covered by stratified squamous epithelium.	back 22 epulis fissuratum
front 23 What is the treatment and prognosis for epulis fissuratum?	back 23 surgical removal remaking or relining of ill-fitting denture
front 24 Clinical Features usually occurs on hard palate beneath a denture base usually asymptomatic erythematous mucosa with pebbly or papillary surface often associated with denture stomatitis Histopathologic Features numerous papillary growths hyperplastic, stratified squamous epithelium chronic inflammatory cell infiltrate is usually seen	back 24 inflammatory papillary hyperplasia

front 25 Erythematous, pebbly appearance of the palatal vault in a denture-wearing patient.	back 25 inflammatory papillary hyperplasia
front 26 An advanced case exhibiting pronounced papular lesions of the hard palate in a denture-wearing patient.	back 26 inflammatory papillary hyperplasia
front 27 Medium-power view showing fibrous and epithelial hyperplasia resulting in papillary surface projections. Heavy chronic inflammation is present.	back 27 inflammatory papillary hyperplasia
front 28 Higher-power view showing pseudoepitheliomatous hyperplasia of the epithelium. This epithelium has a bland appearance that should not be mistaken for carcinoma.	back 28 inflammatory papillary hyperplasia

front 29 What is the treatment and prognosis for inflammatory papillary hyperplasia?	back 29 temporary removal of the denture (early lesions) excision and fabrication of new denture (late lesions)
front 30 Clinical Features most on the skin of the extremities tend to occur orally in middle-aged and older adults tend to occur cutaneously in younger adults painless nodular mass can reach several centimeters in size Histopathologic Features spindle-shaped fibroblastic cells with vesicular nuclei arranged in short, intersecting fascicles ("storiform") poorly defined margins	back 30 fibrous histiocytoma
front 31 A nodular mass on the dorsum of the tongue. These lesions more commonly occur on the skin, especially in younger patients.	back 31 fibrous histiocytoma
front 32 Medium-power view of a skin tumor showing spindle-shaped cells arranged in a storiform pattern.	back 32 fibrous histiocytoma

front 33 High-power view of a skin tumor demonstrating spindle-shaped cells with vesicular nuclei.	back 33 fibrous histiocytoma
front 34 What is the treatment and prognosis for fibrous histiocytoma?	back 34 local surgical excision recurrence is uncommon
front 35 Clinical Features reported primarily in adults (rare in children) slow-growing, painless, soft tissue mass easily removed from the surrounding tissues most common orally in the buccal mucosa Histopathologic Features well-circumscribed lesions blood vessels may show irregular "staghorn" branching cells may arranged in a disorganized “patternless pattern” positive for CD34 and bcl-2 in nearly all cases	back 35 solitary fibrous tumor
front 36 "Staghorn” blood vessels surrounded by haphazardly arranged cells. Moderately cellular fibrous proliferation (“patternless pattern”) with prominent vascularity, slightly myxoid areas, and scattered dense collagen bundles.	back 36 solitary fibrous tumor

front 37 What is the treatment and prognosis for solitary fibrous tumor?	back 37 local excision for benign-appearing tumors recurrence rate of approximately 17% rare examples of malignancy reported
front 38 Clinical Features intermediate between benign lesion and fibrosarcoma firm, painless mass may exhibit rapid or insidious growth most frequently occurs in children or young adults most orally site in paramandibular soft tissues can grow to considerable size adjacent bone destruction may be observed Histopathologic Features spindle-shaped cells arranged in streaming fascicles variable amount of collagen cells lack hyperchromatism and pleomorphism	back 38 fibromatosis
front 39 Streaming fascicles of spindle-shaped fibroblastic cells that demonstrate little pleomorphism.	back 39 fibromatosis
front 40 What is the treatment and prognosis for fibromatosis?	back 40 wide excision due to locally aggressive nature possible adjuvant chemotherapy or radiation therapy recurrence rate of up to 30% metastasis does not occur

front 41 Clinical Features spindle cell neoplasm of myofibroblasts most frequent in the first four decades (22 years) occur in the mandible, tongue, and buccal mucosa painless mass, sometimes exhibits rapid enlargement intrabony tumors create radiolucent defects Histopathologic Features interlacing bundles of spindle cells tapered or blunt-ended nuclei and eosinophilic cytoplasm positive for smooth muscle actin and muscle-specific actin	back 41 myofibroma
front 42 Computed tomography (CT) scan showing an expansile lytic mass of the posterior mandible on the left side of the illustration.	back 42 myofibroma
front 43 Proliferation of spindle-shaped cells with both fibroblastic and smooth muscle features.	back 43 myofibroma
front 44 What is the treatment and prognosis for myofibroma?	back 44 surgical excision small percentage of recurrence spontaneous regression may occur

front 45 Clinical Features most common in young adults predilection for females (2 : 1) most common on gingiva (75%) and hard palate sessile or pedunculated, painless nodular mass same color as the surrounding mucosa up to 2 cm in diameter Histopathologic Features well-localized but nonencapsulated myxomatous connective tissue surrounded by denser, collagenous connective tissue often causes flattening of the rete ridges fibroblasts with delicate, fibrillar processes	back 45 oral focal mucinosis
front 46 Nodular mass arising from the gingiva between the mandibular first and second molars.	back 46 oral focal mucinosis
front 47 Low-power view showing a nodular mass of loose, myxomatous connective tissue surrounded by denser, collagenous connective tissue.	back 47 oral focal mucinosis
front 48 High-power view demonstrating the myxomatous change and fibroblasts with delicate, fibrillar processes.	back 48 oral focal mucinosis

front 49 Clinical Features smooth or lobulated mass, usually pedunculated characteristically ulcerated surface pink to purple, depending on age of lesion may measure up to several centimeters typically painless, but often bleeds easily may exhibit rapid growth occur on ginviga (85%), lips, tongue, buccal mucosa most common in children and young adults female predilection, especially pregnant mothers Histopathologic Features highly vascular proliferation resembling granulation tissue endothelium-lined channels engorged with red blood cells vessels sometimes are organized in lobular aggregates surface is usually ulcerated mixed inflammatory cell infiltrate	back 49 pyogenic granuloma
front 50 Erythematous, hemorrhagic mass arising from the maxillary anterior gingiva.	back 50 pyogenic granuloma
front 51 Ulcerated and lobulated mass on the dorsum of the tongue.	back 51 pyogenic granuloma
front 52 Unusually large lesion arising from the palatal gingiva in association with an orthodontic band. The patient was pregnant.	back 52 pyogenic granuloma

front 53 Large gingival mass in a pregnant woman just before childbirth. The mass has decreased in size and undergone fibrous maturation 3 months after childbirth.	back 53 pyogenic granuloma
front 54 Nodular mass of granulation tissue resembling a pyogenic granuloma that developed in a recent extraction site.	back 54 epulis granulomatosa
front 55 Low-power view showing an exophytic mass of granulation-like tissue with an ulcerated surface. Note the lobular endothelial proliferation in the deeper connective tissue.	back 55 pyogenic granuloma
front 56 Higher-power view of an exophytic mass of granulation-like tissue showing capillary blood vessels and scattered inflammation.	back 56 pyogenic granuloma

front 57 What is the treatment and prognosis for pyogenic granuloma?	back 57 conservative surgical excision is usually curative recurrence rate of 3% to 15% usually treatment should be deferred during pregnancy some lesions resolve spontaneously after parturition
front 58 Clinical Features occur exclusively on gingiva or edentulous alveolar ridge red or red-blue nodular mass most are smaller than 2 cm can be sessile or pedunculated may or may not be ulcerated most occur in first to sixth decades slight female predilection (52% to 60%) Histopathologic Features proliferation of multinucleated giant cells background of plump mesenchymal cells mitotic figures are fairly common hemosiderin deposits from abundant hemorrhage	back 58 peripheral giant cell granuloma
front 59 Nodular blue-purple mass of the mandibular gingiva. These lesions occur exclusively on gingiva or edentulous alveolar ridge.	back 59 peripheral giant cell granuloma
front 60 Ulcerated mass of the mandibular gingiva. These lesions occur exclusively on gingiva or edentulous alveolar ridge.	back 60 peripheral giant cell granuloma

front 61 Low-power view showing a nodular proliferation of multinucleated giant cells within the gingiva.	back 61 peripheral giant cell granuloma
front 62 High-power view showing scattered multinucleated giant cells within a hemorrhagic background of ovoid and spindle-shaped mesenchymal cells.	back 62 peripheral giant cell granuloma
front 63 What is the treatment and prognosis for peripheral giant cell granuloma?	back 63 local surgical excision down to the underlying bone scaling of adjacent teeth to remove source of irritation recurrence rate of 10% to 18% may mimic brown tumors of hyperparathyroidism
front 64 Clinical Features occur exclusively on the gingiva nodular mass, either pedunculated or sessile usually emanates from interdental papilla color ranges from red to pink surface is frequently ulcerated most are less than 2 cm most occur in teenagers (10 to 19 years) more frequent in females (66%) most common in maxillary incisor-cuspid region Histopathologic Features fibrous proliferation associated with mineralized product bone, cementum-like material, or dystrophic calcifications multinucleated giant cells may be found	back 64 peripheral ossifying fibroma

front 65 This red, ulcerated mass of the maxillary gingiva has recurred twice. Such ulcerated lesions are easily mistaken for a pyogenic granuloma.	back 65 peripheral ossifying fibroma
front 66 Pink, nonulcerated mass arising from the maxillary gingiva. The remaining roots of the first molar are present.	back 66 peripheral ossifying fibroma
front 67 Ulcerated gingival mass demonstrating fibrous proliferation and formation of focal early mineralization.	back 67 peripheral ossifying fibroma
front 68 Nonulcerated fibrous mass of the gingiva showing central bone formation. Higher-power view showing trabeculae of bone with adjacent fibrous connective tissue.	back 68 peripheral ossifying fibroma

front 69 What is the treatment and prognosis for peripheral ossifying fibroma?	back 69 local surgical excision down to periosteum scaling of adjacent teeth to remove source of irritation recurrence rate of 8% to 16%
front 70 What is the most common mesenchymal neoplasm?	back 70 lipoma
front 71 Clinical Features soft, smooth-surfaced nodular mass can be sessile or pedunculated asymptomatic and usually less than 3 cm often yellowish, but deeper lesions are pinker occur intraorally on buccal mucosa and vestibule most patients are 40 years or older more common in obese people Histopathologic Features well circumscribed with a thin fibrous capsule distinct lobular arrangement of cells may have a fibrous component (fibro-type) may contain blood vessels (angio-type) may contain spindle cells (spindle-cell type) may contain bizzare giant cells (pleomorphic type) may infiltrate skeletal muscle (intramuscular type)	back 71 lipoma
front 72 Soft, yellow nodular mass in the floor of the mouth. Deeper lesions of this type may be more pink in appearance.	back 72 lipoma

front 73 Nodular mass of the posterior buccal mucosa. Similar presentations may actually represent herniation of the buccal fat pad through the buccinator muscle subsequent to removal of third molars.	back 73 lipoma
front 74 Low-power view of a tumor of the tongue demonstrating a mass of mature adipose tissue.	back 74 lipoma
front 75 High-power view of a tumor of the tongue showing the similarity of the tumor cells to normal fat.	back 75 lipoma
front 76 What is the treatment and prognosis for lipoma?	back 76 conservative local excision recurrence is rare intramuscular types have a higher recurrence rate

front 77 Clinical Features smooth-surfaced, nonulcerated nodule occur by mental foramen, tongue, and lower lip most often in middle-aged adults slightly more common in women altered sensations range from anesthesia to pain Histopathologic Features haphazard proliferation of nerve bundles fibrous connective tissue stroma mild chronic inflammatory cell infiltrate	back 77 traumatic neuroma
front 78 Painful nodule of the mental nerve as it exits the mental foramen. Such lesions often arise subsequent to surgical procedures.	back 78 traumatic neuroma
front 79 Note the irregular nodular proliferation along the mental nerve that is being exposed at the time of surgery.	back 79 traumatic neuroma
front 80 Low-power view showing the haphazard arrangement of nerve bundles within the background fibrous connective tissue.	back 80 traumatic neuroma

front 81 High-power view showing cross-sectioned nerve bundles within dense fibrous connective tissue.	back 81 traumatic neuroma
front 82 What is the treatment and prognosis for traumatic neuroma?	back 82 surgical excision including proximal nerve bundle most lesions do not recur pain may persist or return at a later date
front 83 Clinical Features striking predilection for the face (90%) most occur between fifth and seventh decades smooth-surfaced, painless, papule or nodule usually less than 1 cm occur on hard palate, gingiva, and labial mucosa Histopathologic Features well circumscribed and often encapsulated interlacing fascicles of spindle cells nuclei are characteristically wavy and pointed no significant pleomorphism or mitotic activity positive reaction for S-100 protein	back 83 palisaded encapsulated neuroma
front 84 Small, painless nodule of the lateral hard palate. These lesions most commonly occur extraorally on the face.	back 84 palisaded encapsulated neuroma

front 85 Low-power view showing a well-circumscribed, nodular proliferation of neural tissue. Higher-power view demonstrating spindle cells with wavy nuclei.	back 85 palisaded encapsulated neuroma
front 86 Immunohistochemical reaction demonstrating spindle-shaped cells that are strongly positive for S-100 protein.	back 86 palisaded encapsulated neuroma
front 87 What is the treatment and prognosis for palisaded encapsulated neuroma?	back 87 conservative local surgical excision recurrence is rare not associated with NF or MEN
front 88 Clinical Features slow-growing, encapsulated tumor typically associated with a nerve trunk usually asymptomatic, but pain may occur most occur in young to middle-aged adults can reach several centimeters in size most common intraorally on the tongue Histopathologic Features two microscopic patterns fascicles of spindle-shaped Schwann cells ("Antoni A") randomly arranged spindle-shaped cells ("Antoni B") central acellular, eosinophilic areas ("Verocay bodies") diffuse, positive reaction for S-100 protein	back 88 schwannoma

front 89 Nodular mass in the floor of the mouth. The most common intraoral site for these lesions is on the tongue.	back 89 schwannoma
front 90 Low-power view showing well-organized Antoni A tissue (right) with adjacent myxoid and less organized Antoni B tissue (left) The Schwann cells of the Antoni A tissue form a palisaded arrangement around acellular zones known as Verocay bodies.	back 90 schwannoma
front 91 What hereditary condition, caused by mutation of a tumor suppressor gene on chromosome 22, is characterized by bilateral schwannomas of the auditory-vestibular nerve?	back 91 neurofibromatosis type II (NF2)
front 92 NF2 is an autosomal dominant condition caused by a mutation of a tumor suppressor gene (NF2) on chromosome 22. What protein is encoded by this gene?	back 92 merlin

front 93 What genetic disorder, related to mutation of the SMARCB1 gene on chromosome 22, is characterized by multiple schwannomas without involvement of the auditory-vestibular nerve?	back 93 schwannomatosis
front 94 What is the treatment and prognosis for schwannoma?	back 94 treatment for solitary lesions surgical excision recurrence is rare malignant transformation does not occur vestibular lesions in NF2 are more difficult to manage
front 95 What is the most common type of peripheral nerve neoplasm?	back 95 neurofibroma
front 96 Clinical Features can arise in isolation or as a component of NF slow-growing, soft, painless lesions vary in size from small nodules to larger masses most frequently occur on the skin occur intraorally on tongue and buccal mucosa can also arise centrally within bone Histopathologic Features interlacing bundles of spindle-shaped cells often exhibit wavy nuclei delicate collagen bundles variable amounts of myxoid matrix numerous mast cells (helpful diagnostic feature) scattered, positive reaction for S-100 protein	back 96 neurofibroma

front 97 Smooth-surfaced, nodular mass of the maxillary gingiva and alveolar mucosa. These lesions occur more commonly on the tongue and buccal mucosa.	back 97 neurofibroma
front 98 Intraosseous tumor filling the right mandibular ramus. These lesions may present as well-demarcated or poorly defined unilocular or multilocular radiolucencies.	back 98 neurofibroma
front 99 Low-power view showing a cellular tumor mass below the epithelial surface. Immunostaining would reveal scattered, positive reaction for S-100 protein.	back 99 neurofibroma
front 100 High-power view showing spindle-shaped cells with wavy nuclei. Immunostaining would reveal scattered, positive reaction for S-100 protein.	back 100 neurofibroma

front 101 What is the treatment and prognosis for neurofibroma?	back 101 treatment for solitary lesions is local surgical excision recurrence is rare malignant transformation is possible, but very rare all patients must be evaluated for possibility of NF
front 102 What hereditary condition, caused mutations of a tumor suppressor gene on chromosome 17, is associated with development of multiple neurofibromas and various other skin lesions?	back 102 neurofibromatosis type I (NF1)
front 103 NF1 is an autosomal dominant condition caused by a mutation of a tumor suppressor gene (NF1) on chromosome 17. What protein is encoded by this gene	back 103 neurofibromin
front 104 Clinical Features multiple neurofibromas, most commonly on the skin massive baggy masses (elephantiasis neuromatosa) yellow-tan to dark-brown "café au lait" macules freckling of the axilla ("Crowe sign") brown-pigmented spots on the iris ("Lisch nodules") most common medical problem is hypertension most common oral finding is enlarged fungiform papillae	back 104 neurofibromatosis type I (NF1)

front 105 Both NF1 and polyostotic fibrous dysplasia are associated with the formation of "café au lait" pigmentation on the skin. How are they distinguished from one another?	back 105 In NF1, this pigmentation typically has smooth “coast of California” borders, in contrast to the irregular “coast of Maine” borders that may occur with polyostotic fibrous dysplasia.
front 106 NF1 can be diagnosed if the patient meets at least two of the diagnostic criteria. What are the seven diagnostic criteria for NF1?	back 106 six or more café au lait macules: more than 5 mm prepuberty more than 15 mm postpuberty two or more neurofibromas or one plexiform neurofibroma freckling in the axillary or inguinal regions optic glioma two or more Lisch nodules (iris hamartomas) one distinctive osseous lesion (e.g. sphenoid dysplasia) a first-degree relative with NF1
front 107 Multiple tumors of the trunk and arms. These often appear during puberty and may continue to develop throughout adulthood.	back 107 neurofibromatosis type I
front 108 Baggy, pendulous neurofibroma of the lower neck.	back 108 elephantiasis neuromatosa (neurofibromatosis type I)

front 109 A dark-brown macule of the skin. These lesions may vary in diameter from 1 to 2 mm to several centimeters.	back 109 café au lait pigmantation (neurofibromatosis type I)
front 110 Diffuse neurofibroma resulting in unilateral enlargement of the tongue. The most finding is enlargement of fungiform papillae.	back 110 neurofibromatosis type I
front 111 What is the treatment and prognosis for neurofibromatosis type I?	back 111 there is no treatment, only management of complications most feared is malignant peripheral nerve sheath tumor average lifespan reduced by 8 to 15 years mortality associated with vascular disease and neoplasms
front 112 Tumor of the left cheek in a patient with type I neurofibromatosis. These most commonly occur on the trunk and extremities.	back 112 malignant peripheral nerve sheath tumor

front 113 Tumor of the mandibular buccal vestibule in a patient with type I neurofibromatosis. The patient eventually died of this tumor.	back 113 malignant peripheral nerve sheath tumor
front 114 High-power view of an intraoral tumor that developed in a patient with neurofibromatosis type I. There is a cellular spindle cell proliferation with numerous mitotic figures.	back 114 malignant peripheral nerve sheath tumor
front 115 What group of rare autosomal dominant conditions are characterized by tumors or hyperplasias of the neuroendocrine tissues?	back 115 multiple endocrine neoplasia (MEN) syndromes
front 116 Clinical Features marfanoid body build everted upper eyelids oral mucosal neuromas (usually the first sign) pheochromocytoma (50%) medullary thyroid carcinoma (MTC) Laboratory Values elevated urinary calcitonin elevated urinary vanillylmandelic acid Histopathologic Features marked hyperplasia of nerve bundle normal or loose connective tissue background prominent thickening of the perineurium	back 116 multiple endocrine neoplasia (MEN) type 2B

front 117 Note the narrow face and eversion of the upper eyelids, which occurs due to thickening of the tarsal plate.	back 117 multiple endocrine neoplasia (MEN) type 2B
front 118 Multiple neuromas along the anterior margin of the tongue and bilaterally at the commissures (highly characteristic).	back 118 multiple endocrine neoplasia (MEN) type 2B
front 119 Low-power view of an oral mucosal neuroma showing marked hyperplasia of nerve bundles.	back 119 multiple endocrine neoplasia (MEN) type 2B
front 120 High-power view of an oral mucosal neuroma. Note the prominent thickening of the perineurium.	back 120 multiple endocrine neoplasia (MEN) type 2B

front 121 What is the treatment and prognosis for multiple endocrine neoplasia (MEN) type 2B?	back 121 immediate removal of the thyroid gland (risk of MTC) observation for development of pheochromocytomas
front 122 Clinical Features develops in young children (first year of life) predilection for anterior maxilla (69%) rapidly expanding blue or black mass often destroys the underlying bone displacement of the developing teeth Laboratory Values elevated urinary vanillylmandelic acid Histopathologic Features biphasic population of cells in a collagenous stroma epithelioid cells with dark-brown pigment neuroblastic cells inwith hyperchromatic nuclei	back 122 melanotic neuroectodermal tumor of infancy
front 123 Infant with an expansile mass of the anterior maxilla. These lesions are almost always diagnosed during the first year of life.	back 123 melanotic neuroectodermal tumor of infancy
front 124 Radiolucent destruction of the anterior maxilla associated with displacement of the developing teeth	back 124 melanotic neuroectodermal tumor of infancy

front 125 Low-power view showing nests of epithelioid cells containing granules of dark-brown melanin pigment within a fibrous stroma.	back 125 melanotic neuroectodermal tumor of infancy
front 126 High-power view of a tumor nest demonstrating two cell types: 1) small, hyperchromatic round cells and 2) larger epithelioid cells with vesicular nuclei. Some stippled melanin pigment is also present.	back 126 melanotic neuroectodermal tumor of infancy
front 127 What is the treatment and prognosis for melanotic neuroectodermal tumor of infancy?	back 127 surgical removal - most tumors are benign recurrence rate of 20% about 7% of reported cases malignant
front 128 Clinical Features most common in head and neck area usually occur in middle-aged adults (41 to 47 years) most common type is in the carotid body slowly enlarging, painless mass Histopathologic Features round or polygonal epithelioid cells organized into nests or "zellballen" nests consist primarily of chief cells positive for neuroendocrine markers	back 128 paraganglioma

front 129 Large tumor in the left neck producing a visible external swelling. This is seen more frequently in patients who live at high altitudes.	back 129 paraganglioma
front 130 An magnetic resonance image (MRI) showing a tumor mass at the carotid bifurcation. Arrows indicate the external and internal branches of the carotid artery.	back 130 paraganglioma
front 131 Tumor cells organized into zellballen consisting primarily of chief cells with centrally located, vesicular nuclei and somewhat granular, eosinophilic cytoplasm.	back 131 paraganglioma
front 132 What is the treatment and prognosis for paraganglioma?	back 132 surgery, radiation therapy, or both approximately 6% metastasize

front 133 Clinical Features most occur on tongue (50%), especially dorsal surface occurs in fourth to sixth decades of life more common in females (2 : 1) asymptomatic sessile nodule usually 2 cm or less typically pink, but sometimes yellow usually solitary, although multiple may occur Histopathologic Features large, polygonal cells, usually arranged in sheets abundant pale eosinophilic, granular cytoplasm dark or vesicular nuclei indistinct cell borders ("syncytial" appearance) not encapsulated, intermingles with adjacent tissues acanthosis or pseudoepitheliomatous hyperplasia (50%)	back 133 granular cell tumor
front 134 Submucosal nodule on the dorsum of the tongue. The buccal mucosa is the second most common intraoral location for this lesion.	back 134 granular cell tumor
front 135 Nodular mass of the buccal mucosa near the commissure. The dorsum of the tongue is the most common location for this lesion.	back 135 granular cell tumor
front 136 Medium-high–power view showing polygonal cells with abundant granular cytoplasm and vesicular nuclei.	back 136 granular cell tumor

front 137 Marked pseudoepitheliomatous hyperplasia overlying a tumor. Such cases may easily be mistaken for squamous cell carcinoma.	back 137 granular cell tumor
front 138 What is the treatment and prognosis for granular cell tumor?	back 138 conservative local excision recurrence is uncommon extremely rare examples of malignancy
front 139 Clinical Features occur almost exclusively on alveolar ridges of newborns pink-to-red, smooth-surfaced, polypoid mass most are 2 cm or less in size more common on the maxillary ridge most occur lateral to the midline, in incisor-canine area striking predilection for females (90%) Histopathologic Features large, rounded cells abundant granular, eosinophilic cytoplasm round to oval, lightly basophilic nuclei atrophy of the rete ridges	back 139 congenital epulis
front 140 Polypoid mass of the anterior maxillary alveolar ridge in a newborn. These occur almost exclusively on alveolar ridges of newborns.	back 140 congenital epulis

front 141 Low-power photomicrograph showing a nodular tumor mass. Note the atrophy of the rete ridges.	back 141 congenital epulis
front 142 High-power view of rounded cells with abundant granular, eosinophilic cytoplasm and round to oval, lightly basophilic nuclei.	back 142 congenital epulis
front 143 What is the treatment and prognosis for congenital epulis?	back 143 surgical excision recurrence never reported complete regression can occur without treatment
front 144 Nodular mass on the maxillary alveolar ridge. Instead of being excised, the lesion was monitored clinically. Clinical appearance of the child at 1 year of age. The mass has disappeared without treatment.	back 144 congenital epulis

front 145 Clinical Features most common tumors of infancy (4% to 5% of 1-year-olds) more common in females (3 : 1 to 5 : 1) occur more frequently in whites most occur on the head and neck (60%) rarely present at birth, but develop rapidly in first weeks appear raised and bosselated with bright-red color firm and rubbery to palpation most common problem is ulceration Histopathologic Features numerous plump endothelial cells often-indistinct vascular lumina endothelial cells become more flattened small, vascular spaces become more evident spaces replaced by fibrofatty connective tissue positive for GLUT1	back 145 hemangioma
front 146 Infant with two red, “strawberry” nodular masses on the posterior scalp and neck. These are the most common tumors of infancy.	back 146 hemangioma
front 147 Low-power photomicrograph showing a circumscribed cellular mass of vascular endothelial cells arranged in lobular aggregates.	back 147 hemangioma
front 148 High-power view showing a highly cellular endothelial proliferation forming occasional indistinct vascular lumina.	back 148 hemangioma

front 149 High-power photomicrograph demonstrating well-formed capillary-sized vessels. As this lesion progresses, the vascular spaces become less prominent and are replaced by fibrofatty connective tissue.	back 149 hemangioma
front 150 Large, segmental cervicofacial hemangioma can be a component of PHACE(S) syndrome. What does this acronym stand for?	back 150 posterior fossa brain anomalies hemangioma arterial anomalies cardiac defects and coarctation of the aorta eye anomalies sternal cleft or supraumbilical raphe
front 151 What coagulopathy associated with vascular tumors, characterized by severe thrombocytopenia and hemorrhage because of platelet trapping within the tumor, has a mortality rate as high as 30%?	back 151 Kasabach-Merritt phenomenon
front 152 What is the treatment and prognosis for hemangioma?	back 152 most undergo involution management often consists of “watchful neglect” propranolol has become the first-line treatment surgical removal rarely is warranted

front 153 Clinical Features present at birth and persist throughout life blue and are easily compressible grow proportionately with the patient Histopathologic Features do not show active endothelial cell proliferation may show more dilated vessels many incorrectly categorized as hemangiomas	back 153 vascular malformation
front 154 Blue-purple mass of the anterior tongue. In contrast to hemangiomas, these lesions present at birth and persist throughout life.	back 154 vascular malformation
front 155 Well-circumscribed radiolucency that contains fine trabeculations. A bruit or pulsation may be apparent on auscultation and palpation.	back 155 intrabony vascular malformation
front 156 Occlusal radiograph demonstrating cortical destruction and a “sunburst” periosteal reaction resembling osteosarcoma.	back 156 intrabony vascular malformation

front 157 Periapical radiograph showing an expansile, mottled radiolucency in the mandibular incisor region. Angiogram demonstrating a vascular proliferation between the mandibular incisors.	back 157 intrabony vascular malformation
front 158 Low-power photomicrograph showing multiple large, dilated blood vessels. Because of their similar features, these lesions are often incorrectly categorized as hemangiomas.	back 158 vascular malformation
front 159 What is the treatment and prognosis for vascular malformation?	back 159 flashlamp pulsed dye lasers for port wine stains sclerotherapy or surgical excision for venous malformations treatment of arteriovenous malformations is more challenging
front 160 Clinical Features vascular malformation of the face ("port wine stain") unilateral distribution along trigeminal nerve brain imaging may reveal “tramline” calcifications hypervascular changes to ipsilateral mucosa Histopathologic Features excessive numbers of dilated blood vessels proliferative gingival lesions	back 160 Sturge-Weber syndrome

front 161 Deep purple lesion of the malar area. Unless the lesion includes the region innervated by the ophthalmic branch of the trigeminal nerve, usually the patient does not have CNS involvement.	back 161 port wine stain (Sturge-Weber syndrome)
front 162 Port wine stain of the left face, including involvement along the ophthalmic branch of the trigeminal nerve.	back 162 Sturge-Weber syndrome
front 163 Skull film showing “tramline” calcifications.	back 163 Sturge-Weber syndrome
front 164 Unilateral vascular involvement of the soft palate.	back 164 Sturge-Weber syndrome

front 165 What is the treatment and prognosis for Sturge-Weber syndrome?	back 165 flashlamp pulsed dye lasers for facial port wine nevi extensive neurosurgical treatment may be required gingival port wine nevi can make oral hygiene difficult
front 166 Clinical Features occur almost exclusively in males predilection for adolescents (10 to 17 years) nasal obstruction and epistaxis anterior bowing of posterior wall of maxillary sinus Histopathologic Features dense fibrous connective tissue numerous dilated, thin-walled blood vessels	back 166 nasopharyngeal angiofibroma
front 167 A contrasted computed tomography (CT) scan showing a tumor of the nasopharynx and pterygopalatine fossa, with characteristic anterior bowing of the posterior wall of the right maxillary sinus.	back 167 nasopharyngeal angiofibroma
front 168 Moderately cellular fibrous connective tissue with prominent blood vessels.	back 168 nasopharyngeal angiofibroma

front 169 What is the treatment and prognosis for nasopharyngeal angiofibroma?	back 169 surgical excision recurrence rate varies from 20% to 40% malignant transformation is rare
front 170 Clinical Features predilection for the head and neck (50% to 75%) 50% noted at birth, 90% by age of 2 years occur orally on anterior two thirds of the tongue pebbly surface resembling translucent vesicles Histopathologic Features dilatated lymphatic vessels (microcystic type) macroscopic cystlike structures (macrocystic type)	back 170 lymphatic malformation
front 171 Young boy with a cystic hygroma primarily involving the right side of the face.	back 171 lymphatic malformation
front 172 Pebbly, vesicle-like appearance of a tumor of the right lateral tongue. These lesions have been likened to the appearance of frog eggs.	back 172 lymphatic malformation

front 173 Dorsal tongue lesion demonstrating a purple color, which can be caused by secondary hemorrhage or an associated hemangiomatous component.	back 173 lymphatic malformation
front 174 Lesion of the tongue showing dilated lymphatic vessels beneath the epithelium and in the deeper connective tissues.	back 174 lymphatic malformation, microcystic type
front 175 High-power photomicrograph showing dilated, lymph-filled vessels immediately below the atrophic surface epithelium.	back 175 lymphatic malformation, microcystic type
front 176 Lesion from the neck showing markedly dilated lymphatic vessels. The vessels often diffusely infiltrate the adjacent soft tissues.	back 176 lymphatic malformation, macrocystic type

front 177 What is the treatment and prognosis for lymphatic malformation?	back 177 spontaneous regression occurs rarely (3%) surgical excision or percutaneous sclerotherapy recurrence after surgery is common
front 178 Clinical Features slow-growing, firm, mucosal nodule most are asymptomatic, but some are painful normal in color, or may have a bluish hue most common on lips, tongue, palate, and cheek (80%) Histopathologic Features well-circumscribed bundles of spindle-shaped smooth muscle cells nuclei are elongated, pale staining, and blunt ended stains bright red with Masson trichrome stain	back 178 leiomyoma
front 179 Small, pink-red nodule on the posterior hard palate lateral to the midline. A tissue bispsy of this lesion would stain bright red with Masson trichrome stain.	back 179 leiomyoma
front 180 Low-power view showing a well-circumscribed cellular mass of spindle-shaped smooth muscle cells.	back 180 leiomyoma

front 181 High-power view showing spindle-shaped cells with blunt-ended nuclei. Immunohistochemical analysis shows strong positivity for smooth muscle actin.	back 181 leiomyoma
front 182 Well-circumscribed tumor exhibiting prominent blood vessels surrounded by smooth muscle.	back 182 leiomyoma
front 183 Masson trichrome stain demonstrating bundles of smooth muscle (red) with adjacent normal collagen (blue).	back 183 leiomyoma
front 184 What is the treatment and prognosis for leiomyoma?	back 184 local surgical excision should not recur

front 185 Clinical Features occur in middle-aged and older patients more common in men (75%) most located on pharynx, oral cavity, and larynx occur intraorally on floor, soft palate, and tongue nodule or mass can grow to many centimeters in size Histopathologic Features well-circumscribed lobules large, polygonal cells abundant granular, eosinophilic cytoplasm peripheral vacuolization (“spider web” appearance) positive for myoglobin, desmin, muscle-specific actin	back 185 rhabdomyoma
front 186 Nodular mass in the left cheek. Laryngeal and pharyngeal lesions of this type often lead to airway obstruction.	back 186 rhabdomyoma
front 187 Computed tomography (CT) scan of a tumor. These lesions can grow many centimeters before discovery.	back 187 rhabdomyoma
front 188 Medium-power view showing a uniform tumor composed of rounded and polygonal cells with focal vacuolization.	back 188 rhabdomyoma

front 189 Phosphotungstic acid hematoxylin (PTAH) stain demonstrates focal cross striations in some cells of this lesion.	back 189 rhabdomyoma
front 190 What is the treatment and prognosis for rhabdomyoma?	back 190 local surgical excision recurrence of 10% to 42% (likely due to incomplete removal)
front 191 Clinical Features occur on the tongue (85%) near the foramen cecum firm, smooth-surfaced, sessile or pedunculated nodule between 0.5 and 2.0 cm in diameter Histopathologic Features well-circumscribed mass dense lamellar bone or mature cartilage surrounded by dense fibrous connective tissue	back 191 choristoma
front 192 Hard pedunculated nodule on the posterior dorsum of the tongue. Microscopic examination showed a mass of dense lamellar bone.	back 192 osseous choristoma

front 193 Mass of dense lamellar bone surrounded by dense fibrous connective tissue beneath the surface epithelium.	back 193 osseous choristoma
front 194 What is the treatment and prognosis for osseous or cartilaginous choristomas?	back 194 local surgical excision recurrence has not been reported
front 195 Clinical Features slow-growing masses may reach considerable size before they produce pain can develop at any age can occur anywhere in the head and neck region Histopathologic Features spindle-shaped cells in a “herringbone” pattern little variation in size and shape variable numbers of mitotic figures	back 195 fibrosarcoma
front 196 Child with a large mass of the hard palate and maxillary alveolar ridge. These lesions can develop at any age and occur anywhere in the head and neck region.	back 196 fibrosarcoma

front 197 Cellular mass of spindle-shaped cells in a “herringbone” pattern demonstrating mild pleomorphism.	back 197 fibrosarcoma
front 198 What is the treatment and prognosis for fibrosarcoma?	back 198 surgical excision including a wide margin recurrence is noted in about half of cases 5-year survival ranges from 40% to 70%
front 199 Clinical Features occur primarily in older age groups expanding mass, may be painful or ulcerated most occur in deep tissues of trunk and extremities Histopathologic Features plump spindle cells in a storiform pattern admixed areas of pleomorphic giant cells	back 199 undifferentiated pleomorphic sarcoma
front 200 Spindle cell neoplasm demonstrating marked pleomorphism and scattered mitoses.	back 200 undifferentiated pleomorphic sarcoma

front 201 What is the treatment and prognosis for undifferentiated pleomorphic sarcoma?	back 201 radical surgical resection 40% have local recurrence 30% develop metastases 5-year survival rate is 52% to 55%
front 202 Clinical Features most common soft tissue sarcoma seen primarily in adults (mean age, 57 years) soft, slow-growing, ill-defined mass may appear normal in color or yellow most common in head and neck region occur intraorally on the tongue and cheek Histopathologic Features scattered lipoblasts and atypical, hyperchromatic stromal cells (well-differentiated type) proliferating lipoblasts within a myxoid stroma that contains a rich capillary network (myxoid type) aggressive form of myxoid type with less differentiated, rounded cells (round cell type) extreme cellular pleomorphism and bizarre giant cells (pleomorphic type) well-differentiated type with poorly differentiated changes (dedifferentiated type)	back 202 liposarcoma
front 203 High-power view showing vacuolated lipoblasts with pleomorphic nuclei.	back 203 liposarcoma
front 204 What is the treatment and prognosis for liposarcoma?	back 204 radical surgical excision around 50% recur 5-year survival rate from 59% to 70%

front 205 Clinical Features most common in young adults associated with neurofibromatosis enlarging mass, sometimes rapidily growing commonly cause pain or nerve deficits occur on mandible, lips, and buccal mucosa Histopathologic Features fascicles of atypical spindle-shaped cells cells irregular in shape with wavy nuclei heterologous elements found in some tumors positive for S-100 protein (50%)	back 205 malignant peripheral nerve sheath tumor
front 206 What is the treatment and prognosis for malignant peripheral nerve sheath tumor?	back 206 radical surgical excision possibly adjuvant radiation therapy and chemotherapy prognosis is generally poor disease-specific survival from 39% to 60% at 5 years
front 207 Clinical Features more common in adults (45 to 56 years) arises close to the cribriform plate may extend into adjacent paranasal sinuses nasal obstruction, epistaxis, pain, and anosmia Histopathologic Features small basophilic cells in sheets and lobules rosette and pseudorosette formation delicate neurofibrillary material	back 207 olfactory neuroblastoma
front 208 A T1-weighted sagittal magnetic resonance image (MRI) showing a tumor filling the superior nasal cavity and ethmoid sinus, with extension into the anterior cranial fossa.	back 208 olfactory neuroblastoma

front 209 Sheet of small, basophilic cells adjacent to the sinonasal epithelium (top). Areas of delicate neurofibrillary material may be seen.	back 209 olfactory neuroblastoma
front 210 What is the treatment and prognosis for olfactory neuroblastoma?	back 210 surgical excision, often with adjuvant radiation therapy 5-year survival from 91% (stage A) to 41% (stage C) metastasis occurs in approximately 20% to 37% of cases
front 211 Clinical Features most common in older adult patients early lesions often resemble bruises enlarge to form elevated, nodular, or ulcerated surface occur orally on tongue and mandible Histopathologic Features infiltrative proliferation of endothelium-lined blood vessels endothelial cells appear hyperchromatic and atypical positive for CD31 and factor VIII–related antigen	back 211 angiosarcoma
front 212 Slightly elevated, bluish purple lesion on the scalp. This rare malignancy of vascular endothelium may arise from either blood or lymphatic vessels.	back 212 angiosarcoma

front 213 Sinusoidal vascular spaces lined by pleomorphic endothelial cells. Immunohistochemical studies show the tumor cells to be positive for CD31 and factor VIII–related antigen.	back 213 angiosarcoma
front 214 What is the treatment and prognosis for angiosarcoma?	back 214 radical surgical excision, radiation therapy, or both 10-year survival rate of only 14% to 21% for face and scalp tumors of the oral cavity appear to have a better outcome
front 215 Clinical Features caused by infection with HHV-8 primarily a disease of late adult life most cases occur in men (70% to 95%) affects Italian, Jewish, or Slavic ancestry blue-purple macules and plaques occur on skin of lower extremities Histopathologic Features proliferation of miniature vessels (patch stage) development of spindle cells (plaque stage) formation of tumorlike mass (nodular stage)	back 215 Kaposi sarcoma
front 216 Multiple purple macules and plaques on the lower leg of an older man infected with HHV-8.	back 216 Kaposi sarcoma

front 217 Low-power photomicrograph showing a cellular spindle cell tumor within the connective tissue. This patient is infected with HHV-8.	back 217 Kaposi sarcoma
front 218 High-power photomicrograph showing spindle cells and poorly defined vascular slits. This patient is infected with HHV-8.	back 218 Kaposi sarcoma
front 219 What is the treatment and prognosis for Kaposi sarcoma?	back 219 radiation therapy (especially electron beam) often is used surgical excision can be performed for individual lesions classic form of the disease is slowly progressive 10% to 20% of patients develop disseminated lesions mean survival time is 10 to 15 years
front 220 Clinical Features most common in middle-aged and older adults half of all oral cases occur in the jawbones nonspecific enlarging mass, may be painful Histopathologic Features fascicles of pleomorphic spindle-shaped cells abundant eosinophilic cytoplasm blunt-ended, cigar-shaped nuclei glycogen-positive periodic acid-Schiff (PAS) stain bright red with a Masson trichrome stain	back 220 leiomyosarcoma

front 221 Ulcerated mass of the anterior maxillary alveolar ridge. These lesions are clinically non-specific, but immunohistochemical analysis usually reveals the presence of one or more of myogenic markers.	back 221 leiomyosarcoma
front 222 What is the treatment and prognosis for leiomyosarcoma?	back 222 radical surgical excision sometimes adjunctive chemotherapy or radiation estimated 5-year survival rate of 55%
front 223 Clinical Features occurs during the first decade of life approximately 60% occur in males painless, infiltrative mass that may grow rapidly face and orbit are most frequent locations palate is the most frequent intraoral site Histopathologic Features small round or oval cells hyperchromatic nuclei indistinct cytoplasm strap-shaped rhabdomyoblasts	back 223 rhabdomyosarcoma
front 224 Young child with a mass of the right maxilla. The tumor is most often a painless, infiltrative mass that may grow rapidly.	back 224 rhabdomyosarcoma

front 225 Computed tomography (CT) scan showing expansile lytic lesion of the maxilla characterized by skeletal muscle differentiation.	back 225 rhabdomyosarcoma
front 226 Medium-power view showing a sheet of small, round cells with hyperchromatic nuclei. Better-differentiated lesions show round to ovoid rhabdomyoblasts with distinctly eosinophilic cytoplasm.	back 226 rhabdomyosarcoma
front 227 This tumor shows strap-shaped rhabdomyoblasts that are positive for desmin with immunohistochemical staining. Note the cross striations.	back 227 rhabdomyosarcoma
front 228 What is the treatment and prognosis for rhabdomyosarcoma?	back 228 local surgical excision plus multiagent chemotherapy 5-year survival rate is around 66% to 72%

front 229 Clinical Features occur in teenagers and young adults slight male predilection gradually enlarging mass, often painful occurs primarily near large joints and bursae occur orally in the tongue and cheek Histopathologic Features biphasic tumor of spindle and epithelial cells spindle cells predominate epithelial cells that surround glandlike spaces calcifications may be seen (30%)	back 229 synovial sarcoma
front 230 Biphasic tumor consisting of spindle cells intermixed with cuboidal to columnar epithelial cells that line glandlike spaces.	back 230 synovial sarcoma
front 231 What is the treatment and prognosis of synovial sarcoma?	back 231 radical surgical excision prognosis is poor high rate of recurrence and metastasis 5-year survival rate ranges from 36% to 64%
front 232 Clinical Features slow-growing, painless mass most common in young adults and children lower extremity is the most frequent location can occur orally on the tongue female predilection in first two decades (2 : 1) more common in men after age 30 years Histopathologic Features polygonal cells arranged around alveolar spaces abundant granular, eosinophilic cytoplasm one to several vesicular nuclei PAS-positive, diastase-resistant crystals strong positivity for TFE3 transcription factor	back 232 alveolar soft-part sarcoma

front 233 Alveolar collections of large, polygonal cells containing abundant granular cytoplasm. Special stains will reveal PAS-positive, diastase-resistant crystals that are highly characteristic for this tumor.	back 233 alveolar soft-part sarcoma
front 234 What is the treatment and prognosis for alveolar soft-part sarcoma?	back 234 radical surgical excision possibly conjunctive radiation and chemotherapy poor prognosis due to late metastasis 5-year survival rate of 60%
front 235 Clinical Features most occur on gingiva (54%) and tongue (22.5%) nodular mass often resembles hyperplastic growth occasionally appears as a surface ulceration destruction of underlying bone may loosen teeth more common in males most frequent in middle-aged and older adults Histopathologic Features resemble tumor of origin most cases represent carcinomas	back 235 metastatic oral tumors
front 236 Pigmented nodule of the mandibular gingiva.	back 236 metastatic melanoma

front 237 Nodular mass of the left lateral border of the tongue.	back 237 metastatic renal carcinoma
front 238 Focal swelling of the left retromolar pad area. Same patient 4 weeks later. Note the marked enlargement of the lesion.	back 238 metastatic adenocarcinoma of the colon
front 239 Aggregates of malignant epithelial cells below the surface epithelium.	back 239 metastatic carcinoma of the lung
front 240 What is the treatment and prognosis for metastatic oral tumors?	back 240 prognosis is poor - other metastasis frequently present management is usually palliative