chapter 7sreddy/dh180/chapter 7.pdf · premalignant lesions ... may show epithelial dysplasia, a...

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1Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

Chapter 7

Neoplasia


Outline Description of Neoplasia Causes of Neoplasia Classification of Tumors Names of Tumors Treatment of Tumors Epithelial Tumors Tumors of Squamous Epithelium Salivary Gland Tumors Odontogenic Tumors Tumors of Soft Tissue Tumors of Melanin-Producing Cells Tumors of Bone and Cartilage Tumors of Blood-Forming Tissues Metastatic Tumors of the Jaws


Description of Neoplasia

(pg. 234) Neoplasia

New growth Cells exhibit uncontrolled proliferation

Neoplasm A mass of such cells

Tumor Means swelling, but is often used as a

synonym for neoplasm


Description of Neoplasia (cont.)

The occurrence of neoplasia An irreversible change must take place in the

cells.• This change must be passed on to new cells and

result in uncontrollable cell multiplication.

It is an abnormal process.• The cells are abnormal; the proliferation of the cells

is uncontrolled and unlimited.


Causes of Neoplasia

(pg. 234) Many agents have been shown to cause

neoplastic transformation of cells in the laboratory. Chemicals – hundreds of different ones Viruses – called oncogenic viruses Radiation – sunlight, x-rays, nuclear fission

It can also occur spontaneously secondary to a genetic mutation.


Classification of Tumors

(pgs. 234-235) Two categories

Benign tumor or neoplasia• Remains localized• May be encapsulated with fibrous connective tissue• It can invade adjacent tissue, but does not have the

ability to spread to distant sites. Malignant tumor

• Invades and destroys surrounding tissue• Has the ability to spread throughout the body

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Classification of Tumors (cont.)

Benign tumors almost always resemble normal tissue.

Malignant tumors vary in histologic appearance. Well-differentiated malignant tumors have

neoplastic cells that resemble normal cells; poorly differentiated ones do not.

Others may be undifferentiated or anaplastic, and do not resemble the tissue from which they were derived at all.





(pgs. 234-235) (Table 7-1) Pleomorphic

The cells of malignant tumors often vary in size and shape.

Hyperchromatic The nuclei of these cells are darker than those

of normal cells and exhibit an increased nuclear-cytoplasmic ratio.

Mitotic figures Normal and abnormal mitotic figures are seen

in the nucleus of neoplastic cells.




Names of Tumors (Cont.)


Names of Tumors (Cont.)

(pgs. 234, 236) (Table 7-2) Naming tumors

The prefix is determined by the tissue or cell of origin.

The suffix -oma is used to indicate a tumor. Benign tumors

Lipoma – benign tumor of fat Osteoma – benign tumor of bone

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Names of Tumors (cont.)

Naming malignant tumors Carcinoma – malignant tumor of epithelium Sarcoma – malignant tumor of connective

tissue Malignant tumors

Squamous cell carcinoma or epidermoid carcinoma – malignant tumor of squamous epithelium

Osteosarcoma – malignant tumor of bone


Treatment of Tumors

(pgs. 234-235) Benign tumors

Treated by surgical excision, either wide local excision or enucleation

Malignant tumors Treated by surgery, chemotherapy, or radiation

therapy, often a combination


Epithelial Tumors

(pg. 235) Three different types are found in the oral

cavity. From squamous epithelium From salivary gland epithelium From odontogenic epithelium


Tumors of Squamous Epithelium

Papilloma Premalignant Lesions Squamous Cell Carcinoma Verrucous Carcinoma Basal Cell Carcinoma


Papilloma

(pgs. 235-236) A benign tumor of squamous epithelium

A small exophytic pedunculated or sessile growth

Papillary projections, may be white or the color of normal mucosa

Most often on the soft palate or tongue May occur at any age, with equal sex

predilection


Papilloma (cont.)

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Papilloma (cont.)

Microscopic Numerous fingerlike or papillary projections

with a central core of fibrous connective tissue surfaced by normal stratified squamous epithelium

Treatment Surgical excision


Premalignant Lesions

Leukoplakia Erythroplakia Epithelial Dysplasia


Leukoplakia

(pgs. 235, 237) Means “white plaque”

A clinical term, not a histologic term Biopsy is necessary to establish a definitive

diagnosis. Most are due to a hyperkeratosis, or epithelial

hyperplasia and hyperkeratosis If the cause can be identified, remove the

cause and see if it resolves.• If not, the lesion should be biopsied.


Leukoplakia (cont.)


Leukoplakia (cont.)

Microscopic May show epithelial dysplasia, a premalignant

condition, or even squamous cell carcinoma• Approximately 5% to 25% reveal epithelial dysplasia.

Treatment Dependent on histologic finding


Erythroplakia

(pg. 237) An oral mucosal lesion appearing as a

smooth red patch or a granular red and velvety patch Speckled leukoplakia A lesion that shows a mix of red and white

areas Most often located on the floor of the mouth,

tongue, and soft palate Less common than leukoplakia

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Erythroplakia (cont.)

Microscopic 90% of cases of erythroplakia demonstrate

epithelial dysplasia or squamous cell carcinoma

Treatment Dependent on histologic diagnosis


Epithelial Dysplasia

(pgs. 237-238) A histologic

diagnosis of a premalignant condition Indicates disordered

growth These lesions

frequently precede squamous cell carcinoma.

Changes may revert to normal if the stimulus is removed.


Epithelial Dysplasia (cont.)

Clinically, it may present as an erythematous lesion, a white lesion, or as a mixed erythematous and white lesion. Lesions often arise on the floor of the mouth or

tongue. Dysplasia in other tissues is not

considered a premalignant process.


Epithelial Dysplasia (cont.)

Microscopic Abnormal maturation of epithelial cells with

disorganization of epithelial layers; hyperplasia of basal cells; and epithelial cells with enlarged and hyperchromatic nuclei, increased nuclear cytoplasmic ratios, abnormal keratinization, and increased numbers of normal and abnormal mitotic figures

Carcinoma in situ Severe dysplasia involving the full thickness of

epithelium Treatment

Surgical excision


Squamous Cell Carcinoma (Epidermoid Carcinoma)

(pgs. 238-240) A malignant tumor of squamous epithelium

The most common primary malignancy of the oral cavity

• It can infiltrate adjacent tissues and form distant metastases.

• Usually metastasizes to lymph nodes in the neck and then to distant sites, such as the lungs and liver

Clinically, it usually is an exophytic ulcerative mass.

It can infiltrate and destroy bone.


Squamous Cell Carcinoma (Epidermoid Carcinoma) (cont.)

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Squamous Cell Carcinoma (SCC)

(pgs. 238, 240) Microscopic

Tumor cells invade connective tissue underlying the epithelial basement membrane.

Well-differentiated tumors will show keratin.• Keratin pearls

Keratin may be seen in individual cells within the tumor.

SCC may occur anywhere within the oral cavity, most often on the floor of the mouth, ventrolateral tongue, soft palate, tonsillar pillar, and retromolar areas. May occur on the vermilion border of the lips and skin of

the face – these locations have a better prognosis than SCC of the oral mucosa.


Squamous Cell Carcinoma (SCC) (cont.)


Squamous Cell Carcinoma

Exposure to the sun causes the lips to turn from dark pink to mottled grayish pink. The interface becomes blurred; linear fissures

are seen at right angles to the line of the interface.

Solar cheilitis A condition in which mild to severe epithelial

dysplasia occurs Most patients are over 40 years old.

Most have been men, but the incidence has increased in women.


Risk Factors for Squamous Cell Carcinoma

(pgs. 238-239) Tobacco

Smoking, snuff dipping, tobacco chewing Alcohol consumption


Treatment and Prognosis for Squamous Cell Carcinoma (Cont.)


Treatment and Prognosis for Squamous Cell Carcinoma (Cont.)

(pgs. 239-241) (Table 7-3) Generally is treated by surgical excision.

Radiation therapy or chemotherapy may also be used.

These patients may have xerostomia. TNM staging may be used to determine

the prognosis. The higher the stage, the worse is the

prognosis.

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TNM Staging

(pg. 240) (Box 7-1) T – Tumor

T1 – less than 2 cm in diameter T2 – 2–4 cm in diameter T3 – greater than 4 cm in diameter T4 – invades adjacent structures

N – Node N0 – no palpable nodes N1 – ipsilateral palpable nodes N2 – contralateral or bilateral nodes N3 – fixed palpable nodes

M – metastasis M0 – no distant metastasis M1 – clinical metastatsis


Verrucous Carcinoma

(pgs. 240-242) A form of squamous cell carcinoma, but

separated because it has a much better prognosis A slow growing exophytic tumor with a pebbly

red and white surface Most cases are in men over 55 years old and

involve the vestibule and buccal mucosa.


Verrucous Carcinoma (cont.)


Verrucous Carcinoma (cont.)

Microscopic A tumor with numerous papillary epithelial

projections• Papillary projections are filled with keratin.• Epithelium is well differentiated, does not contain

atypical cells, and exhibits broad-based rete pegs.• The tumor does not show invasion through the

basement membrane.



Basal Cell Carcinoma

(pgs. 241-242) A malignant skin tumor associated with

excessive exposure to the sun. Frequently arises on the skin of the face Appears as a nonhealing ulcer with

characteristic rolled borders Most cases in white adults with no sex

predilection.


Basal Cell Carcinoma (cont.)

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Basal Cell Carcinoma (cont.)

Microscopic Composed of basal cells derived from

squamous epithelium A proliferation of basal cells into underlying

connective tissue Treatment

Surgical excision Radiation therapy may be used to treat large

lesions. Rarely metastasizes


Salivary Gland Tumors

Pleomorphic Adenoma Monomorphic Adenoma Adenoid Cystic Carcinoma (Cylindroma) Mucoepidermoid Carcinoma


Salivary Gland Tumors (cont.)

(pgs. 241, 243) May arise in either major or minor salivary

glands Minor salivary gland tumors are most often

located at the junction of the hard and soft palate.

Adenomas Benign tumors of salivary glands


Salivary Gland Tumors (cont.)


Pleomorphic Adenoma (Benign Mixed Tumor)

(pgs. 241-242, 244) A benign salivary gland tumor

90% of all salivary gland tumors Microscopic

An encapsulated tumor composed of tissue that appears to be a mix of both epithelium and connective tissue

The most common extraoral location is the parotid gland; the most common intraoral location is the palate.


Pleomorphic Adenoma (Benign Mixed Tumor) (cont.)

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Pleomorphic Adenoma

(pgs. 241, 243) Clinically

Appears as a slowly enlarging, nonulcerated, painless, dome-shaped mass

Most occur in individuals less than 40 years old Occurs more often in women than men

Treatment Surgical excision Recurrence rates vary; they are related to the success of

the initial surgical removal. Carcinoma arising in a pleomorphic adenoma

These lesions have been known to undergo malignant transformation.


Pleomorphic Adenoma (cont.)


Monomorphic Adenoma

(pgs. 242, 244) A benign encapsulated salivary gland tumor

Occurs less often than the pleomorphic adenoma

A uniform pattern of epithelial cells Occurs most commonly in adult females Occurs most often in the upper lip and buccal

mucosa Treatment

Surgical excision


Monomorphic Adenoma (cont.)


Monomorphic Adenoma (cont.)

Warthin tumor (papillary cystadenoma lymphomatosum) is a unique type of monomorphic adenoma. An encapsulated tumor with epithelial and

lymphoid tissue• A painless, soft, compressible or fluctuant mass

Usually occurs on the parotid gland, rarely intraorally

• Often develops bilaterally

Occurs predominantly in adult men


Adenoid Cystic Carcinoma (Cylindroma)

(pgs. 243-245) A slow growing malignant tumor of salivary

gland origin Microscopic

Unencapsulated, infiltrates surrounding tissue Small, deeply staining, uniform epithelial cells

that resemble “Swiss cheese”

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Adenoid Cystic Carcinoma (Cylindroma) (cont.)


Adenoid Cystic Carcinoma

Most common extraoral site is the parotid; most common intraoral site is the palate. Most appear as slowly growing masses that

may be ulcerated May be painful More common in women than in men Most occur in the fifth and sixth decades



Mucoepidermoid Carcinoma

(pgs. 243-245) A malignant salivary gland tumor

Unencapsulated, infiltrating tumor A combination of mucus cells interspersed with

squamous-like epithelial cells called epidermoid cells

Major gland tumors are most often found in the parotid gland, minor gland tumors on the palate

Appear clinically as slowly enlarging masses May appear in bone as either a unilocular or

multilocular radiolucency


Mucoepidermoid Carcinoma (cont.)


Mucoepidermoid Carcinoma (cont.)

May occur over a wide age range Usually occurs in adults, but is the most

common malignant salivary gland tumor in children

Occurs most often in females Treatment

Surgical excision


Other Malignant Salivary Gland Tumors

(pg. 245) There are several additional malignant

salivary gland tumors including Polymorphous low-grade adenocarcinoma Acinic cell adenocarcinoma Other adenocarcinomas

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Odontogenic Tumors

Epithelial Odontogenic Tumors Mesenchymal Odontogenic Tumors Mixed Odontogenic Tumors Peripheral Odontogenic Tumors


Odontogenic Tumors (cont.)


Odontogenic Tumors (cont.)

(pgs. 245-246) (Table 7-4) Derived from tooth-forming tissues

They may be composed of epithelium, mesenchyme, or a combination of both.

Most are benign, but there are rare malignant forms.


Epithelial Odontogenic Tumors

Ameloblastoma Calcifying Epithelial Odontogenic Tumor

(CEOT) Adenomatoid Odontogenic Tumor Calcifying Odontogenic Cyst


Ameloblastoma

(pgs. 245-247) A benign, slow-growing but locally

aggressive epithelial odontogenic tumor May occur in either mandible or maxilla, most

often in the mandible in the molar or ramus area

Unencapsulated, infiltrates into surrounding tissue

Composed of ameloblast-like epithelial cells surrounding areas resembling stellate reticulum.


Ameloblastoma (cont.)

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(pgs. 246-247) Radiographic

A multilocular soap-bubble–like or honeycombed radiolucency

May occur anywhere within the jaws, can occur in association with a dentigerous cyst

May cause expansion of bone Most occur in adults with no sex predilection. Treatment

Surgical removal Recurrence is common




Calcifying Epithelial Odontogenic Tumor (CEOT) (Pindborg Tumor) (pgs. 246, 248)

A benign epithelial odontogenic tumor Composed of islands

and sheets of polyhedral epithelial cells

Amyloid-like material are seen with calcifications within the deposits.

Most often affects adults, with no sex predilection


Calcifying Epithelial Odontogenic Tumor

(pgs. 246, 248)

Radiographic A unilocular or

multilocular radiolucency

Occurs more often in mandible than maxilla, most often in the bicuspid and molar area



Adenomatoid Odontogenic Tumor (AOT)

(pgs. 246-248) An encapsulated, benign epithelial

odontogenic tumor The tumor is surrounded by a dense, fibrous

connective tissue capsule. Consists of ductlike structures, whorls, and

large masses of cuboidal and spindle-shaped epithelial cells The structures are ameloblast-like cells rather

than ducts.


Adenomatoid Odontogenic Tumor (AOT) (cont.)

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Adenomatoid Odontogenic Tumor

(pg. 247) 70% occur in females younger than 20 years of

age. 70% involve the anterior portion of the jaws. More common in maxilla than in the mandible. Many are associated with impacted teeth.

Radiographic A well-circumscribed radiolucency, may have

radiopaque areas Treatment

Enucleation


Adenomatoid Odontogenic Tumor (cont.)


Calcifying Odontogenic Cyst

(pgs. 248-249) A nonaggressive cystic lesion lined by

odontogenic epithelium Has an associated, characteristic ghost cell

keratinization Ghost cells are round structures with clear

centers. Radiographic

Usually a well-defined lesion May be either unilocular or multilocular May have calcifications


Calcifying Odontogenic Cyst (cont.)


Calcifying Odontogenic Cyst (cont.)

Most commonly seen in individuals under 40 years old

No sex predilection Treatment

Surgical enucleation Usually does not recur


Mesenchymal Odontogenic Tumors

Odontogenic Myxoma Central Cementifying and Ossifying

Fibromas Benign Cementoblastoma

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Odontogenic Myxoma

(pgs. 249-250) A benign

nonencapsulated infiltrating tumor Composed of pale-staining

mucopolysaccharide ground substance containing dispersed cells with long cytoplasmic processes

Most often occurs in young people between 10 and 29 years of age.

No sex predilection


Odontogenic Myxoma (cont.)


A multilocular, honeycombed radiolucency with poorly defined margins

May become large and displace teeth

Most often occurs in the mandible

Treatment Surgical excision May recur


Central Cementifying and Central Ossifying Fibromas

(pgs. 250-251) A benign well-circumscribed tumor

Composed of fibrous connective tissue and rounded or globular calcifications resembling cementum


Central Cementifying and Central Ossifying Fibromas (cont.)


Central Cementifying and Central Ossifying Fibromas (cont.)

Microscopic Contains fibrous connective tissue and calcifications

• Ossifying fibroma Calcifications resemble bony trabeculae

• Cemento-ossifying fibroma Also have bony calcifications resembling cementum

Usually occur in adults in the third and fourth decades Occurs in females more often than in males Most cases in the mandible

Radiographic Varies from radiolucent to radiopaque depending on the

amount of calcified tissue Treatment

Surgical excision Recurrence is rare.


Benign Cementoblastoma

(pg. 251) A cementum-producing

lesion Fused to the roots of vital

teeth Radiographic

A well-defined radiopaque mass with a surrounding radiolucent halo

Seen in continuity with a mandibular molar or premolar tooth

Typically occurs in young adults

Pain is a frequent symptom.

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Benign Cementoblastoma (cont.)

Microscopic A proliferation of cellular cementum fused to

the root or roots of the affected tooth Treatment

Enucleation of the tumor and removal of the involved tooth

Does not recur


Mixed Odontogenic Tumors

Ameloblastic Fibroma Ameloblastic Fibro-odontoma Odontoma


Ameloblastic Fibroma

(pgs. 251-252) A benign, nonencapsulated odontogenic

tumor Composed of both strands and small islands of

odontogenic epithelium and tissue that resembles the dental papilla

Occurs in young children and adults• Most cases in individuals less than 20 years old.• Occurs more often in males

Most commonly in the mandibular bicuspid and molar region


Ameloblastic Fibroma (cont.)


Ameloblastic Fibroma (cont.)


Either a well-defined or poorly defined unilocular or multilocular radiolucency

Treatment Surgical excision Low recurrence rate


Ameloblastic Fibro-odontoma

(pg. 252) A benign odontogenic tumor

Has features of an ameloblastic fibroma and an odontoma

Most cases in young adults Average age of 10 No sex predilection Typically arises in posterior jaws

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Ameloblastic Fibro-odontoma (cont.)

Radiographic A well-delineated radiolucent lesion May be unilocular or multilocular Calcifications are noted within the

radiolucency. Treatment

Conservative surgical excision Recurrence is unusual.


Odontoma

(pg. 252) An odontogenic tumor – two varieties

Compound• A collection of numerous small teeth

Complex• A mass that does not resemble teeth

Most are found in adolescents and young adults.

No sex predilection


Odontoma (cont.)


Odontoma (cont.)

Compound is usually in the anterior maxilla and complex in the posterior mandible.

The most common clinical manifestation is the failure of a permanent tooth to erupt.

Radiographic Compound – a cluster of miniature teeth Complex – a radiopaque mass



Peripheral Odontogenic Tumors

Peripheral Ossifying Fibroma Other Peripheral Odontogenic Tumors


Peripheral Ossifying Fibroma

(pgs. 252-253) A well-demarcated sessile or pedunculated lesion

Most likely derived from cells of the periodontal ligament More common in females than in males; often occurs in

young individuals Composed of cellular fibrous connective tissue

interspersed with scattered bone and cementum-like calcifications

Treatment Surgical excision Recurrence rate is about 16%.

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Peripheral Ossifying Fibroma (cont.)


Other Peripheral Odontogenic Tumors

(pg. 253) Rare lesions reported to occur in gingiva

without involving underlying bone. Treatment

Surgical excision


Tumors of Soft Tissue

Lipoma Tumors of Nerve Tissue Tumors of Muscle Vascular Tumors


Lipoma

(pgs. 253-254) A benign tumor of mature fat cells

Clinically, it is a yellowish mass surrounded by a thin layer of epithelium.

Most occur in individuals over age 40 There is no sex predilection. Intraorally, they are most commonly located on

the buccal mucosa and the vestibule.


Lipoma (cont.)


Lipoma (cont.)

Microscopic A well-delineated tumor with mature fat cells

uniform in size and shape Treatment

Surgical excision

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Tumors of Nerve Tissue

Neurofibroma and Schwannoma Granular Cell Tumor Congenital Epulis


Neurofibroma and Schwannoma

(pg. 254) Benign tumors derived from Schwann cells

in nerve tissue Schwann cells are a component of the

connective tissue surrounding a nerve. The tongue is the most common intraoral

location. May occur at any age, with no sex predilection


Neurofibroma and Schwannoma (cont.)



(pg. 254) Microscopic

Neurofibroma• A fairly well-delineated, diffuse proliferation of spindle

shaped Schwann cells

Schwannoma• Spindle-shaped Schwann cells arranged in palisaded

whorls around a central pink zone• It is surrounded by a connective tissue capsule.





Granular Cell Tumor

(pgs. 254-255) A benign tumor composed of large cells

with a granular cytoplasm Most likely arises from neural or primitive

mesenchymal cells Most often occurs on the tongue, followed by

the buccal mucosa A painless, nonulcerated nodule Most are found in adults, with a female sex

predilection.

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Granular Cell Tumor (cont.)



(pgs. 254-255) Microscopic

Large oval-shaped cells with a granular cytoplasm





Congenital Epulis

(pgs. 254-255) A benign neoplasm composed of cells closely

resembling those seen in the granular cell tumor Most likely arises from primitive mesenchymal cells Present at birth Appears as a sessile or pedunculated mass on the

gingiva Usually occurs on the anterior maxillary gingiva Almost always occurs in girls



Tumors of Muscle

(pg. 255) Extremely uncommon in the oral cavity

Vascular leiomyomas• Rhabdomyoma

A benign tumor of striated muscle• Leiomyoma

A benign tumor of smooth muscle


Tumors of Muscle (cont.)

Rhabdomyosarcoma• A malignant tumor of striated muscle• The most common malignant soft tissue tumor of the

head and neck in children• Typically occurs in children under 10 years of age• Has a male sex predilection• A rapidly growing, destructive tumor

Treatment Multidrug chemotherapy, radiation therapy, and

surgery Poor prognosis

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Vascular Tumors

Hemangioma Lymphangioma Malignant Vascular Tumors


Hemangioma

(pgs. 255-256) A benign proliferation of capillaries

A common vascular lesion Thought by many to represent a

developmental lesion rather than a tumor because they generally do not exhibit unlimited growth potential

• Capillary hemangioma – contains numerous small capillaries

• Cavernous hemangioma – contains larger blood vessels


Hemangioma (cont.)


Hemangioma (cont.)

Most are present at birth or arise shortly after More than half occur in the head and neck

area The tongue is the most common intraoral

location More common in females May occur in adults in response to trauma Frequently blanch when pressure is applied

Treatment Many undergo spontaneous remission Treatment is variable, includes surgery or the

injection of a sclerosing solution.


Lymphangioma

(pg. 256) A benign tumor of lymphatic vessels

Most are present at birth. Half arise in the head and neck area. No sex predilection Intraorally, the most common location is the tongue,

where it is an ill-defined mass with a pebbly surface. A cystic lymphangioma in the neck is a cystic hygroma.

Treatment Surgical excision Tend to recur


Malignant Vascular Tumors

(pgs. 256-257) Angiosarcoma may occur in the oral cavity

but it is rare. Kaposi sarcoma may arise in multiple

sites, including the skin and oral mucosa. It was historically seen in older men. A more aggressive form has arisen with HIV.

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Malignant Vascular Tumors (cont.)

Kaposi sarcoma and HIV Lesions are often seen in the oral cavity as

purple macules, plaques, or exophytic tumors. Most commonly located on the hard palate and

gingiva May also occur in patients with other forms of

immunodeficiency Caused by a human herpes virus HHV-8 or

KSAH Treatment

Surgical excision, radiation therapy, or a combination of both


Tumors of Melanin-Producing Cells

Melanotic Nevi Malignant Melanoma


Melanotic Nevi

(pg. 257) Nevus may refer to either a developmental

tumor of melanocytes or a pigmented congenital lesion. Melanocytic nevi can arise on the skin or the

oral mucosa. Intraoral tumors consist of tan to brown

macules or papules. Occurs most often on the hard palate or buccal

mucosa


Melanotic Nevi (cont.)


Melanotic Nevi (cont.)

Occur twice as often in women as men Usually first identified in individuals between 20

and 50 years old Most are benign; some may be malignant.

Treatment Biopsy Surgical excision Recurrence is rare.


Malignant Melanoma

(pg. 257) A malignant tumor of melanocytes

Most arise on the skin in response to prolonged exposure to sunlight.

Primary malignant melanoma is rare, but melanomas on the skin may metastasize to the oral cavity.

Usually a rapidly enlarging blue to black mass An aggressive tumor with unpredictable

behavior and early metastasis

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Malignant Melanoma (cont.)


Malignant Melanoma (cont.)

Most common intraoral locations are the palate and maxillary gingiva

Usually occur in adults over 40 years of age Treatment

Surgical excision Chemotherapy may be used along with

surgery. Poor prognosis


Tumors of Bone and Cartilage

(Torus) – “not true tumors” Exostosis Osteoma Osteosarcoma Tumors of Cartilage


Torus

(pg. 258) A benign lesion composed of normal

compact bone Located on the midline of the palate or on the

lingual aspect of the mandible in the area of premolars

They are not true tumors, but resemble osteomas.


Torus (cont.)


Exostosis

(pg. 258) A small nodular excrescence of normal

compact bone Asymptomatic, bony hard nodules on the

buccal aspect of maxillary and mandibular alveolar ridges

Most cases occur in adults, with no sex predilection.

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Exostosis (cont.)


Osteoma

(pgs. 258-259) An asymptomatic benign tumor composed of

benign compact bone Radiographic

• Appears as either a sharply delineated radiopaque mass within bone or attached to the outer surface of bone

No sex predilection A component of Gardner syndrome

Treatment Surgical excision Does not recur.


Osteoma (cont.)


Osteosarcoma (Osteogenic Sarcoma)

(pgs. 259-260) A malignant tumor of

bone-forming tissue The most common

primary malignant tumor of bone in patients less than 40 years of age

The average age of tumors in the jaws is about 37 years.

Occur twice as frequently in the mandible as in the maxilla

More common in males than in females


Osteosarcoma

(pgs. 259-260) Patients may experience a diffuse swelling or

mass that is often painful. Paresthesia is common in tumors involving the

mandible. Radiographic

May vary from radiolucent to radiopaque Usually a destructive poorly defined lesion May or may not involve adjacent soft tissue Asymmetric widening of the periodontal

ligament space and a “sunburst” pattern may be seen


Osteosarcoma (cont.)

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Osteosarcoma (cont.)

Treatment Preoperative multiagent chemotherapy

followed by surgery Jaw tumors frequently recur.


Tumors of Cartilage

(pgs. 259-260) Extremely rare in the jaws

More likely to be malignant than benign• Chondroma – a benign tumor of cartilage• Chondrosarcoma – a malignant tumor of cartilage

The chondrosarcoma may occur in either the maxilla or mandible.

More common in males than females Treatment of chondrosarcomas

Wide surgical excision Poor prognosis


Tumors of Cartilage (cont.)


Tumors of Blood-Forming Tissues

Leukemia Lymphoma Multiple Myeloma


Leukemia

(pgs. 259-260) A broad group of disorders

characterized by an overproduction of atypical white blood cells The types of leukemia

seen are classified according to the kinds of cells that are proliferating: myelocytes, lymphocytes, or monocytes.


Leukemia (cont.)

Divided into acute and chronic forms• Acute is most common in children and young adults.

Characterized by a proliferation of immature white blood cells

• Chronic most frequently occurs in middle-aged adults Characterized by excess proliferation of mature white

blood cells Occurs more often in males than in females The monocytic variant most often exhibits oral lesions.

• Commonly see diffuse gingival enlargement with persistent bleeding

Treatment Chemotherapy, radiation therapy, and corticosteroids Prognosis depends on the type and extent of disease.

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Lymphoma (Non-Hodgkin’s Lymphoma)

(pgs. 259, 261) A malignant tumor of lymphoid tissue

The clinical presentation is gradual enlargement of lymph nodes.

The most common intraoral location are the tonsils.

Usually occurs in adults More common in males than in females.

Treatment Radiotherapy, surgery, chemotherapy, or a

combination of these therapies


Multiple Myeloma

(pgs. 261-262) A systematic, malignant proliferation of

plasma cells Causes destructive lesions in bone Most patients are older than 40; occurs most

commonly in the seventh decade of life Males are affected more often than in females. Patients usually experience bone pain and

swelling.


Multiple Myeloma (cont.)




Multiple radiolucent lesions The mandible is affected more often than the maxilla.

Most patients have an elevation of a single type of immunoglobulin called a monoclonal spike. Patients may have fragments of immunoglobulins in

their urine known as Bence Jones proteins. An extramedullary plasmacytoma is a localized tumor of

plasma cells in soft tissue.

Treatment Chemotherapy and radiation Poor prognosis




Metastatic Tumors of the Jaws

(pg. 262) Tumors of the jaws from primary sites elsewhere

in the body are rare. Most tumors arise from the thyroid, breast, lungs,

prostate gland, and kidneys. The most frequent intraoral site for metastatic tumors is

the mandible. Patients may experience pain, paresthesia or anesthesia

of the lip, swelling, expansion of the affected bone, and loosening of teeth in the affected area.

Most patients are adults. Males are affected more often than females.

•6/27/2011

•26


Metastatic Tumors of the Jaws (cont.)

(pg. 262) Radiographic

Lesions are usually poorly defined and radiolucent.

Roots of involved teeth may show a spiked appearance.

Some tumors may form bone and be radiopaque.

Treatment Chemotherapy and radiation therapy The prognosis for patients with tumors that

have metastasized to the jaws is poor.


Metastatic Tumors of the Jaws (cont.)


Discussion Questions

How are tumors classified? How are tumors treated? What salivary gland tumors may be found

within the oral cavity? What does a lipoma contain? What is a malignant melanoma, and what other

entity may it resemble within the oral cavity? What tumor is associated with a “sunburst”

pattern?

chapter 7sreddy/dh180/chapter 7.pdf · premalignant lesions ... may show epithelial dysplasia, a...

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