11. Other oral malignancies Flashcards
What tissue do carcinomas occur in?
Epithelial cells
What tissues do sarcomas occur in?
Connective tissue
Muscle cells
What tissues do lymphomas and leukaemias occur in?
Haemopoeitic and immune system
What is the name for gland tumours?
Adenoma
Adenocarcinoma
What is the name for cartilage tumours?
Chondroma
Chondrosarcoma
What is the name for fat tissue tumours?
Lipoma
Liposarcoma
What is the name for bone cell tumours?
Osteoma
Osteosarcoma
What is the name for fibroblastic tumours?
Fibromas
Fibrosarcoma
What is the name for smooth muscle tumurs?
Leiomyoma
Leiomyosarcoma
What is the name for striated muscle tumours?
Rhabdomyoma
Rhabdomyosarcoma
How can secondary tumours spread via?
CSF
Implantation
Lymphatic system
Blood stream
What are examples of special diagnostic methods?
Histochemical stains, eg. glycogen, melanin
Immunohistochemistry- peroxidase anti-peroxidase
Recombinant DNA techniques- viruses
Next generation sequencing- mutation analysis
Cytogenetic analysis- chromosome abnormalities
Computerised image analysis (morphometry)
What are some examples of structural antigens immunohistochemical markers?
Keratin
Vimentin
Desmin
Neurofilaments
Collagens
What are some examples of functional antigens immunohistochemical markers?
Lysozyme
Hormones
Immunoglobins
What are lineage antigens immunonohistochemical markers?
Neuron-specific enolase
S100 protein
Carcinoembryonic antigen CEA
What does S100A2 stain?
The basal layer red in normal epithelium
What is basal cell carcinoma and what is it associated with?
Most common skin neoplasm
Associated with long UV light exposure
What genetic diseases is basal cell carcinoma associated with?
Basal cell naevus
Bazex syndrome
What is the description of lesion forming in basal cell carcinoma?
Slow growing nodules that eventually ulcerate in the centre- rodent ulcer
Do not tend to metastasise
What is the histology of basal cell carcinoma?
Cells resemble epithelial basal cells
They have a scanty cytoplasm
No evidence of cellular bridges
The basal cells are more elongated
What is the cause of basal cell naevus syndrome/Gorlin-Goltz syndrome?
Autosomal dominant and variable penetrance
Caused by mutation on PTCH gene on chromosome 9
What is the symptoms of Gorlin-Goltz/Basal cell naevus?
- Multiple odontogenic keratocysts throughout life
- Multiple basal cell carcinomas of the skin
- Calcium and phosphate metabolic abnormalities- calcification of falx cerebri
- Skeletal abnormalities- prognathism, frontal bossing, especially ribs and vertebrae
- Other anomalies- palmar pits, ovarian fibromas, medulloblastomas
What are the 4 types of malignant melanoma?
Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous
What are the characteristics of superficial spreading melanoma?
Commonest-70%
Radial growth
Brown, tan, black
On sun exposed skin
What is nodular melanoma?
13% common
Vertical growth
Pink or black
At back of head, neck skin
What is lentigo maligna melanoma?
10% common
Hutchinson’s melanotic freckle
Occurs in elderly people, sun exposed skin, flat moles, slow growing, non-invasive, melanoma in situ
What is acral lentiginous?
Melanomas that do not occur in sun-exposed areas such as palms, soles, nail beds, oral mucosa
What is the order of most common cancers affecting the skin?
BCC>SCC>Melanoma
What is the characteristic of lesions in oral malignant melanoma?
Usually posterior maxillary alveolar ridge or hard palate
Dark brown/Blue-black lesions
Deeply pigmented
Uneven nodular surface
Ulcerated or haemorrhagic
Progressively increasing in size
What are the differentials for oral malignant melanoma?
Kaposi sarcoma
Blue nevi
Oral nevi
Addison’s disease
Ephelides
What is the treatment for oral malignant melanoma?
Radicular surgery including block removal of the jaws, lymphadenectomy
What can amelanotic melanoma stain for?
They do not contain a lot of melanin as they have differentiated so much.
S100+
HMB45+
What are lymphomas and what broad 2 types can they be?
Involve cells of the lymphoreticular system
Present as nodal or extra-nodal lesions
Where do malignant lymphomas commonly affect most?
Uncommon in head and neck disease
Either part of a disseminated disease
Or primary lesions- cervical lymph nodes or lymphoid structures of Waldeyer’s ring
What is Hodgkin’s lymphoma presentation?
Nodular
Presents in young adults
Most often causes cervical node enlargement
Painless
Progressive
What are the 4 types of Hodkin’s lympohma?
Lymphocyte rich
Lymphocyte depleted
Mixed cellularity
Nodular sclerosing
What is the histology of Hodgkin lymphoma?
Reed Sternberg cells
Multi bi-lobed, bi-nucleated giant cells
Owl eye or mirror appearance
Prominent eosinophilic nuclei
What is the treatment for Hodgkin lymphoma?
Chemotherapy is successful in 50-70%
What cells does Non-Hodgkin lymphoma affect?
B-cells
T-cells
Natural killer cells
Can be low or high grade
Where does Non-Hodkin lymphoma affect?
Can be nodular and affect MALT tissues
Can be diffuse and affect jaw bones, salivary gland and oral soft tissues
Where is the oral lesion for Non-Hodgkin lymphoma often seen?
In the palate- produces a red, purple, rubbery mass
What are 2 types of malignant lymphomas that may occur in the mouth?
Burkitt’s lymphoma
Lethal midline granuloma
What is Burkitt’s lymphoma?
Endemic in Africa
Due to EBV and malaria infection
Causes proliferation of B-cells
Commonly occurs as jaw tumour
What is the histology of Burkitt’s lymphoma?
B-cells form starry sky pattern
What is lethal midline granuloma?
T-cell
Occurs in nose/paranasal sinuses
What are oral malignant lymphomas often confused with?
Chronic apical process
What do oral malignant lymphomas have an increased incidence and risk with?
Sjogren syndrome
Pt’s with HIV and AIDS
What is a vascular tissue neoplasm called?
Angiosarcoma
How do you classify sarcomas?
Difficult to classify even using markers
Microscopic examination is necessary as even the clinical characteristics are too vague
What is MEN2B? What gene does it involve?
Autosomal dominant condition
RET gene on chromosome 11
What are the 5 symptoms of MEN2B?
- Neurofibromas- benign oral, submucosal tumours
- Skeletal features- tall, Marfanoid posture, thin, elongated face
- Low muscle mass
- Protruding, blubbery lips
- Endocrine malignancies
What endocrine malignancies are associated with MEN2B?
Medullary thyroid cancer
Phaeochromocytoma- adrenal gland tumour
What are metastatic tumours?
Tumours that originated elsewhere but have spread through the body
Make up 1% of all malignant oral tumours
What is the presentation of metastatic tumours?
Asymptomatic
Pain
Paraesthesia
Tooth extruded
Tooth loosening
Swelling/expansion
Pathological fracture
What do the metastatic tumour oral lesions appear like on a radiograph?
Often Radiolucent
Can be radiopaque, eg, if come from breast or prostate
In oral metastatic tumours how can you see where the primary tumour is?
Scintigraphy- uses radioactive chemical to produce pictures of where there is cancer cells in the body
Where are oral metastatic tumours most often found in the oral cavity?
The cancer cells usually spread by blood, so most are found in red marrow rich locations such as mandible molar area, gingiva, soft palate and tongue
Where do the oral metastatic tumours most often come from in the body?
Breast> Lung > Kidney > Prostate/thyroid/colon
What are oral metastatic tumours often mistaken with?
Juxtaoral organ of Chievitz
Looks like a tumour but it is not
The origin is unknown- could be vestigial salivary tissue or neuro-epithelial receptor
Marks NSE+, S100+
What are the treatments for malignancies?
Surgery
Radiotherapy
Cytotoxic chemotherapy
Immunotherapy
Combinations of the above
