12 Malignant Neoplasms of Intraoral Soft Tissue

Question 1

Classify malignant tumors as epithelial or mesenchymal.

Answer 1

Epithelial - Basal Cell Carcinoma, Nasopharyngeal carcinoma, Mesenchymal - Fibrosarcoma, Liposarcoma, Angiosarcoma, Kaposi’s Sarcoma (Connective Tissue), Leiomyosarcoma, Rhabdomyosarcoma (muscle), Malignant peripheral nerve sheath tumor (Nerve)

Question 2

Discuss the characteristics, etiology, histologic findings, typical population and location of basal cell carcinoma.

Answer 2

Characteristics - Low grade, slow growing, almost never metastasizes, noduloulcerative. Etiology - UV radiation from chronic sun exposure. Histologic Findings - Islands of basaloid epithelial cells showing invasive growth. Typical Populations - Older people, fair skinned. Location - 90% affect sun exposed head & neck skin

Question 3

Describe the clinical presentation of noduloulcerative basal cell carcinoma

Answer 3

Central often cratered ulceration (umbillicated) with rolled, raised borders with telangiectatic (dilated) vessels

Question 4

Describe the treatment and prognosis of basal cell carcinoma.

Answer 4

Tx - Oral surgeon, dermatologist, plastic or oncologic surgeon - excision or curettage with electrodessication, radiation therapy. Prognosis - 90-95% 5 year survival

Question 5

Describe nasopharyngeal carcinoma and the anatomic considerations that cause referred pain to the tongue or jaw in Trotter’s syndrome.

Answer 5

“Trotter’s Syndrome” - Pain referred to tongue or jaw secondary to invasion of nasopharyngeal carcinoma to base of skill with involment of trigeminal nerve as it exits foramen ovale.

Question 6

Define sarcoma.

Answer 6

Malignant tumor or “bulky or fleshy” mass under surface skin or mucosa

Question 7

Classify sarcomas as connective tissue, muscle or nerve.

Answer 7

Connective Tissue - Fibrosarcoma, Liposarcoma, Angiosarcoma, Kaposi’s Sarcoma. Muscle - Leiomyosarcoma, Rhabdomyosarcoma. Nerve - Malignant peripheral nerve sheath tumor (neurogenic sarcoma).

Question 8

Discuss the characteristics of a fibrosarcoma

Answer 8

Malignancy of fibrous connective tissue

Question 9

Discuss the characteristics of a liposarcoma

Answer 9

Malignancy of fat, rare in H&N

Question 10

Discuss the characteristics of an angiosarcoma

Answer 10

Malignancy of vascular endothelium, found more comong in H&N, scalp & forehead

Question 11

Discuss the characteristics of a Kaposi’s sarcoma

Answer 11

Malignancy of vascular endothelium, HHV-8 implicated, 50% of HIV + KS patients have oral lesions

Question 12

Describe a Leiomyosarcoma

Answer 12

Malignancy of smooth muscle

Question 13

Discuss the characteristics of a rhabdomyosarcoma

Answer 13

Malignancy of skeletal muscle, most common soft tissue malignancy in children, found in H&N, urogenital tract. Sarcoma “botryoides” (grape-like clusters)

Question 14

Discuss the characteristics of a neurogenic sarcoma

Answer 14

Malignancy of nerve, may arise in neurofibromatosis, mass lesion often with pain and nerve deficit

Question 15

Describe metastasis to the oral cavity and typical presentation, radiographic and histologic finding and treatment.

Answer 15

Most common malignancy in bone is metastatic disease. Primary site commonly - lung, kidney, liver, prostate (male), breast, female genital organs, kidney, colorectal (female). Destructive, invasive, poorly marginated lucency. Tx - palliation.

Question 16

10.Classify the common primary site of metastasis for male and female populations.

Answer 16

Male- lung, kidney, liver, prostate. Female - breast, female genital organs, kidney, colorectal.