E2: Malignant tumors of the jaws Flashcards by Ngoc Quyen Nguyen

Uncontrolled growth and locally invasive, metastasizes to lymph nodes or to distant
parts is called _____.

malignancy

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Malignancy of epithelial origin

carcinoma

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Malignancy of mesenchymal origin

sarcoma

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What are the possible origins of malignancy?

epithelial, mesenchymal and hematopoetic origin

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Who is at risk for developing cancer?

everyone
increases with age
80% with cancer are 55+ years of age

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How common is oral and pharynx cancer?

2.8%

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Median age for oral and pharynx cancer

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How long does it take to diagnose and treat a patient? What are the different types of delay?

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What is the location for oral cancer?

Anywhere
Carcinoma in the tongue, FOM, tonsillar area, lips
Sarcoma in mandible, or posterior jaws

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What is the border for oral cancer?

Poorly defined, lacks cortication, no capsule, extends into different depth

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What is the internal content for oral cancer?

Usually radiolucent

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What is the effect for oral cancer?

Rapid destruction, destroys bone rather than roots, minimal displacement of
teeth, sarcomas may resorb roots, destroys cortical bone

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What is the clinical feature of squamous cell carcinoma?

Originates from surface epithelium
Spreads by invasion
Pain, paresthesia, sudden loosening of teeth, foul smell, weight loss

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What is the location of squamous cell carcinoma?

Lateral border of the tongue –> radiographic findings on posterior border of
the mandible
Lip or FOM –> radiographic findings on anterior mandible
Sinus mucosa –> radiographic findings on hard palate

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What is the border of squamous cell carcinoma?

Irregular, rarely smooth, sclerosis of surrounding bone only if the tumor is
infected
Pathologic fracture

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What is the internal content of squamous cell carcinoma?

totally radiolucent

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What is the effect of squamous cell carcinoma?

Widened PDL with loss of lamina dura
‘Floating’ teeth
Destruction of the cortex, and pathological fracture

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squamous cell carcinoma

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What are the characteristics of metastatic tumors?

A new malignant tumor originating from a distant lesion
Usually by blood vessels
Primary sites: breast, kidney, lung, colon, prostate, thyroid

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What is the location of metastatic tumors?

Posterior areas of the jaws
Mandible>maxilla, can be bilateral, PDL spaces
Maxillary sinus

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What is the border of metastatic tumors?

Fairly well-defined, but no cortication. Invasive margins
Sclerotic if primary lesion is breast or prostate

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What is the internal content of metastatic tumors?

Mostly radiolucent
May be multifocal

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What is the effect of metastatic tumors?

Periosteal reaction
Increase width of PDL, with loss of lamina dura
‘Floating’ teeth

metastatic neoplasm

What are the characteristics for osteosarcoma?

* Malignant tumor that produces osteoid * Rare in the jaws, about 7% * Osteoblastic, chondroblastic and fibroblastic * Jaw lesions appear later: average delay 10 years

What is the location of osteosarcoma?

Mandible>maxilla, posterior area, alveolar ridge

What is the border of osteosarcoma?

* Poorly defined, * Linear bony trabeculation when affects the cortex

What is the internal content of osteosarcoma?

* Entirely radiolucent: osteolytic osteosarcoma * Mixed * Mostly radiopaque: osteogenic

What is the effect of osteosarcoma?

* Widening of PDL spaces * Destroys sinus and nasal walls * Destroys canal

What are the characteristics of chondrosarcoma?

* Malignant tumor of cartilaginous origin * Centrally in bone, on the periphery or on soft tissues

What is the location of chondrosarcoma?

* Rare in the jaws, about 10% * Mandible = maxilla * Maxilla : Anterior region * Mandible: coronoid or condylar area

What is the border of chondrosarcoma?

* Well defined, round, ovoid * May have trabecular appearance as in osteosarcoma

What is the internal content of chondrosarcoma?

* Some calcification * Not completely radiolucent

What is the effect of chondrosarcoma?

* Expands cortex * Pushes sinus wall * Remodeling of the condyle

What are the clinical features of fibrosarcoma?

* Composed of malignant fibroblasts * May arise after radiation therapy

What is the location of fibrosarcoma?

* Mostly mandible * Premolar /molar region

What is the border of fibrosarcoma?

* Ill-defined, ragged border * Noncorticated, no capsule

What is the internal content of fibrosarcoma?

* Tend to follow marrow space, grows along a bony margin * Mostly lucent * Reactive bone may be present

What is the effect of fibrosarcoma?

* Destruction of bone, reactive bone formation * Loss of lamina dura * Root resorption rare, but displacement common

What is the characteristics of multiple myeloma?

* Arises from cells of bone marrow that have resemblance to plasma cells. * Mean age: 55-60 years. Rarely seen <35. * More common in males. * Pain, swelling, expansion, numbness, mobility. * Presence of Bence-Jones protein >60% of patients.

What is the border of multiple myeloma?

Radiographically, several, discrete, well-defined, “punched out” radiolucencies seen in jaws and several other bones of the body.

What is the internal content of multiple myeloma?

* Radiolucent areas may expand and coalesce into larger areas and may cause fractures. * Usually none * Some bony islands may be visible

What is the effect of multiple myeloma?

Thinning and disruption of bone

What are the clinical features of Non-Hodgkin's Lymphoma?

* Mostly in lymph nodes * Can occur in bone, skin, GI tract * Many subtypes: Low grade to high grade * New cases in 2007 : 63,000, death 18,000 * Rare in first decade

What is the location of Non-Hodgkin's Lymphoma?

* Lymph nodes * Sinus, posterior mandible, maxilla

What is the border of Non-Hodgkin's Lymphoma?

* Takes up the shape of the bone * Untreated lesions destroy bone * Rounded and multiloculated

What is the internal content of Non-Hodgkin's Lymphoma?

* Usually radiolucent * Rarely bone formation

What are the clinical features of Burkitt's Lymphoma?

* African and American * African type: Jaw involvement, young children * American type: usually no jaw involvement, young adults * Rapid growth, doubling time of 24 hours

What is the location of Burkitt's Lymphoma?

* African type: one or both jaws, posterior part * American type: abdomen

What is the border of Burkitt's Lymphoma?

* Multiple, ill-defined , non-corticated lesions * Merges into one large lesion

What is the internal content of Burkitt's Lymphoma?

Mostly radiolucent

What is the effect of Burkitt's Lymphoma?

* Displaced teeth and buds * Destroys lamina dura

What are the characteristics of leukemia?

* Tumor of hematopoietic stem cells * Usually no signs or symptoms * Weakness and bone pain * Loose teeth

What is the location of leukemia?

throughout the jaw

What is the border of leukemia?

Ill-defined radiolucency

What is the internal content of leukemia?

Granular bone, patchy radiolucency

What is the effect of leukemia?

* Premature loss of teeth * Displacement of the developing teeth