E2: Malignant tumors of the jaws Flashcards
Uncontrolled growth and locally invasive, metastasizes to lymph nodes or to distant
parts is called _____.
malignancy
Malignancy of epithelial origin
carcinoma
Malignancy of mesenchymal origin
sarcoma
What are the possible origins of malignancy?
epithelial, mesenchymal and hematopoetic origin
Who is at risk for developing cancer?
everyone
increases with age
80% with cancer are 55+ years of age
How common is oral and pharynx cancer?
2.8%
Median age for oral and pharynx cancer
64
How long does it take to diagnose and treat a patient? What are the different types of delay?
What is the location for oral cancer?
- Anywhere
- Carcinoma in the tongue, FOM, tonsillar area, lips
- Sarcoma in mandible, or posterior jaws
What is the border for oral cancer?
Poorly defined, lacks cortication, no capsule, extends into different depth
What is the internal content for oral cancer?
Usually radiolucent
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
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
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
What is the border of squamous cell carcinoma?
- Irregular, rarely smooth, sclerosis of surrounding bone only if the tumor is
infected - Pathologic fracture
What is the internal content of squamous cell carcinoma?
totally radiolucent
What is the effect of squamous cell carcinoma?
- Widened PDL with loss of lamina dura
- ‘Floating’ teeth
- Destruction of the cortex, and pathological fracture
squamous cell carcinoma
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
What is the location of metastatic tumors?
- Posterior areas of the jaws
- Mandible>maxilla, can be bilateral, PDL spaces
- Maxillary sinus
What is the border of metastatic tumors?
- Fairly well-defined, but no cortication. Invasive margins
- Sclerotic if primary lesion is breast or prostate
What is the internal content of metastatic tumors?
- Mostly radiolucent
- May be multifocal
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
