Lecture 2 - Malignancy

Question 1

Common chief complaints with malignancies

Answer 1

Numb lip
Ulcer that doesn't heal >10 days
Loose teeth (doesn't improve w/ tx)
Bleeding gums
Denture no longer fits

Question 2

Squamous Cell Carcinoma Clinical Appearance

Answer 2

Rare in jaw

Can have pain or numbness

Question 3

Squamous Cell Carcinoma Radiographic Appearance

Answer 3

Poorly defined or "undulating" borders
Non-sclerotic
Bone destruction, loss of lamina dura
Tooth "floating in space"
Can see pathologic fracture

In sinus:
-Sinus wall destruction

Question 4

Squamous Cell Carcinoma Treatment

Answer 4

Surgery

Question 5

Squamous Cell Carcinoma Ddx

Answer 5

Osteomyelitis (sequestrae, bone reactions)
Periodontal disease (alveolar bone, multiple teeth, stops at apex)
Pressure ulcer from dentures (resolves if dentures removed)
Sinusitis (no wall destruction)

Question 6

Adenocarcinoma complaints

Answer 6

Stuffy nose

Nose bleeds

Question 7

Adenocarcinoma radiographic appearance

Answer 7

Same as SCC

Destruction of cortical border and lamina dura

Question 8

Midline Lethal Granuloma

Answer 8

Almost always fatal
Very rare
Loss of floor of nose (radiographic)

Question 9

Mucoepidermoid Tumor

Answer 9

Malignant tumor of the salivary gland

Posterior mandible

Question 10

Mucoepidermoid Tumor Ddx

Answer 10

Ameloblastoma
OKC
KOT

Question 11

Mucoepidermoid Tumor Radiographic Appearance

Answer 11

Benign radiographic appearance

• tooth movement
• root resorption
• bone expansion

Question 12

Osteosarcoma

Answer 12

Malignant
Rapid growth, within months
Rare in oral cavity
teens-20s - most common in body
30s - oral cavity

No treatment

Question 13

Osteosarcoma Radiographic Appearance

Answer 13

Bone destruction
Bone production extending into soft tissue
Sun-ray appearance (also thalassemia, sickle cell)

Question 14

Osteosarcoma Ddx

Answer 14

Periodontal Disease (Widened PDL, PD improves with tx, older pts)
Traumatic Occlusion (Widened PDL, 1-2 teeth)

Question 15

Chondrosarcoma

Answer 15

In areas of cartilage - condyle, coronoid process, symphysis

Needs treatment

Question 16

Chondrosarcoma Radiographic Appearance

Answer 16

Can look benign w/ intact bone
Missing lamina dura
Abnormal trabeculation “whorled pattern”

Question 17

Chondrosarcoma Ddx

Answer 17

Fibrous dysplasia

Loss of lamina dura (infection, malignancy, dysplastic conditions)

Question 18

Metastases

Answer 18

Breast and Prostate metastases can be bone forming

Prostate - bone reaction
Breast - loss of lamina dura, no fibrous dysplasia

Question 19

Lymphoma

Answer 19

Bone becomes osteoporotic

Question 20

Multiple Myeloma

Answer 20

Uniformly fatal
>40 yr
Presents w/ foamy urine, fever
Pts on bisphosphonates

Question 21

Multiple Myeloma Radiographic Appearance

Answer 21

Multiple lucencies in jaw, skull
Punched out appearance
Well defined borders

Question 22

Multiple Myeloma Ddx

Answer 22

OKC
Cherubism (post. mandible)
Gorlin
Lymphoma, leukemia

Question 23

Langerhans Cell Disease

Answer 23

Proliferation of histiocytes

Older pts - better prognosis

Question 24

Langerhans Cell Disease Radiographic Appearance

Answer 24

Past apex

Cortex visible above lesion (not perio disease)

Question 25

Langerhans Cell Disease Ddx

Answer 25

Periodontal disease (stops at apex)
Hyperparathyroidism
Lymphoma, leukemia

Question 26

Hemangiosarcoma

Answer 26

Vascular origin