Lecture 9 - Oral Non-Squamous Malignancies

Question 1

Leukemia

Answer 1

Originates in bone marrow

Myeloid (affects RBC precursor)
Lymphoid (affects Lymphotic precursor)
Acute or Chronic

Question 2

Leukemia Diagnosis

Answer 2

Via peripheral blood and bone marrow biopsy

Question 3

Leukemia Radiographic Appearance

Answer 3

Teeth floating in air

Question 4

Leukemia Systemic Findings

Answer 4

Hepatosplenomegaly
Lymphadenopathy
Thrombocytopenia
Anemias
Fever

Question 5

Leukemia Oral Manifestations

Answer 5

Oral ulceration
Candidiasis
Gingival hyperplasia (“boggy”)
Gingival hemorrhage (platelets <10,000)

Question 6

Leukemia Histologic Findings

Answer 6

Monotonous proliferation of poorly differentiated cells (RBC or WBC precursors)
Abnormal mitosis

Question 7

Hodgkin’s Lymphoma

Answer 7

Malignancy of lymph nodes

Oral lesions very RARE

Why are we learning this?

Question 8

Hodgkin’s Lymphoma Epidemiology

Answer 8

Bimodal: 15-30yr and >50yr

Males

75% cervical and supraclavicular nodes
5-10% axillary and mediastinal nodes

Question 9

Hodgkin’s Lymphoma Systemic Findings

Answer 9

Non-tender lymph node enlargement
Weight loss
Fever
Night sweats
General pruritis

Question 10

Hodgkin’s Lymphoma Histologic Findings

Answer 10

Reed-Sternberg cells (giant, multi-nucleated cells with prominent nucleoli)

Question 11

Non-Hodgkin’s Lymphoma

Answer 11

Malignancy of lymph nodes

Oral lesions most common in B-cell origin

Adults

Question 12

Non-Hodgkin’s Lymphoma Oral Manifestations

Answer 12

Soft tissue lesions:
-Non-tender, diffuse, “boggy” swelling in buccal vestibule, gingiva, and posterior hard palate

Bone lesions:

• Vague pain
• Parasthesias
• Ill-defined radiolucencies
• Bony expansion with cortical perforation

Question 13

Non-Hodgkin’s Lymphoma

Answer 13

Infiltrative, monotonous proliferation of poorly differentiated lymphocytic cells

Question 14

Burkitt’s Lymphoma

Answer 14

Undifferentiated B-cell lymphoma

Associated with EBV

t(8;14)

Good prognosis with chemotheraphy

Question 15

Osteosarcoma Oral Manifestations

Answer 15

Tooth mobility and root resorption
Swelling
Pain
Parasthesia
Nasal obstruction

Question 16

Osteosarcoma Radiographic Findings

Answer 16

• Loss of lamina dura
• Asymmetric widening of PDL
• Sclerotic, sunburst bone production on lesion surface

Question 17

Burkitt’s Lymphoma Oral Manifestations

Answer 17

Tooth mobility

Radiographic:

• Teeth floating in air
• Ill-defined borders
• Patchy loss of lamina dura

Question 18

Burkitt’s Lymphoma Systemic Findings

Answer 18

Facial swelling

Proptosis

Question 19

Burkitt’s Lymphoma Histologic Findings

Answer 19

“Starry sky” (macrophages in lesional tissue)
Small, hyperchromatic non-cleaved B-cells
High mitotic rate

Question 20

Burkitt’s Lymphoma Epidemiology

Answer 20

Africa:

• 50-70% in jaw
• Kids
• Males
• EBV

America:

• Abdominal lesions
• 15-30% EBV
• 40% of lymphomas in kids

Question 21

Osteosarcoma Epidemiology

Answer 21

7% in jaw
20-30yo
Males
Mandible

Common in elderly with Paget’s Disease

Question 22

Osteosarcoma Treatment

Answer 22

Surgical excision
Radiation
Chemo

30-50% 5yr survival

Question 23

Chondrosarcoma

Answer 23

<1% in head and neck

33yo
Male
Maxilla

Surgical excision, poor prognosis

Question 24

Chondrosarcoma Oral Manifestations

Answer 24

Painless swelling
Loosening of teeth, root resorption
Nasal obstruction/epistaxis

Histo - “cohabitating lacunae”

Rad - cortical penetration in sun-burst pattern

Question 25

Ewing Sarcoma

Answer 25

<20yo White males Mandible Confirm diagnosis with CD99

Question 26

Ewing Sarcoma Presentation

Answer 26

Fever Leukocytosis Painful swelling Paresthesia Loose teeth, teeth "floating in air" Histo - small, round blue cell tumor with pick necrosis b/t sheets of blue cells

Question 27

Multiple Myeloma

Answer 27

Clonal plasma cell proliferation t(4;14) Older black men

Question 28

Multiple Myeloma Systemic Findings

Answer 28

``` Bone pain, pathologic fracture Petechial hemorrhage Myelophthisic anemia Fever Amyloidosis Kidney failure Radiolucent "punched out" bone lesions ```

Question 29

Multiple Myeloma Oral Findings

Answer 29

Amyloid deposition in tongue | Radiolucent "punched out" bone lesions

Question 30

Melanoma

Answer 30

1 in 2million people have oral mucosal melanomas each year in the US 50-70yo Surgery, lymph node removal, hemimaxillectomy if bone involvement 4-20% 5 year survival

Question 31

Melanoma Oral Manifestations

Answer 31

``` Brown/black macule, color variation Irregular borders, asymmetric Favors hard palate and gingiva May be ulcerated >6mm ```

Question 32

Salivary Gland Malignancy

Answer 32

Older patients Slow-growing swelling Weakness or paresthesia if nerve involvement

Question 33

Metastases to Oral Cavity

Answer 33

1. Breast 2. Lung 3. GI 4. Thyroid 5. Prostate 6. Kidney

Question 34

Nasopharyngeal Carcinoma

Answer 34

Most common in Asia, Africa, Pacific Rim Middle age Males Radiation Chemo

Question 35

Nasopharyngeal Carcinoma Presentation

Answer 35

Nasal cavity mass Obstruction Dysconjugate gaze Mets to cervical lymph nodes

Question 36

Rhabdymyosarcoma

Answer 36

Skeletal muscle Children Mucosa looks normal Histo - hot pink cytoplasm, trabecular fibrous connective tissue with floating cells