Malignant diseases of the jaws Flashcards
Categories of malignant
tumors
Carcinomas (lesions of epithelial origin).
Sarcomas (lesions of mesynchymal origin).
Metastatic ( lesions from distant sites).
Malignancies of hematopoietic system
Types of Sarcomas
- Osteosarcoma (sunburst appearance)
- Chondrosarcoma (rarely radiolucent)
- Fibrosarcoma (may develop following radiotherapy Codman’s triangles or sunrays)
- Ewing’s sarcoma (sunburst appearance and the lesion is rare in the jaws)
Root resorption (more in sarcomas)
(osteogenic sarcoma) can cause frank sclerosis
Malignancies of
the Hematopoietic
system
Multiple myeloma (most common malignancy of bone in adults) Single lesions are called Plasmacytoma and multiple lesions are termed Multiple myeloma
Non-Hodgkin’s lymphoma
Burkitt’s lymphoma
Leukemia
Characteristics of Malignant Tumors
They are locally invasive
Have a a greater degree of anaplasia
Have the ability to metastasize
ll-defined invasive border followed by bone destruction
Destruction of the cortical boundary (floor of
maxillary antrum) with an adjacent soft tissue mass
Tumor invasion along the periodontal membrane
space causing irregular thickening of this space
Multifocal lesions located at root apices and in the papilla of a developing tooth destroying the crypt cortex and displacing the developing tooth in an occlusal direction
Clinical features which suggest the
presence or malignancy
- Swelling
- Displaced teeth
- Loosened teeth over a short duration
- Ulceration
- Presence of an ulcer with indurated or rolled borders
- Foul smell
- Exposure of underlying bone
- Sensory or motor neural disorders
- Lymphadenopathy
- Weight loss
- Dysphagia
- Dysphonia
- Dysgeusia
- Hemorrhage
- Lack of normal healing
- Pain with no demonstrable dental cause
Teeth appear floating often without evidence of root resorption
RULE
Evidence of osseous destruction
with adjacent soft tissue mass is
highly suggestive of malignancy
Four types of effects on cortical bone and periosteal reaction
- cortical bone destruction without periosteal reaction.
- Laminated periosteal reaction with destruction of the cortical bone and the new periosteal bone
- Destruction of cortical bone with periosteal reaction at the periphery forming Codman’s triangles.
- Speculated or sunray type of periosteal reaction
Squamous cell carcinoma
arising in soft tissue
Age: over 50 years
Sex : more in males
Site : Soft tissues of the mouth
Differential diagnosis: osteomyelitis
Radiologic features
1. Ill defined non corticated radiolucency borders
1. May be small island of normal bone are observed
1. Finger like extensions are observed at the periphery
1. Loss of lamina dura and widening of the periodontal membrane with loosening of teeth.
1. Desruction of the normal cortical boundaries.
Squamous cell carcinoma originating in bone
(Primary intraosseos carcinoma)
Age: fourth to eighth decade
Gender: more in males
Differential diagnosis:
1. granuloma
2. odontogenic cyst or tumor
May remain silent till it reaches a fairly large size.
Pain and lip parasthesia.
Regional lymphadenopathy
Pathological fractures may occur
Epidermoid cell carcinoma
They may arise from inflammatory
periapical, residual, dentigerous, and odontogenic keratocysts
mucoepidermoid carcinoma
Site : more in mandible (2:1)
Sex : more in females
Differential Diagnosis:
1.Odontogenic myxoma
2. Central giant cell granuloma
3. Odontogenic cyst or tumor
An expansile unilocular or multilocular radiolucent lesion with a soap bubble or honeycomb appearance
Teeth remain unaffected although their adjacent lamina dura is lost
Osteosarcoma
It is also known to occur in association with Paget’s disease and fibrous dysplasia after theraputic irradiation
Sunray specules or hair-on-end specules may be seen
