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DENT 322 - Image Interpretation > Malignant Tumors > Flashcards

Malignant Tumors Flashcards

1
Q

Most frequent class of malignant tumor found in jaws

A

Carcinoma

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2
Q

10 clinical features of malignant tumors of the jaw

A
  • Ulceration, indurated lesion
  • Sensory or motor neural deficit
  • Displaced teeth, loosened teeth over a short time
  • Rapid swelling
  • Pain
  • Lymphadenopathy
  • Dysphagia
  • Dysphonia
  • Dysgeusia
  • Hemorrhage
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3
Q

Location of malignant tumors of the jaw

A

Anywhere in the oral and maxillofacial region

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4
Q

Radiographic periphery and shape of malignant lesions of the jaw

A

Ill-defined borders, absence of encapsulation

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5
Q

Radiographic internal structure of malignant tumors of the jaw

A
  • Radiolucent in most instances
  • Osteogenic sarcomas can induce bone formation –> radiopaque appearance
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6
Q

4 effects of malignant tumors on surrounding structures

A
  • Tumors spread through the adjacent tissues
    • Destroy trabecular bone (floating roots)
    • Destroy cortical boundaries
    • Invade maxillary sinus
    • Spread through mandibular canal (paresthesia of lower lip)
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7
Q

4 general characteristics of epidermoid carcinoma

A
  • Malignant tumor originating from the surface epithelium
  • Invasion of malignant epithelial cells into the underlying connective tissue
  • Spread into deeper soft tissues, adjacent bone, lymph nodes
  • Metastasize into lung, liver and skeleton
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8
Q

7 clinical features of epidermoid carcinoma

A
  • White or red irregular lesion
  • Central ulceration, lesion may bleed
  • Indurated border
  • Pain may be variable
  • Loco-regional lymphadenopathy
  • Swelling (soft tissue mass)
  • Paresthesia, trismus (if spread into pterygoid muscle)
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9
Q

Location of epidermoid carcinoma

A
  • Commonly involves the lateral border of the tongue –> bone invasion into the posterior lingual side of the mandible
  • Lesion of the lip –> anterior part of mandible
  • Lesion involving gingiva spreads into underlying alveolar bone and may mimic periodontal disease
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10
Q

Radiographic periphery and shape of epidermoid carcinoma

A

Irregular outline, non-corticated border

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11
Q

Radiographic internal structure of epidermoid carcinoma

A

Totally radiolucent

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12
Q

3 effects on surrounding structures by epidermoid carcinoma

A
  • Destruction of the adjacent cortical plates
  • Destruction of trabecular bone
  • Invasion of the mandibular canal
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13
Q

Differential diagnosis for epidermoid carcinoma and how to differentiate between them

A

Inflammatory lesions such as osteomyelitis

  • Both are destructive
  • Osteomyelitis produces some periosteal reaction, whereas EC does not (since of dental origin while EC is not)

Osteoradionecrosis (RTH, prior malignancy) –> not associated w/ lesion of oral mucosa as EC is

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14
Q

4 general characteristics of epidermoid carcinoma originating in bone

A
  • Primary intraosseous epidermoid carcinoma
  • Epidermoid carcinoma arising within the jaw and has no original connection with the surface epithelium of the oral mucosa
  • Primary intraosseous epidermoid carcinoma may arise from intraosseous rests of odontogenic epithelium
  • These tumors are very uncommon
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15
Q

4 clinical features of epidermoid carcinoma originating from bone

A
  • Pain
  • Sensory nerve abnormalities such as lip paresthesia
  • Lymphadenopathy
  • Surface epithelium is normal
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16
Q

Location of epidermoid carcinoma originating in bone

A
  • More commonly in mandibular molar area
  • Tooth bearing parts of the jaw
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17
Q

Radiographic appearance of epidermoid carcinoma originating from bone

A

All the characteristics of a malignant disease (refer to cards 3-6)

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18
Q

2 differential diagnoses for epidermoid carcinoma originating from bone

A
  • Metastatic lesions
  • Other carcinomas (i.e. osteosarcoma)
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19
Q

6 general characteristics of osteosarcoma

A
  • Malignant bone forming tumor
  • Second most common primary bone tumor after multiple myeloma
  • Account for 20% of all primary bone tumors
  • Typically occur in young patients (10 - 20yrs) with 75% occuring before age 20
  • Jaw lesoins typically occur about 10 years later than long bone lesions
  • Number of subtypes according to the degree of differentiation and location within bone
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20
Q

3 clinical features of osteosarcoma

A
  • Bone pain occasionally accompanied by soft-tissue mass or swelling
  • Erythema of overlying mucoas, ulceration, trismus, hemorrhage
  • Hypoesthesia (reduced sense of touch)
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21
Q

Location of osteosarcoma

A
  • Most common in the mandible
  • Posterior mandible is most commonly affected
  • Ramus also common location
22
Q

Radiographic periphery and shape of osteosarcoma

A
  • Ill-defined border, no periapical sclerosis or encapsulation
  • Sunray spicules
23
Q

Radiographic internal appearance of osteosarcoma

A
  • Totally radiolucent, mixed radiolucent-radiopaque or radiopaque (most common)
  • Normal trabecular structure of the jaws is lost
24
Q

3 effects of osteosarcoma on surrounding structures

A
  • Destruction of the adjacent cortical plates
  • Invasion of the mandibular canal
  • Adjacent soft tissues can be deeply invaded
25
Q

3 differential diagnoses for osteosarcoma and how to differentiate

A
  • Osteomyelitis –> associated with signs of infection and produces periosteal thickening while osteosarcoma produces sunray appearance
  • Ossifying fibroma
  • Fibrous dysplasia

NOTE: latter two have a more uniform internal structure

26
Q

5 most common primary sites from which metastatic lesoins of the jaw originate

A
  • Breast
  • Kidney
  • Lung
  • Bladder
  • Prostate
27
Q

3 clinical features of metastatic lesions in the jaw

A
  • More common in patients after 50 yrs
  • Pain, numbness, paresthesia of the lips, pathologic fracture of the jaw
  • Sometimes may be asymptomatic
28
Q

Location of metastatic lesions

A
  • Posterior area of the mandible
  • Maxillary sinus
29
Q

Radiographic periphery and shape of metastatic lesions

A
  • May be moderately well-demarcated but have no cortication or encapsulation
  • May also have ill-defined invasive margins
30
Q

Radiographic internal structure of metastatic lesions

A

Generally radiolucent

31
Q

3 effects of metastatic lesions on surrounding structures

A
  • Destruction of the adjacent cortical plates
  • Trabecular bone destruction –> floating roots
  • Extension into surrounding soft tissues
32
Q

2 differential diagnoses for metastatic lesions and how to differentiate

A
  • In most cases, a known primary malignancy is present and diagnosis of metastasis is straightforward
  • Invasion of jaws by primary tumors such as epidermoid carcinoma are radiographically indistinguishable from metastatic lesions, so rely on clinical exam
  • Multiple myeloma –> has multiple radiolucent lesions and punched out appearance (vs. metastatic lesions has only 1 radiolucent lesion)
33
Q

5 general characteristics of multiple myeloma

A
  • Malignancy of the hematopoietic system
  • Malignant neoplasm of plasma cells
  • Most common malignancy of bone in adults
  • Multiple lesions
    • Single = plasmacytoma
  • Fatal systemic malignancy
34
Q

4 clinical features of multiple myeloma

A
  • Patient between 35 - 70 years
  • Fatigue, weight loss, fever, bone pain
  • Orally, patient may complain of dental pain, swelling, paresthesia
  • Sometimes, the patient is asymptomatic
35
Q

Location of mulitple myeloma lesions

A
  • More frequently in the mandible than maxilla
  • Posterior area of the mandible
36
Q

Radiographic periphery and shape of multiple myeloma

A
  • Multiple lesions
  • Lesions may be moderately well demarcated but have no cortication or encapsulation
  • “Punched out” appearance
37
Q

Radiographic internal structure of multiple myeloma

A

Radiolucent lesions

38
Q

3 differential diagnoses for multiple myeloma and how to differentiate

A
  • Metastatic lesions
    • Known prior malignancy may help
  • Osteomyelitis
    • Signs of infection
  • Brown tumors of hyperparathyroidism
    • Generalized decreased bone density
39
Q

4 general characteristics of malignant lymphoma

A
  • Generally occur within lymph nodes
  • Extranodal sites such as bone can be involved
  • Classification into low grade to high grade tumors
  • Malignant lymphoma is very uncommon (0.6% in the jaws)
40
Q

4 clinical features of malignant lymphoma

A
  • Occur in all age groups
  • Fatigue, weight loss
  • Palpable painless swelling, lymphadenopathy
  • Paresthesia may be associated with lesions of the jaws
41
Q

Location of malignant lymphomas

A
  • Most occur in the lymph nodes
  • Extranodal location can involve maxillary sinus, posterior mandible
42
Q

Radiographic periphery and shape of malignant lymphoma

A

Ill-defined and invasive lesion

43
Q

Radiographic internal structure of malignant lymphoma

A

Generally radiolucent

44
Q

2 effects of malignant lymphoma on surrounding structures

A
  • Destruction of adjacent structures
  • Extension into surrounding soft tissues
45
Q

2 differential diagnoses for malignant lymphoma and how to differentiate

A
  • Metastatic lesion
    • Knowledge of prior malignancy may help
  • Osteolytic osteosarcoma and central epidermoid carcinoma radiographically similar to malignant lymphoma
46
Q

6 general characteristics of leukemia

A
  • Malignant tumor of hematopoietic stem cells
  • Subdivided into acute and chronic leukemias
    • Acute more common in very young and very old
    • Chronic patients may have no complaints
  • Acute = feel unwell with weakness and bone pain
    • May also exhibit spontaneous hemorrhage, lymphadenopathy, fever, splenomegaly
47
Q

Location of leukemia

A
  • Affects the entire bone (malignancy of bone marrow)
  • In jaws, lesions may be localized around the periapical region of a tooth –> appearane of periapical or periodontal lesions
48
Q

Radoigraphic periphery and shape of leukemia

A

Ill-defined patchy radiolucent areas

49
Q

Radiographic internal structure of leukemia

A

Patchy areas of radiolucency and generalized radiolucency of bone

50
Q

2 effects of leukemia on surrounding structures

A
  • Bone destruction
  • In young patients, developing teeth may be displaced in an occlusal direction

DENT 322 - Image Interpretation (12 decks)

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