Malignant Tumors Flashcards
Most frequent class of malignant tumor found in jaws
Carcinoma
10 clinical features of malignant tumors of the jaw
- Ulceration, indurated lesion
- Sensory or motor neural deficit
- Displaced teeth, loosened teeth over a short time
- Rapid swelling
- Pain
- Lymphadenopathy
- Dysphagia
- Dysphonia
- Dysgeusia
- Hemorrhage
Location of malignant tumors of the jaw
Anywhere in the oral and maxillofacial region
Radiographic periphery and shape of malignant lesions of the jaw
Ill-defined borders, absence of encapsulation
Radiographic internal structure of malignant tumors of the jaw
- Radiolucent in most instances
- Osteogenic sarcomas can induce bone formation –> radiopaque appearance
4 effects of malignant tumors on surrounding structures
- 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)
4 general characteristics of epidermoid carcinoma
- 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
7 clinical features of epidermoid carcinoma
- 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)
Location of epidermoid carcinoma
- 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
Radiographic periphery and shape of epidermoid carcinoma
Irregular outline, non-corticated border
Radiographic internal structure of epidermoid carcinoma
Totally radiolucent
3 effects on surrounding structures by epidermoid carcinoma
- Destruction of the adjacent cortical plates
- Destruction of trabecular bone
- Invasion of the mandibular canal
Differential diagnosis for epidermoid carcinoma and how to differentiate between them
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
4 general characteristics of epidermoid carcinoma originating in bone
- 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
4 clinical features of epidermoid carcinoma originating from bone
- Pain
- Sensory nerve abnormalities such as lip paresthesia
- Lymphadenopathy
- Surface epithelium is normal
Location of epidermoid carcinoma originating in bone
- More commonly in mandibular molar area
- Tooth bearing parts of the jaw
Radiographic appearance of epidermoid carcinoma originating from bone
All the characteristics of a malignant disease (refer to cards 3-6)
2 differential diagnoses for epidermoid carcinoma originating from bone
- Metastatic lesions
- Other carcinomas (i.e. osteosarcoma)
6 general characteristics of osteosarcoma
- 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
3 clinical features of osteosarcoma
- Bone pain occasionally accompanied by soft-tissue mass or swelling
- Erythema of overlying mucoas, ulceration, trismus, hemorrhage
- Hypoesthesia (reduced sense of touch)
Location of osteosarcoma
- Most common in the mandible
- Posterior mandible is most commonly affected
- Ramus also common location
Radiographic periphery and shape of osteosarcoma
- Ill-defined border, no periapical sclerosis or encapsulation
- Sunray spicules
Radiographic internal appearance of osteosarcoma
- Totally radiolucent, mixed radiolucent-radiopaque or radiopaque (most common)
- Normal trabecular structure of the jaws is lost
3 effects of osteosarcoma on surrounding structures
- Destruction of the adjacent cortical plates
- Invasion of the mandibular canal
- Adjacent soft tissues can be deeply invaded
3 differential diagnoses for osteosarcoma and how to differentiate
- 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
5 most common primary sites from which metastatic lesoins of the jaw originate
- Breast
- Kidney
- Lung
- Bladder
- Prostate
3 clinical features of metastatic lesions in the jaw
- More common in patients after 50 yrs
- Pain, numbness, paresthesia of the lips, pathologic fracture of the jaw
- Sometimes may be asymptomatic
Location of metastatic lesions
- Posterior area of the mandible
- Maxillary sinus
Radiographic periphery and shape of metastatic lesions
- May be moderately well-demarcated but have no cortication or encapsulation
- May also have ill-defined invasive margins
Radiographic internal structure of metastatic lesions
Generally radiolucent
3 effects of metastatic lesions on surrounding structures
- Destruction of the adjacent cortical plates
- Trabecular bone destruction –> floating roots
- Extension into surrounding soft tissues
2 differential diagnoses for metastatic lesions and how to differentiate
- 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)
5 general characteristics of multiple myeloma
- Malignancy of the hematopoietic system
- Malignant neoplasm of plasma cells
- Most common malignancy of bone in adults
- Multiple lesions
- Single = plasmacytoma
- Fatal systemic malignancy
4 clinical features of multiple myeloma
- 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
Location of mulitple myeloma lesions
- More frequently in the mandible than maxilla
- Posterior area of the mandible
Radiographic periphery and shape of multiple myeloma
- Multiple lesions
- Lesions may be moderately well demarcated but have no cortication or encapsulation
- “Punched out” appearance
Radiographic internal structure of multiple myeloma
Radiolucent lesions
3 differential diagnoses for multiple myeloma and how to differentiate
- Metastatic lesions
- Known prior malignancy may help
- Osteomyelitis
- Signs of infection
- Brown tumors of hyperparathyroidism
- Generalized decreased bone density
4 general characteristics of malignant lymphoma
- 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)
4 clinical features of malignant lymphoma
- Occur in all age groups
- Fatigue, weight loss
- Palpable painless swelling, lymphadenopathy
- Paresthesia may be associated with lesions of the jaws
Location of malignant lymphomas
- Most occur in the lymph nodes
- Extranodal location can involve maxillary sinus, posterior mandible
Radiographic periphery and shape of malignant lymphoma
Ill-defined and invasive lesion
Radiographic internal structure of malignant lymphoma
Generally radiolucent
2 effects of malignant lymphoma on surrounding structures
- Destruction of adjacent structures
- Extension into surrounding soft tissues
2 differential diagnoses for malignant lymphoma and how to differentiate
- Metastatic lesion
- Knowledge of prior malignancy may help
- Osteolytic osteosarcoma and central epidermoid carcinoma radiographically similar to malignant lymphoma
6 general characteristics of leukemia
- 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
Location of leukemia
- 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
Radoigraphic periphery and shape of leukemia
Ill-defined patchy radiolucent areas
Radiographic internal structure of leukemia
Patchy areas of radiolucency and generalized radiolucency of bone
2 effects of leukemia on surrounding structures
- Bone destruction
- In young patients, developing teeth may be displaced in an occlusal direction
