Radio features of malignant tumours

Question 1

what are the general features of malignancy

Answer 1

a. Uncontrolled growth of tissues
b. Locally invasive
c. Can metastasize to regional lymph nodes or distant sites
d. There is primary and secondary tumour
i. Primary is malignancy that arises de novo
Secondary is malignancy that originates from a distant primary site

Question 2

what are the general radiographic features for malignant tumours

Answer 2

a. Location
i. May occur anywhere
ii. Primary carcinoma
1) More common in lateral border of tongue, floor of mouth, tonsillar area, soft palate or gingiva and may invade bone
2) Sarcoma
a) More common in mandible and posterior regions of both jaws
3) Metastatic tumour
a) More common in posterior mandible and maxilla, sometimes rarely in the apices or follicles of teeth
b. Edges
i. Ill defined borders
ii. Non corticated
iii. No soft tissue capsule
iv. +/- adjacent soft tissue mass

	c. Size/ Shape
		i. irregular
	d. Internal structures
		i. Usually radiolucent due to osteolysis
			1) Exceptions that may be radioopaque are osteosarcoma, metastatic prostate and breast cancer
		ii. Could have residual islands of bone ( moth eaten appearance, patchy destruction)
	e. Other structures ( effect on)
		i. Cortical bone destruction with soft tissue mass
		ii. Pdl space widening
		iii. Destruction of follicle, tooth displacement
		iv. Floating teeth
	f. Periosteal reaction
		i.

Question 3

what is the radiographic feature of squamous cell carcinoma

Answer 3

1) Usually ill defined, non corticated irregularly shaped
a) SCCa from soft tissue has a broad surface that may appear more well defined
b) Osteolytic (radiotranslucent)
c) Destruction of cortical boundaries
i) For eg buccal and lingual cortical plates, maxillary sinus floor, IDN canal
d) Widening of PDL, loss of lamina dura
e) Possible
f) pathologic fracture

Question 4

what are the radiographic features of osteosarcoma

Answer 4

1) Ill defined, non corticated, irregularly shaped
2) Can be radiolucent, RO or mixed depending on whether malignant osteoblasts are producing bone or osteoid
3) Internally may appear honeycomb shape, cotton ball, wispy, granular or sclerotic
4) Irregular widening of PDL space and loss of lamina dura
5) Possible root resorption
6) Destruction of surrounding structures
7) Soft tissue mass effect if extending past bone surface
8) Periosteal reaction possible ( sunray patter

Question 5

what does multiple myeloma look like and where does it appear more

Answer 5

i. Can appear in other bones
ii. In the jaw, posterior mandible> posterior maxilla
iii. Multiple well defined, non corticated radiolucent punched out circular/oval lesions
May also be jagged and irregular
4) Periosteal reactions and irregular root resorption uncommon
Possible for teeth to appear radiopaque within osteopenic bone. Loss of lamina dura and loss of corticated crypts of follicles

Question 6

what is the radiographic features of lymphoma

Answer 6

1) Extranodal NHL more common in maxilla than posterior mandible
2) Ill defined, non corticated with infiltrative extensions, usually radiolucent
3) Usually takes on shape of host bone, but can appear round
4) Can be multifocal
5) Can appear multilocular if coalescing
6) Destruction of surrounding cortical boundaries such as sinus/ cortical plates/ IDN
7) Destruction of lamina dura
8) Propensity for PDL space
9) Loss of cortical crypts of developing teeth; leads to displacement in occlusal direction
10) Uncommon for periosteal reaction

Question 7

is metastasis RO or RL? what are the exception

Answer 7

usually RL

Breast and prostate cancer metastasis can be radiopaque and stimulate periosteal reactions

Question 8

what is the clinical presentation and demographics of osteosarcoma

Answer 8

• Commonest primary malignant tumor of bone
  
  • Relatively rare in jaws
  • Around 30 years of age
  • More common in the mandible
  • Presents as fairly rapidly enlarging swelling, may be accompanied by pain, numbeness of the lip, trismus, displacement and loosening of the teeth.
  • Nasal obstruction eye symptoms features of maxillary lesion
  • Ulceration of skin or mucosa a late feature

Question 9

what is the radiographic feature of osteosarcoma

Answer 9

○ Variable depending on amount of bone destroyed and amount of neoplastic bone formed
○ Osteolytic lesion- irregular areas of radiolucency
○ Sclerosing type of lesion irregular areas of radioopacity
○ Sunray appearance produced where cortical plates are perforated
○ Widening of pdl space a feature of very early lesions

Question 10

what is the recurrence rate of osteosarcoma

Answer 10

high recurrence rate

Question 11

what is multiple myeloma

Answer 11

Neoplasm composing of plasma cells occuring as solitary intrabony lesions or less commonly in the soft tissue

Question 12

where is burkitts lymphoma commonly found

Answer 12

Jaw–> posterior more common, maxilla>mandible, > one quadrant, rapid growth causing facial disfigurement, teeth loose, involves sinuses, nose, orbit, nasopharynx

Question 13

what is leukemia

Answer 13

Progressive malignant neoplasm of the blood forming organs, marked by diffuse replacement of the bone marrow. Development of leukocytes and their precursors in the blood and bone marrow

Accompanied by reduced number of erythrocytes and blood platelets, resulting in anemia and increase susceptibility to infection and haemorrhage

Question 14

what is langerhan cell disease

Answer 14

Characterised by intense and abnormal proliferation of bone marrow derived histiocytes

Manifests orally with single or multiple lesions of alveolar or basal bone, ulcerated mucosal lesion accompanied by adenopathies and perio lesions, gingival inflammation, bleeding, recession, necrosis, odontalgia, dental hypermobility and premature loss of teeth