Download - malegnant dx1
Malignant
diseasesDone by: FatimaFaisal Marhoon
20102050030
Disease mechanism
Uncontrolled growth of tissue Locally invasive High degree of cellular anaplasia Ability to metastasize regionally to
lymph node and distantly to other sites
Etiology of malignant diseases
Viruses Radiation exposure Exposure to carcinogenic chemicals Genetic defects
Classifications of malignant tumors
Based of histopathology Carcinoma (lesion of epithelial origin) Metastatic lesion from distant sites Sarcoma (lesions of mesenchymal origin) Malignancies of hematopoietic system
Clinical features Displaced teeth Loosened teeth over a short time Foul smell Ulcerations Presence of indurated or rolled border Exposure of underlying bone Hemorrhage Sensorineural or sensorimotor deficits Lymphoadenopathy Weight loss Dysgeusia Dysphonia Dysphagia Lack of normal healing after oral surgery Pain or rapid swelling with no obvious dental causes Most oral cancers occur in men 50 years old and
older
Applied diagnostic imaging
Aid in establishment of an initial diagnosis of a tumor
Aid in the appropriate staging of the disease Determine the anatomic spread of the tumor Presence of osseous involvement from soft
tissue tumor Assess the involvement of lymph nodes Determine good biopsy sites Assess treatment outcome Management of patient who has survived
cancer
Imaging modalities available
Intra oral images: provide the best image resolution
Panoramic: provide an overall assessment of the maxillofacial osseous structure
Cone beam computed tomograhy (CBCT) or multidetector CT (MDCT): superior three dimensional analysis of osseous structure
Positron emission tomographic (PET) imaging: detecting abnormal cellular metabolic activity
Magnetic resonance imaging (MRI): provide 3D soft tissue images of tumor
Imaging features
Location Primary carcinoma: more common in tongue,
floor of the moth, tonsillar area, lip, soft palate, or gingiva and may invade the jaws form any of these sites
Sarcomas: mandible and posterior regions of both jaws
Metastatic tumors: posterior mandible and maxilla, apices of teeth or in the follicle of developing teeth
Imaging features
Periphery and shape Ill-defined borders with lack of cortication
and absent of encapsulation Extend from an area of bone destruction to
region of normal bone (infiltrating pattern) Finger like extensions
Imaging features
Internal structures Radiolucent Residual islands of bone might be present,
patchy destruction with residual internal osseous structure
Some metastatic tumors (prostate and breast lesions) → abnormal appearing internal sclerotic osseous architecture
Osteogenic sarcoma produce abnormal bone → radiopaque appearance
Imaging features
Effects on surrounding structure Teeth appear floating in space Root resorption (sarcomas, multiple myloma) Destruction of internal trabecular bone Destruction of cortical boundaries Widening of PDL with destruction of lamina dura Widening of ID canal “Hair one end” or “Sunburst” appearance ,thin
straight spicules of bone (osteosarcoma; metastatic prostate lesions)
Onion skin like appearance (secondary inflammatory lesion)
Ill-defined borders Infiltrating pattern
Destruction of cortical boundary
with soft tissue mass
Invasion and thickening of PD membrane space Multifocal lesion destroying crypt
cortex and displacing tooth occlusaly
Cortical bone destruction without periosteal reaction
Laminated periosteal reaction with cortical bone destruction
and new periosteal bone
Cortical bone destruction with periosteal reaction at the
periphery forming Codman’s triangle
Sunray periosteal reaction
Floating teeth
Carcinomas
1. SQUAMOUS CELL CARCINOMA
ARISING IN SOFT TISSUE
SQUAMOUS CELL CARCINOMA ARISING IN SOFT TISSUE
Synonym Epidermoid carcinoma
Disease mechanism
Most common oral malignancy Malignant tumor originating from surface
epithelium Etiology: Multifactorial; chronic smoking,
alcohol, mucosal human papillomavirues (tonsiliar and tongue lesions)
Histopathology: invasion of malignant epithelial cells into underlying connective tissue, deeper soft tissue, adjacent bone, regional lymph nodes and ultimately distant sites.
Clinical features
Most common in males older than 50 years White, red or mixed patchy lesion Central ulceration; a rolled or indurated
border Palpable infiltration into adjacent muscle or
bone Pain (variable) Regional lymphadenopaty with hard lymph
nodes Soft tissue mass, paresthesia, anesthesia,
dysesthesia, foul smell, trismus, loosened teeth or hemorrhage
Obstruct air ways, the opening of Eustachian tube or the nasopharynx.
Weight loss, feel unwell
Imaging features
Location SCC commonly involves lateral border of the
tongue Bone invasion posterior lingual aspect of the
mandible Lesions of lip and floor of the mouth invade
the anterior mandible Lesions of attached gingiva and alveolar
bone mimic inflammatory diseases Tonsils, soft palate and buccal vestibule
Imaging features
Periphery and shape Polymorphus irregular outline radiolucency Invasion characterized by an ill defined non
corticated borders Well defined border with a narrow transition band
without any residual bone behind the borders Ill defined border with a wide transition zone with
a finger like extensions into surrounding bone Borders show sharpened thinned bone end with
displacement of segments and adjacent soft tissue mass (pathologic bone fracture)
Well defined border with a narrow transition band
without any residual bone behind the borders
Ill defined border with a wide transition zone
with a finger like extensions into
surrounding bone
Internal structure
Radiolucent Small islands of residual normal trabecular
bone might be visible in the center of radiolucency
Effects on surrounding structure
Widening of PDL space, loss of lamina dura Floating teeth in a mass of radiolucent soft
tissue Growth of soft tissue mass with teeth within it
as a passenger Increase of width and loss of cortical boundary
of ID canal and mental foramen Destruction of normal cortical boundaries (floor
of the nose, maxillary sinus, buccal or lingual mandibular plates)
Inferior border of the mandible thinned or destroyed
Pathologic fracture
Floating teeth Destruction of anterior
floor of nasal fossa
Floating teeth
Destruction of floor of maxillary sinus and soft tissue
mass
Destruction of bone in mandibular retromolar
area
Bone resorption around the roots leave teeth without bony
support
Irregular width of ID canal and destructio
n of its cortical borders
SCC destroying the mandible in mental foramen region and
growing down to ID canal
Differential diagnosis
1 ) Inflammatory lesions such as Osteomyelitis Both destructive leaving island of osseous
structure SCC: profound bone destruction or invasive
characteristics Osteomyelitis: produces periosteal reaction
2) Periodontal disease If bone loss from SCC originate in the soft
tissue of the alveolar process SCC enlargement of extraction socket instead
of healing and new bone formation
-Bone destruction similar to periodontal
disease
-Lack of sclerotic bone reaction at the
periphery
Extraction socket has enlarged instead of
healing
Management
Surgery and radiation therapy Depends on the location and severity
of the tumor
2. SQUAMOUS CELL
CARCINOMA ORIGINATING FROM BONE
Synonyms
Primary intra osseous carcinoma Intraavleolar carcinoma Primary intra Intraavleolar epidermoid
carcinoma Primary epithelial tumor of the jaw Central seqaumous cell carcinoma Primary odontogenic carcinoma Intramandibular carcinoma Central mandibular carcinoma
Disease mechanism
Squamous cell carcimona arising in jaw
Arise from intraosseous remnants of odontogenic epithelium
Clinical features
More common in men Fourth and eight decade of life Pain Pathologic fracture Sensory nerve abnormalities
Imaging features
Location More common in mandible More common in molar region than anterior
aspect of the jaws Tooth bearing parts of the jaw
Imaging features
Periphery and shape Ill-defined periphery Rounded or irregular in shape Borders demonstrate osseous destruction varying degrees of extension at periphery Pathological fractures, step defects Thinned cortical borders Soft tissue mass
Imaging features
Internal structures Radiolucent Little residual bone within the lesion
center
•Poor defined periphery•No internal structures•Thinning of overlying mandibular bone
Imaging features
Effect on surrounding structure Destruction of antral or nasal floor Loss of cortical outline of mandibular
neurovascular bundle Loss of lamina dura Floating teeth
Differential diagnosis Periapical cyst or Granulomas Odontogenic cyst Metastatic lesion, Multiple myeloma,
Fibrosarcoma, carcinoma arising in a dental cyst
Surface squamous cell carcinoma
Management Tumors are excised with their
surrounding osseous structure Radiation and chemotherapy as
adjunctive therapies