Neoplasia.pptx

Copyright © 2018, Elsevier Inc. All Rights Reserved.
Neoplasia
Chapter 7
1

Learning Objectives
Lesson 7.1: Vocabulary,
Neoplasia, and Tumors
1. Define each of the words in the vocabulary list
for this chapter.
2. Describe neoplasia, including its causes.
3. Explain the classification of tumors, including
the difference between a benign tumor and a
malignant tumor.
4. Do the following related to the names and
treatment of tumors:
• Discuss how prefixes and suffixes are combined to form
names of tumors, as well as give examples.
• List tumors according to their tissue or cell of origin.
• Discuss the different ways in which tumors are treated.
2

5. Do the following related to epithelial tumors:
• List and describe the three different types of epithelial
tumors in the oral cavity.
• Define each of the following tumors of squamous
epithelium, describe the clinical features of each, and
explain how they are treated: papilloma, squamous
cell carcinoma, verrucous carcinoma, and basal cell
carcinoma.
• Define and discuss leukoplakia and erythroplakia.
• Explain the concept of epithelial dysplasia and the
microscopic significance of this premalignant
condition.
3
Learning Objectives
Lesson 7.1: Vocabulary,
Neoplasia, and Tumors (Cont.)

Description of Neoplasia
 Neoplasia
 New growth
 Cells exhibit uncontrolled proliferation
 Neoplasm
 A new growth of tissue in which growth is
uncontrolled and progressive
 Tumor
 Means swelling, but is often used as a synonym for
neoplasm
4

Description of Neoplasia (Cont.)
 The occurrence of neoplasia
 An irreversible change must take place in the cells.
This change must be passed on to new cells and
result in uncontrollable cell multiplication
 It is an abnormal process
5

Causes of Neoplasia
 Many agents have been shown to cause
neoplastic transformation of cells in the
laboratory
 Chemicals: Hundreds of different ones
 Viruses: Called oncogenic viruses
 Radiation: Sunlight, x-rays, nuclear fission
 It can also occur spontaneously as a result of a
genetic mutation
6

Classification of Tumors
 Benign tumor or neoplasia
 Remains localized
 May be encapsulated with fibrous connective tissue
 It can invade adjacent tissue, but does not have the
ability to spread to distant sites
 Malignant tumor
 Invades and destroys surrounding tissue
 Has the ability to spread throughout the body
7

Classification of Tumors (Cont.)
 Benign tumors almost always resemble normal
tissue
 Malignant tumors vary in histologic appearance
 Well-differentiated malignant tumors have neoplastic
cells that resemble normal cells; poorly differentiated
ones do not
 Others may be undifferentiated or anaplastic and do
not resemble the tissue from which they were derived
at all
8

Classification of Tumors (Cont.)
 Pleomorphic
 The cells of malignant tumors often vary in size
and shape
 Hyperchromatic
 The nuclei of these cells are darker than those of
normal cells and exhibit an increased nuclear-to-
cytoplasmic ratio
9

Names of Tumors
10

Names of Tumors (Cont.)
 The prefix is determined by the tissue or cell of
origin
 The suffix -oma is used to indicate a tumor
 Benign tumors
 Lipoma: Benign tumor of fat
 Osteoma: Benign tumor of bone
11

Names of Tumors (Cont.)
 Naming malignant tumors
 Carcinoma: Malignant tumor of epithelium
 Sarcoma: Malignant tumor of connective
tissue
 Malignant tumors
 Squamous cell carcinoma or epidermoid
carcinoma: Malignant tumor of squamous
epithelium
 Osteosarcoma: Malignant tumor of bone
12

Treatment of Tumors
 Benign tumors
 Treated by surgical excision, either wide local
excision or enucleation
 Malignant tumors
 Treated by surgery, chemotherapy, or radiation
therapy, often a combination
13

Epithelial Tumors
 Three different types are found in the oral cavity
 From squamous epithelium
 From salivary gland epithelium
 From odontogenic epithelium
14

Tumors of Squamous Epithelium
 Papilloma
 Premalignant lesions
 Squamous cell carcinoma
 Verrucous carcinoma
 Basal cell carcinoma
15

Papilloma
 A benign tumor of squamous epithelium
 A small exophytic pedunculated or sessile growth
 May be white or the color of normal mucosa
 Most often on the soft palate or tongue
16

Papilloma (Cont.)
 Microscopic
 Numerous fingerlike or
papillary projections
with a central core of
fibrous connective
tissue surfaced by
normal stratified
squamous epithelium
 Treatment
 Surgical excision
17

Premalignant Lesions
 Leukoplakia
 Erythroplakia
 Epithelial dysplasia
18

Leukoplakia
 Means “white plaque”
 Biopsy is necessary to establish a definitive
diagnosis
 Most leukoplakias are due to a hyperkeratosis, or
epithelial hyperplasia and hyperkeratosis
19

Leukoplakia (Cont.)
 Microscopic
 May show epithelial dysplasia, a premalignant
condition, or even squamous cell carcinoma
 Treatment
 Dependent on histologic finding
 Remove the cause and see if it resolves; if not, the
lesion should be biopsied
20

Erythroplakia
 An oral mucosal lesion appearing as a smooth
red patch or a granular red and velvety patch
 Speckled leukoplakia: A lesion that shows a mix
of red and white areas
 Most often located on the floor of the mouth,
tongue, and soft palate
 Less common than leukoplakia
21

Oral Submucous Fibrosis
 Chronic oral mucosal disease that is associated
with betel-quid and areca-nut chewing
 Betel-quid and areca-nut chewing are prevalent
in Indian subcontinent and Southeast Asia
 Increased deposition of collagen in the oral
mucosa results in severe restriction of
movement of the oral mucosa tissues
22

Epithelial Dysplasia
 A histologic diagnosis of
a premalignant condition
 Indicates disordered
growth
 These lesions frequently
precede squamous cell
carcinoma
 Changes may revert to
normal if the stimulus is
removed
23

Epithelial Dysplasia (Cont.)
 Clinically, it may present as an erythematous
lesion, a white lesion, or a mixed erythematous
and white lesion
 Lesions often arise on the floor of the mouth or
tongue
 Dysplasia in other tissues is not considered a
premalignant process
24

Epithelial Dysplasia (Cont.)
 Microscopic
 Abnormal maturation of epithelial cells with
disorganization of epithelial layers; hyperplasia of
basal cells; and epithelial cells with enlarged and
hyperchromatic nuclei, increased nuclear-to-
cytoplasmic ratios, abnormal keratinization, and
increased numbers of normal and abnormal mitotic
figures
 Carcinoma in situ
 Severe dysplasia involving the full thickness of
epithelium
 Treatment: Surgical excision
25

Squamous Cell Carcinoma
 A malignant tumor of squamous epithelium
 The most common primary malignancy of the oral
cavity
 It can infiltrate adjacent tissues and form distant
metastases
 Usually metastasizes to lymph nodes in the neck and
then to distant sites, such as the lungs and liver
 Clinically, it usually is an exophytic ulcerative mass
 It can infiltrate and destroy bone
26

Squamous Cell Carcinoma (Cont.)
27
C, Courtesy Dr. Edward V. Zegarelli.

 Tumor cells invade connective tissue underlying
the epithelial basement membrane
 Well-differentiated tumors will show keratin
 Keratin pearl
28

 Occurs most often on the floor of the mouth,
ventrolateral tongue, soft palate, tonsillar pillar,
and retromolar areas
 May occur on the vermilion border of the lips
and skin of the face: These locations have a
better prognosis than SCC of the oral mucosa
29
Courtesy Dr. Edward V. Zegarelli.

 Solar cheilitis: A condition in which mild to
severe epithelial dysplasia occurs
 Avoid sun exposure
 Use a sun-blocking agent
30

Risk Factors for
 Tobacco
 Smoking: Cigar, cigarette, and pipe
 Snuff dipping
 Tobacco chewing
 Alcohol consumption
 Damage from ultraviolet rays
 Human papillomavirus (HPV)
31

Treatment and Prognosis for
 Generally is treated by surgical excision
 Radiation therapy or chemotherapy may also be used
 These patients may have xerostomia
 TNM staging may be used to determine the
prognosis
 The higher the stage, the worse the prognosis
32

TNM Staging System
33

Verrucous Carcinoma
 A slow-growing
exophytic tumor with a
pebbly red and white
surface
 A tumor with numerous
papillary epithelial
projections
34

Verrucous Carcinoma (Cont.)
 Papillary projections are filled
with keratin
 Epithelium is well
differentiated, does not
contain atypical cells, and
exhibits broad-based rete
pegs
 The tumor does not show
invasion through the
basement membrane
35

Basal Cell Carcinoma
 A malignant skin tumor
associated with excessive
exposure to the sun
 Frequently arises on the
skin of the face
 Appears as a nonhealing
ulcer with characteristic
rolled borders
 Most cases in white adults
with no sex predilection
36

Basal Cell Carcinoma (Cont.)
 Microscopic
 Composed of basal cells derived from squamous
epithelium
 A proliferation of basal cells into underlying
connective tissue
 Treatment
 Radiation therapy may be used to treat large lesions
 Rarely metastasizes
37

Learning Objectives
Lesson 7.2: Salivary Gland
and Odontogenic Tumors
6. Define each of the following salivary gland
tumors, describe the clinical features of
each, and explain how they are treated:
pleomorphic adenoma, monomorphic
adenoma, mucoepidermoid carcinoma, and
adenoid cystic carcinoma.
38

7. Define each of the following odontogenic tumors,
describe the clinical features of each, and explain
how they are treated: ameloblastoma, calcifying
epithelial odontogenic tumor, adenomatoid
odontogenic tumor, calcifying cystic odontogenic
tumor, odontogenic myxoma, central cementifying
and ossifying fibromas, benign cementoblastoma,
ameloblastic fibroma, ameloblastic fibro-
odontoma, and odontoma.
39
Learning Objectives
Lesson 7.2: Salivary Gland
and Odontogenic Tumors (Cont.)

Salivary Gland Tumors
 Pleomorphic adenoma
 Monomorphic adenoma
 Adenoid cystic carcinoma (cylindroma)
 Mucoepidermoid carcinoma
40

Salivary Gland Tumors (Cont.)
 May arise in either major or minor salivary
glands
 Minor salivary gland tumors are most often located
at the junction of the hard and soft palate
 Adenomas
 Benign tumors of salivary glands
41

Salivary Gland Tumors (Cont.)
42

Pleomorphic Adenoma
(Benign Mixed Tumor)
 A benign salivary gland tumor
 90% of all salivary gland tumors
 The most common extraoral location is the
parotid gland; the most common intraoral
location is the palate
43

Pleomorphic Adenoma
(Benign Mixed Tumor) (Cont.)
44

Pleomorphic Adenoma (Cont.)
 Clinically
 Appears as a slowly enlarging, nonulcerated,
painless, dome-shaped mass
 Treatment
 Recurrence rates vary; they are related to the
success of the initial surgical removal
 Lesions have been known to undergo malignant
transformation
45

Monomorphic Adenoma
 A benign encapsulated salivary gland tumor
 A uniform pattern of epithelial cells
 Occurs most commonly in adult females
 Occurs most often in the upper lip and buccal
mucosa
46

Monomorphic Adenoma:
Warthin Tumor
 An encapsulated tumor with epithelial and
lymphoid tissue
 A painless, soft, compressible or fluctuant mass
 Usually occurs on the parotid gland, rarely intraorally
 Occurs predominantly in adult men
47

Mucoepidermoid Carcinoma
 A malignant salivary gland tumor
 Unencapsulated, infiltrating tumor
 Major gland tumors are most often found in the
parotid gland, minor gland tumors on the palate
 Appear clinically as slowly enlarging masses
48

Mucoepidermoid Carcinoma (Cont.)
 A combination of mucus cells interspersed with
squamous-like epithelial cells called epidermoid
cells
 May appear in bone as either a unilocular or
multilocular radiolucency
49

Mucoepidermoid Carcinoma (Cont.)
 May occur over a wide age range
 Usually occurs in adults, but is the most common
malignant salivary gland tumor in children
 Occurs most often in females
 Treatment
50

Adenoid Cystic Carcinoma
(Cylindroma)
 A slow-growing malignant tumor of either major
or minor salivary gland tissue
 May be ulcerated and painful
 Most common site: Parotid gland
51

Adenoid Cystic Carcinoma
(Cylindroma) (Cont.)
 Microscopic
 Unencapsulated, infiltrates
surrounding tissue
 Small, deeply staining,
uniform epithelial cells that
resemble “Swiss cheese”
 Treatment
52

Other Malignant Salivary Gland Tumors
 Polymorphous low-grade adenocarcinoma
 Acinic cell adenocarcinoma
 Other adenocarcinomas
53

Odontogenic Tumors
 Epithelial odontogenic tumors
 Mesenchymal odontogenic tumors
 Mixed odontogenic tumors
 Peripheral odontogenic tumors
54

Odontogenic Tumors (Cont.)
55

Odontogenic Tumors (Cont.)
 Derived from tooth-forming tissues
 They may be composed of epithelium,
mesenchyme, or a combination of both
 Most are benign, but rare malignant forms exist
56

Epithelial Odontogenic Tumors
 Ameloblastoma
 Calcifying epithelial odontogenic tumor (CEOT)
 Adenomatoid odontogenic tumor
 Calcifying odontogenic cyst
57

Ameloblastoma
 A benign, slow-growing but locally aggressive
epithelial odontogenic tumor
 May occur in either mandible or maxilla, most
often in the mandible in the molar or ramus area
 Unencapsulated, infiltrates into surrounding
tissue
58

Ameloblastoma (Cont.)
 Composed of ameloblast-like epithelial cells
surrounding areas resembling stellate reticulum
59

Ameloblastoma (Cont.)
 Radiographic
 A multilocular soap bubble–
like or honeycombed
radiolucency
 May occur anywhere within
the jaws; can occur in
association with a
dentigerous cyst
 May cause bone expansion
 Treatment
 Surgical removal
 Recurrence is common
60

Calcifying Epithelial
Odontogenic Tumor
 A benign epithelial
odontogenic tumor
 Composed of islands
and sheets of polyhedral
epithelial cells
 Amyloid-like material is
seen with calcifications
within the deposits
 Most often affects
adults, with no sex
predilection
61

Calcifying Epithelial
Odontogenic Tumor (Cont.)
 Radiographic
 A unilocular or multilocular
radiolucency
 Occurs more often in
mandible than maxilla,
and most often in the
bicuspid and molar area
 Treatment: Surgical
excision
62

Adenomatoid Odontogenic
Tumor (AOT)
 An encapsulated, benign
epithelial odontogenic
tumor
 70% occur in females
less than age 20
 70% involve the anterior
portion of the jaws
 More common in maxilla
than in mandible
 Many are associated with
impacted teeth
63

 The tumor is surrounded by a dense, fibrous
connective tissue capsule
 Consists of ductlike structures, whorls, and large
masses of cuboidal and spindle-shaped
epithelial cells
64
Tumor (AOT) (Cont.)

 Radiographic
 A well-circumscribed radiolucency; may have
radiopaque areas
 Treatment
 Enucleation
65
Tumor (AOT) (Cont.)

Calcifying Odontogenic Cyst
 A nonaggressive cystic
lesion lined by
odontogenic epithelium
 Most commonly seen in
individuals under 40
years old
 Radiographic
 Usually a well-defined
lesion
 May be either unilocular
or multilocular
 May have calcifications
66

Calcifying Odontogenic Cyst (Cont.)
 Has an associated, characteristic ghost cell
keratinization
 Ghost cells are round structures with clear centers
 Treatment
 Surgical enucleation
 Usually does not recur
67

Mesenchymal Odontogenic Tumors
 Odontogenic myxoma
 Central cementifying and ossifying fibromas
 Benign cementoblastoma
68

Odontogenic Myxoma
 A benign nonencapsulated
infiltrating tumor
 Most often occurs in young
people age 10 and 29
 No sex predilection
 Radiographic
 A multilocular, honeycombed
radiolucency with poorly
defined margins
 May become large and
displace teeth
 Most often occurs in the
mandible
69

Odontogenic Myxoma (Cont.)
 Composed of pale-staining mucopolysaccharide
ground substance containing dispersed cells
with long cytoplasmic processes
 Treatment
 May recur
70

Central Cementifying and Central
Ossifying Fibromas
 A benign well-circumscribed
tumor
 Usually occurs in adults in the
third and fourth decades
 Occurs in females more often
than in males
 Most cases occur in the
mandible
 Radiographic
 Varies from radiolucent to
radiopaque depending on the
amount of calcified tissue
71

Central Cementifying and Central
Ossifying Fibromas (Cont.)
 Contains fibrous connective
tissue and calcifications
 Treatment
 Recurrence is rare
72

Benign Cementoblastoma
 A cementum-producing
lesion
 Radiographic
 A well-defined
radiopaque mass with a
surrounding radiolucent
halo
 Treatment
 Enucleation of the tumor
and removal of the
involved tooth
 Does not recur
73

Mixed Odontogenic Tumors
 Ameloblastic fibroma
 Ameloblastic fibro-odontoma
 Odontoma
74

Ameloblastic Fibroma
 A benign, nonencapsulated odontogenic tumor
 Occurs in young children and young adults
 Occurs more often in males
 Most commonly in the mandibular bicuspid and
molar region
75

Ameloblastic Fibroma (Cont.)
 Composed of both strands and small islands of
odontogenic epithelium and tissue that
resembles the dental papilla
76

Ameloblastic Fibroma (Cont.)
 Radiographic
 Well-defined or poorly defined unilocular or
multilocular radiolucency
 Treatment
 Low recurrence rate
77

Ameloblastic Fibro-odontoma
 A benign odontogenic tumor
 Has features of an ameloblastic fibroma and an
odontoma
 Most cases in young adults, with an average age of
10 years
 Typically arises in posterior jaws
78

Ameloblastic Fibro-odontoma (Cont.)
 Radiographic
 A well-delineated radiolucent lesion
 May be unilocular or multilocular
 Calcifications are noted within the radiolucency
 Treatment
 Conservative surgical excision
 Recurrence is unusual
79

Odontogenic Tumor: Odontoma
 Compound
 A mass that resembles teeth
 Usually located in anterior
maxilla
 Complex
 A mass that does not
resemble teeth
 Usually located in posterior
mandible
Compound odontoma
80

Odontogenic Tumor: Odontoma (Cont.)
 Most are found in adolescents and young adults
 Clinical manifestation: Failure of tooth to erupt
Complex odontoma
81

Learning Objectives
Lesson 7.3: Peripheral Odontogenic, Bone,
Cartilage, and Metastatic Tumors
8. Define each of the following peripheral
odontogenic tumors, describe the clinical features
of each, and explain how they are treated: lipoma,
neurofibroma, schwannoma, granular cell tumor,
congenital epulis, rhabdomyosarcoma,
hemangioma (benign vascular malformation),
lymphangioma, and Kaposi sarcoma.
9. Define each of the following tumors of melanin-
producing cells, describe the clinical features of
each, and explain how they are treated:
melanocytic nevi and melanoma.
82

10. Define each of the following tumors of bone and
cartilage, describe the clinical features of each,
and explain how they are treated: osteoma,
osteosarcoma, chondrosarcoma, leukemia,
lymphoma, and multiple myeloma.
11. Describe metastatic tumors.
83
Learning Objectives
Lesson 7.3: Peripheral Odontogenic, Bone,
Cartilage, and Metastatic Tumors (Cont.)

Peripheral Odontogenic Tumors
 Peripheral ossifying fibroma
 Other peripheral odontogenic tumors
84

Peripheral Ossifying Fibroma
 A well-demarcated
sessile or pedunculated
lesion
 Most likely derived from
cells of the periodontal
ligament
 More common in
females than in males
 Often occurs in young
individuals
85
From Neville BW, Damm DD, Allen CM, et al: Oral and maxillofacial pathology, ed 4,
St. Louis, Elsevier, 2016.

Peripheral Ossifying Fibroma (Cont.)
 Composed of cellular fibrous connective tissue
interspersed with scattered bone and
cementum-like calcifications
86

Tumors of Soft Tissue
 Lipoma
 Tumors of nerve tissue
 Tumors of muscle
 Vascular tumors
87

Lipoma
 A benign tumor of mature
fat cells
 Clinically: A yellowish mass
surrounded by a thin layer
of epithelium
 Most commonly located on
the buccal mucosa and the
vestibule
 Most occur in individuals
over age 40
88

Lipoma (Cont.)
 Microscopic
 A well-delineated tumor with mature fat cells uniform
in size and shape
89

Tumors of Nerve Tissue
 Neurofibroma and schwannoma
 Granular cell tumor
 Congenital epulis
90

Neurofibroma and Schwannoma
 Benign tumors derived
from Schwann cells in
nerve tissue
 The tongue is the
most common
intraoral location
 May occur at any age,
with no sex
predilection
 Neurofibromatosis of
von Recklinghausen
91

Neurofibroma and Schwannoma (Cont.)
 Neurofibroma
 A fairly well-delineated, diffuse proliferation of spindle-
shaped Schwann cells
 Schwannoma
 Spindle-shaped Schwann cells arranged in palisaded
whorls around a central pink zone
 It is surrounded by a connective tissue capsule
92

Granular Cell Tumor
 A benign tumor
composed of large cells
with a granular cytoplasm
 Most often occurs on the
tongue, followed by the
buccal mucosa
 A painless, nonulcerated
nodule
 Most are found in adults,
with a female sex
predilection
93
Courtesy Dr. Sidney Eisig.

Granular Cell Tumor (Cont.)
 Most likely arises from neural or primitive
mesenchymal cells
 Large oval cells with a granular cytoplasm
94

Congenital Epulis
 A benign neoplasm composed of cells closely
resembling those seen in the granular cell tumor
 Most likely arises from primitive mesenchymal
cells
 Appears as a sessile or pedunculated mass on
the gingiva
 Usually occurs on the anterior maxillary gingiva
 Almost always occurs in girls
95

Tumors of Muscle
 Extremely uncommon in the oral cavity
 Vascular leiomyomas
 Rhabdomyoma
• A benign tumor of striated muscle
 Leiomyoma
• A benign tumor of smooth muscle
96

Tumors of Muscle (Cont.)
 Rhabdomyosarcoma
 A malignant tumor of striated muscle
 The most common malignant soft tissue tumor of the
head and neck in children
 Typically occurs in children under 10 years of age
 Has a male sex predilection
 A rapidly growing, destructive tumor
 Treatment
 Multidrug chemotherapy, radiation therapy, and
surgery
 Poor prognosis
97

Vascular Tumors
 Hemangioma
 Lymphangioma
 Malignant vascular tumors
98

Hemangioma
 A benign proliferation of capillaries
 Capillary hemangioma: Contains numerous
small capillaries
 Cavernous hemangioma: Contains larger blood
vessels
99

Hemangioma (Cont.)
 Most are present at birth or
arise shortly thereafter
 More than half occur in the
head and neck area
 The tongue is the most
common intraoral location
 More common in females
 May occur in adults in
response to trauma
 Frequently blanch when
pressure is applied
100

Hemangioma (Cont.)
 Treatment
 Many undergo spontaneous remission
 Treatment is variable, includes surgery or the
injection of a sclerosing solution
101

Lymphangioma
 A benign tumor of lymphatic vessels
 Most are present at birth
 Half arise in the head and neck area
 Intraorally, the most common location is the tongue,
where it is an ill-defined mass with a pebbly surface
 A cystic lymphangioma in the neck is a cystic
hygroma
 Treatment
 Tend to recur
102

Malignant Vascular Tumors
 Angiosarcoma may occur in the oral cavity, but it
is rare
 Kaposi sarcoma may arise in multiple sites,
including the skin and oral mucosa
 It was historically seen in older men
 A more aggressive form has arisen with HIV
103

Malignant Vascular Tumors (Cont.)
 Kaposi sarcoma and HIV
 Lesions are often seen in the oral cavity as purple
macules, plaques, or exophytic tumors
 Most commonly located on the hard palate and gingiva
 May also occur in patients with other forms of
immunodeficiency
 Caused by a human herpesvirus (HHV-8; also called
Kaposi sarcoma–associated herpesvirus [KSAH])
 Treatment
 Radiation therapy
 Combination of both
104

Tumors of Melanin-Producing Cells
 Melanotic nevi
 Malignant melanoma
105

Melanocytic Nevus
 Nevus may refer to either a
developmental tumor of
melanocytes or a pigmented
congenital lesion
 Can arise on the skin or the
oral mucosa
 Intraoral tumors consist of
tan-to-brown macules or
papules
 Occur most often on the hard
palate or buccal mucosa
106

Melanocytic Nevus (Cont.)
 Occur twice as often in women as men
 Usually first identified in individuals between 20
and 50 years old
 Most are benign; some may be malignant
 Treatment
 Biopsy
 Recurrence is rare
107

Malignant Melanoma
 A malignant tumor of
melanocytes
 Most arise on the skin in
response to prolonged exposure
to sunlight
 Primary malignant melanoma is
rare, but melanomas on skin may
metastasize to oral cavity
 Usually a rapidly enlarging blue-
to-black mass
 An aggressive tumor with
unpredictable behavior and early
metastasis
108

Malignant Melanoma (Cont.)
 Most common intraoral locations are the palate
and maxillary gingiva
 Usually occur in adults over 40 years of age
 Treatment
 Chemotherapy may be used along with surgery
 Poor prognosis
109

Tumors of Bone and Cartilage
 Osteoma
 Osteosarcoma
 Tumors of cartilage
110

Osteoma
 An asymptomatic benign tumor composed of
benign compact bone
 Radiographic
• Appears as either a sharply delineated radiopaque
mass within bone or attached to the outer surface
of bone
 A component of Gardner syndrome
 Treatment
 Does not recur
111

Osteoma (Cont.)
112
Courtesy Dr, Sidney Eisig.

Osteosarcoma (Osteogenic Sarcoma)
 A malignant tumor of bone-forming tissue
 The most common primary malignant tumor of
bone in patients less than 40 years of age
 The average age of patients with osteosarcoma
involving the jaws is about 37 years
 Occurs twice as frequently in mandible as maxilla
 More common in males
113

Osteosarcoma (Osteogenic Sarcoma) (Cont.)
 Radiographic
 May vary from radiolucent
to radiopaque
 Usually a destructive,
poorly defined lesion
 May or may not involve
adjacent soft tissue
 Asymmetric widening of
the periodontal ligament
space, and a “sunburst”
pattern may be seen
114

 Treatment
 Preoperative multiagent chemotherapy followed by
surgery
 Jaw tumors frequently recur
115
Osteosarcoma (Osteogenic Sarcoma) (Cont.)

Tumors of Cartilage
 Chondroma: A benign tumor of cartilage
 Chondrosarcoma: A malignant tumor of cartilage
 Treatment of chondrosarcomas
 Wide surgical excision
 Poor prognosis
116

Tumors of Cartilage (Cont.)
117

Tumors of Blood-Forming Tissues
 Leukemia
 Lymphoma
 Multiple myeloma
118

Leukemia
 A broad group of disorders characterized by an
overproduction of atypical white blood cells
 The types of leukemia seen are classified
according to the kinds of cells that are proliferating
 Myelocytes, lymphocytes, or monocytes
119
Courtesy Dr, Edward V. Zegarelli.

Leukemia (Cont.)
 Acute leukemia is most common in children and
young adults
 Characterized by a proliferation of immature white
blood cells
 Chronic leukemia most frequently occurs in
middle-aged adults
 Characterized by excess proliferation of mature white
blood cells
 Treatment
 Chemotherapy, radiation therapy, and corticosteroids
 Prognosis depends on the type and extent of disease
120

Lymphoma (Non-Hodgkin Lymphoma)
 A malignant tumor of lymphoid tissue
 Clinical presentation: Gradual enlargement of lymph
nodes
 The most common intraoral location is the tonsils
 Usually occurs in adults
 More common in males than in females
 Treatment
 Radiotherapy, surgery, chemotherapy, or a
combination of these therapies
121

Multiple Myeloma
 A systematic, malignant proliferation of plasma
cells
 Causes destructive lesions in bone
 Most patients are older than 40 years; occurs most
commonly in the seventh decade of life
 Males are affected more often than females
 Patients usually experience bone pain and swelling
122

Multiple Myeloma (Cont.)
 Radiographic
 Multiple radiolucent lesions
 The mandible is affected more often than the maxilla
 Most patients have an elevation of a single type of
immunoglobulin, called a monoclonal spike
 Patients may have fragments of immunoglobulins
in their urine known as Bence Jones proteins
 An extramedullary plasmacytoma is a localized
tumor of plasma cells in soft tissue
 Treatment
 Chemotherapy and radiation
 Poor prognosis
123

Metastatic Tumors
 Metastatic tumors from primary sites elsewhere in
the body are rare
 Most tumors arise from the thyroid, breast, lungs,
prostate gland, and kidneys
 The most frequent intraoral site for metastatic
tumors is the mandible
 Patients may experience pain, paresthesia or
anesthesia of the lip, swelling, expansion of the
affected bone, and loosening of teeth in the affected
area
 Most patients are adults
 Males are affected more often than females
124

Metastatic Tumors (Cont.)
 Radiographic
 Lesions are usually poorly defined and radiolucent
 Roots of involved teeth may show a spiked
appearance
 Some tumors may form bone and be radiopaque
 Treatment
 Chemotherapy and radiation therapy
 The prognosis for patients with tumors that have
metastasized to the jaws is poor
125

Metastatic Tumors (Cont.)
126

Questions?
127

Neoplasia.pptx

Recommended

Recommended

More Related Content

Similar to Neoplasia.pptx

Similar to Neoplasia.pptx (16)

Recently uploaded

Recently uploaded (20)

Neoplasia.pptx

Editor's Notes