Malignant Lesions in Oral Cavitry

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Malignant lesions in oral
cavity
Malignant lesions in oral cavity
Scientific Seminar on

2. Dr. Ashraful Arifin
Honorary Medical Officer
Department of Oral and Maxillofacial Surgery
Dhaka Medical College and Hospital.

3. Introduction
• WHO - carcinoma of oral cavity in males in developing countries
is the sixth most common cancer after lung,
prostate,colorectal, stomach and bladder cancer, while in
females, it is the tenth most common cancer

4. Squamous cell
carcinoma

5. Squamous Cell Carcinoma
• More than 95% of the carcinomas of oral cavity are of squamous
cell type, in nature.
• Tumor cells may resemble any or all of the layers of stratified
squamous epithelium.

6. Aetiology of OSCC
• Use of betel quid, areca nut,alcohol and tobacco
• Irritation of poorly fitting dentures
• Exposure to paint fumes , plastic by products, wood
dust, asbestos and gas line fumes
• EBV and HPV infection.

7. SCC cont'd
Most often characterised as
exophytic or ulcerative or a
combination of both
Exophytic lesions
• Less common, slower growing
• Less infiltrative.
• They can become deeply
infiltrative and invasive in
advanced cases.

8. SCC cont'd
Ulcerative lesions
• More common, slower growing
• Red or grayish ulcers with
heaped up edges that bleed
easily.
• Deeply infiltrative.

9. Clinical features of SCC
1
EarlyLesions
• Asymptomatic
• White or red patches
• Small and exophytic growth
2
Intermediate Lesions
• Persistant ulceration
• Induration
• Fixation underlying structures
• Lymph node enlargement
3
AdvancedLesions
• Hemorrhage or necrosis of
exophytic mass
• Destructive crater like ulcer
with raised or roled edges
• Pain, parasthesia
• Bone destruction, invasion ,
fracture
• Mobility of tooth

10. Histologic
Features
Graded from low to high by degree of keratinisation
, nuclear pleomorphism and frequency of mitoses
Low grade tumors
• Extensive keratinisation
• Frequent mitoses
• Little nuclear pleomorphism
• Maintain orientation from
basal to keratinised layer.
High- grade tumors
• Little keratin
• Many mitosis
• Extreme nuclear
pleomorphism

11. Histologic
Features
• Well Differentiated Presence
of keratin pearls, masses of
prickle cells within
connective tissue surrounded
by basal cell with central
keratinization (fig 1)

12. Histologic
Features
• Morderately differentiated
keratin pearls are spare or
absent, prickle cells are more
pleomorphic, atypical mitotic
figures (fig 2)

13. Histologic
Features
• Poorly differentiated No
keratin. Extreme pleomorphic .
Cells cannot be recognised as
keratinocytes .(fig 3)

14. Histologic variants
of Squamous cell
carcinoma

15. Basaloid Squamous
Cell Carcinoma
• Basaloid cells are arranged in
nests or cords with
pseudoglandular spaces
• Develop distant metastasis more
frequently.

16. Verrucous carcinoma
• Found in elderly who chew
tobacco or consume snuff
• Whitish , warty, bulky
cauliflower like growth with a
broad base
• Piled up in rugal folds with
deep cleft like spaces

17. Basal cell carcinoma

18. Clinical features of
BCC
• It affects facial skin
• More common in older age groups
• It does not metastatise
• Present as a nodule giving a
pearly appearance.

19. Histologic features of
BCC
• Clumps of cell lying as a
connective tissue stroma
• Clumps contain basophillic cells
which resemble immature cells of
basal cells of epidermis with a
peripheral layer of columnar cells
packed together surrounded by
basement membrane

20. Ewing's sarcoma
(Endothelial
myeloma)

21. Ewing's sarcoma
• ES occurs as a primary destructive lesion of bone that most
commonly involves the pelvis and lower extremities.
• Uncommon malignant neoplasm

22. Clinical features of
Ewing's sarcoma
• Predominantly in children
and young adults
• Pain is of intermittent nature
• Swelling of involved bone
• Most commonly affected
bones are long bones of
extremeties.

23. Clinical features of
Ewing's
sarcoma(cont'd)
• The skull, clavicle, ribs, shoulder and
pelvic girdles may be involved as well
as maxilla and mandible
• When there is involvement of the
jaws , there is facial neuralgia and lip
paraesthesia
• Jaw swelling is often relatively rapid
and intraoral mass become ulcerated

24. Radiological features
of Ewing's sarcoma
• The lesion is destructive in
nature and produces diffuse
radiolucency in the bone.
• Formation of layers of new
subperiosteal bone producing
onion skin appearance.

25. Treatment of Ewing's sarcoma
• It has been common for metastatic foci to appear in other
bones and organs such as lungs and lymph nodes within a
matter of few weeks or months
• Integrated therapies are surgery, chemotherapy, radiotherapy

26. Osteosarcoma
• Osteosarcoma is a malignancy of mesenchymal cells that have the
ability to produce osteod or immature bone
• Most common primary neoplasm originating in the bone.

27. • Osteosarcoma is a malignancy of
mesenchymal cells that have the
ability to produce osteoid or
immature bone
• Most common primary neoplasm
originating in the bone.
Osteosarcoma

28. Radiographic features
of Osteosarcoma
• Vary from dense sclerosis to a mixed
sclerotic and radiolucent lesion to an
entirely radiolucent process
• Sunburst or sunray appearance caused
by osteophytic bone production
• Presence of widening of inferior dental
canal and Periodontal ligament.

29. Histopathologic
features of
Osteosarcoma
● Direct formation of
osteoid by malignant
mesenchymal cells

30. • Early radical excision, pre and post operative
radiotherapy adjuvent chemotherapy
Treatment of Osteosarcoma

31. Multiple myeloma
• multiple myeloma is a neoplasm of bone. it originates cellsplasma of
bone marrow.
• these cells resemble plasma cells which are common contituents of an
nflammary infiltrate.

32. • Multiple myeloma is a neoplasm of bone. It originates
from cells of bone marrow.
• These cells resemble plasma cells which are common
contituents of an inflammatory infiltrate.
Multiple myeloma

33. • Mostly in adults
• Pain as an early feature because of destruction of bone,
pathological fracture .
• Swelling over the areas of bone involvement
• Destruction of hematopietic bone marrow can result in
anaemia, fatigue, thrombocytopenia with purpura, epistaxis,
infection and fever due to leucopenia
Clinical features of
multiple myeloma

34. • Pain, swelling, expansion of the
jaw, numbness, abnormal healing
after extration, mandibular
fracture and mobility of teeth
• Extraosseous lesion occurs like
gingival enlargement or epulis
• Extension of the disease to the
lymph node ,skin and viscera.
Oral manifestations of
multiple myeloma

35. • Hyperglobulinaemia resulting in a reversal of the serum albumin
globulin ratioand an increase in total serumprotein 8-16 g%
• Presence of bence jones protein that coaulates when the urine is
heated to 40-60 °C
• Bence jones protein disappears when the urine is boiled and
reappeares, if cooled
• Anaemia is also a common finding
Laboratory features
of multiple myeloma

36. • Numerous sharply punched out
areas in numerous bones of active
haematopiesis like vetebrae, ribs,
skulls,jaws and ends of long
bones.
Radiographic features
of multiple myeloma

37. • Usually the lesion is composed of
sheets of closely packed cells
resembling plasma cells
• These are round or ovoid cells
with eccentrically placed nuclei.
Histological features
of multiple myeloma

38. • Chemotherapy is presently the treatment of choice for multiple
myeloma using alkylating agents such as melphalan or cyclophos,
in combination with prednisolone.
• Localised radiotherapy can be given for palliation of painful bone
lesions.
• Bone marrow transplant has been used for patients who do not
respond to chemotherapy
• Radiation therapy is also used, often in combination with
Treatment and prognosis of multiple
myeloma

39. Thank you.