Malignant epithelial tumors iii/prosthodontic courses

MALIGNANT TUMORS OF THE
EPITHELIAL TISSUE ORIGION
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

BASALOID SQUAMOUS CELL CARCINOMA
• A form of carcinoma with a mixed composition of
basaloid and squamous cells.
• This is a form of oral carcinoma in which the
basaloid component comprises small cells with
hyperchromatic nuclei and scant cytoplasm that
are crowded together into lobulated sheets or
strands focally connected to the surface
epithelium.

Basaloid squamous cell carcinoma-
Low power view
Basaloid squamous cell carcinoma-
High power view

ADENOSQUAMOUS CARCINOMA
 A malignant tumor with histological features of both
adenocarcinoma and squamous cell carcinoma.
 The tumor arise from ducts of minor salivary glands
or from the overlying surface epithelium.
 Comprise glandular structures lined by basaloid,
columnar or mucin secreting cells.

• The components identified as squamous cell
carcinoma may be in situ or invasive, and the
adenocarcinomatous component comprises
glandular structures lined by basaloid, columar or
mucin secreting cells.

LYMPHOEPITHELIOMA AND TRANSITIONAL CELL
CARCINOMA
• These are unusual group of tumors exhibiting
many features in common which involves
nasopharynx, oropharynx, tongue, tonsil and
anatomically associated structures.
• These tumors arise from the mucosa of these
areas.
• Occurs in young or middle-aged persons.

CLINICAL FEATURES:
 Primary lesion is very small, slightly elevated, and
either frankly ulcerated or presenting a granular,
eroded surface.
 The tumor is indurated, often exophytic.
 Common presenting symptom was swelling of
lymph nodes, followed by sore throat, nasal
obstruction, defective hearing or ear pain,
dysphagia, headache, ocular symptoms.

HISTOLOGIC FEATURES:
 Consists of cells growing in solid sheets or in cords and
nests. Individual cells are large, round or polyhedral,
exhibit lightly basophilic cytoplasm and indistinct cell
outlines.
 Nuclei appear large and round, exhibit varying degrees
of mitotic activity.
 Made up of cells growing in a syncytical pattern with
the stroma infiltrated by varying numbers of
lymphocytes.

 Because of general inaccessibility, x-ray
radiation has been the most commonly
accepted treatment.
Treatment and prognosis:

NASOPHARYNGEAL CARCINOMA
 Tumor of nasopharynx involving squamous
epithelium, malignant in nature, prevalent in parts
of south china.
 The most undifferentiated form of tumor is always
associated with EBV, whereas the differentiated
form are not consistently so.

CLINICAL FEATURES:
 NPC has proven to have a genetic background mainly
restricted to south china, intermediate frequency in
some Negro and Mongoloid races and rare in
Causasians.
 Environmental and genetic factors are involved.
 Environmental factors that are thought to play a role
are, consumption of salted fish and food containing
nitrosamines.
 EBV associated undifferentiated type arises in young
patients and differentiated type in older patients.
 Most commonly arises in the posterior wall of
nasopharynx and metastases to the lymph nodes.

Three types are recognized:
• Well differentiated squamous cell carcinoma.
• Nonkeratinizing carcinoma.
• Undifferentiated carcinoma
Histologic features:

Treatment:
• Difficult to surgically excise.
• Radiotherapy is the treatment of choice.

MELANOMA
• Neoplasm of epidermal melanocytes.
• It is one of the more biologically unpredictable and
deadly of all human neoplasms.
• It is the third most common cancer of the skin.
• Cutaneous melanomas are increasing in incidence.

• Among dark skinned ethics it 1 per 100,000 and in
light-skinned upto 50 and higher in some areas of
the world.
• Melanoma may occur or near a previously existing
precursor lesion or in healthy appearing skin.

Malignant melanoma-large
black exophytic mass
Malignant melanoma-large pigmented
area of ulceration of hard palate

ETIOLOGY OF MALIGNANT MELANOMA:
• A) environmental factors:
 Sun exposure
 Artificial UV sources
 Socioeconomic status
 Fair skin, freckles and red hair
 Number of melanocytic nevi
. B) genetic factors:
 Familial melanoma
 Xeroderma pigmentosum

CLINICAL FEATURES:
 Superficial spreading melanoma:
 Common cutaneous melanoma in Caucasians.
 Exists in a radial-growth phase called premalignant
melanosis or pagetoid melanoma in situ.
 The lesion presents as a tan, brown, black or admixed
lesion on sun exposed skin, especially the back.
 The vertical growth phase is characterized by an
increase in size, change in color, nodularity,
ulceration.

NODULAR MELANOMA:
 Accounts for approximately 13 percent of cutaneous
melanomas.
 No clinically recognizable radial-phase growth, exists
solely in vertical-growth phase.
 They may be pink (amelanotic melanoma) or black.
 Predilection for back and head and neck skin of men.

LENTIGO MALIGNA MELANOMA:
 Accounts for 10 per cent of cutaneous melanomas.
 Exists in a radial-growth phase known as lentigo
maligna or melanotic freckle of Hutchinson.
 Shows female predilection.
 The lesions occurs characteristically as a macular
lesion on the malar skin of the middle aged and
elderly Caucasians.

ACRAL LENTIGINOUS MELANOMAS:
 Melanoma developing on the palms and soles, fingers
and toes.
 Represents 10% of cases in whites.
 The tumor is characterized by macular, lentiginous
pigmented area around a nodule.
 They are extremely aggressive, with rapid progression
from the radial to vertical growth phase.

MUCOSAL LENTIGINOUS MELANOMAS:
 Develop from mucosal epithelium that lines the
respiratory, gastrointestinal and genitourinary
systems.
 Noncutaneous melanomas are common in older
age.
 Lentigo melanomas have aggressive course.
• AMELANOTIC MELANOMAS
Seen as erythematous or pink, eroded nodule.

Diagnostic Criteria For MELANOMA (ABCDE-RULE)
• Asymmetry
• Border irregularity
• Color irregularity
• Diameter
• Elevation

ORAL MANIFESTATIONS:
• Primary oral melanoma twice as common in men as in
women.
• Is range between 40-70 years.
• Predilection for palate and maxillary alveolar ridge.
• Appears as deeply pigmented areas.
• Ulcerated and hemorrhagic.
• Increase in size progressively.

HISTOLOGIC FEATURES:
• The malignant cells often nest or cluster in groups in
an organoid fashion.
• The melanoma cells have large nuclei, prominent
nucleoli, nuclear pseudoinclusion.
• Eosinophillic cytoplasm.
• Large epitheloid melanocytes.

Malignant melanoma-pagetoid group
of tumor cells are present in suprabasal
epithelium
Pleomorphic, hyperchromatic
melanocytes withsheets of
pigmented spindle cells

• The radial growth phase of superficial spreading
melanoma is characterized by the presence of
large epithelioid melanocytes distributed in a so
called pagetoid manner.
• The vertical growth phase is characterized by the
proliferation of malignant epithelioid melanocytes
in the underlying connective tissues.

NODULAR MELANOMA-
• Characterized by large epithelioid melanocytes
within the connective tissue.
• Melanin pigment is usually but not invariably
present.
LENTIGO MALIGNA-
• Characterized by increased numbers of atypical
melanocytes in the basal epithelial layer.
• The epithelium is generally atrophic and the
dermal collagen shows the effects of sun damage.

Lentigo maligna-The epithelium has the typical honeycomb
appearance with neoplastic melanocytes

• Lentigo maligna melanoma-
• Characterized by invasive spindle shaped cells into
the underlying dermis.
• A lymphohistiocytic infiltrate is usually present.

TREATMENT AND PROGNOSIS:
• Surgical excision
• X-ray
• Immunotherapy
• Chemotherapy

Malignant epithelial tumors iii/prosthodontic courses

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