2. Learning Outcomes
What is the importance of studying oral malignant
neoplasms???
What is the difference between oral benign
neoplasms and malignant neoplasms???
Listing different types of oral malignant
neoplasms???????
Identify the pathogenesis of oral malignant
neoplasms???????
Diagnose independently & accurately different
malignant neoplasms depending on clinical,
radiographic and microscopic features?????????
How could we difference between benign neoplasms
and malignant neoplasms under microscope??????
5. Metastasis
In C.T the dysplastic epith cells invade :
lymph. Vessels and blood vessels
6. Classification of malignant tumors
Carcinoma Sarcomas
(Epith origin) ( C.T origin)
Old age young age
Lymph metastasis blood metastasis
Better prognosis. Poor prognosis
8. Squamous cell carcinomas
Most common oral cancer
Origin is from stem cells (undifferentiated cells)
Aetiology
Unknown ,
several risk factors:
Tobacco
Alcohol
Viruses
Sun light
9. 1-Tobacco
Most imp. risk factor
Risk for OSCC is 5-10 times
more in cigarette smokers
than in non smokers
Etiology
10. Smoked tobacco - Smokless tobacco - Reverse smoking
Cigarettes causes:
(lung cancer)
Cigar & pipe
causes:
(lip and palate
cancer)
Causes palatal cancer
Causes cancer of
buccal mucosa
11. 2-Alcohol
- Alcohol increases permeability of oral mucosa &
dries it, so it makes it more susceptible to
carcinogens
- Alcohol Liver cirrhosis improper
detoxification of carcinogens present in tobacco
*Combination between alcohol and smoking is a
major risk factor (they act synergistically)
12. 3-Viruses cause cancer
(Oncogenic viruses)
HPV Verrucous carcinoma
EBV Nasopharyngeal carcinoma
Burkitt’s lymphoma
HHV 8 Kapos’s sarcoma
13. 4-Actinic radiation
Causes SCC of the lower lip
*Sun decreases
repair of DNA leading
to accumulation of
mutations
Ex. Xeroderma pigmentosa
17. Indurated or soft ulcer White patch Red patch
Speckled
Exophytic polypoid
Clinical appearance of invasive SCC
Exophytic
verrucous
18. Papillomatous growth.
Ulcerative growth: (crater-form shape)Q
non healing ulcer
1. Raised , rolled , everted edges…(due to
cells grows vertically & laterally)
2. Glazed margins…(due to in esterase
enzyme)
3. Papillomatous floor.
4. Bleeding base (due to invasion of malignant
cell into blood vessels)
5. Indurate base:- infiltration of surrounding
tissues by tumour - fibrosis).
6. Foul odour (due to necrosis at base).
19. Microscopic features
Well differentiated .
Moderately diff.
Poorly diff.
DIFFERENTIATION
If the tumor cells resemble the normal
cell in Shape……Arrangement…..Function so it is well
differentiated
20. Importance:
Assessment of the extent of the disease before treatment.
Selection of the most appropriate treatment.
Comparison of the end result reported from different source.
Staging of an individual lesion is determined by:
1. Size and extent of primary lesion.
2. Degree of infiltration by the primary lesion.
3. Presence or absence of metastasis to regional
lymph nodes.
4. Whether contralateral or epsilateral.
5. Whether or not the nodes are fixed.
6. Presence or absence of distant metastasis.
Clinical Staging of Cancer
21. TNM staging system (clinical staging)
T size o tumor T1 T2T3 T4
N regional lymph node metastasis
N0 no
N1 lymph node at same side
N2 fixed N3 LN at the opposite side
M distant metastasis
Mo no M1 distant metastasis
22. TNM staging system
(clinical staging)
Tis no invasion 100% cure
Stage 1 T1NoMo 64%
Stage II T2NoMo 55%
Stage III T3NoMo
T1N1Mo
T2N1Mo 33%
Stage IV T4NoMo
T4N1Mo
Any T N2 or3 Mo
Any T Any N M1 9%
23. Differentiation
To what extent does
Tumor cell resembles Normal cell
in
Shape arrangement function
Well differentiated . Moderately diff.
Poorly diff.
24. Broader ‘s classification
(Histological grading)
Grade I less than 25 % of cells are undifferentiated
Grade II from 25 -50 % ……………………………………..
Grade III from 50-75% ………………………………………
Grade IV more than 75% …………………………
25. Well diff. Scc
Keratin pearls
function
Individual cell
keratinization
Cell nests arrangement
Mild dysplasia
(very similar to normal)
shape
46. Hidden carcinoma of tongue
Deviation: Sight deviation of the tongue to the
affected side on protrusion: due to restricted
mobility of muscles due to tumor invasion.
Defect: Slight defect in speech.
Dimpling: Slight dimpling .
Defective surface: A minute ulcer on the surface.
Discharge: Bleeding from the surface with fetid
exudates.
Hardness: Indurations at the base.
47.
48. Second most common intra oral site
Elderly men who are heavy smokers and alcoholics
Ant. Part of the floor
Painless & appears as a typical malignant ulcer
Carcinoma of the floor of the
mouth
49. It may appear as a white or red patch
Wide infiltration to the surrounding tissues
causing decreased mobility to the tongue
Early metastasis to LNs is common
51. Most common in Indian population due to the habit of
smokless tobacco
Lesions occur along the occlusal line
Appear as a white patch or indurated nodule or non-
healing ulcer
Carcinoma of the buccal mucosa
52. Squamous cell carcinoma of the gingiva
Uncommon
They invade the
underlying bone
causing:
looseness of teeth with
Absence of periodontal
diseases
53. Extemely rare site
More common in Malizia, philippine where reverse smoking habit
Appear white or red plaques or ulcer,
Palatal carcinoma have poor prognosis : Most are high grade
invading deep into the surrounding structures
spread early to regional LNs
Carcinoma of the palate
54. Carcinoma of Maxillary Sinus
As neoplasm spreads locally it affects various walls
of the antrum:
If floor of antrum affect oral structures & loosening
of maxillary molars.
If medial wall of the antnum nasal obstruction &
nasal discharge.
If superior wall (roof) eye displacement occurs.
If lateral wall bulging of the cheek.
????Metastasis: occurs late to submandibular and
cervical LN.
55.
56.
57.
58.
59. Blunt rete
ridges that
push down and
do not invade
Keratin
plugs
Basement
membrane
appears
intact
Verrucous
carcinoma
64. It may heal for a short period,
but only to break down again
Does not metastasize but may kill the person by
excessive local detruction
It has good prognosis if ttt early
Rodent
ulcer
65. Histopathology
C.T is invaded by nests or islands of
epith. Cells.
The periphery of the tumor islands
are composed of layer of palisaded
cells that resembles the basal cell
layer of the skin
Centra cells are polyhydral cells
having large deeply stained nuclei
and some mitotic figures
Basal cells are pluripotential cells
forming hair, sebaceous glands
sweat glands or squamous epith
and k.
67. Very important
@Scc has raised everted edges while
@basal cell carcinoma has raised
inverted edges
68. Maxilla, alveolar ridge and palate
*enlarged pigmented
area,....ulcerate, bleed easily
surrounded by an erythematous zone
Borders are irregular & often notched
Colour variation
**metastasis local LN and distant to
lung and liver.
Oral melanoma is more aggressive
than cutaneous due to more and easily
infiltration of BV and lymphatics
Malignant Melanoma
69.
70. The ABCDEs of melanoma recognition are:
A: asymmetry, (Benign nevi are roughly
symmetric)
B: border irregularity, (Benign common nevi are
regular and well demarcated from normal skin)
C: color variegation, (Benign common nevi are
uniform in color throughout and may be tan,
brown, black, or blue.)
D: diameter enlargement.
E: elevation.
Early melanoma signs: A darkening in color and
an elevation of the surface.
Late melanoma signs: ulceration, bleeding, or
induration.
71. Closely packed (A typical
melanocytes) arranged
in an alveolar pattern
reaching deep in to the
C.T.
Mitotic activity
presence of melanin
may or may not be
prominent.
Nuclear pleomorphism
hyperchormatism.
Histopathology of Malignant Melanoma
85. Chondrosarcoma
Arises from mesenchymal stem cells
Stem cells undergoes partial differentiation to form
chondrosarcoma
Rare in the oral cavity due to scarce cartilage
Site ant part of maxilla
remnants of meckle
cartilage
Age older than 30 y
86. Firm, expanding swelling,
however, pain may be the
presenting complains as it is
dull aching in character).
Mucosa is often intact.
Loosening of teeth or ill-
fitting dentures.
Lesions metastasize early.
Chondrosarcoma
88. Histopathology (v.imp)
Difficult to diff. from chondroma
Highly cellular
Cells are usually
binucleated
Lacunae contain
more than two cells
Pleomorphism
Hyperchromatism
91. Clinically
Occurs in the body of the mandible
Children and young adults
Painful swelling……..looseneess of teeth
mucosa ulcerates
leucocytosis & fever and raised ESR and anemia
92. Ill defined radiolucency with resorbed
roots and displaced teeth
(Onion skin …..subperiosteal bone
reaction)
93. Ewing’s sarcoma
Histopathology :
Cells resemble lymphocytes,
but are larger
Intracellular glycogen is
noticed
cells are in lobules or sheets
