Non epithelial lesions

1. Non-Epithelial Tumours
Of The Oral Cavity

2. FIBROSARCOMA
Composed of malignant fibroblasts in a
collagenous background.
Two main types of fibrosarcoma of bone exist,
primary and secondary.

3. Primary type produces variable amount of
collagen. It is central, arising within the
medullary canals and peripheral, arising
from the periosteum.
Secondary type arising from a pre existing
lesion or after radiotherapy to the area of
bone or soft tissues. This is more aggressive
tumour with poorer prognosis.

4. ETIOPATHOGENESIS
It has no definite cause.
It has also been noticed to arise from pre-existing
lesion, such as fibrous dysplasia, chronic
osteomyelitis, bone infarcts, paget’s disease and in
previously irradiated area of bone. These are very
aggressive and associated with the much poorer
outcome than the primary fibrosarcoma of the bone

5. CLINICAL FEATURES
Occur slightly more commonly in males.
Most common in fourth decade of life.
Commonly seen in lower extremities i.e. Femur and tibia.
In oral cavity tumour involves mandible, maxilla,
maxillary sinus, lip and palate.
Soft tissue sarcoma mostly present as painless masses
and may become extreme large prior to diagnose.
Sarcoma involving bones often present with pain and
swelling after a long duration of symptoms and also
causes pathologic fractures.

6. HISTOPATHOLOGICAL FEATURES
1. Well differentiated forms have multiple plump
fibroblasts with pale, eosinophilic cytoplasm and
deeply staining spindle nuclei, dispersed in a rich
collagenous background.
Normal mitotic figures are seen in small numbers
but cells and nuclei are not pleomorphic.
2. Intermediate grades are cellular and have the
typical herring comb pattern showing the diagnostic
parallel sheath of cells arranged in interwining whorls
with slight degree of cellular pleomorphism.

7. 3. High grade lesions are very cellular with
marked cellular atypia and mitotic activity. They
are extremely anaplastic, pleomorphic with
bizarre nuclei which brings them in the
differential diagnosis of malignant fibrosis
histiocytoma.

11. TREATMENT
Radical surgery
Radiotherapy is used in conjunction with
surgery for soft tissue fibrosarcomas.

12. EWINGS SARCOMA
Ewing sarcoma is a sarcoma of the bone,
classically described under small round cell
tumours.

13. CLINICAL FEATURES
 Predominantly occur in children and young adults.
 Male:Female is 2:1.
 An episode of trauma often precedes the development of the tumour.
 Intermittent pain and swelling are often the earliest clinical sign and
symptoms.
 The bones most commonly affected are the long bones of the
extremities, although skull, clavicle,ribs, and shoulder may be
involved as well as maxilla and mandible.
 The jaws were involved in 13%, most commonly affected mandible.
 Facial neuralgia,lip paresthesia and loosening of teeth have been
reported in cases of jaw involvement.
 Patient may have low grade fever and an elevated WBC count.

14. HISTOLOGICAL FEATURES
An extremely cellular neoplasm composed of solid sheets
or masses of small round cells with very little stroma.
Cells with scanty cytoplasm and relatively large round or
ovoid nuclei with dispersed chromatin and
hyperchromasia are seen, arranged in Filigree pattern.
Mitotic figures are common.
Haemorrhage with vascular lakes or sinuses may be
seen.
Increased cellular pleomorphism and increased number
of bizarre giant cells may be found in the lesions in
patients treated with radiation and adjuvant
chemotherapy.

16. TREATMENT
It is radiosensitive, but in the past radical
excision was done in the coupled with x ray
radiation.
Five year survival with the combination of
surgery and chemotherapy is good.

17. TORI
Tori are of two types i.e. Torus palatinus and torus
mandibularis.
TORUS PALATINUS
It is a slow growing,flat based bony protuberance
which occurs in midline of hard palate.

18. CLINICAL FEATURES
Women are affected more commonly.
Torus palatinus can occur at any age. It
reaches at its peak incidence at age of
30 years.
It is an outgrowth in the midline of
palate.
It has been classified clinically on the
basis as flat,spindle shaped, nodular or
lobular.
Mucosa overlying torus is intact and
occasionally it appears blanched.
It may become ulcerated if
traumatized.

19. TORUS MANDIBULARIS
It is a common exostosis that develops along the
lingual aspect of mandible.
As with torus palatinus, the mandibular tori is
probably multifactorial, including genetic and
environmental influences.
Studies shows that when one or both parents had
either type of torus , the frequency of occurrence in
children ranged between 40%-64%.
When neither parents had a torus ,the incidence in
the children was only 5-8%.

20. CLINICAL FEATURES
The mandibular tori is
present as a bony
protuberance along the
lingual aspect of the
mandible above the
mylohyoid line in the
region of premolars.
Mandibular tori is
bilateral.

21. TREATMENT
For both tori treatment is surgical excision.

22. THANK YOU