Malignant

diseases
Done by: FatimaFaisal Marhoon
20102050030

Disease mechanism
Uncontrolled

growth of tissue
Locally invasive
High degree of cellular anaplasia
Ability to metastasize regionally to lymph
node and distantly to other sites

Etiology of malignant diseases

Viruses
Radiation exposure
Exposure to carcinogenic chemicals
Genetic defects

Classifications of malignant tumors

Based of histopathology
Carcinoma (lesion of epithelial origin)
Metastatic lesion from distant sites
Sarcoma (lesions of mesenchymal origin)
Malignancies of hematopoietic system

Clinical features

Displaced teeth
Loosened teeth over a short time
Foul smell
Ulcerations
Presence of indurated or rolled border
Exposure of underlying bone
Hemorrhage
Sensorineural or sensorimotor deficits
Lymphoadenopathy
Weight loss
Dysgeusia
Dysphonia
Dysphagia
Lack of normal healing after oral surgery
Pain or rapid swelling with no obvious dental causes
Most oral cancers occur in men 50 years old and older

Applied diagnostic imaging

Aid in establishment of an initial diagnosis of a
tumor
Aid in the appropriate staging of the disease
Determine the anatomic spread of the tumor
Presence of osseous involvement from soft tissue
tumor
Assess the involvement of lymph nodes
Determine good biopsy sites
Assess treatment outcome
Management of patient who has survived cancer

Imaging modalities available

Intra oral images: provide the best image
resolution
Panoramic: provide an overall assessment of the
maxillofacial osseous structure
Cone beam computed tomograhy (CBCT) or
multidetector CT (MDCT): superior three
dimensional analysis of osseous structure
Positron emission tomographic (PET) imaging:
detecting abnormal cellular metabolic activity
Magnetic resonance imaging (MRI): provide 3D
soft tissue images of tumor

Imaging features
Location
Primary carcinoma: more common in tongue,
floor of the moth, tonsillar area, lip, soft palate,
or gingiva and may invade the jaws form any of
these sites
Sarcomas: mandible and posterior regions of
both jaws
Metastatic tumors: posterior mandible and
maxilla, apices of teeth or in the follicle of
developing teeth

Imaging features
Periphery and shape
Ill-defined borders with lack of cortication and
absent of encapsulation
Extend from an area of bone destruction to
region of normal bone (infiltrating pattern)
Finger like extensions

Imaging features
Internal structures
Radiolucent
Residual islands of bone might be present, patchy
destruction with residual internal osseous
structure
Some metastatic tumors (prostate and breast
lesions) abnormal appearing internal sclerotic
osseous architecture
Osteogenic sarcoma produce abnormal bone
radiopaque appearance

Imaging features
Effects on surrounding structure
Teeth appear floating in space
Root resorption (sarcomas, multiple myloma)
Destruction of internal trabecular bone
Destruction of cortical boundaries
Widening of PDL with destruction of lamina dura
Widening of ID canal
Hair one end or Sunburst appearance ,thin
straight spicules of bone (osteosarcoma; metastatic
prostate lesions)
Onion skin like appearance (secondary inflammatory
lesion)

Ill-defined borders
Infiltrating pattern

Destruction of cortical boundary

with soft tissue mass

Invasion and thickening of PD

membrane space
Multifocal lesion destroying crypt cortex
and displacing tooth occlusaly

Cortical bone destruction without

periosteal reaction
Laminated periosteal reaction with
cortical bone destruction and new
periosteal bone
Cortical bone destruction with
periosteal reaction at the periphery
forming Codmans triangle

Sunray periosteal reaction

Floating
teeth

Carcinomas
1.

SQUAMOUS CELL
CARCINOMA
ARISING IN SOFT
TISSUE

SQUAMOUS CELL CARCINOMA ARISING IN

SOFT TISSUE

Synonym
Epidermoid carcinoma

Disease mechanism
Most common oral malignancy
Malignant tumor originating from surface
epithelium
Etiology: Multifactorial; chronic smoking, alcohol,
mucosal human papillomavirues (tonsiliar and
tongue lesions)
Histopathology: invasion of malignant epithelial
cells into underlying connective tissue, deeper
soft tissue, adjacent bone, regional lymph nodes
and ultimately distant sites.

Clinical features
Most common in males older than 50 years
White, red or mixed patchy lesion
Central ulceration; a rolled or indurated border
Palpable infiltration into adjacent muscle or bone
Pain (variable)
Regional lymphadenopaty with hard lymph nodes
Soft tissue mass, paresthesia, anesthesia,
dysesthesia, foul smell, trismus, loosened teeth or
hemorrhage
Obstruct air ways, the opening of Eustachian
tube or the nasopharynx.
Weight loss, feel unwell

Imaging features
Location
SCC commonly involves lateral border of the
tongue
Bone invasion posterior lingual aspect of the
mandible
Lesions of lip and floor of the mouth invade the
anterior mandible
Lesions of attached gingiva and alveolar bone
mimic inflammatory diseases
Tonsils, soft palate and buccal vestibule

Imaging features
Periphery and shape

Polymorphus irregular outline radiolucency

Invasion characterized by an ill defined non corticated
borders
Well defined border with a narrow transition band
without any residual bone behind the borders
Ill defined border with a wide transition zone with a
finger like extensions into surrounding bone
Borders show sharpened thinned bone end with
displacement of segments and adjacent soft tissue
mass (pathologic bone fracture)

Ill defined border with a

wide transition zone with
a finger like extensions
into surrounding bone

Well defined border with a

narrow transition band
without any residual bone
behind the borders

Internal structure
Radiolucent
Small islands of residual normal trabecular bone
might be visible in the center of radiolucency

Effects on surrounding structure

Widening of PDL space, loss of lamina dura
Floating teeth in a mass of radiolucent soft tissue
Growth of soft tissue mass with teeth within it as a
passenger
Increase of width and loss of cortical boundary of
ID canal and mental foramen
Destruction of normal cortical boundaries (floor of
the nose, maxillary sinus, buccal or lingual
mandibular plates)
Inferior border of the mandible thinned or
destroyed
Pathologic fracture

Floating teeth
Destruction of anterior floor
of nasal fossa

Destruction of floor of maxillary

sinus and soft tissue mass

Floating teeth

Destruction of bone in
mandibular retromolar area

Bone resorption around the roots

leave teeth without bony support

Irregular
width of ID
canal and
destruction
of its
cortical
borders

SCC destroying the

mandible in mental
foramen region and
growing down to ID canal

Differential diagnosis
1 ) Inflammatory lesions such as Osteomyelitis
Both destructive leaving island of osseous
structure
SCC: profound bone destruction or invasive
characteristics
Osteomyelitis: produces periosteal reaction
2) Periodontal disease
If bone loss from SCC originate in the soft tissue
of the alveolar process
SCC enlargement of extraction socket instead of
healing and new bone formation

Extraction socket has

enlarged instead of healing

-Bone destruction similar

to periodontal disease
-Lack of sclerotic bone
reaction at the periphery

Management
Surgery

and radiation therapy

Depends on the location and severity of
the tumor

2. SQUAMOUS
CELL
CARCINOMA
ORIGINATING
FROM BONE

Synonyms
Primary intra osseous carcinoma
Intraavleolar carcinoma
Primary intra Intraavleolar epidermoid
carcinoma
Primary epithelial tumor of the jaw
Central seqaumous cell carcinoma
Primary odontogenic carcinoma
Intramandibular carcinoma
Central mandibular carcinoma

Disease mechanism
Squamous

cell carcimona arising in jaw

Arise from intraosseous remnants of
odontogenic epithelium

Clinical features
More common in men
Fourth and eight decade of life
Pain
Pathologic fracture
Sensory nerve abnormalities

Imaging features
Location
More common in mandible
More common in molar region than anterior
aspect of the jaws
Tooth bearing parts of the jaw

Imaging features
Periphery and shape
Ill-defined periphery
Rounded or irregular in shape
Borders demonstrate osseous destruction
varying degrees of extension at periphery
Pathological fractures, step defects
Thinned cortical borders
Soft tissue mass

Imaging features
Internal structures
Radiolucent
Little residual bone within the lesion
center

Poor defined periphery

No internal structures
Thinning of overlying mandibular bone

Imaging features

Effect on surrounding structure

Destruction of antral or nasal floor
Loss of cortical outline of mandibular
neurovascular bundle
Loss of lamina dura
Floating teeth

Differential diagnosis
Periapical cyst or Granulomas
Odontogenic cyst
Metastatic lesion, Multiple myeloma,
Fibrosarcoma, carcinoma arising in a
dental cyst
Surface squamous cell carcinoma

Management
Tumors are excised with their
surrounding osseous structure
Radiation and chemotherapy as adjunctive
therapies