Neoplasia
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| neoplasia | new, abnormal growth, uncontrolled cells proliferation (multiplication, irreversible
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| tumor | "swelling", used as a synonym for neoplasm
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| what behavior do neoplasms exhibit? | unlimited growth and unregulated growth
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| what are causes of neoplasia | chemicals
viruses (aka oncogenic viruses)
radiation (sunlight, xrays, nuclear fission)
(can occur spontaneously secondary to a genetic mutation
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| what are tumor classifications? | benign and malignant
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| benign tumor (neoplasia) | localized, encapsulated w/ fibrous CT, invade adjacent tissue, resemble normal ctissue
tx. surgical excision, either local excision or enucleation
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| malignant tumor (cancerous) | invades and destroys surrounding tiss., can spread,
well differentiated-neoplasic cells resemble normal cells
poorly diferentiated- do not
undifferentiated/anaplastic-do not resemble tiss. derived from at all
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| pleomorphic | cells of malignant tumors vary in size and shape
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| hyperchromatic | nuclei of cells darkers than those of normal cells, exhibit an increased nuclear-cytoplasmic ratio
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| mitotic figures | normal and abnormalmitotic figures seen in nucleus of neoplastic cells
tx. surgery, chemotherapy, radiation therapy (often combo)
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| classification of tumors(benign) | usually well-differentiated
usually slow growth
mitotic figures are rare
usually encapsulated
no metastasis
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| classfication of tumors (malignant) | well differentiated to anaplastic
slow-to-rapid growth
mitotic figures may be numerous
invasive and unencapsulated
metastasis likely
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| what is the suffix "-oma" used to indicate | a tumor
*prefix is determined by tissue or cell of origin
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| lipoma | benign tumor of fat
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| osteoma | benign tumor of bone
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| carcinoma | malignant tumor of epithelium
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| sarcoma | malignant tumor of CT
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| squamous cell carcinoma or epidermoid carcinoma | malignant tumor of squamous epithelium
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| osteosarcoma | malignant tumor of bone
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| what can epithelial tumors derive from? | squamous epithelium
salivary gland epithelium
odontogenic epithelium
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| papilloma | small, benign tumor of squamous epithelium, exophytic
pedunculated or sessile growth
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| what are the papillary projections of papilloma? | *cauliflower
most often on soft palate or tongue
occurs any age or sex
DDX w/ verruca vulgaris and condyloma acuminatum (venereal wart)
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| how does pailloma appear microscopically? | numerous fingerlike or papillary projections w/ central core of fibrous CT surfaced by normal stratified squamous epithelium
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| tx for papilloma? | surgical excision
removal of base to prevent reoccurance
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| what are 3 premalignant lesions? | leukoplakia
erythoplakia
epithelial dysplasia
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| leukoplakia | "white plaque" (clinical term not histologic term)
biopsy needed to establish definitive Dx
most due to hyperkeratosis or epithelial hyperplasia and hyperkeratosis
can't be rubbed off
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| how does leukoplakia appear microscopically? | may show epithelial dysplasia (premalignant condition) or squamous cell carcinoma
~5-25% reveal epithelial dysplasia
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| tx for leukoplakia | dependent on histologic finding
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| leukoplakia-Snuffer's keratosis | aka. tobacco pouch keratosis
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| most leukoplakia are: | asymptomatic
result of hyperkeratosis
result of hyperkeratosis comboed w/ epithelial hyperplasia
tx depends on histo findings
area at increased risk for SCC
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| erythroplakia | located on floor or mouth, tongue, soft palate
can appear as:
smooth red patch, granular red and velvety patch
<common than leukoplakia
>serious than leukoplakia
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| what is speckled leukoplakia? | subcatogory of erythroplakia
lesion shows a mix of red and white areas
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| how does erythroplakia appear microscopically? | 90% of cases demonstartes epithelial dysplasia or squamous cell carcinoma
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| tx of erythroplakia | dependent on histologic Dx
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| epithelial dysplasia | premalignant, disordered growth, precedes squamous cell carcinoma, changes may revert to normal if stimulus is removed
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| how can epithelial dysplasia appear clinically? | erythematous, white, mixed erythematous and white
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| (T/F)Dysplasia in other tissues is not considered a premalignant process | True.
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| tx of epithelial dysplasia | surgical excision
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| (T/F) epithelial dysplasia is carcinoma in situ | True. severe dysplasia involving full thickness of epithelium
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| squamous cell carcinoma | aka. epidermoid carcinoma
malignant tumor of squamous epithelium
*most primary common primary malignancy of oral cavity
can infiltrate adjacent tiss. and form distant metastases (lymph nodes in neck, lungs, <3)
can infiltrate and destroy bone
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| how does squamous carinoma appear clinically? | exophytic ulcerative mass
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| how does SCC microscopically? | tumor cells invade CT underlying epithelial basement membrane
well-differentiated tumors show keratin
-keratin pearls, usually seen in individual cells w/in tumor
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| where can SCC appear in the oral cavity? | *most often on floor of mouth
ventrolateral tongue, soft palate, tonsillar pillar, retromolar areas
*vermillion border of lips, skin of face locations have better Px than of oral mucosa
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| what's the interaction of SCC and sun exposure? | causes lips to turn from dark pink to mottled grayish pink
interface becomes blurred, linear fissures seen at right angles to line of interface
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| who does SCC affect the most? | over 40s
mostly men, incidence has increased in women
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| solar cheilitis | subcategory of squamous cell carcinoma
condition in which mild to severe epithelial dysplasia occurs
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| risk factors of squamous cell caricnoma | tobacco
alcohol consumption
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| tx and px of squamous cell carinoma | surgical excision, radion therapy, chemotherapy (these patients may have xerostomia)
TNM can be used to determine px (higher stage, worse px)
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| TNM Staging- Tumor | T1- <2cm in diameter
T2- 2-4cm in diameter
T3- > 4cm in diameter
T4- invades adjacent structures
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| TNM Staging- Node | N0- no palpable nodes
N1- ipsilateral palpable nodes
N2- contralateral or bilateral nodes
N3- fixed palpable nodes
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| TMN Staging- Metastasis | M0- no distant metastasis (so none at all?)
M1- clinical metastasis
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| verrucous carcinoma | form of SCC
slow growing exophytic tumor w/ pebbly red and white surface
*msot cases in men 55+ and involve vestibule and buccal mucosa
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| how does verrucous carcinoma appear microscopically? | tumor w/ numerous papillary epithelial projections
papillary projections filled w/ keratin
epithelium well differentiated, doesn't contain atypical cells, exhibits broad-based rete pegs, tumor doesn't show invasion through basement membrane
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| tx of verrucous carcinoma | surgical excision
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| basal cell carcinoma | malignant skin tumor assoc. w/ excesive exposure sun
arises on skin of face
appears as nonhealing ulcer w/ charct. rolled borders
white adults w/ no sex predilection
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| how does basal cell carcinoma appear microscopically? | composed of basal cells into underlying CT
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| tx of basal cell carcinoma | surgical excision
radiation therapy
rarely metastasizes
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| name 4 salivary tumors | pelomorphic adenoma
monomorphic adenoma
adenoid cystic carcinoma (cylindroma)
mucoepidermoid carcinoma
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| salivary gland tumors | may arise in either major or minor salivary glands
-minor salivary gland tumors most often located at junction of hard and soft palate
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| adenomas/adenocarcinomas | benign/malignant tumors of salivary glands
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| pleomorphic adenoma (benign mixed tumor) | benign salivary gland tumor
90% of all salivary gland tumors
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| how does pelomorphic adenoma appear microscopically? | encapsulated tumor composed of tiss. that appears to be a mix of both epithelium and CT
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| what is the most common extraoral location of pleomorphic adenoma? | parotid gland
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| what is the most common intraoral location of pleomorphic adenoma? | palate
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| how does pleomorphic adenoma appear clinically? | appears as slowly enlarging, nonulcerated, painless, dome-shaped mass
occurs individuals <40 yrs
more often in women than men
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| tx of pleomorphic adenoma | surgical excision
reoccurence related to success of initial surgical removal
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| does carcinoma arise in a pleomorphic adenoma? | yes, these lesions have been known to undergo malignant transformation
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| monomorphic adenoma | benign, encapsulated salivary gland tumor
*occurs < often than pleomorphic tumor
uniform pattern of epithelial cells
*occurs most commonly adult females upper lip + buccal mucosa
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| tx of monomorphic adenoma | surgical excision
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| Warthin tumor-monomorphic adenoma | aka.papillary cystadenoma lymphomatosum
encapsulated tumor w/ epithelial + lymphoid tiss. (painless, soft, fluctuant mass)
occurs parotid gland
occurs adult malen
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| tx of warthin tumor-monomorphic adenoma | surgical excision
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| adenoid cystic carcinoma | aka. clindroma
slow growing malignant tumor of salivary gland organ
most common extraoral-parotid
most common inftraoral-palate
> common women
> common 5th and 6th decades
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| how does adenoid cystic carcinoma appear microscopically? | unencapsulated, infiltrates surrounding tiss.
small, deeply staining, uniform epithelial cells resembles "swiss cheese"
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| tx for adenoid cystic carcinoma | surgical excision, radiation, reoccurence is common, poor Px is distant metastases
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| mucoepidermoid carcinoma | malignant salivary gland tumor
nonencapsulated, infiltrating females
made of mucous cells w/ epidermoid cells
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| how does mucoepidermoid carcinoma appear clinically? | slowly enlarging mass, usually adults
*most common malignant salivary gland tumor in kids
major glands-parotid
minor gland-palate
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| tx of mucoepidermoid carcinoma | surgical excision w/ follow-up survival rate low as 50% after 5 yrs
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| random mucoepidermoid carcinoma shit | may occur w/in bone (r/l) in mandibular premolar/molar region, can be salivary tiss. trapped in bone or from tranformed epithelial lining of dentigerous cyst
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| odontogenic tumors | derived from tooth-forming tiss.
composed of epithelium, mesenchyme or mixed
most benign
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| epithelial odontogenic tumors | ameloblastoma
calcifying epithelial odontogenic tumor
calcifying odontogenic cyst
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| mesenchymal odontogenic tumors | odontogenic myxoma
cementifying fibroma
ossifying fibroma and ossifying fibroma
benign cementoblastoma
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| mixed odontogenic tumors | amelobastic fibroma
ameloblastic fibro-odontoma
odontoma
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| peripheral odontognic tumors | peripheral ossifying fibroma
other peripheral odontogenic tumors
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| ameloblastoma | benign slow-growing, locally aggressive epithelial odontogenci tumor
occurs max. and man. most often mandible in molar/ramus area
unencapsulated, infiltrates into surrounding tiss.
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| how do ameloblastomas appear radiographically? | multiocular soap-bubble, or honey-combed r/l
occurs anywhere w/in jaw, can occur in assoc. w/ dentigerous cyst
causes bone expansion
occurs in adults
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| tx of ameloblastoma | surgical removal, reoccurence coomon
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| calcifying epithelial odontogenic tumor | aka. pindborg tumor
benign epithelial odontogenic tumor
composed of polyhedral epithelial cells, amyloid like material abnormal enamel seen w/ calcifications
occurs in adults
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| how does the calcifying epithelial odontogenic tumor appear radiographically? | uniocular or mutliocular r/l
occurs >mandible than max., most often bicuspid/molar area
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| tx for calcifying epithelial odontogenic tumor | surgical excision
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| calcifying odontogenic cyst | nonaggressive lined by odontogenic epithelium
ghost cell shit
> common indivudals under 40
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| how do calcifying odontogenic cysts appear radiographically? | well defined lesion r/l
uniocular or multiocular
calcifications may be r/o
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| tx for calcifying odontogenic cysts | surgical enuleation
usually doesn't reoccur
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| odontogenic myxoma | benign, well circumscribed
composed of fibrous tiss. w/ calcifications
classified as fibroosseous lesion
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| ossifying fibromas | benign well circumscribed tumor
composed fibrous CT, calcifications
occurs in adults, 3-4th decades
most cases in mandible
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| how does ossifying fibromas appear microscopically | contains fibrous CT and calcifications
cemento-ossifying tiss.
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| how does ossifying fibromas appear radiographically? | varies r/l to r/o depending on amount of calcified tiss.
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| tx of ossifying fibromas | surgical excision
reoccurence rare
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| perpherial ossifying fibroma | well demarcated sessile or pedunculated lesion
orgins-interdental papilla
derives from pdl cells
> common in women
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| tx of peripheral ossifying fibroma | surgical ecision w/ thorough scaling of adjacent teeth to remove irritants that can induce regrowth
16% recurrence rate
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| benign cementoblastoma | cementum-producing lesion
fused to roots of vital teeth
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| how does benign cementoblastoma appear radiographically | well defined r/o mass surrounded w/ radiolucent halo
seen mandibular molar or premolar teeth
occurs young adults
pain frequent symptom
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| how does benign cementoblastoma appear microscopically? | proliferation of cellular cementum fused to root or roots of affected tooth
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| tx of benign cementoblastoma | enulceation of tumor, removal of involved tooth
doesn't reoccur
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| ameloblastic fibroma | benign, non encapsulated odontogenic tumor
tiss. resembles dental papilla
most cases in <20yr old
> in males
> common in mandibular bicuspid and molar region
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| how does ameloblastic fibroma appear radiographically? | well defined or poorly defined uniocular or multiocular r/l
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| tx for ameloblastic fibroma | surgical excision
low recurrence rate
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| odontoma | odontogenic tumor
composed of enamel, dentin, cementum, pulp tiss.
occurs young adults + yound adults
most common clinical manifestations is failure of permanent tooth to erupt
2 types- complex and compound
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| odontoma- complex | mass (odontogenic tiss.) doesn't resemble teeth (posterior mandible)
radio.-r/o mass
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| odontoma- compound | collection of numerous of small teeth (usually in anterior maxilla)
radio. cluster of miniture teeth
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| tx of odontoma | surgical ecision
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| osteosarcoma | malignant tumor of bone forming tiss.
>common primary malignancy of bone in pt under 40
painful, diffuse swelling, destructive
may initally present as toothache/mobility
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| how does osteosarcoma appear radiographically? | poorly defined lesion, widening of pdl space
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| tx of osteosarcoma | chemo followed by surgery
20% survival rate of Syra
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| peripheral ossifying fibroma |
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| how does osteosarcoma appear radiographically? | poorly defined lesion, widening of pdl space
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| tx of osteosarcoma | chemo followed by surgery
20% survival rate of Syra
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| peripheral ossifying fibroma |
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| how does osteosarcoma appear radiographically? | poorly defined lesion, widening of pdl space
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| tx of osteosarcoma | chemo followed by surgery
20% survival rate of Syra
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| peripheral ossifying fibroma | well demarcated sessile, or pedunculated lesion, females
origins gingival interdental papilla (most likely from pdl cells)
composed fibrous CT w/ bone and calcifications
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| what other fibromas is peripheral ossifying fibroma similar to? | cementifying and ossifying fibromas
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| other peripheral odontogenic tumors | rare lesions occur in gingiva, no bone invvolvment
-peripheral ameloblastoma
-peripheral calcifying epithelial odontogenic tumor
tx.surgical excision
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