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BENIGN

NON-ODONTOGENIC
TUMORS OF ORAL CAVITY
Banun Kusumawardani
Faculty of Dentistry
University of Jember
Definitions
Neoplasia
Neo: new; Plasia: formation.
A neoplasm is defined as an uncoordinated
proliferation of tissue, the growth of which persists
in a potentially unlimited fashion, even after
cessation of the stimulus which evoked the change.
Difference between Hyperplasia and Tumor
Tumor is an abnormal mass of tissue, the growth of
which exceeds and is uncoordinated with that of
normal tissues and persists in the same excessive
manner after cessation of stimuli which evoked the
change.
Hamartoma : An abnormal proliferation of
tissues, native to that part. It is a focal
malformation which resembles a neoplasm,
grossly & microscopically.
Teratoma: A neoplasm composed of
tissues not normally found in the organ, in
which it arises. Derivatives of all three
germ layers are seen.
Choriostoma: A mass formed by
maldevelopment of tissue, a type not native
to that site.
Heteroplasia: Development of cytologic
and histologic elements not native to the
part.

Metaplasia: Change in tissue type after its


full differentiation normally
Classification of tumors
Neoplasms - classified into 2
major groups
Benign tumors
Malignant tumors

This
division is based on the
properties and behavior of the
neoplasm.
Classification of tumors cont
Benign tumor - preserved for
neoplasm that principally do not
endanger the life of the patient

Malignant neoplasm - endanger


the life of the patient.
Classification of tumors cont
Benign tumor of the oral cavity
Epithelial
Mesenchymal
Connective tissue
Blood vessels, nerves, lymphoid
glands
Bones
Classification of tumors cont
Malignant tumors
Epithelial
Mesenchymal
Classification of tumors cont
Benign tumor
Dental tissue (Odontogenic tumors)
Non dental tissues
(Non Odontogenic tumors)

Malignant tumors
Properties of benign tumors
Benign tumors- are tumors that are
Encapsulated berkapsul
Slow growth selowww
Grow by expansion, physically pushing the
normal adjacent structures & tissues out
of their path
Do not invade adjacent tissues
tak nyerang jaringan terdekat
Resemble their normal counterparts (not
anaplastic)
Do not metastasize g metastasis
Properties of malignant tumors
Malignant tumors are tumors that
Not capsulated
Fast growth
Grow by infiltration into surrounding
tissues
Lost or do not resemble tissue of origin
(anaplastic)
Capable of metastasis into distant
regions/tissues through Lymph or blood
circulation
Endanger patients life
Benign tumors-Nomenclature
Cells of benign tumors resemble
tissue of origin.
No histological difference are
visible between tumorous and
normal cells.
Are named after the tissue of
origin with ending (suffix) oma.
Benign tumors cont
Examples
Fibroma- fibrous tissue
Lipoma- adipose tisssue
Malignant tumors-Nomenclature
Tumor cells differ clearly from the
normally differentiated cells.
Sometimes difference is great that it is
difficult to discover the tissue of origin
(poorly differentiated or highly
anaplastic).
Nomenclature is based on tissue of
origin
Carcinoma epithelial cancer
Adeno carcinoma- glandular cancer
Malignant tumors cont
Sarcoma malignant tumor of
mesenchymal tissue.
For mesenchymal tissue start with the
name of tissue then followed by
sarcoma
Example
Fibrosarcoma Fibrous tissue
Rhabdomyosarcoma from skeletal muscles.
Leiomyosarcoma
Osteosarcoma
Signs and symptoms of tumors
Nature of symptoms varies with the
according to the location of the lesion
Oral lesions in asymptomatic phase
may first be recognized by the patient
Irregularity or abnormality of the
contour may be discovered while
brushing the teeth
Bleeding may draw attention
Signs and symptoms of tumors
Loosening of one or more teeth may
occur if the alveolar ridge is involved
Tongue movement may be influenced and
protrusion limited because of infiltration
& fixation of the lesion to the floor of the
mouth
Persistent sore throat for lesions of the
palate, tonsilar fossa, or base of tongue
Signs and symptoms of tumors
Pain may be intermittent initially but
becomes progressively more intense and
prolonged
Local pain eventually develops as the
tumor invades adjacent structures
Pain frequently referred to the ear
Clinical features of oral tumors
Sign Benign Malignant

History Long Short

Induration Absent Present

Ulceration Rare Frequent

Margin Well defined Irregular

Mobility Freely mobile Fixed

Papillary out growth Frequent Infrequent

Regional adenopathy Absent frequent


Benign tumors of the jaw
Benign tumors of the jaw and oral cavity

Can be
True neoplasms
Odontogenic tumors
Non odontogenic tumors
Developmental anomalies or
overgrowth
Other lesions related to bone
Effects on adjacent structures
Non-Odontogenic benign tumors
Non-odontogenic tumors
Tumors not arising from the tooth or tooth-like
structures
can be tumors of:
Epithelial origin (Mostly are premalignant: see
under malignant tumors)
Connective tissue origin
Vascular origin
Nerve origin
Muscle origin
Bone origin
Tumor-like of bone origin
Connective tissue origin

Fibroma reffered as epulis


Peripheral giant cell reperative
glanuloma
Lipoma
Tumors of vascular origin
Hemangioma
Lymphangioma
Nerve tumors
Neurofibroma
Neurilemmoma (Schwannoma,
Neuroma)
Muscle origin
Leiomyoma
Rhabdomyoma
Myoblastoma (Granular cell
myoblastoma)
Neoplasm and dysplasia of bone
Osteoma
Exostosis & tori
Osteogenic fibroma (Osteofibroma)
Fibrous dysplasia
Ossifying fibroma
Central giant cell tumor
Central giant cell reperative
granuloma
Chonndroma
Osteoma
It occurs as a peripheral or as a central
tumor (very seldom).
Clinically present;
Hard, smooth, very slowl growing, circumscript
(round) tumor of the jaw bones.
Observed in individuals over 40 years old.
The mandible more often involved than maxilla.
The growth sometimes selflimited.
On x-ray appears as radiopaque mass with
radioluscent outline.
Treatment is excision of the tumor.
Exostosis
These are peripheral osseous overgrowths or
excess of bone tissue.
Occur in the jaws as so called torus palatinus,
mandibularis, or multiple exostosis of the alveolar
bone.
Torus palatinus is the bone over growth which
usually occur in the midline of the palate, may be
,more or less symmetrically arranged.
Torus mandibularis is often symmetrical bony over
growth of the lingual side of the mandible on the
premolar and canine region.
Tori are often found in older individuals and can
grow to a large size.
They are symptomless.
Ossifying Fibroma

True neoplasm with fibrous connective tissue that contains


variable amount of bony trabeculae, cementum-like material
or both

Wide age range with greatest 3rd-4th decades


Female > Male; Mandible > Maxilla
Mandibular premolar-molar area
Small lesions asymptomatic
Large lesions painless swelling
Juvenile Aggressive Ossifying Fibroma

Radiographic Features
Well-defined unilocular radiolucency
Large lesions: classic downward bowing of the inferior
cortex of mandible
Ossifying Fibroma
Ossifying Fibroma
Histopathology
Tissue submitted as one mass
Fibrous connective tissue with varying degree of
mineralized material

Treatment
Enucleation; good prognosis
Osteoma
It occurs as a peripheral or as a central tumor
(very seldom).
Clinically present;
Hard, smooth, very slowl growing, circumscript
(round) tumor of the jaw bones.
Observed in individuals over 40 years old.
The mandible more often involved than maxilla.
The growth sometimes selflimited.
On x-ray appears as radiopaque mass with
radioluscent outline.
Treatment is excision of the tumor.
Osteoma and Gardner Syndrome

Osteomas are benign tumors composed of mature compact


or cancellous bone
Restricted to the craniofacial skeleton

Gardner Syndrome
Autosomal dominant
Spectrum of diseases comprised of
* familial colorectal polyps (will transform to adenocarcinomas)
* Osteomas (90% of cases) common in the skull, paranasal
sinuses and mandible
* Epidermoid cysts
* Desmoid tumors (locally aggressive fibrous neoplasms)
* Increased incidence of thyroid carcinoma
Cementoblastoma (True Cementoma)
Odontogenic neoplasm of cementoblasts
Mandible > Maxilla with 90% occur in molar/premolar area
50% INVOLVE THE 1ST PERMANENT MOLAR
Children and young adults
Pain at night relieved by aspirin
Swelling
Radiographic Features
Appears as radiopaque mass fused to one or more roots and
is surrounded by a thin radiolucent rim
Outline of root blurred due to fusion with tooth
Histopathology
Sheets of thick trabeculae of mineralized material intermixed
with cellular fibrovascular tissue with multinucleated giant cells
Treatment
Surgical extraction of lesion with teeth
Classification of Non Odontogenic Tumours

Epithelial
Benign Malignant
Papilloma
Basal Cell Carcinoma
Squamous Acanthoma
Epidermoid carcinoma or
Keratoacanthoma Squamous cell carcinoma
Pigmented Cell Nevus Verrucous Carcinoma
Premalignant Spindle Cell Carcinoma
Leukoplakia Adenoid Squamous cell
Leukoedema Carcinoma
Intraepithelial Carcinoma or Lmphoepithelioma and
Carcinoma in situ Transitional cell carcinoma
Erythroplakia Malignant Melanoma
Oral Sub Mucous Fibrosis
Classification of Non Odontogenic Tumours..
Connective Tissue Adipose tissue
Benign Benign
Fibroma Lipoma
Giant Cell Fibroma Verruciform Xanthoma
Peripheral Ossifying Malignant
Fibroma
Liposarcoma
Central Ossifying Fibroma
Peripheral Giant cell
Granuloma
Central GCG
Aneursmal Bone Cyst
Myxoma
Malignant
Fibrosarcoma
Classification of Non Odontogenic Tumours

Vascular Tissue Cartilage tissue


Benign Benign
Hemangioma Chondroma
Hereditary Haemorrhagic Benign Chondroblastoma
Talengiectasia Chondromyxoid Fibroma
Encephalo-trigeminal Malignant
Angiomatosis
Chondrosarcoma
Nasopharyngeal
Angiofibroma
Lmphangioma
Malignant
Haemangioendothelioma
Haemangiopericytoma
Kaposis Sarcoma
Classification of Non Odontogenic Tumours
Bone tissue Lymphoid Tissue
Benign
Malignant
Osteoma
Malignant Lymphoma
Osteoid Osteoma
Non-Hodgkins Lymphoma
Benign Osteoblastoma
Reticular Cell Sarcoma
Malignant Burkitts Lymphoma
Osteosarcoma Hodgkins Disease
Muscle tissue Leukaemias
Benign Ewings Sarcoma
Leiomyoma Plasma Cell Tumours
Angiomyoma Multiple Myeloma
Plasmacytoma
Rhabdomyoma
Malignant
Leiomosarcoma
Rhabdomyosarcoma
Classification of Non Odontogenic Tumours
Nerve Tissue Tumours of Disputed
Benign Origin
Neurofibroma Granular Cell
Neurolemmoma Myoblastoma
Malignant Congenital Epulis
Malignant Schannoma Alveolar Soft Part
Sarcoma
Tumour Like Lesions Melanotic
Peripheral Giant Cell Neuroectodermal tumour
Granuloma of infancy
CGCG Kaposis Sarcoma
Exostoses Ewings Sarcoma
Pyogenic Granuloma
Anurysmal Bone Cyst
Traumatic Neuroma
Non-odontogenic tumors
Tumors are not arising from the tooth or tooth like structures :
Epithelial origin (mostly are premalignant)
Connective tissue origin
Fibroma (epulis)
Peripheral giant cell glanuloma
Lipoma
Vascular origin
Hemangioma
Lymphangioma
Nerve origin
Neurofibroma
Neurilemmoma (Schwannoma, Neuroma)
Muscle origin
Leiomyoma
Rhabdomyoma
Myoblastoma (Granular cell myoblastoma)
Bone origin
Tumor like of bone origin
Odontogenic Nonodontogenic
Osseous lesions
Odontoma
Ossifying fibroma

Ameloblastoma

Juvenile ossifying fibroma
Periapical cemental dysplasia

Odontogenic myxoma Florid cemento-osseous dysplasia


Exostosis (torus mandibularis)
Calcifying epithelial Osteoma
Fibrous dysplasia
odontogenic tumor Paget disease

(Pindborg tumor) Nonosseous lesions


Neurofibroma

Cementoblastoma Schwannoma
Central giant cell granuloma (giant cell reparative cyst)
Ameloblastic fibroma Arteriovenous malformation (AVM)
Central hemangioma
Adenomatoid odontogenic Epulis fissuratum

tumor

Benign Lesions (Solid Lesions)


Prevalence of Solid Benign
Lesions
Most common Less common
Odontoma Calcifying epithelial
odontogenic tumor
Fairly common (Pindborg tumor)
Ameloblastoma Ameloblastic fibroma
Periapical cemental dysplasia* Odontogenic myxoma
Florid cemental dysplasia* Cementoblastoma
Ossifying fibroma* Rare
Adenomatoid odontogenic
tumor
Juvenile ossifying fibroma*
Clear cell odontogenic
tumor
*Nonodontogenic origin. Squamous odontogenic
Contains cystic and solid tumor
components. Calcifying odontogenic cyst
Exostosis
These are peripheral osseous overgrowths or excess of bone
tissue.
Occur in the jaws as so called torus palatinus, mandibularis, or
multiple exostosis of the alveolar bone.
Torus palatinus is the bone over growth which usually occur
in the midline of the palate, may be ,more or less
symmetrically arranged.
Torus mandibularis is often symmetrical bony over growth of
the lingual side of the mandible on the premolar and canine
region.
Tori are often found in older individuals and can grow to a
large size.
They are symptomless.
If they interfere with the fitting of denture the have to be
removed surgically.