Chapter

Neoplasia
Description ofNeoplasia
Neoplasia new
growth, cells are uncontrolled
Neoplasm new growth of tissue, growth is uncontrolled and progressive
lumor swelling, used synonym for neoplasm
·

means as a

occurrence of Neoplasia
irreversible change in cells, passed onto new cells (uncontrollable cell multiplication)
->
abnormal process
causes of Neoplasia
->
chemicals:hundreds ->
Radiation: Sun, X-rays, nuclear fission
spontaneous from
->
->
Viruses:
oncogenic viruses (HPV) genetic mutation
Classification of Tumors
localized, encapsulated, cannot spread
·
-
Benign remains

Malignant non-encapsulated, spreads (metastasis)

·
-

Names of Tumors
Prefix is determined by tissue/cell of origin
·

suffix-oma indicates tumor

tumors: lipomalfat). Osteoma (bone)
Benign
·

Naming Malignant
Tumours
carcinoma: malignant, epithelium
·

·sarcoma: malignant, connective tissue

-squamous cell carcinoma, epidermoid carcinoma: malignant, squamous epithelium
Osteosarcoma: bone
malignant,
other examples: lymphoma, melanoma, etc
Treatment of Tumors
·

Benign: surgical excision; wide local excision or enudation (removalwmor

Malignant: surgery, chemotherapy, radiation, combination
·
 Epithelial Tumors
3 types in mouth: squamous, salivary gland, Odontogenic epithelium
Tumors of Squamous Epithelium
Papilloma
·

-benigh, soft palate or

tongue "microscope: finger-like projections
-Small exophytic pedunculated) sessile growth" treatment: surgical excision
->
white or normal mucosa color

Premalignant
·

lesions
-
LenkoPlakiaplague, biopsy may show epithelial dysplasia, squamous cell carcinomal
-

white

-Erythroplakia red smooth or granular or velvety), floor of mouth, tongue, soft palate
-

-Epithelial dysplasiapremalignant (to squamous cell carcinoma), may revent if stimulus removed

↳white, red, or mixed; floor of mouth or tongue; treatment: surgery

·Squamous cell carcinoma
-floor of mouth, ventrolateral (alsolips/face-better prognosis)
tongue, soft palate, retromolar areas

↳solar cheiltic: sun

damage, mild-severe epithelial dysplasia occurs

Risk Factors for Squamous Cell Carcinoma:

Treatment/Prognosis:
->
Tobacco ->
UV
damage
->
surgery, sometimes radiation
->
Alconol staging: higher stage: worse prognosis
-> ->
HPV TVM
·
Verrucous carcinoma

"slow
growing exophytic tumor; pebbly red and white surface
"numerous papillary epithelial projections filled w/ Keration
"epithelium differentiated, does not contain atypical cells, broad based rete
is well
pegs
-best of all SCC:no invasion through basement membrane
prognosis
=treatment surgical excision

Basal cell carcinoma

·

->
skin tumor associated w/
malignant sun exposure
↳common face; (white adults)
on
nonhealing ulcer with rolled borders
streatment surgical excision, radiation; rarely metastasizes
 Salivary Gland Tumors
"most often of junction of hard and soft palate
Pleomorphic adenoma Adenoid cystic carcinoma (cylindromal
·
·

Monomorphic adenoma Mucoepidermoid

· ·

carcinoma
Pleomorphic Adenoma Benign Mixed Tumor
· -

"Most common; 90% of all salivary gland tumors

most common extraoral location=parotid; intraoral palate =

Clinically: slowly enlarging, non-nucleated, painless, dome shaped mass

·Treatment: surgical excision, recurrance varies due to success of surgery
known to become
·

malignant
Benign Encapsulated Tumor
·

Monomorphic Adenoma
-

"uniform pattern of epithelial cells, treatment surgical excision

most common in adult females, upper lip and basal mucosa
->
Monomorphic Adenoma: Warthin Tumor
encapsulated tumor wl epithelial and lymphoid tissue
·

-usually soft, compressable/fluctant, painless mass

-commonly on
gland, rarely intraoral, adult
parotid men

·Adenoid Cystic Carcinoma (Cylindroma)

-slow
growing, malignant, major or minor salivary glands; commonly on parotid
can be ulcerated/painful (pain: first symptom)
Treatment =
surgical excision, radiation if metastasis,
prognosis is poor

Mucoepidermoid Carcinoma Malignant SalivaryGland Tumor

·
-

unencapsulated, infiltrating tumor; clinically slowly enlarging

-
mass

most common for major is parotid, minor is palate

to

combo of mucus cells and squamous-like cells (epidermoid

-may appear in bone as a unilocular or multilocular radiolucency

"usually occurs in adults; most common
malignant sat in children: women most often
·Treatment: surgical excision, neck dissection if cervical node involvement
 OdontogenicTumors
Epithelial odontogenic tumors.Mixed odontogenic tumors
·

Mesenchymal odontogenic tumors Peripheral Odontogenic tumors

·

->
derived from tooth forming tissues;contain epithelium, mesenchyme, or combo
"usually benign, some rare malignantforms
Epithelial odontogenic tumors
·

·Ameloblastoma Calcifying epithelial odontogenic tumor (CEOT)

·

Adenomatoid
Odontogenic tumor calcifying odontogenic cyst
·

Ameloblastoma
->

·benign, slow growing, locallyaggressive;may cause bone expansion

·max or mand;mostoften mand in molar or ramus area

unencapsulated, infiltrates tissue

surrounding
·

↑rads:multilocular soap bubble/honeycomb;can occur my

dentigerous cyst
->
Treatment surgical
=

removal, reoccurance is common

Calcifying Epithelial Odontogenic Tumor

~

benign;islands/sheets
->
of polyhedral epithelial cells - adults, either sex
we calcifications win deposits treatment:
↳
Amyloid-like material Surgical excision
Rads:a unilocular/multioccular radiolucency- usually mand, bicuspid/molar area
~
Adenomatoid Odontogenic Tumor (AOT)
->
encapsulated, benign:70% in females (20,70% involve anterior jaw
~
more common in max, often associated with impacted teeth
↑rads:well-circumscribed radiolucency;may have
radiopaque areas
->
treatment:enucleation

Calcifying Odontogenic Cyst

->

mostcommon <40
*

nonaggresive cystic lesion lined wi

odontogenic epithelial,
↑Rads:Usually well-defined, unil multilocular, mayhave calcification

microscopically)
->
Associated characteristic keratinization (round wl centres
wi
ghostcen clear

~Treatment:Surgical enucleation;usually does reoccur

not
 Mesenchymal Odontogenic Tumors
·

Odontogenic Benign cementoblastoma

·

myxoma
·

·Central
-
cementifying and ossifying fibromas
Odontogenic Myxoma benign encapsulated, infiltrating
non tumor:Age 10-29
-Rads:multilocular, honeycombed radiolucency, poorly defined
margins
~mostoften in mand.;maybecome
large and displaced
~Treatment
surgical excision,
=

may recur

Cementifying/Ossifying Fibromas
->
Central -

benign, well circumscribed

mostcommon:females, adults
->
305-40s, mandible
from radiolucent calcified
->
to radiolucent
Rads:Varies
depending on amount

contains fibrous connective tissue

->
and calcifications
~
Treatment surgical excision, reoccurance is rare
=

->

Benign Cement oblastoma cementum-producing lesion

-
Rads:well defined radiopaque mass wi halo
radiolucent
->
Treatment:enucleation removal of tooth;does recour
+

not

Mixed Odontogenic Tumors

·

~Ameloblastic fibroma Ameloblastic fibro-odontoma Odontoma

Ameloblastic Fibroma
benign, nonencapsulated
~

-more common:
young children andadults, males, mand.bicnspid/molar
-rads:well or poorly defined unilmultiocular radiolucency
->
Treatment:surgical excision;low recurrance

Ameloblastic fibro-odontomae
·
benign
~features of ameloblastic fibroma and Odontoma

lavg101. Posterior jaws

->
mostcommon: adults
young
wicalcifications
->
Rads:well-delineated radiolucent unil multilocular in radioucency
->
Treatment conservative
=

surgical excision, recurrance is unusual

 ->
Odontoma
teeth, anterior maxilla
~
Compound:mass resembles

Complex:does
~
resemble
not teeth, posterior mandible
mostly adolescents and young adults clinical:failure of tooth to errupt
~ -

~
Treatment:Surgical excision

Tumours of SoftTissue
->
lipoma tumors of nervetissue vascular
->
tumors
Lipoma-benign tumor of mature fatcells
·

~Clinically: yellowish mass, thin epithelium layer common: buccal mucosa, vestibule. 7 4O
~micro: Well delineated, Uniform Sizelshape Treatment:surgical excision
-

Tumors of Nerve Tissue

·

·Granular cell tumor

Congenitalepulic Neurofibroma or Schwannoma
->
Neurofibroma and Schwannoma -
benign, schwann cells

~commonly if intraoral, any

tongue sex or
age Treatment:surgical excision
Neurofibroma:well delineated, diffuse proliferation of spindle shape Schwann cells

Schwannoma:spindle shape arranged in palisaded whorls around a central pink zone

o
WI connective tissue capsule
-Granular CellTumor -

benign, large cytoplasm

cells we
granular
~
often on Tx=
most
tongue, then buccal women
mucosca;adult
surgery
Painless, nonulcerated, flesh coloured nodule
Congenital Epulisebenign, cells closely resembling granular
->
cell tumor
->
likely arises from primative mesenchymal cells;pedunculated sessile
or mass on
gingiva
"usually max
gingiva; almostalways in
girls Tx:
surgical excision
·

Vascular Tumors.Hemangioma lymphangioma. Malignantvascular tumors

->
Hemangioma benign proliferation of capillaries
-

Capillary hemangioma (small capillaries) hemangioma larger vessels)

·

Cavernous or

often presentatbirth or shortlyafter, over half on head/neck

·mostcommon:tongue, females, adults in response to trauma, blanch WI pressure
Tx:spontaneous remission. Surgery, or injection
 -Lymphangioma benign tumor of lymphatic
-
vessels
most present at birth, half head and neck, predilection
·

in no sex

Intraoral-most common tongue ill defined, pebbly surface ecystic in neck=cystic hygroma
-
on

Tx =

surgical excision; tend to recur

-Malignant Vascular Tumors

>Angiosarcoma rare in oral cavity
-
Tx=
surgery, radiation, combo

"Kapos; sarcoma - older men, Hive purple macules, plagues, exophytic tumors; hard palate and
gingiva
Tumors of Melanin producing cells