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Pathology: Ch. 7 Neoplasia

Terms in this set (54)

Neoplasia
• New growth
• Cells exhibit uncontrolled proliferation
Neoplasm
A new growth of tissue in which growth is
uncontrolled and progressive
Tumor
Means swelling
• Often used as a synonym for neoplasm
Occurrence of neoplasia
• An irreversible change must take place in the cells
• This change must be passed on to new cells
• Results in uncontrollable cell multiplication
• An abnormal process
Causes of Neoplasia
• Many agents can cause neoplastic
transformation of cells in the laboratory:
-Chemicals: Hundreds of different ones
-Viruses: Called oncogenic viruses
-Radiation: Sunlight, x-rays, nuclear fission
• Can occur as a result of a genetic mutation
Benign tumor (neoplasia)
• Localized
• Encapsulated with fibrous connective tissue
• Can invade adjacent tissue
• Does not have the ability to spread to distant sites
• Usually resemble normal tissue
Malignant tumor
• Invades and destroys surrounding tissue
• Has the ability to spread throughout the body
(metastasis)
• Vary in appearance:
-Well-differentiated malignant tumors have neoplastic cells that resemble normal cells
-Poorly differentiated tumors do not resemble normal cells
-May be undifferentiated or anaplastic and do not
resemble the tissue from which they were derived
Names of tumors:
• The prefix is determined by the tissue or cell of origin
• The suffix -oma is used to indicate a tumor

Benign:
• Lipoma: Benign tumor of fat
• Osteoma: Benign tumor of bone

Malignant:
• Carcinoma: Malignant tumor of epithelium
• Sarcoma: Malignant tumor of connective tissue
ex:
• *Squamous cell carcinoma or epidermoid
carcinoma:* Malignant tumor of squamous epithelium
• Osteosarcoma: Malignant tumor of bone
Treatment of benign tumors:
Treated by surgical excision
• Wide local excision
• Enucleation
Treatment of malignant tumors:
Treated by:
• Surgery
• Chemotherapy
• Radiation therapy
• Often a combination
3 different types of epithelial tumors are found in the oral cavity:
• Squamous epithelium
• Salivary gland epithelium
• Odontogenic epithelium
Tumors of Squamous Epithelium: Papilloma:
• Benign tumor of squamous epithelium
• Small exophytic pedunculated or sessile growth
• May be white or the color of normal mucosa
• Most often on the soft palate or tongue
Tumors of Squamous Epithelium: Premalignant lesions: Leukoplakia
• Means "white plaque"
• Biopsy is necessary for diagnosis:
• Most are due to:
-Hyperkeratosis
-Epithelial hyperplasia
-Hyperkeratosis

• Microscopic
-May show epithelial dysplasia (premalignant condition)
-Squamous cell carcinoma

• Treatment
-Remove the cause and see if it resolves
-If lesion does not resolve it should be biopsied
Tumors of Squamous Epithelium: Premalignant lesions: Erythroplakia:
• Oral mucosal lesion appears as a smooth red patch or a granular red/velvety patch
• Speckled leukoplakia::* lesion that shows a mix of
red/white areas
• Most often located on the floor of the mouth, tongue, and soft palate
• Lesss* common than leukoplakia
Tumors of Squamous Epithelium: Premalignant lesions: Epithelial dysplasia:
• A histologic diagnosis of a premalignant condition
• Indicates disordered growth
• Frequently preceeds squamous cell carcinoma
• Changes may revert to normal if the stimulus is removed

• May present as:
-Erythematous (red) lesion
-Leukoplakic (white) lesion
-Mixed erythematous/leukoplakic lesion

• Often seen on the floor of the mouth or tongue
• Dysplasia in other tissues is not considered a premalignant process

• Carcinoma in situ
-Severe dysplasia
-Involves the full thickness of epithelium
-Does not go through the basement membrane

• Treatment
-Surgical excision
Tumors of Squamous Epithelium: Squamous cell carcinoma:
• A malignant tumor of squamous epithelium
• Most common primary malignancy of the oral cavity
• Can infiltrate adjacent tissues and form distant metastases
• Usually metastasizes to lymph nodes in the neck
• Distant metastasis sites: lungs and liver
• Usually appears as an exophytic ulcerative mass
• Can infiltrate and destroy bone

• Tumor cells invade connective tissue underlying the epithelial basement membrane
• Well-differentiated tumors will show keratin
• "Keratin pearls"

• Occurs most often:
-floor of the mouth
-ventrolateral tongue
-soft palate
-tonsillar pillar
-retromolar areas
• May occur on the vermilion border of the lips/skin of the face:
-Better prognosis than SCC of the oral mucosa

• Solar cheilitis:
-Mild to severe epithelial dysplasia occurs
-Avoid sun exposure
-Use a sun-blocking agent

• Tobacco
-Smoking: • Cigar • Cigarette • Pipe
-Snuff dipping
-Tobacco chewing
• Alcohol consumption
• Damage from ultraviolet rays
• Human papillomavirus (HPV)

Treatment/prognosis:
• Generally treated by surgical excision:
-Radiation therapy or chemotherapy may also be used
-Patients may experience xerostomia
• TNM staging may be used to determine the prognosis
-The higher the stage, the worse the prognosis
Tumors of Squamous Epithelium: Verrucous carcinoma:
• Slow-growing exophytic tumor
• Pebbly red/whitee* surface
• Many papillary epithelial projections
• Papillary projections filled w/ keratin
• Epithelium is well differentiated (no atypical cells)
• Exhibits broad-based rete pegs
• Does not invade the basement membrane
• Treatment::* Surgical excision
Tumors of Squamous Epithelium: Basal cell carcinoma:
• Malignant skin tumor
• Associated w/ excessive sun exposure
• Frequently on face
• Non-healing ulcer
• Characteristic rolled borders
• White adults w/ no sex predilection

• Microscopic
-Composed of basal cells derived from squamous epithelium
-Proliferation of basal cells into underlying connective tissue
• Treatment
-Surgical excision
-Radiation therapy may be used to treat large lesions
-Rarely metastasizes
Salivary Gland Tumors: Pleomorphic adenoma:
• Benign salivary gland tumor
• Account for 90% of all salivary gland tumors
• Most common extraoral location: parotid gland
• Most common intraoral location: palate
• Encapsulated tumor
• Composed of a mix of both epithelium/ connective tissue
Clinically:
• Slowly enlarging mass
• Non-ulcerated
• Painless
• Dome-shaped
Treatment:
• Surgical excision
• Recurrence rates vary (dependent on the success of initial surgical removal)

• Can undergo malignant transformation
Salivary Gland Tumors: Monomorphic adenoma:
• Benign encapsulated salivary gland tumor
• Uniform epithelial cells
• Often seen in adult females
• Occurs most: upper lip/buccal mucosa
Treatment:
• Surgical excision

Warthin Tumor
• Encapsulated tumor
• Epithelial and lymphoid tissue
• Painless, soft, compressible or fluctuant mass
• Usually occurs on the parotid gland
• Rarely intraoral
• Occurs in adult men
Salivary Gland Tumors: Adenoid cystic carcinoma (cylindroma):
• Slow-growing malignant tumor
• Major or minor salivary gland tissue
• May be ulcerated and painful
• Most common site: Parotid gland
Microscopic
• Unencapsulated; infiltrates surrounding tissue
• Small, deeply staining, uniform epithelial cells (resemble "Swiss cheese")
Treatment:
• Surgical excision
Salivary Gland Tumors: Mucoepidermoid carcinoma:
• Malignant salivary gland tumor
• Unencapsulated, infiltrating tumor
• Major gland tumors: most often found in the parotid gland
• Minor gland tumors: most often on the palate
• Slow growing mass
• Combination of mucus cells and squamous-like epithelial cells (epidermoid cells)
• May appear in bone as unilocular or multilocular radiolucency
• Usually occurs in adults
• Most common malignant salivary gland tumor in children!!!
• Most often seen in females
Treatment
• Surgical excision
Odontogenic Tumors
• Epithelial odontogenic tumors
• Mesenchymal odontogenic tumors
• Mixed odontogenic tumors
• Peripheral odontogenic tumors

• Derived from tooth-forming tissues
• Composed of:
-Epithelium
-Mesenchyme
-Combination of both

• Most are benign
• Rare malignant forms exist
Epithelial Odontogenic Tumors: Ameloblastoma:
• Benignn* epithelial odontogenic tumor
• M=F
• Intraosseous; peripheral tumors can also occur
• Slow-growing
• Can cause expansion of bone
• Occurs in mandible/maxilla
• Most common in mandible/posterior
• Unencapsulated: infiltrates surrounding tissue
Radiographic:
• Unilocular or multilocular: soap bubble/honeycombed radiolucency
• Can occur in association w/ a dentigerous cyst
Treatment:
• Surgical removal
• Recurrence is common
Epithelial Odontogenic Tumors: Calcifying epithelial odontogenic tumor (CEOT):
• Benign epithelial odontogenic tumor
• M=F
• Posterior mandible
• Asymptomatic; slow-growing
• Can cause expansion of bone
Radiographic:
• Unilocular/multilocular radiolucency
• Scattered calcifications
Treatment:
• Surgical excision
Epithelial Odontogenic Tumors: Adenomatoid odontogenic tumor:
• 70% occur under 20 yrs.
• 70% involve anterior portion of the maxilla/mandible
• More common in maxilla
• Asymptomatic swelling
• Associated w/ impacted teeth
Radiographic:
• Well-defined radiolucency
• Radiopacities w/in the radiolucency
Tx: Surgical excision
Epithelial Odontogenic Tumors: Calcifying odontogenic cyst:
• Most commonly seen in individuals <40 years old
• M=F
• 70% involve anterior mandible/maxilla
• More common in maxilla
• Asymptomatic swelling
Radiographic:
• Well-defined radiolucency
• Unilocular or multilocular
• Can present w/ calcifications

• Associated w/ "ghost cell""* keratinization
• Round structures w/ clear centers
Treatment
• Surgical enucleation
• Usually do not reoccur
Mesenchymal Odontogenic Tumors:Odontogenic myxoma:
• Benignn* non-encapsulated infiltrating tumor
• 10- 29 years of age
• No sex predilection
• Asymptomatic; expansion of bone
Radiographic:
• Multilocular (honeycombed) radiolucency
• Poorly defined margins
• Can be large;displace teeth
• Most often in the mandible
Treatment
• Surgical excision
• May reoccur
Mesenchymal Odontogenic Tumors:Central cementifying and ossifying fibroma:
• Benignn* well-circumscribed tumor
• Usually occurs in adults 30-40 yrs.
• More often females
• 90% occur in the mandible
Radiographic:
• Well-defined unilocular lesion
• Varying degrees of opacities
Treatment:
• Surgical excision
• Recurrence is rare
Mesenchymal Odontogenic Tumors:Benign cementoblastoma:
• Cementum producing
• Occurs younger than 25 yrs.
• M=F
• Most occur in association w/ a mandibular molar
• Can cause local expansion of bone
• Pain
• Vital teeth are affected
Radiographic:
• Well-defined radiopaque mass
• Radiolucent halo
Treatment:
• Enucleation of the tumor
• Removal of the involved tooth
• Does not reoccur
Mixed Odontogenic Tumors:Ameloblastic fibroma:
• Benign, non-encapsulated odontogenic tumor
• Younger than 20 yrs.
• Occurs more often in males
• Posterior mandible
• Asymptomatic swelling
Radiographic:
• Well-defined
• Unilocular or multilocular radiolucency
Treatment:
• Surgical excision
• Low recurrence rate
Mixed Odontogenic Tumors:Ameloblastic fibro-odontoma:
Compound:
• Mass that resembles a cluster of mini teeth
• Usually located in anterior maxilla
Complex:
• Mass does not resemble teeth
• Usually located in posterior mandible

• Children/young adults
• M-F
• May see a lack of eruption/swelling
Treatment:
• Surgical excision
Mixed Odontogenic Tumors:Odontoma:
• Benign odontogenic tumor
• Has features of an ameloblastic fibroma and odontoma
• Average age 10 yr.
• No sex predilection
• Posterior maxilla/mandible
• Asymptomatic swelling
Radiographic:
• Well-defined radiolucent lesion
• May be unilocular/multilocular
• Calcifications noted w/in the radiolucency
Treatment:
• Conservative surgical excision
• Recurrence is unusual
Peripheral Ossifying Fibroma
• Probably reactive
• F>M
• Children/young adults
• Gingiva
• Nodular, sessile, or pedunculated mass
Treatment:
• Surgical excision
• Recurrence rate is about 16%
Lipoma
• Benign tumor of mature fat cells
• Most occur > 40 yrs.
• M=F
• Common on buccal mucosa & vestibule
• Yellowish mass
• Delicate pattern of wessels on surface
• Uniform size and shape
Treatment:
• Surgical excision
Tumors of Nerve Tissue:Neurofibroma and schwannoma:
• Benign tumors derived from Schwann cells in nerve tissue
• Most common intraoral location: Tongue
• Any age
• M=F
• Asymptomatic nodule
• Neurofibromatosis of von Recklinghausen
Treatment:
• Surgical excision
Tumors of Nerve Tissue:Granular cell tumor:
• Benign tumor: large cells w/ granular cytoplasm
• 30-50 yrs.
• F>M
• Most often occurs on the tongue & buccal mucosa
• Painless, non-ulcerated nodule
Treatment:
• Surgical excision
Tumors of Nerve Tissue:Congenital epulis:
• Benignn* neoplasm
• Seen at birth
• Most common in baby girls!
• Anterior maxillary gingiva
• Sessile/pedunculated mass on the gingiva
Treatment:
• Surgical excision
Tumors of Muscle
• Extremely uncommon in the oral cavity
• Vascular leiomyomas:
-Rhabdomyoma: benign tumor of striated muscle
-Leiomyoma: benign tumor of smooth muscle

Rhabdomyosarcoma
• Malignantt* tumor of striated muscle
• Most common malignant soft tissue tumor of the head/neck in children
• Typically children<10 yearss* of age
• M>F
• Rapidly growing/destructive tumor
Treatment
• Surgical excision
• Multi-agent chemotherapy
• Radiation therapy
• Poor prognosis
Vascular Tumors:Hemangioma:
• Benignn* proliferation of capillaries
• Congenital: developmental
• Adults: trauma
• F>M
• Most common site: Tongue
Clinically:
• Deep red-blue mass
• Blanches w/ pressure
• Capillary hemangioma:
• Numerous small capillaries
• Cavernous hemangioma:
• Contains larger blood vessels
Treatment:
• Many undergo spontaneous remission
• Treatment is variable:
-Surgery
-Injection of a sclerosing solution
Vascular Tumors:Lymphangioma:
• Benign tumor of lymphatic vessels
• Most present at birth
• Half arise in the head/neck area
• M=F
• Intraorally, the most common location is the tongue
-Ill-defined mass
-Pebbly surface
Treatment:
• Surgical excision
• Tend to reoccur
Vascular Tumors:Malignant vascular tumors:
Angiosarcoma: May occur in the oral cavity (rare)

Kaposi sarcoma:
• Skin and oral mucosa
• Historically seen in older men
• More aggressive form associated w/ HIV
Kaposi sarcoma and HIV
• Lesions are often seen in the oral cavity
• Purple macules, plaques, or exophytic tumors
• Common sites: hard palate/gingiva
• May occur in patients w/ other immunodeficiencies
• Caused by a human herpes virus (HHV-8)
Treatment:
• Surgical excision
• Radiation therapy
• Combination of both
Melanotic nevi
Nevus
• Developmental tumor of melanocytes
• 20-50 yrs.
• F>M
• Most often on the hard palate or buccal mucosa
• Tan/brown macules or papules
• Most are benign; may become malignant
Treatment:
• Biopsy
• Surgical excision
• Recurrence is rare
Malignant melanoma
• Malignant tumor of melanocytes
• Over 40 yrs.
• Arise on skin in response to exposure to sunlight
• Primary malignant melanoma is rare
• Melanomas on the skin may metastasize to the oral cavity
• Common oral sites: hard palate & maxillary gingiva
• Usually rapidly enlarging blue/ black mass
• Aggressive tumor w/ unpredictable behavior
• Early metastasis
Treatment:
• Surgical excision
• Chemotherapy may be used along with surgery
• Poor prognosis
Torus
• Benign lesion composed of normal compact bone
• Located on the midline of the palate/lingual of the mandible in the area of the premolars
Exostosis
Small nodular excrescence of normal
compact bone
Osteoma
• Asymptomatic benign tumor composed of benign compact bone
• M=F
• Intraosseous
• Asymptomatic
Radiographic
• Sharply defined radiopaque mass w/in bone (central)
• Can be attached to the outer surface of bone (peripheral)
• Found w/ Gardner syndrome
Tx: Surgical excision; does not recur
Osteosarcoma (Osteogenic Sarcoma)
• Malignant tumor of bone- forming tissue
• Most common primary malignant tumor of bone
• Patients <40 years of age
• Average age 37 yrs.
• 2x more common in the mandible
• M>F
• Painful
• Diffuse swelling; expansion of bone
Radiographic
• Radiolucent to radiopaque
• Destructive, poorly defined lesion
• May/may not involve adjacent soft tissue
• Asymmetric widening of PDL space
• "Sunburst" pattern
Treatment:
• Preoperative multiagent chemotherapy
• Surgery
• Tumors frequently recur
Chondroma
Benign tumor of cartilage
Chondrosarcoma:
Malignant tumor of cartilage

Treatment:
• Wide surgical excision
• Poor prognosis
Leukemia
• Overproduction of atypical WBC's
• Classified according to the cells that proliferate:
• Myelocytes
• Lymphocytes
• Monocytes
• M>F
• Seen in gingiva: Enlargement w/ bleeding
Acute leukemia:
• Common in children/young adults
• Characterized by a proliferation of immature WBC's
Chronic leukemia:
• Most frequently occurs in middle-aged adults
• Characterized by excess proliferation of mature WBC's
Treatment:
• Chemotherapy
• Radiation therapy
• Corticosteroids
• Prognosis depends on type/extent of disease
Lymphoma (Non-Hodgkin's Lymphoma)
• Malignant tumor of lymphoid tissue
• Gradual enlargement of lymph nodes
• Most common intraoral location: tonsils
• Usually occurs in adults
• M>F
Treatment:
• Radiation therapy
• Chemotherapy
• Combination
Multiple Myeloma
• Malignant systemicc* proliferation of plasma cells
• Adults (most > 40 yrs.-usually in 70's)
• M>F
• Mandible>maxilla
• Pain/paresthesia/swelling/expansion of bone
Radiographic:
• Poorly defined radiolucencies
• Tooth roots show spiked appearance
• May show some radiopacity
• Elevation of single type of immunoglobulin (monoclonal spikee*)
• May have fragments of immunoglobulins in urine (Bence Jones proteinss*)
Treatment:
• Chemotherapy
• Radiation
• Autologous stem cell transplantation
• Systemic bisphosphonate is used to prevent bone destruction
• Oral complications: Osteoneucrosis
• Poor prognosis
Metastatic Tumors of the Jaws
• Most tumors arise from thyroid, breast, lungs, prostate gland, and kidneys
• Most common intraoral site for metastatic tumors is the mandible
• Patients may experience:
-Pain/paresthesia/anesthesia of the lip
-swelling & expansion of affected bone
-loosening of teeth in affected area
• Most patients are adult males
Radiographic:
• Lesions usually poorly defined; radiolucent
• Roots of involved teeth may show a spiked
appearance
• Some tumors may form bone; radiopaque
Treatment:
• Chemotherapy and radiation therapy
• The prognosis for patients with tumors that have
metastasized to the jaws is poor
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