SQUAMOUS CELL CARCINOMA ORIGINATING IN MAXILLARY

SINUS
SQUAMOUS CELL CARCINOMA ORIGINATING IN A CYST
CENTRAL MUCOEPIDERMAIOD CARCINOMA
MALIGNANT AMELOBLASTOMA AND AMELOBLASTIC
CARCINOMA
METASTATIC TUMORS
OSTEOSACOMA

Done By : Rehab Sabeel

SQUAMOUS CELL CARCINOMA ORIGINATING IN A :CYST

Disease Mech.:
Uncommon and exclude invasions
May arise from inflammatory periapical,
residual, dentigerous and OKC.
Squamous epithelium lining gives rise to
malignant neoplasm
Clinical features:
Pain ( dull/long duration ) , Swelling , Pathologic
fracture fistula formation and regional
lymphadenopathy, sinus pain and swelling

Location : mostly Mand. , few cases in Ant

Max.
Periphery and shape:
Round/ oval
( small lesion ) Well defined/corticated >
(advanced) ill-denfined / lack cortication
Internal structure: Radiolucent
Effect on surrounding: destroy lamina dura of
adjacen teeth/adjacent cortical
boundaries/complete destruction of alveolar
process
D/D:
Inflamed dental cysts
Multiple myeloma
Metastatic disease

SQUAMOUS CELL CARCINOMA

ORIGINATING IN MAXILLARY SINUS

Disease mech.:
Rick factors: chronic sinusitis,
chemicals(volatile hydrocarbons , isopropyl
oils, wood dust), metals(Ni , Cr)
Clinical features:
commonly(Africans/Asia heritage)
M>F
Initial sings=to inflammatory disease and may
include recurrent sinusitis, sinus pain , nasal
obstruction, epistaxis

Imaging features: Opacification of max. sinus

with soft tissue / destruction of the sinus
borders and adjacent max alveolar process / soft
tissue mass in oral cavity

CENTRAL MUCOEPIDERMAIOD
CARCINOMA
Disease Mech.:
epithelial tumor arising in bone originate
from(pluripotential odontogenic epithelium , or a
cyst lining)
Presence of intact cortical plates, radiographic
evidence of bone destruction
Clinical features:
F>M
Mimic a benign tumor or cyst
Painless swelling / facial asymmetry / tenderness /
parasthesia of ID / spreading to regional lymph
nodes

Location: 3-4times mand>max

Premolar/ molar region and few
cases in Ant. Mand.
Commonly above the Mand. Canal
Periphery and shape:
uni/multilocular mass
Well defined / well corticated
(rarely not corticated)

Internal structure:
Often multilocular / soap bubble /
honeycomb
Round radiolucent area
with/without thick sclerotic bony
peripheries

Effect on surrounding
structures:
Expansion of adjacent
cortical plates
Expansion into the
surrounding soft tissue
Mand canal may
depressed/ push
laterally-medially
Adjacent lamina dura
may lost / unaffected
teeth

D/D:
Recurrent ameloblastoma = peripheries and
internal structures
Odontogenic myxoma
CGCG
Management :
Treated surgically with resection encompassing
a margin of adjacent normal bone
Postoperative radiation therapy ( to control
spread to lymph nodes )

MALIGNANT AMELOBLASTOMA AND

AMELOBLASTIC CARCINOMA
Disease Mech.:
Malignant ameloblastoma: Typical benign
histological features and malignant of its biologic
behavior (metastasis)
Ameloblastic carcinoma : malignant histology
Clinical features:
M>F
Common btw the 1st and 6th decades
Mass of the jaw
Displaced/loosened teeth and mucosa
Metastatic to cervical lymph nodes, lung, spine
Local extension into adjacent bones, CT, salivary
glands

Location: mand>max / premalar, molar region

Periphery and shape:
Well defined / corticated
Presence of crenations , scalloping of the border
Internal structures:
Unilocular / commonly multilocular (honey comb,
soap bubble pattern) with thick septa

Effect on surrounding structures:

Displace teeth / root resorption
Erode lamina dura
Displace normal anatomic boundaries ( max sinus ,
floor of the nose )
Displace/erode mand neurovascular canal
D/D:
Benign ameloblastoma
Odontogenic keratocyst
Odontogenic myxoma
Central mucoepidrmoid tumer
Carcinoma in dental cyst / CGCG
Final diagnosis is the result of hitological evaluation /
metastasis
Management:
Surgical resection

METASTATIC TUMORS
Disease Mech.:
Usually by blood vessels
Metastatic lesions in jaws usually arise from sites inf
to clavicle
>1%
Clinical features:
(2)f>M
Common in 5th-7th decade
Dental pain/ numbness/ parasthesia of 3 rd branch of
trigemenal nerve / pathologic fracture / hemorrhage

Imaging features:
Location:
1st common: post. area / mand>max
2nd common: max sinus . Followed by ant hard palat
and mand condyle
Frequently Bilateral in mand
May locate in periodontal ligament space / papilla of
developing tooth
Periphery and shape:
Moderately well demarcated / no cortication or
encapsulation / may have ill defined invasive
margins
Polymorphous in shape

Metastatic
breast
carcinoma . It
has destroy Inf.
.border of mand

Bilateral
metastatic
lesions from
the lung
destroying the
mand. ramus

Metastatic
thyroid
lesion
destroying
left condyle

Invasion
into
surrounding
soft tissue

Internal structures:
Generally radiolucent
Sclerotic metastases (prostate/breast)
Effect on surrounding structures:
Stimulate periosteal reaction
(prostate/neuroblastoma)
Effect lamina dura / increase width of
PDL space
Loss of bone support
Cortical bone of adjacent structures
destroyed
Resorption of teeth rare

Prostate
metastatic
causing
sclerosis
and
periosteal
reaction

Widening
in
periodont
al space

D/D:
Multiple myeloma
Periapical inflammatory lesion
Odontogenic cyst
SCC
Management:
Poor prognosis
Usually dies within 1-2 yrs
Chemotherapy , radiotherapy , surgery ,
immunotherapy , hormone therapy

OSTEOSACOMA
Disease Mech.:
Unknown cause (genetic/ viral cause
have been suggested)
Associated with paget dis , fibrous
dyplasia after radiotherapy
Osteoid is produced directly by
malignant stroma
Three major histologic types:
Chondroblastic , osteoblastic ,
fibroblastic

Clinical features:
Rare ( 7% of all osteosarcoma )
(2)M>F
4th decade
Rapid swelling / pain / tenderness / loose teeth/
erythema
May involve neurovascular canals
Location :
mand>max(commonly post areas , lesion occur in
any part)
May cross the midline
Internal structure :
radiolucent/ mixed/ radiopaque
Granular/ sclerotic appearing , cotton balls ,
honeycomb

Periphery and shape:

Ill defined
Radiolucent/ radiopaque with no encapsulation
Typical sunray spicules / hair-on-end trabeculae
(when periosteum is displaced)
Laminar periosteal new bone ( rare )
Extension into surrounding soft tissue ( cause a
mass )

Effects on the surrounding structure :

Widening of the periodontal membrane
Max lesions -> loss of antral/nasal wall cortices
Mand lesions -> loss of adjacent lamina dura ,
enlarged/destroyed neurovascular canal

D/D:
Minimal/absent of abnormal bone
(fibrasarcoma/ metastatic carcinoma)
Osseous structure is visible
( chondrosarcoma )
New bone presence ( prostate/ breast
metastases )
Ewing sarcoma , osteomyelitis , solitary
plasmacytoma
Management:
- Resection with large border
-radio/chemotherapy