Chapter 7

Neoplasia

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 Outline
Description of Neoplasia
Causes of Neoplasia
Classification of Tumors
Names of Tumors
Treatment of Tumors
Epithelial Tumors
Tumors of Squamous Epithelium
Salivary Gland Tumors
Odontogenic Tumors
Tumors of Soft Tissue
Tumors of Melanin-Producing Cells
Tumors of Bone and Cartilage
Tumors of Blood-Forming Tissues
Metastatic Tumors of the Jaws
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 Description of Neoplasia
(pg. 234)
Neoplasia
New growth
Cells exhibit uncontrolled proliferation
Neoplasm
A mass of such cells
Tumor
Means swelling, but is often used as a
synonym for neoplasm

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Description of Neoplasia (cont.)
The occurrence of neoplasia
An irreversible change must take place in the
cells.
This change must be passed on to new cells and
result in uncontrollable cell multiplication.
It is an abnormal process.
The cells are abnormal; the proliferation of the cells
is uncontrolled and unlimited.

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 Causes of Neoplasia
(pg. 234)
Many agents have been shown to cause
neoplastic transformation of cells in the
laboratory.
Chemicals hundreds of different ones
Viruses called oncogenic viruses
Radiation sunlight, x-rays, nuclear fission
It can also occur spontaneously secondary
to a genetic mutation.

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 Classification of Tumors
(pgs. 234-235)
Two categories
Benign tumor or neoplasia
Remains localized
May be encapsulated with fibrous connective tissue
It can invade adjacent tissue, but does not have the
ability to spread to distant sites.
Malignant tumor
Invades and destroys surrounding tissue
Has the ability to spread throughout the body

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Classification of Tumors (cont.)
Benign tumors almost always resemble
normal tissue.
Malignant tumors vary in histologic
appearance.
Well-differentiated malignant tumors have
neoplastic cells that resemble normal cells;
poorly differentiated ones do not.
Others may be undifferentiated or anaplastic,
and do not resemble the tissue from which
they were derived at all.

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Classification of Tumors (cont.)

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Classification of Tumors (cont.)
(pgs. 234-235) (Table 7-1)
Pleomorphic
The cells of malignant tumors often vary in size
and shape.
Hyperchromatic
The nuclei of these cells are darker than those
of normal cells and exhibit an increased
nuclear-cytoplasmic ratio.
Mitotic figures
Normal and abnormal mitotic figures are seen
in the nucleus of neoplastic cells.

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Classification of Tumors (cont.)

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Names of Tumors (Cont.)

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 Names of Tumors (Cont.)
(pgs. 234, 236) (Table 7-2)
Naming tumors
The prefix is determined by the tissue or cell of
origin.
The suffix -oma is used to indicate a tumor.
Benign tumors
Lipoma benign tumor of fat
Osteoma benign tumor of bone

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 Names of Tumors (cont.)
Naming malignant tumors
Carcinoma malignant tumor of epithelium
Sarcoma malignant tumor of connective
tissue
Malignant tumors
Squamous cell carcinoma or epidermoid
carcinoma malignant tumor of squamous
epithelium
Osteosarcoma malignant tumor of bone

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 Treatment of Tumors
(pgs. 234-235)
Benign tumors
Treated by surgical excision, either wide local
excision or enucleation
Malignant tumors
Treated by surgery, chemotherapy, or radiation
therapy, often a combination

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 Epithelial Tumors
(pg. 235)
Three different types are found in the oral
cavity.
From squamous epithelium
From salivary gland epithelium
From odontogenic epithelium

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Tumors of Squamous Epithelium
Papilloma
Premalignant Lesions
Squamous Cell Carcinoma
Verrucous Carcinoma
Basal Cell Carcinoma

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 Papilloma
(pgs. 235-236)
A benign tumor of squamous epithelium
A small exophytic pedunculated or sessile
growth
Papillary projections, may be white or the color
of normal mucosa
Most often on the soft palate or tongue
May occur at any age, with equal sex
predilection

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 Papilloma (cont.)

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 Papilloma (cont.)
Microscopic
Numerous fingerlike or papillary projections
with a central core of fibrous connective tissue
surfaced by normal stratified squamous
epithelium
Treatment
Surgical excision

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 Premalignant Lesions
Leukoplakia
Erythroplakia
Epithelial Dysplasia

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 Leukoplakia
(pgs. 235, 237)
Means white plaque
A clinical term, not a histologic term
Biopsy is necessary to establish a definitive
diagnosis.
Most are due to a hyperkeratosis, or epithelial
hyperplasia and hyperkeratosis
If the cause can be identified, remove the
cause and see if it resolves.
If not, the lesion should be biopsied.

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 Leukoplakia (cont.)

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 Leukoplakia (cont.)
Microscopic
May show epithelial dysplasia, a premalignant
condition, or even squamous cell carcinoma
Approximately 5% to 25% reveal epithelial dysplasia.
Treatment
Dependent on histologic finding

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 Erythroplakia
(pg. 237)
An oral mucosal lesion appearing as a
smooth red patch or a granular red and
velvety patch
Speckled leukoplakia
A lesion that shows a mix of red and white
areas
Most often located on the floor of the mouth,
tongue, and soft palate
Less common than leukoplakia

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 Erythroplakia (cont.)
Microscopic
90% of cases of erythroplakia demonstrate
epithelial dysplasia or squamous cell
carcinoma
Treatment
Dependent on histologic diagnosis

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 Epithelial Dysplasia
(pgs. 237-238)
A histologic
diagnosis of a
premalignant
condition
Indicates disordered
growth
These lesions
frequently precede
squamous cell
carcinoma.
Changes may revert
to normal if the
stimulus is removed.
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 Epithelial Dysplasia (cont.)
Clinically, it may present as an
erythematous lesion, a white lesion, or as
a mixed erythematous and white lesion.
Lesions often arise on the floor of the mouth or
tongue.
Dysplasia in other tissues is not
considered a premalignant process.

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 Epithelial Dysplasia (cont.)
Microscopic
Abnormal maturation of epithelial cells with
disorganization of epithelial layers; hyperplasia of basal
cells; and epithelial cells with enlarged and
hyperchromatic nuclei, increased nuclear cytoplasmic
ratios, abnormal keratinization, and increased numbers
of normal and abnormal mitotic figures
Carcinoma in situ
Severe dysplasia involving the full thickness of
epithelium
Treatment
Surgical excision

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 Squamous Cell Carcinoma
(Epidermoid Carcinoma)
(pgs. 238-240)
A malignant tumor of squamous epithelium
The most common primary malignancy of the
oral cavity
It can infiltrate adjacent tissues and form distant
metastases.
Usually metastasizes to lymph nodes in the neck and
then to distant sites, such as the lungs and liver
Clinically, it usually is an exophytic ulcerative
mass.
It can infiltrate and destroy bone.

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 Squamous Cell Carcinoma
(Epidermoid Carcinoma) (cont.)

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Squamous Cell Carcinoma (SCC)
(pgs. 238, 240)
Microscopic
Tumor cells invade connective tissue underlying the
epithelial basement membrane.
Well-differentiated tumors will show keratin.
Keratin pearls
Keratin may be seen in individual cells within the tumor.
SCC may occur anywhere within the oral cavity,
most often on the floor of the mouth, ventrolateral
tongue, soft palate, tonsillar pillar, and retromolar
areas.
May occur on the vermilion border of the lips and skin of
the face these locations have a better prognosis than
SCC of the oral mucosa.
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Squamous Cell Carcinoma (SCC)
(cont.)

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 Squamous Cell Carcinoma
Exposure to the sun causes the lips to turn
from dark pink to mottled grayish pink.
The interface becomes blurred; linear fissures
are seen at right angles to the line of the
interface.
Solar cheilitis
A condition in which mild to severe epithelial
dysplasia occurs
Most patients are over 40 years old.
Most have been men, but the incidence has
increased in women.
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 Risk Factors for Squamous Cell
Carcinoma
(pgs. 238-239)
Tobacco
Smoking, snuff dipping, tobacco chewing
Alcohol consumption

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 Treatment and Prognosis for
Squamous Cell Carcinoma (Cont.)

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 Treatment and Prognosis for
Squamous Cell Carcinoma (Cont.)
(pgs. 239-241) (Table 7-3)
Generally is treated by surgical excision.
Radiation therapy or chemotherapy may also
be used.
These patients may have xerostomia.
TNM staging may be used to determine
the prognosis.
The higher the stage, the worse is the
prognosis.

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 TNM Staging
(pg. 240) (Box 7-1)
T Tumor
T1 less than 2 cm in diameter
T2 24 cm in diameter
T3 greater than 4 cm in diameter
T4 invades adjacent structures
N Node
N0 no palpable nodes
N1 ipsilateral palpable nodes
N2 contralateral or bilateral nodes
N3 fixed palpable nodes
M metastasis
M0 no distant metastasis
M1 clinical metastatsis
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 Verrucous Carcinoma
(pgs. 240-242)
A form of squamous cell carcinoma, but
separated because it has a much better
prognosis
A slow growing exophytic tumor with a pebbly
red and white surface
Most cases are in men over 55 years old and
involve the vestibule and buccal mucosa.

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Verrucous Carcinoma (cont.)

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 Verrucous Carcinoma (cont.)
Microscopic
A tumor with numerous papillary epithelial
projections
Papillary projections are filled with keratin.
Epithelium is well differentiated, does not contain
atypical cells, and exhibits broad-based rete pegs.
The tumor does not show invasion through the
basement membrane.
Treatment
Surgical excision

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 Basal Cell Carcinoma
(pgs. 241-242)
A malignant skin tumor associated with
excessive exposure to the sun.
Frequently arises on the skin of the face
Appears as a nonhealing ulcer with
characteristic rolled borders
Most cases in white adults with no sex
predilection.

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Basal Cell Carcinoma (cont.)

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 Basal Cell Carcinoma (cont.)
Microscopic
Composed of basal cells derived from
squamous epithelium
A proliferation of basal cells into underlying
connective tissue
Treatment
Surgical excision
Radiation therapy may be used to treat large
lesions.
Rarely metastasizes

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 Salivary Gland Tumors
Pleomorphic Adenoma
Monomorphic Adenoma
Adenoid Cystic Carcinoma (Cylindroma)
Mucoepidermoid Carcinoma

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 Salivary Gland Tumors (cont.)
(pgs. 241, 243)
May arise in either major or minor salivary
glands
Minor salivary gland tumors are most often
located at the junction of the hard and soft
palate.
Adenomas
Benign tumors of salivary glands

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Salivary Gland Tumors (cont.)

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 Pleomorphic Adenoma
(Benign Mixed Tumor)
(pgs. 241-242, 244)
A benign salivary gland tumor
90% of all salivary gland tumors
Microscopic
An encapsulated tumor composed of tissue
that appears to be a mix of both epithelium and
connective tissue
The most common extraoral location is the
parotid gland; the most common intraoral
location is the palate.

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 Pleomorphic Adenoma
(Benign Mixed Tumor) (cont.)

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 Pleomorphic Adenoma
(pgs. 241, 243)
Clinically
Appears as a slowly enlarging, nonulcerated, painless,
dome-shaped mass
Most occur in individuals less than 40 years old
Occurs more often in women than men
Treatment
Surgical excision
Recurrence rates vary; they are related to the success
of the initial surgical removal.
Carcinoma arising in a pleomorphic adenoma
These lesions have been known to undergo malignant
transformation.

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Pleomorphic Adenoma (cont.)

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 Monomorphic Adenoma
(pgs. 242, 244)
A benign encapsulated salivary gland tumor
Occurs less often than the pleomorphic adenoma
A uniform pattern of epithelial cells
Occurs most commonly in adult females
Occurs most often in the upper lip and buccal
mucosa
Treatment
Surgical excision

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Monomorphic Adenoma (cont.)

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Monomorphic Adenoma (cont.)
Warthin tumor (papillary cystadenoma
lymphomatosum) is a unique type of
monomorphic adenoma.
An encapsulated tumor with epithelial and
lymphoid tissue
A painless, soft, compressible or fluctuant mass
Usually occurs on the parotid gland, rarely
intraorally
Often develops bilaterally
Occurs predominantly in adult men

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 Adenoid Cystic Carcinoma
(Cylindroma)
(pgs. 243-245)
A slow growing malignant tumor of salivary
gland origin
Microscopic
Unencapsulated, infiltrates surrounding tissue
Small, deeply staining, uniform epithelial cells
that resemble Swiss cheese

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Adenoid Cystic Carcinoma
(Cylindroma) (cont.)

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 Adenoid Cystic Carcinoma
Most common extraoral site is the parotid;
most common intraoral site is the palate.
Most appear as slowly growing masses that
may be ulcerated
May be painful
More common in women than in men
Most occur in the fifth and sixth decades
Treatment
Surgical excision

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 Mucoepidermoid Carcinoma
(pgs. 243-245)
A malignant salivary gland tumor
Unencapsulated, infiltrating tumor
A combination of mucus cells interspersed with
squamous-like epithelial cells called
epidermoid cells
Major gland tumors are most often found in the
parotid gland, minor gland tumors on the
palate
Appear clinically as slowly enlarging masses
May appear in bone as either a unilocular or
multilocular radiolucency
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Mucoepidermoid Carcinoma
(cont.)

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 Mucoepidermoid Carcinoma
(cont.)
May occur over a wide age range
Usually occurs in adults, but is the most
common malignant salivary gland tumor in
children
Occurs most often in females
Treatment
Surgical excision

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 Other Malignant Salivary Gland
Tumors
(pg. 245)
There are several additional malignant
salivary gland tumors including
Polymorphous low-grade adenocarcinoma
Acinic cell adenocarcinoma
Other adenocarcinomas

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 Odontogenic Tumors
Epithelial Odontogenic Tumors
Mesenchymal Odontogenic Tumors
Mixed Odontogenic Tumors
Peripheral Odontogenic Tumors

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Odontogenic Tumors (cont.)

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 Odontogenic Tumors (cont.)
(pgs. 245-246) (Table 7-4)
Derived from tooth-forming tissues
They may be composed of epithelium,
mesenchyme, or a combination of both.
Most are benign, but there are rare malignant
forms.

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Epithelial Odontogenic Tumors
Ameloblastoma
Calcifying Epithelial Odontogenic Tumor
(CEOT)
Adenomatoid Odontogenic Tumor
Calcifying Odontogenic Cyst

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 Ameloblastoma
(pgs. 245-247)
A benign, slow-growing but locally
aggressive epithelial odontogenic tumor
May occur in either mandible or maxilla, most
often in the mandible in the molar or ramus
area
Unencapsulated, infiltrates into surrounding
tissue
Composed of ameloblast-like epithelial cells
surrounding areas resembling stellate
reticulum.

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Ameloblastoma (cont.)

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 Ameloblastoma (cont.)
(pgs. 246-247)
Radiographic
A multilocular soap-bubblelike or honeycombed
radiolucency
May occur anywhere within the jaws, can occur in
association with a dentigerous cyst
May cause expansion of bone
Most occur in adults with no sex predilection.
Treatment
Surgical removal
Recurrence is common

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Ameloblastoma (cont.)

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 Calcifying Epithelial Odontogenic
Tumor (CEOT) (Pindborg Tumor)
(pgs. 246, 248)
A benign epithelial
odontogenic tumor
Composed of islands
and sheets of
polyhedral epithelial
cells
Amyloid-like material
are seen with
calcifications within the
deposits.
Most often affects
adults, with no sex
predilection
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 Calcifying Epithelial Odontogenic
Tumor
(pgs. 246, 248)
Radiographic
A unilocular or
multilocular radiolucency
Occurs more often in
mandible than maxilla,
most often in the
bicuspid and molar area
Treatment
Surgical excision

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 Adenomatoid Odontogenic Tumor
(AOT)
(pgs. 246-248)
An encapsulated, benign epithelial
odontogenic tumor
The tumor is surrounded by a dense, fibrous
connective tissue capsule.
Consists of ductlike structures, whorls, and
large masses of cuboidal and spindle-
shaped epithelial cells
The structures are ameloblast-like cells rather
than ducts.

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Adenomatoid Odontogenic Tumor
(AOT) (cont.)

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Adenomatoid Odontogenic Tumor
(pg. 247)
70% occur in females younger than 20 years of
age.
70% involve the anterior portion of the jaws.
More common in maxilla than in the mandible.
Many are associated with impacted teeth.
Radiographic
A well-circumscribed radiolucency, may have
radiopaque areas
Treatment
Enucleation

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Adenomatoid Odontogenic Tumor
(cont.)

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 Calcifying Odontogenic Cyst
(pgs. 248-249)
A nonaggressive cystic lesion lined by
odontogenic epithelium
Has an associated, characteristic ghost cell
keratinization
Ghost cells are round structures with clear
centers.
Radiographic
Usually a well-defined lesion
May be either unilocular or multilocular
May have calcifications

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Calcifying Odontogenic Cyst
(cont.)

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 Calcifying Odontogenic Cyst
(cont.)
Most commonly seen in individuals under 40
years old
No sex predilection
Treatment
Surgical enucleation
Usually does not recur

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 Mesenchymal Odontogenic
Tumors
Odontogenic Myxoma
Central Cementifying and Ossifying
Fibromas
Benign Cementoblastoma

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 Odontogenic Myxoma
(pgs. 249-250)
A benign
nonencapsulated
infiltrating tumor
Composed of pale-staining
mucopolysaccharide
ground substance
containing dispersed cells
with long cytoplasmic
processes
Most often occurs in
young people between 10
and 29 years of age.
No sex predilection
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 Odontogenic Myxoma (cont.)
(pgs. 249-250)
Radiographic
A multilocular,
honeycombed
radiolucency with
poorly defined
margins
May become large
and displace teeth
Most often occurs in
the mandible
Treatment
Surgical excision
May recur

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Central Cementifying and Central
Ossifying Fibromas
(pgs. 250-251)
A benign well-circumscribed tumor
Composed of fibrous connective tissue and
rounded or globular calcifications resembling
cementum

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Central Cementifying and Central
Ossifying Fibromas (cont.)

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 Central Cementifying and Central
Ossifying Fibromas (cont.)
Microscopic
Contains fibrous connective tissue and calcifications
Ossifying fibroma
Calcifications resemble bony trabeculae
Cemento-ossifying fibroma
Also have bony calcifications resembling cementum
Usually occur in adults in the third and fourth decades
Occurs in females more often than in males
Most cases in the mandible
Radiographic
Varies from radiolucent to radiopaque depending on the
amount of calcified tissue
Treatment
Surgical excision
Recurrence is rare.
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 Benign Cementoblastoma
(pg. 251)
A cementum-producing
lesion
Fused to the roots of vital
teeth
Radiographic
A well-defined radiopaque
mass with a surrounding
radiolucent halo
Seen in continuity with a
mandibular molar or
premolar tooth
Typically occurs in young
adults
Pain is a frequent
symptom.
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 Benign Cementoblastoma (cont.)
Microscopic
A proliferation of cellular cementum fused to
the root or roots of the affected tooth
Treatment
Enucleation of the tumor and removal of the
involved tooth
Does not recur

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 Mixed Odontogenic Tumors
Ameloblastic Fibroma
Ameloblastic Fibro-odontoma
Odontoma

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 Ameloblastic Fibroma
(pgs. 251-252)
A benign, nonencapsulated odontogenic
tumor
Composed of both strands and small islands of
odontogenic epithelium and tissue that
resembles the dental papilla
Occurs in young children and adults
Most cases in individuals less than 20 years old.
Occurs more often in males
Most commonly in the mandibular bicuspid and
molar region

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Ameloblastic Fibroma (cont.)

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 Ameloblastic Fibroma (cont.)
(pgs. 251-252)
Radiographic
Either a well-defined
or poorly defined
unilocular or
multilocular
radiolucency
Treatment
Surgical excision
Low recurrence rate

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 Ameloblastic Fibro-odontoma
(pg. 252)
A benign odontogenic tumor
Has features of an ameloblastic fibroma and
an odontoma
Most cases in young adults
Average age of 10
No sex predilection
Typically arises in posterior jaws

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 Ameloblastic Fibro-odontoma
(cont.)
Radiographic
A well-delineated radiolucent lesion
May be unilocular or multilocular
Calcifications are noted within the
radiolucency.
Treatment
Conservative surgical excision
Recurrence is unusual.

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 Odontoma
(pg. 252)
An odontogenic tumor two varieties
Compound
A collection of numerous small teeth
Complex
A mass that does not resemble teeth
Most are found in adolescents and young
adults.
No sex predilection

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 Odontoma (cont.)

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 Odontoma (cont.)
Compound is usually in the anterior maxilla
and complex in the posterior mandible.
The most common clinical manifestation is the
failure of a permanent tooth to erupt.
Radiographic
Compound a cluster of miniature teeth
Complex a radiopaque mass
Treatment
Surgical excision

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 Peripheral Odontogenic Tumors
Peripheral Ossifying Fibroma
Other Peripheral Odontogenic Tumors

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 Peripheral Ossifying Fibroma
(pgs. 252-253)
A well-demarcated sessile or pedunculated lesion
Most likely derived from cells of the periodontal ligament
More common in females than in males; often occurs in
young individuals
Composed of cellular fibrous connective tissue
interspersed with scattered bone and cementum-like
calcifications
Treatment
Surgical excision
Recurrence rate is about 16%.

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Peripheral Ossifying Fibroma
(cont.)

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 Other Peripheral Odontogenic
Tumors
(pg. 253)
Rare lesions reported to occur in gingiva
without involving underlying bone.
Treatment
Surgical excision

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 Tumors of Soft Tissue
Lipoma
Tumors of Nerve Tissue
Tumors of Muscle
Vascular Tumors

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 Lipoma
(pgs. 253-254)
A benign tumor of mature fat cells
Clinically, it is a yellowish mass surrounded by
a thin layer of epithelium.
Most occur in individuals over age 40
There is no sex predilection.
Intraorally, they are most commonly located on
the buccal mucosa and the vestibule.

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 Lipoma (cont.)

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 Lipoma (cont.)
Microscopic
A well-delineated tumor with mature fat cells
uniform in size and shape
Treatment
Surgical excision

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 Tumors of Nerve Tissue
Neurofibroma and Schwannoma
Granular Cell Tumor
Congenital Epulis

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 Neurofibroma and Schwannoma
(pg. 254)
Benign tumors derived from Schwann cells
in nerve tissue
Schwann cells are a component of the
connective tissue surrounding a nerve.
The tongue is the most common intraoral
location.
May occur at any age, with no sex predilection

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Neurofibroma and Schwannoma
(cont.)

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 Neurofibroma and Schwannoma
(cont.)
(pg. 254)
Microscopic
Neurofibroma
A fairly well-delineated, diffuse proliferation of spindle
shaped Schwann cells
Schwannoma
Spindle-shaped Schwann cells arranged in
palisaded whorls around a central pink zone
It is surrounded by a connective tissue capsule.
Treatment
Surgical excision

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Neurofibroma and Schwannoma
(cont.)

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 Granular Cell Tumor
(pgs. 254-255)
A benign tumor composed of large cells
with a granular cytoplasm
Most likely arises from neural or primitive
mesenchymal cells
Most often occurs on the tongue, followed by
the buccal mucosa
A painless, nonulcerated nodule
Most are found in adults, with a female sex
predilection.

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Granular Cell Tumor (cont.)

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 Granular Cell Tumor (cont.)
(pgs. 254-255)
Microscopic
Large oval-shaped cells with a granular
cytoplasm
Treatment
Surgical excision

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Granular Cell Tumor (cont.)

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 Congenital Epulis
(pgs. 254-255)
A benign neoplasm composed of cells closely
resembling those seen in the granular cell tumor
Most likely arises from primitive mesenchymal cells
Present at birth
Appears as a sessile or pedunculated mass on the
gingiva
Usually occurs on the anterior maxillary gingiva
Almost always occurs in girls
Treatment
Surgical excision

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 Tumors of Muscle
(pg. 255)
Extremely uncommon in the oral cavity
Vascular leiomyomas
Rhabdomyoma
A benign tumor of striated muscle
Leiomyoma
A benign tumor of smooth muscle

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 Tumors of Muscle (cont.)
Rhabdomyosarcoma
A malignant tumor of striated muscle
The most common malignant soft tissue tumor of the
head and neck in children
Typically occurs in children under 10 years of age
Has a male sex predilection
A rapidly growing, destructive tumor
Treatment
Multidrug chemotherapy, radiation therapy, and
surgery
Poor prognosis

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 Vascular Tumors
Hemangioma
Lymphangioma
Malignant Vascular Tumors

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 Hemangioma
(pgs. 255-256)
A benign proliferation of capillaries
A common vascular lesion
Thought by many to represent a
developmental lesion rather than a tumor
because they generally do not exhibit unlimited
growth potential
Capillary hemangioma contains numerous small
capillaries
Cavernous hemangioma contains larger blood
vessels

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Hemangioma (cont.)

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 Hemangioma (cont.)
Most are present at birth or arise shortly after
More than half occur in the head and neck area
The tongue is the most common intraoral
location
More common in females
May occur in adults in response to trauma
Frequently blanch when pressure is applied
Treatment
Many undergo spontaneous remission
Treatment is variable, includes surgery or the
injection of a sclerosing solution.

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 Lymphangioma
(pg. 256)
A benign tumor of lymphatic vessels
Most are present at birth.
Half arise in the head and neck area.
No sex predilection
Intraorally, the most common location is the tongue,
where it is an ill-defined mass with a pebbly surface.
A cystic lymphangioma in the neck is a cystic hygroma.
Treatment
Surgical excision
Tend to recur

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 Malignant Vascular Tumors
(pgs. 256-257)
Angiosarcoma may occur in the oral cavity
but it is rare.
Kaposi sarcoma may arise in multiple
sites, including the skin and oral mucosa.
It was historically seen in older men.
A more aggressive form has arisen with HIV.

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Malignant Vascular Tumors (cont.)
Kaposi sarcoma and HIV
Lesions are often seen in the oral cavity as
purple macules, plaques, or exophytic tumors.
Most commonly located on the hard palate and
gingiva
May also occur in patients with other forms of
immunodeficiency
Caused by a human herpes virus HHV-8 or
KSAH
Treatment
Surgical excision, radiation therapy, or a
combination of both
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 Tumors of Melanin-Producing
Cells
Melanotic Nevi
Malignant Melanoma

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 Melanotic Nevi
(pg. 257)
Nevus may refer to either a developmental
tumor of melanocytes or a pigmented
congenital lesion.
Melanocytic nevi can arise on the skin or the
oral mucosa.
Intraoral tumors consist of tan to brown
macules or papules.
Occurs most often on the hard palate or buccal
mucosa

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Melanotic Nevi (cont.)

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 Melanotic Nevi (cont.)
Occur twice as often in women as men
Usually first identified in individuals between 20
and 50 years old
Most are benign; some may be malignant.
Treatment
Biopsy
Surgical excision
Recurrence is rare.

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 Malignant Melanoma
(pg. 257)
A malignant tumor of melanocytes
Most arise on the skin in response to
prolonged exposure to sunlight.
Primary malignant melanoma is rare, but
melanomas on the skin may metastasize to the
oral cavity.
Usually a rapidly enlarging blue to black mass
An aggressive tumor with unpredictable
behavior and early metastasis

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Malignant Melanoma (cont.)

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 Malignant Melanoma (cont.)
Most common intraoral locations are the palate
and maxillary gingiva
Usually occur in adults over 40 years of age
Treatment
Surgical excision
Chemotherapy may be used along with
surgery.
Poor prognosis

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Tumors of Bone and Cartilage
(Torus) not true tumors
Exostosis
Osteoma
Osteosarcoma
Tumors of Cartilage

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 Torus
(pg. 258)
A benign lesion composed of normal
compact bone
Located on the midline of the palate or on the
lingual aspect of the mandible in the area of
premolars
They are not true tumors, but resemble
osteomas.

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 Torus (cont.)

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 Exostosis
(pg. 258)
A small nodular excrescence of normal
compact bone
Asymptomatic, bony hard nodules on the
buccal aspect of maxillary and mandibular
alveolar ridges
Most cases occur in adults, with no sex
predilection.

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 Exostosis (cont.)

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 Osteoma
(pgs. 258-259)
An asymptomatic benign tumor composed of
benign compact bone
Radiographic
Appears as either a sharply delineated radiopaque
mass within bone or attached to the outer surface of
bone
No sex predilection
A component of Gardner syndrome
Treatment
Surgical excision
Does not recur.

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 Osteoma (cont.)

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 Osteosarcoma
(Osteogenic Sarcoma)
(pgs. 259-260)
A malignant tumor of
bone-forming tissue
The most common
primary malignant
tumor of bone in
patients less than 40
years of age
The average age of
tumors in the jaws is
about 37 years.
Occur twice as
frequently in the
mandible as in the
maxilla
More common in males
than in females

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 Osteosarcoma
(pgs. 259-260)
Patients may experience a diffuse swelling or
mass that is often painful.
Paresthesia is common in tumors involving the
mandible.
Radiographic
May vary from radiolucent to radiopaque
Usually a destructive poorly defined lesion
May or may not involve adjacent soft tissue
Asymmetric widening of the periodontal
ligament space and a sunburst pattern may
be seen
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Osteosarcoma (cont.)

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 Osteosarcoma (cont.)
Treatment
Preoperative multiagent chemotherapy
followed by surgery
Jaw tumors frequently recur.

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 Tumors of Cartilage
(pgs. 259-260)
Extremely rare in the jaws
More likely to be malignant than benign
Chondroma a benign tumor of cartilage
Chondrosarcoma a malignant tumor of cartilage
The chondrosarcoma may occur in either the
maxilla or mandible.
More common in males than females
Treatment of chondrosarcomas
Wide surgical excision
Poor prognosis

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Tumors of Cartilage (cont.)

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Tumors of Blood-Forming Tissues
Leukemia
Lymphoma
Multiple Myeloma

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 Leukemia
(pgs. 259-260)
A broad group of disorders
characterized by an
overproduction of atypical
white blood cells
The types of leukemia
seen are classified
according to the kinds of
cells that are proliferating:
myelocytes, lymphocytes,
or monocytes.

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 Leukemia (cont.)
Divided into acute and chronic forms
Acute is most common in children and young adults.
Characterized by a proliferation of immature white
blood cells
Chronic most frequently occurs in middle-aged adults
Characterized by excess proliferation of mature white
blood cells
Occurs more often in males than in females
The monocytic variant most often exhibits oral lesions.
Commonly see diffuse gingival enlargement with persistent
bleeding
Treatment
Chemotherapy, radiation therapy, and corticosteroids
Prognosis depends on the type and extent of disease.

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 Lymphoma
(Non-Hodgkins Lymphoma)
(pgs. 259, 261)
A malignant tumor of lymphoid tissue
The clinical presentation is gradual
enlargement of lymph nodes.
The most common intraoral location are the
tonsils.
Usually occurs in adults
More common in males than in females.
Treatment
Radiotherapy, surgery, chemotherapy, or a
combination of these therapies

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 Multiple Myeloma
(pgs. 261-262)
A systematic, malignant proliferation of
plasma cells
Causes destructive lesions in bone
Most patients are older than 40; occurs most
commonly in the seventh decade of life
Males are affected more often than in females.
Patients usually experience bone pain and
swelling.

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Multiple Myeloma (cont.)

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 Multiple Myeloma (cont.)
(pgs. 261-262)
Radiographic
Multiple radiolucent lesions
The mandible is affected more often than the maxilla.
Most patients have an elevation of a single type
of immunoglobulin called a monoclonal spike.
Patients may have fragments of immunoglobulins in
their urine known as Bence Jones proteins.
An extramedullary plasmacytoma is a localized tumor of
plasma cells in soft tissue.
Treatment
Chemotherapy and radiation
Poor prognosis

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Multiple Myeloma (cont.)

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Metastatic Tumors of the Jaws
(pg. 262)
Tumors of the jaws from primary sites elsewhere
in the body are rare.
Most tumors arise from the thyroid, breast, lungs,
prostate gland, and kidneys.
The most frequent intraoral site for metastatic tumors is
the mandible.
Patients may experience pain, paresthesia or
anesthesia of the lip, swelling, expansion of the affected
bone, and loosening of teeth in the affected area.
Most patients are adults.
Males are affected more often than females.

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 Metastatic Tumors of the Jaws
(cont.)
(pg. 262)
Radiographic
Lesions are usually poorly defined and
radiolucent.
Roots of involved teeth may show a spiked
appearance.
Some tumors may form bone and be
radiopaque.
Treatment
Chemotherapy and radiation therapy
The prognosis for patients with tumors that
have metastasized to the jaws is poor.
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Metastatic Tumors of the Jaws
(cont.)

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 Discussion Questions
How are tumors classified?
How are tumors treated?
What salivary gland tumors may be found
within the oral cavity?
What does a lipoma contain?
What is a malignant melanoma, and what other
entity may it resemble within the oral cavity?
What tumor is associated with a sunburst
pattern?

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