Oral Cavity and oropharynx

Renuka Goonesinghe

Oral cavity and oropharynx

# Normal anatomy # Tumours and tumour like conditions of the surface epithelium # Tumours and other lesions of minor salivary glands # Tumours of odontogenic epithelium/mesenchyme # Tumours of soft tissue tissue # Tumors and tumour like conditions of lymphoid tissue # Tumours of melanocytes

Anatomy
Oral cavityExtends from lips to palatoglossal folds Bordered by cheeks,lips,Palate and floor of

the mouth

OropharynxLies behind the oral cavity bounded by the

soft palate,epiglottis,fauces,posterior third of the tongue palatine tonsils and pharyngeal tonsils

Normal structure

EpitheliumSquamous epithelium-Non keratinized keratinized Odontogenic structures- Teeth Bones Maxilla,mandible Minor salivary glands,tonsils Soft tissue-fibrofatty tissue, skelital muscle, nerves, blood vessels Lymphoid tissue

Surface epitheliumTumours and tumour like conditionsBenign tumours- Papillomas-Squamous cell

papilloma

- Condyloma acuminatum - Verruca vulgaris - Focal epithelial hyperplasia - Keratoacanthoma

Pre malignant lesions 1.Leucoplakia/erythroplakia 2.Epithelial dysplasia- disorderly maturation

and disturbed cell proliferation

Premalignanat Conditions-

Oral submucous fibrosis Lichen planus Xeroderma pigmentosum Tylosis Chronic iron deficiency

Malignant tumours

Squamous cell carcinoma Verrucous carcinoma Basaloid squamous cell carcinoma Adenosquamous carcimoma Sarcomatoid(spindle cell )carcinoma Small cell carcinoma Lymphoepithelial carcinoma

Squamous cell carcinoma

Commonest oral and oropharyngeal

malignancy Predominantly in 5th -6th decades

AetiologyMultifactorial Tobaco.beetal chewing,alcohol, Pre malignant conditions/lesions HPV infection-genotypes 16 & 18 Chronic irritation

Clinical features Affected sites-Ventrolateral aspect of

tongue,floor of mouth,buccal,retromolar,gingival,commisura l,lip and soft palate Early painless lesion->ulcer Infiltrates soft tissue and bone Lymph node metastasis

Histological featuresDysplasia of varying degree Keratin pearl formation Strong host response of lymphocytes,plasma

cells and eosinophils Diffenentiation-well,moderate and poor depending on the maturation and keratin pearl formation
Pattern of spreadInfiltrates adjacent soft tissue Submucosal spread Lymphatic spread follows the main anatomical

dranage

 In to mandible through cortical defectsEdentulous alveolar ridges Inferior dental canal Prior irradiation Lymph node spreadTo submental,submandibular,jugulo-

digastric,jugulo-omohyoid nodes (level I- IV)

 Bilateral spread to neck from midline tumours

of posterior tongue,soft palate

Haematogenous spread-less important -often involves lung

Prognosis and predictive factors

Tumour size Pattern of tumour invasion Nodal status Extracapsular extension of nodal disease Tumour thickness Vascular invasion

Verrucous carcinoma
High degree of differentiation Exophytic keratotic surface Broad acanthotic rete pegs Penetrates the underlying tissues by a

pushing margin The basement membrane is intact Local LN metastasis is rare Local resection is the treatment of choice 5 year survival rate is 80-90%

Salivary gland tumours

Most commom sites are the palate and buccal

mucosa Nearly 50% are malignant Involve minor salivary glands Types Benign-pleomorphic adenoma -myoepithelioma -Basal cell adenoma

Malignant-

Mucoepidermoid carcinoma the commonest Adenoid cystic carcinoma Polymorphous low grade adenocarcinoma Myoepithelial carcinoma Oncocytic carcinoma

epithelium and mesenchyme

Benign tumoursAmeloblastoma solid/multicystic/peripheral/desmoplastic/uni cystic types Squamous odontogenic tumour Adenomatoid odontogenic tumour Calcifying epithelial odontogenic tumour Keratocystic odontogenic tumour Ameloblastic fibroma Odontoma Odontoameloblastoma

MalignantMalignant(metastasizing )ameloblastoma Ameloblastic carcinoma Primary intraosseous squamous cell carcinoma Clear cell odontogenic carcinoma Ghost cell odontogenic carcinoma Ameloblastic fibrosarcoma Ameloblastic fibro-odontosarcoma

Mesenchymal tumours
BenignGranular cell tumour Haemangiomas Lymphangioma Focal oral mucinisis Neurofibroma Schwannoma Lipoma Ectomesenchymal chondromyxoid tumour

MalignantRhabdomyosarcoma MPNST Synovial sarcoma Giant cell tumour Kaposi sarcoma

Tumours of lymphoid tissue

Non Hodgkin lymphoma -diffuse large B cell type -Mantel cell -follicular MALT type Burkitt type T cell lymphomas Hodgkin lymphoma

OthersLangerhans cell histiocytosis Extramedullary plasmacytoma Myeloid sarcoma Follicular dendritic cell sarcoma

Tumours of malanocytes
Melanocytic naevi Malignant melanoma

Secondary tumours
Metastases to bone From Breast,kidney,lung prostate,thyroid,colon aerodigestive tract

upper

Metastases to soft tissue From lung,kidney,skin,breast