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Dentistry-5th semester > Benign-Malignant lesions of the jaw > Flashcards

Benign-Malignant lesions of the jaw Flashcards

1
Q

Benign Jaw Tumors types:

A
  • Hyperplasias (tori, exostosis and enostosis)
  • Odontogenic tumors
  • Non – Odontogenic Tumors
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2
Q

Which are the odontogenic tumors?

A
  • Epithelial tumors

▪ Ameloblastoma
▪ Adenomatoid Odontogenic tumor (AOT)

▪ CEOT/ Pindborg’s tumor

  • Mixed (ecto-mesodermal) ▪ Odontoma

▪ Ameloblastic fibroma

▪ Ameloblastic fibro-odontoma

  • Mesodermal tumors

▪ Odontogenic myxoma, Benign cementoblastoma

▪ Central odontogenic fibroma

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3
Q

Which are the non-odontogenic tumors?

A
  • Ectodermal (neurilemoma, neuroma)
  • Mixed tumors (neurofibroma, neurofibromatosis)
  • Mesodermal tumors (osteoma, Gardner’s syndrome,
  • central hemangioma, A-V fistula,osteoblastoma, osteoid osteoma
  • Pseudotumors: Central giant cell granuloma
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4
Q

Which are the differences between Benign (cystic &solid) and Malignant lesions?

A
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5
Q

How do benign lesions affect the adjacent structures?

A

Benign lesions are slow growing and most of the times asymptomatic

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6
Q

What is seen on this image?

A

Torus Palatinus

  • Exostosis are large osseous masses (bony hard).
  • Maxilla -> among the midline of the hard palate (made from cortical + cancellous bone)
  • Mandible -> lingually of the premolar teeth
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7
Q
A

Torus Palatinus

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8
Q
A

Palatal & Mandibular Tori

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9
Q
A

Palatal & Mandibular Tori

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10
Q

What type of lesion is detected on this image?

A

Ameloblastoma

  • Cyst-like mass
  • Multilocular, meaning that is composed of multiple small chambers, sometimes is unilocular and
  • is called either cystic- ameloblastoma or a unilocular ameloblastoma
  • The ameloblastoma has pushed the impacted tooth to the coronoid process and also has pushed mesially the 2nd premolar
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11
Q

What type of lesion is detected on this image?

A

Ameloblastoma

  • This has caused extensive external root resorption and has displaced the impacted tooth
  • Tennis-racket or Honeycomb appearance, external root resorption
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12
Q

What type of lesion is detected on this image?

Which is the density and radiolucency of this radiograph?

A

Ameloblastoma

  • Ameloblastoma is a low density or radiolucent lesion
  • 3rd molar has been displaced almost to the right condyle
  • Patients head is exposed from posterior to anterior.
  • Excellent radiograph to access asymmetry
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13
Q

Describe.

A
  • Multi locular lesion. Loculations -> chambers
  • Caused external root resorption
  • Different level of radiolucency -> suspicious for possible perforation of the lingual or buccal mandibular cortex or both.
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14
Q

What kind of lesion is detected on this image?

A
  • X, Y and Z Axes
  • Piece of ameloblastoma (not inside patient mouth)
  • Honeycomb appearance
  • Benign mass -> we remove it, but the patient has to do reconstruct the jaw after
  • Occlusal radiograph
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15
Q

How do we cope with an ameloblastoma case?

A
  • Confirm Your Diagnosis: Ameloblastoma If lesion is big, we do a biopsy and then we do the jaw resection
  • If lesion is small we do them at the same time
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16
Q

What is the image display in these radiographs?

A

Advanced Imaging: Establish Your Diagnosis

  • T2 images highlight the fluid and cystic fluid is going to be depicted
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17
Q

OKC V. Ameloblastoma:

A

Similar appearance with cystic ameloblastoma e.g. impacted tooth, expanded almost to sigmoid notch,
double layer appearances

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18
Q

Adenomatoid Odontogenic Tumor (AOT):

A
  • Most common location : maxillary canine and premolar region. 2:1 female to male ratio.
  • Average age = ~16 yrs
  • Tumors contain specks of calcified material
  • Low recurrence rate
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19
Q

What type of lesion is seen on this radiograph?

A

Adenomatoid Odontogenic Tumor (AOT)

Cyst like but contains opaque small flex, they are radiolucent

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20
Q

What type of lesion is seen on this radiograph?

A

Adenomatoid Odontogenic Tumor (AOT)

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21
Q

CEOT / Pindborg’s Tumor:

A
  • Behaves like ameloblastoma
  • Predilection for mandible-premolar/molar area

>half of the lesions will have associated impacted or unerupted tooth

  • Periphery well defined to diffuse
  • Cystic lesion with numerous scattered, radiopaque foci of

varying size and density giving it the appearance of “Driven Snow”

  • Presence of amyloid and calcified “Liesegang Rings”
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22
Q

What type of lesion is seen on this image?

A

CEOT / Pindborg’s Tumor

Tremendous expansion noted in right posterior mandible, associated with CEOT (not seen in panoramic)

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23
Q
A

Complex Odontoma

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24
Q

Odontoma:

A

2 types of odontoma

  • Compound -> closer resembles to teeth, low density lesions which contain large opaque masses (cotton- like masses in shape)
  • Compound -> masses are very similar to teeth (tooth-like structures), irregular in shape, high density masses which occupy large portion of the odontoma
  • If compound stays, they may block the eruption of a tooth and the tooth will become impacted
  • Odontomas are the most common odontogenic tumors (70%), they are low density which are almost filled with large high-density masses, which look like teeth
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25
Q

Type of lesion?

A
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26
Q

Type of lesion?

A

Compound odontoma

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27
Q

Type of lesion?

A

Odontoma

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28
Q

Type of lesion?

A

Ameloblastic Fibroma (Soft Odontoma)

  • They are very rare.
  • Ameloblastic fibroma, looks like widen tooth follicle.
  • This is a benign rare mass.
  • The fibroma will always be radiolucent.
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29
Q

Type of lesion?

A

Ameloblastic Fibro – Odontoma Fibro-odontoma

  • are odontomas themselves, they contain a fibrous component. It is visible only on the histological examination
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30
Q

Type of lesion?

A

Odontogenic Myxoma

  • If odontogenic myxomas have a gender predilection, they slightly favor females. Although the lesion can occur at any age, more than half arise in individuals between 10 and 30 years. This tumor often is associated with a congenitally missing or unerupted tooth. It grows slowly and may or may not cause pain. It may also invade the maxillary sinus and cause exophthalmos. Recurrence rate is as high as 25%. This high rate may be explained by the lack of encapsulation of the tumor, its poorly defined boundaries, and the extension of nests or pockets of myxoid (jellylike) tumor into the trabeculae.
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31
Q

Type of lesion?

A

Bening Cementoblastoma

  • Benign cementoblastomas are slow-growing, mesenchymal neoplasms, composed principally of cementum. The tumor manifests as a bulbous growth around and attached to the apex of a tooth root. Its histologic characteristics are similar to those of osteoblastomas, and it is composed of cementoblasts that arise from the mesenchyme of the periodontal ligament.
  • Looks like extension of the root of the tooth
  • Odontogenic in origin mass.
  • In order to remove it, you have to beak the mesial root of the tooth
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32
Q

Type of lesion?

A

PCD (periapical cemento-osseous dysplasia)

  • Lesion is very small, associated with roots of the mandibular incisors and stars as a periapical radiolucency. Usually, these teeth look healthy without evidence of caries.
  • If we leave them like that, some opaque structures will start develop in these radiolucency’s. in time these will occupy the entire radiolucent area.
  • At the end these lesions will be healed
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33
Q

Type of lesion?

A

PCD (periapical cemento-osseous dysplasia)

34
Q

Type of lesion?

A

PCD (periapical cemento-osseous dysplasia)

35
Q

Type of lesion?

A

NeuroFibroma

  • Lesion that is originated from nerve fiber
  • Radiolucent lesion, because it is growing inside the bone, it causes osteolysis.
  • If it is associated with large nerve brand, we may see also sensory disturbances e.g.
  • if it grows inside the mandibular canal, the patient may complain about numbness of the lower lip or if it grows in the branched of the infraorbital nerve, they will complain on loss of sensation on maxillary teeth
36
Q

Type of lesion?

A

Central Hemangioma

  • Vascular in origin tumor, moderately defined, diagnosed in young kids.
  • For this mass the moment you put a needle inside it, you will observe that the removable part of the syringe will start being withdrawn by it self from the inside pressure of the hemangioma
37
Q

Type of lesion?

A

Osteoblastoma

  • Is a benign bone tumor which is originated from osseous elements.
  • They are considered locally aggressive tumors.
  • They are painful.
38
Q

Osteoma:

A
  • Looks like exostosis
  • When you have solitary osteoma, you remove it surgically like an exostosis.
39
Q

Type of lesion?

A

Osteoma

Gardner’s syndrome: Gardner’s syndrome, inherited as an autosomal dominant disorder, is characterized by intestinal polyposis, multiple osteomas, fibromas of the skin, epidermal and trichilemmal cysts, impacted permanent and supernumerary teeth, and odontomas.

40
Q

Type of lesion?

A

Central Giant Cell Granuloma

  • Appearance lucent in general not always very clear border, this is also a tumor that affects young kids
  • This is pure bone tumor and has nothing to do with teeth
  • Occlusal view of the tumor
41
Q

Define:

  1. Malignancies
  2. Primary tumors
  3. Metastatic tumors
  4. Malignancies classification
A
  • Malignancies are uncontrolled growths of tissue
  • Primary tumors represent de novo tumors in
  • their initial site
  • Metastatic tumors originate from distant primary growths
  • Malignancies are generally classified by tissue of origin
42
Q

Malignant Lesions:

Four Categories:

A
  1. Carcinomas (epithelial origin)
  2. Sarcomas (mesenchymal origin)
  3. Hematopoieticorigin
  4. Metastases
43
Q

Clinical Presentation of Malignant Lesions:

A

▪ Displaced or mobile teeth

▪ Ulceration

▪ Foul odor

▪ Swelling

▪ Paresthesia

▪ Dysesthesia

▪ Pain

▪ Dysgeusia (decreased taste)

▪ Dysphagia (difficulty swallowing)

▪ Dysphonia (difficulty speaking)

▪ Dysphasia (impaired speech)

▪ Exposed bone

▪ Poorly healing or non-healing surgical or trauma sites

▪ Sensory or neural deficits

▪ Weight loss

▪ Hemorrhage

44
Q

Malignant lesions:

Location:

A

Varies depending on the type.

  • Carcinomas: soft tissue locations
  • Sarcomas: mandible and posterior region of jaws
  • Metastatic lesions : common in the posterior mandible and maxilla and within the follicles of developing teeth
45
Q

Malignant lesions:

Periphery & Shape:

A

▪ Ill defined border with lack of cortication and absence of encapsulation. Associated non- healing soft tissue ulceration and or swelling is highly suggestive

▪ Shape is generally irregular

46
Q

Malignancies:

Effects on Adjacent Structures:

A
  • Destruction of cortical borders
  • Soft tissue mass
  • Invasion of PDL
  • Widened PDL space
  • Destruction of bone at apices
  • Displacement of developing tooth
  • Teeth appear to float due to bone destruction
47
Q

Malignancies:

Effects on Cortical Bone:

A

▪ Cortical bone destruction without periosteal reaction

▪ Laminated periosteal reaction + cortical bone destruction

▪ Codman’s triangle

▪ Sunray or sunburst periosteal reaction

48
Q

Codman’s Triangle:

A

▪ Codman’s triangle is the radiographic appearance of the rim of new subperiosteal bone which forms when a lesion such as a tumor lifts the periosteum away from the bone.

▪ The small triangle of bone is seen at the advancing margin of the lesion.

▪ The three main causes for a Codman’s triangle are:

 Osteosarcoma
 Ewing’s sarcoma
 Subperiosteal abscess

▪ Layering of the new bone may result in an “onion skin” appearance.

49
Q

Squamous Cell Carcinoma

A

▪ Malignant tumor from surface epithelium

▪ Invades

 Deeper soft tissue
 Connective tissue
 Underlying bone
 Local and regional nodes
 Metastases to liver, lung, and skeleton

50
Q

Squamous Cell Carcinoma:

Clinical Appearance:

A

▪ Red, white, or mixed lesion

▪ Ulcerated

▪ Indurated or rolled borders

▪ Can be painful or painless

▪ Rubbery or hard lymph nodes that are “fixed” to

underlying structures.

▪ Usually occurs in patients >50 years

▪ More common in males

51
Q

Squamous Cell Carcinoma:

Radiographic Features:

A

Location:

 Often on lateral border of the tongue Therefore, it is

seen radiographically in the posterior mandible

 Lesions in lip and floor of the mouth may invade

anterior mandible

 Gingival lesions may initially mimic periodontal disease

Shape & Borders:

 Commonly irregular and ill-defined borders

 Finger-like projections demonstrating invasion

 Occasionally, the lesion may have smooth borders, indicating erosion

 Pathologic fractures may occur. Sharp, thin edges may

be evident

Internal Architecture:

 Squamous cell carcinoma tends to be completely radiolucent. There may be trapped pieces of residual bone within the lesion

52
Q

Type of lesion?

A

Squamous Cell Carcinoma

53
Q

Type of lesion?

A

Squamous Cell Carcinoma

54
Q

Type of lesion?

A

Squamous Cell Carcinoma

55
Q

Type of lesion?

A

Squamous Cell Carcinoma – Soft Tissue Origin

  • Carcinoma invaded the mandible and grew outside patients’ skin.
  • All entire mandible is gone, there are floating teeth
56
Q

Type of lesion?

A

Squamous cell carcinoma

  • originated on the base of the tongue
  • Invasion of tumor in the mandible
57
Q

Squamous Cell Carcinoma Originating in a Cyst:

A

Location:

 Tooth-bearing areas
 Most occur in the mandible

Shape & Borders:

 Initially indistinguishable from a cyst. Smooth, corticated and hydraulic

 Advanced lesions are ill-defined, diffuse, and lack cortication

Internal Architecture:

 Entirely radiolucent

Effect on Adjacent Structures:

 Destroys cortices and adjacent lamina dura of teeth.  Capable of destroying alveolar processes

58
Q

type of lesion?

A

Squamous Cell Carcinoma Originating in a Cyst

  • Residual cyst, with destruction of the bone
59
Q

Central Mucoepidermoid Carcinoma:

A

Location:

 Twice as common in the mandible than the maxilla

 Usually in the premolar or molar region

 Occurs superior to the mandibular canal. This might indicate odontogenic origin

Borders & Shape:

 Unilocular or multilocular mass

 Thick, corticated borders

Internal Architecture:

 Multilocular soap bubble appearance similar to ameloblastoma or odontogenic myxoma

 Septae are from remodeled residual bone

Effects on Adjacent Structures:
 Expands buccal and lingual cortices

 Expands inferior border of mandible  May thin or scallop cortices
 Similar effects to benign tumors

60
Q

Type of lesion?

A
61
Q

Type of lesion?

A

This is called a small ameloblastoma or a small myxoma, there is distraction of the crestal cortex, displacement of the mandibular canal

62
Q

Osteosarcoma:

A

▪ Malignant neoplasm of bone

▪ New bone is produced by the lesion (not by reactive bone formation of surrounding osteoclasts)

▪ Three major types

  1. Chondroblastic
  2. Osteoblastic
  3. Fibroblastic

Location:

 More common in the mandible

 Usually arises in the posterior mandible. The molar

areas and ramus are most commonly affected

 In maxilla, usually arises in the posterior. The ridge,

sinus, and palate are most commonly affected

Borders and Shape:

 Ill-defined

 Radiolucent without capsule or surrounding osteosclerosis

 If the periosteum is involved, sunray spicules (aka: “hair-on-end” trabeculae, or orthoradial striations) may be present

Effects on Adjacent Structures:

 Widening of the PDL

 Destruction of cortices

 May destroy or widen the cortex of the inferior alveolar

canal

 Codman’s triangles are seen

63
Q

Type of lesion?

A

Osteosarcoma

Destruction of right posterior mandible

PA View

64
Q

Type of radiograph?

Window?

type of lesion?

A

Axial CT Bone Window

Tremendous destruction and bone formation by the tumor Aggressive malignancies

65
Q

Type of radiograph?

Window?

A

Axial CT Soft Tissue Window

66
Q

Describe:

A

Looks like hair are growing from the mandibular cortex and gross destruction of the PDL space

67
Q

Describe:

A

PDL widening and destruction of the affected teeth, radiolucent appearance

68
Q

Describe:

A
69
Q

Chondrosarcoma:

A

Location:

 Unusual in the facial bones. Accounts for only 10% of all cases

 Occurs equally in maxilla and mandible near cartilage

 Maxillary lesions tend toward the anterior, while

mandibular lesions occur in the coronoid process, head of the condyle and neck, and sometimes in the mandibular symphysis

Borders & Shape:

 Round, ovoid, or lobulated

 Borders can range from smooth and well corticated to indistinct

 If the periosteum is involved, sunray spicules (aka:

“hair-on-end” trabeculae, or orthoradial striations)

Internal Architecture:

 May appear as multilocular lucencies to highly calcified lesions. Usual appearance is mixed density

 Radiographic appearance – may be “flocculent” (snow- like)

 “Moth eaten appearance” may be seen, amid islands of unaffected bone

Effects on Adjacent Structures:

 Expand cortical boundaries due to slow growth

 Can remodel condyle and glenoid fossa

 Widened PDL and lack of lamina dura of associated

teeth

70
Q

What type of lesion is chondrosarocma?

A

In general, chondrosarcomas share the general radiographic features of malignant neoplasms.

71
Q

Describe:

A

Lesions have caused soft tissue expansion. PDL widening is the main feature. Affected retromolar part Mass developed in soft tissue

72
Q

Ewing’s Sarcoma:

A

Location:

 2:1 mandibular to maxillary cases

 Found in posterior

 Lesions start in marrow spaces and expand to involve

cortices

Shape & Borders:

 Poorly demarcated
 Non-corticated borders
 There is no typical shape to lesions of Ewing’s sarcoma

Internal Architecture:

 Radiolucent

Effects on Adjacent Structures:

 May stimulate the periosteum to lay down new bone in sunray pattern or Codman’s triangles

 Will destroy cortices of normal anatomy such as lamina dura of teeth

73
Q

type of lesion?

A

Fibrosarcoma

74
Q

Type of lesion?

A

Multiple Myeloma

  • Multiple hold on the calvarium
  • Multiple myeloma
  • Punched-out -> characteristic
  • Irregular in shape, radiolucent areas in the calvarium indicating multiple myeloma
75
Q

Type of lesion:

A

Lymphoma Involving the Maxillary Sinus

76
Q

Type of lesion?

A

Lymphoma

77
Q

Type of lesion?

A

Leukemia

78
Q

Lymphoma Vs. Leukemia:

A
  • Lymphoma is localized Gross destruction, radiolucent areas, but is localized on lymphoma
  • Leukemia is generalized Gross destruction of the mandibular bone throughout the mandible and the maxilla. Maxillary teeth have lost support (floating teeth)
79
Q

Type of lesion?

A

Metastatic Bone Lesions

80
Q

Type of lesion?

A
  • Metastatic lesion
  • Gross destruction of PDL

Dentistry-5th semester (9 decks)

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