Lecture 9 - Oral Non-Squamous Malignancies Flashcards Preview

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Flashcards in Lecture 9 - Oral Non-Squamous Malignancies Deck (36)
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1

Leukemia

Originates in bone marrow

Myeloid (affects RBC precursor)
Lymphoid (affects Lymphotic precursor)
Acute or Chronic

2

Leukemia Diagnosis

Via peripheral blood and bone marrow biopsy

3

Leukemia Radiographic Appearance

Teeth floating in air

4

Leukemia Systemic Findings

Hepatosplenomegaly
Lymphadenopathy
Thrombocytopenia
Anemias
Fever

5

Leukemia Oral Manifestations

Oral ulceration
Candidiasis
Gingival hyperplasia ("boggy")
Gingival hemorrhage (platelets <10,000)

6

Leukemia Histologic Findings

Monotonous proliferation of poorly differentiated cells (RBC or WBC precursors)
Abnormal mitosis

7

Hodgkin's Lymphoma

Malignancy of lymph nodes

Oral lesions very RARE

Why are we learning this?

8

Hodgkin's Lymphoma Epidemiology

Bimodal: 15-30yr and >50yr

Males

75% cervical and supraclavicular nodes
5-10% axillary and mediastinal nodes

9

Hodgkin's Lymphoma Systemic Findings

Non-tender lymph node enlargement
Weight loss
Fever
Night sweats
General pruritis

10

Hodgkin's Lymphoma Histologic Findings

Reed-Sternberg cells (giant, multi-nucleated cells with prominent nucleoli)

11

Non-Hodgkin's Lymphoma

Malignancy of lymph nodes

Oral lesions most common in B-cell origin

Adults

12

Non-Hodgkin's Lymphoma Oral Manifestations

Soft tissue lesions:
-Non-tender, diffuse, "boggy" swelling in buccal vestibule, gingiva, and posterior hard palate

Bone lesions:
-Vague pain
-Parasthesias
-Ill-defined radiolucencies
-Bony expansion with cortical perforation

13

Non-Hodgkin's Lymphoma

Infiltrative, monotonous proliferation of poorly differentiated lymphocytic cells

14

Burkitt's Lymphoma

Undifferentiated B-cell lymphoma

Associated with EBV

t(8;14)

Good prognosis with chemotheraphy

15

Osteosarcoma Oral Manifestations

Tooth mobility and root resorption
Swelling
Pain
Parasthesia
Nasal obstruction

16

Osteosarcoma Radiographic Findings

-Loss of lamina dura
-Asymmetric widening of PDL
-Sclerotic, sunburst bone production on lesion surface

17

Burkitt's Lymphoma Oral Manifestations

Tooth mobility

Radiographic:
-Teeth floating in air
-Ill-defined borders
-Patchy loss of lamina dura

18

Burkitt's Lymphoma Systemic Findings

Facial swelling
Proptosis

19

Burkitt's Lymphoma Histologic Findings

"Starry sky" (macrophages in lesional tissue)
Small, hyperchromatic non-cleaved B-cells
High mitotic rate

20

Burkitt's Lymphoma Epidemiology

Africa:
-50-70% in jaw
-Kids
-Males
-EBV

America:
-Abdominal lesions
-15-30% EBV
-40% of lymphomas in kids

21

Osteosarcoma Epidemiology

7% in jaw
20-30yo
Males
Mandible

Common in elderly with Paget's Disease

22

Osteosarcoma Treatment

Surgical excision
Radiation
Chemo

30-50% 5yr survival

23

Chondrosarcoma

<1% in head and neck

33yo
Male
Maxilla

Surgical excision, poor prognosis

24

Chondrosarcoma Oral Manifestations

Painless swelling
Loosening of teeth, root resorption
Nasal obstruction/epistaxis

Histo - "cohabitating lacunae"

Rad - cortical penetration in sun-burst pattern

25

Ewing Sarcoma

<20yo
White males
Mandible

Confirm diagnosis with CD99

26

Ewing Sarcoma Presentation

Fever
Leukocytosis

Painful swelling
Paresthesia
Loose teeth, teeth "floating in air"

Histo - small, round blue cell tumor with pick necrosis b/t sheets of blue cells

27

Multiple Myeloma

Clonal plasma cell proliferation
t(4;14)

Older black men

28

Multiple Myeloma Systemic Findings

Bone pain, pathologic fracture
Petechial hemorrhage
Myelophthisic anemia
Fever
Amyloidosis
Kidney failure
Radiolucent "punched out" bone lesions

29

Multiple Myeloma Oral Findings

Amyloid deposition in tongue
Radiolucent "punched out" bone lesions

30

Melanoma

1 in 2million people have oral mucosal melanomas each year in the US

50-70yo

Surgery, lymph node removal, hemimaxillectomy if bone involvement

4-20% 5 year survival