Benign And Malignant Tumours.(Op)

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Osler-weber-rendu syndrome

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Also called as hereditary hemorrhagic telangiectasia.

Autosomal dominant disorder.

Characterized by triad of telangiectasia (dilation of blood vessels), recurrent epistaxis, positive family history.

Most commonly affected areas are lips, gingiva, buccal mucosa and palate, floor of the mouth and tongue.

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Reed-sternbeg cells

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Multinucleated

Malignant cells.

In Hodgkin's disease.

Derived from B lymphocytes or monocyte macrophage.

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Basal cell carcinoma

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Second most common cancer of skin.

Mostly involving the middle third of face.

Rarely seen in oral cavity.

No tendency of metastasis

Benign carcinoma

Etiology sunlight UV radiation

Historical feature shows nuclear palisading.

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Junctional nevurs

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Epithelium is thin and irregular.

Shows cell crossing the junction and growing down into connective tissue.

Called as abtropfung or dropping off.

May transfer in to malignant Melanoma.

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Benign tumor of smooth muscle.

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Leiomyoma.

Angiomyoma.

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Malignant tumor of smooth muscle.

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Leiomyosarcoma

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Benign tumor of striated muscle

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Rhabdomyoma.

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Malignant tumor of striated muscles

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Rhabdomyosarcoma.

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Benign tumor of nervous tissue

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Traumatic neuroma.

Neuro fribroma.

Neurilemmoma.

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Malignant tumor of nervous tissue

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Malignant schwannoma.

Olfactory neuroblastoma.

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Criteria for diagnosis of epithelial dysplasia in carcinoma include

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Increased abnormal Mitosis

Individual cell keratinization.

Epithelial pearls in the spinous layer.

Alterations in nuclear cytoplasmic ratio.

Loss of polarity and disorientation of cells.

Hyperchromatism.

Large nucleoli.

Dyskaryosis or nuclear atypism including giant nuclei.

Poikilokarynosis or division of nuclei without division of cytoplasm.

Basilar hyperplasia.

Note- individual cell keraterisation and epithelial Pearl formation is absent in carcinoma in situ or intraepithelial carcinoma.

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Pseudocyst are

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Stafne's cyst

Aneurysmal bone cyst

Hemorrhagic bone cyst/traumatic bone cyst

Mucocele extravasation type.

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Bence jones

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Is a unusual protein

Coagulase when urine is heated to 40 to 60 degree Celsius.

Disappears when urine is boiled.

Reappears when urine is cooled

Seen in patients with leukaemia polycythemia and multiple myeloma.

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Precancerous lesions

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Leukoplakia

Erythroplakia

Palatal keratosis associated with reverse smoking.

Squamous epithelial dysplasia

Squamous cell carcinoma in situ

Solar keratosis

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Precancerous conditions

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Sideropenic dysphagia

Lichen planus

Oral Submucous Fibrosis

Syphilis

Discoid lupus erythematosus

Xeroderma pigmentosa

Epidermolysis bullosa.

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Burkitt lymphoma

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Also called as African jaw lymphoma

B cell neoplasm

Children between 2 and 14 years

Macrophages are seen throughout

Starry Sky effect

Virus implicated-herpes simplex virus 4 or Epstein Barr virus.

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Bowen's disease

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Intraepithelial carcinoma

In patients who have had arsenical chemotherapy.

Open associated with internal or external cutaneous cancer.

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Leukokeratosis nicotina palati

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Also called as stomatitis nicotina or pipe smokers palate.

In heavy smokers

Keratotic patch In palate with red spot in centre of each nodule representing dilated or partially occluded orifice of accessory palatal salivary gland duct.

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Herpes simplex 2 or genital herpes

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Carcinoma of uterine cervix.

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Herpes simplex 4 or Epstein Barr virus

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African jaw lymphomas or burkitt's lymphoma and nasopharyngeal carcinoma.

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Herpes simplex 8

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Kaposi's sarcoma

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Papovaviridae( human papillomavirus)

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Cervical, penile,vulvar Cancers,

Squamous cell carcinoma.

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Hepadna viridae(hepatitis B virus)

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Hepatocellular carcinoma.

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Retroviridae(HTL virus)

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Adult t cell leukaemia.

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Neurofibroma

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Arises from schwann cell and perineural cells.

Non encapsulation

Potential for malignant transformation.

Cafe -au-lait,spots are seen In neurofibroma and polyostotic type of fibrous dysplasia.

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Greenspan lesion

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Hairy leukoplakia

Is not premalignant

Seen in HIV AIDS.

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Most common malignancy in females

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Breast cancer followed by lung cancer

Breast cancer commonly metastasis into jaw bones and is

Commonly primary cancers that metastasis to the oral region in females.

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Most common malignancy in females in India

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Breast cancer followed by carcinoma of uterine cervix

(Chennai)

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Most common malignancy in males

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Lung cancer

Commonly metastasis to the oral soft tissues.

Common primary cancers that metastasis to oral lesion in male.

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Most common malignancy in males in India

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Oral cancer

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Most common skin cancer

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Basal cell carcinoma followed by squamous cell carcinoma followed by malignant Melanoma.

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Most common oral cancer

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Squamous cell carcinoma

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Most deadly of all human neoplasm

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Malignant Melanoma

Twice as common in men than women occurring in between 40 to 70 years.

Most common in palate and maxillary gingiva or alveolar Ridge in oral cavity.

Is very painful

Rare in children

Depth of inversion is measured by breslow thickness.

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Most common benign tumor of bone

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Osteochondroma

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Most common bone tumor of long bones

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Osteosarcoma

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Most common primary malignant bone tumor

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Multiple myeloma

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Third most common cancer in adolescence

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Osteosarcoma

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Most common malignant bone tumor in India

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Osteosarcoma

Sunburst appearance in radiography

Codman's Triangle

Occurs in young person 10 to 25 years old.

Chiefly involve the femur and Tibia.

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Most common malignant bone tumor in children

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Osteosarcoma followed by ewings sarcoma

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Most common leukaemia in children

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Acute lymphocytic leukaemia or a l l

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Most common leukaemia in elders

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Chronic lymphocytic leukaemia

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Most common malignant salivary gland tumor in children and adults

Most common salivary gland tumor in bone

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mucoepidermoid carcinoma

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Most common salivary gland tumor or most common tumor of parotid

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Pleomorphic adenoma

benign tumor

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Second most common salivary gland tumor

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Warthins tumor

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Most common benign soft tissue neoplasm in oral cavity

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Fibroma

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Multiple myeloma

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Fatal malignant neoplasm

Of plasma cells

Poor prognosis

Survival time 2 to 3 years

Infection anaemia and kidney failure are common cause of death

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All carcinoma metastasis by lymph nodes except renal cell carcinoma(occurs by blood)

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All sarcomas metastasis by bloodstream except rhabdomyosarcoma(occurs by lymph)

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Brachytherapy

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Irradiation of tissue by implants within the tissue

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Human papillomavirus type 6 and 11

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Commonly associated with squamous papillomas.

Multiple papillomas lesion are seen in cowdens syndrome.

It is considered as cutaneous marker of breast cancer

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Staghorn pattern

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Important historical feature of hemangiopericytoma which resembles glomous tumour.

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Classification of oral leukoplakia

L1 size of leukoplakia less than two centimetre

L2 size of leukoplakia 2 to 4 cm

L3 size of leukoplakia more than 4 cm

LX no size specified

PO no epithelial dysplasia

P1 distant epithelial dysplasia

PX dysplasia not specified.

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Stage 1-L1 PO

Stage 2 L2 PO

Stage 3 L3 PO or L1 L2 P1

Stage 4 L3 P1.

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Widening of pdl is seen in

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Osteosarcoma,

Chondrosarcoma

Scleroderma

Trauma from occlusion

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Obliteration of pdl is seen in

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Hypercementosis

Ankylosis

Hypofunction of teeth

Paget disease.

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storiform pattern of fibrous tissue

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Seen in malignant fibrous histiocytoma

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Proliferative verrucous leukoplakia

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Described by Hansen and is associated with risk of squamous cell carcinoma.

May associated with human papillomavirus.

,

Seen where quid is kept.

Cauliflower white growth

Differential diagnosis verrucous carcinoma.

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Nodular or speckled leukoplakia

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Raised from surface red and white areas

Seen in angle of mouth in chronic smokers

Fissuring ulcer formation is seen

Epithelial dysplasia is common and tendency of malignancy is more.

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granular cell myoblastoma

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Benign tumor of muscle tissue

Common in tongue

Epithelium shows pseudo epitheliomatous hyperplasia.

Differential diagnosis epidermoid carcinoma.

Pseudoepitheliomatous hyperplasia is also seen in

Granular cell myoblastoma

Blastomycosis

Papillary hyperplasia

Discoid lupus erythematosus .

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Most common bone cancer

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Metastatic bone cancer.

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Verocay bodies with predilection for occurrence in tongue.

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Neurilemmoma

Histopathology picture shows Antoni type a and Antonitype b.

Type a tissue is made of cells with elevated spindle shaped nucleus.

Type b shows disorderly arrangement of cells and fibres.

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Cancer which most commonly metastasis to jaw bones

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Breast cancer commonly metastasis to jaw bone followed by lung,bone or colorectum and Kidneys.

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Onion skin appearance, periosteal new bone formation or Neoperiostotis.

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Infantile cortical hyperostosis or caffeys disease

Hypervitaminosis a

Syphilis

Ewing's sarcoma

Metastatic neuroblastoma

Garres osteomyelitis.

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Teratoma

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Hamartous developmental manifestation consisting of three different layers of tissue.

Made up of number of different types of tissue which are not native to that area.

teratoma may occur in various parts of body and is made up of various epithelial appendages such as hair, sweat glands, sebaceous glands and salivary glands. Teeth are usually normal and resembles premolars. inflammatory gingivitis may be seen.

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Papules

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Solid lesion raised above the skin surface that are smaller than 1 cm in diameter.

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Plaque

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Solid raised sections that are over 1 cm in diameter are called plaque.

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Macules

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Well circumscribed flat lesions that are noticeable because of change of colour.

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Vesicles

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Elevated blisters containing clear fluid that are under 1 cm in diameter

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Hemangioma are associated with

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Rendu osler Weber syndrome

Sturge Weber syndrome(port wine stain).

Kasabach Merritt syndrome

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Cancer inversion into perineural areas

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Adenoid cystic carcinoma

Keratoacanthoma.

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Multiple endocrine neoplasia (m e n)

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Type 1

hyperplasia of pituitary gland with acromegaly

Hyperplasia of parathyroid and adrenal cortex

Hyperplasia of pancreatic islets with increased production of insulin gastrin and glucagon with peptic ulcer and gastric hypersecretion.

Type 2 (sipples syndrome) hyperplasia of parathyroid

No tumors of pancreas, no peptic ulcer.

Patient may have pheochromo- cytomas of the adrenal medulla and medullary carcinoma of thyroid gland.

Type 3

pheochromo- cytomas and medullary carcinoma of thyroid gland.

Oral neuromas that are common on lips tongue and buccal mucosa

Lips are described as bumpy lips.

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Human papillomavirus HPV conditions lesion are

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Hecks disease

Proliferative verrucous leukoplakia

Squamous papilloma

Carcinoma of cervix

Condyloma acuminatum

Verrucous vulgaris (common wart of skin)

Molluscum contagious (caused by pox group virus with characteristic Henderson-peterson or molluscum bodies)

Oral squamous cell carcinoma.

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Central ossifying fibroma of bone

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Mandible is commonly involved

Displacement of teeth is an area clinical feature.

In early stages appears as radiolucent area which becomes clasified later.

Ultimately the lesion appears as a relatively uniform radiopaque mass.

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Central Giant Cell granuloma and Giant cell tumor of bone.

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Common in young below 30 years of age.

Usually shows no signs and symptoms but sometimes may cause expansion of cortex and perforation. mobility, displacement and root resorption of associated teeth.

M N G self and hemosiderin pigment are seen.

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Peripheral ossifying fibroma

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Involves gingiva

No radiological features

Shows different forms of calcification historically​

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Peripheral Giant Cell granuloma

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Involves alveolar process

Frequently anterior to molars

Originate from either periodontal ligament or mucoperiosteum.

Historical shows mng cells which resemble osteoclast

Numerous capillaries, foci of haemorrhage , hemosiderin pigment are characteristic feature.

Radiographically it exhibits superficial erosion of born with pathognomonic "peripheral cuffing" of bone.

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Keratoacanthoma

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Self healing carcinoma,

Mulluscum pseudo carcinomatosum.

Molluscum sebaceum.

Low grade malignancy

Originate from pilosebaceous glands.

Etiology is trauma, HPV virus ,genetic.

Twice common in men than woman.

Usually on sun exposed area

Lips and vermilion border affected.

Spontaneous healing by its own over 6 to 8 weeks.

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Ewing sarcoma

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Also called as round cell sarcoma, seen in children and young adults.

Painful swelling of bone

Facial Neuralgia and lip paraesthesia

Diffuse radiolucency, onion skin and sun Ray appearance of bone.

Intracytoplasmic glycogen of these cells helps in differenciation from reticulum cell sarcoma.

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Sturge Weber syndrome

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Congenital hemartomatous malformation.

Effects Eye Skin and CNS

Characterized by venous angioma of leptomeninges with ipsilateral angiomatous lesion of the face ,skull jaw and oral soft tissue.

The port wine nevi(cutaneous capillary venous angioma) are observed first at birth.

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Pel ebstein fever in

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Hodgkin's lymphoma

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Elephantiasis neuromatosa.

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Von recklinghausens disease.