malignancies

malignancies

1. lymphoma

   • hodgkin
     • bimodal age incidence
       • occurs between 15-35
         • can occur after age 50
     • affects lymph nodes
       • cervical and supraclavicular nodes involved initially
       • clinical presentation
         • persistent enlarging, non tender mass in lymph node
         • lymph node movable but becomes fixed to adjacent tissue
         • weight loss, fever , night sweats generalized pruritus
     • reed-sternberg cell
       • owl-eye or pennies on a plate nucleus seen microscopically
   • non-hodgkin
     • burkitt
       • expression of epstein barr virus
       • b cell lymphocytes
       • endemic
         • African - involves posterio maxillar mandible
           • 50-70%
         • ratio of 2:1 maxillary involvement
         • prevalent in young children
       • sporadic
         • american
           • involves abdominal region
       • clinical findings
         • facial swelling , proptosis, enlargemtent of ginigvia, destruction of alvelor bone , decioud tooth loss
       • starry sky pattern histopathology
       • transloaction t 8:14 q 24:q32 overexpressed myc oncogene
     • malignacny of AIDs patients
     • MALT lymphoma
       • mucosa assocated lymphoidtissue
         • associated sjogren syndrome
     • clinical presentation
       • slowly, enlaring nontender mass lymph nodes
       • oral cavity
         • extranodal involve soft tissue or bone
       • soft tissue appears ertythematous and bogy
         • affects buccal vestibule hard palate ginigiva
       • bony involvement vague pain
         • ill defined radiolucency on radiograph
   • extranodal nk/t cell
     • angiocentric t cell / lymphoma midline leathal grnauloma
     • nasal an palatal perforations
     • clinical features
       • nasal stuffiness
       • epistaxis
       • swelling of soft palate followed by necrotic ulceration

2. leukemia

   • malignancy of hematopoietic stem cells
     • proliferation of abnormal white blood cells
     • inccrease in immature white cells leukocytosis
   • Myelophthisic anemia-crowding out normal hematopoietic stem cells (white and red blood cells) by malignant cells Fatigue Thrombocytopenia (spontaneous gingival hemorrhage) Fever Intraoral findings Diffuse, boggy gingival enlargement (usually w/ AML or CML) Candidiasis Deep, punched-out neutropenic ulcers Herpetic infection (affect any area of oral mucosa) Prominent tumorlike growth (myeloid sarcoma-leukemic cells)
   • Chronic Myeloid Leukemia-[Philadelphia Chromosome-(9,22)] Chronic Lymphocytic-most common type affecting elderly adults Acute Lymphoblastic-occurs exclusively in children and a common childhood malignancy Acute Myeloid-seen in patients over 40 but can occur in all ages

3. multiple myeloma

   • Malignancy of plasma cells
   • Radiographic features “Punched out” well-defined radiolucencies
   • Presenting symptoms Bone pain (lumbar spine) Fatigue Renal failure Due to excess of Bence Jones proteins
   • Clinical features Tongue-firm and enlarged from amyloid deposition Periorbital skin-firm, waxy, plaquelike lesions (amyloid)

4. carcinoma

   • basal cell
     • Most common skin cancer
     • Caused by chronic exposure to ultraviolet radiation
     • • Arise from BASAL CELL LAYER OF SKIN
     • Associated with Nevoid basal cell carcinoma syndrome (Gorlin syndrome)
     • Clinical Features Found on sun-exposed areas (Face, Extremities, Trunk) Firm, painless papule with a central depression or crater Ulcerated and destroy underlying structures
     • Treatment Depends on size and site of lesion (Surgical excision, Mohs technique, Laser, etc.) Metastasis is rare
   • nasopharyngeal
     • Can be caused by Can be found in Waldeyer ring Seen in Asian males Epstein Barr virus (HHV-4) Lack of Vitamin C Consumption of salt fish
   • metaastic
     •  Most common form of cancer involving bone overall
     • Mandible affected especially molar region
     • Common tumors Breast, Lung, Prostate, Thyroid, Kidney
     • Clinical features Pain, swelling, tooth mobility, trismus Numb-chin syndrome-paresthesia in lower lip & chin
     • Radiographic features Ill-defined/ “moth eaten” radiolucency Mixed (common for breast and prostate) Pathologic fracture Widening of PDL

5. malignant peripheral nerve sheath tumor

   • Commonly seen in patients with Neurofibromatosis Type 1
   • Clinical features Rapidly enlarging mass with pain or nerve deficit Radiographs can reveal widening of mandibular canal or mental foramen

6. sarcomas

   • kaposi sarcoma
     •  Caused by Human Herpesvirus 8 (HHV-8)
     • Epidemic-single or multiple lesions of skin and/or oral cavity Oral cavity-hard palate, gingiva, tongue Red or purple plaques that do not blanch Can invade bone and cause tooth mobility
   • rhabdomysarcoma
     • Most common soft tissue sarcoma in children
     • Frequent location is head & neck followed by genitourinary tract
     • Several types Embryonal-most common Alveolar Pleomorphic-occur on extremities
   • leiomyosarcoma
     • Malignancy of smooth muscle differentiation
     • Uterine wall and gastrointestinal tract common locations
   • angiosarcoma
     • Malignant tumor of vascular endothelium
   • osteosarcoma
     •  Malignancy of mesenchymal cells that produce osteoid or immature bone
     • Most common primary malignancy in bone excluding hematopoietic neoplasms
     •  Paget disease of bone can be a risk factor
     • “Sunburst” pattern-classic (25% cases) Codman triangle-triangular elevation of periosteum Early stages-symmetrical widening of PDL Radiopaque Mixed
     • Radiographic findings
   • chondrosarcoma
     • Malignant neoplasm of tumor cells forming cartilage
   • ewing
     •  Second most common primary malignant bone tumor in children
     • Translocation t(11;22) (q24;q12)
     • Radiographic appearance “Onion skin” appearance Ill-defined radiolucency or mixed pattern

7. malignant salivary gland tumors

   • Mucoepidermoid carcinoma-most common salivary gland malignancy