NEOPLASIA STUDY NOTE - ALMA FUENTES

Description of Neoplasia
Neoplasia
- New growth
- Cells exhibit uncontrolled proliferation
Neoplasm
- A new growth of tissue in which growth is uncontrolled and progressive
tumour
- Means swelling, but is often used as a synonym for neoplasm
The occurrence of neoplasia
- An irreversible change must take place in the cells. This change must be
passed on to new cells and result in uncontrollable cell multiplication
- It is an abnormal process

Causes of Neoplasia
Many agents have been shown to cause neoplastic transformation of cells in the
laboratory
- Chemicals: Hundreds of different ones
- Viruses: Called oncogenic viruses
- Radiation: Sunlight, x-rays, nuclear fission
It can also occur spontaneously as a result of a genetic mutation

Classification of Tumours
Benign tumour or neoplasia
- Remains localized
- May be encapsulated with fibrous connective tissue
- It can invade adjacent tissue, but does not have the ability to spread to distant
sites
Malignant tumour
- Invades and destroys surrounding tissue
- Has the ability to spread throughout the body
Benign tumours almost always resemble normal tissue
Malignant tumours vary in histologic appearance
- Well-differentiated malignant tumours have neoplastic cells that resemble
normal cells; poorly differentiated ones do not
- Others may be undifferentiated or anaplastic and do not resemble the tissue
from which they were derived at all
Pleomorphic
- The cells of malignant tumours often vary in size and shape
Hyperchromatic
- The nuclei of these cells are darker than those of normal cells and exhibit an
increased nuclear-to-cytoplasmic ratio
NEOPLASIA STUDY NOTE - ALMA FUENTES

Names of Tumours
The prefix is determined by the tissue or cell of origin
The suffix -oma is used to indicate a tumour
Benign tumours
- Lipoma: Benign tumour of fat
- Osteoma: Benign tumour of bone
Naming malignant tumours
- Carcinoma: Malignant tumour of epithelium
- Sarcoma: Malignant tumour of connective tissue
Malignant tumours
- Squamous cell carcinoma or epidermoid carcinoma: Malignant tumour of
squamous epithelium
- Osteosarcoma: Malignant tumour of bone

Treatment of Tumours
Benign tumours
- Treated by surgical excision, either wide local excision or enucleation
Malignant tumours
- Treated by surgery, chemotherapy, or radiation therapy, often a combination

EPITHELIAL TUMOURS:
Three different types are found in the oral cavity
- From squamous epithelium

- Papilloma
- A benign tumour of squamous epithelium
- A small exophytic pedunculated or sessile growth
- May be white or the color of normal mucosa
- Most often on the soft palate or tongue
- Microscopic
NEOPLASIA STUDY NOTE - ALMA FUENTES

- Numerous fingerlike or papillary projections with a central

core of fibrous connective tissue surfaced by normal
stratified squamous epithelium
- Treatment
- Surgical excision

- Premalignant lesions
- Leukoplakia
- Means “white plaque”
- Biopsy is necessary to establish a definitive diagnosis
- Most leukoplakias are due to a hyperkeratosis, or
epithelial hyperplasia and hyperkeratosis
- Microscopic
- May show epithelial dysplasia, a premalignant
condition, or even squamous cell carcinoma
- Treatment
- Dependent on histologic finding
- Remove the cause and see if it resolves; if not, the
lesion should be biopsied
- Erythroplakia
- An oral mucosal lesion appearing as a smooth red patch
or a granular red and velvety patch
- Speckled leukoplakia: A lesion that shows a mix of red
and white areas
- Most often located on the floor of the mouth, tongue, and
soft palate
- Less common than leukoplakia
- Oral Submucous Fibrosis
- Chronic oral mucosal disease that is associated with
betel-quid and areca-nut chewing
- Betel-quid and areca-nut chewing are prevalent in Indian
subcontinent and Southeast Asia
- Increased deposition of collagen in the oral mucosa
results in severe restriction of movement of the oral
mucosa tissues
- Epithelial dysplasia
- A histologic diagnosis of a premalignant condition
- Indicates disordered growth
NEOPLASIA STUDY NOTE - ALMA FUENTES

- These lesions frequently precede squamous cell

carcinoma
- Changes may revert to normal if the stimulus is
removed
- Clinically, it may present as an erythematous lesion, a
white lesion, or a mixed erythematous and white lesion
- Lesions often arise on the floor of the mouth or
tongue
- Dysplasia in other tissues is not considered a
premalignant process
- Microscopic
- Abnormal maturation of epithelial cells with
disorganization of epithelial layers; hyperplasia of
basal cells; and epithelial cells with enlarged and
hyperchromatic nuclei, increased nuclear-to-
cytoplasmic ratios, abnormal keratinization, and
increased numbers of normal and abnormal mitotic
figures
- Carcinoma in situ
- Severe dysplasia involving the full thickness of
epithelium
- Treatment: Surgical excision

- Squamous cell carcinoma

- A malignant tumour of squamous epithelium
- The most common primary malignancy of the oral cavity
- It can infiltrate adjacent tissues and form distant metastases
- Usually metastasizes to lymph nodes in the neck and then to
distant sites, such as the lungs and liver
- Clinically, it usually is an exophytic ulcerated mass
- It can infiltrate and destroy bone
- tumour cells invade connective tissue underlying the epithelial
basement membrane
- Well-differentiated tumours will show keratin
- Keratin pearl
- Occurs most often on the floor of the mouth, ventrolateral
tongue, soft palate, tonsillar pillar, and retromolar areas
- May occur on the vermilion border of the lips and skin of the
face: These locations have a better prognosis than SCC of the
oral mucosa
NEOPLASIA STUDY NOTE - ALMA FUENTES

- Solar cheilitis: A condition in which mild to severe epithelial

dysplasia occurs
- Avoid sun exposure
- Use a sun-blocking agent
- Risk factors
- Tobacco
- Smoking: Cigar, cigarette, and pipe
- Snuff dipping
- Tobacco chewing
- Alcohol consumption
- Damage from ultraviolet rays
- Human papillomavirus (HPV)
- Tx and prognosis
- Generally is treated by surgical excision
- Radiation therapy or chemotherapy may also be used
- These patients may have xerostomia
- TNM staging may be used to determine the prognosis
- The higher the stage, the worse the prognosis

- Verrucous carcinoma
- A slow-growing exophytic tumour with a pebbly red and white
surface
- A tumour with numerous papillary epithelial projections
- Papillary projections are filled with keratin
- Epithelium is well differentiated, does not contain atypical cells,
and exhibits broad-based rete pegs
- The tumour does not show invasion through the basement
membrane
- Treatment: Surgical excision

- Basal cell carcinoma

- A malignant skin tumour associated with excessive exposure to
the sun
- Frequently arises on the skin of the face
- Appears as a nonhealing ulcer with characteristic rolled borders
- Most cases in white adults with no sex predilection
NEOPLASIA STUDY NOTE - ALMA FUENTES

- Microscopic
- Composed of basal cells derived from squamous
epithelium
- A proliferation of basal cells into underlying connective
tissue
- Treatment
- Surgical excision
- Radiation therapy may be used to treat large lesions
- Rarely metastasizes
- From salivary gland epithelium
- From odontogenic epithelium

SALIVARY GLAND TUMOURS

May arise in either major or minor salivary glands
- Minor salivary gland tumours are most often located at the junction of the hard
and soft palate
Adenomas
- Benign tumours of salivary glands
Pleomorphic adenoma (Benign Mixed Tumour)
- A benign salivary gland tumour
- 90% of all salivary gland tumours
- The most common extraoral location is the parotid gland; the most common
intraoral location is the palate
- Clinically
- Appears as a slowly enlarging, nonulcerated, painless, dome-shaped
mass
- Treatment
- Surgical excision
- Recurrence rates vary; they are related to the success of the initial
surgical removal
- Lesions have been known to undergo malignant transformation
Monomorphic adenoma
- A benign encapsulated salivary gland tumour
- A uniform pattern of epithelial cells
- Occurs most commonly in adult females
NEOPLASIA STUDY NOTE - ALMA FUENTES

- Occurs most often in the upper lip and buccal mucosa

- Treatment: Surgical excision
- Warthin tumour
- An encapsulated tumour with epithelial and lymphoid tissue
- A painless, soft, compressible or fluctuant mass
- Usually occurs on the parotid gland, rarely intraorally
- Occurs predominantly in adult men
Adenoid cystic carcinoma (cylindroma)
- A slow-growing malignant tumour of either major or minor salivary gland
tissue
- May be ulcerated and painful
- Most common site: Parotid gland
- Microscopic
- Unencapsulated, infiltrates surrounding tissue
- Small, deeply staining, uniform epithelial cells that resemble “Swiss
cheese”
- Treatment
- Surgical excision
Mucoepidermoid carcinoma
- A malignant salivary gland tumour
- Unencapsulated, infiltrating tumour
- Major gland tumours are most often found in the parotid gland, minor
gland tumours on the palate
- Appear clinically as slowly enlarging masses
- A combination of mucus cells interspersed with squamous-like epithelial cells
called epidermoid cells
- May appear in bone as either a unilocular or multilocular radiolucency
- May occur over a wide age range
- Usually occurs in adults, but is the most common malignant salivary gland
tumour in children
- Occurs most often in females
- Treatment
- Surgical excision
Other:
- Polymorphous low-grade adenocarcinoma
- Acinic cell adenocarcinoma
- Other adenocarcinomas
NEOPLASIA STUDY NOTE - ALMA FUENTES

ODONTOGENIC TUMOURS:

Derived from tooth-forming tissues

They may be composed of epithelium, mesenchyme, or a combination of both
Most are benign, but rare malignant forms exist
Epithelial odontogenic tumours
- Ameloblastoma
- A benign, slow-growing but locally aggressive epithelial odontogenic
tumour
- May occur in either mandible or maxilla, most often in the mandible in
the molar or ramus area
- Unencapsulated, infiltrates into surrounding tissue
- Composed of ameloblast-like epithelial cells surrounding areas
resembling stellate reticulum
- Radiographic
- A multilocular soap bubble–like or honeycombed radiolucency
- May occur anywhere within the jaws; can occur in association
with a dentigerous cyst
- May cause bone expansion

- Treatment
- Surgical removal
- Recurrence is common
- Calcifying epithelial odontogenic tumour (CEOT)
- A benign epithelial odontogenic tumour
- Composed of islands and sheets of polyhedral epithelial cells
- Amyloid-like material is seen with calcifications within the
deposits
- Most often affects adults, with no sex predilection
- Radiographic
- A unilocular or multilocular radiolucency
- Occurs more often in mandible than maxilla, and most often in the
bicuspid and molar area
- Treatment: Surgical excision
- Adenomatoid odontogenic tumour
- An encapsulated, benign epithelial odontogenic tumour
- 70% occur in females less than age 20
- 70% involve the anterior portion of the jaws
- More common in maxilla than in mandible
NEOPLASIA STUDY NOTE - ALMA FUENTES

- Many are associated with impacted teeth

- The tumour is surrounded by a dense, fibrous connective tissue
capsule
- Consists of duct-like structures, whorls, and large masses of cuboidal
and spindle-shaped epithelial cells
- Radiographic: A well-circumscribed radiolucency; may have
radiopaque areas
- Treatment: Enucleation
- Calcifying odontogenic cyst
- A nonaggressive cystic lesion lined by odontogenic epithelium
- Most commonly seen in individuals under 40 years old
- Radiographic
- Usually a well-defined lesion
- May be either unilocular or multilocular
- May have calcifications
- Has an associated, characteristic ghost cell keratinization
- Ghost cells are round structures with clear centers
- Treatment
- Surgical enucleation
- Usually does not recur
-

- Mesenchymal odontogenic tumours

- Odontogenic myxoma
- A benign nonencapsulated infiltrating tumour
- Most often occurs in young people age 10 and 29
- No sex predilection
- Radiographic
- A multilocular, honeycombed radiolucency with poorly
defined margins
- May become large and displace teeth
- Most often occurs in the mandible
- Composed of pale-staining mucopolysaccharide ground
substance containing dispersed cells with long cytoplasmic
processes
- Treatment
- Surgical excision
- May recur
- Central cementifying and ossifying fibromas
- A benign well-circumscribed tumour
- Usually occurs in adults in the third and fourth decades
- Occurs in females more often than in males
NEOPLASIA STUDY NOTE - ALMA FUENTES

- Most cases occur in the mandible

- Radiographic
- Varies from radiolucent to radiopaque depending on the
amount of calcified tissue
- Contains fibrous connective tissue and calcifications
- Treatment
- Surgical excision
- Recurrence is rare
- Benign cementoblastoma
- A cementum-producing lesion
- Radiographic
- A well-defined radiopaque mass with a surrounding
radiolucent halo
- Treatment
- Enucleation of the tumour and removal of the involved
tooth
- Does not recur
- Mixed odontogenic tumours
- Ameloblastic fibroma
- A benign, nonencapsulated odontogenic tumour
- Occurs in young children and young adults
- Occurs more often in males
- Most commonly in the mandibular bicuspid and molar region
- Composed of both strands and small islands of odontogenic
epithelium and tissue that resembles the dental papilla
- Radiographic
- Well-defined or poorly defined unilocular or multilocular
radiolucency
- Treatment
- Surgical excision
- Low recurrence rate
- Ameloblastic fibro-odontoma
- A benign odontogenic tumour
- Has features of an ameloblastic fibroma and an
odontoma
- Most cases in young adults, with an average age of 10
years
- No sex predilection
- Typically arises in posterior jaws
- Radiographic
- A well-delineated radiolucent lesion
- May be unilocular or multilocular
NEOPLASIA STUDY NOTE - ALMA FUENTES

- Calcifications are noted within the radiolucency

- Treatment
- Conservative surgical excision
- Recurrence is unusual
- Odontoma
- Compound
- A mass that resembles teeth
- Usually located in anterior maxilla
- Complex
- A mass that does not resemble teeth
- Usually located in posterior mandible
- Most are found in adolescents and young adults
- Clinical manifestation: Failure of tooth to erupt
- Treatment: Surgical excision
Peripheral odontogenic tumours
- Peripheral ossifying fibroma
- A well-demarcated sessile or pedunculated lesion
- Most likely derived from cells of the periodontal ligament
- More common in females than in males
- Often occurs in young individuals
- Composed of cellular fibrous connective tissue interspersed with
scattered bone and cementum-like calcifications
- Treatment: Surgical excision
Tumours of Soft Tissue
- Lipoma
- A benign tumour of mature fat cells
- Clinically: A yellowish mass surrounded by a thin layer of
epithelium
- Most commonly located on the buccal mucosa and the vestibule
- Most occur in individuals over age 40
- Microscopic
- A well-delineated tumour with mature fat cells uniform in
size and shape
- Treatment: Surgical excision
- tumours of nerve tissue
- Neurofibroma and schwannoma
- Benign tumours derived from Schwann cells in nerve
tissue
- The tongue is the most common intraoral location
- May occur at any age, with no sex predilection
- Neurofibromatosis of von Recklinghausen
- Neurofibroma
NEOPLASIA STUDY NOTE - ALMA FUENTES

- A fairly well-delineated, diffuse proliferation of

spindle-shaped Schwann cells
- Schwannoma
- Spindle-shaped Schwann cells arranged in
palisaded whorls around a central pink zone
- It is surrounded by a connective tissue capsule
- Treatment: Surgical excision
- Granular cell tumour
- A benign tumour composed of large cells with a granular
cytoplasm
- Most often occurs on the tongue, followed by the buccal
mucosa
- A painless, non-ulcerated nodule
- Most are found in adults, with a female sex predilection
- Most likely arises from neural or primitive mesenchymal
cells
- Large oval cells with a granular cytoplasm
- Treatment: Surgical excision
- Congenital epulis
- A benign neoplasm composed of cells closely resembling
those seen in the granular cell tumour
- Most likely arises from primitive mesenchymal cells
- Appears as a sessile or pedunculated mass on the
gingiva
- Usually occurs on the anterior maxillary gingiva
- Almost always occurs in girls
- Treatment: Surgical excision
- tumours of muscle
- Extremely uncommon in the oral cavity
- Vascular leiomyomas
- Rhabdomyoma
- A benign tumour of striated muscle
- Leiomyoma
- A benign tumour of smooth muscle
- Rhabdomyosarcoma
- A malignant tumour of striated muscle
- The most common malignant soft tissue tumour of the
head and neck in children
- Typically occurs in children under 10 years of age
- Has a male sex predilection
- A rapidly growing, destructive tumour
- Treatment
NEOPLASIA STUDY NOTE - ALMA FUENTES

- Multidrug chemotherapy, radiation therapy, and surgery

- Poor prognosis
- Vascular tumours
- Hemangioma
- A benign proliferation of capillaries
- Capillary hemangioma: Contains numerous small
capillaries
- Cavernous hemangioma: Contains larger blood vessels
- Most are present at birth or arise shortly thereafter
- More than half occur in the head and neck area
- The tongue is the most common intraoral location
- More common in females
- May occur in adults in response to trauma
- Frequently blanch when pressure is applied
- Treatment
- Many undergo spontaneous remission
- Treatment is variable, includes surgery or the
injection of a sclerosing solution
- Lymphangioma
- A benign tumour of lymphatic vessels
- Most are present at birth
- Half arise in the head and neck area
- No sex predilection
- Intraorally, the most common location is the
tongue, where it is an ill-defined mass with a
pebbly surface
- A cystic lymphangioma in the neck is a cystic
hygroma
- Treatment
- Surgical excision
- Tend to recur
- Malignant vascular tumours
- Angiosarcoma may occur in the oral cavity, but it is rare
- Kaposi sarcoma may arise in multiple sites, including the
skin and oral mucosa
- It was historically seen in older men
- A more aggressive form has arisen with HIV
- Kaposi sarcoma and HIV
- Lesions are often seen in the oral cavity as purple
macules, plaques, or exophytic tumours
- Most commonly located on the hard palate and
gingiva
NEOPLASIA STUDY NOTE - ALMA FUENTES

- May also occur in patients with other forms of

immunodeficiency
- Caused by a human herpesvirus (HHV-8; also
called Kaposi sarcoma–associated herpesvirus
[KSAH])
- Treatment
- Surgical excision
- Radiation therapy
- Combination of both

Tumours of Melanin-producing Cells:

- Melanotic nevi
- Nevus may refer to either a developmental tumour of melanocytes or a
pigmented congenital lesion
- Can arise on the skin or the oral mucosa
- Intraoral tumours consist of tan-to-brown macules or papules
- Occur most often on the hard palate or buccal mucosa
- Occur twice as often in women as men
- Usually first identified in individuals between 20 and 50 years old
- Most are benign; some may be malignant
- Treatment
- Biopsy
- Surgical excision
- Recurrence is rare
- Malignant melanoma
- A malignant tumour of melanocytes
- Most arise on the skin in response to prolonged exposure to
sunlight
- Primary malignant melanoma is rare, but melanomas on skin
may metastasize to oral cavity
- Usually a rapidly enlarging blue-to-black mass
- An aggressive tumour with unpredictable behavior and early
metastasis
- Most common intraoral locations are the palate and maxillary gingiva
- Usually occur in adults over 40 years of age
- Treatment
- Surgical excision
- Chemotherapy may be used along with surgery
- Poor prognosis

TUMOURS OF BONE AND CARTILAGE:

- Osteoma
NEOPLASIA STUDY NOTE - ALMA FUENTES

- An asymptomatic benign tumour composed of benign compact bone

- Radiographic
- Appears as either a sharply delineated radiopaque mass
within bone or attached to the outer surface of bone
- No sex predilection
- A component of Gardner syndrome
- Treatment
- Surgical excision
- Does not recur
- Osteosarcoma
- A malignant tumour of bone-forming tissue
- The most common primary malignant tumour of bone in patients less
than 40 years of age
- The average age of patients with osteosarcoma involving the jaws is
about 37 years
- Occurs twice as frequently in mandible as maxilla
- More common in males
- Radiographic
- May vary from radiolucent to radiopaque
- Usually a destructive, poorly defined lesion
- May or may not involve adjacent soft tissue
- Asymmetric widening of the periodontal ligament space, and a
“sunburst” pattern may be seen
- Treatment
- Preoperative multiagent chemotherapy followed by surgery
- Jaw tumours frequently recur
- tumours of cartilage
- Chondroma: A benign tumour of cartilage
- Chondrosarcoma: A malignant tumour of cartilage
- Treatment of chondrosarcomas
- Wide surgical excision
- Poor prognosis

Tumours of blood-forming tissues:

- Leukemia
- A broad group of disorders characterized by an overproduction of
atypical white blood cells
NEOPLASIA STUDY NOTE - ALMA FUENTES

- The types of leukemia seen are classified according to the kinds of

cells that are proliferating
- Myelocytes, lymphocytes, or monocytes
- Acute leukemia is most common in children and young adults
- Characterized by a proliferation of immature white blood cells
- Chronic leukemia most frequently occurs in middle-aged adults
- Characterized by excess proliferation of mature white blood cells
- Treatment
- Chemotherapy, radiation therapy, and corticosteroids
- Prognosis depends on the type and extent of disease
- Lymphoma (Non-Hodgkin)
- A malignant tumour of lymphoid tissue
- Clinical presentation: Gradual enlargement of lymph nodes
- The most common intraoral location is the tonsils
- Usually occurs in adults
- More common in males than in females
- Treatment
- Radiotherapy, surgery, chemotherapy, or a combination of these
therapies
- Rarely, a lymphoma may present as a primary lesion in the oral
soft tissues or bone.
- The prognosis depends on the type of lymphoma and the extent
of involvement.
- Multiple myeloma
- A systematic, malignant proliferation of plasma cells
- Causes destructive lesions in bone
- Most patients are older than 40 years; occurs most commonly in
the seventh decade of life
- Males are affected more often than females
- Patients usually experience bone pain and swelling
- Radiographic
- Multiple radiolucent lesions
- The mandible is affected more often than the maxilla
- Most patients have an elevation of a single type of immunoglobulin,
called a monoclonal spike
- Patients may have fragments of immunoglobulins in their urine known
as Bence Jones proteins
- An extramedullary plasmacytoma is a localized tumour of plasma cells
in soft tissue
- Treatment
- Chemotherapy and radiation
- Poor prognosis
NEOPLASIA STUDY NOTE - ALMA FUENTES

METASTATIC TUMOURS:
- Metastatic tumours from primary sites elsewhere in the body are rare
- Most tumours arise from the thyroid, breast, lungs, prostate gland, and
kidneys
- The most frequent intraoral site for metastatic tumours is the mandible
- Patients may experience pain, paresthesia or anesthesia of the lip, swelling,
expansion of the affected bone, and loosening of teeth in the affected area
- Most patients are adults
- Males are affected more often than females
- Radiographic
- Lesions are usually poorly defined and radiolucent
- Roots of involved teeth may show a spiked appearance
- Some tumours may form bone and be radiopaque
- Treatment
- Chemotherapy and radiation therapy
- Systemic bisphosphonate medication is used to prevent bone
destruction in patients with tumours such as breast and prostate cancer
that metastasize to bone.
- The prognosis for patients with tumours that have metastasized to the
jaws is poor