Oral Pathology Malignant Tumors Quiz

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Questions and Answers

What type of tumors originate from a distant primary tumor?

  • Primary tumors
  • Secondary tumors (correct)
  • Benign tumors
  • Mixed tumors

Malignant tumors are typically encapsulated and have well-defined borders.

False (B)

List one general clinical feature of malignant lesions.

Pain or rapid swelling

Malignant tumors that arise from tissue with an uncontrolled growth are known as ________ tumors.

<p>malignant</p> Signup and view all the answers

Match the type of malignant lesion to its origin:

<p>Carcinomas = Lesions of epithelial origin Metastatic lesions = From distant sites Sarcomas = Lesions of mesenchymal origin Hematopoietic malignancies = Blood system malignancies</p> Signup and view all the answers

Which common jaw malignancy is more prevalent in the posterior regions of the jaws?

<p>Sarcomas (C)</p> Signup and view all the answers

Dysphonia is a possibly significant symptom associated with malignant lesions.

<p>True (A)</p> Signup and view all the answers

What is the typical age range for the occurrence of most oral cancers?

<p>50 years old and older</p> Signup and view all the answers

Where are large malignant lesions commonly located?

<p>Lateral border of the tongue (D)</p> Signup and view all the answers

Malignant lesions typically have well-defined borders.

<p>False (B)</p> Signup and view all the answers

What symptoms do patients with malignant lesions often report?

<p>Significant weight loss and feeling unwell</p> Signup and view all the answers

Malignant lesions may lead to the destruction of adjacent normal cortical boundaries, such as the floor of the _______.

<p>nose</p> Signup and view all the answers

Which of the following is NOT a common feature of squamous cell carcinoma?

<p>Periosteal reaction (C)</p> Signup and view all the answers

Match the types of lesions with their characteristics:

<p>Osteomyelitis = Produces periosteal reaction Squamous cell carcinoma = Does not produce periosteal reaction Malignant lesions = Irregular in shape with ill-defined borders Benign lesions = Well-defined borders</p> Signup and view all the answers

Teeth affected by malignant lesions may appear to float in radiolucent soft tissue.

<p>True (A)</p> Signup and view all the answers

What characteristic does the internal structure of malignant lesions typically have?

<p>Totally radiolucent</p> Signup and view all the answers

What characteristic may lead to a misdiagnosis of certain lesions as periapical cysts or granulomas?

<p>Non-aggressive nature and smooth border (A)</p> Signup and view all the answers

Squamous cell carcinoma (SCC) can originate from the maxillary sinus.

<p>True (A)</p> Signup and view all the answers

What is the most common complaint associated with central mucoepidermoid carcinoma?

<p>painless swelling</p> Signup and view all the answers

The internal structure of lesions related to squamous cell carcinoma is typically __________.

<p>radiolucent</p> Signup and view all the answers

Match the following features with their corresponding types of squamous cell carcinoma (SCC):

<p>SCC originating in cyst = Dull pain of several months’ duration SCC originating in maxillary sinus = Recurrent sinusitis and nasal obstruction</p> Signup and view all the answers

What is an effect of SCC lesions on nearby structures?

<p>Destruction of surrounding cortices (D)</p> Signup and view all the answers

Advanced lesions of SCC are usually well-defined with an even corticated margin.

<p>False (B)</p> Signup and view all the answers

What may be a clinical feature of SCC originating in the maxillary sinus?

<p>epistaxis</p> Signup and view all the answers

What characteristic internal structure is commonly seen in the lesion described?

<p>Multilocular radiolucency with a soap bubble appearance (A)</p> Signup and view all the answers

Paresthesia of the inferior alveolar nerve is a common symptom of benign odontogenic tumors.

<p>False (B)</p> Signup and view all the answers

What is a defining factor for an ameloblastoma to be classified as malignant?

<p>Metastasis</p> Signup and view all the answers

The lesions are typically 3-4 times more common in the __________ compared to the maxilla.

<p>mandible</p> Signup and view all the answers

Which of the following features is least likely to indicate malignancy in a lesion?

<p>Thick peripheral cortication (D)</p> Signup and view all the answers

Match the following terms with their descriptions.

<p>Malignant ameloblastoma = Ameloblastoma with typical benign histology but biological malignancy Ameloblastic carcinoma = Ameloblastoma with malignant histologic features Odontogenic myxoma = A benign tumor that can resemble malignant lesions Central giant cell granuloma = A non-neoplastic lesion that can be confused with malignancy</p> Signup and view all the answers

Teeth adjacent to the lesion are largely affected by the malignant process.

<p>False (B)</p> Signup and view all the answers

What is the chief differential diagnosis for lesions resembling mucoepidermoid carcinoma?

<p>Recurrent ameloblastoma</p> Signup and view all the answers

What is a common radiographic feature of malignant ameloblastoma?

<p>Well-defined border with cortication (D)</p> Signup and view all the answers

Metastatic malignancies in the jaws arise mainly from sites above the clavicle.

<p>False (B)</p> Signup and view all the answers

Where is malignant ameloblastoma more commonly located?

<p>Mandible</p> Signup and view all the answers

The internal structure of malignant ameloblastoma commonly gives the appearance of a ________ or soap bubble pattern.

<p>honeycomb</p> Signup and view all the answers

Match the following types of tumors with their common characteristics:

<p>Benign ameloblastoma = Well-defined unilocular Odontogenic keratocyst = Cystic appearance Odontogenic myxoma = Multilocular with soap bubble appearance Central mucoepidermoid tumor = Varied radiographic appearances</p> Signup and view all the answers

Which metastatic lesion is most likely to occur in the jaw?

<p>Breast carcinoma (C)</p> Signup and view all the answers

What symptom might patients with metastatic malignancy in the jaw complain of?

<p>Dental pain</p> Signup and view all the answers

Men have a higher incidence of metastatic tumors in the jaw than women.

<p>False (B)</p> Signup and view all the answers

Which site is the most common for metastatic lesions in the jaw?

<p>Maxillary sinus (A)</p> Signup and view all the answers

Metastatic lesions in the mandible are typically unilateral.

<p>False (B)</p> Signup and view all the answers

What internal structure characteristics are generally observed in malignant lesions?

<p>Radiolucent</p> Signup and view all the answers

The abnormal increase in the width of the periodontal ligament space due to malignant tumors is usually caused by ________.

<p>Tumor effacement</p> Signup and view all the answers

Which of the following features is typical of malignancy in relation to surrounding structures?

<p>Destruction of the cortical bone (D)</p> Signup and view all the answers

Match the type of lesion with its characteristic feature:

<p>Benign lesions = Well-defined borders Malignant lesions = Irregular borders Inflammatory lesions = Periodontal ligament space widening centered about root apex Metastatic tumors = Bilaterally distributed lesions</p> Signup and view all the answers

Sclerotic metastatic lesions can cause a ragged radiolucent appearance.

<p>True (A)</p> Signup and view all the answers

Identify a type of cancer that may stimulate a periosteal reaction with a spiculated pattern.

<p>Prostate cancer</p> Signup and view all the answers

Flashcards

Malignant tumor

Uncontrolled growth of tissue that is locally invasive, has high cellular anaplasia, and can spread to lymph nodes or distant organs.

Primary tumor

A malignant tumor starting in the body's original location, such as the oral cavity.

Metastatic malignancy

A malignant tumor that started in another part of the body and spread to a new location, like the jaw.

What causes malignant tumors?

Cancer caused by exposure to things like viruses, radiation, genetic defects, or harmful chemicals.

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Clinical feature of malignant tumor

Pain or rapid swelling without any clear dental cause.

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Radiographic appearance of a malignant lesion

Soft tissue lesion with an indistinct border, lacking a defined capsule and often showing a radiolucent periphery.

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Where malignant tumors are found

Areas in the jaw that are more commonly affected by different types of malignant tumors.

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Carcinoma

Originating from epithelial tissues, commonly seen in the tongue, floor of mouth, etc.

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Symptoms of Oral Squamous Cell Carcinoma

Large lesions can obstruct the airway, eustachian tube, or nasopharynx. Patients may experience significant weight loss and feel unwell.

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Locations of Oral Squamous Cell Carcinoma

Commonly found on the lateral border of the tongue, floor of the mouth, and gingiva. Can also affect tonsils, soft palate, and buccal vestibule.

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Radiographic Features of Oral Squamous Cell Carcinoma: Periphery and Shape

Polymorphous, irregular shape due to bone erosion. Invasion often observed with an ill-defined, non-corticated border.

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Radiographic Features of Oral Squamous Cell Carcinoma: Internal Structure

Completely radiolucent, meaning the original bone structure is lost.

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Effect of Oral Squamous Cell Carcinoma on Teeth

WIDENING of the periodontal ligament space and DESTRUCTION of adjacent lamina dura. Teeth may appear floating without bony support.

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Effects of Oral Squamous Cell Carcinoma on the Mandibular Canal

Tumors can grow along the inferior neurovascular canal and through the mental foramen, widening and eroding the surrounding bone.

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Effects of Oral Squamous Cell Carcinoma on Surrounding Structures

Destruction of normal cortical boundaries like the maxillary sinus, buccal, and lingual plates. Thinning or destruction of the mandibular border.

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Differentiating Osteomyelitis from Squamous Cell Carcinoma

Osteomyelitis produces periosteal reaction (new bone formation), whereas squamous cell carcinoma does not.

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Squamous Cell Carcinoma (SCC)

A type of cancer that starts in the squamous cells, which are flat cells that make up the lining of the mouth, skin, and other parts of the body. It can occur in different locations in the mouth.

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Primary Intraosseous SCC

SCC that originates within bone, often arising from the lining of a cyst or other pre-existing structures.

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SCC Originating in Cyst

SCC that begins within a cyst, often related to dental problems.

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SCC Originating in the Maxillary Sinus

SCC that starts in the maxillary sinus, a hollow space in the upper jaw.

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Central Mucoepidermoid Carcinoma

A type of tumor that originates from epithelial cells within bone, potentially arising from the lining of a cyst.

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Central Mucoepidermoid Carcinoma - Symptoms

The most common symptom of Central Mucoepidermoid Carcinoma is a painless swelling in the affected area. It may be a slow-growing tumor that feels like a lump.

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Aggressive Lesions Radiographic Appearance

Aggressive, fast-growing lesions often have irregular borders and an opaque appearance on radiographs.

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Non-Aggressive Lesions Radiographic Appearance

Smooth-bordered and radiolucent lesions, meaning they appear dark on X-rays, can resemble normal structures like cysts or granulomas, making diagnosis challenging.

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Malignant Ameloblastoma

A type of malignant tumor that starts in the cells that form enamel in the teeth.

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Common Primary Tumors

The most common primary tumors that metastasize to the jaws, often originating from the breast, lungs, and prostate.

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Clinical Features of Malignant Ameloblastoma

A hard, expanding growth in the jaw with displaced teeth and normal overlying mucosa. May cause a slight tenderness.

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Radiographic Features of Malignant Ameloblastoma

Well-defined borders with cortical boundaries. However, it can breach the cortex, invading the soft tissue.

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Internal Structure of Malignant Ameloblastoma

The tumor often presents with a honeycomb or soap bubble pattern on radiographs, with thick septa.

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Location of Malignant Ameloblastoma

Usually found in the mandible, more prevalent in the premolar and molar region.

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Demographic Features of Metastatic Malignancy in the Jaw

Occurs in older adults, especially women, with a ratio of almost 2:1.

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Metastatic tumor in the jaw

A type of malignant tumor that starts in another part of the body and spreads to the jaw.

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Common sites of metastatic tumors in the jaw

The maxillary sinus, anterior hard palate, and mandibular condyle are common locations for metastatic tumors.

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Mimicking other conditions

Metastatic tumors in the jaw can resemble inflammatory lesions or periapical disease.

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Tumor shape and margin

The tumor margins may lack a distinct border and have irregular shapes.

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Tumor effect on teeth

The malignant tumor disrupts the normal bony structure around the teeth's roots.

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Sclerotic metastatic tumors

Tumors, like those from prostate or breast cancers, can cause the bone to become denser.

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Spiculated pattern in X-rays

A spiculated pattern on X-rays can indicate tumors like those from prostate or neuroblastoma.

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Comparing tumor to inflammation

The tumor can cause a widening of the space between the tooth root and the bone, unlike inflammation.

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Mucoepidermoid Carcinoma

A type of tumor that often arises in the mandible, typically above the mandibular canal in the premolar/molar area. It is known for its well-defined, often corticated borders and a multilocular radiolucent appearance resembling a soap bubble or honeycomb structure.

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Mucoepidermoid Carcinoma: Effect on Surrounding Structures

This tumor tends to expand and may perforate the surrounding bone, sometimes even extending into the soft tissues. While it often pushes the mandibular canal, the teeth themselves are usually not directly affected.

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Mucoepidermoid Carcinoma: Differential Diagnosis

This tumor can be mistaken for benign odontogenic tumors due to its appearance, but its aggressive nature is revealed by its tendency to expand and potentially perforate the bone, even extending into surrounding tissues.

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Malignant Ameloblastoma vs. Ameloblastic Carcinoma

These tumors are categorized by their behavior rather than just their appearance. Malignant ameloblastoma is recognized for its tendency to metastasize despite benign histological features. Ameloblastic carcinoma, on the other hand, exhibits classic malignant characteristics at the cellular level, like abnormal cell division and enlarged nuclei.

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Malignant Ameloblastoma: Behavior

This tumor, marked by its aggressive nature, expands outward and may even break through the outer bone to infiltrate surrounding tissues.

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Ameloblastic Carcinoma: Cellular Features

Cells in this tumor display characteristics of malignancy with abnormal cell division and enlarged nuclei. This differentiates it from malignant ameloblastoma, which may not show these features at the cellular level.

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Mucoepidermoid Carcinoma: Cortication

The distinctive feature of this tumor is the prominent cortication, which is a thick layer of bone surrounding the lesion.

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Mucoepidermoid Carcinoma: Location

This type of tumor is often found in the jaw, more commonly in the mandible compared to the upper jaw.

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Study Notes

Radiographic Interpretation of Malignant Lesions (Part I)

  • Malignant tumors are uncontrolled tissue growth, more invasive, have higher cellular abnormality (anaplasia), and can spread (metastasize)
  • Primary tumors originate directly, secondary/metastatic tumors from elsewhere
  • Common jaw malignancies are categorized as: carcinomas (epithelial origin), metastatic lesions, sarcomas (mesenchymal origin), and hematopoietic system malignancies
  • General clinical features include pain/swelling with no dental cause, ulceration with indurated/rolled border (leading to bone exposure), tooth displacement/loosening, lymphadenopathy, and foul smell.
  • Location of primary and metastatic malignant tumors can be anywhere in the oral and maxillofacial region, commonly in the tongue, floor of the mouth, tonsils, lips, soft palate, gingiva, mandible, and maxilla.
  • Metastatic tumors are often in the posterior mandible/maxilla.
  • The periphery of a malignant lesion is often ill-defined, lacking cortication or encapsulation. It infiltrates, extending from a bone destruction area and unevenly into normal bone.
  • The internal structure is often radiolucent. Some tumors can stimulate bone formation (appearing as sclerotic osseous structure in the internal part)
  • Malignant tumors cause effects on surrounding structures including alveolar bone destruction, cortical boundary damage, and potential for tooth displacement. Internal trabecular bone and dental follicles are also affected.
  • Tumors can be found in the maxillary antrum or through periodontal space, which might lead to abnormal widening
  • Some tumors can stimulate unusual ossification (e.g., hair-on-end, sunburst patterns) if inflammation coexists, similar to inflammatory reactions
  • Malignant tumors are characterized by a rapid growth, leading to invasion through easy pathways (e.g., maxillary antrum, periodontal ligament) and destruction of lamina dura
  • Different malignancies exhibit different patterns (e.g., ill-defined borders, infiltrative patterns)
  • SCC originates in soft tissue, most frequently in persons older than 50, presenting as white, red, or mixed irregular lesions with central ulceration, rolled edges, and infiltration into adjacent structures (muscle or bone)
  • Pain, lymphadenopathy, and other symptoms (e.g., paresthesia, pain, foul smell) can accompany SCC
  • Primary intraosseous carcinoma originates within the jaw bone, without connection to oral mucosa.
  • It often appears later in life (fourth to eighth decades), as rounded/irregular radiolucent shapes, causing bone erosion and destruction.
  • Central Mucoepidermoid carcinoma: odontogenic epithelial tumor, often painless swelling, most frequently in the mandible,
  • Central Mucoepidermoid carcinoma: unilocular or multilocular, well-defined to ill-defined cortication, often having a soap-bubble/honeycomb appearance, possibly eroding adjacent bone.
  • Differential diagnoses of these issues may include other types of malignancies (including metastatic lesions), benign odontogenic tumors, or inflammatory disorders like osteomyelitis

Radiographic Interpretation of Malignant Lesions (Part II)

  • Metastatic lesions in the jaws, less than 1%, often originating from breast, lung, prostate, colon, rectum.
  • Can cause pathological fracture/hemorrhage .
  • Posterior areas are most frequently affected for metastatic disease in the jaw.
  • Internal and other structures, including the maxillary sinus, alveolus, or periodontal ligament, can be affected.
  • Other possible diagnostic considerations include multiple myeloma, inflammatory conditions, and other bone lesions.

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