BDS12032-Radiographic interpretation of non-odontogenic benign tumors.pdf

BDS12032 Radiographic Interpretation of Non-Odontogenic Benign Tumors Aim: The aim of this tutorial is to orient the student with the clinical and radiographic features of various non-odontogenic benign tumors with different tissue origins. Subject Title Goes Here Objectives: By the end of the...

BDS12032 Radiographic Interpretation of Non-Odontogenic Benign Tumors Aim: The aim of this tutorial is to orient the student with the clinical and radiographic features of various non-odontogenic benign tumors with different tissue origins. Subject Title Goes Here Objectives: By the end of the tutorial, the student should be able to: • • Describe the clinical and radiographic features of benign non-odontogenic tumors of neural, cartilaginous, osseous, vascular and fibrous origins. Differentiate between various benign non-odontogenic tumors. Tumors Malignant Benign Odontogenic Non-odontogenic Odontogenic Non-odontogenic Benign Non-odontogenic Tumors Neural origin Osseous origin Vascular origin • Neuroma • Neurolemmoma • Neurofibroma • Osteoma • Osteoid Osteoma • Osteoblastoma • Central Hemangioma • Arteriovenous fistula Fibrous origin • Desmoplastic fibroma of bone Cartilaginous origin • Chondroma Neural origin • Neuroma • Neurolemmoma • Neurofibroma Neuroma (Amputation neuroma or traumatic neuroma) • It’s not a neoplasm • An overgrowth of severed nerve fibers attempting to regenerate with abnormal proliferation of scar tissue • The original nerve damage may be the result of mechanical or chemical irritation of the nerve caused by fracture, orthognathic surgery, removal of a tumor or cyst, extrusion of endodontic cement, dental implants, or tooth extraction. Clinical Features • slow-growing reactive hyperplasia (rarely exceeding 1 cm in diameter) • may cause severe pain resulting from pressure applied as the mass enlarges in its bony cavity or as the result of external trauma. • patient may have reflex neuralgia, with pain referred to the eyes, face, and head. Neuroma Radiographic Features • Location: at the mental foramen, anterior maxilla, posterior mandible In the mandible the tumor usually forms in the mandibular canal. • Shape & periphery: well-defined, corticated • Internal Structure: unilocular RL. • Effects on surrounding structures: expansion of the inferior alveolar canal Neurolemmoma (Schwannoma) • Arises from Schwann cells • Rare, but it is the most common intraosseous nerve tumor Clinical features: • slowly growing swelling • mandible and sacrum are the most common sites. • When related to the inferior alveolar canal, pain and paresthesia may occur if the tumor encroaches on adjacent nerves (Pain: at the site of the tumor; paresthesia: felt anterior to the tumor) Neurolemmoma Radiographic features • Location: within the inferior alveolar canal in the mandible • Shape & periphery: well-defined, corticated • Internal structures: unilocular RL, may enlarge & scallop between the roots: Pseudo- multilocular • Effects on surrounding structures: ✓ If the tumor reaches the mandibular or mental foramen: enlargement of the foramen. ✓ Slow expansion of the inferior alveolar canal (cortical boundaries are maintained) ✓ The expansion is usually localized with a definite epicenter, unless the lesion is large. ✓ May cause root resorption of adjacent teeth Neurolemmoma Neurofibroma • Proliferation of Schwann cells in a disorderly pattern that includes portions of nerve fibers (neurolemmoma: only Schwann cells) Clinical Features • Any age, more in young • Swelling • pain or paresthesia, if associated with the mandibular • may expand and perforate the cortex • The central lesion of a neurofibroma may be the same as the multiple lesions that develop in Neurofibromatosis (von Recklinghausen disease). Neurofibroma Radiographic features • Location: within the inferior alveolar canal in the mandible or in cancellous bone • Shape & periphery: well-defined, corticated • Internal structures: unilocular RL • Effects on surrounding structures: A neurofibroma of the inferior dental nerve shows a fusiform enlargement of the canal. Neurofibromatosis (von Recklinghausen disease) • A syndrome: - skin: café-au-lait spots, freckles, soft pedunculated cutaneous neurofibromas & firm subcutaneous neurofibromas. - multiple peripheral nerve tumors: schwannomas and neurofibromas. - other dysplastic abnormalities of the skin, nervous system, bones, endocrine organs, and blood vessels Radiographic features • - Changes in the shape of the mandible: enlargement of the coronoid notch an obtuse angle between the body and the ramus deformity of the condylar head & lengthening of the condylar neck lateral bowing and thinning of the ramus enlargement of the mandibular canal and mental and mandibular foramina Vascular origin • Central Hemangioma • Arteriovenous fistula Central Hemangioma • A hemangioma: proliferation of blood vessels creating a mass that resembles a neoplasm (hamatoma). • The central (intraosseous) type: found in the vertebrae and skull. • The lesions may be developmental or traumatic in origin. Clinical features • • • • Females, first decade Non tender, hard, bony expansion of the jaw (if pain is present: throbbing type) Pulsations detected on auscultation Teeth in the affected area: - loosening and migration - gingival bleeding around the neck - rebound mobility - Aspiration: arterial blood (may be fatal) Central Hemangioma Radiographic features • Location: mandible > maxilla, within the inferior alveolar canal • Shape & periphery: well-defined & corticated or ill-defined. - sunray-like appearance: formation of linear spicules of bone, emanating from the surface of the bone in a can occur when the hemangioma breaks through the outer cortex and displaces the periosteum Central Hemangioma • Internal structures: Multilocular RL ( coarse, dense, and well-defined trabeculae: honeycomb pattern) -If lesion within mandibular canal: increased in width of the whole canal (serpiginous enlargement) Central Hemangioma • Effect on surrounding structures: ✓ Related teeth: resorbed or displaced. ✓ If inferior alveolar nerve canal is involved: it is enlarged along its entire length and its shape may be changed to a serpiginous path. ✓ The mandibular and mental foramen may be enlarged. ✓ Developing teeth may be larger and erupt earlier when in intimate relationship with a hemangioma Arteriovenous fistula • Arteriovenous (A-V) defect, A-V shunt, A-V aneurysm, and A-V malformation • It is a direct communication between an artery and a vein that bypasses the intervening capillary bed. • It usually results from trauma but, rarely, may be a developmental anomaly. • May occur anywhere in the body: in soft tissue, in the alveolar process, and centrally in the jaw. • Aspiration: blood. • Extraction of an associated tooth: life-threatening bleeding. • CT with contrast Arteriovenous fistula Radiographic features • Location: ramus and retromolar area of the mandible and involves the mandibular canal • Shape & periphery: well-defined & corticated • Internal structure: unilocular RL or multilocular RL (tortuous path of an enlarged vessel in bone) • Effect on surrounding structures: - May erode bone: well-defined (cyst like) lesions - Serpiginous enlargement of mandibular canal, if affected Osseous origin • Osteoma • Osteoid Osteoma • Osteoblastoma Osteoma • Osteomas originate from the periosteum • Structurally, divided into three types: - composed of compact bone (ivory), - composed of cancellous bone - composed of a combination of both • May be solitary or multiple • Asymmetry caused by a bony, hard swelling on the jaw. • Painless, until its size or position interferes with function. • The mucosa covering the tumor is normal in color and freely movable Osteoma Radiographic features • Location: mandible> maxilla, posteriorly, lingual or at the inferior boarder. May also occur in the paranasal sinuses, especially the frontal sinus. • Shape & periphery: well-defined • Internal structure: if composed of compact bone only: uniformly RO, if contains cancellous bone: trabeculae are seen • Effect on surrounding structures: may displace adjacent soft tissues, such as muscles, and cause dysfunction. Osteoma Gardner’s Syndrome • Familial multiple polyposis • A hereditary condition characterized by: - multiple osteomas (appear early on, help in early detection) - multiple dense bone islands (enostosis) - epidermoid cysts - subcutaneous desmoid tumors - multiple polyps of the small and large intestine (premalignant) Osteoid Osteoma • A benign tumor, its core consists of osteoid and newly formed trabeculae within highly vascularized, osteogenic connective tissue. Clinical features: • Young males • Severe pain • Rare in the jaws. Osteoid Osteoma Radiographic features • Location: mostly in limb bones, if in the mandible: mandibular body • Shape & periphery: well-defined, with a rim of sclerotic bone • Internal structure: - immature lesions: a small ovoid or round RL area (core). - mature lesions: RO • Effect on surrounding structures: sclerotic bone reaction and thickening of the outer cortex by stimulating periosteal new bone formation. Osteoblastoma (Giant osteoid osteoma) • Benign tumor of osteoblasts with areas of osteoid and calcific tissue. • This tumor occurs most often in the spine of a young person. • Rare in jaws Clinical Features • Males > females • Swelling • Pain, not as severe as osteoid osteoma Osteoblastoma Radiographic features • Location: in tooth-bearing regions and TMJ • Shape & periphery: well defined, corticated, or diffuse. Has a RL capsule • Internal structure: early: RL, mature: RO • Effect on surrounding structures: expands the bone, but outer cortex is maintained. • Larger in size than Osteoid Osteoma Fibrous origin • Desmoplastic fibroma of bone Desmoplastic fibroma of bone • Aggressive fibromatosis • An aggressive, infiltrative neoplasm that produces abundant collagen fibers, composed of fibroblast- like cells. Clinical features • Facial swelling, dysfunction (when close to the joint), pain is rare • Young age (first and second decades) • Originates in bone, but may invade the surrounding soft tissue extensively. • May occur as part of Gardner’s syndrome. Desmoplastic fibroma of bone Radiographic features • Location: mandible (posterior, ramus) > maxilla • Shape & periphery: ill-define and invasive. • Internal structure: small lesions: unilocular RL, larger lesions: multilocular RL with very coarse, thick septa (straight or irregular) • Effect on surrounding structures: expands the bone cortex, may perforate it and extend into the soft tissue • CT or MRI is required to determine the exact soft tissue extent of the lesion. Cartilaginous origin • Chondroma Chondroma • A benign cartilaginous tumor, which is encapsulated, with a lobular growing pattern. • Rare in the jaws • Based on their location, chondromas can be classified as: (1) enchondromas that are located in the medullary cavity of the bony skeleton; (2) juxtacortical or periosteal chondromas that originate adjacent to the periosteum below the cortical surface; and (3) extra-skeletal or soft tissue chondromas, which have been reported in the tongue and buccal mucosa. • It is similar clinically and radiographically to chondrosarcoma Chondroma Radiographic features • Location: mandibular condyle and coronoid process or anterior maxilla • Shape & periphery: round, lobulated. Well-defined, may be corticated • Internal structure: Mixed RL/RO (flocculent calcification) • Effect on surrounding structures: - Expands the bone cortex. - If in TMJ: widens joint space and erosion of the articular fossa - If lesion occurs near teeth: root resorption, tooth and widening of the periodontal membrane space. Neural origin Osseous origin Vascular origin • Neuroma • Neurolemmoma • Neurofibroma • Osteoma • Osteoid Osteoma • Osteoblastoma • Central Hemangioma • Arteriovenous fistula Fibrous origin • Desmoplastic fibroma of bone Cartilaginous origin • Chondroma Reading material: • Oral Radiology: Principles and Interpretation (7th Ed.) by White, S. C. and Pharoah, M. J, published by Mosby Elseiver. Aim: The aim of this tutorial is to orient the student with the clinical and radiographic features of various non-odontogenic benign tumors with different tissue origins. Subject Title Goes Here Objectives: By the end of the tutorial, the student should be able to: • • Describe the clinical and radiographic features of benign non-odontogenic tumors of neural, cartilaginous, osseous, vascular and fibrous origins. Differentiate between various benign non-odontogenic tumors.