BDS12033 Radiographic Interpretation of Malignancies PDF

BDS12033 Radiographic Interpretation of Malignancies Aim: The aim of this tutorial is to orient the student with the clinical and radiographic features of various malignant neoplasms with different tissue origins. Objectives: By the endTitle of the the student should be able to: Subject Goestutor...

BDS12033 Radiographic Interpretation of Malignancies Aim: The aim of this tutorial is to orient the student with the clinical and radiographic features of various malignant neoplasms with different tissue origins. Objectives: By the endTitle of the the student should be able to: Subject Goestutorial, Here • Recognize the general characteristics of malignancy. • Describe the clinical and radiographic features of carcinomas, sarcomas, metastatic tumors and those of hematopoietic origin. • Identify classically appeared malignant neoplasms through radiographic images. • Differentiate between various malignant neoplasms. • It is an uncontrolled new growth of uncoordinated abnormally arranged tissues What are the differences between benign and malignant neoplasms? Classifications of Malignant neoplasms Classifications of Malignant neoplasms Carcinoma Odontogenic Sarcoma Non-odontogenic Hematopoietic Primary Secondary Classification 1 Carcinomas 2 Sarcomas 3 Hematopoietic origin 4 Metastatic 1971 1992 2005 2017 Malignant Tumors Clinical Features Radiographic Features Clinical Features Rapid swelling Paresthesia Paralysis Trismus Malignancy Ulceration Pain Clinical Features Unhealed wounds Weight loss Foul odor Fatigue Malignancy Bleeding Lymphadenopathy Radiographic Features Location Shape & Periphery Ill-defined border – invasive - infiltrative Internal Structure Mainly RL – sometimes mixed or RO Effects on Surrounding Structures Erosion – perforation of the cortices – floating teeth • These clinical and radiographic features are common in most malignant tumors affecting the jaws • They gives you the impression of malignancy • You should look for the characteristic feature(s) for each malignant entity Radiographic Features Flouting teeth Erosion Ill-defined Irregular widening of PMS M A L I G N A N C Y Carcinoma Sarcoma Hematopoietic Metastatic 1 Carcinomas Peripheral squamous cell carcinoma Central squamous cell carcinoma Ameloblastic carcinoma Sclerosing odontogenic carcinoma Odontogenic Clear cell odontogenic carcinoma Rare Ghost cell odontogenic carcinoma Odontogenic carcinocarcinoma Mucoepidermoid carcinoma Peripheral squamous cell carcinoma • • • • • • Synonym: epidermoid carcinoma Surface epithelial Gingiva, maxillary sinus, floor of the mouth, tongue, soft palate The most common malignant tumor in oral cavity Hard fixed lymph nodes Saucer shape Peripheral squamous cell carcinoma • Exophytic mass • Ulcer Peripheral squamous cell carcinoma Peripheral squamous cell carcinoma Peripheral squamous cell carcinoma Squamous cell Carcinoma of maxillary sinus Peripheral squamous cell carcinoma Central squamous cell carcinoma • Epithelial remnants inside the bone • Originating from cystic wall • rare Central squamous cell carcinoma Central squamous cell carcinoma Ameloblastic carcinoma • Ameloblastoma with histopathological features of epithelial dysplasia Sclerosing odontogenic carcinoma • Very rare • Low grade malignancy Clear cell odontogenic carcinoma • Rare • Mandible 75% • High recurrence Clear cell odontogenic carcinoma Ghost cell odontogenic carcinoma • Ghost cell A- Cystic B- Solid - benign - malignant • RL or Mixed Ghost cell odontogenic carcinoma Mucoepidermoid carcinoma • Originates from salivary glands • May have benign behavior (low grade malignancy) • Multilocular Mucoepidermoid carcinoma M A L I G N A N C Y Carcinoma Sarcoma Hematopoietic Metastatic 2 Sarcomas Osteogenic sarcoma Fibrosarcoma Chondrosarcoma Ewing’s sarcoma Odontogenic sarcomas Rare Osteogenic sarcoma • Malignant tumor of osteoblasts • Osteolytic or osteoblastic • Middle age Osteogenic sarcoma • • • • RL (osteolytic)– Mixed or RO (osteoblastic) Irregular widening of periodontal membrane space Sunray Codman’s triangle Osteogenic sarcoma Osteogenic sarcoma Fibrosarcoma • Malignant tumor of fibroblasts • Gingiva – Periodontal ligament Fibrosarcoma • Saucer shape • Irregular widening of periodontal membrane space Chondrosarcoma • Malignant tumor of cartilaginous cells • May have benign behavior • Symphysis menti, condyle, coronoid, anterior part of maxilla Chondrosarcoma • RL or Mixed • May be well-defined • Irregular widening of periodontal membrane space Chondrosarcoma Ewing’s sarcoma • Malignant tumor of endothelial cells (debatable) • Rare • Age: 5 – 55 y Ewing’s sarcoma • Onion skin • Invasion of teeth crypts M A L I G N A N C Y Carcinoma Sarcoma Hematopoietic Metastatic 3 Hematopoietic Multiple myeloma Burkitt’s lymphoma Malignant lymphoma Leukemia Multiple Myeloma • • • • • • Malignant tumor of plasma cells Skull- ribs-spine-pelvis-femur Pancytopenia (anemia – infection tendency – bleeding tendency) Renal problems +ve Bence Jones test > 40 y Multiple Myeloma • Punched out • Multiple Multiple Myeloma Burkitt’s Lymphoma • • • • • B-cell non-Hodgkin lymphoma Epstein Barr virus Children (Africans) Adolescents (American) Very rapid and huge enlargement Burkitt’s Lymphoma • Invasion of teeth crypts • Premature eruption of teeth Malignant Lymphoma • • • • • Young age Night sweat Pruritus Lymphadenopathy Periosteal reaction Leukemia • • • • • Young age Invasion of teeth crypts Premature eruption of teeth Punched out Periosteal reaction M A L I G N A N C Y Carcinoma Sarcoma Hematopoietic Metastatic 4 Metastatic Metastasis is the spread of malignant cells from the primary tumor location to new areas of the body, often by way of the lymph system or bloodstream Primary tumor • • • • • • • Breast Prostate Lung Kidney Thyroid Rectum Colon • • • • • • • Breast Prostate Lung Kidney Thyroid Rectum Colon In most of cases, patient is aware with primary tumor Metastatic (Secondary) Carcinoma • • • • Single – multiple Well-defined - ill-defined Radiolucent – radiopaque (prostate, breast) Bone - periodontal membrane space – teeth apices Remember 1 carcinoma 2 sarcoma 3 hematopoietic Malignancy 4 Metastatic Remember Carcinoma Sarcoma Hematopoietic Metastatic 1 Peripheral SCC Osteosarcoma Multiple myeloma Breast 2 Central SCC Fibrosarcoma Burkitt’s lymphoma Prostate 3 Ameloblastic carcinoma Chondrosarcoma Malignant lymphoma Lung 4 Sclerosing odontogenic carcinoma Ewing’s sarcoma Leukemia Kidney 5 Clear cell odontogenic carcinoma Thyroid 6 Ghost cell odontogenic carcinoma Colon 7 Odontogenic carcinocarcinoma Rectum 8 Mucoepidermoid Malignancy 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 malignant neoplasms with different tissue origins. Objectives: By the endTitle of the the student should be able to: Subject Goestutorial, Here • Recognize the general characteristics of malignancy. • Describe the clinical and radiographic features of carcinomas, sarcomas, metastatic tumors and those of hematopoietic origin. • Identify classically appeared malignant neoplasms through radiographic images. • Differentiate between various malignant neoplasms.