Oral Pathology for the Dental Hygienist

Chapter 7Neoplasia

Neoplasia Description

Neoplasia= New growth. It is a process in which cells exhibit uncontrolled proliferation. Neoplasm- is a mass of cells. Ex. Tumor is a commonly used synonym for neoplasm Oncology- study of tumors Neoplasia is an abnormal process, cells are abnormal, and the proliferation of these cells is uncontrolled and unlimited

CAUSE OF NEOPLASIA
Chemicals

mainly, viruses and radiation have been shown to cause neoplastic transformation of cells Radiation from sunlight, x-rays, nuclear fission, or other sources are well established as cancer-producing agents in humans Viruses that cause tumors are oncogenic viruses

CLASSIFICATION OF TUMORS
2

categories: Benign & Malignant Benign tumor- remains localized, can be encapsulated (walled off by surrounding fibrous connective tissue), can not spread to distant sites, normal cells Malignant tumor- invades and destroys surrounding tissue and has the ability to spread throughout the body. Compromised of neoplastic cells

MALIGNANT
Well-differentiated

tumors, but can also be poorly differentiated Have only some characteristics of the tissue which they were derived Pleomorphic- vary in size Nuclei darker than normal (hyperchromatic) Composed of cells that vary in size and shape (pleomorphic)

Names of Tumors-Benign
Prefix

of the name of the tumor is determined by the tissue or cell of origin Suffix oma- used to indicate a tumor Ex. Lipoma= benign tumor of fat Osteoma= benign tumor of bone

Names of Tumors- Malignant

Malignant

tumors prefix is also determined by the tissue or cell of origin Ex. Malignant tumors of epithelium = carcinoma Malignant tumors of connective tissue= sarcoma Malignant tumor of squamous epithelium= squamous cell carcinoma Malignant tumor of bone= osteosarcoma

Treatment of Tumors
Benign-

generally treated by surgical excision either by local excision or enucleation Malignant- treated by surgery, chemotherapy, or radiation therapy, a combination is often used

Figure 7-1

Epithelial Tumors
3

different types 1.tumors derived from squamous epithelium 2. tumors derived from salivary gland epithelium 3. tumors derived from odontogenic epithelium

Tumors of Squamous Epithelium

Papilloma- benign tumor of squamous epithelium that presents as a small, exophytic, pedunculated or sessile Tumors are composed of numerous papillary projections, can be white or the color of normal mucosa Often described as cauliflower like Most cases on soft palate or tongue Treated by surgical excision , and must include the base of the growth

Figure 7-2 papilloma

Premalignant LesionsLeukoplakia
Clinical

term and does not refer to a specific histologic appearance Defined as white palquelike lesion of the oral mucosa that cant re rubbed off and cant be diagnosed as a specific disease Most leukoplakias are the result of hyperkeartosis or a combination of epithelial hyperplasia

Figure 7-3 Leukoplakia

Figure 7-4 tobacco pouch keratosis

Leukoplakia continued
Leukoplakia

may also show epithelial dysplasia, a premalignant condition, or even squamous cell carcinoma, a malignant tumor of squamous epithelium studies have shown that leukoplakia found on floor of mouth, ventrolateral tongue, and lip is more likely to be epithelial dysplasia or squamous cell carcinoma than leukoplakia

Leukoplakia continued

When a white lesion is identified in the oral cavity. First goal is to identify the cause If lesion does not resolve a biopsy and histologic exam must be performed Any white lesion that is found as epithelial dysplasia or that cant be diagnosed as a specific disease should be completely removed. When leukoplakia is found on floor of mouth, ventrolateral tongue, or lip, the lesion should be removed regardless of the histologic appearance

Erythroplakia
Oral

mucosal lesion that appears as a smooth red patch or a granular red velvety patch Lesion that shows a mix of red and white areas is called speckled leukoplakia Can occur in the floor of the mouth, tongue, and soft palate.

Epithelial Dysplasia
Disordered

growth Considered a premalignant condition. Cellular changes may revert to normal if stimulus such as tobacco is removed Presents clinically as an erythematous lesion (erythroplakia), white lesion (leukoplakia), or a mixed erythematous and white lesion (speckled leukoplakia) Often in floor of the mouth

Figure 7-5 epithelial dysplasia

Squamous Cell Carcinoma

Malignant tumor of squamous epithelium Most common primary malignancy of the oral cavity Usually mestasizes to the lymph nodes of the neck and then to lungs and liver Clinically presents as exophytic ulcerative mass Early presents as erythematous and plaquelike (erythroplakia), white and plaquelike ( leukoplakia), or a mix (speckled leukoplakia)

Squamous cell Carcinoma continued

It

can occur anywhere in the oral cavity, but most tumors are on the floor of the mouth, ventrlateral tongue, soft palate, tonsillar pillar, and retromolar areas

Figure 7-6 multiple places that squamous cell carcinoma appears

Squamous cell carcinoma cont.

May

occur on vermilion border of lips and skin of face Much better prognosis than in the oral cavity Solar or actinic cheilitis- mild to sever epithelial dysplasia occurs from sun damage

Risk factors-squamous cell carcinoma

Tobcaao

most significant (cigar,pipe, cigatette, snuff/chewing tobacco)

Alcohol

Treatment and Prognosis