Oral Medicine

Oral Medicine Tumours Short Essays

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Oral Medicine Tumours Short Essays

Question 1. Hemangioma

Answer:

Hemangioma

  • They are relatively common benign proliferative lesions of vascular tissue origin

Hemangioma  Clinical Features:

  • Age and sex: Early-age females are commonly affected
  • Site: Intraorally over
    • Tongue
    • Lip
    • Buccal mucosa
    • Palate
    • Within jawbones
    • Within salivary gland
  • Hemangioma Presentation
    • They are usually raised, multinodular, red or purple lesions
    • When a hemangioma is compressed with the help of a slide it blanches
    • Once the pressure is released, its reddish appearance returns due to the refilling of the tumor cells with blood
    • It is soft and compressible
    • The size of the lesion varies from time to time
    • Port wine stain is often seen over the face
    •  Jawbones involvement
      • Mandible is more commonly affected
      • It produces slow enlarging, painful, expansile jaw swelling
      • It may cause erosion of the bone
      • Loosening of the teeth
      • Anesthesia or paraesthesia of the skin and oral mucosa

Hemangioma  Differential Diagnosis:

  • Pyogenic granuloma
  • Mucoceles
  • Kaposi’s sarcoma
  • Salivary gland neoplasm

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Hemangioma  Management:

  • Local excision for smaller lesions
  • Larger lesions are treated by excision after pretreat¬ment of the lesion with sclerosing agents to reduce the size of the lesion

Question 2. AOT

Answer:

AOT Origin: reduced enamel epithelium

AOT Clinical Features:

  • Age: Young age
  • Sex: Female
  • Site: Maxillary anterior region

AOT Presentation:

  • Slow enlarging, small, bony hard swelling
  • Elevation of the upper lip
  • Displacement of teeth
  • Expansion of cortical plates
  • Asymptomatic
  • Nodular swelling over gingiva

AOT Radiographic Features:

  • Well-defined, unilocular, radiolucent area
  • Interior small radiopaque foci

AOT Treatment:

Surgical enucleation

Question 3. Ossifying fibroma

Answer:

Ossifying fibroma

Oral Medicine Tumours Ossifying fibroma

Question 4. Malignant melanoma.

Answer:

Malignant melanoma

  • It is a malignant neoplasm arising from melanocytes of the skin and mucous membrane

Malignant melanoma Clinical Features:

  • Age and sex: It affects older aged people
  • Sites:
    • Hardpalte
    • Maxillary alveolar ridge
    • Less frequently,
      • Lower jaw
      • The floor of the mouth
      • Tongue
      • Buccal mucosa
      • Parotid gland

Malignant melanoma Presentation

  • It initiates as a macular pigmented lesion
  • Some of them appear as inflamed area
  • The pigmented lesions are dark brown or bluish-black
  • Initially, they are rapidly growing, large painful dif¬fuse mass
  • Surface ulceration may occur It may be secondarily infected
  • It spreads rapidly and destroys the involved bone
  • It leads to the loosening and exfoliation of teeth
  • There may be a metastasis of the tumor cells to distant sites.

Oral Medicine Tumours

Malignant melanoma Management:

Radical surgery with prophylactic neck dissection is done

Question 5. Kaposi sarcoma.

Answer:

Kaposi sarcoma

  • It is a malignant neoplasm arising from the endothelial cells of the blood capillaries

Kaposi sarcoma Etiology:

  • Genetic predisposition
  • HIV
  • Immunosuppression
  • Environmental factors

Kaposi sarcoma Clinical Features:

  • Sites: Maxillary gingival, tongue
  • Clinical stages:

1. Patch stage:

  • It is the initial stage of the disease and during this, a pink, red, or purple macule appears over the oral mucosa

2. Plaque stage:

  • It continues into the plaque stage with time and during this stage, the lesion appears as a large, raised plaque

3. Nodular stage:

  • It is the last stage of the disease
  • It is characterized by the occurrence of multiple nodular lesions on the skin or the mucosa

Kaposi sarcoma Differential Diagnosis:

  • Pyogenic granuloma
  • Hemangioma
  • Angiosarcoma

Kaposi sarcoma Management:

  • Radiotherapy
  • Chemotherapy.

Tumours Notes and Short Question And Answers

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Oral Medicine Tumours Important Notes

1. Tumours of muscles

Oral Medicine Tumours Tumours of muscles

2. Features of epithelial dysplasia

  • Increased abnormal mitosis
  • Individual cell keratinization
  • Epithelial pearls in the spinous layer
  • Alterations in nuclear cytoplasm ratio
  • Loss of polarity and disorientation of cells
  • Hyperchromatism
  • Large nucleoli
  • Poikilokarynosis
  • Basilar hyperplasia

3. Burkitt’s lymphoma

  • It is a B cell neoplasm
  • Commonly affects children between 214 years of age
  • Macrophages are found uniformly throughout the tumour producing the starring sky effect

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4. Basal cell carcinoma

  • Involves the exposed surfaces of skin mostly the middle third of the face
  • Does not tend metastasize
  • UV light is the main etiological agent
  • Men are commonly affected

5. Histological features of squamous cell carcinoma

  • Enlarged nuclei
  • Increased nuclear/ cytoplasmic ratio
  • Hyperchromatic nuclei
  • Dyskeratosis
  • Increased mitotic activity

6. Teratoma

  • It is made up of some different types of tissue which are not native to the area
  • Occurs in various parts of the body
  • Made up of various epithelial appendages such as hair, sweat glands, sebaceous glands, and salivary glands
  • Teeth are usually normal
  • Inflammatory gingivitis may be seen

7. Syndromes associated with haemangioma

  • RenduoslerWeber syndrome
  • SturgeWeber syndrome
  • KasabachMerritt syndrome

8. Odontogenic tumors and their common sites

Oral Medicine Tumours Odontogenic tumours and their common sites

9. Odontoma

  • It has two types
    • Compound odontoma
  • Resembles normal tooth
  • Affects anterior maxilla
    • Complex odontoma
    • Has no morphological similarity
    • Affects posterior maxilla

10. Sunray appearance is seen in

  • Osteogenic sarcoma
  • Central hemangioma
  • Ewing’s sarcoma

11. Onion peel appearance is seen in

  • Ewing’s sarcoma
  • Garre’s osteomyelitis
  • Caffey’s disease

12. Russell’s body is seen in

  • Multiple myeloma
  • Periapical granuloma

Oral Medicine Tumours Long Essays

Question 1. Give differences between benign and malignant tumors. Describe clinical features and radio¬graphic features of squamous cell carcinoma

Answer:

Differences between benign and malignant tumors

Oral Medicine Tumours Differences between benign and malignant tumour

Benign and Malignant Tumors Clinical Features:

  • Age and sex: It is common in older men
  • Sites: sites involved in their order are
    • Lower lip
    • Lateral tongue
    • The floor of the mouth
    • Soft palate
    • Gingiva
    • Alveolar ridge
    • Buccal mucosa

Benign and Malignant Tumors Presentation:

  • Initially, it is an asymptomatic lesion
  • It may resemble leukoplakia or erythroplakia
  • It appears as a white or red nodule or fissure over the mucosa
  • The advanced lesion appears as a rapidly enlarging exophytic growth or ulcer or tumor-like mass
  • The ulcer has persistent induration around the periph¬ery with elevated and everted margins
  • It may predispose to candidal infections
  • It may be secondarily infected
  • There is a presence of regional lymphadenopathy
  • Pathological fractures of jawbones may sometimes occur
  • Maxillary lesions may lead to nasal bleeding and pressure sensation over the eyeball
  • Involvement of the inferior alveolar nerve leads to parties these of lower teeth and lip

Benign and Malignant Tumors – Radiographic Features:

  • The involved bone exhibits large, irregular, and ill-defined borders in radiolucent areas
  • It gives a typical moth-eaten appearance
  • There is the destruction of interdental bone
  • It causes exfoliation or displacement of regional teeth

Oral Medicine Tumours.

Oral Medicine Tumours Short Answers

Question 1. Odontomes.

Answer:

Odontomes

Common hamartomatous odontogenic lesions with limited growth potential

Odontomes Types:

1. Complex odontoma:

  • Consists of a mass of haphazardly arranged enamel, dentin, and cementum

2. Compound odontoma:

  • Consists of collections of numerous small, discrete, tooth-like structures

Odontomes Clinical Features:

  • Age: Children and young adults
  • Sex: Both
  • Site: Compound in the maxilla
  • Complex mandible

Odontomes Presentation:

  • Small asymptomatic lesion
  • Expansion of cortical plates
  • Displacement of teeth
  • Impacted or retained deciduous teeth
  • Pain, inflammation
  • Ulceration
  • Fistula formation

Odontomes Radiographic Features:

  • Compound A bag of teeth appearance
  • Complex sunburst appearance

Odontomes Treatment:

  • Surgical enucleation

Question 2. Keratoacanthoma.

Answer:

Keratoacanthoma

  • It is a benign endophytic epithelial tissue neoplasm, which commonly occurs in the sun-exposed skin of the face and it usually appears as a circumscribed keratin-filled crater

Keratoacanthoma Features:

  • It appears as a small, well-circumscribed, elevated, and crater-like lesion with a central depression
  • It initiates as a small lump or bud-like growth on the sun-exposed skin surface of the face
  • It grows rapidly and achieves its maximum size over about 48 weeks
  • It reveals a well-circumscribed, elevated nodule that has a sharply delineated, rolled margin and a central keratotic core
  • It is often painful
  • It may have associated lymphadenopathy

Keratoacanthoma Treatment:

  • Surgical excision of the lesion is done

Question 3. Papilloma

Answer:

Keratoacanthoma

  • Papilloma is a common benign neoplasm of the oral cavity arising from epithelial tissue
  • It is characterized by exophytic growth with a typical cauliflower-like appearance

Papilloma Clinical Features:

  • Age third, fourth, and fifth decade of life
  • Sex both sexes are equally affected
  • Site involved
  • Tongue
  • Lips
  • Buccal mucosa
  • Gingiva
  • Hard and soft palate
  • Present as slow-growing, exophytic, soft, pedunculated, painless, nodular growth with a cauliflower-like appearance
  • Have numerous fingerlike projections over the surface
  • It appears as ovoid swelling with a corrugated surface
  • Size a few mm to 1 cm in diameter
  • The base of the lesion may be pedunculated or sessile
  • The color white in color
  • Surface highly keratinized
  • Superficial ulceration and secondary infection occur
  • Rarely papilloma grows inward

Question 4. Osteosarcoma.

Answer:

Osteosarcoma

  • Osteosarcoma is a highly malignant primary neoplasm arising from the bone

Osteosarcoma Types:

1. According to the location of the lesion

  • Medullary osteosarcoma
  • Periosteal osteosarcoma
  • Parosteal osteosarcoma
  • Soft tissue osteosarcoma

2. According to radiological characteristic

  • Osteoblastic type of osteosarcoma
  • Osteolytic type of osteosarcoma
  • Mixed type

3. According to tumor histology

  • Osteoblastic type of osteosarcoma
  • Chondroblastic type of osteosarcoma
  • Fibroblastic type of osteosarcoma
  • Telangiectatic type of osteosarcoma

Osteosarcoma Clinical Features:

  • Age- 10-20 years of age
  • Sex- common in males
  • Site involved
  • Long bone
  • Maxilla alveolar ridge, antrum, palate
  • Mandible Symphysis, angle, ramus
  • Temporomandibular joint
  • Tongue
  • Lip
  • Presents as fast enlarging, firm, painful swelling of the jaw
  • Expansion and distortion of cortical plates
  • Restricted jaw movements
  • Displacement and loosening of teeth
  • Paraesthesia of lower lip and chin regions
  • Paraesthesia of infraorbital nerve
  • Epistaxis
  • Nasal obstruction
  • Redness and inflamed overlying skin and mucosa
  • Ulceration, hemorrhage, pathological fracture

Question 5. Radiographic features of osteosarcoma.

Answer:

Radiographic features of osteosarcoma

  • Widening of PDL space is seen
  • There are 3 radiographical types
  • Osteolytic
    • Margins are ill-defined
    • Gives moth-eaten appearance
    • Mandibular lesions may destroy the cortex of neuromuscular bundles
    • Maxillary sinus involvement destroys bone
    • Lamina Dura is destroyed
  • Mixed
    • New bone is laid down with not well-defined margins
    • There are areas of destruction as well as bone formation
    • This gives a honeycomb appearance
  • Osteoblastic
    • Mixed lesions have ragged, ill-defined borders
    • The sclerotic portion shows vertical obliteration of the trabecular pattern giving a granular appearance
    • If the tumor invades the periosteum, many thin irregu¬lar spicules of new bone are directed outwards and perpendicular to the surface of the lesion producing sun ray appearance
    • Sometimes two triangular radiopacities project from the cortex and mark the lateral extremities of the lesion referred to as Codman’s triangle
    • The subperiosteal bone may be laid down in layers giving an onion-peel appearance
    • There is a distortion of the alveolar ridge

Question 6. Brachytherapy.

Answer:

Brachytherapy

  • It is a type of radiation therapy used to treat cancers
  • In it, the radioactive source is kept close to the patient’s body and directed to the surface of the tumor

Brachytherapy Types:

  • Mold treatment
    • The radiation source is placed into the plastic mold on the patient’s skin or mucous membrane to treat su¬perficial tumors
  • Interstitial therapy
    • Involves the insertion of a radioactive source into the tumor
  • Intracavitary therapy
    • In this, the radiation source is placed into the body cavity to irradiate the surrounding tissues

Question 7. Oncovirus,

Answer:

Oncovirus

  • Oncovirus are associated with neoplasms
  • Based on nucleic acid content, oncovirus is divided into 2 groups:
  1. DNA virus
  2. RNA virus

1. DNA virus

  • They have direct access to the host cell nucleus and are incorporated into the genome of the host cell’s DNA
  • Classified into 5 groups:
  • Papova virus: responsible for skin warts and invasive cervical cancer
  • Herpes virus: Epstein Burr virus causes Burkitt’s lymphoma, Human herpes virus
  • causing Kaposi’s sarcoma
  • Adenovirus: causes respiratory tract infections and pharyngitis
  • Poxvirus: causes molluscum contagiosum
  • Hepadna virus : Hepatitis B virus

Oral Medicine Tumours Viva Voce

  1. Cementifying fibroma is a tumor of mesodermal origin
  2. Floating teeth are found in Langerhans cell granulomatosis
  3. The majority of tongue carcinoma occurs in the anterior two-thirds of the tongue
  4. Burkitt’s lymphoma is caused by Epstein Burr virus
  5. Multiple myeloma is a malignant neoplasm of plasma cells
  6. Metastasis mainly involves submaxillary and cervical lymph nodes
  7. A common route for metastasis of oral cancer is lymphatics
  8. A common site of metastatic in the oral cavity is a mandibular molar area
  9. In cylindroma, basal cells are arranged in the honeycomb or Swiss cheese pattern
  10. Ameloblastoma is an ectodermal tumor of Odontogenic origin
  11. Verocay bodies are seen in neurilemmoma
  12. Reed Sternberg cells are seen in Hodgkin’s lymphoma
  13. Lisegang rings are seen in the Pindborg tumor