DEFINITION :
A tumour is an abnormal mass of tissue the growth of which exceeds
and is uncoordinated with that of normal tissue and persists in the same excessive
manner after cessation of stimuli of which evoked the change.
CLASSIFICATION :
(A) Benign :
(b) Sarcoma :
01. Osteosarcoma.
02. Chondroma.
03. Fibroma.
(d) Others :
01. Malignant melanoma.
02. Multiple myeloma.
03. Hodgkin’s disease.
04. 2-wing’s disease.
Ameloblastoma :
It is a true neoplasm of enamel organ which does not under go
differentiation to the point of enamel formation.
Origin :
1. Cell rest of enamel organ either remnant of dental lamina or remnant of
Heart Wing’s Root Sheath the cell rest of malassez.
2. Epithelium of odontogenic cyst particularly dentigerous cyst or odontoma.
3. Disturbance of developing enamel organ.
4. Basal cells of surface epithelium of the jaw.
5. Hetaroplastic epithelium in other parts of the body specially pituitary
gland.
Clinical Feature :
1. Ameloblastoma may be intra-osseous or extra osseous, but generally they
are intra osseous.
2. They are most neoplasm of jaws.
3. Age—30 to 50 years, rare in children and elder person.
4. Site—80% in the mandible, particularly to the posterior of the mandible
often involve ramous.
5. Generally they are asymptomatic appear multilocular radiolucent larger
ameloblastoma provide symptom.
6. Spread—Locally invasive, metastasis does not occur.
7. Rediographically they are typically formed rounded, cyst like radiolucent
areas with moderately well defined margins and typically appears
multilocular. Lingual expansion some times seen some verity of
honeycomb pattern.
Histological Features :
They are 5 types according to histopathological finding—
1. Follicular.
2. Plexiform.
3. Acanthomatous.
4. Granular cell ameloblastoma.
5. Basal cell ameloblastoma.
1. Follicular Type :
Contains cuboidal/ columnar with polarized nuclei as pre-ameloblastic cell.
2. Plexiform Type :
Arranged as irregular mass(Mesh work like).
3. Acanthomatous Type :
Under goes squamous metaplasia in stellate reticulum with keratin pearls.
4. Granular Cell Type :
Cytoplasm has coarse granular eusinophilic appearance.
5. Basal Cell type :
Rare.
Consist of most dirty staining cells.
Predominantly in a trabicular pattern.
Treatment :
Surgical management of ameloblastoma has been debated topic thought out.
Some group advocates conservative approach like curettage etc. where as
other group is in favors of radical excision of the tumour. Because of the recurrent
nature of tumour.The various treatment modalities are as follows:-
(a) Curettage.
(b) Chemical cauterization.
(c) Electro cauterization.
(d) Enblock excision.
(e) Radical resection with or without reconstruction.
(a) Curettage :
Due to high rate of recurrence the curettage is no more considered to be
desirable from of treatment in the management of ameloblastoma curettage
involves eradication of the macroscopically visible mass of tumour by
scarping procedure.
(b) Chemical Cauterization :
Chemical cauterization of the tumour bed is supplemented with the
curettage. The bed of tumour is cauterized with concentrated Carbolic Acid.
Use of “Carney Solution” is also recommended for fixing the tissue in the
tumour bed contents— Absolute alcohol - 6ml.
-- Chloroform -------3 ml.
-- Glacial accetic acid—1ml.
(c) Electro cauterization :
(d) Enblock excision :
An intro-oral or extra-oral enblock reaction of the tumour at distance of 1-
2cm beyond the radio-graphic margin.
(e) Radical Resection Or Segmental Resection : It is considered to be most effective
method of treatment of ameloblastoma.
Fig- Ameloblastoma. Typical presentation. There is a
rounded, bony swelling of the posterior alveolar,
bony and angel of the mandible. There is no
ulceration, a feature only seen in very large tumours
which have perforated the cortex.
Clinical feature :
1. Adults mainly affected.
2. Average age of about 40 years.
3. There is no significant difference in occurrence between the sex.
4. Mandible and maxilla ratio—2:1.
5. The prevalence in the molar region is 3 times that in the bicuspid region.
6. The lesions are asymptomatic and painless swelling.
7. The typical site is the posterior body of mandible.
Histological Feature :
1. The calcifying epithelial odontogenic tumour is composed of polyhedral
epithelial cell.
2. The tumour cell have a well outline cell border with a finally granular
eosinophilic cytoplasm.
3. The nuclei are pleomorphic with giant nuclei and multinucleation.
4. A well recognized form of this neoplasm is the clear cell variant.
5. The nucleus may remain round or oval in centre of the cells or be flattened
against the cell membrane.
6. According to “Kroll’s and Pindborg” the histomorphology variation most of the
clear cells are muci-carmine negative although a few may show a fainting.
7. This tumour are not encapsulated are locally invasive.
Treatment :
Complete excision of the tumour with a boundary of normal bone should be
curative, but recurrence follows incomplete excision.
Fig- Calcifying epithelial odontogenic tumour (Pindborg tumour). The tumour is composed of strands and sheets
of polyhedral epithelial cells lying in pale pink staining amyloid-like material. Some of the material has
mineralized, stains a darker blue colour and gives rise to radiopacities, within the lesion.
Fig- Calcifying epithelial odontogenic tumour. At higher power the epithelial cells are seen to have sharply defined
cell membranes resembling squamous epithelium and pleomorphic hyper chromatic nuclei. The pale pink
maerialis amyeloid-like
Odontogenic Tumour :
Odontogenic tumours are neoplasm that arise from the dental lamina or any
of its derivatives. Most of them are benign and at least one is malignant.
Clinical Feature :
1. It occurs most frequently in the 2nd and 3rd decade of life, average age is 23 to
30 years.
2. There are particular sex predilection in the occurrence of the tumour.
3. It occurs usually in the mandible, usually in the condyle or neck of the condyle.
4. This is a central lesion at the jaw which expand the bone and may causes
destruction of the cortex.
Histological Feature :
1. It made up at loosely arranged spindle shaped and stellate cell.
2. The loose tissue is not highly cellular and cells punts do not show evidence of
significant activity.
3. The inter cellular substance is nuclei.
4. The tumour is usually interspersed which is a variable number of tiny capillaries
and occasionally standards of collagen.
Treatment :
1. Treatment is surgical excision followed by cautery.
2. Extensive lesion may required resection to eradicate the tumour.
Fig- Odontogenic myxoma of the mandible. An occlusal view showing the finely trabeculated. Soup-bubble
appearance and gross expansion of the mandible. Evidence of residual tumour was still present after 35 years in
sprite of vigorous treatment, both surgery and radiotherapy, in its earlier stages.
Fig- Odontogenic myxoma. This cross-section of the mandible through a myxoma shows extensive bony
resorption and gross expansion. The pale staining myxoid lesion gives the tumour an empty appearance.
Fig- Odontogenic myxoma. High power view showing the typical appearance of sparse fibroblasts lying in a
myxoid or ground substance-rich matrix.
Osteogenic Sarcoma :
Osteogenic sarcoma is highly malignant and the most common primary
neoplasm of bone.
Causes :
Osteogenic sarcoma rarely have identifiable cause but a few develop late in
life after irradiation or ‘Paget’s’ disease of bone.
Site :
The body of the mandible is most common site.
There is typically a firm swelling which grows noticeably in a few months
and become painful. There may be paraesthesia Or loss of sensation in the mental
nerve area. Metastases to the lungs may develop early.
Radiological Feature :
The neoplastic, osteoblastic very in size. They may be small and angular or
large and hyper-chromatic.It may be seen particularly in the more highly cellular areas.
Giant cell may be conspicuous, but many cells are non
Bone formation does not necessarily predominate and osteoid formation is
the main diagnostic criteria and is seen in metastases.
Cartilage and fibrous tissue are usually also present and sometimes
predominate but usually only in part of the tumour.
A small biopsy may therefore show only a single tissue, such as cartilage
and be mistaken for a chondro-sarcoma.
Management :
Etiological Features :
1. Possible carcinogens—Tobacco, Alcohol, Areca nut (Betel).
2. Sunlight (Lip only).
3. Infections—Syphilis, Candidacies, Viruses.
4. Mucosal Diseases—Oral epithelial dysplasia, Lichen planus, Oral sub-mucous
Fibrosis.
5. Genetic disorder—Dyskeratosis congenital, Fanconi’s anemia.
Clinical Features :
1. In the earliest stages, carcinoma appear as painless red speckled or white
patches and only a monitory are ulcerated.
2. If a carcinoma enlarges, it may develop into a raised module or become
ulcerated.
3. Indurations result from inflammation and fibrosis and infiltration of the tissues.
4. Carcinoma has formed an indurated ulcer with the typical rolled border.
5. Ulceration may be associated with soreness or stinging pain when sharply
flavored food is eaten.
6. Spontaneously bleeding or to mild trauma is also a late feature.
Histological Features :
1. Squamous cell carcinoma consist of sheets and nests of cells with obvious
origin form squamous epithelium.
2. These cells are generally large and show a distinct cell membrane, although
intercellular bridges or tonofibrils often cannot be demonstrated.
3. The nuclei of the neoplastic cells are large.
4. Nuclei which stain heavily with haematoxylin are referred to as hyper
chromatic.
5. Presence of individual cell keratinization and the formation of numerous
epithelial or keratin, pearls of varying size.
Metastasis :
Metastasis from intra oral carcinoma of different sites involved chiefly the sub-
maxillary and superficial and deep cervical lymph nodes.
Treatment :
Mode of Treatment—
-- Radiotherapy.
-- Chemotherapy.
-- Radiotherapy and Chemotherapy.
-- Surgery and Radiotherapy.
-- Chemotherapy and Surgery, Radiotherapy.
-- Cryosurgery and others—if lesion is small.
Fig- A small squamous carcinoma. At low power the Fig- Squamous carcinoma. In this poorly-
epithelium is seen to invade deeply into the differentiated carcinoma there is little or no keratin
connective tissue and underlying muscle. At this formation and the malignant cells show great
early stage there is no ulceration. pleomorphism with variably-sized nuclei, many of
which are hyper chromatic, and frequent mitotic
figures.
Stage Grouping :
Stage— І : T1 , No , Mo.
Stage— ІІ : T2 , No , Mo.
Stage—ІІІ : T3 , No , Mo.
T1 Or T2 Or T3 , N1 , Mo
Stage-- ІV : T4 , No Or N1 , Mo
Any T1 , N2 Or N3 , Mo
Any T , Any N , M1
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