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Oral cavity neoplasms Dr.Farahnaz Bidari Robbins.

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Presentation on theme: "Oral cavity neoplasms Dr.Farahnaz Bidari Robbins."— Presentation transcript:

1 Oral cavity neoplasms Dr.Farahnaz Bidari Robbins

2 Pyogenic granuloma  Usually in gingiva  Pregnancy tumor  ulcerated

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6 Peripheral giant cell granuloma  Epulis  Clinically similar to pyogenic granuloma  Giant cells  Fibrovascular stroma

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9 Hairy leukoplakia  80% HIV infected  White patches of fluffy thikening  Fungal and bacterial overgrowth

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11 Tumors and precancerous lesions  1) Leukoplakia and erythroplakia  2)squamous cell Ca.

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13 Leukoplakia  White plaque ( a clinical not pathologic term)  Rule out of known causes like lichen planus and candidiasis  Favoured location : buccal,floor of mouth,tongue  Dysplasia (1-16%)

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15 Erythroplakia  Red,velvety,possibly eroded area  Less common and much higher risk of malignant transformation than leukoplakia  Dysplasia (50%)

16 Risk factors  Use of tobacco, most common antecedent  Alcohol  Persistent irritants ( hot pizza)  HPV specially type 16

17 Squamous cell ca.  95% of cancers  Many of them detected late  Age : y

18 pathogenesis  Tobacco = 2-4 fold  Tobacco + alcohol = 15 fold  Marijuana, betel nuts ( india),HPV( waldeyer ring), sunlight area and pipe ( lower lip)  Chromosomal abnormality : INT2,BCL1 oncogens

19 Morphology  Irregular or verrucous mucosal thikening  Favoured location :floor of mouth, tongue  Grade : 1-3  Prognosis : beter with lip lesion and poorer with tumors in floor of mouth

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25 Odontogenic cysts and tumors  Odontogenic cysts : lined with keratinizing squamous epithelium  Multiple form is a component of nevoid basal cell carcinoma syndrome(Gorlin syn)

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28 Odontogenic tumors  Neoplasms of the jaws which differentiated toward tooth structures  Ameloblastoma: most common, from inner dental epithelium of developing tooth follicle ( ameloblastic layer),enamel and dentine are not seen,cystic, slow growing and locally invasive

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32 Odontoma  Odontogenic tumors featuring production of calcified parts of teeth

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35 Nasal polyp  Mostly non allergic

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38 Sinusitis ( fungal)  Mucormycosis  Diabetic

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40 Angiofibroma  Adolescent males  Benign nature  Tendency to bleeding

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43 Nasal papilloma  Benign neoplasms  HPV 6,11  Inverted papilloma :invasive locally

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47 Esthesioneuroblastoma  Uncommon  Superolateral of nose  IHC :NSE, S100, chromogranin  Surgery and chemoradiotherapy  50% 5 years

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50 Nasopharyngeal carcinoma  EBV  Three patterns : kerainizing SCC, nonkeratinizing SCC, undifferentiated  Undifferentiated also called lymphoepithelioma  radiotherapy

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52 Vocal cord polyp  Most often in heavy smokers  Singers nodule

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54 Laryngeal papilloma  Usually on TVC  Rarely more than 1 cm  Papillomatosis in children (HPV 6,11)  Malignant transformation is rare

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56 Salivary gland neoplasms  relatively uncommon neoplasm of human  65-80% arise within parotid  Chance of malignancy increase with decrease in the size of gland  Slight female predominance( except for warthin tumor)  Adult (5% of cases less than 16y)

57  Benigns: slow growing, well defined  Malignants:rapid growth, ill defined, fixed

58 Benign neoplasms  Pleomorphic adenoma (50%)  Warthin tumor ( 5-10%)

59 Malignant  Mucoepidermoid ca.(15%)  Adenoca.,NOS (10%)  Adenoid cystic ca.(5%)  Acinic cell tumor(5%)  Malignant mixed tumor (3-5%)

60 Pleomorphic adenoma  Also called mixed tumor  60% in parotid  Radiation exposure increase the risk  Treatment: adequate parotidectomy (4%)  enucleation (25%)  Malignant transformation : increase with duration, common form is adenoca.  Malignant mixed tumor most aggressive salivary gland tumor

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62 Morphology  Well demarcated <6cm  Encapsulated( not fully) with tongue like protrusions  Cut surface is gray white and translucent  Epithelial elements (ducts nests of squamous or nests of myoepithelial cells) embedded in myxoid,hyalin or chondroid stroma (both of them from epithelial and myoepithelial cells of ducts)

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65 Warthin tumor  Almost always in parotid gland  More common in males  40-60y  10% multifocal, 10% bilateral  Smokers ( 8 times)

66 morphology  Round, encapsulated, 2-5 cm  Gray, cystic  Cysts lined by double layer of epithelium resting on a dense lymphoid stroma  Lining cells are columnar cells with abundant eosinophilic cytoplasms containing many mitochondria( oncocytic cells) upon cuboidal cells

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69 Mucoepidermoid ca.  60-70% in parotid  Large fraction of salivary gland neoplasms in other glands  Most common form of malignant tumors  Most common radiation induced neoplasm

70 Morphology  Lack well defined capsule  Infiltrative margin  Pale gray white, small cysts  Cords, sheets, cystic area  Squamous, mucus cells, intermediate (hybrid cells)

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72 Grade  Low, intermediate, high  Low grade : largly of mucus secreting  High grade: largly squamous cells  Low, intermediate, high : recur in 15%, 25%, 30%  Low :90% 5-year  High : 50% 5-year

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75 Adenoid cystic ca.  Most common neoplasm in minor salivary gland (mouth, nose, sinuses, upper airway)  Slow growing, unpredictable tumor  Tendency to invade perineural spaces  Most painfull salivary gland neoplasm  50%disseminate widely to distant sites, sometimes decades later  % 5-year survival

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77 Morphology  Infiltrative, gray pink  Small cells with dark compact nuclei and scant cytoplasms  Forming tubular, solid or cribriform patterns  Histologically is like cylindroma of skin  Gland like structures filled with excess basement membrane

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81 Acinic cell tumor ( ca)  Uncommon  Most in parotid. Rarely in minor salivary glands  Sometimes bilateral or multicentric  Recurrence uncommon  10-15% metastasize to LN  Survival:90% 5-year

82 Morphology  Generally small, discrete  Sheets, glandular and papillary patterns  Neoplastic cells have clear cytoplasms like normal acinar cells

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