TOPIC: TUMORS OF JAW
🌟 IMPORTANT POINTS TO REMEMBER
🔸Ameloblastoma: It is also called adamantinoma. It begins as a central lesion of bone which is slowly destructive but tends to expand the bone rather than perforate it. Teeth in the involved region may be displaced. Radiographically, classic ameloblastoma appears as multilocular cyst-like lesion and gives ‘honeycomb’ or ‘soap bubble’ appearance.
🔸CEOT: It is also known as Pindborg tumour. It presents as small, painless, slowly growing swelling. It appears as a diffuse or well-circumscribed unilocular radiolucent area. Border may be irregular and ill-defined in some cases. Sometimes, radio-opaque, calcifying foci are seen within the radiolucent lesion giving rise to a ‘driven-snow’ appearance.
🔸Squamous Odontogenic Tumours: The site of occurrence is greater in the mandibular bicuspid area. It presents as a semicircular or triangular radiolucent area with or without a well-sclerotic border.
🔸Calcifying Odontogenic Cyst And Dentinogenic Ghost Cell Tumour: It is slow-growing, intraosseous or extraosseous lesion. The lesion that occurs peripherally on the gingival presents as painless swelling or nodules. It may appear as cyst-like radiolucency of variable size, or may present as radiolucent lesion with radio-opaque foci. Cyst may be unilocular or multilocular.
🔸Odontoma: Most of the odontomas are asymptomatic in nature.
🔸Compound Odontoma: It appears as radio-opaque, well-formed tooth-like structure which may be single or several dozens in number having equal or varying density depending on size of each structure.
🔸Complex Odontoma: It appears as radio-opaque, small, shapeless, irregular, dense solid mass of calcified tissue, having density equal to or more than adjacent tooth depending on its size.
🔸Ameloblastic Fibroma: It is slow growing than simple ameloblastoma and generally it has no tendency to invade the bone and surrounding tissue. Ameloblastic fibromas appear as unilocular or multilocular radiolucent lesion with a smooth outline, sometimes, with sclerotic border.
🔸Ameloblastic Fibro-odontoma: It causes facial asymmetry due to swelling of jaw. It shows well-circumscribed radiolucent lesion containing single radio-opaque mass or multiple radio-opacities representing odontoma may be seen.
🔸Odontogenic Myxoma: It is also called odontogenic fibromyxoma or myxofibroma. It is slow-growing central lesion of jaw which expands the bone causing destruction of cortical plate of bone. Radiograph may present mottled or ‘honeycomb’ appearance, same as in ameloblastoma. It may show mixed radiolucent–radio-opaque pattern due to entrapment of residual bone within the lesion with straight and thin septa giving ‘tennis-racket’ appearance.
🔸Benign Cementoblastoma: Benign cementoblastoma is slow-growing tumour which may cause pain or swelling. It appears as well-defined radio-opaque area with well-corticated border attached to the root portion of tooth. It is surrounded by well-defined radiolucent band inside the cortical border.
🔸Keratocystic Odontogenic Tumour: Previously called odontogenic keratocyst, it is now called as keratocystic odontogenic tumour by the WHO. Large lesions may be associated with pain, swelling or drainage.
🔸Keratocystic Odontogenic Tumour : It has radiolucency associated with teeth either in a pericoronal, inter-radicular or periapical or in association with missing teeth. It appears as round or oval unilocular or multilocular radiolucency.
🔸Torus Palatinus: It represents an outgrowth of varying size and shape in the midline of palate. Torus palatinus appears as a dense radio-opaque shadow in the midline of hard palate.
🔸Torus Mandibularis: It appears as a focal bony growth on the lingual aspect of mandible above the mylohyoid side in premolar area. There is an area of increased density which appears as homogeneous radio-opaque area.
🔸Enostosis: It is also called dense bony island. It appears as focal, oval or round dense radio-opacities of varying sizes situated in molar–premolar area.
🔸Neurilemmoma: It is slow-growing, painless tumour. It appears as well-defined unilocular radiolucency. In mandible, radiolucency appears to enlarge inferior alveolar canal running on along its course along the distal foramina.
🔸Neurofibroma: Cafe-au-lait spot can be seen. The margin of radiolucent area is sharp and well defined.
🔸Osteoma: The swelling is bony hard on palpation. Radiographically, it appears as homogeneous radio-opaque area situated below the molar in the mandible.
🔸Osteoblastoma: Pain and swelling of the affected region are constant features. On radiograph, it appears as well-circumscribed radiolucency. In some cases, it appears as mixed radiolucent–radiopaque area owing to presence of calcified material.
🔸Osteoid Osteoma: There is predilection for mandible. Small lesion with severe pain is characteristic feature of this disease. Radiographically, osteoid osteoma appears as characteristic central radiolucent area surrounded by the zone of sclerosis, called nidus.
🔸Central Haemangioma: It is compressible, pulsatile swelling which bruits on auscultation. Pumping tooth syndrome is characteristic feature of this disease. The margin of lesion is well demarcated and corticated. A honeycomb or soap-bubble appearance can be seen. Bony spicule may radiate from the margin of the lesion, running perpendicular to the lesion causing ‘sunray’ appearance.
🔸Desmoplastic Fibroma: It presents with swelling. It presents as well-defined radiolucency. Small lesions are completely radiolucent with well-defined or ill-defined border.
🔸Squamous Cell Carcinoma: The presenting complaint of the patient is mass or ulcer in the oral cavity. Paraesthesia may result. Squamous cell carcinoma usually presents as fungating, papillary exophytic growth. There is irregular, semicircular or saucer-shaped bone destruction. Margins of the lesion are irregular and ill defined; floating teeth appearance is present.
🔸Metastatic Carcinoma: Mandible is more commonly affected site in the metastatic carcinoma as it is rich in haemopoietic marrow. An earlier symptom is nodule present in the oral cavity. It may present as of osteoclastic variety or osteoblastic variety. In osteoblastic variety typical ‘salt and pepper’ appearance is seen.
🔸Malignant Melanoma: It can be superficial spreading melanoma, nodular melanoma and lentigo maligna melanoma. It starts as pigmentation which can advance into ulcerated growth. It presents as ill-defined radiolucency with ill-defined margin.
🔸Verrucous Carcinoma: Verrucous carcinoma appears as papillary growth. Surface is pebbly and covered by white leukoplakic film. Radiologically in some cases, there may be underlying erosion of bone.
🔸Osteosarcoma: Patient complains of pain and swelling of the affected area. Pathological fracture can occur.
🔸The following features can be seen: Sunray/Sunburst Appearance, Codman Triangle and second infiltration of tumours in the periodontal ligament space which causes widening of periodontal ligament.
🔸Chondrosarcoma: Swelling is the most common complaint of the patient. It is painless. Loosening of teeth is also a common sign. Radiolucency consists of scattered and variable radio-opaque foci due to calcification of cartilage matrix.
🔸Burkitt Lymphoma: African form is common in jaw while American form is common in the abdomen. Swelling of the affected jaw is present. Margins of the radiolucency are ragged. Small radio-opaque foci are scattered, producing a ‘moth-eaten’ appearance.
🔸Multiple Myeloma: It is also called myelomatosis. There is a gingival enlargement or epulis. ‘punched-out’ bone destruction is the most striking feature of this disease. Margins are well-defined.
🔸Ewing Sarcoma: Intermittent pain and swelling are the earliest features of the disease. It is osteolytic lesion. It has irregular or ill-defined margin.
🔸Hodgkin Lymphoma: It is malignant lymphoproliferative disorder. Patient is having enlarged, non-tender, discrete mass of lymph nodes. Nodes are typical rubbery in consistency. Pel–Ebstein fever is present.
🔸Leukaemia: It occurs due to bone marrow suppression and infiltration, dyspnoea, headache and lymph node enlargement. Ill-defined radiolucent area is present which is patchy in distribution. ‘moth-eaten’ appearance and ‘onion peel’ appearance are present.
📌 MULTIPLE CHOICE QUESTIONS (MCQs)
💡Aggressive neoplasm which is derived from remnants of the dental lamina and dental organ is called
- CEOT
- Adenomatoid odontogenic tumour
- Adamantinoma
- All of the above
Answer: 3
💡Soap bubble appearance is seen in
- Central haemangioma
- Aneurysmal bone cyst
- Ameloblastoma
- All of the above
Answer: 4
💡Tumour which arises from the cystic lining of a dentigerous cyst is called
- AOT
- Ameloblastoma
- Odontogenic myxoma
- Ameloblastic fibro-odontoma
Answer: 2
💡Pindborg tumour is another name of
- Ameloblastoma
- AOT
- CEOT
- Odontoma
Answer: 3
💡Wheel spoke pattern in a radiograph is seen in
- CEOT
- AOT
- Benign cementoblastoma
- Odontogenic myxoma
Answer: 3
💡Reed–Sternberg cells are seen in
- Hodgkin lymphoma
- Leukaemia
- Burkitt lymphoma
- Malignant melanoma
Answer: 1
💡Punched-out bone destruction is seen in
- Multiple myeloma
- Leukaemia
- Ewing sarcoma
- Chondrosarcoma
Answer: 1
💡Cafe-au-lait spots are seen in
- Leukaemia
- Neurilemmoma
- Neurofibroma
- None of the above
Answer: 3
💡Dense bone island is a synonym of
- Osteoma
- Chondroma
- Enostosis
- All of the above
Answer: 3
💡Syndrome associated with osteoma is
- Down syndrome
- Treacher Collins syndrome
- Rubinstein–Taybi syndrome
- Gardner syndrome
Answer : 4
💡Von Recklinghausen’s neurofibromatosis syndrome is associated with
- Neurilemmoma
- Myxoma
- Multiple neurofibroma
- Chondroma
Answer: 3
💡Codman triangle is present in
- Ameloblastoma
- Osteogenic sarcoma
- Ewing sarcoma
- None of the above
Answer: 2
💡 The tennis racket pattern on the radiograph is seen in
- Ewing sarcoma
- Odontogenic myxoma
- Ameloblastoma
- None of the above
Answer: 2
💡Which of the following is the radiographic appearance of osteosarcoma?
- Onion skin appearance
- Moth-eaten appearance
- Soap bubble appearance
- Sunburst appearance
Answer: 4