Malignant tumors

By Dr. Vishaal Bhat on Sunday, 4 November, 2007 with 0 comments

Malignant tumors of the oro-facial area are marked by an invasive and destructive growth, formation of metastases and cachectization of patients.

  1. Malignant epithelial tumors originate from the covering epithelium of the skin, oral mucosa or salivary glands mucosa. Among the most frequently occurring carcinomas of the oro-facial area is the lip carcinoma, which appears on the lower lip of men in 95% of cases. It is a spinous cellular carcinoma which appears in two forms. The surface form grows exophytically. It begins in most cases as a small focus of peeling hyperkeratosis on the lip vermilion, grows gradually, it develops the form of verruca and finally gets ulcerous. Resulting ulcer possesses a stiff base, infiltrated edges and is painless. On the mucous side, the ulcer is covered often with a leukoplakia-like altered mucosa. The deep, endophytic form begins by a primary lip infiltration. A crater-like ulcer with reddish edges appears soon. Metastases into regional lymph nodes appear rarely at late stages. Surgical therapy - the quadratic excision - has a very good prognosis at early stages. On the other hand, the tongue carcinoma has much worse prognosis. It appears mainly in young men. It begins on the tongue’s edge, around the base, and sometimes on the underside of the tongue. An initial rough infiltrate quickly assumes an ulcerous form and tumor grows into the oral cavity. It often forms metastases at the deep lymph nodes of the neck. Therapy of carcinomas of the tongue is very tedious and requires utilization of all components of the complex, integrated treatment. The carcinoma of the maxillary sinus that originates from the mucosa of epithelial lining of the antrum, causes diagnostic difficulties. Due to its location, it can remain hidden for a long time (crypto-carcinoma) with vague signs that resemble rather a chronic sinusitis. The first signs are feeling of stuffy nose, loosening of the teeth, eventually a prolapse of neoplastic tissue from the extracted tooth alveolus at the upper jaw. At late stages, the tumor spreads through the bone walls of antrum into adjacent areas and outgrows into cheeks and orbits. A prognosis depends on the stage at which the tumor is identified. The carcinoma of the buccal mucosa originates mostly from a proliferating leukoplakia around the occlusal line and the mouth corners. It is characterized by cauliflower-like projections of tumor tissue, formation of ulcers and infiltration into adjacent tissues. The carcinoma of the lower jaw manifests as an ulcerous structure of the alveolar mucosa which grows into the bone, the oral base and soft tissues. A central form of carcinoma occurs rarely, originating from remaining epithelial Malassez’s cells. If osteolysis of jawbones is found on X-ray images, it is necessary to consider metastasizing tumors of remote organs into jawbones, e.g. carcinomas of the thyroid gland, mammary glands, lungs or seminomas.

  2. Malignant mesenchymal tumors.
    According to the place of origin, these tumors can be identified as sarcomas of soft tissues and jawbones.

    • Soft tissue sarcomas arise from submucosal ligaments, fascial connective tissues and lympho-reticular tissue. On the basis of prevalent types of cells they can be divided further as sarcomas with round cells, spindle cells and polymorphic cells. Compared to malignant epithelial tumors, sarcomas affect younger population and children with a bad prognosis. Metastases are spread by the bloodstream. Tumors grow rapidly and infiltrate adjacent structures. Somewhat better prognosis have partially differentiated sarcomas - fibrosarcomas and myxosarcomas.
    • Sarcomas of the bones (osteogenous) metastase into the lungs shortly. The osteolytic form causes rapid destruction of the jawbones and outgrowths into surrounding tissues. The osteoplastic form (sclerotic) grows at slower pace and often reaches a considerable size. Areas of diffusive clear patches and condensed bony tissue can be seen on X-ray images, with radially arranged spikes on the bone edges (spikula). Sarcomas that arise from the lympho-reticular tissue, namely hemo-blastomas and myelosarcomas, form a separate group. Diagnostics and therapy of these tumors belong to the scope of specialists. A skilled stomatologist can identify some of these tumors based on a clinical picture of changes inside the oral cavity (hyperplastic ulcerous gingivitis associated with leukemia etc.).

Category: Featured , Stomatology Notes



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