Malignant Tumours

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BASAL CELL CARCINOMA SQUAMOUS CELL CARCINOMA CARCINOMA OF LIP CARCINOMA OF TONGUE CARCINOMA OF FLOOR OF MOUTH CARCINOMA OF BUCCAL MUCOSA CARCINOMA OF GINGIVA CARCINOMA OF PALATE VERRUCOUS CARCINOMA SPINDLE CELL CARCINOMA ADENOID SQUAMOUS CELL CARCINOMA BASALOID SQUAMOUS CELL CARCINOMA LYMPHO EPITHELIOMA MALIGNANT MELANOMA

ETIOLOGY - sunlight, radiation, carcinogenic agents SITES --

Skin, face, scalp

CLINICAL FEATURES  NODULAR BASAL CELL CARCINOMA Small slightly elevated papule with central depression ulcerates ,heals over and breaks down.

PIGMENTED BASAL CELL CARCINOMA Increased brown or black pigment in dark skin individuals

CYSTIC BASAL CELL CARCINOMA

Translucent blue-grey cystic nodules scaly patches or papules-pink, red brown, central clearing with threading yellow-white lesion when stretched and firm to touch, with well defined border.

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MORPHEAFORM AND INFILTRATING BCC -- Aggressive BCC sub types with sclerotic plaques or papules. -- Absence of ulceration, crusting, bleeding and well defined borders.

HISTOPATHOLOGY - Islands of cells – large

deep staining oval nucleipalisading periphery. - Melanocytes, buds of basaloid cells attached to under surface of epidermis. - Growth pattern in strands.

ETIOLOGY - Tobacco, trauma, nutritional deficiencies, - 5 S- Syphilis, Sunlight, Spirit [alchohol], Spicy food, Sepsis.

HISTOPATHOLOGY

Differentiation-

* Highly

* Well – [ individual cell keratinization and numerous keratin pearl formation] * Moderately- [epithelium less pronounced, rapid mitosis] * Poorly -[break in basement membrane scanty keratinization]

PRIMARY TUMOR T1s – Carcinoma in situ T1 – Tumour 2 cms T2 – Tumuor > 2cms T3 – Tumour > 4cms

REGIONAL LYMPH NODES – N NO – no clinically palpable lymph nodes. metastasis suspected. N1 – palpable homolateral cervical lymph nodes,not fixed ,no metastasis. N2 – palpable bilateral cervical lymph nodes, not fixed and metastasis N3 – clinically palpable lymph nodes ,fixed, metastasis suspected.

METASTASIS- M M0- no distance metastasis

clinical or /and radigraphic evidence of metastasis other than cervical lymph nodes. M1 –

Occurs along or inferior to the line opposite to the occlusal plane. Painful indurated area.

erosive ,exophytic ,granular or verrucous type of growth

poorly defined painful lesion,extending laterally to involve tonsillar pillars and lingual gingiva.

- Indurated and ulcerated irregular

surface small crater like exophytic proliferative tumour tissue. HISTOPATHOLOGY well- differentiated

- Painless indurated the fungating exophytic mass. HISTOPATHOLOGY - Rapid metastasis,higher grade of malignancy

Variant squamous cell CA Exophytic papillary lesion with pebbly surface, covered with white leukoplakic film. Rugae like folds with deep clefts.,tender lymph nodes.

HISTOPATHOLOGY

- ‘Cleft like spaces’ lined by

parakeratin layer. - Parakeratin plugging seen. - Broad rete ridges with intact basement membrane. - Epithelial differentiation.

Painful non-healing ulcer – polypoid,exophytic or endophytic growth.

HISTOPATHOLOGY - Bimorphic or biphasic tumour - ‘Dropping off’ of basal cell to spindle cell –common phenomenon - Streaming fascicles of anaplastic cells - Elongated nuclei with myxomatous tissue - Giant cells, bizarre cells, pleomorphic atypical cells found

Also called adenoacanthoma. Skin lesions – elevated nodules showing ulceration, crusting, scaling. Intraoral lesion – hyperkeratotic, exophytic or ulcerated.

HISTOPATHOLOGY - Proliferation of surface dysplastic epithelium. - Tubular duct like structures lined by a layer of cuboidal cells with acantholytic or dyskeratotic cells.

-Neoplasm of epidermal melanocytes.

SUPERFICIALLY SPREADING MELANOMA -Tan, brown, black or admixed sun exposed areas – head, neck, chest & abdomen.

NODULAR MELANOMA -Sharply delineated nodule with degrees of pigmentation

LENTIGO MALIGNA MELANOMA -Macular lesion on the malar skin, eye & mucous membrane

ACRAL LENTIGINOUS MELANOMA -Pigmented area around a nodule – palms, soles, fingers & toes.

MUCOSAL LENTIGENOUSMELANOMA - Mucosal epithelium lining respiratory tract, GIT, GUT.

AMELANOTICMELANO MA -

Erythematous or pink erode

HISTOPATHOLOGY

- Loosly arranged nests and cords of epitheloid and spindle melanocytes - Melanin pigments found. - Melanocytes are engulfed within connective tissue.

Also called as transitional cell epidermoid CA Unusual type of neoplasms, small hidden exophytic, fungating, granular eroded surface.

HISTOPATHOLOGY - Nests, cords and sheets of cells – large round polyhedral cells with basophilic cytoplasm. - Intercellular bridging present, lacking keratinisation and pearl formation. - Mitotic division of lymphocytes – syncitial pattern.

REFERENCES 

Oral and maxillofacial pathology – ALLEN.

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Text book of oral pathology – SHAFFER’S.

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Manual of oral histology and oral pathology - MAJI JOSE.