Malignant tumors

Dr.N.Govindrajkumar
Reader
Dept.Oral &Maxillo Facial Pathology

Histopathology

Histopathology

Histopathology

Histopathology

Malignant melanoma
Definition: It is a malignant neoplasm of
melanocytic origin that arises from a
benign melanocytic lesion or de novo from
melanocytes within otherwise normal skin
or mucosa.
First oral melanoma : Reported by Heinter
in 1787 on mandibular gingiva

Eito pathogenesis
Ultra violet radiation usually acute
exposure rather than chronic exposure
Ultra-violet radiation
Mutation in p16 gene
Activation of ras
Proliferation of cells
Tumour

DEMOGRAPHICS
Race: whites when compared to blacks
Age: 30 to 80 years
Site: back, posterior upper arm, posterior
and lateral neck, and scalp.
Sex: equal sex predication

Clinical features
A: Asymmetry ( because of uncontrolled growth
pattern)
B: Border irregularity ( often with notching)
C: Colour variegation ( from brown black to
white, red, and blue depending on the amount
and depth of the melanin pigmentation)
D: Diameter greater than 6 mm ( which is the
diameter of a pencil eraser).

Types of melanoma
Clinico-pathological
Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma

Types of growth phase

The radial growth phase
The vertical growth phase
Lentigo maligna melanoma, superficial
spreading melanoma, acral lentigenous
melanoma tend to have radial growth phase
The nodular melanoma , the radial growth is
very short or non existent the vertical growth is
predominates.

Superficial spreading melanoma

It represents 70% of melanoma
It is most common form of cutaneous
melanoma
Site: BANS
It appears as macule with a variety of
colour
Sometimes presents as a nodule

NODULAR MALNOMA
It represents 15% of cutaneous
melanomas
It start as nodular mass with immediate
vertical phase growth
It is usually deeply pigmented exophytic
lesion
Some times melanoma cells are so poorly
differentiated that they no longer produce
melanin , resulting in a non pigmented
lesion known as amelanotic melanoma

Lentigenous maligna melanoma

It represents 5 to 10 % of cutaneous
melanomas
It develops from precursor lesion called
Hutchinsons freckle.
It has varying colour
Usually starts as macule some times as
nodule

Acral lentigenous melanoma

It is most common form in blacks
It is most common form in oral melanomas
It develops from palms of the hands, soles
of the feet, sublingual area and mucous
membranes
Males are common than females
Hard palate and maxillary alveolus

Acral lentigenous melanoma

Beings as brown black macule with
irregular borders
Ulceration may develop some times
exophytic masses
Pain is not a common feature unless
ulcerated

Histopathology
Cells proliferate into underlying connective
tissue in nests or cords, or sheets
Shape of the cells are spindle, epitheloid
Chronic lymphocyte infiltration
Increased blood vessels.

Measuring depth of melanoma

Measuring the depth and invasion is an

important component of the
histopathological evaluation of melanoma
because of its correlation with prognosis.

Measuring systems
The Clark system
The Breslow system ( recent )
Clark system of measurement assigns a
level to the lesion that depends on the
deepest anatomic cutaneous region that
has invaded by the tumour cells.

Breslow system

It is based on actual mesurement of the

distance from the top the granular layer to
deepest identifiable point of tumor
invasion

Two classification systems

Clarks
Cells confined to epithelium
Cells penetrating papillary dermis
Cells filling papillary dermis

Cells extending into reticular dermis

Cells invading subcutaneous fat

level
Level I

Breslow 10
N/A

Level II

0.00 to 0.75
mm

Level III

0.76 to1.69

Level iv

Level V

1.70 to 3, 59

More than 3.6

96%
96%

90%

67%

26%

YEARS
N/A
98%

89%

67%

43%

Osteosarcoma
It is the most common primary malignant
tumor of the bone, exclusive of myeloma
and lymphoma.
It accounts for approximately 20% of
primary bone cancers.
Majority will demonstrate intramedullary
origin but a small number may be juxtra
cortical or extra skeletal.

CLINICAL FEATURES
It has bi-modal age distribution.
75% of patients between the ages of 10
to 20 years
Second peak is above 50 years of age.
Elderly patients with Pagets disease of
the bone with irradiation have increased
risk than normal.
Men more commonly effected than
females 1.6 : 1

Clinical features
Long bones and flat bones are more commonly effected
Osteosarcomas of jaws are uncommon they represents
only 6 to 8 % of all osteosarcomas.
Maxilla and mandible are equally involved
Mandibular tumors arise from body and ramus
Maxillary tumors arise from alveolar ridge, sinus floor
and superior aspects of zygomatic, & orbital rims.

Clinical features
Swelling and pain are
common symptoms
Loosening of teeth
Paresthesia
Nasal obstruction in case
of maxillary tumors

EITO-PATHOGENESIS
GENE MUTATION

pRb gene

MDM2
Non-hereditary

GENETIC
P53

OSTEO SARCOMA

Radiographic features
Variable with combination of bone
destruction and bone formation
Sun ray spicules (Radial ossification) and
Codmans triangle (lifting of periosteum)
may be evident
Cortical breach common
Adjacent soft tissue mass
Joint space rarely involved

Radiographic findings
Widening of the periodontal ligament
space around the tooth or several teeth.
Sunburst appearance production on the
surface of the lesion caused by
osteophytic bone production
Radiographic findings varies from dense
sclerosis to mixed sclerotic and
radiolucent lesion to entirely radiolucent

Sun burst and Codmans triangle

Osteolytic & Osteoblastic activity in

bone

TYPES OF OSTEOSARCOMAS
Based on anatomic portion of the bone
Intramedullary
Intracortical (Periosteal)
Surface
(Paraosteal)
Origin of tumour
Primary
Secondary (pagets, Postirradiation)
Multicentric
Synchronous
Metachronous

Histological
Osteoblastic
Chondroblastic
Fibroblastic
Telangiectatic
Small cell
Giant cell

Periosteal

Rare
X-Rays : ill defined swelling
sub-periosteal new bone
large external, poorly mineralized mass
within a depression of cortical erosion
Usually mid-shaft of femur or tibia

Paraosteal
Incidence
1% of primary malignant bone tumours
Usually patient more than 20 years old
Peak incidence 30 - 50 years
Male : Female 2:3

Paraosteal
Clinically
Present with a constant ache or lump
Usually a long bone juxta metaphyseal
Commonest site = posterior aspect of
distal femur

Paraosteal
X-ray findings:
Well circumscribed mass
May be separated from cortex by a lucent line
(30%)
Broad based tumour with mottled calcification
Cortex not eroded
Does not invade medullary cavity (unlike
chondrosarcoma)
Tends to encircle bone

X-ray of Paraosteal

Histopathology
Three variants mainly
Osteogenic osteosarcoma
Fibroblastic osteosarcoma
Chondrogenic osteosarcoma
Less common variants
Small cell osteosarcoma
Giant cell osteosarcoma
Telangiectatic

Normal & Neoplastic Osteiod

OSTEOGENIC OSTEOSARCOMA

OSTEOGENIC OSTEOSARCOMA

FIBROBLASTIC
OSTEOSARCOMA

CHONDROBLASTIC
OSTEOSARCOMA

SMALL CELL OSTEOSARCOMA

GIANT CELL OSTEOSARCOMA

Treatment
SURGICAL EXCISION
CHEMOTHERPAY