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Renuka Goonesinghe
# Normal anatomy # Tumours and tumour like conditions of the surface epithelium # Tumours and other lesions of minor salivary glands # Tumours of odontogenic epithelium/mesenchyme # Tumours of soft tissue tissue # Tumors and tumour like conditions of lymphoid tissue # Tumours of melanocytes
Anatomy
Oral cavityExtends from lips to palatoglossal folds Bordered by cheeks,lips,Palate and floor of
the mouth
soft palate,epiglottis,fauces,posterior third of the tongue palatine tonsils and pharyngeal tonsils
Normal structure
EpitheliumSquamous epithelium-Non keratinized keratinized Odontogenic structures- Teeth Bones Maxilla,mandible Minor salivary glands,tonsils Soft tissue-fibrofatty tissue, skelital muscle, nerves, blood vessels Lymphoid tissue
papilloma
Premalignanat Conditions-
Oral submucous fibrosis Lichen planus Xeroderma pigmentosum Tylosis Chronic iron deficiency
Malignant tumours
Squamous cell carcinoma Verrucous carcinoma Basaloid squamous cell carcinoma Adenosquamous carcimoma Sarcomatoid(spindle cell )carcinoma Small cell carcinoma Lymphoepithelial carcinoma
AetiologyMultifactorial Tobaco.beetal chewing,alcohol, Pre malignant conditions/lesions HPV infection-genotypes 16 & 18 Chronic irritation
tongue,floor of mouth,buccal,retromolar,gingival,commisura l,lip and soft palate Early painless lesion->ulcer Infiltrates soft tissue and bone Lymph node metastasis
Histological featuresDysplasia of varying degree Keratin pearl formation Strong host response of lymphocytes,plasma
cells and eosinophils Diffenentiation-well,moderate and poor depending on the maturation and keratin pearl formation
Pattern of spreadInfiltrates adjacent soft tissue Submucosal spread Lymphatic spread follows the main anatomical
dranage
In to mandible through cortical defectsEdentulous alveolar ridges Inferior dental canal Prior irradiation Lymph node spreadTo submental,submandibular,jugulo-
Verrucous carcinoma
High degree of differentiation Exophytic keratotic surface Broad acanthotic rete pegs Penetrates the underlying tissues by a
pushing margin The basement membrane is intact Local LN metastasis is rare Local resection is the treatment of choice 5 year survival rate is 80-90%
mucosa Nearly 50% are malignant Involve minor salivary glands Types Benign-pleomorphic adenoma -myoepithelioma -Basal cell adenoma
Malignant-
Mucoepidermoid carcinoma the commonest Adenoid cystic carcinoma Polymorphous low grade adenocarcinoma Myoepithelial carcinoma Oncocytic carcinoma
MalignantMalignant(metastasizing )ameloblastoma Ameloblastic carcinoma Primary intraosseous squamous cell carcinoma Clear cell odontogenic carcinoma Ghost cell odontogenic carcinoma Ameloblastic fibrosarcoma Ameloblastic fibro-odontosarcoma
Mesenchymal tumours
BenignGranular cell tumour Haemangiomas Lymphangioma Focal oral mucinisis Neurofibroma Schwannoma Lipoma Ectomesenchymal chondromyxoid tumour
OthersLangerhans cell histiocytosis Extramedullary plasmacytoma Myeloid sarcoma Follicular dendritic cell sarcoma
Tumours of malanocytes
Melanocytic naevi Malignant melanoma
Secondary tumours
Metastases to bone From Breast,kidney,lung prostate,thyroid,colon aerodigestive tract
upper