Non odontogenic tumors

Dr .mohammed Rhael aliTikrit dentistry college

Classification according to itsClassification according to itsoriginorigin

➢ A. A. gaintgaint cell lesion cell lesion● GaintGaint cell reparative granuloma cell reparative granuloma● Brown tumor of hyperparathyroidism Brown tumor of hyperparathyroidism● CherubismCherubism➢ B. VascularB. Vascular● Vascular tumor Vascular tumor● Vascular malformation Vascular malformation➢ C. Hematopoietic-reticuloendothelialC. Hematopoietic-reticuloendothelial● eosinophilic granuloma eosinophilic granuloma● hand- hand-schullerschuller – –christianchristian disease disease

giant cell giant cell lesionslesions

• Giant Giant cells are very large, multinucleate,cells are very large, multinucleate,modified macrophages which may bemodified macrophages which may beformed by coalescence of mononuclearformed by coalescence of mononuclearcells or by nuclear division withoutcells or by nuclear division withoutcytoplasmic division of monocytes,cytoplasmic division of monocytes,particularly in response to the presence ofparticularly in response to the presence ofa foreign body.a foreign body.

Giant cell lesions include :Giant cell lesions include :

• aneurysmal bone cystaneurysmal bone cyst• chondroblastomachondroblastoma• simple (traumatic) bone cystsimple (traumatic) bone cyst• osteoid osteomaosteoid osteoma• osteoblastomaosteoblastoma• osteosarcomaosteosarcoma• giant-cell giant-cell reparative reparative granulomagranuloma• brown tumor of hyperparathyroidismbrown tumor of hyperparathyroidism• cherubismcherubism

central central gaintgaint cell cell granulomagranuloma• Mandible more than maxillaMandible more than maxilla• Female more than maleFemale more than male• Young more than oldYoung more than old• Mostly in anterior region of lower jaw. Mostly in anterior region of lower jaw. • Mainly Asymptomatic ,may cause expansionMainly Asymptomatic ,may cause expansion

perforation of cortexperforation of cortex• Present almost exclusively in jawsPresent almost exclusively in jaws

central central gaintgaint cell cell granulomagranuloma Classified Classified on the basis of biologic behavior on the basis of biologic behavior as :as :➢ Non-aggressive :Non-aggressive :● AsymptomaticAsymptomatic, slow, slow● expansion of the expansion of the affected Boneaffected Bone

➢ Aggressive type:Aggressive type:● Painful, rapid growth, Painful, rapid growth, root resorptionroot resorption● perforation of cortical boneperforation of cortical bone● paraesthesiaparaesthesia Etiology :Etiology :➢ Reactive lesionReactive lesion➢ TraumaTrauma

➢Treatment conservatively by localTreatment conservatively by localcurettagecurettage

• Recurrence may Recurrence may occureoccure Recurrence Recurrence , , Varies fromVaries from10 – 50 %10 – 50 %

• Use Use of liquid nitrogen after of liquid nitrogen after curretagecurretage decrease decreasethe the reccurancereccurance rate rate

➢ IntralesionalIntralesional steroids:steroids:• • • Triamcinolone Triamcinolone – Suppresses – Suppresses inflammatoryinflammatory

component of component of lesionlesion

➢ Calcitonin – Calcitonin – s.c.s.c. inj inj.:.:• Antagonizes Antagonizes bone resorption by inhibiting Giantbone resorption by inhibiting Giant

TreatmentTreatment

PERIPHERAL GIANT CELLPERIPHERAL GIANT CELLGRANULOMAGRANULOMA

• Common Common tumor like growth in thetumor like growth in theoral oral cavitycavity

• • Does not represent a true neoplasmDoes not represent a true neoplasmbut a reactive but a reactive lesionlesion • • Arising from periosteum or PDLArising from periosteum or PDLmembrane. membrane. Often Often called as peripheralcalled as peripheralgiant cell reparative granuloma.giant cell reparative granuloma.

C/F:C/F:AgeAge: 5th 0r 6th decade of life.: 5th 0r 6th decade of life.Common in females.Common in females.Mandible is affected more oftenMandible is affected more often..Occurs Occurs exclusively on exclusively on gingivagingivaReddish Reddish or bluish nodule, most lesionsor bluish nodule, most lesionssmaller than 2cm in diametersmaller than 2cm in diameter..May be ulcerated due to trauma.May be ulcerated due to trauma. Treatment: Treatment: Local surgical excision down toLocal surgical excision down tothe underlying bonethe underlying bone

ParathormoneParathormone (PTH) is normally produced by (PTH) is normally produced byparathyroid glands, which regulates the Ca+parathyroid glands, which regulates the Ca+metabolism.metabolism. Hyperthyroidism may be Hyperthyroidism may be ::Primary :Primary : due to over production of due to over production ofparathyroid hormonesparathyroid hormonesSecondary :Secondary : due to decrease calcium level in due to decrease calcium level inthe blood (as in chronic renal disease)the blood (as in chronic renal disease)

Brown tumor ofBrown tumor ofhyperparathyroidismhyperparathyroidism

BROWN TUMOR BROWN TUMOR OF HYPERPARATHYROIDISMOF HYPERPARATHYROIDISM

C/F C/F ➢ Predilection Predilection for femalesfor females..➢ Jaw - not as frequent as in long bones andJaw - not as frequent as in long bones and

skull.skull.➢ Vague aches, severe bone pain, tendernessVague aches, severe bone pain, tenderness

following fractures.following fractures.➢ Mobility of Mobility of teethteeth R/FR/F::• Generalized loss of lamina dura. • Ground glassGeneralized loss of lamina dura. • Ground glass

appearance. • Cortical plate may be thinned orappearance. • Cortical plate may be thinned or

Benign Mesenchymal tumorsBenign Mesenchymal tumors(Fibrous dysplasia )(Fibrous dysplasia )

Benign Mesenchymal tumorsBenign Mesenchymal tumors(Fibrous dysplasia )(Fibrous dysplasia )

Benign Mesenchymal tumorsBenign Mesenchymal tumors(Fibrous dysplasia )(Fibrous dysplasia )

Benign Mesenchymal tumorsBenign Mesenchymal tumors(Fibrous dysplasia )(Fibrous dysplasia )

• ReplacemntReplacemnt of bone by immature bone with of bone by immature bone withextensive vascular fibrous elementextensive vascular fibrous element

• Affect childrenAffect children• Appear usually as painless Appear usually as painless enlargmentenlargment of maxilla of of maxilla of

affected side leading to facial asymmetryaffected side leading to facial asymmetry• Ground glass appearance is the typicalGround glass appearance is the typical

radiographicalradiographical feature feature

treatmenttreatmentSelf limited , usually disappear after completion ofSelf limited , usually disappear after completion ofskeletal growthskeletal growth

Benign Benign Mesenchymal tumorsMesenchymal tumors((cherubismcherubism ) )

Benign Benign Mesenchymal tumorsMesenchymal tumors((cherubismcherubism ) )

Benign Benign Mesenchymal tumorsMesenchymal tumors((cherubismcherubism ) )

➢ It consider as familial It consider as familial inhertedinherted type of type offibrous dysplasiafibrous dysplasia

➢ affect mandible more than maxillaaffect mandible more than maxilla➢ Clinically Appear as painless slowClinically Appear as painless slow

growing of angle of mandible bilaterallygrowing of angle of mandible bilaterally,early exfoliation of deciduous teeth,early exfoliation of deciduous teeth

➢ Multiple missing and impacted permanentMultiple missing and impacted permanentteethteeth

➢ Radiographically appear as Radiographically appear as multilocularmultilocularradiolucencyradiolucency

Vascular Vascularlesionslesions • vascular tumors : vascular tumors :hemangiomas whichhemangiomas whichdemonstratingdemonstrating

HemangiomasHemangiomas

• The The word "hemangioma" comes from theword "hemangioma" comes from theGreek Greek haemahaema-, "blood"; -, "blood"; angeioangeio , "vessel"; - , "vessel"; -omaoma , "tumor". , "tumor".

• A hemangioma is a benign and usuallyA hemangioma is a benign and usuallyself-self-involutinginvoluting tumor of the endothelial tumor of the endothelialcells that line blood vessels, and iscells that line blood vessels, and ischaracterisedcharacterised by increased number of by increased number ofnormal or abnormal vessels filled withnormal or abnormal vessels filled withbloodblood..

• Exhibits Exhibits rapid early growth until 6-8rapid early growth until 6-8months of age, followed by regression by 5-months of age, followed by regression by 5-

Vascular MalformationsVascular Malformations➢ Vascular Vascular malformations are present at birth and unlike hemangiomas, domalformations are present at birth and unlike hemangiomas, do

not go through not go through a a “rapid proliferative phase”“rapid proliferative phase”➢ not not “involute”.“involute”.➢ They They grow grow constantly with constantly with the the patientpatient growthgrowth➢ Approximately 31% of these malformations are found in the head andApproximately 31% of these malformations are found in the head and

neck region.neck region.➢ Abnormal Abnormal development of either arterial or the venous side of vasculardevelopment of either arterial or the venous side of vascular

network during this phase of developmentnetwork during this phase of development➢ TraumaTrauma, infection, and hormonal fluctuation (pregnancy or puberty) may, infection, and hormonal fluctuation (pregnancy or puberty) may

stimulate increased growth of the vascular malformation.stimulate increased growth of the vascular malformation.➢ The mechanism of growth is not increased endothelial proliferation -The mechanism of growth is not increased endothelial proliferation -

which is within a normal range in these lesions, which is within a normal range in these lesions, ““but alteration in thebut alteration in theflow dynamics within and around the lesion”.flow dynamics within and around the lesion”.

➢ This results in recruitment of “collateral vessels” and dilatation ofThis results in recruitment of “collateral vessels” and dilatation ofinvolved vessels.involved vessels.

Classified in to :Classified in to :1. low flow :1. low flow :➢ CappillaryCappillary malformation malformation➢ Venous malformationVenous malformation➢ Lymphatic malformationLymphatic malformation2. High flow :2. High flow :➢ Arterial malformation ,Arterial malformation , ArteriovenousArteriovenous

MalformationsMalformations

Vascular MalformationsVascular Malformations

Capillary Capillary Malformations ( Malformations ( portwineportwine stain) stain) • appear appear as reddish-pink macules over facialas reddish-pink macules over facial

dermatomes may be smooth initially butdermatomes may be smooth initially butbecome more “ pebble – like” as the patientbecome more “ pebble – like” as the patientgrowsgrows..

Venous MalformationsVenous Malformations

• Venous Venous malformations aremalformations arebluish, soft and easilybluish, soft and easilycompressible,compressible,

• auscultation auscultation reveals noreveals no

bruits. bruits. The The clinical absence ofclinical absence of“pulsations or a thrill”“pulsations or a thrill”generally indicates a lowgenerally indicates a lowflow Venous vascularflow Venous vascularmalformationmalformation

Lymphatic MalformationsLymphatic Malformations

• Low- Low- flow lesionsflow lesions• Within Within the oral cavity the LMs are morethe oral cavity the LMs are more

commonly found on the anterior 2/3 ofcommonly found on the anterior 2/3 oftongue, followed by tongue, followed by palate,gingivapalate,gingiva, and, andoral mucosa.oral mucosa.

• Predilection for head and neck and thePredilection for head and neck and theaxilla, where embryonic lymph sacs areaxilla, where embryonic lymph sacs arelocatedlocated

➢ MICROCYSTIC LM (MICROCYSTIC LM (LymphangiomaLymphangioma))• In In the oral cavity appear as multiple translucent the oral cavity appear as multiple translucent non-non-

compressible compressible cysts or vesiclescysts or vesicles ➢ MacrocysticMacrocystic LMs LMs (cystic (cystic hygromahygroma))• usually usually presents as multiple cysts of >2 cm and arepresents as multiple cysts of >2 cm and are

commonly found in the commonly found in the neckneck, and in the cervical area just, and in the cervical area justbelow the angle of the mandible. They clinically appearbelow the angle of the mandible. They clinically appearas localized painless non-pulsatile swelling with no bruitas localized painless non-pulsatile swelling with no bruitor thrill, having a rubbery compressible consistency, andor thrill, having a rubbery compressible consistency, andcovered by normal appearing skin unless hemorrhage orcovered by normal appearing skin unless hemorrhage orcommunication with venous malformations produce acommunication with venous malformations produce ablue blue discolourationdiscolouration. . Positive to Positive to transilluminationtransillumination ..

Lymphatic MalformationsLymphatic Malformations

MICROCYSTIC LMMICROCYSTIC LM((LymphangiomaLymphangioma))

MacrocysticMacrocystic LMs LMs

TransilluminationTransillumination of cystic of cystichygromahygroma

Arterial / Arteriovenous MalformationsArterial / Arteriovenous Malformations

• “High-flow High-flow lesionslesions• create create a direct communication between the arterial and venous systems,a direct communication between the arterial and venous systems,• AVM is present at birth, but become clinically apparent only during the 4-AVM is present at birth, but become clinically apparent only during the 4-

5th decade of life and is often misdiagnosed due to delay in clinical5th decade of life and is often misdiagnosed due to delay in clinicalpresentation.presentation.

• The The most common site for AVM is the brain, followed by the head, neck,most common site for AVM is the brain, followed by the head, neck,limbs, trunk, and viscera.limbs, trunk, and viscera.

• They They appear as purple-blue raised painful macule, are pulsatile with thrillappear as purple-blue raised painful macule, are pulsatile with thrilland bruit, warm to and bruit, warm to touchtouch

• do do not empty fully on compression, and refill quickly on reliving digitalnot empty fully on compression, and refill quickly on reliving digitalpressure.pressure.

• They are associated with embolism, pain, bleeding, ulceration, andThey are associated with embolism, pain, bleeding, ulceration, andcongestive cardiac failure due to increased cardiac loadcongestive cardiac failure due to increased cardiac load..

• Often a patient presents with severe bleeding as the first sign that a highOften a patient presents with severe bleeding as the first sign that a highflow-lesion is present. They may also complain of recurrent gingivalflow-lesion is present. They may also complain of recurrent gingivalbleeding and loose or depressible teethbleeding and loose or depressible teeth..

➢ DIAGNOSIS of vascular lesions : DIAGNOSIS of vascular lesions :• HistoryHistory• Clinical examinationClinical examination• MRI MRI• Doppler Doppler UltrasoundUltrasound• CT CT• Arteriography Arteriography

Treatment of vascular lesionsTreatment of vascular lesions

Hemangioma : Hemangioma :• Self limited ,usually disappear after 12 y ageSelf limited ,usually disappear after 12 y age• Treatment indicated when the lesion Treatment indicated when the lesion interferinterfer

with development (obstructivewith development (obstructivevision,recurrentvision,recurrent bleeding bleeding,,ulcerations,interfereulcerations,interfere with vocal cords with vocal cordsfunction.function.

• Treatment options :Treatment options :• Steroid (systemic or Steroid (systemic or intralesionalintralesional injection) injection)• InterferoneInterferone

Treatment of vascular lesionsTreatment of vascular lesions

CappillaryCappillary malformatiosmalformatios:: ● LaserLaser venous malformationsvenous malformations1.Injection of 1.Injection of sclerosingsclerosing agents ( absolute agents ( absolutealcohol,sodiumalcohol,sodium tetradecyletetradecyle sulphatesulphate((stdstd),),and bleomycin.and bleomycin.2. Surgical excision2. Surgical excision

Treatment of vascular lesionsTreatment of vascular lesions

Lymphatic Lymphatic malformations:malformations:1.Aggressive surgical 1.Aggressive surgical debulkingdebulking may maybe necessary in vary large be necessary in vary large lesions.lesions.2. Infections such as upper2. Infections such as upperrespiratory infections often causerespiratory infections often causedramatic and painful swelling of thedramatic and painful swelling of thelesion and should treatedlesion and should treatedaggressively by antibiotic andaggressively by antibiotic anddraingedrainge to avoid obstructions of to avoid obstructions of

Neurogenic tumorsNeurogenic tumors• NEUROFIBROMAS. -It may occur as solitaryNEUROFIBROMAS. -It may occur as solitary

cutaneous cutaneous lesions (lesions (neorfibromaneorfibroma ) , ) , in which casein which caseone finds no café-au-one finds no café-au-laitlait spots and no family spots and no familyhistory of the disease. -Multiple cutaneoushistory of the disease. -Multiple cutaneouslesions w/café- au-lesions w/café- au-laitlait spots, dominantly spots, dominantlyinherited, referred as neurofibromatosis inherited, referred as neurofibromatosis thatthatstarts to be manifested since starts to be manifested since childhoodchildhood

• LANGERHANS CELL HISTIOCYTOSISLANGERHANS CELL HISTIOCYTOSIS➢ Results Results from abnormal proliferation offrom abnormal proliferation of

Langerhans cells or their precursors.Langerhans cells or their precursors.➢ Langerhans Langerhans cells are specialized cells ofcells are specialized cells of

the histiocytic cell line that normally arethe histiocytic cell line that normally arefound in the skin.found in the skin.

Types : Types :➢ Eosinophilic Eosinophilic granuloma (Solitary)granuloma (Solitary)➢ Hand Schuller Christian disease (ChronicHand Schuller Christian disease (Chronic

disseminated)disseminated)➢ Letterer Letterer SiweSiwe disease (Acute disseminated) disease (Acute disseminated)

Hematopoietic-reticuloendothelial lesions Hematopoietic-reticuloendothelial lesions

EsonophilicEsonophilic granuloma granuloma C/F C/F::• Occurs in older children & young adultsOccurs in older children & young adults..• Male > Male > femalefemale• May May be asymptomatic – incidental finding be asymptomatic – incidental finding onon

radiographradiograph• • Affects skull & mandible, also long bones.Affects skull & mandible, also long bones.• Local pain, swelling, tenderness.Local pain, swelling, tenderness.• General General malaise and fever occasionallymalaise and fever occasionally

accompanyaccompany..• May cause bony swelling and involveMay cause bony swelling and involve

overlying soft tissue.overlying soft tissue.

• R/F: • Single or multiple irregularR/F: • Single or multiple irregularradiolucent lesions. • Well circumscribed. •radiolucent lesions. • Well circumscribed. •Usually involving superficial alveolar bone.Usually involving superficial alveolar bone.• Cortex often destroyed. • Tooth ‘floating• Cortex often destroyed. • Tooth ‘floatingin air’ appearance. • Pathologic fracturesin air’ appearance. • Pathologic fracturesmay occurmay occur

• Treatment: • CurettageTreatment: • Curettage

EsonophilicEsonophilic granuloma granuloma

hand-hand-schullerschuller ––christianchristian disease diseaseC/FC/F::• Occurs in early life (Age < 5 Occurs in early life (Age < 5 yrsyrs))• Widespread Widespread skeletal & extra-skeletal lesions.skeletal & extra-skeletal lesions.• Chronic Chronic clinical clinical coursecourse• Classic Classic triad of: 1. Multiple ‘punched-out’triad of: 1. Multiple ‘punched-out’

lesions of skull. 2. U/L or B/L Exophthalmos.lesions of skull. 2. U/L or B/L Exophthalmos.3. Diabetes insipidus with or without3. Diabetes insipidus with or withoutDyspituitarismDyspituitarism..

• Oral Oral manifestations – earliest signs ofmanifestations – earliest signs ofdiseases. diseases. StomatitisStomatitis, Gingivitis, Halitosis, Gingivitis, Halitosis

• Loose Loose teeth, premature exfoliation.teeth, premature exfoliation.

TreatmentTreatment::• Spontaneous Spontaneous regression – approx. half of theregression – approx. half of the

patientspatients..• Curettage Curettage / / excisionexcision• Radiotherapy Radiotherapy – – inaccesibleinaccesible lesions lesions• Chemotherapy Chemotherapy• Prognosis Prognosis – good– good

letterer – letterer – siwesiwe diseasedisease C/FC/F• Occurs in infants (age < 3 Occurs in infants (age < 3 yrsyrs).).• Diffuse Diffuse involvement of skeletal system.involvement of skeletal system.

Ulcerative lesions of oral mucosa. • GingivalUlcerative lesions of oral mucosa. • Gingivalhyperplasia. • Loosening & premature loss ofhyperplasia. • Loosening & premature loss ofteeth.teeth.

TreatmentTreatment::• Chemotherapy – only few pt. respond.Chemotherapy – only few pt. respond.• Poor Poor prognosis.prognosis.• Rapid Rapid course of disease – terminates fatallycourse of disease – terminates fatally

in short time.in short time.

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