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Head and neck tumors
Head and neck tumors
Tumors of the nasal cavity, paranasal sinuses, oral cavity, nasopharynx, oropharynx, salivary glands, hypopharynx, and larynx.
Also tumors of local lymphoid tissue, skin, ear, eye, thyroid gland
Risk Smoking and chewing tobacco. Heavy alcohol use. A diet low in fruits and vegetables. Chewing betel quid, a stimulant commonly used
in parts of Asia. Being infected with human papilloma virus
(HPV). EBV infection. plummer-Vinson syndrome. poor nutrition ill-fitting dentures and other rough surfaces on
the teeth P53 mutation
Risk
Alcohol and tobacco use are the most common risk factors. They are likely synergistic in causing cancer
poor diet resulting in vitamin deficiencies
Environmental carcinogens include occupational exposures such as nickel
BUT- marijuana use was not shown to be associated with oral squamous cell carcinoma (potential protective factor against the development of head and neck squamous cell carcinoma
Dietary factors
Excessive consumption of processed meats and red meat were associated with increased rates of cancer
Betel nut chewing is associated with an increased risk of squamous cell cancer of the head and neck
Salted fish (nitrites) – nasopharyngeal carcinoma
Consumption of raw and cooked vegetables seemed to be protective.
Vitamin E was not found to prevent the development of leukoplakia
Human papillomavirus
HPV16, is a causal factor for some head and neck squamous cell carcinoma . Approximately 15 to 25% contain genomic DNA from HPV,
HPV-positive oropharyngeal cancer, with highest distribution in the tonsils, where HPV DNA is found in (45 to 67%) of the cases,
less often in the hypopharynx (13%–25%) least often in the oral cavity (12%–18%) and larynx
(3%–7%). cancers of the tonsil may be infected with HPV (25%) Oral sex can result in HPV-related cancer
Epstein-Barr virus
Associated with nasopharyngeal cancer – high grade.
Nasopharyngeal cancer occurs endemically - Mediterranean countries and Asia, EBV antibody titers can be measured to screen high-risk populations
Oral cavity – benign epithelial tumors
Squamous papilloma less common than in larynx Adults 30-50 yrs HPV 6 and 11
Condyloma accuminatum young adults – lip, palate
Verruciform xantoma Middle aged toolder adults Alveolar ridges
Prognosis HPV-positive cancers tend to have higher survival rates.
The prognosis for people with oropharyngeal cancer depends on the age and health of the person and the stage of the disease. It is important for people with oropharyngeal cancer to have follow-up exams for the rest of their lives as cancer can occur in nearby areas.
It is important to eliminate risk factors such as smoking and drinking alcohol, which increase the risk for second cancers
Location and type of tumor
Oral cavity –precursor (premalignant lesions) HIGH-risk lesions
Leukoplakia Erythroplakia speckled Erythroplakia (a mixture of both) chronic hyperplastic candidiasis dysplasia
Medium- risk lesions oral submucosal fibrosis syphilitic glossitis sideropenic dysphagia
low-risk lesions oral lichen planus discoid lupus erythematosus discoid keratosis congenita
Precanceroses
Leukoplakia
Leukoplakia
Leukoplakia
High grade dysplasia
Erythroplakia
Erythroplakia is a general term for red, flat, or eroded velvety lesions that develop in the mouth. In this image, an exophytic squamous cell carcinoma is surrounded by a margin of erythroplakia.
Erythroplakia
Oral cavity – malignant epithelial tumors
Squamous cell carcinoma (the vast majority of head and neck cancers)
Conventional (keratinizing) Endophytic X exophytic X ulcerated
Nonkeratinizing HPV16-95% Asymptomatic neck mass
Verrucous carcinoma Well differentiated, non metastasizing ca
Spindle cell ca Adenosquamous carcinoma Neuroendocrice ca
High grade, poor prognosis
Oral cavity – malignant epithelial tumors
Squamous carcinomas – the most common
Prognosis associated with location Lip (good prognosis) Tongue (highly aggresive) Mouth floor (highly aggresive) Bucal mucosa (highly aggresive) Gingiva (slow growth)
Squamous cell carcinoma
Squamous cell carcinoma
Squamous cell carcinoma
Verrucous carcinoma
Oral cavity, mesenchymal tu
Vascular Pyegenic granuloma (Lobular capillary
hemangioma), lip, tongue, gingival and bucal mucosa
Hemangioma Lymphangioma Kaposi´s sarcoma
Oral cavity, mesenchymal tu
Peripheral ossifying tumor Gingiva, along incisors
Peripheral giant cell granuloma Gingiva along incisors, caused by chronic irritation
Congenital granular cell epulis Lipoma Osteoma (torus palatinus, mandibularis) Fibrosarcoma
Fibroepithelial polyp
Fibroepithelial polyp
Oral cavity, neuroectodermal tu
Neurinoma Neurofibroma Melanocytic nevus Malignant melanoma
60 yrs (20-80) More aggresive than cutaneous
Odontogenic tumor
Rare, from remnants od dental crest
Classification: Epithelial Mesenchymal Mixed
Epithelial odontogenic tumors
Ameloblastoma (adamantinoma)
Calcifying epithelial odontogenic tumor
(Pindborg´s tumor), slowly growing, painless, posterior mandible
Adenomatoid odontogenic tumor
Anterior portion of maxila, younger than 30, females,
Squamous odontogenic tumor
Malignant ameloblastoma and ameloblastic carcinoma
(1% of ameloblastomas)
Ameloblastoma (Adamantinoma)
The most common
Manifestation 20.-40 yrs
Mandibula
Cystic, ill.defined borders – destructive growts,
histology: Histopathology will show cells that have the tendency to move
the nucleus away from the basement membrane. This process is referred to
as "Reverse Polarization". The follicular type will have outer arrangement of
columnar or palisaded ameloblast like cells and inner zone of triangular
shaped cells resembling stellate reticulum
Commom reccurences
May be malignant transformation
Ameloblastoma (adamantinoma)
Ameloblastoma
Ameloblastoma
Calcifying epithelial odontogenic tumor
Mezenchymal odontogenic tumors
Cementoblastoma
Cemento-ossifying fibroma fibrom
Odontogenic fibroma
Odontogenic myxoma
Mesenchymal odontogenic tumors
Cementoblastoma
Childhood Both jaws Cementoblastic proliferation around molars
Cementoblastoma
Cementoblastoma
Mesenchymal odontogenic tumors
Odontogenic myxoma
arising from embryonic connective tissue associated with tooth formation. consists mainly of spindle shaped cells and scattered collagen fibers
distributed through a loose, mucoid material. young people ill - defined borders bone resorption Local infiltration high recurrence rate
Mesenchymal odontogenic tumors Odontogenic myxoma
Mezenchymal odontogenic tumors Odontogenic myxoma
Mesenchymal odontogenic tumors
Odontogenic fibroma55% in mandible
45% in maxilla 2/3 of maxillary tumors found in the anterior segment 4-80 years Females 69% Recurrence rate is low Cellular tumor with minimal ground substance and droplets of calcified
matrix representing bone or atubular dentin Small round nests and irregular clusters of epithelial cells
Mesenchymal odontogenic tumors Odontogenic fibroma
Mixed odontogenic tumors
Odontomas Dentinom Ameloblastic fibroma Ameloblastic fibroodontoma Ameloblastic fibrosarcoma Odontogenic carcinosarcoma
Mixed odontogenic tumors
Ameloblastic fibroma
Childhood, adolescence Ameloblastic fibromas are neoplasms of
odontogenic epithelium and mesenchymal tissues
2% of odontogenic tumors Uni or multilocular cysts
Mixed odontogenic tumorsAmeloblastic fibroma
Ameloblastic fibroma
Mixed odontogenic tumors
Odontoma
66% of odontogenic tumors are odontomas
hamartoma Between 10. and 20 years More often in maxila compound odontoma - three separate dental tissues
(enamel, dentin and cementum) no definitive demarcation of separate tissues between the individual "toothlets
Complex odontoma - type is unrecognizable as dental tissues, usually presenting as a radioopaque area with varying densities.
Mixed odontogenic tumorsOdontoma
Mixed odontogenic tumorsOdontoma
Ameloblastic fibrosarcoma
Rare malignant variant of ameloblastic fibroma Invazive and destructive growth, minimal
metastases
Ameloblastic fibrosarcoma
Ameloblastic fibrosarcoma
Nonodontogenic tumors of jaws
Benign fibro-osseous lesions Fibrous dysplasia (polyostotic, monoostotic Juvenile ossifying fibroma Cemento osseous dysplasia
Giant cell lesions Central giant cell granuloma (osteolytic,
mostly mandible) Brown tumor of hyperparathyroidism cherubism
Salivary gland tumor Salivary gland neoplasms make up 6% of all head and
neck tumors Salivary gland neoplasms most commonly appear in the
sixth decade of life. Patients with malignant lesions typically present after age 60 years, whereas those with benign lesions usually present when older than 40 years. Benign neoplasms occur more frequently in women than in men, but malignant tumors are distributed equally between the sexes.
80% arise in the parotid glands, 10-15% arise in the submandibular glands, and the remainder arise in the sublingual and minor salivary glands. Almost 50% submandibular gland neoplasms and most sublingual and minor salivary gland tumors are malignant.
Most patients with salivary gland neoplasms present with a slowly enlarging painless mass.
Laryngeal salivary gland neoplasms may produce airway obstruction, dysphagia, or hoarseness.
Minor salivary tumors of the nasal cavity or paranasal sinus can manifest with nasal obstruction or sinusitis. Facial paralysis or other neurologic deficit associated with a salivary gland mass indicates malignancy.
Pain may be a feature associated with both benign and malignant tumors. Pain may arise from suppuration or hemorrhage into a mass or from infiltration of a malignancy into adjacent tissue.
malignant epithelial tumors benign epithelial tumors soft tissue tumors (Hemangioma) hematolymphoid tumors (e.g. Hodgkin
lymphoma) secondary tumors
Benign lesion
Pleiomorphic adenoma Myoepithelioma Basal cell adenoma Warthin´s tumor Oncocytoma Cystadenoma Canalicular adenoma
Malignant tumors
Acinic cell carcinoma Mucoepidermoid carcinoma Adenoid cystic carcinoma Salivary duct carcinoma Myoepithelialcarcinoma Carcinoma ex pleimorphic adenoma Squamous cell carcinoma Epi-myoepithelial cyrcinoma Cystadenocarcinoma
Salivary gland neoplasms are rare in children. Most tumors (65%) are benign, with hemangiomas being the most common, followed by pleomorphic adenomas.
35% of salivary gland neoplasms are malignant. Mucoepidermoid carcinoma is the most common salivary gland malignancy in children.
Pleomorphic adenoma common benign salivary gland neoplasm characterised
by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality.
It is the most common type of salivary gland tumor and the most common tumor of the parotid gland.
It derives its name from the architectural pleomorphism (variable appearance) seen by light microscopy. It is also known as "Mixed tumor, which describes its pleomorphic appearance as opposed to its dual origin from epithelial and myoepithelial elements
Warthin's tumor
the second most common benign parotid tumor. strong association with cigarette smoking.
Smokers are at 8 times greater risk of developing Warthin's tumor than the general population
Warthin's tumor primarily affects older individuals (age 60–70 years). There is a slight female predilection according to recent studies, but historically it has been associated with a strong male predilection.