MULTIPLE MYELOMA:Its the most common malignancy of bone in adults.

Synonyms:Myeloma , plasma cell myeloma , plasmacytoma (single leasion).

Disease Mechanism: Its a malignant neoplasm of plasma cells (B.lymphocytes). Its accumulate in bone marrow and interfere with normel hematopoiesis.

Clinical features:Its a fatal systemic malignancy.

Age:35-70 years, common in men.

Symptoms:Fatique, weight loss, fever, bone pain ,anemia ,low back pain,

Secondary signs:amyloidosis, hypercalcemia ,foamy urine (due to bence jones protein ).

Oral manifestation:Dental pain ,swelling ,hemorrhage ,parasthesia ,dysesthesia .

Imaging features:Location:-Common in the mandible (posterior body,ramus,condyles.-Maxilla:Posterior site.

Periphery and shape:-well defined not corticated.-punch out appearnce.-oval or cystic shape.-soft tissue lesions reported in the jaws and nasopharynx .

:Internal structure-totally radiolucent-apperance of new trabucular bone within the mass.

Effects on surrounding structures:-the teeth will appear too opaque if a good bone mineral lost is happened.-lamina dura and follicles of impacted teeth may lose their typical corticated appearnce.-periosteal reaction is uncommon, it is takes two forms if happened (single radiopaque line or sun ray appearance.

Management:-chemotherapy with or without autologus or allogenic bone marrow transplantation.-radiation therapy for symptom osseous leasion.

Differential diagnosis:-mostly disease is the radiolucent form of metastatic carcinoma.-sever osteomyelitis.-simple bone cyst.-brown tumors of hyperparathyroidism.-oxalosis or gauchers disease.

NON-HODGKINS LYMPHPMA:

Synonyms:Malignant lymphoma and lymphosarcoma.

Disease mechanism:Its a malignant tumor of cells normally resident in lymphatic system.-the term describes a family heterogeneous tumors.

Site:Mainly lymph nodes.-bone, skin ,gastrointestinal mucosa and tonsils.

Classification:Based on histological appearance ,(high grade is the most aggressive)

Clinical features:

Age: in all age groups ,rare in first decade of life.

Site: maxillary sinus ,palate , tonsills, bone ,lymph nodes.

Manifestation:feeling unwell , night sweats , Wight lose.Palpable painless swelling ,lymphoadnophay may cause pain and ulcerationMobile teeth(due to bone lost).

Imaging features:Location: mostly in lymph nodes and also its affect maxillary sinus, posterior of the mandible and maxillary region.

Shape:Its take the shape of host bone.-they appear round , multiloculated and ill defined border.-its appear as finger like extensions of malignant tumors cells in a buccal or lingual walls.-the structures appear mostly radiolucent..

Effects on surrounding structures:-in maxillary sinus ,antral walls may affected.-in mandible ,the cortex of neurovascular canal will destroyed.-the cortex of the crypts of developing teeth may be lost and the involoved teeth may Exfoliated..

Differential diagnosis:-multiple myeloma metastatic carcinoma-Ewings sarcoma -langerhans histiocytosis-Osteolytic osteosarcoma-Squamous cell carcinoma --leukemia

Management:-radiation therapy ,with or without chemotherapy.

Burkitts lymphomaSynonym:Afrcian jaw lyymphoma .

Disease mechanism:Its a high grade B-cell lymphoma which different than other by histological appearance and clinical behavior.

There are two form: the African form which affect young children.The American form which affects adolescent and young adults ,with no involvement of jaws.

Clinical features:Male more than female.Rapid growth within less than 24 hours.Cause facial deformity , swelling , blocking nasal passage ,displace orbital contents and feeling pain .Teeth became lossened .

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Imaging features:Location:African form: affect one or both jaws and especially posterior part of its.American form: affect abdominal and tests.

Periphery and shape:-multiple-ill defined-Non-corticated radiolucencies.-may expanse like a balloon with thinning of adjacent structures.

Effects on surrounding structures:-displaced erupted teeth , destroyed lamina Dura.

Differential diagnosis:-metastatic neuroblastoma -Ewings tumor-Osteolytic osteosarcoma-Cherubism-Non-hodgkins lymphoma.

Management:-chemotherapy.

Synonyms: acute Myelogenous leukemia, acute lymphoblastic leukemia ,acute myelogenous Leukemia.

Disease mechanism:Its a malignant tumor of hematopoietic stem cells.-its displace normal bone marrow and spill it out into the peripheral blood.-there are subdivided to :1-acute leukemia (range from very young patients to very old )

2-chronic leukemia

Leukemia:

Clinical features:-in chronic leukemia patient theres no signs and symptoms.-in acute leukemia , patient feel unwell, weakness and bone pain.In addition to spontaneous hemorrhage , splenomegaly and fever.Oral symptoms present as ulceration ,loose teeth and enlarged gingiva.

Imaging features :Location:Its affect the whole body due to bone marrow defect.In the jaws its affect area of developing teeth.

Periphery and shape:-bilaterally ill defined patchy radiolucent area.-teeth appear stand out from their surrounding osteopenic bone.

:Effects on surrounding structures:-it doesn't cause expansion of bone.-the lamina Dura and cortical outline of follicles may be affected.-teeth displaced in an occlusal direction.-the crestal bone may lost.

Differential diagnosis:-lymphoma-neuroblastoma-metabolic disorder Management:By combination of chemotherapy with or without allogenic or autologous bone marrow transplantion.-chronic leukemia with low dose chemotherapy.