Radiodiagnosis Radiodiagnosis of dontogenous of dontogenous tumours and non tumoral tumours and non tumoral formations of jaws formations of jaws . . Radio Radio diagnosis of diagnosis of no no n n dontogenous dontogenous benign and benign and malignant malignant tumours and tumours and non tumoral formations of jaws non tumoral formations of jaws . . Prof. G.S. Moroz, MD Prof. G.S. Moroz, MD Department of Oncology & Department of Oncology & Radiology, Radiology, Ternopil State Medical Ternopil State Medical University University
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Radiodiagnosis of dontogenous tumours and non tumoral formations of jaws. Radio diagnosis of non dontogenous benign and malignant tumours and non tumoral.
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Radiodiagnosis Radiodiagnosis of dontogenous of dontogenous tumours and tumours and non tumoral formations of jawsnon tumoral formations of jaws. . Radio Radio
diagnosis of diagnosis of nonon n dontogenous dontogenous benign andbenign and malignant malignant tumours and non tumoral tumours and non tumoral
formations of jawsformations of jaws..
Prof. G.S. Moroz, MDProf. G.S. Moroz, MD
Department of Oncology & Department of Oncology & Radiology,Radiology,
Ternopil State Medical UniversityTernopil State Medical University
Carotid Body Tumor*Note: The pictures don't correspond with the text of the slides
EtiologyRare neoplasm arising from nonchromaffin paraganglia in
carotid artery bifurcation
Heredofamilial (autosomal-dominant) form can occur (in less
than 10%) Can be multiple,
bilateral, or multicentric
Clinical Presentation
Typically presents as a mass in the lateral neck
May be associated with bruit, hoarseness, dysphagia
Diagnosis
Ultrasonography as a screening measure • Angiography of both carotid systems
Differential Diagnosis
Metastatic tumor • Vagal nerve sheath tumor
Treatment
Surgical removal • Radiation therapy • Combined surgical and radiotherapy
Correlation of histologic and radiographic findings
Differential Diagnosis
Osteosarcoma • Central giant cell granuloma • Odontogenic tumor
Treatment
Wide local excision or resection •
Reconstruction
Prognosis
Recurrence rate
of 30 to 50%
Langerhans Cell Disease(Idiopathic Histiocytosis)
Etiology • Unknown • Proliferation of Langerhans’
cells (immune surveillance cells) normally found in skin, mucosa,
bone marrow, and lymph nodes
Clinical Presentation
A broad spectrum, typically divided into three subsets, as follows:
• Unifocal or multifocal chronic disease of bone (eosinophilic granuloma) • Widely disseminated chronic disease of bone and soft tissue (Hand-Schüller-Christian disease) • Acute, disseminated disease with bone marrow involvement (Letterer-Siwe disease) • Most arise in childhood; eosinophilic granuloma often arises
in adolescents and adults. • Jaw lesions noted in up to 20% of cases with tenderness,
loose teeth (focal to segmental), gingival inflammation, and friability
Radiographic Findings
Bone lesions often punched out, sharply circumscribed
• “Floating teeth” appearance with alveolar bone involvement
• Skeletal survey should be performed to rule out multiple bone
involvement
Diagnosis
Radiographic demonstration of lytic bony lesions • Infiltrate of mononuclear cells, often with clefted
nuclei • Often accompanied by a variety of other cell types,
including eosinophils, lymphocytes, giant cells, plasma cells • Immunohistochemical demonstration of CD1a
staining • Langerhans’ cells also stain for S-100 protein,
although the antibody is less specific. • Ultrastructural demonstration of cytoplasmic
Excellent • Little recurrence potential • When associated with Gardner’s
syndrome, malignant conversion of intestinal polyps is assured.
Peripheral Ossifying Fibroma
Etiology • A reactive hyperplasia of the
gingiva; may be related to chronic irritation • Periodontal ligament/membrane
origin postulated
Clinical Presentation
Exclusive gingival location; commonly interdental
• Nodular, sessile to pedunculated, usually ulcerated mass
• Slow growing; may rarely displace teeth • Usually in young adults and adolescents • Early lesions may bleed easily. • Anterior maxillary arch is favored site
Diagnosis
Central islands or trabeculae of bone/cementum
• Fibroblastic proliferation in a sheet-like configuration
t(7;22), t(7;21) noted • Gene rearrangement often noted, that is,
(22;q12) and expression of the MIC2 gene • Genetically related to primitive peripheral
neuroectodermal tumor via translocations
Clinical Presentation
60% in males; over 95% in those under 20 years of age
• Chiefly in bone and soft tissues • Highly malignant • Pain, numbness, and swelling often early complaints • Diffuse, irregular, lytic bone lesion • Cortical expansion variable • Second most common bone tumor of
children/adolescents • Soft tissues of head and neck account for 11% of
extraskeletal sites
Diagnosis
Radiographs often show “moth-eaten” appearance and laminar periosteal bone reaction • Cortex may be eroded or expanded
May be associated with pre-existing bone disease such as the
following: • Paget’s disease (10 to 15%) • Fibrous dysplasia (0.5%) • Mutation/amplification of p53, c-
myc, c-JUN, c-fos, MOM2, CDK4, SAS
Clinical Presentation
May present with pain paresthesia, trismus, nasal or paranasal
sinus obstruction • May masquerade as an odontogenic
infection • Intraoral signs are as follows: • Tooth mobility (vertical) • Periapical radiolucency (teeth vital) • Distal displacement of terminal molar • Jaw mass may be ulcerat
Radiographic Findings
Early intraoral findings • Displacement of teeth • Root resorption • Absent or attenuated lamina dura • Uniformly widened periodontal membrane space • Later jaw bone findings • Lytic, “moth-eaten” destruction • Cortical destruction • Soft tissue extension • Erosion of mandibular canal • 25% of cases have “sunburst effect” (radiating
radiopaque spicules)
Microscopic Findings
Sarcomatous stroma • Osteoid production by neoplastic
glandular odontogenic cyst • Central giant cell granuloma
Treatment
Excision with bony curettage • Large lesions may require en bloc resection.
Prognosis
Good • Can be aggressive rarely • Recurrences not uncommon,
secondary to gelatinous quality and lack of capsule
Odontoma
Etiology • A hamartomatous or benign
mixed odontogenic tumor of the jaw
• Composed of enamel, dentin, cementum, and pulp tissue
Clinical Presentation
Two forms, as follows: • Complex: a randomly arrayed mixture of dental
tissues with no gross resemblance to a tooth • Compound: multiple, tooth-like structures • Mean age of occurrence, 12 to 16 years • Asymptomatic, usually small and discovered
incidentally • Jaw expansion may be present with large lesions. • Presence may be heralded by an over-retained
primary tooth or by alveolar swelling.
Radiographic Findings
Well-localized, mixed radiolucent and radiopaque lesion
• Within alveolar segment of jaws • Complex form most commonly noted
in mandibular molar area • Compound form favors anterior jaw
region, usually the maxilla; may contain a few small teeth or large
numbers of tiny tooth-like structures
Diagnosis
Radiographic presentation • Histologic demonstration of dental hard tissues