Neoplasia: Tumors of Blood-Forming Tissues

Leukemia

• Broad group of disorders

• Overproduction of atypical wbc

• Prolif in marrow & spill into circulating blood & tissues

• Classified by type of prolif cells

• Divisions: Acute & Chronic

• Gingival enlargement

• Persistent bleeding

Lymphoma

• Malignant/lymphoid tissue

• Numerous types (differentiated by microscopic exam)

Lymphoma clinically appearance

***Gradual enlargement of involved lymph nodes***

– Rare primary site in oral soft tissue or bone

• Intraoral lymphoma→ tonsillar pillars

Multiple Myeloma

Systemic, malignant prolif of plasma cells that cause destructive lesions in bone

• Plasma cells produce large amounts of immunoglobulins

• >40 yrs. (most 70 yrs)

• M>W

• Bone pain & swelling

• Fractures (common)

Multiple Myeloma Radiographic appearance

Multiple radiolucent lesions

Multiple Myeloma histology

**↑ Ig = monoclonal spike**

**Fragments of Ig in urine = Bence Jones proteins**

– Sheets of well to poorly differentiated plasma cells

Tx for Multiple Myeloma

- Chemo-Radiation

- Stem cell transplants

- Systemic bisphosphonates

• To prevent bone destruction

New tx = dramatic improvement in prognosis

Extramedullary Plasmocytoma

• Localized tumor of plasma cells in soft tissue

• Rare occurrence

• Head & neck, more common

• Precursor to multiple myeloma

Langerhan's Cell Disease Types

• aka histocytosis X

Types

-Letterer-Siwe disease

- Hand-Schuller-Christian disease

- Solitary eosiniphilic granuloma

Cellular involvement of Langerhan's Cell Disease

L-cells-Type of macrophage

-Mononuclear phagocyte

-Participates in CMI

Causes of Langerhan's Cell Disease

Cause unclear

- Reactive process

- Primary immunodeficiency

- Neoplastic process

Letterer-Siwe

- Acute

- 10% of LCH cases

- Most severe

- Children < 2-3

- Seborrheic rash

- Multiple systemic manifestations

•Hand-Schuller-Christian

-Chronic-Children < 5

- Classic symptoms (triad)

• Diabetes insipidous

• Well defined punched out radiolucencies in skull (granulomatous lesions)

- Geographic skull

- Conditions mimicking advanced perio disease

• Exophthalmus

Eosinophilic granuloma of bone

- Most benign & most common

- Older children

• Peaks at 5-10yrs

• Possibly up to age 30

- Males 2x > females

- Localized, predominantly in bones

• Solitary or multifocal

- Resembles perio/floating teeth

Dx for Langerhan's cell disease

Microscopic/biopsy

Tx for Langerhan's Cell Disease

- Surgical excision

- Low dose radiation

- Chemo (possible if organ involvement LS)

- Intra-lesional injections of steroids (EG)

Metastatic Tumors of the Jaw

• Rare

• Arise from primary lesions elsewhere

• Mand most common

• M>F

• Pain, parasthesia of lip, bone expansion, loose teeth

Metastatic Tumors of the Jaw radiographic appearance

Poorly defined radiolucency

Tx for Metastatic Tumors of the Jaw

- Chemo

- Radiation

- Poor prognosis