malignant diseases

lecture given 6/8/2026

what are the general properties of malignancies?

uncontrolled growth of tissue, locally invasive, able to metastisize to lymph nodes or distant sites

*displaced teeth, loosened teeth over short time, ulceration, indurated or rolled border, exposure of underlying bone, lymphadenopathy, hemorrhage, lack of normal healing, pain and swelling, pathologic fractures

M>F, >50 yo

what are the common locations of malignancies?

tongue, floor of the mouth, tonsillar area, lip, soft palate, gingiva, may invade jaws, sarcomas of both jaws

metastatic tumors: posterior mandible and maxilla, some at apices or in follicles

what are the imaging modalities for malignancies?

intraoral- best resolution, reveals subtle changes

panoramic- quick, overall assessment, anatomical information (boundaries of maxillary sinuses)

CBCT- 3D analysis to better determine extent of tumor

PET- detects cellular metabolic activity, can be fused with MDCT for accurate localization

MRI- 3D soft tissue images showing perineural spread and involvement of lymph nodes

A?

ill defined invasive borders followed by bone destruction

B?

destruction of the cortical boundary (floor of the maxillary antrum) with an adjacent soft tissue mass (arrows)

C?

tumor invasion along the periodontal membrane space causing irregular thickening of this space

D?

multifocal lesions located at root apices and in the papilla of a developing tooth destroying the crypt cortex and displacing the developing tooth in an occlusal direction

*E?

4 types of effects on the cortical bone and periosteal reaction

cortical bone destruction without periosteal reaction

laminated periosteal reaction with destruction of the cortical bone and the new periosteal bone

destruction of cortical bone with periosteal reaction at the periphery forming **Codman’s triangles

**a spiculated or sunray type of periosteal reaction

F?

bone destruction around existing teeth, producing an appearance of teeth floating in space

what are general features of malignancies on radiographs?

ill defined, irregular, non-corticated, infiltrating

radiolucent, radiopaque

rapidly destructive- destroy bone but leave teeth or resorb roots, destroy cortices, follow path of least resistance

squamous cell carcinoma arising in soft tissue

arises from surface epithelium, smoking/alcohol/papilloma viruses play a role

red or white, irregular patchy lesions, variable pain, lymphadenopathy, significant weight loss, feel unwell

lateral tongue, invades bone

irregular outline, ill defined, non-corticated, sclerosis from secondary infection may occur

irregular PDL widening → teeth floating → teeth drifting, increased width and cortical destruction of mandibular canal, other cortices

squamous cell carcinoma arising in soft tissue

squamous cell carcinoma arising in the soft tissue

squamous cell carcinoma arising from soft tissue

squamous cell carcinoma arising from soft tissue

*is this T1 or T2 image, and what is the white arrow pointing to?

T1, evidence of necrosis

*is this T1 or T2, and what is the itty bitty white arrow pointing at?

T2, evidence of inflammation

squamous cell carcinoma arising in bone

remnants of odontogenic epithelium, no connection with surface epithelium

clinically: rare, pain, pathological fracture

M>F, 4-8th decade

imaging features: mand > max, molar region, ragged border

radiolucent

destruction of adjacent structures

squamous cell carcinoma arising in bone

squamous cell carcinoma arising in bone

squamous cell carcinoma arising in cyst

uncommon, arise from inflammatory periapical, residual, dentigerous, and odontogenic keratocystic

dull pain, swelling

imaging features: early- cystic, later turns into malignancy

mand, anterior max

characteristic of cyst and malignancy

DD: inflamed cysts show peripheral sclerosis

squamous cell carcinoma arising in a cyst

squamous cell carcinoma arising in the max sinus

risk factors: chronic sinusitis, inhaling manufacturing chemicals

african, asian, M>F, sinus symptoms

opacification of the sinus, destruction of borders

squamous cell carcinoma arising in the maxillary sinus

central mucoepidermoid carcinoma

mimic benign tumor or cyst, painless swelling, F>M

mand:max 4:1, posterior, above canal

well defined and corticated

uni or multilocular, expansile, resorbs cortices, does not affect teeth, displaces canal

DD: myxoma, CGCG

central mucoepidermoid carcinoma

metastatic tumors

secondary malignancy, tumor spreads via blood vessels, typically carcinoma

breast 31%, lung 18%, kidney 15%, thyroid 6%, prostate 6%, colon and rectum 6%, stomach 5%, melanoma 5%, testicle/bladder/liver/ovarian/cervical

F>M 2:1, dental pain, paresthesia, bleeding

post mand, max sinus, hard palate, condyle, PDL, mimicking PARL, maybe defined, non-corticated,

breast and prostate stimulate bone formation- patchy sclerosis, may cause spiculated periosteal reaction

metastatic tumors

*

metastatic tumors

osteoscarcoma

osteoid is produced directly by tumor

M>F 2:1, peaks in 4th decade, rapid swelling, pain, tenderness

posterior mand, max, may cross midline

ill defined, radiolucent/radiopaque, periosteal reaction, destruction of cortices

*

osteoscarcoma

osteosarcoma

chondroscarcoma

slow growing malignant tumor that produces cartilage and tends to calcify

any age, more common in adults, mean age 47, M=F, long duration firm mass, near TMJ can affect joint function

mand = max, anterior, condylar head and neck, coronoid process

well defined, can be corticated, but can be ill defined, invasive, expands cortices, possibly large

mixed radiolucent/radiopaque

root resorption and displacement, widened PDL space

chrondrosarcoma

chrondrosarcoma

*ewing’s sarcoma

small round cell tumor that arises in medullary portion of bone and spread to cortex

common in second decade, age 5-30, M>F 2:1

mand > max, posterior, never corticated, ragged border, radiolucent periosteal bone formation, **codman’s triangle, destroys bone and cortices

ewing’s sarcoma

fibroscarcoma

malignant fibroblasts that produce collagen and elastin

M=F, 4th decade, enlarging mass, pain

mand premolar-molar region, ill defined, ragged

grow along bone through marrow space, sclerosis of adjacent bone, radiolucent, destroy bone and cortices

fibrosarcoma

mutliple myeloma

systemic malignancy of plasma cells, single lesions are called plasmacytoma

35-70 yo, M>F, fatigue, weight loss, bone pain, anemia

mand > max, posterior, well defined, non-corticated, **punched out, may be ragged and infiltrative, radiolucent, rarely root resorption, resorbs cortices

multiple myeloma

multiple myeloma

non-hodgkin’s lymphoma

malignant tumor of lymphatic cells, typically found in lymph nodes but can appear extranodal

all age groups, rare under 10, feeling unwell, night sweats, swelling

maxillary sinus, posterior mand and max, ill-defined, invasive, radiolucent, effacted sinus walls, soft tissue mass visible, destroys cortices, propensity to grow in PDL space, displaces developing teeth occlusally

non-hodgkin’s lymphoma

non-hodgkin’s lymphoma

leukemia

malignancy of hematopoietic stems cells

acute: bimodal (so very young or very old), feeling unwell, bone pain

seen around PA of developing teeth in children, ill defined, patchy radiolucencies that can enlarge

no expansion, teeth displaced occlusally

leukemia

leukemia

langerhan’s cell histocytosis

langerhan’s cell histocytosis

non-malignant (eosinophilic granuloma) or malignant (letterer-siwe disease and others), have neoplastic nature

older children to young adult most common, forms quickly, dull pain, bony or soft tissue swelling, bleeding, ulceration

multifocal in the alveolar bone, solitary elsewhere, mandibular ramus

moderately well-defined, non-corticated, can appear scooped out, at midroot level scooped out appearance, smooth or irregular borders, destroys bone

langerhan’s cell histocytosis

periosteal reactions from langerhan’s cell histocytosis

what are the differential diagnoses for langerhan’s cell histocytosis?

periodontal disease- PD starts at the crest of bone, LCH midroot

squamous cell carcinoma (and other malignancies)- LCH typically better defined, younger age group, periosteal reaction