The document discusses various types of malignant tumors that can occur in the jaws. It describes carcinomas such as squamous cell carcinoma arising in soft tissue, originating in bone, or originating in a cyst. It also discusses metastatic tumors that spread to the jaws from other sites, sarcomas such as osteosarcoma and chondrosarcoma, and malignancies of the hematopoietic system like multiple myeloma and lymphoma. For each type of tumor, it provides information on characteristics, clinical features, radiological features, signs and symptoms, and differential diagnosis. It also includes case reports and diagrams to illustrate radiological features of malignancy.

1. M.Ekram
Malignant Diseases Of the Jaws
Prof. M. Ekram

2. M.Ekram
Malignant Diseases
Of The Jaws
Malignant tumors
represent an
uncontrolled growth
of tissues

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Categories of malignant
tumors
Carcinomas (lesions of epithelial origin).
Sarcomas (lesions of mesynchymal origin).
Metastatic ( lesions from distant sites).
Malignancies of hematopoietic system.
Classification of malignant
tumors of the jaws

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Malignant tumors of the jaws
I. Carcinomas
Sq.cell.carcinoma arising in soft tissue
Sq.cell.carcinoma originating in bone
Sq.cell.carcinoma originating in a cyst
Central mucoepidermoid carcinoma
II. Metastatic tumors

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III. Sarcomas
Osteosarcoma
Chondrosarcoma
Fibrosarcoma
Ewing’s sarcoma
IV. Malignancies of
the Hematopoietic
system
Multiple myeloma
Non-Hodgkin’s
lymphoma
Burkitt’s lymphoma
Leukemia
Malignant tumors of the jaws

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Characteristics of Malignant Tumors
Unlike benign tumors, they are :
More locally invasive
Have a a greater degree of anaplasia
( Loss of structural differentiation of the cells being more primitive with
Marked reproductive activity )
Have the ability to metastasize
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Clinical features which suggest the
presence or malignancy
Swelling
Displaced teeth
Loosened teeth over a short duration
Ulceration
Presence of an ulcer with indurated or rolled
borders.
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Foul smell
Exposure of underlying bone
Sensory or motor neural disorders
Lymphadenopathy
Weight loss
Clinical features which suggest
the presence or malignancy

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Dysphagia
Dysphonia
Dysgeusia
Hemorrhage
Lack of normal healing
Pain with no demonstrable dental cause
Clinical features which suggest the
presence or malignancy
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The following features may suggest
the presence of malignancy
I. Location
Primary carcinomas
Tongue , floor of the mouth , tonsillar area , lip ,
soft palate or gingiva.
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Metastatic tumors
*Posterior mandible or maxilla
* Apex of a tooth or follicle of a
developing tooth
Sarcomas
* More in the mandible
* More in posterior region of both jaws
The following features may suggest the presence of malignancy
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Malignant
Tumor
II. Periphery and shape
They grow by
invasion and
destruction of
surrounding bone
without cortical
expansion
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Radiologic features which suggest the
Presence of malignancy

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Ill defined irregular
borders with lack
of cortication or
encapsulaion.
This infiltrative border has uneven extensions of
bone destruction.
Finger-like extensions of the tumor in many
directions may be seen.
The following features may suggest the presence of malignancy
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Malignant lesions tend to cause
bone destruction without evidence of repair.
“ Punched out lesions “
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III. Internal structure
Typically radiolucent
in most instances.
May be residual
islands of bone.
The following features may suggest the presence of malignancy
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Bone destruction may
be associated with
an adjacent soft tissue
mass.
The following features may suggest the presence of malignancy
RULE
Evidence of osseous destruction
with adjacent soft tissue mass is
highly suggestive of malignancy.

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Floating Teeth
Rapidly growing malignant lesions spreads Rapidly, destroying
the supporting alveolar bone but leaving the teeth in their
original position so the teeth appear floating often without
evidence of root resorption.

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Rapid invasion of the
periodontal ligament
space around the teeth
resulting in irregular
widening with destru-
ction of the lamina
dura.
Occasionally root resorption (more in sarcomas) .
The following features may suggest the presence of malignancy

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Some metastatic tumors
(prostate and breast)
can induce bone
formation whereas
others (osteogenic
sarcoma) can cause
frank sclerosis.
The following features may suggest the presence of malignancy (con)

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Where the tumor
destroys the outer
cortex of bone ,
usually no periosteal
reaction occurs.
The following features may suggest the presence of malignancy

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The presence of a malignant tumor growing near a
cortex tends to cause destruction and occasionally rapid
elevation of the bone-forming periostium, resulting in
bone specules resembling sunburst.
Malignant
Tumor
Sunburst appearance

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Lesions such as
osteosarcoma
and prostate
metastatic
carcinoma
can stimulate
thin straight specules of bone giving a
“sunburst” appearance.
The following features may suggest the presence of malignancy

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Diagrammatic
representation of
radiologic features of
malignancy
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Ill-defined invasive border followed
by bone destruction
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Destruction of the cortical boundary (floor of
maxillary antrum) with an adjacent soft tissue mass.
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Tumor invasion along the periodontal membrane
space causing irregular thickening of this space.
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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.
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1. cortical bone destruction
without periosteal reaction.
2. Laminated periosteal reaction
with destruction of the cortical
bone and the new periosteal
Bone
3. Destruction of cortical bone
with periosteal reaction at the
periphery forming Codman’s
triangles.
4. Speculated or sunray type of
periosteal reaction.
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Four types of effects on cortical bone and periosteal reaction

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Carcinomas

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Squamous cell carcinoma
arising in soft tissue
A malignant tumor originating within the surface
epithelium. This malignant epithelium can invade
the underlying connective tissue , and occasionally
the adjacent bone and local regional lymph nodes.

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Age: over 50 years
Sex : more in males
Site : Soft tissues of the mouth.
Differential diagnosis: osteomyelitis.
Squamous cell carcinoma
arising in soft tissue

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Swelling
Displaced teeth
Loosened teeth over a short duration
Ulceration
Presence of an indurated or rolled borders.
Foul smell
Exposure of underlying bone
Sensory or motor neural disorders
Lymphadenopathy
Weight loss
Dysphagia
Dysphonia
Dysgeusia
Hemorrhage
Lack of normal healing
Pain with no demonstrable dental causeM.Ekram
signs and symptoms

34. M.Ekram
Signs and Symptoms
White or red (or mixed) patch that
ulcerates.
Swelling ,displaced teeth,
loosened teeth over a short
duration, Ulceration, Presence of
an indurated or rolled borders.
Foul smell, exposure of
underlying bone, Sensory or
motor neural disorders,
lymphadenopathy and
weight loss

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Radiologic features
Ill defined non corticated
radiolucency borders .
May be small island of
normal bone are observed.
Finger like extensions are
observed at the periphery.

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Radiologic features
Loss of lamina dura
and widening of the
periodontal membrane
with loosening of teeth.
Desruction of the
normal cortical
boundaries.

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Squamous cell Carcinoma
of The Maxillary Sinus
Reported Case

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CT CARCINOMA 3
CT CARCINOMA 4

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CT CARCINOMA 1
CT CARCINOMA 2

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CT CARCINOMA 5 CT CARCINOMA6

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Another Case of
Squamous cell
Carcinoma of
The Maxilla

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CARCINOMA C 1
CARCINOMA C 2

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CARCINOMA C 3 CARCINOMA C 4

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CARCINOMA C 5

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CARCINOMA C 6

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Squamous cell carcinoma
originating in bone
(Primary intraosseos carcinoma)
It is a squamous cell carcinoma arising within the
jaw and that has no original connection with the
surface epithelium of the oral mucosa.

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Carcinoma in bone
Age: fourth to eighth decade
Gender: more in males
Differential diagnosis:
1. granuloma
2. odontogenic cyst or tumor

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Signs and Symptoms
May remain silent till it
reaches a fairly large size.
Pain and lip parasthesia.
Regional lymphadenopathy
Pathological fractures may
occur.

51. M.Ekram
Radiologic features
Round or irregular
radiolucency with ill or well
defined border.
Displacement of teeth.
Destruction of the normal
cortical boundary
Root resorption is unusual.
Regional lymphadenopathy

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Squamous cell carcinoma
originating in a cyst
(Epidermoid cell carcinoma )
An uncommon form of
squamous cell carcinoma
arising in a preexisting
dental cyst. They may arise
from inflammatory
periapical , residual ,
dentigerous , and
odontogenic keratocysts.

53. M.Ekram
Signs and Symptoms
Site: more in the mandible .
Dull pain lasting for several
months.
Swelling and may be facial
disfigurement.
Regional lymphadenopathy.
In maxilla sinus pain and / or
swalling may occur.

54. M.Ekram
Radiologic features
Round or oval radiolucency.
Early has well defined borders
but later become ill- defined.
Thining and desruction of the
lamina dura of teeth or adjacent
cortical boudaries.
Destruction of the alveolar
process.

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Central mucoepidermoid
carcinoma
( mucoepidermoid carcinoma )
It is an epithelial tumor arising in bone. It is
believed to derive from the salivary duct system.
The criteria for diagnosis include:
the presence of intact cortical plates
radiographic evidence of bone destruction
histologic features of mucoepidermoid tumors

56. M.Ekram
Site : more in mandible (2:1)
Sex : more in females
Differential Diagnosis:
1.Odontogenic myxoma
2. Central giant cell granuloma
3. Odontogenic cyst or tumor
Signs and Symptoms

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Signs and Symptoms
painless swelling that lasts
for months or even years
causing facial asymmetry.
Tenderness may occur.
Parasthesia of the inferior
alveolar nerve.
The lesion may spread to
the regional lymph nodes.

58. M.Ekram
Radiologic features
An expansile unilocular or
multilocular radiolucent lesion with
a soap bubble or honeycomb
appearance.
Borders are well defined and
corticated but rarely not corticated
and has a malignant appearance.
Expansion of the adjacent normal
bone.
Teeth remain unaffected although
their adjacent lamina dura is lost.

59. M.Ekram
Malignant ameloblastoma and
ameloblastic carcinoma
An ameloblastoma exhibiting the
histologic criteria of a malignant neoplasm
such as increased and abnormal mitosis
and hyperchromatic , large nuclei.

60. M.Ekram
Age : first to sixth decade
Sex : more in males
Site : more in mandible
(molar and premolar
regions))
Signs and Symptoms

61. M.Ekram
Signs and Symptoms
A hard expansile mass
of the jaw with displaced
and perhaps loosened
teeth.
Tenderness of the
overlying soft tissue.

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Signs and Symptoms
Local extension may
occur into adjacent
bones, connective tissue
or salivary glands.
Metastasis may spread
to cervical lymph nodes,
lung, viscera or spine.

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Radiologic features
Similar to benign
ameloblastoma but with
more invasion and
destruction of the cortical
boundaries.
Teeth may be displaced
with root resorption as in
benign ameloblastoma

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Radiologic features
Expansion of the adjacent
normal bone.
The lesion may erode the
lamina dura and displace
the normal cortical
boundaries.

65. M.Ekram
Malignant ameloblastoma and ameloblastic carcinoma
Differential Diagnosis:
benign ameloblastoma
Odontogenic myxoma
Central mucoepidermoid
carcinoma
Central giant cell
granuloma
Odontogenic keratocyst

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Malignant
Ameloblastoma
Reported Case

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Metastatic
Tumors

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Metastatic tumors
(General metastatic tumors)
Metastatic tumors represent the
establishment of new foci of malignant
disease from a distant malignant tumor
(primary lesion). Metastasis involve the jaw ,
skull , spine , pelvis , ribs and humerous.
Most common primary sited include the
prostate , kidney , thyroid , , breast , and
lung.

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Metastatic tumors
Age : fifth to seventh
decade
Sex : males and females
Site : more in mandible,
may be bilateral
(more in posterior region of
both jaws)
In maxilla , max.sinus,
hard palate, mandibular
Condyle, periodontal
ligament and papillae of
developing teeth.

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Signs and Symptoms
Dental pain
Numbness of the
mandibular nerve.
Pathological fracture of
the jaws.
Haemorrhage from the
tumor site.

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Radiologic features
Irregularly shaped
lesion.
Somewhat demarcated
but without cortication.
Expansion of the
adjacent normal bone.
May have ill defined
invasive border.

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Radiologic features
May start as small zones
(Multifocal)separated by normal
bone that coalesce forming a
large ill defined lesion.
The lesion is generally radiolucent
but may be with islands of
residual normal bone.
Prostate and breast metastasis
may show areas of patchy
sclerosis i.e. bone formation.

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Radiologic features
Tooth crypts may be
destroyed and extraction
sockets failto heal and
increase in size.
Teeth may appear floating.
Destruction of the adjacent
structures as IAC,
max.sinus or nasal fossa.
Sometimes the tumor
breaches the cortical plate
and present as an intraoral
mass.

78. M.Ekram
Scintegraphy - SPECT
Nuclear Medicine
M.Ekram Skeletal metastasis

79. M.Ekram
Malignant ameloblastoma and ameloblastic carcinoma
Differential Diagnosis:
1. multiple myeloma
2. Periapical inflammation
3. Infected cyst
4. Squamous cell carcinoma

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Sarcomas

81. M.Ekram
Osteosarcoma
(Osteogenic sarcoma)
Osteosarcoma is a malignant neoplasm of
bone in which osteoid is produced directly by
malignant stroma.
N.B. It is also known to occur in association
with Paget’s disease and fibrous dysplasia
after theraputic irradiation.

82. M.Ekram
Age : peak in fourth decade
Sex : more in males (2:1)
Site : more in mandible
(more in posterior region)
Osteosarcoma
(Osteogenic sarcoma)

83. M.Ekram
Signs and Symptoms
Swelling that is usually
rapid.
Pain, tenderness,
ulceration and loose
teeth.
Erythema of the
overlying mucosa.

84. M.Ekram
Signs and Symptoms
Hypoesthesia if the
neurovascular canals
are involved.
Epistaxis, hemorrhage,
nasal obstruction,
exophthalmos, trismus
and blindness.

85. M.Ekram
Radiologic features
The lesion is usually
radiolucent with no sclerosis
or encapsulation and has ill
defined margins.
Widening of the PL space.
If the lesion involves the
periostium directly or by
extension and when the
periostium is partially
destroyed sunray specules or
hair-on-end specules may be
seen.

86. M.Ekram
Radiologic features
Lesions may be mixed RL /
RP or Quite radiopaque.
the lesion may take the
appearance of sclerotic
bone, cotton bolls or wisps.

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Osteosarcoma

88. M.Ekram
Differential Diagnosis:
1. fibrosarcoma
2. Metastatic carcinoma
3. Ossifying fibroma
4. Fibrous dysplasia
5. Chronic osteomyelitis
6. Ewing sarcoma
7. Solitary plasmacytoma

89. M.Ekram
Chondrosarcoma
(Chondrogenic sarcoma)
Chondrosarcoma is a malignant neoplasm
of cartilaginous origin. It may occur centrally
within bone , on the periphery of bone or
less commonly in soft tissue.

90. M.Ekram
Age : any age (adults mean 47)
Sex : males = females
Site :
1. in bone , bone periphery but less common in soft
tissue.
2. In cartilage or within benign cartilagenous tumor (2ry
chondrosarcoma)
Chondrosarcoma
(Chondrogenic sarcoma)

91. M.Ekram
Signs and Symptoms
Firm or hard mass of relatively long duration.
Enlargement of the lesion may cause pain, and
facial deformity.
Less frequently hemorrhage from the tumor or
necks of teeth, sensory nerve deficits, proptosis
and visual disturbances.

92. M.Ekram
Signs and Symptoms
The lesion is covered by
normal skin or mucosa
unless secondarily
ulcerated.
Trismus or abnormal
TMJ function may occur
if the lesion occurs near
the TMJ region.

93. M.Ekram
Radiologic features
The lesion is generally round,
ovoid or lobulated.
Borders are commonly well
defined but less commonly ill
defined and invasive.
The lesion is commonly mixed
RL / RP with sunray
appearance (hair-on-end) and
rarely radiolucent.

94. M.Ekram
Radiologic features
The radiopaque structure is
described as flocculent
implying snow-like features.
A ground glass appearance
is sometimes observed.
Expansion of the cortical
boundaries rather than
destroying them.
Tooth displacement, root
resorption and widening of the
periodontal membrane may
occur.

95. M.Ekram
Differential Diagnosis:
1. Osteosarcoma.
2. Fibrous dysplasia
Chondrosarcome
(Chondrogenic sarcoma)

96. M.Ekram
Ewing’s sarcoma
(Round cell sarcoma)
It is a tumor of long bones and is relatively
rare in the jaws. Lesions arise in the
medullary portion of the bone and spread to
the endosteal and later periosteal surfaces.

97. M.Ekram
Age : second decade
(5 – 30 y)
Sex : males more than
females (2 – 1)
Site : mandible more than
maxilla & more in the
posterior region
N.B the lesion is rare in the
jaws.
Ewing’s sarcoma
(Round cell sarcoma)

98. M.Ekram
Signs and Symptoms
Swelling
Pain
Parasthesia
Ulceration
Shifted teeth
Exophthalmos
Ptosis
Epistaxis
Sinusitis (in maxilla)
Trismus
Cervical lumphadenopathy.

99. M.Ekram
Radiologic features
Round or ovoid
radiolucency that is poorly
demarcated , ill defined and
never corticated.
The lesion is solitary and
pathological fractures may
occur.

100. M.Ekram
Radiologic features
The lesion abuts teeth or
tooth follicles with
destruction of their cortices.
This tumor doesn’t cause
root resorption but destroys
the supporting bone of the
adjacent teeth.
Bone formation may occur
but it is not a common
feature.

101. M.Ekram
Ewing’s
Sarcoma
Reported Case

102. M.Ekram
EWING SARCOMA PT

103. M.Ekram
EWING SARCOMA PANORAMA

104. M.Ekram
Whole body scanning
revealed free skeleton
Increased uptake of the
tracer in the region of left
mandibular ramus

105. M.Ekram
Diagrammatic
representation of
radiologic features of
malignancy
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106. M.Ekram
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.
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107. M.Ekram

108. M.Ekram

109. M.Ekram

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111. M.Ekram

112. M.Ekram
The surgical incision and
immediate post-operative healing

113. M.Ekram
One year post-operatively

114. M.Ekram
Medium power with lymphocyte-like cells
In diffuse sheets with vacoulation
Ewing’s Sarcoma

115. M.Ekram
Differential
Diagnosis:
1. Osteomyelitis
2. Eosinophilic
granuloma
3. Osteosarcoma
4. Chondrosarcoma
5. fibrosarcoma
Ewing’s sarcoma
(Round cell sarcoma)

116. M.Ekram
Fibrosarcoma
It is a neoplasm composed of malignant
fibroblasts that produce collagen and elastin.
Fibrosarcoma is of unknown etiology but
may develop following radiotherapy.

117. M.Ekram
Age : fourth decade (as a mean)
Sex : males and females equally
Site : mandible more in the premolar - molar
region
N.B the lesion is rare in the jaws.
Fibrosarcoma

118. M.Ekram
Signs and Symptoms
Rapidly enlarging mass may be within the bone in
which case it is acompanied with pain.
The lesion involves local soft tissues causing a
bulky lesion.
The overlying mucosa may become erythematous
or ulcerated.
Trismus may be due to involvement of the TMJ or
paramandibular structures.

119. M.Ekram
Radiologic features
The lesion is radiolucent with ill
defined non corticated borders
borders.
The lesion may invade the bone
or produce a saucer shaped
depression in it.
It destroys the adjacent
structures, and cause
displacement or loosening of
teeth but root resorption is
uncommon.

120. M.Ekram
Radiologic features
Widening of the periodontal
membrane space.
Codman’s triangles or
sunray appearance may be
evident if the lesion disturbs
the periostium.

121. M.Ekram
Fibrosarcoma
Differential Diagnosis:
1. Multiple myeloma
2. Metastatic carcinoma
3. Intraosseous carcinoma
4. Fibrous dysplasia
5. Chondrosarcoma
6. Ewing’s sarcoma
7. Squamous cell carcinoma

122. M.Ekram
Malignancies of the
hematopoitic
system

123. M.Ekram
Multiple myeloma
(Plasma cytoma)
It is a malignant neoplasm of plasma cells. It
is the most common malignancy of bone in
adults.
Single lesions are called Plasmacytoma and
multiple lesions are termed Multiple
myeloma.

124. M.Ekram
Age : 35 to 70 years (mean age 60 years)
Sex : more in males
Site : mandible more than the maxilla.
*in the mandible it occurs in the body and ramus
regionspremolar - molar region
*In the maxilla it occurs in the posterior region
N.B the lesion is rare in the jaws.
Multiple myeloma
(Plasma cytoma)

125. M.Ekram
Signs and Symptoms
Fatigue, weight loss, fever, bone
pain, anemia and low back pain.
Dental pain is uncommon, swelling,
hemorrhage, parasthesia,
dysesthesia or the patient has no
complaint.
Amyloidosis, hypercalcemia and
Bence Jones protein in urine.

126. M.Ekram
Radiologic features
Generally the lesions are oval
or cystic and may be multiple
giving a multi focal
appearance.
The individual lesions are
punched out with well defined
borders but not corticated.
Islands of residual bone may
be seen in the internal structure
of the giving the appearance of
new bone.

127. M.Ekram
Radiologic features
Periosteal reaction is
uncommon with the result a
single radiopacity or even
sunray appearance.
The teeth are loose and the
cortical boubdaries are
destroyed.
Other bones may be
involved as the skull,
pelvice ,ribs and humerus.

128. M.Ekram
Differential Diagnosis:
1. Metastatic carcinoma
2. Hyperparathyroidism
3. Lymphosarcoma
4. Osteomyelitis
5. Gauchers disease
6. Oxalosis
Multiple myeloma
(Plasma cytoma)

129. M.Ekram
Non-Hodgkin’s lymphoma
(Lymphosarcoma)
It is a malignant tumor of cells normally
resident in the lymphatic system.
Lymphomas occur within lymph nodes.
Extranodal sites include bone , skin , GIT
mucosa and tonsils.

130. M.Ekram
Age : All ages except the first decade 0f life.
Sex : both
Site : Lymph nodes, maxilla ,maxillary sinus,and
posterior mandible.
Non-Hodgkin’s lymphoma
(Lymphosarcoma)

131. M.Ekram
The Pt feel unwell with
night sweat, pruritis and
weight loss.
A palpable painless
swelling is noted with
lymphadenopathy ans
sensorineural deficits.
Lesions may cause pain
and ulceration.
Teeth may become mobile
due to bone destruction.
Signs and Symptoms

132. M.Ekram
Unilocular or multilocular
radiolucency with ill defined and
invasive border.
The tumor may grow in the
periodontal ligament space with
diplacement of teeth.
When located in the developing
papilla the developing teeth are
displaced in an occlusal
direction.
Radiologic features

133. M.Ekram
Non-Hodgkin’s
lymphoma
(Lymphosarcoma)

134. M.Ekram
Non-Hodgkin’s
lymphoma
(Lymphosarcoma)

135. M.Ekram
Differential Diagnosis:
1. Multiple mteloma
2. Metastatic carcinoma
3. Ewing’s sarcoma
4. Langrhans histocytosis
5. Squamous cell carcinoma
6. Osteolytic osteosarcoma
7. Apical rarifying osteitis
Non-Hodgkin’s lymphoma
(Lymphosarcoma)

136. M.Ekram
Burkitt’s lymphoma
It is a high - grade B-cell lymphoma that
differs from other B-cell lymphomas with
respect to it’s histologic appearance and
clinical behavior.

137. M.Ekram
Age : any age, children and
adults in their 7th
decade.
Sex : males more than
females
Site :
* African type may involves
the posterior region of one
or both jaws.
*American type affects the
abdominal viscera and
testes
Burkitt’s lymphoma

138. M.Ekram
Gros facial deformity and facial
swelling with obstruction of the
nasal passages and
displacement of the orbital
contents.
The lesion may erode the skin.
Loosening of teeth.
Parasthesia of the IA nerve and
other sensory facial nerves.
Signs and Symptoms

139. M.Ekram
The lesion may begin as
multiple ill-defined , non
corticated radiolucencies that
coalesce to form a larger ill
defined radiolucency with
expansile periphery.
Displacement of the orbital
contents if the lesion involves
the orbit.
Radiologic features

140. M.Ekram
Thinning of adjacent
structures and formation
of a soft tissue mass
adjacent to the osseous
defect.
Destruction of the lamina
dura and cortical
boundaries with
loosening of teeth.
Radiologic features

141. M.Ekram
Burkitt’s lymphoma
Differential Diagnosis:
1. Ewing’s sarcoma
2. Osteolytic osteosarcoma
3. Cherubism
4. Metastatic neuroblastoma

142. M.Ekram
Leukemia
Leukemia is a malignant neoplasm of
hematopoitic stem cells. These malignant
cells displace normal bone marrow
constituents and spill out into the
peripheral blood. They are subdivided into
acute and chronic leukemias and further
subdivided by the cell of origin i.e.
Myelogenous, Lymphatic and Monocytic.

143. M.Ekram
Pt’s with chronic leukemia may have no signs.
Pt’s with acute leukemia have :
Pt feel unwell with weakness and bone pain.
Fever, pallor and spontaneous hemorrhage.
Hepatomegally, splenomegally and
lymphadenopathy.
Oral symptoms (if present) include loose teeth,
petechia, gingival bleeding, ulceratin and
enlarged gingiva.
Signs and Symptoms

144. M.Ekram
The lesion may begin as
multiple ill-defined , non
corticated radiolucencies that
coalesce to form a larger ill
defined radiolucency and
granular bone may be seen
within the lesion.
The periodontal structures
are affected and the teeth
with loss of the alveolar bone
around the teeth.
Radiologic features

145. M.Ekram
Differential Diagnosis:
1. Lymphoma
2. Neuroblastoma
3. Periapical rarifying osteitis.
Leukemia

146. M.Ekram
Causes of death in oral malignancy
Metastasis to the brain (brain stroke).
Metastasis to the heart and blood vessels
(thrombosis and embolism).
Metastasis to the lung (aspiration pneumonia
, respiratory obstruction).

147. M.Ekram
Causes of death in oral malignancy
Metastasis to the liver (liver cirrhosis , hepatitis
and affection of body metabolism).
Bone marrow (anemia, leukopenia,
agranulocytosis, thrombocytopenia and
inhibition of the immune system).
Tumors in the throat area (dysphagia and
suffocation).

148. M.Ekram
Thank you