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    Lecture 14 Oral malignant epithelial tumors

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    Lecture 14 Oral malignant epithelial tumors

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    Lecture 14 Oral malignant epithelial tumors

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    Malignant epithelial

    tumours of oral cavity

    Pathology 2 , 1601312

    26/11/2024 1st Semester , 3rd year

    Dr. Moataz Saeed, MD Week 7, Lecture 14


    References:

    2
    Objectives:
    To Know:
    1-Aetiological factors of oral cancer.
    2-Squamous cell carcinoma.
    3-Describe the criteria of the malignant ulcer.
    4-TNM staging of squamous cell carcinoma
    5-Verrucous carcinoma.
    6- Basal cell carcinoma.
    .

    3
    Introduction:

     More than 90% of malignant neoplasms in the mouth are


    squamous cell carcinomas arising from mucosal
    epithelium.
     Most of the remainder arise in minor salivary glands and a
    few are metastases.
     Oral cancer is an age-related disease, and 95% of patients
    are older than 40 years, with median age at diagnosis of
    just older than 60 years.
     Males more frequently affected.

    4
    Possible etiological factors for
    oral cancer:
     Major factors
    • Tobacco smoking
    • Smokeless tobacco (Chewed, sucked or sniffed)
    • Betel quid habit
    • Alcohol
    • Sunlight (lip only)

     Low risk factors


    • Diet
    • Candidosis
    • Human papillomavirus
    • Lichen planus
    Diet and malnutrition
    Oral carcinoma is more frequent in those with low
    intake of fruit and vegetables. Vitamin A, C and
    carotenoids and other antioxidants are key protective
    factors, together with zinc and selenium.
    Malignant Neoplasms Of Surface Epithelium
    A) Squamous cell carcinoma (SCC)
     SCC variants
     Verrucous carcinoma
     Spindle cell carcinoma
     Nasopharyngeal carcinoma
    B) Basal cell carcinoma
    Squamous Cell Carcinoma
     Squamous cell carcinoma (sq.c.c) is the most common malignant
    tumor of oral cavity (more than 90%) arising from squamous
    epithelium .
    Clinical Features:
     Age SCC increases with increasing age especially for
    males.
     Sex Males affected more than females.
    This ratio is altered as the women lifestyle changes
    especially in smoking habit.

    1446 ‫ جمادى األولى‬24


    COMMON AFFECTED SITES:
    1. Tongue; lateral aspects and ventral tongue
    2. Floor of mouth
    3. Lingual aspect of the alveolar margin
    4. Buccal mucosa: Forming a U shape area, extending towards
    the oropharynx.
    Sometimes on the soft palate and the lip.
    Rarely; the hard palate and central dorsum of tongue.
    Signs of hidden cancer of the tongue:
     Deviation to the affected side on protrusion
     Defective speech
     Dimpling, furrowing, mucous membrane retraction
     Defective surface, minute ulcer
     Discharge, bleeding with fetid smelling
     Hardness.
    Scc clinical presentation :
    1) As an exophytic lesion (Swelling)
    2) As an endophytic lesion (Ulcer)

    24
    ‫جمادى األولى‬ 9
    1446
    Exophytic lesion Endophytic lesion
    3) May appear as a white lesion or an
    erythematous Lesion

    24
    ‫جمادى األولى‬ 10
    1446
    Criteria of malignant ulcer

     Fetid (bad) odor,


     Granular friable & easily bleed floor,
     Indurated raised “rolled” borders. The rolled border
    results from invasion of tumor downward and laterally.
     It shows fixation to the underlying & surrounding tissues
     Regional lymphadenopathy &
     It doesn’t respond to the treatment.
    TNM CLINICAL STAGING
    TNM staging: is a system put to
    determine the stage of different
    malignant tumors according to size
    of main mass, lymph node
    metastases and distant metastases.
     T refers to tumor size at the
    primary site,
     T = Extent of the primary
    tumor
     N refers to the status of the
    cervical chain of lymph nodes,
     N = State of regional lymph
    nodes
     M refers to the presence or
    absence of distant metastases. 24
    ‫جمادى األولى‬ 12

    M = Metastases
    1446

    Histopathology of squamous cell carcinoma:
    • Differentiation: is the extent to which tumor cells are mature i.e.
    resemble the normal cells of origin.
    • According to degree of differentiation of the tumor cells, SCC is
    divided into 3 histological grades:
    1. Well differentiated tumor cells closely resemble its tissue of
    origin and tend to grow and spread at a slower rate than
    undifferentiated or poorly differentiated tumor cells.
    2. Poorly differentiated tumors
    - Little resemble their tissue of origin,
    - Lack the structure and function of normal cells,
    - Grow uncontrollably and
    - Able to invade muscle, soft tissue, etc., even bone.
    3. Moderately differentiated tumors : (grade in-between).
    Grades of squamous cell carcinoma.
    Grade of SCC is evaluated according to the percent of
    keratinization and the degree of anaplasia and nuclear
    pleomorphism.

    Well diff.

    Moderately diff.

    Poorly diff.
    Well differentiated S.C.C.
    • Invasion and proliferation of masses of
    malignant epithelial cells (prickle cells)
    in the form of
    • Keratin pearls, concentric squames of
    keratin.
    • epithelial pearls consisting of a central
    area of keratin surrounded by whorls of
    epithelial cells
    • Cell nests, whorls of epithelial cells.
    • Intercellular bridges are still present to
    some extent.
    • Slight alteration of nuclear/cytoplasmic
    ratio.
    • Abnormal or bizarre cells are rare
    • Lymphocytes and plasma cells
    infiltration of the stroma.
    Poorly differentiated S.C.C.
    • Little resemblance of epithelial
    cells to cells of origin (immature)
    • Marked pleomorphism, the cells
    are rounded, may be spindle
    • Loss of intercellular cohesion
    • Increased normal and abnormal
    mitosis (tripolar, multipolar)
    • No keratin formation
    • Chronic inflammatory cells are
    variable
    • Loss of function (keratin
    formation) and Shape of
    epithelial cells (desmosomal
    attachements) is characterestic
    of poorly differentiated squamous
    cell carcinoma.
    16
    Invasion of Bone by SCC.

    Radographically:
     Ill-defined, irregular
    radiolucency; moth- eaten
    appearance (similar to
    osteomyelitis), then complete
    fixation to the mandible
     The extent of bone
    involvement is more than what
    we see in the radiograph.

    24
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    1446
    Causes of The Death in patient with
    oral SCC.

     Pain, infection difficult eating


     Loss of weight, cachexia
     Anemia
     Bronchopneumonia: septic infection
     Hemorrhage
     Metastasis to vital organ(lung, bone, brain,
    liver).

    18
    Verrucous carcinoma:
    • Uncommon tumor appears as a warty
    white lesion.
    • Is a subtype of SCC affects skin and
    mucosa.
    • It may represent a later stage of
    proliferative verrucous leukoplakia.
    • Grow slowly.
    • Distinct, diffuse, papillary, verrucae
    superficial, nonmetastasizing form of
    well-differentiated squamous cell
    carcinoma.
     It has the best prognosis as No or low
    metastatic potential
     Surgical excision (not aggressive).
    It is a highly differentiated
    Histopathology
    malignant tumor

    • Very well differentiated cells.


    Heavily parakeratinized, with
    papillary surface.

    • Wide elongated and bulbous,


    broad blunt rete ridges.

    • Down growth of epith. into


    C.T.
    • Little atypia
    • No obvious invasion through
    the basement membrane

    20
    Basal cell carcinoma

    It is a common skin cancer does NOT arise in oral mucosa.


    Locally invasive (locally malignant), slowly spreading without
    metastasis.
    Histogenesis:
    Arises from the basal layer of skin and its appendages; Pilo-
    sebaceous follicles or sweat gland.

    Etiology:
    Long exposure to UV radiation.
    Atrophy by age.
    **Multiple BCC occur in younger age as a sign of basal cell
    nevus syndrome (Gorlin-Goltz Syndrome)

    21
    Basal Cell Carcinoma
    (Rodent Ulcer)

    • Site: Common in the skin of the


    mid-face, does not arise in oral
    mucosa.
    • Sex: Males>Females
    • Age: Over 40 ys
    • Firm elevated, slowly-growing
    nodule with central depression
    and ulceration with rolled margin.
    • Healing & scarring centrally.
    • Destruction, erode surrounding &
    22

    underlying tissues.
    Histopathology of basal cell carcinoma
     Nests and cords of
    cuboidal cells arise from
    the region of the
    epidermal basal cells
     Neoplastic cells around
    the periphery of the
    invading nests and strands
    are usually palisaded and
    often columnar.
     Proliferation of basaloid
    cells in the form of
    islands, nests and cords of
    small darkly staining ovoid
    cells beneath an intact
    epidermis. 23

     Mitotic figures are seen


    Peripheral
    palisading and
    columnar
    basal layer

    Basal Cell Carcinoma


    24

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