Head and neck tumors
Head and neck tumors
Tumors of the nasal cavity,
paranasal sinuses, oral cavity,
nasopharynx, oropharynx,
salivary glands, hypopharynx,
and larynx.
Also tumors of local lymphoid
tissue, skin, ear, eye, thyroid
gland
Risk
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Smoking and chewing tobacco.
Heavy alcohol use.
A diet low in fruits and vegetables.
Chewing betel quid, a stimulant commonly used
in parts of Asia.
Being infected with human papilloma virus
(HPV).
EBV infection.
plummer-Vinson syndrome.
poor nutrition
ill-fitting dentures and other rough surfaces on
the teeth
P53 mutation
Risk
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Alcohol and tobacco use are the most common risk factors.
They are likely synergistic in causing cancer
poor diet resulting in vitamin deficiencies
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Environmental carcinogens include occupational exposures
such as nickel
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BUT- marijuana use was not shown to be associated with
oral squamous cell carcinoma (potential protective factor
against the development of head and neck squamous cell
carcinoma
Dietary factors
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Excessive consumption of processed meats and red
meat were associated with increased rates of cancer
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Betel nut chewing is associated with an increased risk
of squamous cell cancer of the head and neck
 Salted fish (nitrites) – nasopharyngeal carcinoma
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Consumption of raw and cooked vegetables seemed
to be protective.
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Vitamin E was not found to prevent the development
of leukoplakia
Human papillomavirus
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HPV16, is a causal factor for some head and neck
squamous cell carcinoma . Approximately 15 to
25% contain genomic DNA from HPV,
 HPV-positive oropharyngeal cancer, with highest
distribution in the tonsils, where HPV DNA is found
in (45 to 67%) of the cases,
 less often in the hypopharynx (13%–25%)
 least often in the oral cavity (12%–18%) and
larynx (3%–7%).
 cancers of the tonsil may be infected with HPV
(25%)
 Oral sex can result in HPV-related cancer
Epstein-Barr virus
 Associated
with nasopharyngeal cancer –
high grade.
 Nasopharyngeal cancer occurs
endemically - Mediterranean countries and
Asia, EBV antibody titers can be
measured to screen high-risk populations
Oral cavity –
benign epithelial tumors
 Squamous
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papilloma
less common than in larynx
Adults 30-50 yrs
HPV 6 and 11
 Condyloma
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young adults – lip, palate
 Verruciform
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accuminatum
xantoma
Middle aged toolder adults
Alveolar ridges
Prognosis
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HPV-positive cancers tend to have higher survival rates.
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The prognosis for people with oropharyngeal cancer
depends on the age and health of the person and the
stage of the disease. It is important for people with
oropharyngeal cancer to have follow-up exams for the
rest of their lives as cancer can occur in nearby areas.
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It is important to eliminate risk factors such as smoking
and drinking alcohol, which increase the risk for second
cancers
 Location and type of tumor
Oral cavity –
precursor (premalignant lesions)
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HIGH-risk lesions
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Medium- risk lesions
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Leukoplakia
Erythroplakia
speckled Erythroplakia (a mixture of both)
chronic hyperplastic candidiasis
dysplasia
oral submucosal fibrosis
syphilitic glossitis
sideropenic dysphagia
low-risk lesions
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oral lichen planus
discoid lupus erythematosus
discoid keratosis congenita
Precanceroses
Leukoplakia
Leukoplakia
Leukoplakia
High grade dysplasia
Erythroplakia
Erythroplakia is a general term for red, flat, or eroded velvety lesions that develop in the mouth.
In this image, an exophytic squamous cell carcinoma is surrounded by a margin of erythroplakia.
Erythroplakia
Oral cavity – malignant epithelial
tumors
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Squamous cell carcinoma (the vast majority of head and
neck cancers)
 Conventional (keratinizing)
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Nonkeratinizing
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HPV16-95%
Asymptomatic neck mass
Verrucous carcinoma
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Endophytic X exophytic X ulcerated
Well differentiated, non metastasizing ca
Spindle cell ca
Adenosquamous carcinoma
Neuroendocrice ca
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High grade, poor prognosis
Oral cavity – malignant
epithelial tumors
 Squamous
carcinomas – the most
common
 Prognosis associated with location
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Lip (good prognosis)
Tongue (highly aggresive)
Mouth floor (highly aggresive)
Bucal mucosa (highly aggresive)
Gingiva (slow growth)
Squamous cell carcinoma
Squamous cell carcinoma
Squamous cell carcinoma
Verrucous carcinoma
Oral cavity, mesenchymal tu
 Vascular
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Pyegenic granuloma (Lobular capillary
hemangioma), lip, tongue, gingival and bucal
mucosa
Hemangioma
Lymphangioma
Kaposi´s sarcoma
Oral cavity, mesenchymal tu
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Peripheral ossifying tumor
 Gingiva, along incisors
 Peripheral giant cell granuloma
 Gingiva along incisors, caused by chronic irritation
 Congenital granular cell epulis
 Lipoma
 Osteoma (torus palatinus, mandibularis)
 Fibrosarcoma
Fibroepithelial polyp
Fibroepithelial polyp
Oral cavity, neuroectodermal tu
 Neurinoma
 Neurofibroma
 Melanocytic
nevus
 Malignant melanoma
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60 yrs (20-80)
More aggresive than cutaneous
Odontogenic tumor
Rare, from remnants od dental crest
Classification:
 Epithelial
 Mesenchymal
 Mixed
Epithelial odontogenic tumors
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Ameloblastoma (adamantinoma)
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Calcifying epithelial odontogenic tumor
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(Pindborg´s tumor), slowly growing, painless, posterior mandible
Adenomatoid odontogenic tumor
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Anterior portion of maxila, younger than 30, females,
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Squamous odontogenic tumor
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Malignant ameloblastoma and ameloblastic carcinoma
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(1% of ameloblastomas)
Ameloblastoma (Adamantinoma)
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The most common
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Manifestation 20.-40 yrs
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Mandibula
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Cystic, ill.defined borders – destructive growts,
histology: Histopathology will show cells that have the tendency to move
the nucleus away from the basement membrane. This process is referred to
as "Reverse Polarization". The follicular type will have outer arrangement of
columnar or palisaded ameloblast like cells and inner zone of triangular
shaped cells resembling stellate reticulum
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Commom reccurences
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May be malignant transformation
Ameloblastoma (adamantinoma)
Ameloblastoma
Ameloblastoma
Calcifying epithelial
odontogenic tumor
Mezenchymal odontogenic tumors
 Cementoblastoma
 Cemento-ossifying
 Odontogenic
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fibroma fibrom
fibroma
Odontogenic myxoma
Mesenchymal odontogenic tumors
Cementoblastoma
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Childhood
Both jaws
Cementoblastic proliferation around molars
Cementoblastoma
Cementoblastoma
Mesenchymal odontogenic tumors
Odontogenic myxoma
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arising from embryonic connective tissue associated with tooth formation.
consists mainly of spindle shaped cells and scattered collagen fibers
distributed through a loose, mucoid material.
young people
ill - defined borders
bone resorption
Local infiltration
high recurrence rate
Mesenchymal odontogenic tumors
Odontogenic myxoma
Mezenchymal odontogenic tumors
Odontogenic myxoma
Mesenchymal odontogenic tumors
Odontogenic fibroma
55% in mandible
45% in maxilla
 2/3 of maxillary tumors found in the anterior segment
 4-80 years
 Females 69%
 Recurrence rate is low
 Cellular tumor with minimal ground substance and droplets of calcified
matrix representing bone or atubular dentin
 Small round nests and irregular clusters of epithelial cells
Mesenchymal odontogenic tumors
Odontogenic fibroma
Mixed odontogenic tumors
 Odontomas
 Dentinom
 Ameloblastic
fibroma
 Ameloblastic fibroodontoma
 Ameloblastic fibrosarcoma
 Odontogenic carcinosarcoma
Mixed odontogenic tumors
Ameloblastic fibroma
 Childhood,
adolescence
 Ameloblastic fibromas are neoplasms of
odontogenic epithelium and mesenchymal
tissues
 2% of odontogenic tumors
 Uni or multilocular cysts
Mixed odontogenic tumors
Ameloblastic fibroma
Ameloblastic fibroma
Mixed odontogenic tumors
Odontoma
 66%
of odontogenic tumors are
odontomas
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hamartoma
Between 10. and 20 years
More often in maxila
compound odontoma - three separate dental tissues
(enamel, dentin and cementum) no definitive
demarcation of separate tissues between the individual
"toothlets
Complex odontoma - type is unrecognizable as dental
tissues, usually presenting as a radioopaque area with
varying densities.
Mixed odontogenic tumors
Odontoma
Mixed odontogenic tumors
Odontoma
Ameloblastic fibrosarcoma
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Rare malignant variant of ameloblastic fibroma
 Invazive and destructive growth, minimal
metastases
Ameloblastic fibrosarcoma
Ameloblastic fibrosarcoma
Nonodontogenic tumors of jaws
 Benign
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Fibrous dysplasia (polyostotic, monoostotic
Juvenile ossifying fibroma
Cemento osseous dysplasia
 Giant
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fibro-osseous lesions
cell lesions
Central giant cell granuloma (osteolytic,
mostly mandible)
Brown tumor of hyperparathyroidism
cherubism
Salivary gland tumor
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Salivary gland neoplasms make up 6% of all head and
neck tumors
 Salivary gland neoplasms most commonly appear in the
sixth decade of life. Patients with malignant lesions
typically present after age 60 years, whereas those with
benign lesions usually present when older than 40 years.
Benign neoplasms occur more frequently in women than
in men, but malignant tumors are distributed equally
between the sexes.
 80% arise in the parotid glands, 10-15% arise in the
submandibular glands, and the remainder arise in the
sublingual and minor salivary glands. Almost 50%
submandibular gland neoplasms and most sublingual
and minor salivary gland tumors are malignant.
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Most patients with salivary gland neoplasms present with
a slowly enlarging painless mass.
Laryngeal salivary gland neoplasms may produce airway
obstruction, dysphagia, or hoarseness.
Minor salivary tumors of the nasal cavity or paranasal
sinus can manifest with nasal obstruction or sinusitis.
Facial paralysis or other neurologic deficit associated
with a salivary gland mass indicates malignancy.
Pain may be a feature associated with both benign and
malignant tumors. Pain may arise from suppuration or
hemorrhage into a mass or from infiltration of a
malignancy into adjacent tissue.
 malignant
epithelial tumors
 benign epithelial tumors
 soft tissue tumors (Hemangioma)
 hematolymphoid tumors (e.g. Hodgkin
lymphoma)
 secondary tumors
Benign lesion
 Pleiomorphic
adenoma
 Myoepithelioma
 Basal cell adenoma
 Warthin´s tumor
 Oncocytoma
 Cystadenoma
 Canalicular adenoma
Malignant tumors
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Acinic cell carcinoma
 Mucoepidermoid carcinoma
 Adenoid cystic carcinoma
 Salivary duct carcinoma
 Myoepithelialcarcinoma
 Carcinoma ex pleimorphic adenoma
 Squamous cell carcinoma
 Epi-myoepithelial cyrcinoma
 Cystadenocarcinoma
 Salivary
gland neoplasms are rare in
children. Most tumors (65%) are benign,
with hemangiomas being the most
common, followed by pleomorphic
adenomas.
 35% of salivary gland neoplasms are
malignant. Mucoepidermoid carcinoma is
the most common salivary gland
malignancy in children.
Pleomorphic adenoma
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common benign salivary gland neoplasm characterised
by neoplastic proliferation of parenchymatous glandular
cells along with myoepithelial components, having a
malignant potentiality.
 It is the most common type of salivary gland tumor and
the most common tumor of the parotid gland.
 It derives its name from the architectural pleomorphism
(variable appearance) seen by light microscopy. It is also
known as "Mixed tumor, which describes its pleomorphic
appearance as opposed to its dual origin from epithelial
and myoepithelial elements
Warthin's tumor
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the second most common benign parotid tumor.
 strong association with cigarette smoking.
Smokers are at 8 times greater risk of
developing Warthin's tumor than the general
population
 Warthin's tumor primarily affects older
individuals (age 60–70 years). There is a slight
female predilection according to recent studies,
but historically it has been associated with a
strong male predilection.