the radiology of malignant neoplasms

TheRadiologyofMalignant Neoplasms

Juan F. Yepes, DDS, MD, MPH

Spring 2009

The Radiology of Malignant Neoplasms

Malignant

Tending to become progressively worse, and resulting in death

CarcinomaSarcoma

CarcinomaA malignant neoplasm made up of

epithelial cells.

SarcomaA malignant neoplasm usually arising

from connective tissue cells, but some are of epithelial cell origin.

1995 Estimated Cancer Deaths, United States

Percent Distribution of Sites by Sex

*Excluding basal and squamous cell skin cancers and in situ carcinomas except bladder

1995 Estimated New Cancer Cases, United States

Percent Distribution of Sites by Sex*

Melanoma of Skin 3%

Oral 3%

Lung 14%

Pancreas 2%

Stomach 2%

Colon & Rectum 10%

Prostate 36%

Urinary 8%

Leukemia & Lymphomas 7%

All Other 15%

3% Melanoma of Skin

2% Oral

32% Breast

13% Lung

2% Pancreas

12% Colon & Rectum

5% Ovary

8% Uterus

4% Urinary

4% Leukemia & Lymphoma

13% All Other

Melanoma of Skin 2%

Oral 2%

Lung 33%

Pancreas 5%

Stomach 3%

Colon & Rectum 9%

Prostate 14%

Urinary 5%

Leukemia & Lymphomas 6%

All Other 19%

1% Melanoma of Skin

1% Oral

18% Breast

24% Lung

5% Pancreas

11% Colon & Rectum

6% Ovary

4% Uterus

3% Urinary

8% Leukemia & Lymphoma

19% All Other

Poorly defined Non-corticated Space occupying Non-resorption of teeth Destruction of anatomical structures

Poorly DefinedWell Defined

Corticated Non-corticated

Space Occupying vs. Non-Space Occupying

Poorly defined Non-corticated Space occupying Non-resorption of teeth, usually Destruction of anatomical structures

Poorly defined Non-corticated Space occupying Non-resorption of teeth, usually, but Destruction of anatomical structures

only if

Poorly defined Non-corticated Space occupying Non-directional resorption of teeth Destruction of anatomical structures

Poorly defined Non-corticated Space occupying Non-resorption of teeth, usually Destruction of anatomical structures

Destruction of periosteum

Internal structure: trabeculae & calcification

“Unilocular” / “multilocular”

Codman Triangles

Sunray Spicules

Sunburst Appearance

Destruction of periosteum

Internal structure: trabeculae & calcification

“Unilocular” / “multilocular”

Cyst or

Benign Neoplasm Benign Neoplasm Malignant Neoplasm

Carcinoma Ulceration Not usually a tumor mass*

Carcinoma Primary carcinoma Secondary (metastatic) carcinoma

Squamous Cell Carcinoma

Primary squamous cell carcinomaSecondary squamous cell carcinoma

Teeth “standing in space”

Carcinoma involving sinuses

CarcinomaSarcoma

SarcomaA malignant neoplasm usually arising from connective tissue

cells, but some are of epithelial cell origin.

Sarcoma

•Myeloma

•Osteosarcoma

•Chondrosarcoma

•Fibrosarcoma

•Ewing’s Sarcoma

•Leukemia

Sarcoma

•Myeloma

•Osteosarcoma

•Chondrosarcoma

•Leukemia

Sarcoma

• Mass (tumor) often found

• Bone production possible

• Mass (tumor) often found

Sarcoma

•Myeloma

•Osteosarcoma

•Chondrosarcoma

•Leukemia

Sarcoma

•Myeloma

Multiple Myeloma

Solitary Plasmacytoma

Sarcoma

•Myeloma

•Osteosarcoma

•Chondrosarcoma

•Leukemia

Sarcoma

•Osteosarcoma

Rare in the jaws (distal femur, proximal tibia)

20s-30s (10s-70s)

Maxillofacial lesions in older age group

Sarcoma

•Osteosarcoma

Mandible > Maxilla

Mandible younger than maxilla

Sarcoma

•Osteosarcoma

Garrington sign (widened periodontal space)

Ragged, ill-defined radiolucent area

mixed radiopaque/radiolucent area

radiopaque area

Sarcoma

•Osteosarcoma

Destruction of cortex

“Sun ray” spicule appearance

Codman triangles

Sarcoma

•Myeloma

•Osteosarcoma

•Chondrosarcoma

•Leukemia

Sarcoma

Chondroma vs.Chondrosarcoma

It may be difficult, if not impossible, to tell chondromas from chondrosarcomas,

radiographically or histopathologically, in all cases.

Sarcoma

•Chondrosarcoma

Chondrosarcoma

Mesenchymal Chondrosarcoma

Sarcoma

•Chondrosarcoma

Moderately radiolucent

Sarcoma

•Chondrosarcoma

Destructive, space occupying

Sarcoma

•Chondrosarcoma

Flocculent calcification

Sarcoma

•Chondrosarcoma

Flocculent calcification

Garrington sign (widened periodontal ligament)

Sarcoma

•Chondrosarcoma

Anterior maxilla, posterior mandible

Maxilla: mandible 1:1

Mandible: symphysis, coronoid p., condyle

Maxilla: septal area

Sarcoma

•Myeloma

•Osteosarcoma

•Chondrosarcoma

•Leukemia

Sarcoma

•Leukemia

Monocytic

Myelocytic

Lymphocytic

Sarcoma

•Leukemia

Chronic

Sarcoma

•Leukemia

Loss of teeth

Loss of lamina dura and trabeculae

Simulation of periapical inflammation

Langerhans Cell Histiocytosis

Langerhans Cell Disease

Langerhans Histiocytosis

Histiocytosis X

Histiocytosis

the radiology of malignant neoplasms

melanoma of skin

squamous cell skin cancers

leukemia lymphomas

epithelial cell origin

colon rectum6

colon rectum5

leukemia lymphoma13

leukemia lymphoma19

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