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TheRadiologyofMalignant Neoplasms
Juan F. Yepes, DDS, MD, MPH
Spring 2009
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The Radiology of Malignant Neoplasms
Malignant
Tending to become progressively worse, and resulting in death
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The Radiology of Malignant Neoplasms
CarcinomaSarcoma
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The Radiology of Malignant Neoplasms
CarcinomaA malignant neoplasm made up of
epithelial cells.
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The Radiology of Malignant Neoplasms
SarcomaA malignant neoplasm usually arising
from connective tissue cells, but some are of epithelial cell origin.
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The Radiology of Malignant Neoplasms
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
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The Radiology of Malignant Neoplasms
Poorly defined Non-corticated Space occupying Non-resorption of teeth Destruction of anatomical structures
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Poorly DefinedWell Defined
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Corticated Non-corticated
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Space Occupying vs. Non-Space Occupying
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The Radiology of Malignant Neoplasms
Poorly defined Non-corticated Space occupying Non-resorption of teeth, usually Destruction of anatomical structures
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The Radiology of Malignant Neoplasms
Poorly defined Non-corticated Space occupying Non-resorption of teeth, usually, but Destruction of anatomical structures
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The Radiology of Malignant Neoplasms
ifand
only if
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The Radiology of Malignant Neoplasms
Poorly defined Non-corticated Space occupying Non-directional resorption of teeth Destruction of anatomical structures
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The Radiology of Malignant Neoplasms
Poorly defined Non-corticated Space occupying Non-resorption of teeth, usually Destruction of anatomical structures
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Destruction of periosteum
Internal structure: trabeculae & calcification
“Unilocular” / “multilocular”
The Radiology of Malignant Neoplasms
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Codman Triangles
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Sunray Spicules
Sunburst Appearance
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Destruction of periosteum
Internal structure: trabeculae & calcification
“Unilocular” / “multilocular”
The Radiology of Malignant Neoplasms
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Cyst or
Benign Neoplasm Benign Neoplasm Malignant Neoplasm
The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
Carcinoma Ulceration Not usually a tumor mass*
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The Radiology of Malignant Neoplasms
Carcinoma Primary carcinoma Secondary (metastatic) carcinoma
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
Squamous Cell Carcinoma
Primary squamous cell carcinomaSecondary squamous cell carcinoma
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
Teeth “standing in space”
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
Carcinoma involving sinuses
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
CarcinomaSarcoma
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The Radiology of Malignant Neoplasms
SarcomaA malignant neoplasm usually arising from connective tissue
cells, but some are of epithelial cell origin.
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The Radiology of Malignant Neoplasms
Sarcoma
•Myeloma
•Osteosarcoma
•Chondrosarcoma
•Fibrosarcoma
•Ewing’s Sarcoma
•Leukemia
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The Radiology of Malignant Neoplasms
Sarcoma
•Myeloma
•Osteosarcoma
•Chondrosarcoma
•Leukemia
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The Radiology of Malignant Neoplasms
Sarcoma
• Mass (tumor) often found
• Bone production possible
• Mass (tumor) often found
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The Radiology of Malignant Neoplasms
Sarcoma
•Myeloma
•Osteosarcoma
•Chondrosarcoma
•Leukemia
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The Radiology of Malignant Neoplasms
Sarcoma
•Myeloma
Multiple Myeloma
Solitary Plasmacytoma
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
Sarcoma
•Myeloma
•Osteosarcoma
•Chondrosarcoma
•Leukemia
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The Radiology of Malignant Neoplasms
Sarcoma
•Osteosarcoma
Rare in the jaws (distal femur, proximal tibia)
20s-30s (10s-70s)
Maxillofacial lesions in older age group
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The Radiology of Malignant Neoplasms
Sarcoma
•Osteosarcoma
M > F
Mandible > Maxilla
Mandible younger than maxilla
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The Radiology of Malignant Neoplasms
Sarcoma
•Osteosarcoma
Garrington sign (widened periodontal space)
Ragged, ill-defined radiolucent area
mixed radiopaque/radiolucent area
radiopaque area
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The Radiology of Malignant Neoplasms
Sarcoma
•Osteosarcoma
Destruction of cortex
“Sun ray” spicule appearance
Codman triangles
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
Sarcoma
•Myeloma
•Osteosarcoma
•Chondrosarcoma
•Leukemia
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The Radiology of Malignant Neoplasms
Sarcoma
Chondroma vs.Chondrosarcoma
It may be difficult, if not impossible, to tell chondromas from chondrosarcomas,
radiographically or histopathologically, in all cases.
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The Radiology of Malignant Neoplasms
Sarcoma
•Chondrosarcoma
Chondrosarcoma
Mesenchymal Chondrosarcoma
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The Radiology of Malignant Neoplasms
Sarcoma
•Chondrosarcoma
Moderately radiolucent
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The Radiology of Malignant Neoplasms
Sarcoma
•Chondrosarcoma
Moderately radiolucent
Destructive, space occupying
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The Radiology of Malignant Neoplasms
Sarcoma
•Chondrosarcoma
Moderately radiolucent
Destructive, space occupying
Flocculent calcification
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The Radiology of Malignant Neoplasms
Sarcoma
•Chondrosarcoma
Moderately radiolucent
Destructive, space occupying
Flocculent calcification
Garrington sign (widened periodontal ligament)
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The Radiology of Malignant Neoplasms
Sarcoma
•Chondrosarcoma
Anterior maxilla, posterior mandible
Maxilla: mandible 1:1
Mandible: symphysis, coronoid p., condyle
Maxilla: septal area
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
Sarcoma
•Myeloma
•Osteosarcoma
•Chondrosarcoma
•Leukemia
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The Radiology of Malignant Neoplasms
Sarcoma
•Leukemia
Monocytic
Myelocytic
Lymphocytic
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The Radiology of Malignant Neoplasms
Sarcoma
•Leukemia
Acute
Chronic
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The Radiology of Malignant Neoplasms
Sarcoma
•Leukemia
Loss of teeth
Loss of lamina dura and trabeculae
Simulation of periapical inflammation
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The Radiology of Malignant Neoplasms
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The Radiology of Malignant Neoplasms
Langerhans Cell Histiocytosis
Langerhans Cell Disease
Langerhans Histiocytosis
Histiocytosis X
Histiocytosis