BENIGN

NON-ODONTOGENIC
TUMORS OF ORAL CAVITY
Banun Kusumawardani
Faculty of Dentistry
University of Jember
 Definitions
Neoplasia
Neo: new; Plasia: formation.
A neoplasm is defined as an uncoordinated
proliferation of tissue, the growth of which
persists in a potentially unlimited fashion, even
after cessation of the stimulus which evoked the
change.
Difference between Hyperplasia and Tumor
Tumor is an abnormal mass of tissue, the growth
of which exceeds and is uncoordinated with that
of normal tissues and persists in the same
excessive manner after cessation of stimuli
which evoked the change.
 Hamartoma : An abnormal
proliferation of tissues, native to that
part. It is a focal malformation which
resembles a neoplasm, grossly &
microscopically.
Teratoma: A neoplasm composed of
tissues not normally found in the organ, in
which it arises. Derivatives of all three
germ layers are seen.
Choriostoma: A mass formed by
maldevelopment of tissue, a type not
native to that site.
Heteroplasia: Development of
cytologic and histologic elements
not native to the part.

Metaplasia: Change in tissue type

after its full differentiation
normally
Classification of tumors
Neoplasms - classified into 2
major groups
Benign tumors
Malignant tumors

This division is based on the

properties and behavior of
the neoplasm.
Classification of tumors
cont
Benign tumor - preserved
for neoplasm that principally
do not endanger the life of
the patient

Malignant neoplasm -
endanger the life of the
patient.
Classification of tumors
cont
Benign tumor of the oral
cavity
Epithelial
Mesenchymal
Connective tissue
Blood vessels, nerves,
lymphoid glands
Bones
Classification of tumors
cont
Malignant tumors
Epithelial
Mesenchymal
 Classification of tumors
cont
Benign tumor
Dental tissue (Odontogenic
tumors)
Non dental tissues
(Non Odontogenic tumors)

Malignant tumors
Properties of benign
tumors
Benign tumors- are tumors that are
Encapsulated berkapsul
Slow growth selowww
Grow by expansion, physically
pushing the normal adjacent
structures & tissues out of their path
Do not invade adjacent tissues
tak nyerang jaringan terdekat
Resemble their normal counterparts
(not anaplastic)
Do not metastasize g metastasis
Properties of malignant
tumors
Malignant tumors are tumors that
Not capsulated
Fast growth
Grow by infiltration into surrounding
tissues
Lost or do not resemble tissue of origin
(anaplastic)
Capable of metastasis into distant
regions/tissues through Lymph or
blood circulation
Endanger patients life
Benign tumors-
Nomenclature
Cells of benign tumors
resemble tissue of origin.
No histological difference are
visible between tumorous and
normal cells.
Are named after the tissue of
origin with ending (suffix)
oma.
Benign tumors cont
Examples
Fibroma- fibrous tissue
Lipoma- adipose tisssue
Malignant tumors-
Nomenclature
Tumor cells differ clearly from the
normally differentiated cells.
Sometimes difference is great that
it is difficult to discover the tissue
of origin (poorly differentiated or
highly anaplastic).
Nomenclature is based on tissue of
origin
Carcinoma epithelial cancer
Adeno carcinoma- glandular cancer
Malignant tumors cont
Sarcoma malignant tumor of
mesenchymal tissue.
For mesenchymal tissue start with
the name of tissue then followed by
sarcoma
Example
Fibrosarcoma Fibrous tissue
Rhabdomyosarcoma from skeletal
muscles.
Leiomyosarcoma
Osteosarcoma
Signs and symptoms of
tumors
Nature of symptoms varies with the
according to the location of the
lesion
Oral lesions in asymptomatic phase
may first be recognized by the
patient
Irregularity or abnormality of the
contour may be discovered while
brushing the teeth
Bleeding may draw attention
Signs and symptoms of
tumors
Loosening of one or more teeth may
occur if the alveolar ridge is
involved
Tongue movement may be
influenced and protrusion limited
because of infiltration & fixation of
the lesion to the floor of the mouth
Persistent sore throat for lesions of
the palate, tonsilar fossa, or base of
tongue
Signs and symptoms of
tumors
Pain may be intermittent initially
but becomes progressively more
intense and prolonged
Local pain eventually develops as
the tumor invades adjacent
structures
Pain frequently referred to the
ear
 Clinical features of oral
tumors
Sign Benign Malignant

History Long Short

Induration Absent Present

Ulceration Rare Frequent

Margin Well defined Irregular

Mobility Freely mobile Fixed

Papillary out growth Frequent Infrequent

Regional adenopathy Absent frequent

Benign tumors of the jaw
 Benign tumors of the jaw and oral
cavity

Can be
True neoplasms
Odontogenic tumors
Non odontogenic tumors
Developmental anomalies or
overgrowth
Other lesions related to bone
Effects on adjacent
structures
Non-Odontogenic benign
tumors
Non-odontogenic tumors
Tumors not arising from the tooth or tooth-
like structures
can be tumors of:
Epithelial origin (Mostly are premalignant:
see under malignant tumors)
Connective tissue origin
Vascular origin
Nerve origin
Muscle origin
Bone origin
Tumor-like of bone origin
Connective tissue origin

Fibroma reffered as epulis

Peripheral giant cell reperative
glanuloma
Lipoma
Tumors of vascular origin
Hemangioma
Lymphangioma
Nerve tumors
Neurofibroma
Neurilemmoma (Schwannoma,
Neuroma)
Muscle origin
Leiomyoma
Rhabdomyoma
Myoblastoma (Granular cell
myoblastoma)
Neoplasm and dysplasia of
bone
Osteoma
Exostosis & tori
Osteogenic fibroma (Osteofibroma)
Fibrous dysplasia
Ossifying fibroma
Central giant cell tumor
Central giant cell reperative
granuloma
Chonndroma
Osteoma
Itoccurs as a peripheral or as a central
tumor (very seldom).
Clinically present;
Hard, smooth, very slowl growing,
circumscript (round) tumor of the jaw bones.
Observed in individuals over 40 years old.
The mandible more often involved than
maxilla.
The growth sometimes selflimited.
On x-ray appears as radiopaque mass with
radioluscent outline.
Treatment is excision of the tumor.
Exostosis
These are peripheral osseous overgrowths or
excess of bone tissue.
Occur in the jaws as so called torus palatinus,
mandibularis, or multiple exostosis of the
alveolar bone.
Torus palatinus is the bone over growth which
usually occur in the midline of the palate,
may be ,more or less symmetrically arranged.
Torus mandibularis is often symmetrical bony
over growth of the lingual side of the
mandible on the premolar and canine region.
Tori are often found in older individuals and
can grow to a large size.
They are symptomless.
 Ossifying Fibroma

True neoplasm with fibrous connective tissue that contains

variable amount of bony trabeculae, cementum-like material
or both

Wide age range with greatest 3rd-4th decades

Female > Male; Mandible > Maxilla
Mandibular premolar-molar area
Small lesions asymptomatic
Large lesions painless swelling
Juvenile Aggressive Ossifying Fibroma

Radiographic Features
Well-defined unilocular radiolucency
Large lesions: classic downward bowing of the inferior
cortex of mandible
Ossifying Fibroma
 Ossifying Fibroma
Histopathology
Tissue submitted as one mass
Fibrous connective tissue with varying degree of
mineralized material

Treatment
Enucleation; good prognosis
Osteoma
Itoccurs as a peripheral or as a central
tumor (very seldom).
Clinically present;
Hard, smooth, very slowl growing,
circumscript (round) tumor of the jaw bones.
Observed in individuals over 40 years old.
The mandible more often involved than
maxilla.
The growth sometimes selflimited.
On x-ray appears as radiopaque mass with
radioluscent outline.
Treatment is excision of the tumor.
 Osteoma and Gardner Syndrome

Osteomas are benign tumors composed of mature compact

or cancellous bone
Restricted to the craniofacial skeleton

Gardner Syndrome
Autosomal dominant
Spectrum of diseases comprised of
* familial colorectal polyps (will transform to adenocarcinomas)
* Osteomas (90% of cases) common in the skull, paranasal
sinuses and mandible
* Epidermoid cysts
* Desmoid tumors (locally aggressive fibrous neoplasms)
* Increased incidence of thyroid carcinoma
 Cementoblastoma (True Cementoma)
Odontogenic neoplasm of cementoblasts
Mandible > Maxilla with 90% occur in molar/premolar area
50% INVOLVE THE 1ST PERMANENT MOLAR
Children and young adults
Pain at night relieved by aspirin
Swelling
Radiographic Features
Appears as radiopaque mass fused to one or more roots and
is surrounded by a thin radiolucent rim
Outline of root blurred due to fusion with tooth
Histopathology
Sheets of thick trabeculae of mineralized material intermixed
with cellular fibrovascular tissue with multinucleated giant cells
Treatment
Surgical extraction of lesion with teeth
 Classification of Non Odontogenic Tumours

Epithelial
Benign Malignant
Papilloma Basal Cell Carcinoma
Squamous Acanthoma Epidermoid carcinoma or
Keratoacanthoma Squamous cell carcinoma
Pigmented Cell Nevus Verrucous Carcinoma
Spindle Cell Carcinoma
Premalignant
Adenoid Squamous cell
Leukoplakia
Carcinoma
Leukoedema Lmphoepithelioma and
Intraepithelial Carcinoma Transitional cell
or Carcinoma in situ carcinoma
Erythroplakia Malignant Melanoma
Oral Sub Mucous Fibrosis
 Classification of Non Odontogenic Tumours..
Connective Tissue Adipose tissue
Benign Benign
Fibroma Lipoma
Giant Cell Fibroma Verruciform
Peripheral Ossifying Xanthoma
Fibroma Malignant
Central Ossifying Fibroma Liposarcoma
Peripheral Giant cell
Granuloma
Central GCG
Aneursmal Bone Cyst
Myxoma
Malignant
Fibrosarcoma
 Classification of Non Odontogenic Tumours

Vascular Tissue Cartilage tissue

Benign Benign
Hemangioma Chondroma
Hereditary Haemorrhagic Benign Chondroblastoma
Talengiectasia Chondromyxoid Fibroma
Encephalo-trigeminal
Malignant
Angiomatosis
Chondrosarcoma
Nasopharyngeal
Angiofibroma
Lmphangioma
Malignant
Haemangioendothelioma
Haemangiopericytoma
Kaposis Sarcoma
 Classification of Non Odontogenic Tumours
Bone tissue Lymphoid Tissue
Benign
Malignant
Osteoma
Malignant Lymphoma
Osteoid Osteoma
Non-Hodgkins Lymphoma
Benign Osteoblastoma
Reticular Cell Sarcoma
Malignant Burkitts Lymphoma
Osteosarcoma Hodgkins Disease
Muscle tissue Leukaemias
Benign Ewings Sarcoma
Leiomyoma Plasma Cell Tumours
Angiomyoma Multiple Myeloma
Plasmacytoma
Rhabdomyoma
Malignant
Leiomosarcoma
Rhabdomyosarcoma
 Classification of Non Odontogenic Tumours
Nerve Tissue Tumours of Disputed
Benign Origin
Neurofibroma Granular Cell
Neurolemmoma Myoblastoma
Malignant Congenital Epulis
Malignant Schannoma Alveolar Soft Part
Sarcoma
Tumour Like Lesions Melanotic
Peripheral Giant Cell Neuroectodermal tumour
Granuloma of infancy
CGCG Kaposis Sarcoma
Exostoses Ewings Sarcoma
Pyogenic Granuloma
Anurysmal Bone Cyst
Traumatic Neuroma
 Non-odontogenic tumors
Tumors are not arising from the tooth or tooth like structures :
Epithelial origin (mostly are premalignant)
Connective tissue origin
Fibroma (epulis)
Peripheral giant cell glanuloma
Lipoma
Vascular origin
Hemangioma
Lymphangioma
Nerve origin
Neurofibroma
Neurilemmoma (Schwannoma, Neuroma)
Muscle origin
Leiomyoma
Rhabdomyoma
Myoblastoma (Granular cell myoblastoma)
Bone origin
Tumor like of bone origin
Odontogenic Nonodontogenic
Osseous lesions
Odontoma
Ossifying fibroma

Ameloblastoma Juvenile ossifying fibroma

Periapical cemental dysplasia
Odontogenic myxoma Florid cemento-osseous dysplasia
Exostosis (torus mandibularis)
Calcifying epithelial Osteoma
Fibrous dysplasia
odontogenic tumor Paget disease

(Pindborg tumor) Nonosseous lesions

Cementoblastoma
Ameloblastic fibroma
Adenomatoid
odontogenic tumor
Neurofibroma
Schwannoma
Central giant cell granuloma (giant cell
reparative cyst)
Arteriovenous malformation (AVM)
Central hemangioma
Epulis fissuratum

Benign Lesions (Solid

Lesions)
 Prevalence of Solid
Benign Lesions
Most Less common
common
Calcifying epithelial
Odontoma odontogenic tumor
Fairly common (Pindborg tumor)
Ameloblastoma Ameloblastic fibroma
Periapical cemental Odontogenic myxoma
dysplasia* Cementoblastoma
Florid cemental dysplasia* Rare

Ossifying fibroma* Adenomatoid

odontogenic tumor
Juvenile ossifying
fibroma*
Clear cell odontogenic
tumor
*Nonodontogenic origin. Squamous odontogenic
tumor
Contains cystic and solid
Calcifying odontogenic
components. cyst
 Exostosis
These are peripheral osseous overgrowths or excess
of bone tissue.
Occur in the jaws as so called torus palatinus,
mandibularis, or multiple exostosis of the alveolar
bone.
Torus palatinus is the bone over growth which usually
occur in the midline of the palate, may be ,more or
less symmetrically arranged.
Torus mandibularis is often symmetrical bony over
growth of the lingual side of the mandible on the
premolar and canine region.
Tori are often found in older individuals and can grow
to a large size.
They are symptomless.
If they interfere with the fitting of denture the have to
be removed surgically.