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Growths of the gingiva and palate. III. Epithelial growths
Oral GROWTHS
Pathology
OF THE GINGIVA AND PALATE, GROWTHS
IIT.
EPITHELIAL
Introduction
T
IIR purpose of this portion of the report is to study and classify all types of epithelial growths that occur on the gingiva and palat,e. The epithelia! growths (papillomas, leucoplakia, adenoma, and squamous-cell carcinoma) make up 26 per cent of the growths found on the gin&a and palate. The benign epithelial growths arc to be distinguished by differential diagnosis from the malignant carcinomas. The sex and age incidence of this group is similar to that of the inflammatory growths, i.e., they occur more frequently in females and are illOre commonly found during the fourth and fifth decades. on the, other hand, the carcinomas differ in sex and age frequency. They occur about five times more frequently in males than in females and arc found during the later decades of life (Tahles I and 11).
Carcinom3 I’apilloma Leucoplalda &fixed-cell tumor drum the Ikthology, School *Dewrrtment California.
Department
of Dentistry, of Oral
1
1 ?
of
Pathology, UniversityHistopatholoay.
2 ‘7 ;
I 1 I 1
-I 10 .I --I
3 (i
I:{ ” i
1
1ti I (i
2
1
:uM the IXgartment School of Mt‘dicine, of Minnesota. School of Dcnti?;tr,p, I~niwrsity of
of
Oral
Soutlwrn
I. Carcinomas The squamous-cell carcinomas arising from the epithelium of the gingivacl show two gross forms : papillary and infiltrating. Papillary carcinomas of the jaw may resemble other types of gingival growt.hs so closely that biopsy is necessary for establishing the diagnosis. The) usually develop slowly and project into the oral cavity from the surface of the jaw in the gingival region. Involvement, of the periosteum and metastasis to the regional lymph nodes usually oc~r later than in the infiltrating type (Figs. 1 and 2). The infiltrating type presents a wide variety of clinical manifestations. Occasionally an infilkating cancer may show papillary projections into t,he
GROWTHS
OF GIKGIVA
ASD
PALATE.
L’J!J
III
mouth. The tumor usually develops rapidly and often there is bleeding fronr its ulcerated surface. An irregular progressive destruction of the underI;-in? alveolar process may be seen in the roentgenograph. The erosive infiltrating type of carcinoma presents an extensive but shallow\ destruction of the bony surface of the jaw. Instead of a projecting tumor thcrc is present a patch of leucoplakia on the alveolar process which presents a tlcpression, crack, or shallow ulceration. The more deeply infiltrating t,ypes arc more treacherous and tlificult to diagnose. Leucoplakia of long standin g may precede the development of I hc tumor. ACE IIWDEliC6
OF IzpI’ITiELIAL GRWl’I
No.
CARCINOMA
I
I
x’ ’ Fig.
DECADE
3.
An interesting form of infiltratin, ~7carcinoma is one associat,ed with estraction wounds. Usually the carcinomatous process is already established before the extraction of the tooth, and has by infilt,ration led to slight loosening and soreness. The tooth is extracted, and the dentist does not suspect carcinoma. The patient usually returns to the dentist because the tooth socket does not heal. As the tumor cells may extend deeply into the jaws, repeated roentgenographs will clarify the diagnosis. In other cases the margins of the sock&s will show ulceration and enlargement with perhaps an associated patch of leucoplakia. The dental film will show the deeper destruction of bone. Carcinoma of the gingivae and palate constituted 11,s per cent of growths of the gingivae. It, however, makes up only 0.2 per cent of all operative speciGingival carcinomas make up mens collected in the Department of Pathology. 2.8 per cent of the carcinomas occurring throughout the body. They arc found in 0.9 per cent of all oral lesions. These tnmors were found to be more prevalent in males than in females. There were 60 cases in males and 13 in females. C:nl*-
cinonlas appear ou the gingivae during the latter hall 01’ lift. ‘I’hc earliest cast occurred in the latter halC of the fourth tlccade. Srvcnty-two per writ of thcsc lesions appeared clurin~ Ihc swenth i\?ltl t>ightli tlwacles ( Fig. 3).
Darlington and COIT (1929) pointcti out 111at iu ulost textbooks, medical and dental, t,hc frequenry of cawinoma of the lip or tongue is emphasized, but little is said ahout gingival carcinomas. (Iapciuom;Is are found more frequentl?
on the mandible than on the maxilla. In the material studied there were 3i cases located on t,he mandible and only 19 on the maxilla. There were 21 cases situated on the left side of the mandible. About one-half of the lesions were t’ound in the molar region, posterior to the second permanent tnolnr. Four casts WPW found on the palate.
Fig.
i.-Squamous-cell
carcinoma. Note comifled q~ithelium.
epithelial (High
pearl consisting of magnification x 650.)
concentric
In:ws
of
Microscopic sections show a squamous-cell type of carcinoma. In the early stages they have t,he appearance of chronic inflammat~ion with marked infiltration of plasma cells and lymphocytes. Whether thin inflammatory reaction is a result, of the proliferation and infiltration of thr (>pithelium or the epithelial
infiltration is a result of the inflammat,ion is a dcbatablc question. The conncctive tissue papillae are hypertrophied and elongated. The squamous epit,helial cells increase in number and invade the underlying caonnective tissue (Figs. 4-7) As they invade the underlying tissue, thcly tna,v I*etain their typical form and appear as nests of coiled epithelial pearls. CASE 7.-The patient, a male aged 73 years, had a lower right first molar extracted about three months before his adrnission to the clinic. 11~ had noticed for about one and one-half years whitish patches on the buccal aspect of the first molar. The tooth socket failed to heal and presented an ulcerated surface. The patch of leucoplakia extended from the second molar forward to the buccal X-ray examination showed the premolar teet,ll surface of the two premolars. to be in good condition. Between the molar and premolar region there was shown in the x-ray an area of bone destruction apparently of the clrosivc type rather than of the infiltrating type. The right. half of the mandible was excised. Microscopic examination revealed a typical squamons-cell carcinoma. CASE S.-The patient, a male aged 58, had a tumorlike mass just external This has been growing for six or eight weeks to his lower left second premolar. Before that time the tooth was noted as before his appearance in the clinic. being carious and rough on its external surface. X-ray examination showed no bone involvement. The appearance OF the tumor suggested a benign epulis tather than malignancy. There were no areas 01’ 11le tllmor that seemed indurat,ed and there were no ~~:lpal~le lymph IIO~CS. The biopsy revealed a squamous-cell carcinoma.
II. Papilloma Papillomas are found on the gingivac and palate. The present study included 63 lesions or 7.3 per cent, of growths found on the gingivae and palate. The {tumors occurred in females in the same ratio as in males. Thirty-one patients were females; twenty-four were males. Papillomas occurred from the first decade of life to the eighth; however, three-fourths appeared during the fifth and sixth decades (Fig. 8). The majority of the tumors (19 cases) were situated on the palate; only 6 cases were found on t,hc mandible. Papillomas present an irregular surface which on probing seems to be made up of multiple small projections. They are usually pedunculated, but may also be attached by a broad base and may extend over a considerable area as seen in Pigs. 9 and 10. They vary in size from a small pea to the size of a hazelnut. Microscopically, these tumors consist of thin caonnective tissue cores which are covered with a layer of stratified squamous epithelium. Inflammation may or may not bc present (Fig. 11). If’ present. it maJ- bc due to local infection or it may be the result c,f ever-prescnl irritation found in the mouth. It has not been determined whether papillomas are true neoplasms or a simple response 13loodgood stated that these growths of the epithelium to chronic irritation. may develop f rant irritations I’roln t (Jet11or tic111ures, i.c., from burns 0 f cigars or other forms of t,obacco. The clinical course of a papilloma is usually benign, and in most cases the growth capacities nl-e limitrd.
15 no 14 13 12
PAPILLOMA
11 10 -
9 8
L
5 4
2 ii
Id Fig.
Fig. Fig. Fig.
9.-A lo.--.\
widespread small
8
9. papillonra Dapillomn
DECADE
Fig. on situatid
the
gingiva on the
of the palate.
mandible.
Nute
10. papillary
infolding.
III.
Leucoplakia
The simplest forttt of epitltelial tlisturhattw consists of a keratosis of the gingivae known as leucoplakia, which is considotwl hy man?- authors to hc a “precancerous lesion. ” (irossly, the ni~~cous ntcinbranc shows a whitish 01’ grayish-white patch. These patches arch slightly raised ahow the level of the ttt ncosa. Some form of chronic irritaltiott is Iwlicved to be iwponsiltle. Syphilis hut has been n~ucli overenihws often been regarded as an etiological I’ilClOt’, Irt*itation From fault,y dental restoration phasized especially hy French writers. or decayed teeth wit,h sharp edges may ol’tcn he related to leucoplakia. In the series of casts studied, 43 or 4.9 per wtit ot’ the Iesions were Ieucoplakia. Leucoplakia affects females wilh the sanw frequency as males. There were 15 cases 01253.3 per writ occurrin, ~‘1in females and 13 cases in malts. The \-oungest. patient, was 28 years old, and thr oldest was 78 years old. Forty-four per cent of the cases were in the seventh and eighth decades of life (Fig. 12). The maxilla was affected more frequently than the mandible. Seventy-six pet vent of the patients had lesions on the maxilla. Microsc’ol,ically the eJtitlteliunt sltow~ ntarl~c:d ihickening, the epithelial papillae are greatlv enlarged and deepottcd, ant1 thr surface is covcrcd with a thick layer of cornified epitht~lint~t. The cwnnwtivc~ tissur sltows marked changes of lymphocytes ant1 affecting the fiber ltundles (sclerosis i ( with infiltration plasma, ~11s (Fig. 13)
leucoplakia CASE lO.-The patient, a 56-pear-old man, had a papillary extending distally from the lateral incisor to the tuherosit,y on the labial and lmccal surfaces of the alveolar process and from the serond premolar distally to the third molar along the gingiva and the palate (Fig. 1-t). There was a papillomatous growth in the area From which the first molar was extracted.
LEXJCOPLAKIA
76-w 54-
3-
This extended to the mucosa of the cheek as a. corrugated surface opposite the molar teeth. There was a large area of leucoplakia extending from the part opposite the occlusal surface of the lower teeth to the corrugated area covering the distal half of the cdheek. The patieltt smoked four or five cigars a day. Hc
was first operated on four years previously, but noticed a recurrcncc about five months previously. He felt pain only when chewing on the area. The area was excised by eaulcry. The microscopic csanlination rcvealcd 1europlaki:l.
Adenomas of t,he gingiva and palate arc quite rare; only 0.45 per cent of the growths on the gingivae were adcnornas; howcvcr, adenoma may occur in t.he palate as a component of mixed tumors.
V. Adamantinoma Adamantinoma may occur as a polylikc growth on the alveolar border and may closely simulat,c the appearance of giant-cell tumor or other types of growths. Ewing has noticed that it “may project from the alveolar border as It was a form of epulis. ” Only one case occurred in the material studied. found in a female, aged 67 years. She had a few remaining lower teeth with an anterior bridge, which was removed in ,January, 1931. A slight abnormalit,? was noticed by the dentist at that time, and three months later a tumor was Tn April a biopsy was done, and a diagnoted in the region of the symphysis. nosis of adamantinoma was made.
VI. Mixed Tumors Mixed tumors containing both epithelial and connective tissue elements occur in various localities in or about the oral cavity, such as in the salivary glands and on the palate. New and Childre>- 11931) in their study of seventyfour cases of mixed-cell tumors of t.hc pharynx and palate (56 per cent in the palate) came to the conclusion that such neoplasms arc potentially malignant, and therefore they should be called ;ldelloc~arc~inc,Inas instead of’ mixed-cell tumors. McFarland in his study found that thcsc tumSrs rarely become sarcomatous. Eggers (1928) and D’Anno (1930) regarded them a4 benign.
Nixed tumors made up 2.5 per cent of growths appearing on the gingivatr and palate. There were 21 casts in our series. All the tumors appeared to IW located on the palate. They appeared i’rom the second t,o t.he seventh decades of life (Fig. 15). The disease affects females with the same frequency as males. Mixed tumors are individual neoplastic formations not related to other tumors or to the tissue in which they grow. They arc probably derived from embryonic2 cell rests. The cpithelial elements may be arranged in strands or cords and ma) simulate an adenocarcinoma, or they may consist of diffuse masses of cells. Tltv mesoblastic tissue may consist of cellular connectSi\-e tissue, muscle, cartilage, or bone. In the various tumors any one of these tissues may predominate. producing a pure carcinoma or sarcoma. AS a rule three types of tissues are present, in every tumor : cartilage. epithelium, and fibrous tissue.
MIXED-CELL TUMOR 10 No, 9 8 7
1 -
56 4
II -
23
z
L-
-
1
’ 2 ‘3
‘4
’ 5 ‘6 Fig.
Fig.
lfi.--A
mixc(l-ccl1
tunlor
’ 7 ’ 8 ‘9
‘10 ‘Decade
15.
situated
on
the
palate.
These tumors are usually circurnseribed and the surface is always smooth and normal unless interfered wilh. Pain is absent, and discomfort appears only when the tumor assumes large dimensions (Fig. 16).
References I~lood~oo~l, .I. t’.: (knt ral Lesions OF the Lovcer Jaw. .J. Am. Dent. A. 20: l!)C!fi-L’Ol:S, I!)::::. I~lun~, ‘I’.: Jlixrtl Tumors of the Palat,e, Dental (losmos 34: i-I-5, 1932. Ibyko, I,.: Mixed (‘ell Tumor of the Palate, .J. Am. Dent. A. 13: 158, 19Z6. I)arlington, C+. (+., and (‘err, 1’. S.: Cancer of the Month I+om it Dental Stanllpoint. .r. Am. Dent. A. 16: X129, 19%. I) ‘Aunoy, R.: llixed Tumors of the Palate, Am. .I. Path. 6: lXi, 1!):10. Qgers, H. F;.: Mired Tumors of the Palate, Arch. Path. 6: 3%. 1928. Qullifer, H. W.: Papilloma, Am. J. Orthodontics and Oral Surg. 24: X84, lH:Ill. JIalignant Growths of the Head and Neck, Dental Cosmos 77: T,(; 1:):~ Kress, I,. (i.: J,yons, C’. J.: Malignant and Other Growths Ahout the Mouth, J. Am. Dent. A! 20: 3, lo).?::. 3leans, J. W.: Precancerous Lesions of the Face, Dental Digest 45: 122, 1916. h’ew, G. H., and C’hildrey, .I.: Benign Tumors of Tonsil and Pharynx, Arch. OtolaryI1F;. 14: 49, 193 1. Tun~ors of t,he Cpper Jaw, Arch. f. klin. Chir. 167: iti!I, I!J:<~. Pichler, H.: Malignant Bein, C. R.: Mixed Tumors of the Palate, .I. Am. Dent. A. 23: 1X10, IOK ShrnofY, .I. C., and Lisa, -1. J.: Adenocarcinnma Arising +‘rom MUC~OUS (:laltds of the Palate, Arch. Otolar\-ng. 31: 185, ICMI. Stout? A.: Tumors of the Palate, Dental (‘osmns 78: 440. I!l::Ci.
Pathology
OF THE GINGIVA AND PALATE, GROWTHS
IIT.
EPITHELIAL
Introduction
T
IIR purpose of this portion of the report is to study and classify all types of epithelial growths that occur on the gingiva and palat,e. The epithelia! growths (papillomas, leucoplakia, adenoma, and squamous-cell carcinoma) make up 26 per cent of the growths found on the gin&a and palate. The benign epithelial growths arc to be distinguished by differential diagnosis from the malignant carcinomas. The sex and age incidence of this group is similar to that of the inflammatory growths, i.e., they occur more frequently in females and are illOre commonly found during the fourth and fifth decades. on the, other hand, the carcinomas differ in sex and age frequency. They occur about five times more frequently in males than in females and arc found during the later decades of life (Tahles I and 11).
Carcinom3 I’apilloma Leucoplalda &fixed-cell tumor drum the Ikthology, School *Dewrrtment California.
Department
of Dentistry, of Oral
1
1 ?
of
Pathology, UniversityHistopatholoay.
2 ‘7 ;
I 1 I 1
-I 10 .I --I
3 (i
I:{ ” i
1
1ti I (i
2
1
:uM the IXgartment School of Mt‘dicine, of Minnesota. School of Dcnti?;tr,p, I~niwrsity of
of
Oral
Soutlwrn
I. Carcinomas The squamous-cell carcinomas arising from the epithelium of the gingivacl show two gross forms : papillary and infiltrating. Papillary carcinomas of the jaw may resemble other types of gingival growt.hs so closely that biopsy is necessary for establishing the diagnosis. The) usually develop slowly and project into the oral cavity from the surface of the jaw in the gingival region. Involvement, of the periosteum and metastasis to the regional lymph nodes usually oc~r later than in the infiltrating type (Figs. 1 and 2). The infiltrating type presents a wide variety of clinical manifestations. Occasionally an infilkating cancer may show papillary projections into t,he
GROWTHS
OF GIKGIVA
ASD
PALATE.
L’J!J
III
mouth. The tumor usually develops rapidly and often there is bleeding fronr its ulcerated surface. An irregular progressive destruction of the underI;-in? alveolar process may be seen in the roentgenograph. The erosive infiltrating type of carcinoma presents an extensive but shallow\ destruction of the bony surface of the jaw. Instead of a projecting tumor thcrc is present a patch of leucoplakia on the alveolar process which presents a tlcpression, crack, or shallow ulceration. The more deeply infiltrating t,ypes arc more treacherous and tlificult to diagnose. Leucoplakia of long standin g may precede the development of I hc tumor. ACE IIWDEliC6
OF IzpI’ITiELIAL GRWl’I
No.
CARCINOMA
I
I
x’ ’ Fig.
DECADE
3.
An interesting form of infiltratin, ~7carcinoma is one associat,ed with estraction wounds. Usually the carcinomatous process is already established before the extraction of the tooth, and has by infilt,ration led to slight loosening and soreness. The tooth is extracted, and the dentist does not suspect carcinoma. The patient usually returns to the dentist because the tooth socket does not heal. As the tumor cells may extend deeply into the jaws, repeated roentgenographs will clarify the diagnosis. In other cases the margins of the sock&s will show ulceration and enlargement with perhaps an associated patch of leucoplakia. The dental film will show the deeper destruction of bone. Carcinoma of the gingivae and palate constituted 11,s per cent of growths of the gingivae. It, however, makes up only 0.2 per cent of all operative speciGingival carcinomas make up mens collected in the Department of Pathology. 2.8 per cent of the carcinomas occurring throughout the body. They arc found in 0.9 per cent of all oral lesions. These tnmors were found to be more prevalent in males than in females. There were 60 cases in males and 13 in females. C:nl*-
cinonlas appear ou the gingivae during the latter hall 01’ lift. ‘I’hc earliest cast occurred in the latter halC of the fourth tlccade. Srvcnty-two per writ of thcsc lesions appeared clurin~ Ihc swenth i\?ltl t>ightli tlwacles ( Fig. 3).
Darlington and COIT (1929) pointcti out 111at iu ulost textbooks, medical and dental, t,hc frequenry of cawinoma of the lip or tongue is emphasized, but little is said ahout gingival carcinomas. (Iapciuom;Is are found more frequentl?
on the mandible than on the maxilla. In the material studied there were 3i cases located on t,he mandible and only 19 on the maxilla. There were 21 cases situated on the left side of the mandible. About one-half of the lesions were t’ound in the molar region, posterior to the second permanent tnolnr. Four casts WPW found on the palate.
Fig.
i.-Squamous-cell
carcinoma. Note comifled q~ithelium.
epithelial (High
pearl consisting of magnification x 650.)
concentric
In:ws
of
Microscopic sections show a squamous-cell type of carcinoma. In the early stages they have t,he appearance of chronic inflammat~ion with marked infiltration of plasma cells and lymphocytes. Whether thin inflammatory reaction is a result, of the proliferation and infiltration of thr (>pithelium or the epithelial
infiltration is a result of the inflammat,ion is a dcbatablc question. The conncctive tissue papillae are hypertrophied and elongated. The squamous epit,helial cells increase in number and invade the underlying caonnective tissue (Figs. 4-7) As they invade the underlying tissue, thcly tna,v I*etain their typical form and appear as nests of coiled epithelial pearls. CASE 7.-The patient, a male aged 73 years, had a lower right first molar extracted about three months before his adrnission to the clinic. 11~ had noticed for about one and one-half years whitish patches on the buccal aspect of the first molar. The tooth socket failed to heal and presented an ulcerated surface. The patch of leucoplakia extended from the second molar forward to the buccal X-ray examination showed the premolar teet,ll surface of the two premolars. to be in good condition. Between the molar and premolar region there was shown in the x-ray an area of bone destruction apparently of the clrosivc type rather than of the infiltrating type. The right. half of the mandible was excised. Microscopic examination revealed a typical squamons-cell carcinoma. CASE S.-The patient, a male aged 58, had a tumorlike mass just external This has been growing for six or eight weeks to his lower left second premolar. Before that time the tooth was noted as before his appearance in the clinic. being carious and rough on its external surface. X-ray examination showed no bone involvement. The appearance OF the tumor suggested a benign epulis tather than malignancy. There were no areas 01’ 11le tllmor that seemed indurat,ed and there were no ~~:lpal~le lymph IIO~CS. The biopsy revealed a squamous-cell carcinoma.
II. Papilloma Papillomas are found on the gingivac and palate. The present study included 63 lesions or 7.3 per cent, of growths found on the gingivae and palate. The {tumors occurred in females in the same ratio as in males. Thirty-one patients were females; twenty-four were males. Papillomas occurred from the first decade of life to the eighth; however, three-fourths appeared during the fifth and sixth decades (Fig. 8). The majority of the tumors (19 cases) were situated on the palate; only 6 cases were found on t,hc mandible. Papillomas present an irregular surface which on probing seems to be made up of multiple small projections. They are usually pedunculated, but may also be attached by a broad base and may extend over a considerable area as seen in Pigs. 9 and 10. They vary in size from a small pea to the size of a hazelnut. Microscopically, these tumors consist of thin caonnective tissue cores which are covered with a layer of stratified squamous epithelium. Inflammation may or may not bc present (Fig. 11). If’ present. it maJ- bc due to local infection or it may be the result c,f ever-prescnl irritation found in the mouth. It has not been determined whether papillomas are true neoplasms or a simple response 13loodgood stated that these growths of the epithelium to chronic irritation. may develop f rant irritations I’roln t (Jet11or tic111ures, i.c., from burns 0 f cigars or other forms of t,obacco. The clinical course of a papilloma is usually benign, and in most cases the growth capacities nl-e limitrd.
15 no 14 13 12
PAPILLOMA
11 10 -
9 8
L
5 4
2 ii
Id Fig.
Fig. Fig. Fig.
9.-A lo.--.\
widespread small
8
9. papillonra Dapillomn
DECADE
Fig. on situatid
the
gingiva on the
of the palate.
mandible.
Nute
10. papillary
infolding.
III.
Leucoplakia
The simplest forttt of epitltelial tlisturhattw consists of a keratosis of the gingivae known as leucoplakia, which is considotwl hy man?- authors to hc a “precancerous lesion. ” (irossly, the ni~~cous ntcinbranc shows a whitish 01’ grayish-white patch. These patches arch slightly raised ahow the level of the ttt ncosa. Some form of chronic irritaltiott is Iwlicved to be iwponsiltle. Syphilis hut has been n~ucli overenihws often been regarded as an etiological I’ilClOt’, Irt*itation From fault,y dental restoration phasized especially hy French writers. or decayed teeth wit,h sharp edges may ol’tcn he related to leucoplakia. In the series of casts studied, 43 or 4.9 per wtit ot’ the Iesions were Ieucoplakia. Leucoplakia affects females wilh the sanw frequency as males. There were 15 cases 01253.3 per writ occurrin, ~‘1in females and 13 cases in malts. The \-oungest. patient, was 28 years old, and thr oldest was 78 years old. Forty-four per cent of the cases were in the seventh and eighth decades of life (Fig. 12). The maxilla was affected more frequently than the mandible. Seventy-six pet vent of the patients had lesions on the maxilla. Microsc’ol,ically the eJtitlteliunt sltow~ ntarl~c:d ihickening, the epithelial papillae are greatlv enlarged and deepottcd, ant1 thr surface is covcrcd with a thick layer of cornified epitht~lint~t. The cwnnwtivc~ tissur sltows marked changes of lymphocytes ant1 affecting the fiber ltundles (sclerosis i ( with infiltration plasma, ~11s (Fig. 13)
leucoplakia CASE lO.-The patient, a 56-pear-old man, had a papillary extending distally from the lateral incisor to the tuherosit,y on the labial and lmccal surfaces of the alveolar process and from the serond premolar distally to the third molar along the gingiva and the palate (Fig. 1-t). There was a papillomatous growth in the area From which the first molar was extracted.
LEXJCOPLAKIA
76-w 54-
3-
This extended to the mucosa of the cheek as a. corrugated surface opposite the molar teeth. There was a large area of leucoplakia extending from the part opposite the occlusal surface of the lower teeth to the corrugated area covering the distal half of the cdheek. The patieltt smoked four or five cigars a day. Hc
was first operated on four years previously, but noticed a recurrcncc about five months previously. He felt pain only when chewing on the area. The area was excised by eaulcry. The microscopic csanlination rcvealcd 1europlaki:l.
Adenomas of t,he gingiva and palate arc quite rare; only 0.45 per cent of the growths on the gingivae were adcnornas; howcvcr, adenoma may occur in t.he palate as a component of mixed tumors.
V. Adamantinoma Adamantinoma may occur as a polylikc growth on the alveolar border and may closely simulat,c the appearance of giant-cell tumor or other types of growths. Ewing has noticed that it “may project from the alveolar border as It was a form of epulis. ” Only one case occurred in the material studied. found in a female, aged 67 years. She had a few remaining lower teeth with an anterior bridge, which was removed in ,January, 1931. A slight abnormalit,? was noticed by the dentist at that time, and three months later a tumor was Tn April a biopsy was done, and a diagnoted in the region of the symphysis. nosis of adamantinoma was made.
VI. Mixed Tumors Mixed tumors containing both epithelial and connective tissue elements occur in various localities in or about the oral cavity, such as in the salivary glands and on the palate. New and Childre>- 11931) in their study of seventyfour cases of mixed-cell tumors of t.hc pharynx and palate (56 per cent in the palate) came to the conclusion that such neoplasms arc potentially malignant, and therefore they should be called ;ldelloc~arc~inc,Inas instead of’ mixed-cell tumors. McFarland in his study found that thcsc tumSrs rarely become sarcomatous. Eggers (1928) and D’Anno (1930) regarded them a4 benign.
Nixed tumors made up 2.5 per cent of growths appearing on the gingivatr and palate. There were 21 casts in our series. All the tumors appeared to IW located on the palate. They appeared i’rom the second t,o t.he seventh decades of life (Fig. 15). The disease affects females with the same frequency as males. Mixed tumors are individual neoplastic formations not related to other tumors or to the tissue in which they grow. They arc probably derived from embryonic2 cell rests. The cpithelial elements may be arranged in strands or cords and ma) simulate an adenocarcinoma, or they may consist of diffuse masses of cells. Tltv mesoblastic tissue may consist of cellular connectSi\-e tissue, muscle, cartilage, or bone. In the various tumors any one of these tissues may predominate. producing a pure carcinoma or sarcoma. AS a rule three types of tissues are present, in every tumor : cartilage. epithelium, and fibrous tissue.
MIXED-CELL TUMOR 10 No, 9 8 7
1 -
56 4
II -
23
z
L-
-
1
’ 2 ‘3
‘4
’ 5 ‘6 Fig.
Fig.
lfi.--A
mixc(l-ccl1
tunlor
’ 7 ’ 8 ‘9
‘10 ‘Decade
15.
situated
on
the
palate.
These tumors are usually circurnseribed and the surface is always smooth and normal unless interfered wilh. Pain is absent, and discomfort appears only when the tumor assumes large dimensions (Fig. 16).
References I~lood~oo~l, .I. t’.: (knt ral Lesions OF the Lovcer Jaw. .J. Am. Dent. A. 20: l!)C!fi-L’Ol:S, I!)::::. I~lun~, ‘I’.: Jlixrtl Tumors of the Palat,e, Dental (losmos 34: i-I-5, 1932. Ibyko, I,.: Mixed (‘ell Tumor of the Palate, .J. Am. Dent. A. 13: 158, 19Z6. I)arlington, C+. (+., and (‘err, 1’. S.: Cancer of the Month I+om it Dental Stanllpoint. .r. Am. Dent. A. 16: X129, 19%. I) ‘Aunoy, R.: llixed Tumors of the Palate, Am. .I. Path. 6: lXi, 1!):10. Qgers, H. F;.: Mired Tumors of the Palate, Arch. Path. 6: 3%. 1928. Qullifer, H. W.: Papilloma, Am. J. Orthodontics and Oral Surg. 24: X84, lH:Ill. JIalignant Growths of the Head and Neck, Dental Cosmos 77: T,(; 1:):~ Kress, I,. (i.: J,yons, C’. J.: Malignant and Other Growths Ahout the Mouth, J. Am. Dent. A! 20: 3, lo).?::. 3leans, J. W.: Precancerous Lesions of the Face, Dental Digest 45: 122, 1916. h’ew, G. H., and C’hildrey, .I.: Benign Tumors of Tonsil and Pharynx, Arch. OtolaryI1F;. 14: 49, 193 1. Tun~ors of t,he Cpper Jaw, Arch. f. klin. Chir. 167: iti!I, I!J:<~. Pichler, H.: Malignant Bein, C. R.: Mixed Tumors of the Palate, .I. Am. Dent. A. 23: 1X10, IOK ShrnofY, .I. C., and Lisa, -1. J.: Adenocarcinnma Arising +‘rom MUC~OUS (:laltds of the Palate, Arch. Otolar\-ng. 31: 185, ICMI. Stout? A.: Tumors of the Palate, Dental (‘osmns 78: 440. I!l::Ci.