外语读物2009,05,06.doc

,MULTIPLE PRIMARY MALIGNANT TUMORS The oral mucosa or jaws are often involved in those unusual widespread malignant tumors that are of apparent multicentric origin rather than metastatic. The oral mucosa maybe involved with lesiohs of Kaposis sarcoma. The jaws may be involved with lesions of multiple myeloma or Ewings sarcoma. Kaposis Sarcoma Kaposis sarcoma (idiopathic multiple hemorrhagic sarcoma) is a well- established entity, occurring on the skin and occasionally on the oral mucosa and other mucosal sites. It is found predominantly in males and the onset is usually after age 40. Kaposis sarcoma is an unusual malignant tumor of blood vessel origin. The lesions are composed of numerous dilated, engorged blood vessels and the microscopic appearance is that of a well-differentiated malignant tumor of endothelial cells. Early Kaposi lesions may resemble nonspecific, granulomatous, inflammatory lesions microscopically, but there is a gradual proliferation of connective tissue and an overgrowth of endothelial cells to form large numbers of vascular channels. An angiomatous or a fibroblastic pattern may predominate. Mitotic figures are seen as well as atypical spindle- shaped cells. Bizarre cell forms and bizarre mitoses are not found in Kaposis sarcoma. Prognosis for patients with Kaposis sarcoma is generally good and is far more favorable than that for other malignant tumors of endothelial cells. Prognosis for other forms of angiosarcoma is poor. Kaposis sarcoma is treated by surgical excision, cryotherapy, or radiation therapy. The tumor is radiosensitive, and most lesions are treated by this modality. Because the lesions are highly radiosensitive, low dosages such as 200 reds in divided doses can be effective. Clinical manifestations. Clinical manifestations of oral Kaposis sarcoma may be red-purple macular lesions such as those seen on the skin, with eventual development of raised, indurated lesions with central areas of necrosis and ulceration (Fig..18.16). Coex