14.1 Bone Pathology Flashcards
What are features of benign bone neoplasias?
- asymptomatic
- symmetrical
- displaces teeth
- expands cortex
- corticated rim on radiograph
What are features of malignant bone neoplasias?
- symptomatic
- asymmetrical
- extends past cortex
- ill-defined borders
- destroys adjacent structures, including teeth
osteogenesis imperfecta is a defect in what?
Collagen Type I maturation
What is the most common inherited bone disease?
osteogenesis imperfecta
How does osteogenesis imperfecta present clinically?
- blue sclera
- altered teeth (brown to blue)
- long bone/spine deformities
- hearing loss
What is this feature called?
Wormian bones of the skull (mosaic pattern)
What disease is this feature associated with?
Osteogenesis Imperfecta
What type of Osteogenesis imperfecta is the mildest and most common, and which is the most severe?
Type I is mildest
Type III is most severe
What is also known as the “marble bone disease”?
osteopetrosis
What is adult-type osteopetrosis also called?
Benign osteopetrosis
What is unique about this patient’s radiograph?
Bone is more radiopaque than normal. Probably has osteopetrosis.
What are these lesions caused by?
Osteopetrosis caused his bone to necrose, leading to these fistulous tracts.
Why are this child’s eyes blue?
osteogenesis imperfecta
Pt sits down in chair and presents with these teeth. Eyes are blue and legs are bowed. What are you thinking they might have?
osteogenesis imperfecta
What are characteristics of infantile osteopetrosis?
- poor prognosis
- marrow failure
- facial deformities
- frequent fractures
This is clearly not natural. What could they have if their teeth are also involved?
cleidocranial dysplasia
This pano looks good right? No. What does this patient have?
cleidocranial dysplasia
What are some features of Cleidocranial dysplasia?
- prolonged retention of primary teeth
- supernumary teeth
- clavicular hypoplasia
- high-arched palate
What is an increased radiolucency of the bone marrow called?
Focal Osteoporotic Marrow Defect
Features of Focal Osteoporotic Marrow Defect?
- no jaw expansion
- ill-defined borders
- fine central trabeculations
- typically asymptomatic
Define Idiopathic Osteosclerosis.
A focal area of increased radiodensity that is of unknown cause but cannot be attributed to anything else
What is this? (hint: no hx of infection)
Idiopathic osteosclerosis
What is this?
idiopathic osteosclerosis
What are radiographic features of idiopathic osteosclerosis?
- well-defined borders
- usually associated w/ root apex
- more radiopaque than surrounding bone
How should you treat idiopathic osteosclerosis?
No treatment is necessary unless there are symptoms or the bone pathology keeps growing
Pt has a clinically obvious Mn deformity and reports pain. You report extreme tooth mobility in Q3. What could this be?
massive osteolysis
This pathology presents more in children and young adults, and is seen more in the Mn than the Mx. It typically results with the total loss of the bone affected. What is this?
massive osteolysis
(pt has obvious deformity, pain, tooth mobility, and deviation of the mandible)
What bone pathology is abnormal deposition and resorption of bone, commonly polyostotic, and forms near joints?
paget’s disease of bone
What sign is noted when pt has paget’s disease of the skull?
Increasing circumference of the skull
What is leontiasis ossea?
A “lion-like” facial deformity where the middle 1/3 of the face is enlarged (seen in Paget’s disease)
What is the appearance of bone upon radiograph in Paget’s disease of bone?
cotton wool or cotton roll
The cotton roll appearance of bone here may suggest what pathology?
Paget’s disease of bone
How would you describe this pt’s mandible? What polyostotic disease is this?
- cotton wool appearance
- paget’s disease of bone
What bone pathology frequently occurs in the anterior mandible and crosses the midline?
Central Giant Cell Granuloma
What two other pathologies should be tested for if you think it’s central giant cell granuloma?
brown tumor of hyperthyroidism and cherubism
This pathology is not considered a neoplastic condition, and frequently involves the anterior Mn. What is this?
Central giant cell granuloma
This will histologically appear like brown tumor of hyperthyroidism. What is this?
central giant cell granuloma
What is this developmental jaw condition that usually goes away by 30 years old?
cherubism
What are two physical features of people with cherubism?
- plump cheeks
- upturned eyes
What is the disease course of cherubism?
- Dx usually between 2-5
- Disease progresses through puberty
- Disease usually resides by 30
What is this?
Cherubism
What is a traumatic bone cyst?
A benign, empty, or fluid filled cavity within the bone.
Why is the name traumatic bone cyst a misnomer?
Because the cavity is NOT lined by epithelium like a true cyst.
What is this cavity called? (hint: not lined by epithelium)
Traumatic bone cyst
You get into this bone during surgery and find no epithelial lining. What is your likely diagnosis?
Simple bone cyst
(aka traumatic bone cyst)
What a unique radiographic feature seen in simple bone cysts?
“scalloped” border along the tooth roots
What age range is most popular to see Traumatic bone cysts?
10-20 yrs
You see a radiolucent area on the radiograph and upon surgery find this. What is this? (hint: hole was there and no lining was seen in hole)
Traumatic bone cyst
Define Aneurysmal Bone Cyst.
An intraosseus accumulation of blood-filled spaces surrounded by connective tissue.
Why is an Aneurysmal bone cyst not a true cyst?
It doesn’t have an epithelial lining
Unilateral x-ray finding on 20 year old patient. They report pain and that it developed quickly. What could this be?
Aneurysmal bone cyst
What age is most common to see an aneurysmal bone cyst?
20 yrs old
What is the most common clinical sign of an aneurysmal bone cyst?
Rapid swelling of the mandible
Image shows intraosseus bone surrounded by connective tissue. What is this?
Aneurysmal bone cyst
What is the clinical appearance of an Aneurysmal bone cyst?
A “blood-soaked” sponge
What are three examples of fibro-osseous lesions?
- fibrous dysplasia
- cemento-osseous dysplasia (types: focal, periapical, florid)
- ossifying fibroma
What kind of benign fibro-osseous lesion is characterized by the replacement of normal bone by fibrous CT with altered bone?
Fibrous dysplasia
Define polyostotic.
Involving multiple bones
What types of fibrous dysplasia are there?
Monostotic and polyostotic.
What are two syndromes associated with polyostotic fibrous dysplasia?
- Jaffe-Lichtenstein syndrome
- McCune-Albright syndrome
Polyostotic fibrous dysplasia, coast of maine cafe au lait spots, and multiple endocrinopathies are diagnostic for which syndrome?
McCune-Albright syndrome
What is the radiographic evidence of monostotic fibrous dysplasia?
A “ground-glass” appearance
Bone has a ground-glass appearance. What is this?
Monostotic fibrous dysplasia
Radiograph suggests fibrous dysplasia and pt has coast of maine cafe au lait spots. What syndrome might they have?
Jaffe-Lictenstein syndrome
If your pt presents with polyostotic fibrous dysplasia, cafe au lait spots (coast of maine), and reports very early puberty - what syndrome might they have?
McCune-Albright syndrome
What is the most common fibro-osseous lesion encountered in clinical practice?
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia occurs most commonly in what demographic?
African-american (and 90% are females)
What differentiates focal cemento-osseous dysplasia from Idiopathic osteosclerosis and condensing osteitis?
A thin radiolucent rim around the lesion.
Pt is a 40 yr old black female. What can the radiograph be showing?
Focal cemento-osseous dysplasia
What is the physical difference between focal, periapical, and florid cemento-osseous dysplasia?
Focal is local to one tooth
Periapical is root(s)
Florid is generalized
Based on the RO core and RL border of this lesion, what kind of cemento-osseous dysplasia is this?
Periapical
What area of the mouth is involved with periapical cemento-osseous dysplasia?
Anterior mandible
What could this florid condition be?
Florid cemento-osseous dysplasia
Biopsy of florid COD can cause what to happen to the bone?
Can become necrotic from hypovascularity
Root divergence or resorption can occur with what kind of benign fibro-osseous lesion?
ossifying fibroma
What unique physical feature shows with large ossifying fibromas?
A downward bowing of the inferior cortex of the mandible
Do ossifying fibromas undergo malignant transformation?
Nopers
Ossifying fibroma occurs more in the Mx or Mn? And in females or males?
Mn > Mx
F > M
Does juvenile ossifying fibroma occur more in the Mn or Mx? And in females or males?
Mn < Mx
F < M
What are the two variants of juvenile ossifying fibroma?
Trabecular and Psammomatoid
Is this psammomatoid or trabecular juvenile ossifying fibroma?
Psammomatoid
What is a benign tumor of mature bone called?
Osteoma
What location of osteoma is most common?
paranasal sinus
Multiple osteomas might be a sign the patient has ________ _________.
Gardner syndrome
Gardner Syndrome is characterized by what manifestations?
- colonic polyps/adenocarcinoma
- skeletal abnormalities
- pigmented ocular fundus
- supernumerary teeth
T or F: Colonic polyps in Gardner Syndrome WILL transform into adenocarcinoma.
True
What is the most common skeletal abnormality of Gardner Syndrome?
osteomas
Both osteoblastomas and osteoid osteomas produce prostaglandins, but which one is relieved by aspirin?
Osteoid osteomas (because they’re smaller than 2cm and produce less prostaglandins)
What is an odontogenic neoplasm of cementoblasts that’s almost always seen in the molar/premolar region?
Cementoblastoma
Is the PDL dinstinctly visible in cementoblastomas?
No, and the cementoblastoma is surrounded by a thin RL rim
What is this?
cementoblastoma
