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oral path 2 > 3 - bone neoplasms > Flashcards

3 - bone neoplasms Flashcards

1
Q

3 benign neoplasms of bone

A

central ossifying fibroma (hyperparathyroidism-jaw tumor syndrome)

Osteoma (gardner syndrome)

central giant cell granuloma (hyperparathyroidism, renal osteodystrophy)

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2
Q

3 malignant neoplasms of bone

A

chondrosarcoma

osteosarcoma

metastatic disease

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3
Q

benign
confused with focal cemento-osseous dysplasia in past
orging PDL? Odontogenic? ~controversy
these tumors also seen outside the jaws
most consider it to be an osteogenic neoplasm

A

central ossifying fibroma

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4
Q

central ossifying fibroma

common/uncommon
young or adult
male or female
symptomatic/asympto
expansion or none

where in mouth

A

uncommon - rare

adult 3/4 decade

female predilection

asymptomatic esp when small

may see jaw expansion - facial asymm to significaint deformity

primarily mandibular molar/PM region - but also maxilla

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5
Q

radiographic features

usually uniocular (occasionally multilocular

well circumscribed with varying amount of central opacity - range from almost completely radiolucent to radiodense with a defined lucent border
resembles focal cemento-osseous dysplasia

A

central ossifying fibroma (benign)

can cause expansion and root divergence

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6
Q

histopathic features

fibrous tissue with variable mixture of bony trabeculae and cementum like material
mineralized product in cellular fibrous CT
microscopically similar to fibrous dysplasia: need radiograph for correlation

A

central ossifying fibroma

usually shells out in one piece

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7
Q

Tx for central ossifying fibroma

Px and recurrence?

A

enucleation - lesion tends to shell out as one mass

excellent Px and recurrence uncommon

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8
Q

multiple jaw lesions that histopathologically are consistent with central ossifying fibroma

A

hyperparathyoid jaw tumor syndrome

hyperparathuroidism - hypercalcemia

increased risk for development of parathyroid carcinoma

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9
Q

benign
palatal tori, mandibular tori, buccal exostoses are NOT considered to be _, although they are histopathologically identical
composed of compact or cancellous bone

A

osteomas

osteomas are confirmed by continuous growth

NOT osteomas

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10
Q

Osteoma - benign

young/adult
sympto/asymptp
fast/slow growing

A

adult

usually painless, but pain/swelling possible

slow growing

may arise on the bone surface (exostosis) or within bone (enostosis)

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11
Q

benign bone neoplasm

paranasal sinus involvement (frontal, ethomoid and maxillary) more common than gnathic lesions

if gnathic lesions - body of mandible and condyle most often, (inferior border of angle. coronoid process and ramus also)

A

osteoma

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12
Q

osteoma clinical locations

A

paranasal sinus - most often

body of mandible often lingual PM/molar region

condylar involvement may limit opening - maloclussion- midline deviation and chin to UNAFFECTED SIDE

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13
Q

radiographic features

circumscribed radiopaque mass
periosteal may be uniformly sclerotic or have central trabeculations

endosteal may appear similar/idential to idiopathic osteosclerosis or condensing osteitis

A

osteoma

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14
Q

radiographically endosteal within bone osteoma looks like _

A

idiopathic osteosclerosis or condensing osteitis

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15
Q

histopathological features

dense bone, minimal marrow or trabeculae and fibrofatty marrow

A

osteoma

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16
Q

osteoma tx Px

A

tx - non if small and sympto - observe

conservative excision
condylar osteomas usually symptomatic - local resection or condylectomy

Px - good

rare recurrence

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17
Q

if multiple osteomas - need to rule out _, uncommon autosomal domintant, highly penetrant (most people with the mutation will develop the disease)

~30% new mutations

A

gardner syndrome

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18
Q

most common cancers seen in bone

A

metastatic cancer
multiple myeloma
osteosarcoma
condylata sarcoma

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19
Q

one of several polyposis syndromes

most significant aspect is development of precancerous polyps of the colon

A

osteoma - Gardner syndrome

generally refers to cases in which the extra intestinal manifestations are especially prominent

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20
Q

multiple osteoma - Gardner syndrome

intestinal polyps; one of the multiple intestinal polyposis syndromes

colorectial polps develop by 2nd decade, ultimately transform to _

A

adenocarcinoma

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21
Q

multiple osteomas, develop around puberty
epidermoid cysts
desmoid tumors (locally aggressive fibrous neoplasms of soft tisssue)

A

Osteoma - Gardner syndrome

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22
Q

osteoma and Gardner Syndrome abnormalities of teeth

A

impacts
supernumerary teeth ~35%
odontomas ~10% cases

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23
Q

Osteoma - Gardner syndorme

can resemble _ cemento-osseous dysplasia or _

radiopacities ranging from a few mm to several cm in diameter

A

florid COD

or fibrous dysplasia

24
Q

histopatholgoical features

keratinized stratified squamous epi with keratin debris in the lumen of epidermoid cyst

consistent with normaly findings in osteoma and epidermoid cysts

A

osteoma - gardner syndrome

25
Q

tx is prophylatic colectomy
removal of cosmetically problematic cysts and osteomas
genetic counseling

Px - guarded - follow up

50% of patients develop adenocarcinoma of the colon by 30 years old

A

gardner syndrome

26
Q

Central giant cell granuloma

benign/malignant
etiology?
CGCG vs giant cell tumor of bone

young or old

male or female

mandi or max
anterior or posterior

sym/asymp
expand or no

A

benign
unknown etiology

tumor of bone - arises especially in knee distal femur

broad age - most before 30

2:1 female

mandible usually often crosses midline
more common anterior

asymptomatic
can expand - locally aggressive behavir (root resoprtion)

can break thru bone and mvoe into soft tissue

27
Q

radiographic features

unilocular/multioclular radiolucency
range in size from a few mm to several cm
well-delineated, generally not corticated
root resorption suggests aggressive behavior, but root divergence suggests benign process

A

central giant cell granuloma

28
Q

histopathological features
same as brown tumor of hyperparathyroidism, peripheral giant cell granuloma and giant cell tumor of bone

need radiographic correlation and blood test for parathromone PTH

A

central giant cell granuloma

29
Q

tx for central giant cell granuloma

Px
recurrence

A

tx - aggressive curettage/ peripherl osteotomy - rule-out hyperparathyroidism

Px - good

15-20% recurrence

30
Q

2 types of primary or secondary hyperparathyroidism

parathroid hyperplasia, parathyroid adenoma or carcinoma - inappropriate secretion of PTH causing increased Ca++ in blood

A

primary

31
Q

2 types of primary or secondary hyperparathyroidism

renal failure, altered vitamin D metabolism - poor calcium retention

A

secondary

inadequate production of Vitamin D - which is needed to absorb Ca from the gut – increased serum Ca

32
Q

central giant cell granuloma
PTH
_ activation causing increased _ uptake by kidneys

A

osteoclastic activation

increased Ca uptake by kidneys

increase vitamin D synthesis (kidneys) which promotes Ca++ from the gut

“bones, stones, groans, moans” thrones

33
Q

radiographic features

loss of lamina dura
“ground glass” trabecular pattern
unilocular/multilocular radioluceny

A

hyperparathyroidism

brown tumor of hyperthyroidism 
renal osteodystrophy (enlargement of jaws due to long -standing renal failure)
34
Q

cystic change of _ asspear as giant cell tumor of bone

A

hyperparathyroidism

activates osteoclastic

35
Q

histopathologic features

brown tumors show vascular granulation tissue with extravasated erythrocytes and numerous benign multinucleated giant cells

microscoppically the same as Peripheral giant cell granuloma, CGCG and giant cell tumor of bone

A

hyperparathyroidism

36
Q

hyperparathyroidism feature

unusual hyprplastic response of bone in patients with poorly controlled secondary hyperparathyroidism
often seen in patients on long-term renal dialysis
may manifest as prominent jaw enlargement

A

renal osteodystrophy

37
Q

hyperparathyrodism tx

Px

A

remove source of hormone secretion if primary (remove parathyrodi

better control of cerum Ca if secondary - parathyroidectomy may be needed - renal transplant

px - fair - associated with etiology

38
Q

malignancy of cartilaginous differentiation

A

chondrosarcoma

39
Q

chondrosarcoma
common/rare
male/female
young or adult

bones affected

sympto/asympt

A

rare - but 2nd most common PRIMARY bone malignancy

male - 4th-6th adult

mainly femur, pelvis, or ribs - 10% head and neck

  • may present with pain or swelling(may miic dental infection
40
Q

2nd most common primary bone malignancy 10% head and neck

may mimic dental infection pain swelling loose teeth

A

chondrosarcoma

primary - meaning from bone tissue

41
Q

radiographic features

poorly defined radioluceny with variable amounts of radiopacity
larger lesions may appear multilocular

may see widened PDL in area of tumor

loss of lamina dura - teeth test vital

A

chondrosarcoma

42
Q

histopathological features
invasive lobules of atypical cells showing cartilaginous differentiation
lobules of cartilage with hyperchromatic cells
eggshell lick chamber with vacuolar space holding the chondrocyte

A

chondrosarcoma

43
Q

chondrosarcoma tx

px - metastasis especially to _

A

radical surgerh “one chance for cure”

px - depend on location and histo grade of tumor but generally poor

death usually by direct extension of tumor involving vital structures

metastasis especiallly to lung

44
Q

Osteosarcoma
rare or common

bones affected
young/adult

A

rare ~900 cases in US annually - most common primary bone malgnacny;

8% head and neck

10% shoulder
15-pelvis
60 - knee femur- long bones usually around knee

younger ~18

jaws ~28
pain often initial compliant long bones and jaws

45
Q

most common primary bone malignancy

8% affect jaws

A

osteosarcoma

twice as common as chondrosarcoma

swelling, loose teeth, test teeth vital
paresthesia

46
Q

radiographic features

“sunburst” appearance pattern uncommon in jaws

mixed radiolucent/radiopaque with ill-defined borders
symmetrically widened PDL of teeth in the area

calcification filling sinus - widened PDL - spiked appearance of roots

A

osteosarcoma

47
Q

histopathological features

infiltrating sheets of malignant spindle cells
production of osteoid by tumor cells
mitotic activity variable
osteoblastic, chondroblastic, and fibroblastic differentiation can be seen

A

osteosarcoma

48
Q

osteosarcoma tx

Px, metastasis especially to _

A

radical surgery go for cure
more recently induction chemotherapy, then surgery to remove the tumor

px FAIR - 5 year survival 30-50%, better Px for jaws

one study using radical surgery had 80% 5 year survival

esp. to lung - death usually due to uncontrolled disease

49
Q

metastatic disease

overall metastases typically go to _

jaws occasionally affected ~_% of all oral malignancies

A

bone

1%

oral soft tissues can be affected as well
must be aware of this diagnosis due to importance

50
Q

the most common form of cancer involving bone

A

metastatic disease

then multiple myeloma

51
Q

metastasis from _ may affect jaws via Batson’s paravertebral plexus of veins

A

from below the neck

batsons plexus - a valveless vertebral venous plexus - may allow retrograde spread of tumor cells, bypassing filtration thru the lungs

connects deep pelvic veins and thoracic cenis in the internal vertebral venous plexuses

52
Q

metastatic disease most common cancer in bone

young or old
bones?

A

over 1/2 of affected patients are greater than 50

mandible 61%
maxilla 24%
soft tissue 15% (gingiva 54%, tongue 22.5%)

53
Q

paresthesia, tooth mobility, swelling, hemorrhage, pathologic fracture, trismus - lack of a healing tooth socket consider _ _ _

A

granulation tissue
lymphoma
metastatic disease

54
Q

radiographic features

poorly defined radioluceny less commonly radiopacity
moth eaten
histo - same pattern as primary malignancy
“seeded effect” from scattered clusters of cells
most common _______

A

metastatic disease

breast, lung, colon, thyroid, prostate, kidney, melanoma

55
Q

metastatic disease tx and px

_%of jaw metasases are initial manifestation

A

tx - palliation - radiation therapy

px = very poor - most patients die within 1 year of the dx
22% of jaw metastases are initial manifestation

oral path 2 (7 decks)

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