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Oral Pathology > Benign Non-Odontogenic Lesions > Flashcards

Benign Non-Odontogenic Lesions Flashcards

1
Q

Cemento-Ossifying Fibroma clinical features

A

3-4th decade 5:1 female predilection Common in mandible

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2
Q

Cemento-Ossifying Fibroma radio appearance

A

Well-demarcated lesion Radiolucent to mixed appearance

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3
Q

Cemento-Ossifying Fibroma histo appearance

A

Potato-like mass that usually comes out in one chunk Lots of connective tissue and bone/cementum interspersed. NO inflammation seen

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4
Q

Cemento-Ossifying Fibroma treatment

A

Enucleation This is a TRUE neoplasm.

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5
Q

Fibrous Dysplasia Types of Lesion

A

Polyostotic Monostotic

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6
Q

Fibrous Dysplasia clinical features

A

MAXILLA more common Bones have fracture risk because they are weaker. Can have a hockey stick discrepancy. One leg longer than the other Will see SWELLING over time. Can see expansion.

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7
Q

Fibrous Dysplasia radio appearance

A

Ground glass appearance with ill-defined borders Narrowing PDL space and the lamina dura hard to make out

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8
Q

Fibrous Dysplasia histo appearance

A

Irregular shaped woven bone (Chinese characters) Bone has NO OSTEOBLAST around it. Distinctive feature. Bone arises in slide via metaplasia from fibroblasts Woven bone becomes more lamellar over time

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9
Q

Fibrous Dysplasia treatment

A

Resection, but not in children. Lesion will regress over time maybe to 70% of size. Remove at skeletal maturity. Radiation is CONTRAINDICATED. It may actually cause malignant transformation to osteosarcoma.

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10
Q

Fibrous Dysplasia age

A

Stage of fetal development determines if polyostotic or monostotic (MOST cases are monostotic) 1-2nd decade (YOUNGER) population

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11
Q

Fibrous Dysplasia types of polyostotic involvement

A

Jaffe Type

  • Cafe au lait spots on the trunk and thigh
  • Multiple bone involvements

McCune-Albright Type

  • Cafe au lait spots
  • Endocrine hyperfunction
  • Precocious puberty
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12
Q

Types of cemento-osseous dysplasias

A

Periapical

Focal

Florid

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13
Q

Clinical features of periapical osseous dysplasias

A

14:1 Black female predilection

30-50 years old

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14
Q

Clinical features of focal osseous dysplasias

A

80% in Caucasian females

4-5th decade

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15
Q

Clinical features of florid osseous dysplasias

A

Black females

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16
Q

Location of periapical osseous dysplasias

A

Mandibular anterior

Multiple lesions

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17
Q

Location of focal osseous dysplasias

A

Posterior mandible ONE lesion

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18
Q

Location of florid osseous dysplasias

A

More than one quadrant

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19
Q

Radiograph of periapical osseous dysplasias

A

Start as RL then add more osteoid and become RO

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20
Q

Radiograph of focal osseous dysplasias

A

RL to RO. RL rim remains over time

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21
Q

Radiograph of florid osseous dysplasias

A

Multiple “cotton-wool” radiopacities

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22
Q

Treatment of periapical osseous dysplasias

A

NONE needed. No biopsy

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23
Q

Treatment of focal osseous dysplasias

A

Biopsy to rule out cemento-ossifying fibroma

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24
Q

Treatment of florid osseous dysplasias

A

MAINTAIN DENTITION. Normal alveolar bone will resorb, but dysplastic bone will not and osteomylitis could occur.

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25
Q

Clinical features of all osseous dysplasias

A

Occur in tooth-bearing areas. Not outside the jaws Reactive lesions with cause unknown All types have the same histology, but are a spectrum along the process. No expansion seen Asymptomatic NO teeth displacement and teeth remain vital

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26
Q

Histo of all osseous dysplasias

A

Come out as coffee grounds

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27
Q

Clinical features of osteoblastoma

A

Pain NOT relieved by aspirin

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28
Q

Clinical features of osteoid osteoma

A

NOCTURNAL PAIN relieved by aspirin

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29
Q

Radiograph of osteoid osteoma

A

Well-circumscribed with radiolucent rim and central radiopacity.

Less than 2cm in diameter

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30
Q

Radiograph of osteoblastoma

A

Similar location to OO (outside the jaws)

Greater than 2cm

Can have a RL rim with a mixed center

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31
Q

Histo of osteoid osteoma and OO

A

Lots of woven bone, NOT lamellar bone in a fibrovascular stroma Both can resemble low-grade osteosarcoma (malignancy) This similarity contributes to their misdiagnosis

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32
Q

TX of osteoid osteoma and OO

A

Local excision

Curettage

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33
Q

Types of osteoma

A

Periosteal Endosteal

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34
Q

Clinical features of osteoma

A

Simply a benign bone lesion Paranasal sinuses are the most common, but can happen in bone

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35
Q

Radiograph of osteoma

A

Radiopaque

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36
Q

Histo of osteoma

A

Dense bone combined with cancellous bone

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37
Q

TX of osteoma

A

Surgical excision or just observation over time

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38
Q

Clinical presentation of Gardner syndrome

A

Epidermoid cysts GI polyps with 50% becoming malignant by age 30 Desmoid tumors: locally aggressive benign fibrous proliferations at incision site of colectomy Ocular – hypertrophy retinal pigment Oral – impacted supernumerary teeth and odontomas

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39
Q

Key indicator of Gardner syndrome

A

If you see multiple osteomas think about this lesion

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40
Q

Radiograph of Gardner syndrome

A

Osteomas

NO radiolucent rim

Supernumerary teeth

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41
Q

Heredity of Gardner syndrome

A

Autosomal dominant condition

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42
Q

TX of Gardner syndrome

A

Prophylactic colectomy as GI polyps will become malignant

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43
Q

Age of central giant cell granuloma

A

2-4th decade with a 2:1 female predilection

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44
Q

Location of central giant cell granuloma

A

Presents in posterior mandible 70% of time CROSSES MIDLINE

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45
Q

Radiograph of central giant cell granuloma

A

Radiolucency Start off as unilocular and over time become more multilocular and expansile Displacement of teeth Resorption of teeth possible

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46
Q

Histology of central giant cell granuloma

A

Granulation tissue Giant cells (frequently around the periphery) Reactive bone around periphery → body is trying to wall off the lesion; bone not made by lesion Extravasated RBC’s

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47
Q

DDX of central giant cell granuloma

A

ABC

  • Typically in children and doesn’t cross the midline Has blood-filled spaces in lesions with GC around the periphery of lesion

Brown tumor

  • Need to rule out hyperparathyroidism Have calcium levels checked

Giant cell tumor of bone

  • Most common in distal tibia and femur area not jaws
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48
Q

TX of central giant cell granuloma

A

Curettage Resection if the lesion recurs

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49
Q

Clinical features of Hemangioma of Bone (Vascular Malformation)

A

Pain and swelling when larger Sulcular bleeding Bruit or pulse if has a artery component. If only venous, no bruit present.

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50
Q

Location of Hemangioma of Bone (Vascular Malformation)

A

Seen in posterior mandible

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51
Q

Age of Hemangioma of Bone (Vascular Malformation)

A

2nd and 3rd decades most common

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52
Q

Radiograph of Hemangioma of Bone (Vascular Malformation)

A

Multilocular Presents as a mixed to radiolucent lesion Occasional sunburst pattern Cortical expansion

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53
Q

Histology of Hemangioma of Bone (Vascular Malformation)

A

Cavernous and capillary vessels

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54
Q

TX of Hemangioma of Bone (Vascular Malformation)

A

Make sure to aspirate the lesion before biopsy Pre-surgery embolization with resection, curettage

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55
Q

Types of Langerhans Cell Disease

A

Acute disseminated (Letterer-Siwe Disease) Chronic disseminated (Hand-Schuller-Christian Disease) Eosinophilic granuloma of bone

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56
Q

Features of Letterer-Siwe Disease

A

Most severe manifestation of disease Seen in infants and very young children. Usually FATAL. Lesions seen on (SOB) skin, organs, and bone

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57
Q

Features of Hand-schuller-Christian Cell Disease

A

(SOB) skin, organs, bone also involved, but organ involvement NOT as severe TRIAD: Bone lesions Exophthalmos → histiocytic cells accumulate around the eyeball Diabetes insipidus → histiocytic proliferation involves the posterior pituitary gland

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58
Q

Features of Eosinophilic granuloma of bone

A

MOST COMMON presentation of this disease

BONE ONLY (solitary or multiple lesions)

No skin or visceral involvement

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59
Q

Location of Langerhans Cell Disease

A

Skull and mandible in the head/neck area

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60
Q

What is Langerhans Cell Disease

A

Benign neoplasm consisting of histiocytic cells

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61
Q

What does Langerhans Cell Disease look like on radiograph

A

Radiolucency Usually well-defined and non-corticated Significant bone destruction Mobile teeth from bone loss

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62
Q

Histology of Langerhans Cell Disease

A

Large number of mononuclear histiocytic cells Large numbers of eosinophils Diagnosis NOT made only on light microscopy. Need immunohistochemistry with S100 stain. Histiocytes can appear as a coffee bean Look for birbeck cells in histiocytes (Langerhans cells)

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63
Q

TX of Langerhans Cell Disease

A

Curettage Low dose radiation of intralesional chemo NO ORGAN INVOLVEMENT WINS Acute is fatal. Chronic not as much.

64
Q

Types of Osteomyelitis

A

ACUTE and CHRONIC

65
Q

Common site of Osteomyelitis

A

Mandible

66
Q

Clinical features of acute osteomyelitis

A

Will see acute inflammatory response Fever, leukocytosis, lymphadenopathy, pain, and swelling Will see chunks of bone out of lesion Drainage of pus

67
Q

Clinical features of chronic osteomyelitis

A

Granulation tissue seen (Fibroblasts and BV’s) Swelling, pain, and discharge seen

68
Q

Etiology of Osteomyelitis

A

Odontogenic infections

Fractures

Immunocompromised patients (poorly controlled diabetics)

Decrease vascularity of bone

69
Q

Radiograph of acute osteomyelitis

A

Typically radiolucent POORLY defined

70
Q

Radiograph of chronic osteomyelitis

A

Mixed radiolucent, radiopaque lesion

71
Q

Histo of acute osteomyelitis

A

Lots of neutrophils (HALLMARK cell of acute inflammation) Necrotic bone

72
Q

Histo of chronic osteomyelitis

A

Chronic inflamed fibrous tissue Sequestra

73
Q

TX of acute osteomyelitis

A

Oral antibiotics – amoxicillin

74
Q

TX of chronic osteomyelitis

A

IV antibiotics. Oral antibiotics can’t reach the tissue. Harder to treat because granulation tissue can encase the necrotic bone

75
Q

Clinical features of Condensing Osteitis

A

Usually asymptomatic A bony reaction to pulpal inflammation.

76
Q

What is Condensing Osteitis

A

This is a reaction to a low grade infection (large caries or non-vital teeth)

77
Q

Radiograph of Condensing Osteitis

A

Periapical radiopacity

78
Q

TX of Condensing Osteitis

A

Treat source of infection and it will regress

79
Q

Clinical features of Proliferative Periostitis (Garres Osteomyelitis)

A

Reactive bone formed along the cortex of bone Seen with caries or periodontal infection

80
Q

Ages of Proliferative Periostitis (Garres Osteomyelitis)

A

Seen in younger children

81
Q

Radiograph of Proliferative Periostitis (Garres Osteomyelitis)

A

Onion skin radiopacity This ALSO seen in Ewing’s sarcoma

82
Q

Histo of Proliferative Periostitis (Garres Osteomyelitis)

A

Cellular reactive bone seen

83
Q

TX of Proliferative Periostitis (Garres Osteomyelitis)

A

NO Biopsy performed Resolve the infection and this goes away

84
Q

Age and predilection of Osteosarcoma of Jaws

A

2:1 MALE predilection 34 years old

85
Q

Clinical features Osteosarcoma of Jaws

A

MOST common primary malignancy of bone Pain and swelling Pick up on widening of the PDL before other symptoms

86
Q

Etiology of Osteosarcoma of Jaws

A

Previous radiation Usually occur 10 years after radiation Osteitis deformans (Paget’s Disease) If the patient is over 50 and has osteosarcoma, check if they have Paget’s Disease. Very rare to not have Paget’s.

87
Q

Radiograph of Osteosarcoma of Jaws

A

Uniform widening of the PDL Mixed lesion on radiograph Resorption, but not displacement of teeth Sun burst pattern

88
Q

Clinical features Osteosarcoma of Jaws

A

Plump spindle-shaped cells (osteoblasts) Haphazard osteoid in sample Malignant osteoid Three cellular types

89
Q

TX of Osteosarcoma of Jaws

A

Radical surgery Maxillary tumors worse prognosis than mandible because harder to resect the full tumor Best predictor of success is clean resection Can do preoperative chemo to shrink the tumor and then resect Check to see if tumor is susceptible to chemo

90
Q

Age of Chondrosarcoma

A

50-60 years old (OLDER than osteosarcoma) Rare in less than 45 years old

91
Q

Clinical features of Chondrosarcoma

A

2nd most common malignancy of the jaws More commonly painless than osteosarcoma Maxilla more than mandible Can show nasal obstruction and nose epitaxis

92
Q

Radiograph of Chondrosarcoma

A

Poorly defined radiolucency and can have calcified material develop over time Lower grade have more Radiopaque Widened PDL and resorption

93
Q

Histo of Chondrosarcoma

A

Histo determines prognosis Grade 1: mimic chondroma, prominent calcification/ossification Grade 2: increased cellularity and nuclear size; myxoid matrix Grade 3: even more cellular; spindle shaped cells; cartilage rare Variants Clear cell (low grade) Dedifferentiated (high grade)

94
Q

TX of Chondrosarcoma

A

RADIO AND CHEMO RESISTANT Surgical excision Difficult in the maxilla

95
Q

Age of Ewing’s Sarcoma

A

Usually in KIDS (60% male)

96
Q

Location of Ewing’s Sarcoma

A

Posterior mandible most common site

97
Q

Genetic cause of Ewing’s Sarcoma

A

85% have a t(11;22) translocation

98
Q

What is Ewing’s Sarcoma

A

Poorly-differentiated PNET → “small round cell blue tumor”

99
Q

Clinical features of Ewing’s Sarcoma

A

Fever and leukocytosis (high WBC’s) Increased ESR Tend to penetrate the cortex and cause loose teeth

100
Q

Radiograph of Ewing’s Sarcoma

A

Ill-defined radiolucency Onion skin Resorption of teeth not displacement

101
Q

Histo of Ewing’s Sarcoma

A

Sheets of small round cells Necrosis and hemorrhage Cytoplasmic glycogen granules CD99 staining also see in Ewing’s Must do FISH to diagnose it Shows the translocation of genes

102
Q

TX``` of Ewing’s Sarcoma

A

Surgery Radiation and chemo. Usually MULTI-agent chemo Lung, liver, lymph node, bone mets are common metastatic sites Distal lesions have better prognosis since radical excision ca`n be accomplished easier

103
Q

Predilection of multiple myeloma

A

63 average age African American males most common

104
Q

What is multiple myeloma

A

Plasma cell neoplasm in which a monoclonal Ig light chain is produced (Lambda or Kappa)

105
Q

Clinical symptoms of multiple myeloma

A

Bone pain most common presenting symptom Swelling + expansion Pathologic fracture Paresthesia and loose teeth Weakness and anemia → thrombocytopenia and lymphopenia Amyloidosis deposition (WAXY nodules or plaques)

106
Q

Test results of multiple myeloma

A

Bence-Jones proteinuria: monoclonal light chains in your piss Can see an “M spike” in monoclonal gammopathy

107
Q

Radiograph of multiple myeloma

A

Multiple well-defined punched out radiolucencies

108
Q

Histo of multiple myeloma

A

Sheet-like monoclonal proliferation of plasma cells

109
Q

TX of multiple myeloma

A

Chemo, steroids, radiation Can do a bone marrow transplant in healthier patients

110
Q

Predilection of solitary plasmacytoma

A

50 years average age Male predilection

111
Q

Clinical features of solitary plasmacytoma

A

Rare in jaws, but angle of mandible is most common site HIGH risk to develop multiple myeloma Pain swelling and pathologic fracture seen ONE LESION

112
Q

Test results of solitary plasmacytoma

A

NO M spike

Most cases do not have IgG in piss like in MM

Normal peripheral blood picture

113
Q

Radiograph of solitary plasmacytoma

A

Well-defined radiolucency.

Lytic lesion of the bone

Destruction of cortical bone possible

114
Q

Histo of solitary plasmacytoma

A

Identical to multiple myeloma, but there is only 1 lesion

115
Q

TX of solitary plasmacytoma

A

Complete bone scan to make sure not MM Radiation to the area Curette the lesion

116
Q

Criteria for diagnosis of metastatic disease

A

Histologically verified primary tumor Metastatic deposit same as primary No possibility of direct extension Important in salivary gland tumors

117
Q

Age of metastatic disease

A

50 years or older

118
Q

Location of metastatic disease

A

Mandible (60%) maxilla (25%) of lesions

119
Q

Radiograph of metastatic disease

A

Usually poorly defined radiolucency Radiopacity if breast of prostate cancer

120
Q

Histo of metastatic disease

A

Variable depending on primary tumor Usually a carcinoma, NOT sarcoma

121
Q

TX of metastatic disease

A

Palliative as these lesions are STAGE 4

122
Q
A
122
Q
A
122
Q
A
122
Q

What is this?

A

Hemangioma of bone

122
Q

What is this?

A

Cemento-ossifying fibroma

123
Q

What is this?

A

Fibrous dysplasia

124
Q

What is this

A

Hemangioma of bone

125
Q

What is this

A

Central giant cell granuloma

126
Q

What is this?

A

Central giant cell granuloma

127
Q

What is this?

A

Cemento-osseous dysplasia

128
Q

What is this

A

Langerhans Cell Disease

129
Q

What is this

A

Electron microscope

Langerhans Cell Disease

130
Q

What is this

A

Osteosarcoma

131
Q

What is this

A

Chronic osteomyelitis

132
Q

What is this?

A

Acute osteomyelitis

133
Q

What is this?

A

Ewing’s sarcoma

134
Q

What is this?

A

Chondrosarcoma

135
Q

What is this?

A

Ewing’s sarcoma

136
Q

What is this?

A

Multiple myeloma

137
Q

What is this?

A

Chondrosarcoma

138
Q

What lesions have onion skin appearance on radiograph?

A
  1. Garres osteomyelitis (proliferative periostitis)
  2. Ewings sarcoma
139
Q

what is this

A

cemento ossifying fibroma

140
Q

what is this

A

fibrous dysplasia

141
Q

what is this

A

fibrous dysplasia

142
Q

what is this

A

focal osseous dysplasia

143
Q

what is this

A

hemangioma of bone

144
Q

what is this

A

langerhans cell disease

145
Q

what is this

A

acute osteomyelitis

146
Q

what is this

A

osteosarcoma

147
Q

what is this

A

ewing’s sarcoma

148
Q

what is this

A

metastatic cancer

149
Q

CK7 positive histo means what

A

Carcinoma from the lung

150
Q

what immunostain is used for langerhans cell disease

A

CD1aaaaa

151
Q

what does langerhans cell disease look like on radiograph

A

large bone destruction

multiple radiolucent lesions in the skull and jaws

152
Q

patient complaints with langerhans cell disease

A

Pain, swelling, and loose teeth

Oral Pathology (5 decks)

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