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Pathology Final > Black and White > Flashcards

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1
Q

Benign neoplasms of bone

A 
asymptomatic
grows slowly by expansion
displaces teeth and expands cortex
symmetrical 
doesn't metastasize
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2
Q

Malignant neoplasms of bone

A 
symptomatic
grows quickly
invades and destroys structures (cortex)
asymmetrical
ragged/poor defined margins
lays down bone outside of cortex
can metastasize
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3
Q

Focal osteoporotic marrow defect

A

hematopoietic marrow produces radiolucency
ill defined borders with fine trabeculations
not pathology
asymptomatic
diagnose with incisional biop
not associated with a hematological disorder

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4
Q

Focal osteoporotic marrow defect F

A

75% F

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5
Q

Focal osteoporotic marrow defect location

A

posterior mandible (no jaw expansion)

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6
Q

Idiopathic osteosclerosis

A

focal area radiopaque with unknown cause
diagnose with history, clinical feathers and radiograph
biop only if symptoms, growth, or cortical expansion

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7
Q

Idiopathic osteosclerosis differentials

A

condensing osteitis (associated with infection)
focal cemnto-osseous dysplasia (with radiolucent rim)
cemntoblastoma (fused with tooth)

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8
Q

Condensing osteitis

A

focal sclerosing osteomyelitis
local area of bone associated with apices of teeth with pulpitis
associated with inflammation is necessary for diagnosis

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9
Q

Central giant cell granuloma

A

non-neoplastic
before age 30
most asymptomatic, some have pain, paresthesia, and perforation of cortical plate

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10
Q

Central giant cell granuloma F/M

A

F>M

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11
Q

Central giant cell granuloma location

A

Mand > Max

common in anterior jaw and crosses midline

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12
Q

Central giant cell granuloma tx

A

curettage with 20% recurrence, > in young patient
more curettage if recurrence
long term prognosis is good without risk of metastasis

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13
Q

Traumatic bone cyst

A 
simple bone cyst
asymptomatic 
20% have swelling
ages 10-20
scalloping: doesnt involve roots
radiographic findings suggestive but not diagnostic (surgical exploration)
cyst but NOT epithelium lined
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14
Q

Traumatic bone cyst location

A

mand

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15
Q

Traumatic bone cyst tx

A

surgery
curette walls to rule out thin walled lesions
little/no tissue obtained
rapid obliteration of defect and bone fills in
radiographs until resolved
excellent prognosis

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16
Q

Aneurysmal bone cyst

A

intraosseous accumulation of blood filled spaces surrounded by connective tissue
not a true cyst!
etiology unclear
swelling that develops rapidly

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17
Q

Aneurysmal bone cyst location

A

mostly long bones, jaw rare

~20 years in posterior mand

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18
Q

Aneurysmal bone cyst F/M

A

F=M

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19
Q

Fibro-osseous lesions

A

diverse group of processes where normal bone is replaced by fibrous tissue containing mineralized product
microscopically similar, need clinical and radiographic findings to diagnose

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20
Q

Benign fibro-osseous lesions

A

fibrous dysplasia
cemnto-osseous dysplasia
ossifying fibroma

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21
Q

Cemento-osseous dysplasia types

A

in tooth bearing areas of jaw

focal (caucasians)
periapical (african americans)
florid (african americans)

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22
Q

Focal cemento-osseous dysplasia

A

single site of involvement
~ 40 yrs
asymptomatic lesions < 1.5 cm

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23
Q

Focal cemento-osseous dysplasia location

A

posterior mand (1st molar)

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24
Q

Periapical cemento-osseous dysplasia

A

multiple foci usually
~ 40 yrs
teeth vital

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25
Periapical cemento-osseous dysplasia location
periapical of anterior mandible (canine to canine)
26
Periapical cemento-osseous dysplasia F/M
90% F > 70% african american
27
Florid cemento-osseous dysplasia
multiple foci not limited to anterior mand middle-aged older adults can be asymptomatic usually bilateral and symmetrical
28
Focal cemento-osseous dysplasia F/M
90% F
29
Florid cemento-osseous dysplasia F/M
90% F > 90% african american
30
Ossifying fibroma
true neoplasm with large growth potential tumor of fibrous tissue with mix of bone and cementum wide age range small seen on x ray, no swelling or symptoms large cause painless swelling bowing downward of interior cortex of mand for large tumors root divergence or resorption can occur or teeth displacement well defined, unilocular radiolucent or radiolucent-radiopaque mix (depends on amount of calcified material)
31
Cementoblastoma
odontogentic neoplasm of cementoblasts 75% < 30 yrs 2/3 have pain and swelling radiopaque mass surrounded by radiolucent rim fused to tooth roots, outline of roots usually obscured
32
Cementoblastoma tx
extract tooth and calcified mass
33
Osteosarcoma
mesenchymal malignancy cells able to produce osteoid/immature bone most common type of neoplasm to originate in bone minus hematopoietic neoplasms can be intramedullary, juxtacortical or extraskeletal
34
Metastatic tumors to the jaws
poor prognosis (stage IV disease) 5 yr survival rare pt succumbs to cancer within a year most common type of cancer in the bone
35
Dentigerous cyst
originates from separation of follicle from around the crown of unerupted tooth most common developmental cyst encloses crown of unerupted tooth and attaches at the CEJ
36
Odontogenic keratocyst (OKC)
30% recurrence associated with gorlins syndrome (nevoid basal cell carcinoma syndrome) - PTCH gene - WHO: keratocystic odontogenic tumor thin friable wall unifrom 6-8 layers of epithelium thick basal cell layer > palisading and hyperchromatic (picket fence) epithelium surfaced with wavy parakeratin small satellite (daughter cysts) cells away from primary lesion
37
Orthokeratinized odontogenic cyst (OOC)
orthokeratinized lining not palisading typically uniclocular - looks like dentigerous cyst 2% recurrence after enuculation and curettage
38
Orthokeratinized odontogenic cyst location
posterior mandible (3rd molar)
39
Calcifying odontogenic cyst (COC)
Gorlin cyst WHO: calcifying cystic odontogenic tumor ~ 35 yrs 20% associated with odontomas
40
Calcifying odontogenic cyst radiographically
unilocular, well defined radiolucency with radiopaque structures 50% of the time
41
Calcifying odontogenic cyst location
65% incisor-canine area max = mand 1/3rd associated with unerupted tooth (canine)
42
Adenamatoid odontogenic tumor (AOT)
10-20 yrs asymptomatic discovered by radiograph when tooth hasnt erupted
43
Adenamatoid odontogenic tumor location
almost always anterior jaw | max > mand
44
Adenamatoid odontogenic tumor F/M
2F>M
45
Adenamatoid odontogenic tumor radiographically
75% time tumor circumscribed, uniloculare radiolucency with crown of unerupted tooth (canine) Radiolucency extends apically past CEJ (unlike dentigerous cyst) fine, snowflake calcifications thick fibrous capsule
46
Calcifying epithelial odontogenic tumor (CEOT)
Pindborg tumor | painless slow growing swelling
47
Calcifying epithelial odontogenic tumor location
mand > max | posterior > anterior
48
Calcifying epithelial odontogenic tumor F/M
F=M
49
Calcifying epithelial odontogenic tumor radiographically
uni/multilocular - unilocular more common in max scalloped will defined margins - corticated or ill defined associated with impacted tooth often (mand molar) calcified structures varying size and density
50
Calcifying epithelial odontogenic tumor histology
nuclear polymophism and atypia amyloid like extracellular material positive for congo red green birefringence under polarized light Liesegang rings: calcifications with concentric rings form in amyloid like areas
51
Odontoma
``` most common odontogenic tumor developmental anomolies > haratomas (not true neoplasm) ~ 15 yrs asymptomatic usually associated with unerupted tooth ```
52
Odontoma types
Compound (multiple, small tooth like structures, > in anterior max) Complex (mixed mass of enamel and dentin, > in molar area)
53
Ameloblastic fibroma
true mixed tumor epithelial and mesenchymal tissues neoplastic younger, usually < 20 yrs 75% associated with unerupted tooth
54
Ameloblastic fibroma location
70% posterior mandible
55
Ameloblastic fibro-odontoma
like ameloblastic fibroma but with enamel and dentin | ~ 10 yrs
56
Ameloblastic fibro-odontoma location
posterior jaws
57
Ameloblastic fibro-odontoma radiographically
well circumscribed unilocular radiolucency varying amounts of calcified material usually associated with unerupted tooth
58
Ameloblastic fibro-odontoma tx
conservative curettage and rare recurrence
59
Odontogenic keratocyst
arise from cell rests of dental lamina
60
Nevoid basal cell carcinoma syndrome
``` Gorlin syndrome autosomal dominant chromosome 9 PTCH gene abnormal of OKC 1. multiple nevoid basal cell carcinomas 2. OKCs 3. calcification of faux cerebri 4. ribs splayed/bifid ```
61
Carcinoma arising in odontogenic cysts
carcioma in bone rare and only in jaw (odontogenic carcinoma) most arise from odontogenic cysts older patients
62
Carcinoma arising in odontogenic cysts F/M
2M > F
63
Carcinoma arising in odontogenic cysts radiographically
like odontogenic cysts but margins irregular and ragged
64
Ameloblastoma
most common clinically significant odontogenic tumors | typors of odontogenic epithelial origin
65
Ameloblastoma types
conventional solid or multicystic (85%) unicystic (15%) peripheral (1%)
66
Ameloblastoma patterns
``` follicular (most common) plexiform (second most common) acanthomatous (has keratin) granular cell basal cell (very rare) desmoplastic ```
67
Desmoplastic ameloblastoma
mixed radiolucent-radiopaque (osseous metaplasia)
68
Desmoplastic ameloblastoma histology
palisading-hyperchromatic basal layer reversible polarity apical vacuolization
69
Peripheral ameloblastoma
painless nonulcerated, sessile gingival lesion clinically on of the three Ps for bump on the gums ~ 50 yrs innocuous clinical behavior
70
Peripheral ameloblastoma tx
15% recurrence, further excision has 0% recurrence
71
Peripheral ameloblastoma location
gingival mucosa | mand > max

Pathology Final (4 decks)

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