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Oral Medicine > Black and White Pathology > Flashcards

Black and White Pathology Flashcards

1
Q

what are the features of benign neoplasms of bone?

A
  • asymptomatic
  • grows slowly and by expansion: displaces teeth and expands the cortex
  • symmetrical
  • does not metastasize
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2
Q

what are the features of a malignant bony neoplasm?

A
  • usually symptomatic
  • grows more rapidly
  • invades and destroys adjacent structures (cortex)
  • often asymmetrical
  • ragged or poorly defined margins and destroys cortex
  • laying down bone outside the cortex
  • capable of metastasis
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3
Q

___ is an area of hematopoietic marrow that produces a radiolucency that may be confused with an intraosseous neoplasm

A

focal osteoporotic marrow defect

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4
Q

is focal osteoporotic marrow defect a pathology?

A

no, but the radiographic features may look like it

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5
Q

are focal osteoporotic marrow defects symptomatic or asymptomatic?

A

typically asymptomatic and incidental finding on radiograph

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6
Q

___% of focal osteoporotic marrow defects occur in women, typically in what location?

A
  • 75%
  • posterior mandible
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7
Q

is there jaw expansion associated with focal osteoporotic marrow defects?

A

no

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8
Q

describe the radiographic appearance of focal osteoporotic marrow defects?

A

typically has ill-defined borders with fine central trabeculations

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9
Q

asymptomatic, no jaw expansion

A

focal osteoporotic marrow defect

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10
Q

what is necessary for the diagnosis of focal osteoporotic marrow defect? once diagnosis is established, what is the treatment?

A
  • incisional biopsy
  • no treatment necessary
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11
Q

T or F:

there is no association between focal osteoporotic marrow defect and any hematologic disorder

A

true

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12
Q

unknown cause, asymptomatic

A

idiopathic osteosclerosis

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13
Q

___ is a focal area of increased radiodensity that is of unknown cause and cannot be attributed to anything else

A

idiopathic osteosclerosis

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14
Q

what is the differential diagnosis for a focal area of increased radiodensity?

A
  • idiopathic osteosclerosis
  • condensing osteitis - associated with an infection
  • focal cemento-osseous dysplasia - will have a radiolucent rim
  • cementoblastoma - fused with the tooth
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15
Q

asymptomatic

A

idiopathic osteosclerosis

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16
Q

asymptomatic

A

bone scar

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17
Q

asymptomatic

A

idiopathic osteosarcoma

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18
Q

asymptomatic

A

idiopathic osteosclerosis

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19
Q

how is idiopathic osteosclerosis diagnosed? when is a biopsy indicated? what if the lesion is discovered during adolescence?

A
  • can be made based on history, clinical features, and radiographic findings
  • biopsy is considered only if there are symptoms, continued growth, or cortical expansion
  • if discovered during adolescence, periodontic xrays are prudent until the area stabilizes; after that, no treatment is necessary
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20
Q

associated with inflammation

A

condensing osteitis

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21
Q

what is another term for condensing osteitis?

A

focal sclerosing osteomyelitis

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22
Q

___ is a localized area of bone sclerosis associated with apices of teeth with pulpitis

A

condensing osteitis

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23
Q

what is critical for the diagnosis of condensing osteitis?

A

association with inflammation

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24
Q

associated with inflammation

A

condensing osteitis

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25
Q

associated with inflammation

A

condensing osteitis

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26
Q

associated with inflammation

A

condensing osteitis

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27
Q

associated with inflammation

A

condensing osteitis

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28
Q

asymptomatic

A

central giant cell granuloma

*notice it crosses the midline*

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29
Q

central giant cell granuloma is considered a ___ lesion

A

non-neoplastic

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30
Q

most central giant cell granuloma cases occur before age ___, and more common in _males/females_, and is more common in the _maxilla/mandible_

A

most cases occur before age 30, F>M, Md>Mx

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31
Q

central giant cell granuloma is more common in the _anterior/posterior_ jaw, and frequently crosses the ___

A

anterior jaw, frequently crosses the midline

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32
Q

how are most central giant cell granulomas discovered?

A
  • most are asymptomatic and discovered during routine xray or due to painless bone expansion
  • a minority of cases are aggressive and associated with pain, parasthesia, and perforation of the cortical plate
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33
Q
A

central giant cell granuloma

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34
Q
A

central giant cell granuloma

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35
Q
A

central giant cell granuloma

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36
Q

what is the treatment for central giant cell granuloma?

A
  • curettage with a recurrence of 20%
    • recurrence is greater in young patients
    • most recurrent lesions respond to further curettage
  • new treatments are used with aggressive tumors, such as injections of corticosteroids
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37
Q

what is the prognosis for central giant cell granuloma? is there a risk for metastasis?

A

long term prognosis is good, no risk for metastasis

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38
Q

___ is a benign, empty or fluid filled cavity within bone

A

traumatic bone cyst

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39
Q

what is another name for a traumatic bone cyst?

A

simple bone cyst

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40
Q

why is “cyst” a misnomer for a traumatic bone cyst?

A

the lesion does not have an epithelial lining

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41
Q

what is the most widely accepted etiological theory for traumatic bone cysts?

A

trauma-hemorrhage theory

  • trauma to the bone which is insufficient to cause a fracture results in intraosseous hematoma
  • if the hematoma does not undergo organization and repair, it may liquefy and result in a defect
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42
Q

empty cavity

A

traumatic bone cyst

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43
Q

empty cavity

A

traumatic bone cyst

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44
Q

empty cavity

A

traumatic bone cyst

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45
Q

empty cavity

A

traumatic bone cyst

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46
Q

can you diagnose a traumatic bone cyst based off of radiographs?

A

no; radiographic features are suggestive but not diagnostic

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47
Q

what is necessary to get a diagnosis for traumatic bone cyst?

A
  • surgical exploration is necessary
    • little or no tissue will be obtained
    • during surgery, the wall of the cavity should be curetted to rule out thin-walled lesions
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48
Q

what is the treatment for traumatic bone cyst? prognosis?

A
  • surgical exploration (required for diagnosis) is curative; there will be rapid obliteration of the defect by new bone formation
  • periodic xrays should be taken until complete resolution has occurred; the prognosis is excellent
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49
Q

___ is intraosseous accumulation of blood-filled spaces surrounded by connective tissue

A

aneurysmal bone cyst

*NOT a true cyst - no epithelial lining

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50
Q

what is the etiology of an aneurysmal bone cyst?

A

unclear

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51
Q

aneurysmal bone cysts are typically located where?

A
  • long bones; jaw lesions are uncommon
  • most jaw lesions are found in patients around age 20 in the posterior mandible, M=F
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52
Q

what is the most common clinical manifestation of an aneurysmal bone cyst?

A

swelling that has developed rapidly

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53
Q

swelling has developed rapidly and the lesion is filled with blood

A

aneurysmal bone cyst

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54
Q

___ is a diverse group of processes characterized by replacement of normal bone by fibrous tissue containing a mineralized product

A

fibro-osseious lesions

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55
Q

what are necessary to establish diagnosis of fibro-osseous lesions?

A

clinical AND radiographic findings

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56
Q

what are 3 benign fibro-osseous lesions?

A
  • fibrous dysplasia
  • cemento-osseous dysplasia
  • ossifying fibroma
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57
Q

___ occurs in tooth-bearing areas of the jaws and is the most common fibro-osseous lesion encountered in clinical practice

A

cemento-osseous dysplasia

58
Q

what are the 3 types of cemento-osseous dysplasia?

A

focal, periapical, florid

59
Q

asymptomatic

A

focal cemento-osseous dysplasia

60
Q

which type of cemento-osseous dysplasia exhibits a single sight of involvement?

A

focal cemento-osseous dysplasia

61
Q

___% of focal cemento-osseous dysplasia cases occur in females, with an average age of ___

A
  • 90%
  • 40
62
Q

what is the most common location of focal cemento-osseous dysplasia?

A

posterior mandible

63
Q

is focal cemento-osseous dysplasia symptomatic or asymptomatic? what size are the lesions?

A

asymptomatic, lesions are smaller than 1.5cm

64
Q

asymptomatic

A

focal cemento-osseous dysplasia

65
Q

asymptomatic

A

focal cemento-osseous dysplasia

66
Q

asymptomatic

teeth are vital

A

periapical cemento-osseous dysplasia

67
Q

describe periapical cemento-osseous dysplasia

A
  • involves periapical region of the anterior mandible
  • multiple foci usually present
  • 90% female, 70% AA
  • average age = 40
  • teeth are vital
68
Q
A

periapical cemento-osseous dysplasia

69
Q
A

periapical cemento-osseous dysplasia

70
Q
A

periapical cemento-osseous dysplasia

71
Q

asymptomatic

symmetrical

A

florid cemento-osseous dysplasia

72
Q

which type of cemento-osseous dysplasia is multiple focal involvement not limited to the anterior mandible?

A

florid cemento-osseous dysplasia

73
Q

describe florid cemento-osseous dysplasia

A
  • 90% female, 90% AA
  • occurs in middle-aged or older adults
  • marked tendency to be bilateral and symmetrical
  • may be completely asymptomatic
74
Q

symmetrical

asymptomatic

A

florid cemento-osseous dysplasia

75
Q

asymptomatic

symmetrical

A

florid cemento-osseous dysplasia

76
Q

___ is a true neoplasm with significant growth potential composed of fibrous tissue that contains a variable mixture of bone and cementum

A

ossifying fibroma

77
Q

are ossifying fibromas more common in the maxilla or mandible?

A

mandible

78
Q

what is the difference between small ossifying fibroma lesions and large ones?

A
  • small lesions do not cause symptoms and are detected via xray
  • large lesions result in a painless swelling
79
Q

what are the radiographic features of an ossifying fibroma?

A
  • well-defined
  • typically unilocular
  • can be completely radiolucent or, more commonly, mixed RL-RO (depends on amount of calcified material)
  • root divergence or resorption of roots can occur
  • large ossifying fibromas of the mandible demonstrate a characteristic downward bowing of the inferior cortex of the mandible
80
Q
A

ossifying fibroma

…even though it is not well-defined or unilocular

notice the downward bowing of the mandible, mixed RL-RO, and root divergence

81
Q
A

ossifying fibroma

82
Q
A

ossifying fibroma

83
Q
A

cementoblastoma

84
Q

a cementoblastoma is an odontogenic neoplasm of which cell type?

A

cementoblasts

85
Q

75% of cementoblastomas appear in what location?

A

in the mandible, almost always in the molar/premolar region

86
Q

75% of cementoblastomas occur before what age?

A

30

87
Q

pain and swelling are present in what fraction of cementoblastoma cases?

A

2/3

88
Q

what is the radiographic presentation of cementoblastomas?

A
  • RO mass that is fused to one or more tooth roots
  • outline of the root or roots is usually obscured
  • surrounded by a thin RL rim
89
Q
A

cementoblastoma

90
Q
A

cementoblastoma

91
Q
A

cementoblastoma

92
Q

what is the treatment for a cementoblastoma?

A

surgical extraction of the tooth with the calcified mass

93
Q

contains malignant osteoid

A

osteosarcoma

notice the spiking resorption

94
Q

contains malignant osteoid

A

osteosarcoma

notice the spiking resorption

95
Q

contains malignant osteoid

A

osteosarcoma

classic sunburst appearance

96
Q

excluding hematopoietic neoplasms, ___ is the most common type of malignancy to originate within bone

A

osteosarcoma

97
Q

osteosarcomas of the jaws comprise ___% of all osteosarcomas

A

7%

98
Q

osteosarcomas of the jaws typically occur around what age? how does this differ from osteosarcoma of long bones?

A
  • jaws - age 33
  • long bones - 10-15 years earlier
99
Q

the PDL widening in osteosarcomas is due to ___

A

tumor infiltration

it is important to remember that PDL widening is seen in other malignancies and is not specific for osteosarcomas and is

100
Q
A

osteosarcoma

101
Q
A

osteosarcoma

102
Q
A

osteosarcoma

103
Q

of osteosarcoma jaw lesions and long bone lesions, which ones have a greater tendency to metastasize, and what are the most commonly affected sites

A
  • long bones
  • brain and lung
104
Q

what is the prognosis for osteosarcoma jaw lesions? what if initial radical surgery is performed?

A
  • 30-70% depending on the study
  • prognosis can appraoch 80% using initial radical surgery
105
Q

___ is the most common form of cancer involving bone

A

metastatic carcinoma

(versus osteosarcoma, which is the most common type of malignancy to ORIGINATE within bone, excluding hematopoietic neoplasms)

106
Q

what are the most common origins of gnathic metastases?

A

breast, lung, thyroid, prostate, and kidney

107
Q

what are the most common bone sites of metastatic tumors?

A

vertebrae, ribs, pelvis, and skull

108
Q

___% of metastatic tumors to the jaws occur in the mandible

A

80%

109
Q

what are the symptoms of metastatic tumors to the jaws?

A

pain, swelling, loosening of teeth, parasthesia

110
Q

what is numb chin syndrome?

A
  • mets to the mandible with involvement of the inferior alveolar nerve occasionally produces a distinctive pattern of anesthesia
  • unexplained loss of sensation in the lower lip and chin
111
Q

metastatic tumor to the jaws can be discovered in a ___

A

nonhealing extraction site

112
Q

what are the radiographic features of metastatic tumors to the jaws?

A
  • ill-defined borders (moth eaten)
  • widening of the PDL ligament
113
Q
A

metastatic tumor of the jaws

widening of the PDL and ill-defined borders (moth eaten)

114
Q
A

metastatic tumor to the jaws

115
Q
A

metastatic tumor to the jaws

116
Q

what is the prognosis of metastatic tumors to the jaws?

A
  • poor (stage IV disease)
  • 5-year survival is exceedingly rare
  • patient’s typically succomb to cancer within a year
117
Q
A

bone graft

118
Q
A

tonsillolith

119
Q

contains marrow

A

focal osteoporotic marrow defect

120
Q

what are the radiographic features of central giant cell granuloma?

A
  • not diagnostic
  • radiolucent lesions which may be multilocular or unilocular
  • typically well-delineated
  • noncorticated margins
121
Q

which bone pathology is histologically identical to a brown tumor of hyperparathyroidism (so patients MUST be evaluated for this condition) and the lesions found in cherubism?

A

central giant cell granuloma

122
Q
A

antral pseudocyst and central giant cell granuloma

123
Q

what are the radiographic features of cherubism?

A
  • multilocular
  • expansile
  • radiolucent
  • the appearance is virtually diagnostic due to the bilateral location in a young person
124
Q
A

cherubism

125
Q
A

cherubism

126
Q

what are the radiographic features of an aneurysmal bone cyst?

A
  • radiolucent lesion with marked cortical expansion and thinning
  • usually unilocular, can be multilocular
  • frequently described as a “blow-out” or ballooning distention of the contour of the affected bone
127
Q

how do aneurysmal bone cysts appear during surgery?

A
  • venous blood wells up and there may be bleeding
  • appearance is like a “blood soaked sponge”
128
Q
A

aneurysmal bone cyst

129
Q
A

fibrous dysplasia

ground glass appearance

130
Q

describe how periapical cemento-osseous dysplasia lesions mature over time

A
  • early lesions begin as circumscribed areas of RL involving the apex of a tooth, and looks ldentical to that of a periapical granuloma or cyst
  • lesions mature over time to have a mixed RL-RO appearance
  • end-stage lesions are densely RO with a RL rim
    • the PDL is intact and the lesion does not fuse to the tooth
131
Q

T or F:

each periapical cemento-osseous dysplasia lesion is self-limiting and progressive growth does not occur

A

true

132
Q

what are the radiographic features of florid cemento osseous dysplasia?

A
  • initially, lesions are predominantly radiolucent
  • over time become mixed RL-RO
  • end-stage lesions are predominantly radiopaque with a thin peripheral RL rim
133
Q

which two forms of cemento-osseous dysplasia can be diagnosed based on the distinctive clinical xrays, and do not require a biopsy? why should you avoid a biopsy in these cases?

A
  • periapical and florid
  • biopsy should be avoided because it may lead to necrosis due to the hypovascularity
134
Q

which form of cemento-osseous dysplasia requires a biopsy for diagnosis and why?

A

focal because the features are less specific than the other two forms

135
Q

why is it important to encourage good oral hygiene in patients with florid cemento-osseous dysplasia?

A

you want them to keep their teeth because extraction may lead to necrosis

136
Q

juvenile (active) ossifying fibroma is distinguished from ossifying fibroma on the basis of what 3 things?

A

age of patient, most common sites of involvement, and clinical behavior

137
Q

which two different neoplasms have been reported under juvenile ossifying fibroma, and which is more common?

A
  • trabecular
  • psammomatoid (4x more common than trabecular)
138
Q

both forms of juvenile ossifying fibroma are more common in males or females? more common in the maxilla or mandible?

A
  • males
  • maxilla
  • both of these characteristics are opposite of ossifying fibroma
139
Q

with juvenile ossifying fibromas, as a general rule, the younger the patient, the _more/less_ aggressive the tumor

A

more

140
Q

how are small vs large juvenile ossifying fibroma lesions treated?

A
  • smaller - local excision or curettage
  • larger - wide resection

Oral Medicine (10 decks)

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