Black and White Pathology Flashcards
what are the features of benign neoplasms of bone?
- asymptomatic
- grows slowly and by expansion: displaces teeth and expands the cortex
- symmetrical
- does not metastasize
what are the features of a malignant bony neoplasm?
- 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
___ is an area of hematopoietic marrow that produces a radiolucency that may be confused with an intraosseous neoplasm
focal osteoporotic marrow defect
is focal osteoporotic marrow defect a pathology?
no, but the radiographic features may look like it
are focal osteoporotic marrow defects symptomatic or asymptomatic?
typically asymptomatic and incidental finding on radiograph
___% of focal osteoporotic marrow defects occur in women, typically in what location?
- 75%
- posterior mandible
is there jaw expansion associated with focal osteoporotic marrow defects?
no
describe the radiographic appearance of focal osteoporotic marrow defects?
typically has ill-defined borders with fine central trabeculations
asymptomatic, no jaw expansion
focal osteoporotic marrow defect
what is necessary for the diagnosis of focal osteoporotic marrow defect? once diagnosis is established, what is the treatment?
- incisional biopsy
- no treatment necessary
T or F:
there is no association between focal osteoporotic marrow defect and any hematologic disorder
true
unknown cause, asymptomatic
idiopathic osteosclerosis
___ is a focal area of increased radiodensity that is of unknown cause and cannot be attributed to anything else
idiopathic osteosclerosis
what is the differential diagnosis for a focal area of increased radiodensity?
- idiopathic osteosclerosis
- condensing osteitis - associated with an infection
- focal cemento-osseous dysplasia - will have a radiolucent rim
- cementoblastoma - fused with the tooth
asymptomatic
idiopathic osteosclerosis
asymptomatic
bone scar
asymptomatic
idiopathic osteosarcoma
asymptomatic
idiopathic osteosclerosis
how is idiopathic osteosclerosis diagnosed? when is a biopsy indicated? what if the lesion is discovered during adolescence?
- 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
associated with inflammation
condensing osteitis
what is another term for condensing osteitis?
focal sclerosing osteomyelitis
___ is a localized area of bone sclerosis associated with apices of teeth with pulpitis
condensing osteitis
what is critical for the diagnosis of condensing osteitis?
association with inflammation
associated with inflammation
condensing osteitis
associated with inflammation
condensing osteitis
associated with inflammation
condensing osteitis
associated with inflammation
condensing osteitis
asymptomatic
central giant cell granuloma
*notice it crosses the midline*
central giant cell granuloma is considered a ___ lesion
non-neoplastic
most central giant cell granuloma cases occur before age ___, and more common in _males/females_, and is more common in the _maxilla/mandible_
most cases occur before age 30, F>M, Md>Mx
central giant cell granuloma is more common in the _anterior/posterior_ jaw, and frequently crosses the ___
anterior jaw, frequently crosses the midline
how are most central giant cell granulomas discovered?
- 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
central giant cell granuloma
central giant cell granuloma
central giant cell granuloma
what is the treatment for central giant cell granuloma?
- 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
what is the prognosis for central giant cell granuloma? is there a risk for metastasis?
long term prognosis is good, no risk for metastasis
___ is a benign, empty or fluid filled cavity within bone
traumatic bone cyst
what is another name for a traumatic bone cyst?
simple bone cyst
why is “cyst” a misnomer for a traumatic bone cyst?
the lesion does not have an epithelial lining
what is the most widely accepted etiological theory for traumatic bone cysts?
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
empty cavity
traumatic bone cyst
empty cavity
traumatic bone cyst
empty cavity
traumatic bone cyst
empty cavity
traumatic bone cyst
can you diagnose a traumatic bone cyst based off of radiographs?
no; radiographic features are suggestive but not diagnostic
what is necessary to get a diagnosis for traumatic bone cyst?
- 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
what is the treatment for traumatic bone cyst? prognosis?
- 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
___ is intraosseous accumulation of blood-filled spaces surrounded by connective tissue
aneurysmal bone cyst
*NOT a true cyst - no epithelial lining
what is the etiology of an aneurysmal bone cyst?
unclear
aneurysmal bone cysts are typically located where?
- long bones; jaw lesions are uncommon
- most jaw lesions are found in patients around age 20 in the posterior mandible, M=F
what is the most common clinical manifestation of an aneurysmal bone cyst?
swelling that has developed rapidly
swelling has developed rapidly and the lesion is filled with blood
aneurysmal bone cyst
___ is a diverse group of processes characterized by replacement of normal bone by fibrous tissue containing a mineralized product
fibro-osseious lesions
what are necessary to establish diagnosis of fibro-osseous lesions?
clinical AND radiographic findings
what are 3 benign fibro-osseous lesions?
- fibrous dysplasia
- cemento-osseous dysplasia
- ossifying fibroma
___ occurs in tooth-bearing areas of the jaws and is the most common fibro-osseous lesion encountered in clinical practice
cemento-osseous dysplasia
what are the 3 types of cemento-osseous dysplasia?
focal, periapical, florid
asymptomatic
focal cemento-osseous dysplasia
which type of cemento-osseous dysplasia exhibits a single sight of involvement?
focal cemento-osseous dysplasia
___% of focal cemento-osseous dysplasia cases occur in females, with an average age of ___
- 90%
- 40
what is the most common location of focal cemento-osseous dysplasia?
posterior mandible
is focal cemento-osseous dysplasia symptomatic or asymptomatic? what size are the lesions?
asymptomatic, lesions are smaller than 1.5cm
asymptomatic
focal cemento-osseous dysplasia
asymptomatic
focal cemento-osseous dysplasia
asymptomatic
teeth are vital
periapical cemento-osseous dysplasia
describe periapical cemento-osseous dysplasia
- involves periapical region of the anterior mandible
- multiple foci usually present
- 90% female, 70% AA
- average age = 40
- teeth are vital
periapical cemento-osseous dysplasia
periapical cemento-osseous dysplasia
periapical cemento-osseous dysplasia
asymptomatic
symmetrical
florid cemento-osseous dysplasia
which type of cemento-osseous dysplasia is multiple focal involvement not limited to the anterior mandible?
florid cemento-osseous dysplasia
describe florid cemento-osseous dysplasia
- 90% female, 90% AA
- occurs in middle-aged or older adults
- marked tendency to be bilateral and symmetrical
- may be completely asymptomatic
symmetrical
asymptomatic
florid cemento-osseous dysplasia
asymptomatic
symmetrical
florid cemento-osseous dysplasia
___ is a true neoplasm with significant growth potential composed of fibrous tissue that contains a variable mixture of bone and cementum
ossifying fibroma
are ossifying fibromas more common in the maxilla or mandible?
mandible
what is the difference between small ossifying fibroma lesions and large ones?
- small lesions do not cause symptoms and are detected via xray
- large lesions result in a painless swelling
what are the radiographic features of an ossifying fibroma?
- 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
ossifying fibroma
…even though it is not well-defined or unilocular
notice the downward bowing of the mandible, mixed RL-RO, and root divergence
ossifying fibroma
ossifying fibroma
cementoblastoma
a cementoblastoma is an odontogenic neoplasm of which cell type?
cementoblasts
75% of cementoblastomas appear in what location?
in the mandible, almost always in the molar/premolar region
75% of cementoblastomas occur before what age?
30
pain and swelling are present in what fraction of cementoblastoma cases?
2/3
what is the radiographic presentation of cementoblastomas?
- 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
cementoblastoma
cementoblastoma
cementoblastoma
what is the treatment for a cementoblastoma?
surgical extraction of the tooth with the calcified mass
contains malignant osteoid
osteosarcoma
notice the spiking resorption
contains malignant osteoid
osteosarcoma
notice the spiking resorption
contains malignant osteoid
osteosarcoma
classic sunburst appearance
excluding hematopoietic neoplasms, ___ is the most common type of malignancy to originate within bone
osteosarcoma
osteosarcomas of the jaws comprise ___% of all osteosarcomas
7%
osteosarcomas of the jaws typically occur around what age? how does this differ from osteosarcoma of long bones?
- jaws - age 33
- long bones - 10-15 years earlier
the PDL widening in osteosarcomas is due to ___
tumor infiltration
it is important to remember that PDL widening is seen in other malignancies and is not specific for osteosarcomas and is
osteosarcoma
osteosarcoma
osteosarcoma
of osteosarcoma jaw lesions and long bone lesions, which ones have a greater tendency to metastasize, and what are the most commonly affected sites
- long bones
- brain and lung
what is the prognosis for osteosarcoma jaw lesions? what if initial radical surgery is performed?
- 30-70% depending on the study
- prognosis can appraoch 80% using initial radical surgery
___ is the most common form of cancer involving bone
metastatic carcinoma
(versus osteosarcoma, which is the most common type of malignancy to ORIGINATE within bone, excluding hematopoietic neoplasms)
what are the most common origins of gnathic metastases?
breast, lung, thyroid, prostate, and kidney
what are the most common bone sites of metastatic tumors?
vertebrae, ribs, pelvis, and skull
___% of metastatic tumors to the jaws occur in the mandible
80%
what are the symptoms of metastatic tumors to the jaws?
pain, swelling, loosening of teeth, parasthesia
what is numb chin syndrome?
- 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
metastatic tumor to the jaws can be discovered in a ___
nonhealing extraction site
what are the radiographic features of metastatic tumors to the jaws?
- ill-defined borders (moth eaten)
- widening of the PDL ligament
metastatic tumor of the jaws
widening of the PDL and ill-defined borders (moth eaten)
metastatic tumor to the jaws
metastatic tumor to the jaws
what is the prognosis of metastatic tumors to the jaws?
- poor (stage IV disease)
- 5-year survival is exceedingly rare
- patient’s typically succomb to cancer within a year
bone graft
tonsillolith
contains marrow
focal osteoporotic marrow defect
what are the radiographic features of central giant cell granuloma?
- not diagnostic
- radiolucent lesions which may be multilocular or unilocular
- typically well-delineated
- noncorticated margins
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?
central giant cell granuloma
antral pseudocyst and central giant cell granuloma
what are the radiographic features of cherubism?
- multilocular
- expansile
- radiolucent
- the appearance is virtually diagnostic due to the bilateral location in a young person
cherubism
cherubism
what are the radiographic features of an aneurysmal bone cyst?
- 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
how do aneurysmal bone cysts appear during surgery?
- venous blood wells up and there may be bleeding
- appearance is like a “blood soaked sponge”
aneurysmal bone cyst
fibrous dysplasia
ground glass appearance
describe how periapical cemento-osseous dysplasia lesions mature over time
- 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
T or F:
each periapical cemento-osseous dysplasia lesion is self-limiting and progressive growth does not occur
true
what are the radiographic features of florid cemento osseous dysplasia?
- initially, lesions are predominantly radiolucent
- over time become mixed RL-RO
- end-stage lesions are predominantly radiopaque with a thin peripheral RL rim
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?
- periapical and florid
- biopsy should be avoided because it may lead to necrosis due to the hypovascularity
which form of cemento-osseous dysplasia requires a biopsy for diagnosis and why?
focal because the features are less specific than the other two forms
why is it important to encourage good oral hygiene in patients with florid cemento-osseous dysplasia?
you want them to keep their teeth because extraction may lead to necrosis
juvenile (active) ossifying fibroma is distinguished from ossifying fibroma on the basis of what 3 things?
age of patient, most common sites of involvement, and clinical behavior
which two different neoplasms have been reported under juvenile ossifying fibroma, and which is more common?
- trabecular
- psammomatoid (4x more common than trabecular)
both forms of juvenile ossifying fibroma are more common in males or females? more common in the maxilla or mandible?
- males
- maxilla
- both of these characteristics are opposite of ossifying fibroma
with juvenile ossifying fibromas, as a general rule, the younger the patient, the _more/less_ aggressive the tumor
more
how are small vs large juvenile ossifying fibroma lesions treated?
- smaller - local excision or curettage
- larger - wide resection
