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PATH II > Bone lecture 2 > Flashcards

Bone lecture 2 Flashcards

1
Q

Central giant cell granuloma
 Etiology

A

 Etiology uncertain; reactive process vs benign neoplasm

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2
Q

Central giant cell granuloma
 Clinical features:

ages and location

A

 60% cases occur before 30 years
 70% mandible, anterior MC

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3
Q

Central giant cell granuloma
 Nonaggressive lesions:
 size?
 symptoms?
 growth?
 Discovered how?

A

 Smaller
 Fewer symptoms
 Slow growth
 Discovered on routine radiographs
MORE COMMON

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4
Q

Central giant cell granuloma
 Aggressive lesions:
 size?
 symptoms?
 growth?
 effect on teeth?
 Cortex?
 recurrence potential?

A

 Larger at dx
 Pain, paresthesia
 Rapid growth
 Root resorption, displacement
 Cortical perforation
 Greater recurrence potential

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5
Q

Central giant cell granuloma
 Radiographic findings:

A

unilocular or multilocular RL, well-defined borders

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6
Q

Central giant cell granuloma histopath

A

Multinucleated giant cells in a background of mesenchymal cells

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7
Q

which form of CGCG is this? what else could this be?

A

aggressive CGCG

odontogenic myxoma
glandular odontogenic cyst
OKC

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8
Q

biopsy from ML RL

A

CGCG, multinucleated giant cells

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9
Q

Central giant cell granuloma
 Treatment:
 Recurrence rate:

A

 Curettage
 Peripheral ostectomy
 Intralesional corticosteroids, calcitonin
 Recurrence rate: appx 20%

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10
Q

Cherubism
 where?
 Mutation of?
 result?
 Appearance reminiscent of?

A

 Developmental jaw disease
 Mutation of SH3BP2
 Enhanced osteoclastic activity →lytic bone lesions
 Appearance reminiscent of cherubs

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11
Q

Cherubism
 Clinical features:

A

 First evident 2-5 years, mild cases dx 10-12
 Alterations progress until puberty, then slowly regress
 Bilateral expansion of the posterior mandible: Angle, rami, coronoid process
 Involvement of inferior/lateral orbital wall →“eyes upturned to heaven”

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12
Q

Cherubism
 Dental implications:

A

Tooth displacement
mobility
failure of eruption
impaired mastication
speech difficulties

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13
Q

Cherubism
 Radiographic findings:

A

 Bilateral, multilocular, expansile RL
 Resorption of adjacent tooth roots
 Thinning of cortical bone

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14
Q

Cherubism
 Histopathology:

A

 Clinical and RG correlation essential
 Multinucleated giant cells, vascular fibrous tissue

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15
Q

biopsy from bilateral mulitlocular lucency, root resorbing

A

cherubism, multinucleated giant cells with a more pink stroma than CGCG (less RBC)

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16
Q

dif dx?

A

cherubism
CGCG?
OKC(s)

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17
Q
A

mild cherubism, may not be symmetrical but both sides involved

18
Q

Cherubism
 Treatment:

A

 Lesions regress after puberty
 Facial features appear normal by 4th decade
 Conservative therapy (observation)
 Surgical intervention for aggressive lesions, marked facial deformity

19
Q

Fibro-osseous lesions of the jaw
 Characterized by?
 what is necessary to establish specific diagnosis?

A

 Characterized by replacement of normal bone by fibrous tissue and mineralized product
 Clinical, radiographic, and histopathologic correlation necessary to establish specific diagnosis

20
Q

Fibro-osseous lesions of the jaw

A

 Fibrous dysplasia
 Ossifying (cemento-ossifying) fibroma
 Cemento-osseous dysplasia

21
Q

types of Cemento-osseous dysplasia

A

 periapical cemento-osseous dysplasia
 focal cemento-osseous dysplasia
 florid cemento-osseous dysplasia

22
Q

Fibrous dysplasia
 lesion type?
 mutation?
 result?

A

 Developmental lesion
 GNAS mutation
 Replacement of normal bone by cellular fibrous connective tissue with irregular bony trabeculae

23
Q

Fibrous dysplasia
 Monostotic disease clinical features:
 % cases? how many bones are involved?
 Dx at what age?
 preferred jaw locations?
 presentation?

A

 Monostotic disease: 80 to 85% of all cases, single bone involved
 Dx in 2nd to 3rd decade
 Maxilla (posterior) > mandible
 Painless unilateral swelling

24
Q

Fibrous dysplasia
 Polyostotic disease Clinical features:
 Dx at what age? how many bones involved?
 demo?
 sigs/symptoms?

A

 Dx in 1st decade, multiple bones involved
 Female predilection
 Long bone involvement: pain, pathologic fracture, bowing deformity

25
Q

Fibrous dysplasia
 Polyostotic disease associated syndromes

A

 Jaffe-Lichtenstein syndrome: café-au-lait pigmentation
 McCune-Albright syndrome: café-au-lait pigmentation, multiple endocrine lesions

26
Q

Fibrous dysplasia
 Radiographic features:
 Mandible expansion?
 lamina dura?

A

 fine, ground-glass opacification with poorly defined borders
 Mandible: buccal-lingual expansion
 Ill-defined lamina dura

27
Q

Fibrous dysplasia
 Treatment:
 Minimal cosmetic or functional disturbances?
 Large, extensive lesions?
 % show regrowth after surgical debulking?
 Complete surgical resection for which lesions?

A

 Minimal cosmetic or functional disturbances: may not require surgery
 Large, extensive lesions: Surgical debulking/contouring
 20-50% show regrowth after surgical debulking
 Complete surgical resection: monostotic lesions, refractory lesions

28
Q

Cemento-osseous dysplasia
common?
where?
variants?

A

 MC fibro-osseous lesion
 Occurs in tooth-bearing areas of the jaw
 Three variant: periapical, focal, florid

29
Q

Periapical cemento-osseous dysplasia
 Clinical features:
 common location?
 # foci?
 demo?
 Dx age?

A

Involves lower anterior periapical region
 Usually multiple foci present
 Marked female predilection: 10:1, 70% cases affect blacks
 Dx: 30-50 years of age

30
Q

Periapical cemento-osseous dysplasia
 Radiographic features: stages

A

 Early lesions: circumscribed periapical radiolucency
 Older lesions: mixed RL-RO
 End stage: circumscribed radiopacity, with radiolucent rim

31
Q

Focal cemento-osseous dysplasia
 Clinical features:
 # sites?
 MC location?
 demo?
 Dx age?

A

 Involves a single site
 MC in posterior mandible
 90% females
 MC in blacks
 Dx: 3rd–6th decade

32
Q

Focal cemento-osseous dysplasia
 Radiographic findings:

A

 Same as periapical COD, but focal

33
Q

Florid cemento-osseous dysplasia
 Clinical features:
 site involvement?
 MC demo
 Dx age?
 symptoms?

A

 Multifocal involvement, may involve all 4 quadrants
 MC black females
 Dx: 3rd–6th decade
 Usually asymptomatic, may have dull pain

34
Q

Florid cemento-osseous dysplasia
 Radiographic features:

A

 similar in progress to other types of COD
 Multifocal involvement

35
Q

Cemento-osseous dysplasia
 Treatment:

A

 Not required; periapical COD is especially distinct
 Periodic observation
 Focal COD less specific, bx may be needed to confirm
 Prone to necrosis (especially sclerotic phase) - avoid unnecessary bx

36
Q

Ossifying fibroma
 growth potential?
 Resembles what radiographically?

A

 True neoplasm, significant growth potential
 Resemble cemento-osseous dysplasia

37
Q

Ossifying fibroma
 Clinical features:
 ages?
 location?
 Small lesions vs large lesions symptoms?

A

 Broad age range: peek in 3rd to 4th decade
 Mandible (posterior) > maxilla
 Small lesions: often asymptomatic
 Large tumors: painless jaw swelling

38
Q

Ossifying fibroma
 Radiographic features:
 expansion?
 inferior cortex?

A

 Mixed RL-RO lesion, or well-defined unilocular lesion
 Buccal lingual expansion common
 Downward bowing of inferior cortex

39
Q

Ossifying fibroma
 Treatment:
 Recurrence

A

 Often circumscribed, facilitates easy removal
 Large lesions may require surgical resection
 Recurrence uncommon

40
Q

dif dx

A

oss fibroma
cementoblastoma
osteoblastoma

PATH II (25 decks)

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