Bone lecture 2 Flashcards
Central giant cell granuloma
Etiology
Etiology uncertain; reactive process vs benign neoplasm
Central giant cell granuloma
Clinical features:
ages and location
60% cases occur before 30 years
70% mandible, anterior MC
Central giant cell granuloma
Nonaggressive lesions:
size?
symptoms?
growth?
Discovered how?
Smaller
Fewer symptoms
Slow growth
Discovered on routine radiographs
MORE COMMON
Central giant cell granuloma
Aggressive lesions:
size?
symptoms?
growth?
effect on teeth?
Cortex?
recurrence potential?
Larger at dx
Pain, paresthesia
Rapid growth
Root resorption, displacement
Cortical perforation
Greater recurrence potential
Central giant cell granuloma
Radiographic findings:
unilocular or multilocular RL, well-defined borders
Central giant cell granuloma histopath
Multinucleated giant cells in a background of mesenchymal cells
which form of CGCG is this? what else could this be?
aggressive CGCG
odontogenic myxoma
glandular odontogenic cyst
OKC
biopsy from ML RL
CGCG, multinucleated giant cells
Central giant cell granuloma
Treatment:
Recurrence rate:
Curettage
Peripheral ostectomy
Intralesional corticosteroids, calcitonin
Recurrence rate: appx 20%
Cherubism
where?
Mutation of?
result?
Appearance reminiscent of?
Developmental jaw disease
Mutation of SH3BP2
Enhanced osteoclastic activity →lytic bone lesions
Appearance reminiscent of cherubs
Cherubism
Clinical features:
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”
Cherubism
Dental implications:
Tooth displacement
mobility
failure of eruption
impaired mastication
speech difficulties
Cherubism
Radiographic findings:
Bilateral, multilocular, expansile RL
Resorption of adjacent tooth roots
Thinning of cortical bone
Cherubism
Histopathology:
Clinical and RG correlation essential
Multinucleated giant cells, vascular fibrous tissue
biopsy from bilateral mulitlocular lucency, root resorbing
cherubism, multinucleated giant cells with a more pink stroma than CGCG (less RBC)
dif dx?
cherubism
CGCG?
OKC(s)
mild cherubism, may not be symmetrical but both sides involved
Cherubism
Treatment:
Lesions regress after puberty
Facial features appear normal by 4th decade
Conservative therapy (observation)
Surgical intervention for aggressive lesions, marked facial deformity
Fibro-osseous lesions of the jaw
Characterized by?
what is necessary to establish specific diagnosis?
Characterized by replacement of normal bone by fibrous tissue and mineralized product
Clinical, radiographic, and histopathologic correlation necessary to establish specific diagnosis
Fibro-osseous lesions of the jaw
Fibrous dysplasia
Ossifying (cemento-ossifying) fibroma
Cemento-osseous dysplasia
types of Cemento-osseous dysplasia
periapical cemento-osseous dysplasia
focal cemento-osseous dysplasia
florid cemento-osseous dysplasia
Fibrous dysplasia
lesion type?
mutation?
result?
Developmental lesion
GNAS mutation
Replacement of normal bone by cellular fibrous connective tissue with irregular bony trabeculae
Fibrous dysplasia
Monostotic disease clinical features:
% cases? how many bones are involved?
Dx at what age?
preferred jaw locations?
presentation?
Monostotic disease: 80 to 85% of all cases, single bone involved
Dx in 2nd to 3rd decade
Maxilla (posterior) > mandible
Painless unilateral swelling
Fibrous dysplasia
Polyostotic disease Clinical features:
Dx at what age? how many bones involved?
demo?
sigs/symptoms?
Dx in 1st decade, multiple bones involved
Female predilection
Long bone involvement: pain, pathologic fracture, bowing deformity
Fibrous dysplasia
Polyostotic disease associated syndromes
Jaffe-Lichtenstein syndrome: café-au-lait pigmentation
McCune-Albright syndrome: café-au-lait pigmentation, multiple endocrine lesions
Fibrous dysplasia
Radiographic features:
Mandible expansion?
lamina dura?
fine, ground-glass opacification with poorly defined borders
Mandible: buccal-lingual expansion
Ill-defined lamina dura
Fibrous dysplasia
Treatment:
Minimal cosmetic or functional disturbances?
Large, extensive lesions?
% show regrowth after surgical debulking?
Complete surgical resection for which lesions?
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
Cemento-osseous dysplasia
common?
where?
variants?
MC fibro-osseous lesion
Occurs in tooth-bearing areas of the jaw
Three variant: periapical, focal, florid
Periapical cemento-osseous dysplasia
Clinical features:
common location?
# foci?
demo?
Dx age?
Involves lower anterior periapical region
Usually multiple foci present
Marked female predilection: 10:1, 70% cases affect blacks
Dx: 30-50 years of age
Periapical cemento-osseous dysplasia
Radiographic features: stages
Early lesions: circumscribed periapical radiolucency
Older lesions: mixed RL-RO
End stage: circumscribed radiopacity, with radiolucent rim
Focal cemento-osseous dysplasia
Clinical features:
# sites?
MC location?
demo?
Dx age?
Involves a single site
MC in posterior mandible
90% females
MC in blacks
Dx: 3rd–6th decade
Focal cemento-osseous dysplasia
Radiographic findings:
Same as periapical COD, but focal
Florid cemento-osseous dysplasia
Clinical features:
site involvement?
MC demo
Dx age?
symptoms?
Multifocal involvement, may involve all 4 quadrants
MC black females
Dx: 3rd–6th decade
Usually asymptomatic, may have dull pain
Florid cemento-osseous dysplasia
Radiographic features:
similar in progress to other types of COD
Multifocal involvement
Cemento-osseous dysplasia
Treatment:
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
Ossifying fibroma
growth potential?
Resembles what radiographically?
True neoplasm, significant growth potential
Resemble cemento-osseous dysplasia
Ossifying fibroma
Clinical features:
ages?
location?
Small lesions vs large lesions symptoms?
Broad age range: peek in 3rd to 4th decade
Mandible (posterior) > maxilla
Small lesions: often asymptomatic
Large tumors: painless jaw swelling
Ossifying fibroma
Radiographic features:
expansion?
inferior cortex?
Mixed RL-RO lesion, or well-defined unilocular lesion
Buccal lingual expansion common
Downward bowing of inferior cortex
Ossifying fibroma
Treatment:
Recurrence
Often circumscribed, facilitates easy removal
Large lesions may require surgical resection
Recurrence uncommon
dif dx
oss fibroma
cementoblastoma
osteoblastoma
