bone lecture 3

Question 1

Osteoma

Answer 1

 Benign tumors composed of mature compact or cancellous bone

Question 2

Osteoma MC what region of body?

Answer 2

 MC craniofacial region

Question 3

osteomas may arise from what parts of the bone?

Answer 3

May arise from bone surface or within medullary bone

Question 4

osteomas are distinct what from other growth?

Answer 4

Distinct from exostosis

Question 5

Osteoma
 Clinical features:
 age
 MC where
 many/one? symptoms?
 growth rate?
 Large lesions may produce:

Answer 5

 Observed in adults
 MC mandibular body and condyle
 Solitary and asymptomatic
 Slow growth
 Large lesions may produce marked facial deformity

Question 6

Osteoma
 Radiographic features:

Answer 6

 Circumscribed radiopaque mass
 Smaller endosteal osteomas – more discrete

Question 7

dif dx

Answer 7

osteoma
osteoblastoma

Question 8

from biopsy post man well defined/ circumscribed opacity in adult male

Answer 8

osteoma

Question 9

Gardner syndrome
 Characterized by:
 Variant of?
 numerous what?
 inheritence/mutation?

Answer 9

 Characterized by intestinal polyps and abnormalities of bone, teeth, skin, soft tissue
 Variant of familial adenomatous polyposis
 numerous intestinal polyps →colorectal cancer
 AD disorder, mutations in APC (tumor suppressor gene)

Question 10

Gardner syndrome
 Clinical features:
 Colorectal polyps develop by what decade?
 symptoms?
 May cause what GI disturbances?
 If untreated, will transform into?

Answer 10

 Colorectal polyps develop by 2nd decade
 Often asymptomatic
 May cause diarrhea, constipation, abdominal pain
 If untreated, will transform into adenocarcinoma

Question 11

Gardner syndrome
 Clinical features:
 % developing osteomas?
 cysts where?
 Pigmented lesions of?

Answer 11

 90% develop skeletal abnormalities: osteomas (multiple)
 Epidermoid cysts
 Pigmented lesions of ocular fundus

Question 12

Gardner syndrome
 Dental abnormalities:

Answer 12

 Odontomas, supernumerary teeth, impacted teeth

Question 13

Gardner syndrome Treatment:
 Without treatment?
 Prophylactic?
 Osteomas?
 Dental management for?

Answer 13

 Without treatment: 50% develop colorectal cancer by 30 years, nearly 100% by 5th decade
 Prophylactic colectomy recommended
 Osteomas removed for functional issues
 Dental management for impacted teeth, odontoma

Question 14

what are these findingd indicative of?

Answer 14

gardner syndrome

Question 15

Osteoblastoma
 occurance?
 Arise from what cells?
 MC where?

Answer 15

 Rare, appx 1% of bone tumors
 Arise from osteoblasts
 MC in vertebral column, long bones, pelvis, facial bones, small bones of hands and feet

Question 16

Osteoblastoma
 Clinical features:
 MC which jaw?
 85% occur before?
 symptoms?
 Teeth?

Answer 16

 MC in mandible
 85% occur before 30 years
 Dull pain, swelling
 Tooth mobility, root resorption or displacement

Question 17

Osteoblastoma
 Radiographic features:

Answer 17

 Mixed RL/RO, variable mineralization
 May be well-defined or poorly defined

Question 18

Osteoblastoma tx/recurrence

Answer 18

 Local excision or curettage
 Recurrence uncommon

Question 19

dif dx

Answer 19

osteoma
osteoblastoma

Question 20

biopsy from a ill defined opacity of the mandible, pt has dull pain

Answer 20

osteoblastoma

Question 21

Cementoblastoma

Answer 21

 Benign neoplasm of cementum

Question 22

 cementoblastoma Clinical features:
 location?
 50% cases arise by what age?
 symptoms?
 Bony expansion?

Answer 22

 80% mandible (50% 1st molar)
 50% cases arise by 20 years
 Pain and swelling
 Bony expansion uncommon

Question 23

Cementoblastoma
 Radiographic features:

Answer 23

 Radiopaque mass that is fused to one or more tooth roots
 May be surrounded by thin RL rim

Question 24

Cementoblastoma
 Treatment:

Answer 24

 Surgical extraction of tooth and calcified mass

Question 25

Answer 25

cementoblastoma

Question 26

from extracted tooth

Answer 26

cementoblastoma

Question 27

Langerhans cell histiocytosis

Answer 27

 Proliferation of Langerhans cells (dendritic cells)
 Antigen presenting cell
 Normally found in epidermis, mucosa, lymph nodes, bone marrow

Question 28

Langerhans cell histiocytosis mutation

Answer 28

BRAF mutations – 40-60% cases

Question 29

Langerhans cell histiocytosis
 Clinical features:
 involvment patterns?
 50% cases below what age?
 Bone lesions patterns?
 common bones?
 symptoms?

Answer 29

 Single organ involvement: bone or skin
 Multi-organ involvement
 50% cases <15 years
 Bone lesions – solitary or multiple
 Skull, ribs, vertebrae, mandible
 Dull pain, tenderness

Question 30

Langerhans cell histiocytosis
 Mucosal involvement:

Answer 30

ulcerative or proliferative gingival mass

Question 31

Langerhans cell histiocytosis
 Radiographic features:
 May resemble?

Answer 31

 Sharply punched-out radiolucency (no corticated rim)
 Occasionally ill-defined
 May resemble aggressive periodontitis
 Extensive alveolar involvement: teeth “floating in air”

Question 32

Langerhans cell histiocytosis
 Histopathologic features:

Answer 32

 Diffuse infiltration of large, pale-staining mononuclear cells
 Eosinophils
 other mixed inflammatory cells
 Immunohistochemistry (IHC): CD-1a, CD-207 (+)

Question 33

Langerhans cell histiocytosis
 Electron microscope:

Answer 33

 Birbeck granules: rod-shaped cytoplasmic structures

Question 34

dif dx

Answer 34

Langerhans cell histiocytosis
OKCs
ameloblastomas

Question 35

Langerhans cell histiocytosis
 Treatment:
 Accessible bone lesions?
 Chronic disseminated disease?

Answer 35

 Accessible bone lesions often treated with curettage – prognosis is good
 Chronic disseminated disease - management complex