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PATH II > bone lecture 4 > Flashcards

bone lecture 4 Flashcards

1
Q

Multiple Myeloma
 Malignancy of?
 Most common tumor of?
 May arise from?
 Monoclonal proliferation of? producing?

A

 Malignancy of plasma cells
 Most common tumor of bone, excluding metastatic disease
 May arise from a plasmacytoma (unifocal)
 Monoclonal proliferation of plasma cells →produce non-functional immunoglobin

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2
Q

Multiple Myeloma
 Clinical features:
 demo age?
 race?
 Jaw involvement %?
 symptoms?

A

 Observed in adults, Dx: 60-70 years
 Twice as common in Black patients
 Jaw involvement – 30% cases
 Bone pain common, bone fractures
 Fatigue
 Petechial hemorrhage
 Fever

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3
Q

Multiple Myeloma
 Clinical features:
amyloid?
renal?
lab urine results?

A

 Amyloid deposits- tongue MC site
 Renal failure
 Bence Jones protein in urine

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4
Q

Multiple Myeloma
 Radiographic features:

A

 Sharply punched out radiolucency
 Ill defined, ragged radiolucency
non corticated

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5
Q

where does MM originate?

A

bone marrow from plasma cells producing abnormal Ig

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6
Q

dif dx

A

MM
langerhans histocytosis
lucent osteosarcoma

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7
Q

Immunohistochemistry (IHC) of MM

A

kappa and lambda light chain products
staining for these looking for excess (monoclonal = +, polyclonal = -)

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8
Q

Multiple myeloma
 Treatments:
 5-year prognosis

A

 Chemotherapy
 Bone marrow transplantation
 Bisphosphonates
 5-year prognosis: 50-70%

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9
Q

Osteosarcoma
 Malignancy of? that produce?
risk factors?
genetic alterations to what genes?

A

 Malignancy of mesenchymal cells that produce malignant osteoid
 Risk factors: Radiation exposure, alkylating agents, Paget disease, hereditary retinoblastoma
 Genetic alterations: p53, RB1

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10
Q

Osteosarcoma
 Clinical features:
 % arise in jaws
 MC in? decades?
 Gnathic cases decades?
 preffered arch?
 symptoms

A

 6% arise in jaws
 MC in long bones: 2nd-3rd decade
 Gnathic cases: 3rd – 5th decade
 Slight mandibular predilection
 Swelling and pain

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11
Q

Osteosarcoma
 Radiographic features:
 Cortiex?
 Periosteum?
 roots?
 PDL?

A

 Ill-defined RO, mixed RL-RO, or entirely RL lesion
 Cortical expansion, destruction
 Periosteal reaction – “sunburst” pattern
 “spiking” root resorption
 Symmetrical PDL widening (early cases)

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12
Q
A

osteosarcoma

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13
Q

Osteosarcoma
 Treatment:
 5-year survival?
 Prognostic factor?

A

 Wide surgical resection
 Radiation and chemotherapy may be considered
 5-year survival 60-70%
 Prognostic factor: complete surgical removal

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14
Q

Chondrosarcoma
 defined?
 commonality compared to osteosarcoma
 May develop how?
 Mutations in?

A

 Malignant neoplasm, tumor cells form malignant cartilage
 Half as common compared to osteosarcoma
 May develop de novo or from a preexisting benign cartilaginous tumor
 Mutations in IDH1 and IDH2 frequent

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15
Q

Chondrosarcoma
 Clinical findings:
 Mean age
 MC sites
 Gnathic cases common site
 mandibular lesions where?
 symptoms?

A

 Mean age: 51 years
 MC sites: ilium, femur, humerus, ribs
 Gnathic cases: MC anterior maxilla
 mandibular lesions: posterior
 Painless swelling

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16
Q

Chondrosarcoma
 Radiographic findings:

A

 Ill-defined RL with RO foci or may appear as multilocular RL
 May show “sunburst” pattern
 Root resorption, loosening of teeth
 Symmetrical widening of PDL

17
Q

Chondrosarcoma
 Treatment:

A

 Surgical resection
 Radiation and chemotherapy may be considered for high-grade

18
Q

Ewing Sarcoma
 defined?
 gene?
 lesions most frequent in what tissue?

A

 Malignant neoplasm – undifferentiated round cells
 EWS-FLI1 fusion gene
 Bone lesions most frequent

19
Q

Ewing Sarcoma
 Clinical findings:
 MC decade?
 MC race?
 MC where?
 jaw?
 symptoms?

A

 MC in 2nd decade
 MC in White patients
 MC long bones, pelvis, ribs
 1-2% arise in jaws, MC mandible
 Paresthesia and tooth mobility
 Pain and swelling

20
Q

Ewing Sarcoma
 Radiographic findings:

A

 Ill-defined RL, mixed RL-RO
 Cortical destruction or expansion
 “onionskin” periosteal reaction

21
Q

Ewing Sarcoma
 Treatment:
 5-year survival: localized vs metastasized

A

 Surgery with multiagent chemotherapy and radiotherapy
 5-year survival: 70% localized, 25% metastasis

22
Q

Metastasis to the oral cavity
 Primary sites:
 Jaw metastasis?

A

 MC form of cancer involving bone
 Primary sites: breast, lung, thyroid, prostate, kidney
 Jaw metastasis uncommon

23
Q

Metastasis to the oral cavity
 Clinical features:
 MC age
 jaw locations?
 symptoms?

A

 MC older adults
 Mandible (posterior) > maxilla
 Pain and swelling
 Tooth mobility
 Paresthesia of lower lip/chin (numb-chin syndrome)

24
Q

Metastasis to the oral cavity
 Radiographic features:

A

 Ill-defined, “moth-eaten” RL
 Occasionally, may have mixed RL-RO
 May cause cortical destruction, pathologic fracture

25
Q

Metastasis to the oral cavity
 Treatment:

A

 Solitary lesion – surgical excision or radiation
 Management depends on underlying cancer
 Prognosis poor overall

26
Q

dif?

A

multi myeloma
langerhans cell histocytosis
chrondorsarcoma
metatsis to oral cavity
ewing sarcoma

27
Q

dif

A

chondrosarcoma
osteosarcoma
Langerhans cell histocytosis

28
Q

biopsy from 70yo male in posterior mandible as a RL, +congo red

A

MM

29
Q

biopsy from ill defined RO of mandible from a 50yo, swelling and pain present

A

osteosarcoma

30
Q

dif

A

osteo/chondrosarcoma

31
Q

biopsy from 55yo in anterior maxilla, presented as a RL with RO foci

A

chondrosarcoma

32
Q

dif

A

ewing sarcoma
osteosarcoma
chondrosarcoma
metasis to oral cavity

33
Q

biopsy from ill defined mixed lesion in mandible in 26yo

A

ewing sarcoma

34
Q

dif

A

metasis
ewing sarcoma
osteosarcoma

35
Q

dif

A

metasis
ewing
osteosarcoma

PATH II (25 decks)

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