bone lecture 4 Flashcards
Multiple Myeloma
Malignancy of?
Most common tumor of?
May arise from?
Monoclonal proliferation of? producing?
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
Multiple Myeloma
Clinical features:
demo age?
race?
Jaw involvement %?
symptoms?
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
Multiple Myeloma
Clinical features:
amyloid?
renal?
lab urine results?
Amyloid deposits- tongue MC site
Renal failure
Bence Jones protein in urine
Multiple Myeloma
Radiographic features:
Sharply punched out radiolucency
Ill defined, ragged radiolucency
non corticated
where does MM originate?
bone marrow from plasma cells producing abnormal Ig
dif dx
MM
langerhans histocytosis
lucent osteosarcoma
Immunohistochemistry (IHC) of MM
kappa and lambda light chain products
staining for these looking for excess (monoclonal = +, polyclonal = -)
Multiple myeloma
Treatments:
5-year prognosis
Chemotherapy
Bone marrow transplantation
Bisphosphonates
5-year prognosis: 50-70%
Osteosarcoma
Malignancy of? that produce?
risk factors?
genetic alterations to what genes?
Malignancy of mesenchymal cells that produce malignant osteoid
Risk factors: Radiation exposure, alkylating agents, Paget disease, hereditary retinoblastoma
Genetic alterations: p53, RB1
Osteosarcoma
Clinical features:
% arise in jaws
MC in? decades?
Gnathic cases decades?
preffered arch?
symptoms
6% arise in jaws
MC in long bones: 2nd-3rd decade
Gnathic cases: 3rd – 5th decade
Slight mandibular predilection
Swelling and pain
Osteosarcoma
Radiographic features:
Cortiex?
Periosteum?
roots?
PDL?
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)
osteosarcoma
Osteosarcoma
Treatment:
5-year survival?
Prognostic factor?
Wide surgical resection
Radiation and chemotherapy may be considered
5-year survival 60-70%
Prognostic factor: complete surgical removal
Chondrosarcoma
defined?
commonality compared to osteosarcoma
May develop how?
Mutations in?
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
Chondrosarcoma
Clinical findings:
Mean age
MC sites
Gnathic cases common site
mandibular lesions where?
symptoms?
Mean age: 51 years
MC sites: ilium, femur, humerus, ribs
Gnathic cases: MC anterior maxilla
mandibular lesions: posterior
Painless swelling
Chondrosarcoma
Radiographic findings:
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
Chondrosarcoma
Treatment:
Surgical resection
Radiation and chemotherapy may be considered for high-grade
Ewing Sarcoma
defined?
gene?
lesions most frequent in what tissue?
Malignant neoplasm – undifferentiated round cells
EWS-FLI1 fusion gene
Bone lesions most frequent
Ewing Sarcoma
Clinical findings:
MC decade?
MC race?
MC where?
jaw?
symptoms?
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
Ewing Sarcoma
Radiographic findings:
Ill-defined RL, mixed RL-RO
Cortical destruction or expansion
“onionskin” periosteal reaction
Ewing Sarcoma
Treatment:
5-year survival: localized vs metastasized
Surgery with multiagent chemotherapy and radiotherapy
5-year survival: 70% localized, 25% metastasis
Metastasis to the oral cavity
Primary sites:
Jaw metastasis?
MC form of cancer involving bone
Primary sites: breast, lung, thyroid, prostate, kidney
Jaw metastasis uncommon
Metastasis to the oral cavity
Clinical features:
MC age
jaw locations?
symptoms?
MC older adults
Mandible (posterior) > maxilla
Pain and swelling
Tooth mobility
Paresthesia of lower lip/chin (numb-chin syndrome)
Metastasis to the oral cavity
Radiographic features:
Ill-defined, “moth-eaten” RL
Occasionally, may have mixed RL-RO
May cause cortical destruction, pathologic fracture
Metastasis to the oral cavity
Treatment:
Solitary lesion – surgical excision or radiation
Management depends on underlying cancer
Prognosis poor overall
dif?
multi myeloma
langerhans cell histocytosis
chrondorsarcoma
metatsis to oral cavity
ewing sarcoma
dif
chondrosarcoma
osteosarcoma
Langerhans cell histocytosis
biopsy from 70yo male in posterior mandible as a RL, +congo red
MM
biopsy from ill defined RO of mandible from a 50yo, swelling and pain present
osteosarcoma
dif
osteo/chondrosarcoma
biopsy from 55yo in anterior maxilla, presented as a RL with RO foci
chondrosarcoma
dif
ewing sarcoma
osteosarcoma
chondrosarcoma
metasis to oral cavity
biopsy from ill defined mixed lesion in mandible in 26yo
ewing sarcoma
dif
metasis
ewing sarcoma
osteosarcoma
dif
metasis
ewing
osteosarcoma
