Bone Neoplasms (3) Flashcards
List three malignant neoplasms of bone?
- Chondrosarcoma
- Osteosarcoma
- Metastatic disease
Which syndrome is associated with central ossifying fibroma?
Hyperparathyroidism-jaw tumor syndrome
Which syndrome is associated with an osteoma?
Gardner syndrome
Which syndrome is associated with giant cell granuloma?
- Hyperparathyroidism
2. Renal osteodystrophy
Most authorities consider a central ossifying fibroma to be an _______________.
Osteogenic neoplasm
T/F: Central ossifying fibromas are benign tumors that are sometimes seen outside of the jaw.
True
Where are central ossifying fibromas often found?
Mandibular molar/pre-molar region
Female predilection (3rd-4th decade)
T/F: Jaw expansion and facial asymmetry is possible with central ossifying fibroma.
True
T/F: Central ossifying fibroma will show radiographically as completely radiolucent.
False
Can be totally radiolucent or have radiopacity within it
What type of tissue is seen in a central ossifying fibroma?
Fibrous tissue with mix of bony and cementum like material
What is the treatment and prognosis for central ossifying fibroma?
Enucleation as one mass
Excellent
T/F: Tori and exostoses are considered osteomas.
False
They are histopathologically identical, but osteomas do not stop growing
T/F: Osteomas can occur on the surface of bone or within the bone.
True
Where are the most common places for osteomas?
Paranasal sinuses
Where is the most common place to get a gnathic osteoma?
Mandibular body and condyle… often see on lingual premolar/molar area
What will an osteoma look like radiographically?
Circumscribed radiopaque mass
Those within bone may appear similar to idiopathic osteosclerosis/condensing osteitis
T/F: Osteomas are filled with bone marrow.
False
Minimal marrow or trabeculae
What is the treatment/prognosis of osteomas?
Nothing… excision if symptomatic
Good, recurrence rare
T/F: Gardner syndrome is autosomal dominant and highly penetrant.
True
If you have the mutation, will most likely get the disease
Multiple Epidermoid cysts and osteomas can lead to what possible diagnosis?
Gardner syndrome
High risk for intestinal polyps that will transform to adenocarcinoma
What is the prognosis for Gardner syndrome?
Guarded
50% Patients develop adenocarcinoma by 30 years old
T/F: Central giant cell granulomas are more common in older patients.
False
Mostly females under 30
What is the most common location for a central giant cell granuloma?
Usually in the anterior mandible crossing the midline
T/F: Central giant cell granulomas can break through bone and into soft tissue.
True
Typically asymptomatic but can be more aggressive
What is the treatment and prognosis for central giant cell granuloma?
Aggressive curettage/osteotomy
Good, recurs 15-20% of the time
What are the two types of hyperparathyroidism?
Primary - parathyroid hyperplasia, parathyroid adenoma or carcinoma -> inappropriate secretion of PTH
Secondary - renal failure -> altered vitamin D -> poor calcium retention
T/F: PTH activates osteoblasts.
False
PTH activates osteoclasts to break down bone calcium and increase blood calcium
What is often seen in dental radiographs of a patient with hyperparathyroidism?
Loss of lamina dura and “ground glass” appearence
What tumor is associated with Hyperparathyroidism and what is it similar to?
Brown tumors
Similar to peripheral giant cell granuloma, CGCG, and giant cell tumor of bone
What oral manifestations will be seen with Hyperparathyroidism patients with renal osteodystrophy that may be on dialysis?
Prominent enlargement of the jaw(s)
What is the treatment/prognosis for hyperparathyroidism?
Primary - remove source
Secondary - better control, renal transplant
Fair
What is the 2nd most common bone malignancy?
Chondrosarcoma
Still rare however
Chondrosarcoma is a malignancy of _____________ differentiation.
cartilaginous
What are the most likely places to see a chondrosarcoma?
Femur, pelvis, ribs
What percentage of chondrosarcoma are seen in head and neck?
10%
T/F: Chondrosarcoma in the head and neck can mimic dental infection.
True
T/F: Chondrosarcoma will present as a well defined radiolucency.
False
Poorly defined radiolucency with some radiopacity
What is the histopathological features of chondrosarcoma?
Invasive lobules of atypical cells with cartilaginous differentiation
What is the treatment/prognosis for chondrosarcoma?
Radical surgery
Generally poor, depends on location and grade
Metastasis to lung
What is the most common primary bone malignancy?
Osteosarcoma
What percentage of osteosarcoma affect the jaws?
8%
Where do most osteosarcomas occur?
In the long bones at the knee
What are the clinical features of an osteosarcoma in the jaws?
Swelling, loose teeth, parasthesia
T/F: Osteosarcoma in the jaws often shows as a “sun burst” pattern radiographically.
False
Less common in the jaw
Will see mixed radiopaque/radiolucent lesion instead
What types of cells will be seen in an osteosarcoma?
Osteoblastic, chondroblastic, and fibroblastic cells producing osteoid
T/F: Radical surgery is the only treatment for osteosarcoma.
False
Induction chemotherapy, then surgery to remove tumor
What is the prognosis for osteosarcoma?
Fair
5 year survival 30-50%
Metastasis to lung
What is the most common form of cancer involving the bone?
Metastatic disease
T/F: Jaws are often affected with metastatic disease.
False
1% of all oral malignancies are metastatic disease
What is the significance of Batson’s plexus?
Valveless vertebral venous plexus allows spread of tumor cells against gravity up to the jaws
Which jaw is most commonly affected with metastatic disease?
Mandible
T/F: Metastatic disease is most commonly seen as a poorly defined radiolucency.
True
What are the most common metastatic diseases?
Breast, lung, colon, thyroid, prostate, kidney, melanoma
What is the treatment and prognosis of metastatic disease?
Palliative with radiation therapy
Very poor, most die within a year
22% of jaw metastases are initial manifestation
