Bone neoplasms

Question 1

Central Ossifying Fibroma comes from where

Answer 1

PDL firbroblast

Question 2

Central Ossifying Fibroma confused with what in the past

Answer 2

focal cementosseos dysplasia

Question 3

Central Ossifying Fibroma found in which region and in who?

Answer 3

30-40s adult females

molar premolar region

Question 4

Central Ossifying Fibroma radiographic characteristics

Answer 4

well circumscribed radiolucency with central opacity

can range from mostly radiolucent and radiodense in the middle

Question 5

Central Ossifying Fibroma clinical appearance

Answer 5

asymmpotmatic swelling
facial deformation
root divergence

Question 6

Central Ossifying Fibroma biopsy

Answer 6

seperates from host bone easily in one piece.

Question 7

Central Ossifying Fibroma histology

Answer 7

Cellular fibrous connective tissue with calcified trabeculae/spherules resembling cellular cementum or woven bone
Similar histology to fibrous dysplasia

Question 8

Central Ossifying Fibrom trt

Answer 8

enucleation

Question 9

Central Ossifying Fibrom prognosis

Answer 9

very good, low recurrence

Question 10

Osteoma histology

Answer 10

normal bone with or without marrow

Question 11

Osteoma what is it and where

Answer 11

benign osseous tumor
primary craniofacial bones (paranasal sinus)
and mandible (body and condylar region)

Question 12

Osteoma clinical

Answer 12

painless, slow growing

Question 13

Gardner Syndrome what kind of diseas

Answer 13

genetic
1:8,000- 1:16,000 births
APC gene, chromosome 5

Question 14

Gardner Syndrome main characteristics

Answer 14

multiple osteomas of the facial bones.
epidermoid cysts
desmoid tumors

Question 15

Gardner Syndrome teeth problems

Answer 15

may see impacted supernumeray teeth

Question 16

Gardner Syndrome radiographically

Answer 16

may resemble florid cemento- osseous dysplasia or osteitis deformans

Question 17

Gardner Syndrome most significant aspect of the syndrome

Answer 17

development of precancerous polyps of the colon

Question 18

Gardner Syndrome precancerous poly problems…

Answer 18

50% of patients develop adenocarcinoma of the colon by 30 years of age (approaches 100% by 5th decade)

Question 19

Gardner Syndrome management

Answer 19

– Prophylactic colectomy
– Removal of problematic cysts and osteomas
– Removal of impacted teeth/odontomas with prosthodontic work as needed
– Genetic counseling


Question 20

Central Giant Cell Granuloma

Answer 20

benign lesion of the jaw,
neoplasm or reactive process???
(use to be called reactive giant cell)

Question 21

Central Giant Cell Granuloma affects who most

Answer 21

60% under 30 years old

female

Question 22

Central Giant Cell Granuloma found where

Answer 22

mandible (70%), anterior, can cross midline

Question 23

Central Giant Cell Granuloma radiographically

Answer 23

unilocular when small, multilocular when larger. LARGE radiolucency

Question 24

Central Giant Cell Granuloma histo

Answer 24

cellular granulation tissue with numerous benign multinucleated giant cells
RBC extravasation and hemosiderin deposits are common

Question 25

Central Giant Cell Granuloma trt

Answer 25

generally consists of aggressive curettage, although alternative non- surgical therapies have been reported

Question 26

Central Giant Cell Granuloma prognosis

Answer 26

good

Question 27

Central Giant Cell Granuloma recurrence

Answer 27

20%

Question 28

Hyperparathyroidism primary vs secondary

Answer 28

primary-due to parathyroid hyperplasia, parathyroid adenoma, parathyroid carcinoma secondary- due to renal failure, which is responsible for poor calcium retention and altered vitamin D metabolism

Question 29

Hyperparathyroidism bone lesions

Answer 29

Unilocular/multilocular radiolucencies may develop - “brown tumor” Diffuse jaw enlargement may develop with chronic renal failure: renal osteodystrophy

Question 30

Hyperparathyroidism bone lesion radiographically

Answer 30

loss of lamina dura and “ground-glass” trabecular pattern

Question 31

Hyperparathyroidism histo

Answer 31

brown tumors show vascular granulation tissue with numerous multinucleated giant cells and extravasated erythrocytes

Question 32

Hyperparathyroidism looks similar to what in microscope

Answer 32

Microscopically identical to central giant cell granuloma

Question 33

Renal Osteodystrophy

Answer 33

Hyperplastic response of the bone in patients with poorly-controlled secondary hyperparathyroidism related to end-stage renal disease Prominent jaw enlargement may result

Question 34

Hyperparathyroidism trt

Answer 34

If primary, remove the source of excess hormone secretion – If secondary, better control of serum calcium levels. Parathyroidectomy may be needed if medical therapy fails. Renal transplant is another alternative

Question 35

Hyperparathyroidism prognosis

Answer 35

fair to good

Question 36

Osteosarcoma

Answer 36

Most common primary bone malignancy | tumor cells produce osteoid

Question 37

Osteosarcoma, how many affect the jaw

Answer 37

6-8%

Question 38

Osteosarcoma who

Answer 38

second decade long bones- mean age 18 Jaws- 33-39

Question 39

Osteosarcoma clinical appearance

Answer 39

pain, swelling, paresthesia, loose teeth

Question 40

Osteosarcoma radiographically

Answer 40

mixed radiopaque and radiolucency with ill defined borders Widen PDL Sun Burst pattern is uncommon in the jaws

Question 41

Osteosarcoma histo

Answer 41

Infiltrating sheets of malignant spindle-shaped or angular lesional cells Direct production of osteoid or bone Mitotic activity can vary from field to field Osteoblastic, chondroblastic and fibroblastic differentiation may be seen

Question 42

Osteosarcoma trt

Answer 42

is radical surgery, together with chemotherapy is some cases

Question 43

Osteosarcoma prognosis

Answer 43

Overall 5 yr survival: 60-70% | death usually due to uncontrolled local disease than metastasis

Question 44

Chondrosarcoma

Answer 44

Rare malignancy of cartilaginous differentiation (1/2 as common as osteosarc) pain, swelling, loose teeth

Question 45

Chondrosarcoma seen in who and where?

Answer 45

``` adult males 4th 6th decade of life femur, pelvis, or ribs mostly .1% of all head and neck malignancies anterior maxilla posterior mandible ```

Question 46

Chondrosarcoma radiographic

Answer 46

Poorly defined radiolucency with variable amounts of radiopacity Larger lesions may appear multilocular May see widened PDL of the teeth in the area of the tumor, similar to osteosarcoma

Question 47

Chondrosarcoma histo

Answer 47

characterized by invasive lobules of atypical cells showing cartilaginous differentiation most jaw lesions are grade 1 or 2

Question 48

Chondrosarcoma trt

Answer 48

radical surgery

Question 49

Chondrosarcoma prognosis

Answer 49

depends on histo grade and location of tumor

Question 50

Chondrosarcoma survival

Answer 50

5 and 10 yr survival: 87% and 71% respectively | death usually due to direct extension of the tumor into vital structures.

Question 51

Metastatic Disease

Answer 51

Most common form of cancer to involve bone | sometimes Jaws are affected.

Question 52

Metastatic deposits from malignancies below the neck may affect the jaws through

Answer 52

Batson’s paravertebral plexus of veins which lack valves

Question 53

Metastatic Disease who and where

Answer 53

43-52 years old. | posterior mandible.

Question 54

Metastatic Disease clinical characteristics

Answer 54

- paresthesia, tooth mobility, swelling, bleeding, trismus, fracture - failure of tooth socket to heal.

Question 55

Metastatic Disease radiology

Answer 55

Poorly defined radiolucency; less commonly, mixed radioluceny/radiopacity

Question 56

Metastatic Disease histo what do the mimic

Answer 56

the primary malignancy from which they arose

Question 57

Metastatic Disease scattered cluster of

Answer 57

lesional cells give a “seeded” effect

Question 58

Metastatic Disease primary malignancy arise from where

Answer 58

Breast, lung, colon, thyroid, prostate, kidney, melanoma

Question 59

_____% of jaw metastases represent the initial manifestation of the malignant process

Answer 59

22%

Question 60

Metastatic Disease trt

Answer 60

palliation, usually with radiation therapy, anti-resorptives

Question 61

Metastatic Disease prognosis

Answer 61

very poor, most die within a year