Bone neoplasms Flashcards
Central Ossifying Fibroma comes from where
PDL firbroblast
Central Ossifying Fibroma confused with what in the past
focal cementosseos dysplasia
Central Ossifying Fibroma found in which region and in who?
30-40s adult females
molar premolar region
Central Ossifying Fibroma radiographic characteristics
well circumscribed radiolucency with central opacity
can range from mostly radiolucent and radiodense in the middle
Central Ossifying Fibroma clinical appearance
asymmpotmatic swelling
facial deformation
root divergence
Central Ossifying Fibroma biopsy
seperates from host bone easily in one piece.
Central Ossifying Fibroma histology
Cellular fibrous connective tissue with calcified trabeculae/spherules resembling cellular cementum or woven bone
Similar histology to fibrous dysplasia
Central Ossifying Fibrom trt
enucleation
Central Ossifying Fibrom prognosis
very good, low recurrence
Osteoma histology
normal bone with or without marrow
Osteoma what is it and where
benign osseous tumor
primary craniofacial bones (paranasal sinus)
and mandible (body and condylar region)
Osteoma clinical
painless, slow growing
Gardner Syndrome what kind of diseas
genetic
1:8,000- 1:16,000 births
APC gene, chromosome 5
Gardner Syndrome main characteristics
multiple osteomas of the facial bones.
epidermoid cysts
desmoid tumors
Gardner Syndrome teeth problems
may see impacted supernumeray teeth
Gardner Syndrome radiographically
may resemble florid cemento- osseous dysplasia or osteitis deformans
Gardner Syndrome most significant aspect of the syndrome
development of precancerous polyps of the colon
Gardner Syndrome precancerous poly problems…
50% of patients develop adenocarcinoma of the colon by 30 years of age (approaches 100% by 5th decade)
Gardner Syndrome management
– Prophylactic colectomy
– Removal of problematic cysts and osteomas
– Removal of impacted teeth/odontomas with prosthodontic work as needed
– Genetic counseling

Central Giant Cell Granuloma
benign lesion of the jaw,
neoplasm or reactive process???
(use to be called reactive giant cell)
Central Giant Cell Granuloma affects who most
60% under 30 years old
female
Central Giant Cell Granuloma found where
mandible (70%), anterior, can cross midline
Central Giant Cell Granuloma radiographically
unilocular when small, multilocular when larger. LARGE radiolucency
Central Giant Cell Granuloma histo
cellular granulation tissue with numerous benign multinucleated giant cells
RBC extravasation and hemosiderin deposits are common
Central Giant Cell Granuloma trt
generally consists of aggressive curettage, although alternative non- surgical therapies have been reported
Central Giant Cell Granuloma prognosis
good
Central Giant Cell Granuloma recurrence
20%
Hyperparathyroidism primary vs secondary
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
Hyperparathyroidism bone lesions
Unilocular/multilocular radiolucencies may develop - “brown tumor”
Diffuse jaw enlargement may develop with chronic renal failure: renal osteodystrophy
Hyperparathyroidism bone lesion radiographically
loss of lamina dura and “ground-glass” trabecular pattern
Hyperparathyroidism histo
brown tumors show vascular granulation tissue with numerous multinucleated giant cells and extravasated erythrocytes
Hyperparathyroidism looks similar to what in microscope
Microscopically identical to central giant cell granuloma
Renal Osteodystrophy
Hyperplastic response of the bone in patients with poorly-controlled secondary hyperparathyroidism related to end-stage renal disease
Prominent jaw enlargement may result
Hyperparathyroidism trt
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
Hyperparathyroidism prognosis
fair to good
Osteosarcoma
Most common primary bone malignancy
tumor cells produce osteoid
Osteosarcoma, how many affect the jaw
6-8%
Osteosarcoma who
second decade
long bones- mean age 18
Jaws- 33-39
Osteosarcoma clinical appearance
pain, swelling, paresthesia, loose teeth
Osteosarcoma radiographically
mixed radiopaque and radiolucency with ill defined borders
Widen PDL
Sun Burst pattern is uncommon in the jaws
Osteosarcoma histo
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
Osteosarcoma trt
is radical surgery, together with chemotherapy is some cases
Osteosarcoma prognosis
Overall 5 yr survival: 60-70%
death usually due to uncontrolled local disease than metastasis
Chondrosarcoma
Rare malignancy of cartilaginous differentiation (1/2 as common as osteosarc)
pain, swelling, loose teeth
Chondrosarcoma seen in who and where?
adult males 4th 6th decade of life femur, pelvis, or ribs mostly .1% of all head and neck malignancies anterior maxilla posterior mandible
Chondrosarcoma radiographic
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
Chondrosarcoma histo
characterized by invasive lobules of atypical cells showing cartilaginous differentiation
most jaw lesions are grade 1 or 2
Chondrosarcoma trt
radical surgery
Chondrosarcoma prognosis
depends on histo grade and location of tumor
Chondrosarcoma survival
5 and 10 yr survival: 87% and 71% respectively
death usually due to direct extension of the tumor into vital structures.
Metastatic Disease
Most common form of cancer to involve bone
sometimes Jaws are affected.
Metastatic deposits from malignancies below the neck may affect the jaws through
Batson’s paravertebral plexus of veins which lack valves
Metastatic Disease who and where
43-52 years old.
posterior mandible.
Metastatic Disease clinical characteristics
- paresthesia, tooth mobility, swelling, bleeding, trismus, fracture
- failure of tooth socket to heal.
Metastatic Disease radiology
Poorly defined radiolucency; less commonly, mixed radioluceny/radiopacity
Metastatic Disease histo what do the mimic
the primary malignancy from which they arose
Metastatic Disease scattered cluster of
lesional cells give a “seeded” effect
Metastatic Disease primary malignancy arise from where
Breast, lung, colon, thyroid, prostate, kidney, melanoma
_____% of jaw metastases represent the initial manifestation of the malignant process
22%
Metastatic Disease trt
palliation, usually with radiation therapy, anti-resorptives
Metastatic Disease prognosis
very poor, most die within a year
