Bone Neoplasms Flashcards
What are the 3 benign lesions of bone?
- central ossifying fibroma
- osteoma
- central giant cell granuloma
What are the 3 malignant lesions of bone?
- chondrosarcoma
- osteosarcoma
- metastatic disease
What is an uncommon benign neoplasm with questionable PDL or odontogenic origin?
central ossifying fibroma
In the past, what other disorder was central ossifying fibroma confused with?
focal cemento-osseous dysplasia
Central ossifying fibroma is seen in the mandibular ___/___ region in adult ___ of the ___ or ___ decade.
premolar/molar; females; 3rd; 4th
Central ossifying fibroma is a well-circumscribed ___ with variable amount of ___ ___.
radiolucency; central opacity
In Central ossifying fibroma, the range is almost purely radiolucent to very ___ with a defined ___ border.
radiodense; lucent
Histologically, central ossifying fibroma has central fibrous CT containing mineralized trabeculae and ___ of material that may resemble cellular cementum or woven bone.
spherules
T/F. Microscopically, central ossifying fibroma is different from fibrous dysplasia, so radiographs are often necessary.
Microscopically, central ossifying fibroma is SIMILAR to fibrous dysplasia, so radiographs are often necessary.
How is central ossifying fibroma treated? What is the prognosis?
enucleation - lesion tends to shell out as one mass.
Prognosis is excellent and recurrence is very uncommon
What disease has multiple jaw lesions that histopathologically are consistent with central ossifying fibroma?
hyperparathyroidism-jaw tumor syndrome
Osteoma is a ___ osseous tumor usually affecting the ___ bone.
benign; membranous
Osteoma is a pain___, slowly enlarging tumor that may arise on the bone surface or in the bone (___).
less; enostosis
T/F. Gnathic lesions are more common than paranasal involvement with osteomas.
False, paranasal sinus (frontal, ethmoid and maxillary) is more common than gnathic lesions.
T/F. Common palatal tori, mandibular tori and buccal exostoses are all considered different types of osteomas because they are histopathologically identical
False, Common palatal tori, mandibular tori and buccal exostoses are NOT CONSIDERED osteomas altough they are histopathologically identical.
osteomas can be confirmed by documentation of continued growth
An osteoma is composed of ___ bone, with only minimal ___ elements.
dense; marrow
Osteomas of the jaw are most often detected in ___ (children/adults) with predilection for the mandibular ___ and ___.
adults; body; condyle
What are the less common mandibular locations of osteomas?
angle (particularly at the inferior border)
coronoid process
ramus
Osteoma lesions involvling the mandibular ___ are frequently found on the ___ surface adjacent to the ___ or ___.
body; lingual; premolars; molars
With osteomas, ___ involvement may limit mouth opening or cause ___, with midline deviation and chin toward the ___ side. Pain and facial swelling are possible.
condylar; malocclusion; unaffected
T/F. Radiographically, osteomas are circumscribed sclerotic masses.
True
___ osteomas may show a uniformly sclerotic pattern or may demonstrate a sclerotic periphery with central trabeculation.
Periosteal
Endosteal osteomas may appear similar/identical to ___ ___ or ___ ___.
condensing osteitis; idiopathic osteosclerosis
T/F. Gardner syndrome is an autosomal dominant trait - uncommon.
True.
Gardner syndrome has intestinal ___, osteomas of ___ bones; abnormalities of teeth and ___ cysts and ___ tumors.
polyps; facial; epidermoid; desmoid
In Gardner syndrome, impacted supernumerary teeth are found in ___% of patients and odontomas are found in ___%of patients.
35; 10
What could gardner syndrome resemble radiographically?
florid cemento-osseous dysplasia or osteitis deformans
What is the most significant aspect of Gardner syndrome?
the development of precancerous polyps of the colon
When do colorectal polyps typically develop?
by the 2nd decade of life
___% of patients develop adenocarcinoma of the colon by ___ years of age.
50%; 30
How is Gardner syndrome managed? What is the prognosis?
- prophylactic colectomy
- removal of cosmetically problematic cysts and osteomas
- genetic counseling
guarded prognosis with frequent followup visits
What is a benign, somewhat controversial lesion of the jaws that appears in the 2nd to 4th decade? Why?
central giant cell granuloma
Some pathologist feel it is the same as giant cell tumor of bone, which is typically in long bones, particularly the knee area
Central giant cell granuloma is more common in ___ (females/males) and usually affects the ___, often crossing the ___.
females; mandible; midline
T/F. Central giant cell granuloma is multilocular when lesions are small.
False, unilocular when small, larger lesions are multilocular
T/F. Central giant cell granuloma can become expansile.
True.
What disease has proliferation of vascular granulation tissue with numerous multinucleated giant cells scattered throughout the tissue.
central giant cell granuloma
Central giant cell granuloma has the same histological appearance as what diseases? Therefore, what test is needed?
- brown tumor of hyperparathyroidism
- peripheral giant cell granuloma
- giant cell tumor of bone
blood test for parathyroid hormone (PTH) levels
Treatment of central giant cell granuloma consist of aggressive ___ that may include peripheral ___.
curettage; osteotomy
Prognosis of Central giant cell granuloma is ___ and the recurrence rate is ___-___%
good; 15-20
___ hyperparathyroidism is due to parathyroid hyperplasia, parathyroid adenoma, parathyroid carcinoma and results in inappropriate secretion of ___.
Primary; parathormone
What is secondary hyperparathyroidism caused by?
renal failure, altered vit D metabolism which is responsible for poor calcium retention
What are the actions of PTH?
- osteoclastic activation
- increased Ca2+ uptake by kidneys
- increased vit D synthesis (kidneys) which promotes Ca2+ absorption from the gut
T/F. In primary hyperparathyroidism, kidney failure leads to inadequate production of vit D, which is needed to absorb calcium from the gut.
T/F. This results in increased serum Ca2+.
False, this describes secondary hyperparathyroidism. Primary hyperparathyroidism has inappropriate secretion of PTH leading to increased serum Ca2+.
True
T/F. Both primary and secondary hyperparathyroidism leads to increased serum Ca2+.
True.
With hyperPTH, radiographically, there is loss of ___ ___ and “___ ___” trabecular pattern
lamina dura; ground glass
In hyperPTH, unilocular or multilocular radiolucencies may develop into “___ ___”.
brown tumor
What is renal osteodystrophy?
When hyperPTH patients have enlargement of jaws due to long standing renal failure, (often seen in patients on longterm renal dialysis
What disease is described by “Bones, stones groans and moans”?
hyperPTH
also thrones, constipation and polyuria
Brown tumors show ___ granulation tissue with extravasated ___ and numerous benign multinucleated ___ cells.
vascular; erythrocytes; giant
T/F. Microscopically, hyperPTH is identical to central giant cell granuloma, peripheral giant cell granuloma and giant cell tumor of bone.
True.
What unusual hyperplastic response happens to patients with poorly controlled secondary hyperPTH?
renal osteodystrophy
How is hyperPTH treated? What is the prognosis?
remove the source of the hormone secretion if primary (remove parathyroid)
if secondary, better control serum calcium (parathyroidectomy or renal transplant may be necessary)
prognosis: fair
What is a rare malignancy of cartilaginous differentiation?
chondrosarcoma
Chondrosarcoma is mostly seen in adult ___ (4th to 6th decade) and affects the ___, ___ or ___.
males; femur; pelvis; ribs
What percentage of chondrosarcoma occurs in the head and neck region?
10%
Describe the radiograph of chondrosarcoma.
poorly defined radiolucency with variable amounts of radiopacity
larger lesions appear multilocular
widened PDL of the teeth in area of tumor, similar to osteosarcoma
Which of the following is true of chondrosarcoma?
- vague lucency/opacity
- loss of lamina dura
- widened PDL
- teeth test vital
All are true.
Chondrosarcoma can displace the ___ and break thru ___. It metastasizes to the ___.
tongue; bone; spine
Histopathologically, chondrosarcoma is characterized by invasive ___ of atypical cells showing ___ differentiation.
lobules; cartilaginous
What is the treatment for chondrosarcoma?
radical surgery
What does prognosis depend on for chondrosarcoma? What is the prognosis?
location and histopathologic grade
poor
T/F. Death of chondrosarcoma is usually due to direct extension of tumor, involving vital structures.
True
What malignancy shows produciton of osteoid by tumor cells?
osteosarcoma
What is the most common PRIMARY bone malignancy?
osteosarcoma
T/F. Osteosarcoma is not as common as chondrosarcoma.
False, it is TWICE as common as chondrosarcoma
___ ___ is the most common malignancy in bone, followed by ___ ___.
Metastatic disease; multiple myeloma
Of the ___ new cases of osteosarcoma in the US annually, only ___% of these affect the jaws.
900; 7
Match the following skeletal distributions of osteosarcoma.
A. knee
B. shoulder
C. hip
D. jaw
- 8%
- 10%
- 15%
- 60%
1 - D
2 - B
3 - C
4 - A
How is osterosarcoma of the jaw different from osteosarcoma of the long bones?
it has a different presentation epidemiologically
long bones - knee, 18 yo
jaw - 28 yo
What is the initial complaint of osteosarcoma? What is it followed by?
pain, followed by swelling, loose teeth or paresthesia
What is a mixed radiopaque/radiolucent lesion with ill-defined borders?
osteosarcoma
T/F. There is asymmetrical widening of the PDL in osteosarcoma
False, there is symmetrical widening of the PDL
T/F. The “sunburst” pattern is commonly seen in osteosarcoma of the jaws.
False, it is uncommonly seen
What condition has root resorption, mottled bone, widened PDL and loss of lamina dura?
osteosarcoma
Histopathology of osteosarcoma is infiltrating sheets of malignant ___-shaped or ___ lesional cells; direct production of osteoid or bone; mitotic activity and ___, ___, ___ differentiation.
spindle; angular; osteoblastic; chondroblastic; and fibroblastic
How is osteosarcoma treated?
induction chemotherapy then surgery to remove the tumor. If areas of necrosis are found, continue chemotherapy; if not use alternative chemotherapeutic agent
Historically, 5-yr survival has been in the ___-___% range, better prognosis for ___. One study, using radical surgery had an ___% 5-yr survival for osteosarcoma.
30-50; 80
What is death from osteosarcoma usually due to ?
uncontrolled local disease
How does osteosarcoma metastasize?
via the blood to lung, liver and brain
What is the most common malignant process to involve bone?
metastatic disease
jaws are occasionally affected
Metastatic tumors to the oral cavity are ___% of all oral malignancies.
1
How would metastatic deposits from malignancies below the neck affect the jaws?
through Batson’s paravertebral plexus of veins
___ ___ is a valveless vertebral venous plexus that might allow ___spread of tumor cells, bypassing filtration through the ___.
Batson plexus; retrograde; lungs
What does Batson plexus connect?
deep pelvic veins and thoracic veins in the internal vertebral venous plexuses
With metastatic disease, over half of affected patients are over ___ years of age.
50
Match the following as it relates to metastatic disease.
A. mandibule
B. maxilla
C. Soft tissue
- 15%
- 24%
- 61%
A - 3
B - 2
C - 1
___ is the most common soft tissue metastatic sites (___%) followed by the ___ (___%).
Gingiva; 54%; tongue; 22.5%
Paresthesia, tooth mobility, swelling, hemorrhage, pathologic fracture and trismus are all signs seen with what diesease?
metastatic disease
With lack of healing in a tooth socket, what should one clinically consider?
granulation tissue; lymphoma; metastatic disease
T/F. Metastatic disease has a poorly defined radiolucency; “moth eaten” less commonly, radiopacity
True
T/F. Histopathologically, lesions in metastatic disease have the pattern of the primary malignancy from which they arose.
True
In metastatic disease, ___ clusters of lesional cells give a “___” effect
scattered; seeded
What are some of the more common primary sites of metastatic disease?
breast, lung, colon, thyroid, prostate, kidney, melanoma
How is metastatic disease treated?
What is the prognosis?
palliation, usually with radiation therapy
very poor; most patients die within one year of the diagnosis
___ of jaw metastases represent the initial manifestation of the malignant process.
22
