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Oral Path Exam 3 > Bone Neoplasms > Flashcards

Bone Neoplasms Flashcards

1
Q

Uncommon Benign neoplasms of PDL or odontogenic origin

A

Central Ossifying Fibroma

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2
Q

What is the most common region and age to see Central Ossifying Fibroma

A

Mandibular molar/PM region, 3rd to 4th decade

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3
Q

What are the clinical signs seen with a Central Ossifying Fibroma

A

Swelling if large

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4
Q

What are the radiographic signs of a Central Ossifying Fibroma

A

Well circumscribed radiolucency w/ variable central opacity

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5
Q

Histopathologic features of a Central Ossifying Fibroma

A

Cellular fibrous CT, mineralized trabeculae and spherules of material resembling cellular cementum or woven bone (similar to fibrous dysplasia)

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6
Q

Treatment and prognosis for a Central Ossifying Fibroma

A

Enucleation (one large mass shelled out), excellent

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7
Q

What syndrome are there multiple jaw lesions w/ histopathologic features consistent w/ Central Ossifying Fibroma

A

Hyperparathyroidism-jaw tumor syndrome

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8
Q

Benign osseous tumor usually affecting membranous bone

A

Osteoma

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9
Q

What are the clinical features of an Osteoma

A

Painless and enlarging (tori and exostoses are histopathologically identical but do not continue growth so not classified as an Osteoma), composed of dense bone

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10
Q

Where are the 2 places an Osteoma may arise

A

Bone surface or in the bone (enostosis)

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11
Q

What is a common gnathic lesion for an Osteoma

A

Paranasal sinus involvement

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12
Q

What age and location are osteomas usually detected in the jaw?

A

Adults, mandibular condyle (limits opening, midline deviates towards unaffected side) and body (lingual to molar and PM)

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13
Q

Radiographic appearance of an Osteoma (end/periosteal)

A

Circumsribed sclerotic mass

  • Peri- Uniformly sceloritc or sclerotic periphery w/ central trabeculation
  • End- Similar to condensing osteitis
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14
Q

What as an uncommon AD syndrome charatcterized by osteomas of the facial bones

A

Gardner syndrome

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15
Q

What are GI issues associated with Gardner Syndrome and what percent of patients develop what cancer?

A

Precancerous polyps in the colon (2nd decade of life), 50% develop adenocarcinoma of the colon by 30

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16
Q

What are the dental symptoms associated with Gardner Syndrome (2 %’s)

A

Abnormal teeth, epidermoid cysts, desmoid tumors

  • 35% imacted supernumerary teeth
  • 10% odontomas
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17
Q

How is Gardner Syndrome treated

A

Prohpylactic colectomy, removal of cysts and osteomas, guarded prognosis

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18
Q

Benign lesion of the jaw, which some pathologists consider the same a the Giant Cell Tumor of bone (long bones)

A

Central Giant Cell Granuloma

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19
Q

What age, sex, and oral location are Central Giant Cell Granulomas most common

A
  • 2nd to 4th decade
  • 2:1 Female
  • Mandible often crosses midline
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20
Q

Clinical and radiographic symtptoms (small and large)

A
  • Often asymptomatic (can become expansile)
  • Small- uni
  • Large- multilocular
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21
Q

What lesion shows proliferation of vascular granulation tissues w/ numerous mutinucleated Giant cells

A

Central Giant Cell Granuloma

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22
Q

What test must be ran for confirmation of Central Giant Cell Granuloma diagnosis

A

PTH, (same histo appearance of giant cell granuloma/tumor of bone and brown tumor of hyperparathyroidism)

23
Q

Treatment and prognosis for Central Giant Cell Granuloma

A

Aggressive curettage, good prognosis

24
Q

What percent of Central Giant Cell Granulomas recur

A

15-20%

25
Q

What condition results in a marked increase in serum ca2+ level

A

Hyperparathyroidism

26
Q

What are the 2 types of Hyperparathyroidism, and how do they differ

A

1) Primary- Parathyroid hyperplasisa/adenoma/carcnioma results in increased release of PTH
2) Secondary- Due to renal failure (altered Vitamin D metabolism, poor Ca2+ retention)

27
Q

3 actions of PTH

A

1) Osteoclastic activation
2) Increased Ca2+ uptake by kidneys
3) Increased Vit D synthesis, promotes Ca2+ absorption from gut

28
Q

Radiographic appearance associated with Hyperparathyroidism

A
  • Loss of lamina dura (ground glass)

- Brown tumor radiolucencies

29
Q

What histopathologic feature associated w/ Hyperparathyroidism shows vascular granulation tissue w/ extravasated RBCs and numerous benign multinucleated giant cells?

A

Brown tumor

30
Q

What is Renal Osteodysrophy, signs, and condition it is associated with?

A
  • Hyperplastic response of bone w/ poorly controlled hyperparathyroidism
  • Prominent jaw enlargement
31
Q

How do you treat Hyperparathyroidism

A

Remove parathyroid or renal transplant

- Fair prognosis

32
Q

What is a rare malignancy of cartilaginous differentiation

A

Chondrosarcoma

33
Q

Sites, sex, and population most often seen w/ Chondrosarcoma?

A 
Adult males (4th-6th decade)
- Femur, pelvis, or ribs
34
Q

What percent of Chondrosarcomas present in head and neck region and what are the symptoms

A
  • 10%

- Pain, swelling, lose teeth

35
Q

What are radiographic signs of Chondrosarcoma

A
  • Poorly defined radiolucency w/ variable radiopacity

- My see widened PDL of teeth around tumor (similar to osteosarcoma)

36
Q

Do teeth test vital or non vital w/ Chondrosarcoma

A

Vital

37
Q

What tumor is characterized by invasive lobules of atypical cells showing cartilaginous differentiation

A

Chondrosarcoma

38
Q

Treatment and prognosis for Chondrosarcoma

A
  • Radical surgery

- Poor, death usually from direct extension of tumor involving vital structures

39
Q

Malignancy showing production of osteoid by tumor cells

A

Osteosarcoma

40
Q

What is the most common primary bone malignancy

A

Osteosarcoma, 2x more common than Chondrosarcoma

41
Q

What percent of Osteosarcomas affect the jaw, what age do they occur, and what are the clinical signs

A
  • 7%
  • 28
  • Pain, followed by swelling, loose teeth, or parathesia
42
Q

What is average age of Osteosarcomas in long bones?

A

18

43
Q

Radiographic signs of Osteosarcoma

A
  • Mixed lesion w/ ill defined borders, widened PDL, uncommon to see sun burst pattern
44
Q

What lesion shows infiltrating sheet of malignant spindle or angular cells w/ direct production of osteoid or bone

A

Osteosarcoma

45
Q

Treatment and prognosis (5 year survival) for Osteosarcoma, how does it metastasize and where to

A
  • Chemo then surgery (see if necrotic if not change chemo agent)
  • 5 year survival 30%-80%
  • Death from uncontrolled local disease
  • Metastasis via blood to lung, liver, brain
46
Q

What is the most common malignant process to involve bone

A

Metastatic process

47
Q

What percent of oral malignancies are metastatic tumors

A

1%

48
Q

What anatomic structure can allow metastatic desposits from below the neck to affect the jaw?

A

Batson’s paravertebral plexus of veins (Valveless plexus that may allow retrograde spread of tumor cells, bypassing lung filtration) Deep pelvic-Thoracic veins

49
Q

What age are patients affected by metastatic disease of the jaw and perentage of sites it is seen in jaw

A
  • 50% over 50
  • Mandible- 61%
  • Maxilla- 24%
  • Soft tissue- 15% (Gingiva (54%, tongue (22.5%)
50
Q

What are clinical signs of metastatic disease intraorally

A

Parathesia, tooth mobility, swelling, hemorrhage, pathologic fracture, trismus, moth eaten radiolucency

51
Q

What 3 things should be considered if a tooth socket does not heal

A

1) Granulation tissue lymphoma

2) Metastatic disease

52
Q

What are the more common primary sites associated w. metastatic disease of the jaw

A
  • Breast, lung, colon, thyroid, prostate, kidney, melanoma (carry these patterns histologically) (seeded effect)
53
Q

Treatment/Prognosis of Metastatic Disease

A
  • Palliation and radiation

- Poor most die within one year

54
Q

What perfect of jaw metastases represent the initial manifestation of the malignant process?

A

22%

Oral Path Exam 3 (4 decks)

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