Bone Neoplasms Flashcards
Uncommon Benign neoplasms of PDL or odontogenic origin
Central Ossifying Fibroma
What is the most common region and age to see Central Ossifying Fibroma
Mandibular molar/PM region, 3rd to 4th decade
What are the clinical signs seen with a Central Ossifying Fibroma
Swelling if large
What are the radiographic signs of a Central Ossifying Fibroma
Well circumscribed radiolucency w/ variable central opacity
Histopathologic features of a Central Ossifying Fibroma
Cellular fibrous CT, mineralized trabeculae and spherules of material resembling cellular cementum or woven bone (similar to fibrous dysplasia)
Treatment and prognosis for a Central Ossifying Fibroma
Enucleation (one large mass shelled out), excellent
What syndrome are there multiple jaw lesions w/ histopathologic features consistent w/ Central Ossifying Fibroma
Hyperparathyroidism-jaw tumor syndrome
Benign osseous tumor usually affecting membranous bone
Osteoma
What are the clinical features of an Osteoma
Painless and enlarging (tori and exostoses are histopathologically identical but do not continue growth so not classified as an Osteoma), composed of dense bone
Where are the 2 places an Osteoma may arise
Bone surface or in the bone (enostosis)
What is a common gnathic lesion for an Osteoma
Paranasal sinus involvement
What age and location are osteomas usually detected in the jaw?
Adults, mandibular condyle (limits opening, midline deviates towards unaffected side) and body (lingual to molar and PM)
Radiographic appearance of an Osteoma (end/periosteal)
Circumsribed sclerotic mass
- Peri- Uniformly sceloritc or sclerotic periphery w/ central trabeculation
- End- Similar to condensing osteitis
What as an uncommon AD syndrome charatcterized by osteomas of the facial bones
Gardner syndrome
What are GI issues associated with Gardner Syndrome and what percent of patients develop what cancer?
Precancerous polyps in the colon (2nd decade of life), 50% develop adenocarcinoma of the colon by 30
What are the dental symptoms associated with Gardner Syndrome (2 %’s)
Abnormal teeth, epidermoid cysts, desmoid tumors
- 35% imacted supernumerary teeth
- 10% odontomas
How is Gardner Syndrome treated
Prohpylactic colectomy, removal of cysts and osteomas, guarded prognosis
Benign lesion of the jaw, which some pathologists consider the same a the Giant Cell Tumor of bone (long bones)
Central Giant Cell Granuloma
What age, sex, and oral location are Central Giant Cell Granulomas most common
- 2nd to 4th decade
- 2:1 Female
- Mandible often crosses midline
Clinical and radiographic symtptoms (small and large)
- Often asymptomatic (can become expansile)
- Small- uni
- Large- multilocular
What lesion shows proliferation of vascular granulation tissues w/ numerous mutinucleated Giant cells
Central Giant Cell Granuloma
What test must be ran for confirmation of Central Giant Cell Granuloma diagnosis
PTH, (same histo appearance of giant cell granuloma/tumor of bone and brown tumor of hyperparathyroidism)
Treatment and prognosis for Central Giant Cell Granuloma
Aggressive curettage, good prognosis
What percent of Central Giant Cell Granulomas recur
15-20%
What condition results in a marked increase in serum ca2+ level
Hyperparathyroidism
What are the 2 types of Hyperparathyroidism, and how do they differ
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)
3 actions of PTH
1) Osteoclastic activation
2) Increased Ca2+ uptake by kidneys
3) Increased Vit D synthesis, promotes Ca2+ absorption from gut
Radiographic appearance associated with Hyperparathyroidism
- Loss of lamina dura (ground glass)
- Brown tumor radiolucencies
What histopathologic feature associated w/ Hyperparathyroidism shows vascular granulation tissue w/ extravasated RBCs and numerous benign multinucleated giant cells?
Brown tumor
What is Renal Osteodysrophy, signs, and condition it is associated with?
- Hyperplastic response of bone w/ poorly controlled hyperparathyroidism
- Prominent jaw enlargement
How do you treat Hyperparathyroidism
Remove parathyroid or renal transplant
- Fair prognosis
What is a rare malignancy of cartilaginous differentiation
Chondrosarcoma
Sites, sex, and population most often seen w/ Chondrosarcoma?
Adult males (4th-6th decade) - Femur, pelvis, or ribs
What percent of Chondrosarcomas present in head and neck region and what are the symptoms
- 10%
- Pain, swelling, lose teeth
What are radiographic signs of Chondrosarcoma
- Poorly defined radiolucency w/ variable radiopacity
- My see widened PDL of teeth around tumor (similar to osteosarcoma)
Do teeth test vital or non vital w/ Chondrosarcoma
Vital
What tumor is characterized by invasive lobules of atypical cells showing cartilaginous differentiation
Chondrosarcoma
Treatment and prognosis for Chondrosarcoma
- Radical surgery
- Poor, death usually from direct extension of tumor involving vital structures
Malignancy showing production of osteoid by tumor cells
Osteosarcoma
What is the most common primary bone malignancy
Osteosarcoma, 2x more common than Chondrosarcoma
What percent of Osteosarcomas affect the jaw, what age do they occur, and what are the clinical signs
- 7%
- 28
- Pain, followed by swelling, loose teeth, or parathesia
What is average age of Osteosarcomas in long bones?
18
Radiographic signs of Osteosarcoma
- Mixed lesion w/ ill defined borders, widened PDL, uncommon to see sun burst pattern
What lesion shows infiltrating sheet of malignant spindle or angular cells w/ direct production of osteoid or bone
Osteosarcoma
Treatment and prognosis (5 year survival) for Osteosarcoma, how does it metastasize and where to
- 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
What is the most common malignant process to involve bone
Metastatic process
What percent of oral malignancies are metastatic tumors
1%
What anatomic structure can allow metastatic desposits from below the neck to affect the jaw?
Batson’s paravertebral plexus of veins (Valveless plexus that may allow retrograde spread of tumor cells, bypassing lung filtration) Deep pelvic-Thoracic veins
What age are patients affected by metastatic disease of the jaw and perentage of sites it is seen in jaw
- 50% over 50
- Mandible- 61%
- Maxilla- 24%
- Soft tissue- 15% (Gingiva (54%, tongue (22.5%)
What are clinical signs of metastatic disease intraorally
Parathesia, tooth mobility, swelling, hemorrhage, pathologic fracture, trismus, moth eaten radiolucency
What 3 things should be considered if a tooth socket does not heal
1) Granulation tissue lymphoma
2) Metastatic disease
What are the more common primary sites associated w. metastatic disease of the jaw
- Breast, lung, colon, thyroid, prostate, kidney, melanoma (carry these patterns histologically) (seeded effect)
Treatment/Prognosis of Metastatic Disease
- Palliation and radiation
- Poor most die within one year
What perfect of jaw metastases represent the initial manifestation of the malignant process?
22%
