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Oral Path 2, Exam 3 > Bone Neoplasms > Flashcards

Bone Neoplasms Flashcards

1
Q

3 Benign neoplasms of the bone

A
  1. Central ossifying fibroma
  2. Osteoma
  3. Central Giant Cell Granuloma
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2
Q

3 Malignant neoplasms of the bone

A
  1. Chondrosarcoma
  2. Osteosarcoma
  3. Metastatic disease
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3
Q

Syndrome associated with central ossifying fibroma

A

Hyperparathyroidism-jaw tumor syndrome

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4
Q

Syndrome associated with osteoma

A

Gardner syndrome

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5
Q

Conditions associated with central giant cell granuloma

A

Hyperparathyroidism and Renal osteodystrophy

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6
Q

Uncommon benign neoplasm that is seen in female adults, primarily in the mandibular molar/pre-molar region

A

Central ossifying fibroma

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7
Q

True/False: Central ossifying fibroma may cause jaw expansion

A

True

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8
Q

Central ossifying fibroma resembles ___ ___-___ ___

A

Focal cemento-osseous dysplasia

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9
Q

Microscopically, central ossifying fibroma is similar to ___ ___. Because of this, you need a ____ for correlation

A

Fibrous dysplasia

Radiograph

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10
Q

Treatment for central ossifying fibroma

A

Enucleation - lesion tends to shell out as one mass

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11
Q

Multiple jaw lesions that histopathologically are consistent with central ossifying fibroma

A

Hyperparathyroidism-jaw tumor syndrome

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12
Q

Hyperparathyroidism leads to _____

A

Hypercalcemia

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13
Q

Patients with hyperparathyroidism-jaw tumor syndrome are at an increased risk for development of ___ ___

A

Parathyroid carcinoma

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14
Q

Although they are histopathologically identical, palatal tori, mandibular tori, and buccal exostoses are NOT considered to be ____

A

Osteomas

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15
Q

Osteomas are composed of what types or bone?

A

Compact or cancellous

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16
Q

How are osteomas confirmed?

A

By continuous growth

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17
Q

___ ___ involvement is more common than gnathic lesions for osteomas

A

Paranasal sinus

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18
Q

Gnathic involvement is most often in the ___ ___ and ___

A

Mandibular body and condyle

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19
Q

Osteomas on the body of the mandible are often in the ___ ___/___ area

A

Lingual pre-molar/molar area

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20
Q

What may happen to a patient with an osteoma if the condyle is involved?

A

Limited opening - malocclusion - deviation of midline and chin to unaffected side

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21
Q

Describe what periosteal (exostoses) in osteomas appear like radiographically?

A

Uniformly sclerotid or have central trabeculations

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22
Q

Describe what endosteal (enostoses) in osteomas appear like radiographically?

A

Similar/identical to idiopathic osteosclerodid or condensing osteitis

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23
Q

Overall, osteomas have ___ bone, minimal marrow or ____ and ____ marrow

A

Dense
Trabeculae
Fibrofatty

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24
Q

What is the osteoma treatment if the lesion is small? What if it’s bigger?

A

Small - no treatment

Bigger - conservative excision

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25
Q

Are condylar osteomas usually symptomatic or asymptomatic? What is their treatment?

A

Symptomatic - local resection or condylectomy

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26
Q

What must be ruled out if the patient has multiple osteomas?

A

Gardner syndrome

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27
Q

Is Gardner syndrome autosomal dominant or recessive?

A

Dominant

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28
Q

What is the most significant aspect of Gardner syndrome

A

The development of precancerous polyps of the colon

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29
Q

What type of cases does Gardner syndrome typically refer to?

A

Cases in which extraintestinal manifestations are especially prominent

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30
Q

What do colorectal polyps ultimately transform into?

A

Adenocarcinoma

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31
Q

When does Gardner syndrome develop?

A

Around puberty

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32
Q

Locally aggressive fibrous neoplasms of soft tissue

A

Desmoid tumors

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33
Q

Tooth abnormalities related to Gardner syndrome

A
  1. Impacted teeth
  2. Sueprnumerary teeth
  3. Odontomas
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34
Q

Gardner syndrome can resemble :

A

Florid cemento-osseous dysplasia or fibrous displasia

35
Q

Treatment for Gardner Syndrome

A

Prophylactic colectomy and removal of cosmetically problematic cysts and osteomas

36
Q

Prognosis for Gardner syndrome

A

Guarded - half will develop adenocarcinoma of the colon

37
Q

Central Giant Cell Granuloma has a ____ predilection

A

Female

38
Q

Where is a Central Giant Cell Granuloma normally seen?

A

In the mandible, often crosses midline - more common in the anterior

39
Q

Central Giant Cell Granuloma can cause root ____

A

Divergence

40
Q

What does root divergence suggest? What about root resorption?

A

Divergence - benign

Resorption - aggressive

41
Q

Central Giant Cell granuloma has the same histologic appearance as what other conditions? What must you have to distinguish them?

A

Brown tumor of hyperparathyroidism, peripheral giant cell granuloma, and giant cell tumor of bone

Radiographic correlation and blood test for PTH

42
Q

Treatment for Central Giant Cell Granuloma?

A

Aggressive curettage/peripheral osteotomy

43
Q

2 types of hyperparathyroidism

A
  1. Primary

2. Secondary

44
Q

Primary hyperparathyroidism

A

Parathyroid hyperplasia, parathyroid adenoma or carcinoma –> inappropriate secretion of PTH

45
Q

Secondary hyperparathyroidism

A

Renal failure –> altered vitamin D metabolism –> poor calcium retention

46
Q

Actions of PTH

A
  1. Osteoclast activity
  2. Increased Ca uptake by kidney
  3. Increased vitamin D synthesis (kidneys) which promotes Ca from the gut
47
Q

Actions of inappropriate secretion of PTH in primary hyperparathyroidism results in increased serum ___

A

Ca

48
Q

Kidney failure in secondary hyperparathyroidism leads to inadequate production of vitamin D. What does this lead to?

A

Increased serum Ca

49
Q

Clinical features of hyperparathyroidism

A

Bones, stones, groans, moans

50
Q

Radiographic feature of hyperparathyroidism

A

Loss of lamina dura, ground glass trabecular pattern

51
Q

Unusual hyperplastic response of bone in patients with poorly controlled secondary hyperparathyroidism

A

Renal osteodystrophy

52
Q

Renal osteodystrophy is often seen in patients on long term ___ ___ and may manifest as prominent ___ ___

A

Renal dialysis

Jaw enlargement

53
Q

Treatment for primary and secondary hyperparathyroidism

A

Primary - remove source of hormone secretion

Secondary - better control of serum calcium

54
Q

Malignancy of cartilaginous differentiation

A

Chondrosarcoma

55
Q

2nd most common primary bone malignancy

A

Chondrosarcoma

56
Q

Chondrosarcoma has a _____ predilection

A

Male

57
Q

Where are chondrosarcomas mainly seen?

A

Femur, pelvis, or ribs

58
Q

This malignancy may mimic a dental infection (+/- pain, swelling, loose tooth)

A

Chondrosarcoma

59
Q

The teeth will test ____ (vital/non-vital) with a Chondrosarcoma

A

Vital

60
Q

Treatment for Chondrosarcoma

A

Radical surgery - “one chance for cure”

61
Q

Prognosis for Chondrosarcoma

A

Generally poor - death usually due to tumor expansion into vital structures - metastasis esp. to the lungs

62
Q

Most common primary bone malignancy (2x as common as chondrosarcoma)

A

Osteosarcoma

63
Q

Where are most osteosarcomas found? What percent?

A

In the knee (60%)

8% in the jaw

64
Q

Are patients with osteosarcoma typically old or young?

A 
Long bone (knee) = Young - mean age ~ 18 
Jaw = Older - mean age ~28
65
Q

What is often the initial complaint for patients with osteosarcoma?

A

Pain

66
Q

Radiographic features of osteosarcoma

A

“Sun-burst” pattern (uncommon in jaws)

Symmetrically widened PDL of teeth

67
Q

Why does a parosteal osteosarcoma have a better prognosis?

A

Because it is peripheral

68
Q

What do the tumor cells produce in osteosarcoma?

A

Osteoid

69
Q

Treatment for osteosarcoma

A

Chemotherapy and then surgery for removal

70
Q

Where can osteosarcoma often metastasize?

A

The lung

71
Q

What is the common cause of death in patients with osteosarcoma?

A

Death usually due to uncontrolled disease

72
Q

Overall, where do metastases typically go?

A

To the bone

73
Q

What is the most common form of cancer involving bone? What is the second most common?

A

Metastatic disease - most common

Multiple myeloma - 2nd most common

74
Q

Metastasis from below the neck may affect jaws via ___ ___ ___ of ____

A

Batson’s paravertebral plexus of veins

75
Q

What is Batson’s plexus?

A

A VALVELESS vertebral venous plexus (may allow retrograde spread of tumor cells), bypassing filtration through the lungs

76
Q

What does Batson’s plexus connect?

A

Deep pelvic veins and thoracic veins in the internal vertebral venous plexuses

77
Q

Are patients with metastatic disease typically older or younger?

A

Older - over 1/2 are > 50 yo

78
Q

Most cases of metastases in the jaws involve the _____ (maxilla/mandible). What is the 2nd most common site?

A

Mandible - second site is the gingiva

79
Q

If a tooth socket is not healing, what three things should you consider?

A

Granulation tissue, lymphoma, metastatic disease

80
Q

Radiographic appearance of metastatic disease

A

“Moth-eaten”

81
Q

Most common metastatic diseases:

A

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

82
Q

Treatment for metastatic disease

A

Palliation, usually with radiation

83
Q

Prognosis for metastatic disease

A

Very poor

Oral Path 2, Exam 3 (6 decks)

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