Bone Neoplasms Flashcards
3 Benign neoplasms of the bone
- Central ossifying fibroma
- Osteoma
- Central Giant Cell Granuloma
3 Malignant neoplasms of the bone
- Chondrosarcoma
- Osteosarcoma
- Metastatic disease
Syndrome associated with central ossifying fibroma
Hyperparathyroidism-jaw tumor syndrome
Syndrome associated with osteoma
Gardner syndrome
Conditions associated with central giant cell granuloma
Hyperparathyroidism and Renal osteodystrophy
Uncommon benign neoplasm that is seen in female adults, primarily in the mandibular molar/pre-molar region
Central ossifying fibroma
True/False: Central ossifying fibroma may cause jaw expansion
True
Central ossifying fibroma resembles ___ ___-___ ___
Focal cemento-osseous dysplasia
Microscopically, central ossifying fibroma is similar to ___ ___. Because of this, you need a ____ for correlation
Fibrous dysplasia
Radiograph
Treatment for central ossifying fibroma
Enucleation - lesion tends to shell out as one mass
Multiple jaw lesions that histopathologically are consistent with central ossifying fibroma
Hyperparathyroidism-jaw tumor syndrome
Hyperparathyroidism leads to _____
Hypercalcemia
Patients with hyperparathyroidism-jaw tumor syndrome are at an increased risk for development of ___ ___
Parathyroid carcinoma
Although they are histopathologically identical, palatal tori, mandibular tori, and buccal exostoses are NOT considered to be ____
Osteomas
Osteomas are composed of what types or bone?
Compact or cancellous
How are osteomas confirmed?
By continuous growth
___ ___ involvement is more common than gnathic lesions for osteomas
Paranasal sinus
Gnathic involvement is most often in the ___ ___ and ___
Mandibular body and condyle
Osteomas on the body of the mandible are often in the ___ ___/___ area
Lingual pre-molar/molar area
What may happen to a patient with an osteoma if the condyle is involved?
Limited opening - malocclusion - deviation of midline and chin to unaffected side
Describe what periosteal (exostoses) in osteomas appear like radiographically?
Uniformly sclerotid or have central trabeculations
Describe what endosteal (enostoses) in osteomas appear like radiographically?
Similar/identical to idiopathic osteosclerodid or condensing osteitis
Overall, osteomas have ___ bone, minimal marrow or ____ and ____ marrow
Dense
Trabeculae
Fibrofatty
What is the osteoma treatment if the lesion is small? What if it’s bigger?
Small - no treatment
Bigger - conservative excision
Are condylar osteomas usually symptomatic or asymptomatic? What is their treatment?
Symptomatic - local resection or condylectomy
What must be ruled out if the patient has multiple osteomas?
Gardner syndrome
Is Gardner syndrome autosomal dominant or recessive?
Dominant
What is the most significant aspect of Gardner syndrome
The development of precancerous polyps of the colon
What type of cases does Gardner syndrome typically refer to?
Cases in which extraintestinal manifestations are especially prominent
What do colorectal polyps ultimately transform into?
Adenocarcinoma
When does Gardner syndrome develop?
Around puberty
Locally aggressive fibrous neoplasms of soft tissue
Desmoid tumors
Tooth abnormalities related to Gardner syndrome
- Impacted teeth
- Sueprnumerary teeth
- Odontomas
Gardner syndrome can resemble :
Florid cemento-osseous dysplasia or fibrous displasia
Treatment for Gardner Syndrome
Prophylactic colectomy and removal of cosmetically problematic cysts and osteomas
Prognosis for Gardner syndrome
Guarded - half will develop adenocarcinoma of the colon
Central Giant Cell Granuloma has a ____ predilection
Female
Where is a Central Giant Cell Granuloma normally seen?
In the mandible, often crosses midline - more common in the anterior
Central Giant Cell Granuloma can cause root ____
Divergence
What does root divergence suggest? What about root resorption?
Divergence - benign
Resorption - aggressive
Central Giant Cell granuloma has the same histologic appearance as what other conditions? What must you have to distinguish them?
Brown tumor of hyperparathyroidism, peripheral giant cell granuloma, and giant cell tumor of bone
Radiographic correlation and blood test for PTH
Treatment for Central Giant Cell Granuloma?
Aggressive curettage/peripheral osteotomy
2 types of hyperparathyroidism
- Primary
2. Secondary
Primary hyperparathyroidism
Parathyroid hyperplasia, parathyroid adenoma or carcinoma –> inappropriate secretion of PTH
Secondary hyperparathyroidism
Renal failure –> altered vitamin D metabolism –> poor calcium retention
Actions of PTH
- Osteoclast activity
- Increased Ca uptake by kidney
- Increased vitamin D synthesis (kidneys) which promotes Ca from the gut
Actions of inappropriate secretion of PTH in primary hyperparathyroidism results in increased serum ___
Ca
Kidney failure in secondary hyperparathyroidism leads to inadequate production of vitamin D. What does this lead to?
Increased serum Ca
Clinical features of hyperparathyroidism
Bones, stones, groans, moans
Radiographic feature of hyperparathyroidism
Loss of lamina dura, ground glass trabecular pattern
Unusual hyperplastic response of bone in patients with poorly controlled secondary hyperparathyroidism
Renal osteodystrophy
Renal osteodystrophy is often seen in patients on long term ___ ___ and may manifest as prominent ___ ___
Renal dialysis
Jaw enlargement
Treatment for primary and secondary hyperparathyroidism
Primary - remove source of hormone secretion
Secondary - better control of serum calcium
Malignancy of cartilaginous differentiation
Chondrosarcoma
2nd most common primary bone malignancy
Chondrosarcoma
Chondrosarcoma has a _____ predilection
Male
Where are chondrosarcomas mainly seen?
Femur, pelvis, or ribs
This malignancy may mimic a dental infection (+/- pain, swelling, loose tooth)
Chondrosarcoma
The teeth will test ____ (vital/non-vital) with a Chondrosarcoma
Vital
Treatment for Chondrosarcoma
Radical surgery - “one chance for cure”
Prognosis for Chondrosarcoma
Generally poor - death usually due to tumor expansion into vital structures - metastasis esp. to the lungs
Most common primary bone malignancy (2x as common as chondrosarcoma)
Osteosarcoma
Where are most osteosarcomas found? What percent?
In the knee (60%)
8% in the jaw
Are patients with osteosarcoma typically old or young?
Long bone (knee) = Young - mean age ~ 18 Jaw = Older - mean age ~28
What is often the initial complaint for patients with osteosarcoma?
Pain
Radiographic features of osteosarcoma
“Sun-burst” pattern (uncommon in jaws)
Symmetrically widened PDL of teeth
Why does a parosteal osteosarcoma have a better prognosis?
Because it is peripheral
What do the tumor cells produce in osteosarcoma?
Osteoid
Treatment for osteosarcoma
Chemotherapy and then surgery for removal
Where can osteosarcoma often metastasize?
The lung
What is the common cause of death in patients with osteosarcoma?
Death usually due to uncontrolled disease
Overall, where do metastases typically go?
To the bone
What is the most common form of cancer involving bone? What is the second most common?
Metastatic disease - most common
Multiple myeloma - 2nd most common
Metastasis from below the neck may affect jaws via ___ ___ ___ of ____
Batson’s paravertebral plexus of veins
What is Batson’s plexus?
A VALVELESS vertebral venous plexus (may allow retrograde spread of tumor cells), bypassing filtration through the lungs
What does Batson’s plexus connect?
Deep pelvic veins and thoracic veins in the internal vertebral venous plexuses
Are patients with metastatic disease typically older or younger?
Older - over 1/2 are > 50 yo
Most cases of metastases in the jaws involve the _____ (maxilla/mandible). What is the 2nd most common site?
Mandible - second site is the gingiva
If a tooth socket is not healing, what three things should you consider?
Granulation tissue, lymphoma, metastatic disease
Radiographic appearance of metastatic disease
“Moth-eaten”
Most common metastatic diseases:
Breast, lung, colon, thyroid, prostate, kidney, melanoma
Treatment for metastatic disease
Palliation, usually with radiation
Prognosis for metastatic disease
Very poor
