Bone Neoplasms - part I Flashcards
benign neoplasms of bone
- central ossifying fibroma
- osteoma
- central giant cell granuloma
malignant neoplasms of bone
- chondrosarcoma
- osteosarcoma
- metastatic disease
what is central ossifying fibroma confused with in the past?
focal COD
T/F: most authorities consider central ossifying fibroma to be an osteogenic neoplasm
true
T/F: central ossifying fibroma is common
false, rare
who is affected by central ossifying fibroma?
adult (3rd-4th decade)
T/F: central ossifying fibroma has a female predilection
true
where does central ossifying fibroma primarily affect?
mandibular molar/pre-molar region
T/F: central ossifying fibroma can be asymptomatic esp when small
true
clinical features of central ossifying fibroma
- may see jaw expansion
2. facial asymmetry to significant deformity
radiographic features of central ossifying fibroma
- usually unilocular, occasionally multilocular
2. well-circumscribed with varying amount of central opacity
what is the range of radiolucency for central ossifying fibroma?
range from almost completely radiolucent to radiodense with a defined lucent border
what does central ossifying fibroma resemble radiographically?
focal COD
histopathologic features of central ossifying fibroma
- fibrous tissue with variable mixture of bony trabeculae and cementum-like material
- microscopically similar to fibrous dysplasia
what is needed for the correlation of fibrous dysplasia and central ossifying fibroma?
need radiograph
tx of central ossifying fibroma
enucleation - lesion tends to shell out as one mass
prognosis of central ossifying fibroma
excellent
T/F: recurrence of central ossifying fibroma is common
false, uncommon
what can central ossifying fibroma cause?
hyperparathyroid-jaw tumor syndrome
hyperparathyroid-jaw tumor syndrome
- multiple jaw lesions
2. hyperparathyroidism –> hypercalcemia
hyperparathyroid-jaw tumor syndrome lesions are histopathologically consistent with what?
central ossifying fibroma
hyperparathyroid-jaw tumor syndrome increases one’s risk for development of what?
parathyroid carcinoma
what is NOT considered osteoma?
- palatal tori
- mandibular tori
- buccal exostoses
T/F: although palatala tori, mandibular tori and buccal exostoses are not considered osteomas, they are all histopathologically identical
true
what is osteoma composed of?
compact or cancellous bone
what is osteoma confirmed by?
continuous growth
who is affected by osteoma?
adult
clinical features of osteoma
- usually painless, but pain/swelling possible
2. slow growing
where may osteoma arise?
on bone surface or within bone (exostosis/enostosis)
T/F: gnathic lesions are more common than paranasal sinus involvement in osteoma
false, paranasal sinus involvement more common
where does gnathic osteoma lesions most commonly found?
- mandibular body
- condyle
- inferior border of angle
- coronoid process
- ramus
osteomas on body of mandible is often found where?
lingual premolar/molar area
what might condylar involvement for osteoma cause?
- limit mouth opening
- cause malocclusion
- deviation of midline
- chin to unaffected side
radiographic features of osteoma
circumscribed radiopaque mass
how might periosteal (exostoses) osteoma appear on radiographs?
may be uniformly sclerotic or have central trabeculations
how might endosteal (endostoses) appear on radiographs?
may appear similar/identical to idiopathic osteosclerosis or condensing osteitis
histopathologic features of osteoma
dense bone, minimal marrow or trabeculae and fibrofatty marrow
tx of small, asymptomatic osteoma
none, observe
tx of osteoma
conservative excision
T/F: osteoma with condylar involvement is usually symptomatic
true
tx for osteoma with condylar involvement
local resection or condylectomy
prognosis of osteoma
good
T/F: recurrence of osteoma is common
false, rare
what should be ruled out if pt presents with multiple osteomas?
rule-out Gardner syndrome
T/F: Gardner syndrome is common
false, uncommon
T/F: Garner syndrome is autosomal dominant
true, highly penetrant
what is the most significant aspect of Garner syndrome?
development of precancerous polyps of colon
what does Garner syndrome generally refers to?
to cases in which the extraintestinal manifestations are especially prominent
T/F: Garner syndrome is one of several polyposis syndromes
true
T/F: intestinal polyps due to Garner syndrome are one of the multiple intestinal polyposis syndromes
true
what does Garner syndrome eventually develop to?
colorectal polyps develop by 2nd decade, ultimately transform to adenocarcinoma
when do multiple osteomas develop?
around puberty
clinical features of Garner syndrome
- intestinal polyps
- multiple osteomas
- epidermoid cysts
- desmoid tumors
- abnormalities of teeth
desmoid tumors
locally aggressive fibrous neoplasm of soft tissue
abnormalities of teeth seen in pts with Garner syndrome
- impacted teeth
- supernumerary teeth
- odontomas
what can Garner syndrome resemble radiographically?
- florid COD
2. fibrous dysplasia
size of radioopacities of ppl with Garner syndrome
ranging from a few mm to several cm in diameter
histopathologic features of Garner syndrome
intestinal polyps with varying degrees of dysplasia/adenocarcinoma
Garner syndrome histopathologically is consistent with what normal findings?
- osteoma
2. epidermoid cyst
tx of Garner syndrome
- prophylactic colectomy
- removal of cosmetically problematic cysts and osteomas
- genetic counseling
prognosis of Garner syndrome
guarded
etiology of central giant cell granuloma (CGCG)
unknown
who is affected by CGCG?
broad age range, most before 30 y.o.
what is the gender predilection for CGCG?
2:1 female
where does CGCG usually occur?
mandible, often crosses midline
T/F: CGCG is more common in anterior portions of jaw
true
clinical features of CGCG
- typically asymptomatic
- can be expansile
- can break through bone and move into soft tissue
T/F: some CGCG show locally aggressive behavior
true, i.e. root resorption
radiographic features of CGCG
- unilocular/multilocular radiolucency
- range in size from a few mm to several cm
- well-delineated, generally not corticated
histopathologic features of CGCG
- proliferation of vascular granulation tissue with numerous multinucleated giant cells and extravasated erythrocytes
CGCG has the same histologic appearance as what?
- brown tumor of hyperparathyroidism
- peripheral giant cell granuloma
- giant cell tumor of bone
T/F: need radiographic correlation and blood test for parathormone (PTH) in CGCG
true
tx of CGCG
aggressive curettage/peripheral osteotomy
what should be ruled out before tx of CGCG?
hyperparathyroidism
prognosis of CGCG
good
2 types of hyperparathyroidism
- primary
2. secondary
primary hyperparathyroidism
inappropriate secretion of PTH
what may cause primary hyperparathyroidism?
- parathyroid hyperplasia
- parathyroid adenoma
- carcinoma
secondary hyperparathyroidism
renal failure –> altered vitamin D metabolism –> poor calcium retention
what are the actions of PTH?
- osteoclastic activation
- increased Ca2+ uptake by kidneys
- increase vitamin D synthesis (kidneys) which promotes Ca2+ from the gut
inappropriate secretion of PTH in primary hyperparathyroidism causes what?
increased serum Ca2+
kidney failure –> inadequate producation of vitamin D which is needed to absorb calcium from the gut causes what in secondary hyperparathyroidism?
increased serum Ca2+
clinical features of hyperparathyrodism
“bones, stones, groans and moans” (thrones)
radiographic features of hyperparathyroidism
- loss of lamina dura
- “ground glass” trabecular pattern
- unilocular/multilocular radiolucency
what might the radiolucencies in ppl with hyperparathyroidism resemble radiographically?
- brown tumor of hyperparathyroidism
2. renal osteodystrophy
renal osteodystrophy
enlargement of jaws due to long-standing renal failure
histopathologic features of ppl with hyperparathyroidism
brown tumors show vascular granulation tissue with extravasated erythrocytes and numerous benign multinucleated giant cells
what does hyperparathyroidism microscopically the same as?
- peripheral giant cell granuloma
- CGCG
- giant cell tumor of bone
renal osteodystrophy due to hyperparathyroidism
unusual hyperplastic response of bone in patients with poorly controlled secondary hyperparathyroidism
renal osteodystrophy due to hyperparathyroidism is seen in what type of patients?
patients on long-term renal dialysis
T/F: renal osteodystrophy due to hyperparathyroidism may manifest as prominent jaw enlargement
true
tx of primary hyperparathyroidism
remove parathyroid
tx of secondary hyperparathyroidism
better control of serum calcium
what may be needed to tx secondary hyperparathyroidism?
- parathyroidectomy may be needed
2. renal transplant
prognosis of hyperparathyroidism
fair
what is prognosis of hyperparathyroidism associated with?
etiology
