bone neoplasms/tumors Flashcards
A __________ is an uncommon neoplasm that probably arises from periodontal ligament fibroblasts
Central Ossifying Fibroma
Central Ossifying Fibromas can often be confused with what benign condition?
focal cemento-osseous dysplasia
Clinical characteristics of Central Ossifying Fibromas:
1) Mandibular premolar/molar region
2) often in adult female, 3rd to 4th decade
3) Asymptomatic swelling, root divergence, facial deformity with larger lesions
Radiographic features of Central Ossifying Fibromas:
A) Well-circumscribed radiolucency with variable amount of central opacity
B) Range from almost purely radiolucency to very radiodense with a well-defined lucent border
T/F: when surgically removing a central ossifying fibroma, the lesional tissue will separate readily from the underlying bone
True
Histological characteristics of Central Ossifying Fibromas:
A) Cellular fibrous connective tissue with calcified trabeculae/spherules resembling cellular cementum or woven bone
B) Similar histology to fibrous dysplasia/COD, radiographic correlation is often helpful
what is the treatment/prognosis/reoccurrence for central ossifying fibromas?
1) Treatment consists of enucleation
2) Prognosis is very good
3) recurrence rate of 12%
what is an Osteoma? what bones does it usually effect?
Benign osseous tumor
primarily affecting craniofacial bones (esp. paranasal sinuses)
Characteristics of Osteomas:
1) Painless, slowly enlarging
2) In the jaws, predilection for mandibular body and condylar area
3) Histology: normal bone +/- marrow tissue
T/F: Gardners syndrome has an Autosomal Recessive inheritance pattern
FALSE
Autosomal Dominant
Inheritance characteristics of Gardners Syndrome:
A) 1:8,000-16,000 live births
B) One of the familial adenomatous polyposis syndromes
C) APC gene, chromosome 5
what are the clinical characteristics of Gardners syndrome?
1) Characterized by multiple osteomas of the facial bones (skull, paranasal sinuses, mandible)
2) epidermoid cysts and desmoid tumors
Radiographic features of Gardners Syndrome:
A) osteomas of Gardner syndrome can resemble florid cemento-osseous dysplasia or osteitis deformans
B) May see impacted supernumerary teeth or, less commonly, odontomas
The most significant aspect of Gardners syndrome is the development of __________________
precancerous polyps of the colon
50% of patients with gardeners syndrome develop _____________ of the colon by 30 years of age
adenocarcinoma
how is gardeners syndrome managed?
A) Prophylactic colectomy
B) Removal of problematic cysts and osteomas
C) Removal of impacted teeth/odontomas with prosthodontic work as needed
D) Genetic counseling
what neoplasm is considered “controversial” due to the fact it may be either a neoplasm or simply a reactive process?
Central Giant Cell Granuloma
clinical characteristics of Central Giant Cell Granulomas:
1) Broad age range, 60% of pts are under 30 yrs old
2) 2:1 female predilection
3) location: Mandible favored (70%), often anterior, frequently crossing the midline
Small central giant cell granulomas are often ________, while larger lesions become ________ and _________
Unilocular when small; larger lesions become multilocular and expansile
what are the histopathological characteristics of giant cell granulomas?
A) cellular granulation tissue with numerous benign multinucleated giant cells
B) RBC extravasation and hemosiderin deposits are common
what is the treatment/prognosis/recurrence rate for Giant Cell Granulomas?
A) Treatment generally consists of aggressive curettage, although alternative non-surgical therapies have been reported
B) Recurrence rate of approximately 20%
C) Prognosis is generally considered good
____________ is caused by the Inappropriate secretion of parathormone
Hyperparathyroidism
Define primary and secondary Hyperparathyroidism:
Primary - due to parathyroid hyperplasia, parathyroid adenoma, parathyroid carcinoma
Secondary - due to renal failure, which is responsible for poor calcium retention and altered vitamin D metabolism
what are the radiographic characteristics of Hyperparathyroidism lesions?
1) Radiographically, loss of lamina dura and “ground-glass” trabecular pattern
2) Unilocular/multilocular radiolucencies may develop - “brown tumor”
T/F: diffuse jaw enlargement can be caused by chronic renal failure
true
secondary hyperparathyroidism (jaw enlargement) caused by renal failure
what are the histopathological characteristics of lesions caused by Hyperparathyroidism?
1) Microscopically identical to central giant cell granuloma
2) brown tumors show vascular granulation tissue with numerous multinucleated giant cells and extravasated erythrocytes
what is the definition of Renal Osteodystrophy?
Hyperplastic response of the bone in patients with poorly-controlled secondary hyperparathyroidism related to end-stage renal disease
what physical effects can result from Renal Osteodystrophy?
Prominent jaw enlargement may result
what are the treatments for hyperparathyroidism?
If primary, remove the source of excess hormone secretion
If secondary, better control of serum calcium levels. Parathyroidectomy may be needed if medical therapy fails. Renal transplant is another alternative
A ___________ is a malignancy showing production of osteoid by tumor cells
Osteosarcoma
T/F: Osteosarcomas are the most common primary bone malignancy
true
how many cases of osteosarcoma are found each year? what population groups are at the highest risk?
A) About 1,000 new cases in the US annually; only 6-8% of these affect the jaws
B) Bi-modal age distribution, major peak: 2nd decade, lesser peak: after 6th decade
T/F: Osteosarcoma of the jaws is different epidemiologically compared to osteosarcoma of long bones
True
what age groups are likely to acquire osteosarcoma of long bones? how about lesions of the jaws/maxilla?
1) Osteosarcoma of long bones; knee area or pelvis; mean age: 18 years
2) Osteosarcoma of the jaws; maxilla = mandible; mean age: 33-39 years
clinical characteristics of Osteosarcomas:
Initial complaint is often pain, followed by swelling, loose teeth or paresthesia
radiographic signs of osteosarcoma:
1) Mixed radiopaque/radiolucent lesion with ill-defined borders
2) Symmetrically widened PDL of teeth in the area may be seen
3) “Sun-burst” pattern is uncommon in jaws
what are the histological characteristics of Osteosarcomas?
A) Infiltrating sheets of malignant spindle-shaped or angular lesional cells
B) Direct production of osteoid or bone
C) Osteoblastic, chondroblastic and fibroblastic differentiation may be seen
what is the treatment/prognosis/survival for Osteosarcomas?
1) Treatment is radical surgery, together with chemotherapy is some cases
2) Overall 5 yr survival: 60-70%
3) Death is more often due to uncontrolled local disease than metastasis
A _____________ is a rare malignancy of cartilaginous differentiation
Chondrosarcoma
T/F: chondrosarcomas are only half as common as osteosarcomas
true
what groups are at the highest risk for developing chondrosarcomas? what sites are most likely to be effected?
A) Most are seen in adult males (4th to 6th decade)
B) affect femur, pelvis or ribs
Chondrosarcomas account for only ____% of all head and neck malignancies
0.1%
where in the head/neck region are chondrosarcomas most likely to be found?
what are the symptoms associated with them?
A) found in Anterior maxilla, Posterior mandible
B) May present with pain, swelling or loose teeth
what are the radiographic finding for chondrosarcomas?
1) Poorly defined radiolucency with variable amounts of radiopacity
2) Larger lesions may appear multilocular
3) May see widened PDL of the teeth in the area of the tumor, similar to osteosarcoma
list the histopathological characteristics of Chondrosarcomas:
invasive lobules of atypical cells showing cartilaginous differentiation
T/F: most chondrosarcomas of the jaw are high grade (grade 3)
FALSE
most are low grade (1 or 2)
Treatment/prognosis/recurrence of chondrosarcomas:
what is the 5 & 10 year survival rate for chondrosarcomas?
A) Treatment is radical surgery
B) Prognosis depends on the location and histopathologic grade of the tumor
C) 5 and 10 yr survival: 87% and 71% respectively
T/F: Death due to chondrosarcomas are usually due to direct extension of tumor, involving vital structures
true
T/F: death due to osteosarcomas are due to uncontrolled disease, while death due to chondrosarcoma is due to direct effects of the tumor
true
__________ is the most common form of cancer involving bone
Metastatic Disease
Metastatic deposits from malignancies below the neck may affect the jaws through ____________________ veins which lack valves
Batson’s paravertebral plexus of veins
what groups are at the highest risk for metastatic disease? what areas does it usually effect in the head/neck?
Mean age: 43 - 52 years
No gender predilection
Marked predilection for the posterior mandible
clinical characteristics of metastatic disease in the head/neck region:
A) Paresthesia, tooth mobility, swelling, hemorrhage, pathologic fracture, trismus
B) Failure of tooth socket to heal: consider metastatic disease or lymphoma
what does metastatic disease look like radiographically
Poorly defined radiolucency
less commonly, mixed radioluceny/radiopacity
histopath features of metastatic disease:
A) lesions mimic the primary malignancy from which they arose
B) Scattered clusters of lesional cells give a “seeded” effect
C) Breast, lung, colon, thyroid, prostate, kidney, melanoma are among the more common primary malignancies
___% of jaw metastases represent the initial manifestation of Metastatic disease
22%
what is the treatment/prognosis for metastatic disease?
Treatment: palliation, usually with radiation therapy, anti-resorptives
Prognosis: very poor; most patients die within one year of the diagnosis
