Bone Path IV

Question 1

Multiple Myeloma
 Malignancy of

 May arise from a
 Monoclonal proliferation of plasma cells →

Answer 1

plasma cells
Most common tumor of bone, excluding metastatic disease
plasmacytoma (unifocal)
produce non-functional immunoglobin

Question 2

Multiple Myeloma
 Clinical features:
(7)

Answer 2

 Observed in adults, Dx: 60-70 years
 Twice as common in Black patients
 Jaw involvement – 30% cases
 Bone pain common, bone fractures
 Fatigue
 Petechial hemorrhage
 Fever

Question 3

Multiple Myeloma
 Clinical features:
(3)

Answer 3

 Amyloid deposits- tongue MC site
 Renal failure
 Bence Jones protein in urine

Question 4

Multiple Myeloma
 Radiographic features:
(2)

Answer 4

 Sharply punched out radiolucency
 Ill defined, ragged radiolucency

Question 5

Multiple myeloma
 Treatment:
(4)

Answer 5

 Chemotherapy
 Bone marrow transplantation
 Bisphosphonates
 5-year prognosis: 50-70%

Question 6

Osteosarcoma
 Malignancy of
 Risk factors: (4)
 Genetic alterations: (2)

Answer 6

mesenchymal cells that produce malignant osteoid
Radiation exposure, alkylating agents, Paget disease, hereditary retinoblastoma
p53, RB1

Question 7

Osteosarcoma
 Clinical features:

 MC in
 Gnathic cases:
 Slight — predilection


Answer 7

6% arise in jaws
long bones: 2nd-3rd decade
3rd – 5th decade
mandibular
Swelling and pain

Question 8

Osteosarcoma
 Radiographic features:
(5)

Answer 8

 Ill-defined RO, mixed RL-RO, or entirely RL lesion
 Cortical expansion, destruction
 Periosteal reaction – “sunburst” pattern
 “spiking” root resorption
 Symmetrical PDL widening (early cases)

Question 9

Osteosarcoma
 Treatment:
(4)

Answer 9

 W ide surgical resection
 Radiation and chemotherapy may be considered
 5-year survival 60-70%
 Prognostic factor: complete surgical removal

Question 10

Chondrosarcoma

 — as common compared to osteosarcoma
 May develop
 Mutations in

Answer 10

Malignant neoplasm, tumor cells form malignant cartilage
Half
de novo or from a preexisting benign cartilaginous tumor
IDH1 and IDH2 frequent

Question 11

Chondrosarcoma
 Clinical findings:
 Mean age:
 MC sites:
 Gnathic cases:


Answer 11

51 years
ilium, femur, humerus, ribs
MC anterior maxilla (mandibular lesions: posterior)
Painless swelling

Question 12

 Gnathic cases: (2)

Answer 12

MC anterior maxilla
 mandibular lesions: posterior

Question 13

Chondrosarcoma
 Radiographic findings:
(5)

Answer 13

 Ill-defined RL with RO foci
 Infrequently, may appear as multilocular RL
 May show “sunburst” pattern
 Root resorption, loosening of teeth
 Symmetrical widening of PDL

Question 14

Chondrosarcoma
 Treatment:
(2)

Answer 14

 Surgical resection
 Radiation and chemotherapy may be considered for high-grade

Question 15

Ewing Sarcoma
(3)

Answer 15

 Malignant neoplasm – undifferentiated round cells
 EWS-FLI1 fusion gene
 Bone lesions most frequent

Question 16

Ewing Sarcoma
 Clinical findings:
age
who
where (2)
symptoms (2)

Answer 16

 MC in 2nd decade
 MC in W hite patients
 MC long bones, pelvis, ribs
 1-2% arise in jaws, MC mandible
 Paresthesia and tooth mobility
 Pain and swelling

Question 17

Ewing Sarcoma
 Radiographic findings:
(3)

Answer 17

 Ill-defined RL, mixed RL-RO
 Cortical destruction or expansion
 “onionskin” periosteal reaction

Question 18

Ewing Sarcoma
 Treatment:
(2)

Answer 18

 Surgery with multiagent chemotherapy and radiotherapy
 5-year survival: 70% localized, 25% metastasis

Question 19

Metastasis to the oral cavity
(3)

Answer 19

 MC form of cancer involving bone
 Primary sites: breast, lung, thyroid, prostate, kidney
 Jaw metastasis uncommon

Question 20

Metastasis to the oral cavity
 Clinical features:
age
where
symptoms (3)

Answer 20

 MC older adults
 Mandible (posterior) > maxilla
 Pain and swelling
 Tooth mobility
 Paresthesia of lower lip/chin (numb-chin syndrome)

Question 21

Metastasis to the oral cavity
 Radiographic features:
(3)

Answer 21

 Ill-defined, “moth-eaten” RL
 Occasionally, may have mixed RL-RO
 May cause cortical destruction, pathologic fracture

Question 22

Metastasis to the oral cavity
 Treatment:
(3)

Answer 22

 Solitary lesion – surgical excision or radiation
 Management depends on underlying cancer
 Prognosis poor overall