Bone Pathology Flashcards
What four things are characteristic of benign bone neoplasms?
1-Asymptomatic
2-Grows slowly and by expansion: displaces teeth and expands the cortex
3-Symmetrical (corticated radiolucency rim)
4-Does not metastasize
What 7 things are characteristic of malignant bone neoplasms?
1-Usually symptomatic
2-Grows more rapidly
3-Invades and destroys adjacent structures (cortex)
4-Often asymmetrical (non-corticated radiolucency)
5-Ragged or poorly defined margins and destroys cortex
6-Laying down bone outside the cortex
7-Capable of metastasis
What heritable disorder is a defect in type I collagen, is the most common type of inherited bone disease and can result in bowing bone structure as well as wormian bones in the skull?
Osteogenesis Imperfecta
What are 6 symptoms or signs of Osteogenesis Imperfecta?
1-Bone fragility 2-Blue sclera 3-Altered teeth- opalescent teeth 4-Hearing loss (hypoacusis) 5-Long bone & spine deformities 6-Joint hyperextensiblity
AKA Marble bone disease, what condition results from a defect in remodeling causing failure of normal osteoclastic resorption?
Osteopetrosis
*appears as very radiopaque bone in radiographs. Hard to visual roots
Which clinical pattern of Osteopetrosis is discovered at birth, results in marrow failure, frequent fractures, cranial nerve compression, facial deformities, and delayed tooth eruption?
Infantile Osteopetrosis (aka malignant osteopetrosis)
*most die in first decade of life
Which clinical pattern of Osteopetrosis is discovered later in life and is less severe?
Adult Osteopetrosis (AKA benign osteopetrosis)
*40% are asymptomatic
What syndrome is characterized by supernumerary impacted teeth and clavicle abnormalities?
Cleidocranial Dysplasia
*delay/failure of permanent tooth eruption
A non-pathologic area of hematopoietic marrow that produces a radiolucency is called?
Focal Osteoporotic Marrow Defect
*incisional biopsy necessary for diagnosis
A focal area of increased radiodensity that is of unknown cause and cannot be attributed to anything else is called?
Idiopathic osteosclerosis
*NO cortical expansion, 90% in mandible, No corticated rim
What are three things Idiopathic Osteosclerosis could be confused with?
1-Condensing osteitis, which is associated with an infection
2-Focal cemento-osseous dysplasia, which will have a radiolucent rim
3-Cementoblastoma, which will be fused with the tooth
What condition results from abnormal resorption and deposition of bone causing distortion and weakening of affected bones causing bone pain?
Paget’s Disease of bone
*usually near joints. Maxilla more often than mandible
What are 4 commonly affected bones in Paget’s disease?
1-vertebrae
2-Pelvis
3-Skull (circumference)
4-Femur
An enlargement of the middle 1/3 of the face in Pagets disease is called?
Leontiasis ossea, or lionlike facial deformity
What serum test results would you expect in a patient with Paget’s disease?
High serum alkaline phosphatase levels with Normal calcium and phosphorus levels
What is a complication of Paget’s disease that occurs in up to 10%?
Malignant bone tumor (Osteosarcoma)
*very aggressive. commonly in pelvis or long bones
What is considered a non-neoplastic lesion, frequently crosses the midline of anterior jaw and is a radiolucency, with a multilocular noncorticated margin?
Central Giant Cell Granuloma
What two conditions have identical histopathology to Central Giant Cell Granuloma?
1-Brown tumor of hyperparathyroidism
2-Cherubism
*Treatment is curettage
What developmental condition causes plump-cheeks, eyes upturned to heaven and typically progresses until puberty and slowly regresses?
Cherubism
*Mutilocular bilateral radiolucency
Also known as a simple bone cyst, what lesion presents as a scalloped radiolucency involving several teeth?
Traumatic Bone Cyst
*Cyst is a misnomer because lesion does not have epithelial lining
What is the theory for why a Traumatic bone Cyst forms?
Trauma to bone causes fracture resulting in intraossesous hematoma. Hematoma does not repair and liquefies resulting in defect
An intraosseous accumulation of blood-filled spaces surrounded by connective tissue that presents clinically as a rapidly formed swelling and a “blow out” radiographic appearance is likely?
Aneurysmal bone cyst
- Looks like a blood soaked sponge
What are the three main types of Fibro-Osseous lesions?
1-FIbrous dysplasia
2-Cemento-osseous dysplasia (3 types)
3-Ossifying fibroma
What tumor-like condition is characterized by replacement of normal bone by fibrous connective tissue intermixed with bone?
Fibrous Dysplasia
Fibrous dysplasia can be monostotic (1 bone) or polysostotic (multiple bones), What two syndromes are polyostotic fibrous dysplasias?
1-Jaffe-Lichtenstein Syndrome
2-McCune-Albright Syndrome
Which type of Fibrous dysplasia accounts for 80% of all cases and appears as an ill defined, ground glass opacification radiographically?
Monostotic Fibrous Dysplasia
Which type of fibrous dysplasia can involve up to 75% of the skeleton, and tends to stabilize and stop growing at skeletal maturity?
Polyostotic Fibrous Dysplasia
What syndrome is characterized by Polyostotic fibrous dysplasia and Café au lait spots (coast of Maine, jagged)?
Jaffe-Lichtenstein syndrome
What syndrome is characterized by Polyostotic fibrous dysplasia, Café au lait spots (coast of Maine)
and multiple endocrinopathies?
McCune-Albright Syndrome
*Sexual precocity is the most common endocrinopathy
What occurs in tooth-bearing areas of the jaw and is the most common fiber-osseous lesion encountered in clinical practice?
Cemento-Osseous Dysplasia
What are the three types of Cemento-Osseous Dysplasia?
1-Focal- usually 1st molar in mandible
2-Periapical
3-Florid
Which type of Cemento-osseous Dysplasia Exhibits single sight involvement most commonly in the posterior mandible near 1st molar and appears as a mixed RL and RO radiographic pattern?
Focal Cemento-Osseous Dysplasia
*90% are women in 40’s (Caucasian)
Which type of Cemento-osseous Dysplasia involves the periapical region of the anterior mandible, or which early lesions may look like multiple periapical granuloma/cyst?
Periapical Cemento-Osseous Dysplasia
*Most commonly female african americans. later lesions are mixed RO-RL radiographically
Which type of Cemento-osseous Dysplasia has Multiple focal involvement not limited to the anterior mandible and tends to be bilateral/symmetrical?
Florid Cemento-osseous Dysplasia
*90% female, 90% African American
Of the three Cemento-Osseous Dysplasias, may need to be biopsied?
Focal Cemento-osseous dysplasia
*Florid and Periapical do not need biopsy or intervention
What lesion is a true neoplasm with significant growth potential made of bone and cementum typically in the mandible with a characteristic downward bowing of the inferior cortex?
Ossifying fibroma
*more common in Females and in the Mandible
What lesion is typically found in males more than females and in the maxilla more than the mandible?
Juvenile (Active) Ossifying Fibroma
*RL with central RO
Benign tumors of mature bone that are well circumscribed masses that exhibit continued growth are called?
Osteoma
What are three main characteristics of Gardner’s syndrome?
1-Bowel Polyps (Will turn into adenocarcinoma)
2-Skeletal abnormalities (osteomas)
3-Dental abnormalities (supernumerary, impacted teeth, odontomas)
Osteoid osteomas are __________ than 2 cm; osteoblastomas are _______
SMALLER, LARGER
Which bone condition is a rare lesion in the jaws that can be well-defined or ill-defined radiolucency with radiopacities, is usually between 2-4 cm and that is NOT relieved by aspirin?
Osteoblastoma
Which bone condition is very rare in jaws but and is a small (less than 1 cm) well-circumscribed lesion with a radiolucent defect-rim with a target like appearance that causes nocturnal pain relieved by aspirin?
Osteoid Osteoma
An odontogenic neoplasm of cementoblasts appearing as a radiopacity fused to one or more roots 75% or which arise in the mandible, (almost always in the molar/premolar region) are called?
Cementoblastoma
What non-neoplastic condition most commonly affects large joints as well as the TMJ and show loose bodies called joint mice near the joint on a radiograph?
Synovial Chondromatosis
What Mesenchymal malignancy is the most common type of malignancy originating in bone (excluding hematopoietic)?
Osteosarcoma
*extragnathic occur between 10-20 yrs old and after 50. Ave age 33 for the jaw
What are three characteristics of Osteosarcomas radiographically?
- Spiking resorption around and on roots (widening of PDL)
- Sunburst appearance in 25%
- Codman’s traingle (periosteum)
Which Osteosarcomas have the best prognosis?
Long bones (80%
*Jaw lesions are between 30-70%
A malignant bone tumor of cartilage is called?
Chondrosarcoma
What condition is a primary malignant tumor of bone-hematologic, is the 3rd most common osseous neoplasm (after osteosarc & chondrosarc) and is caused by a translocation on 11 and 22?
Ewing Sarcoma
*onionskin periosteal reaction
What conditions is the most common form of cancer involving bone?
Metastatic Tumors to the Jaws
*Stage IV disease. poor 5 year survival
What are 5 common origins of gnathic metastasis?
1-Breast 2-Lung 3-Thyroid 4-Prostate 5-Kidney
When the inferior alveolar never is involved in metastasis is can cause a pattern of anesthesia termed?
Numb-chin syndrome
How do Metastatic Tumors of the jaw appear like on radiographs?
- Ill-defined (moth eaten) borders
- widening PDL
