Bone Pathology Flashcards
Diff dx of well defined radiopacity
Retained root Impacted tooth Odontoma (complex/compound) Condensing osteitis Cementoblastoma Osteoma Osteoid ostetoma Osteoblastoma
Diff dx of poorly defined radiopacity
Condensing osteitis Cementoosseous dysplasia (late) Fibrous dysplasia Sclerosing osteomyelitis Proliferative periostitis (Garres osteomyelitis) Pagets disease Osteosarcoma Osteopetrosis
Ground glass appearance
Fibrous dysplasia
Cotton wool appearance
Cementoosseous dysplasia
Pagets disease
Multiple osteomas (Gardner syndrome)
Sunburst appearance
Osteosarcoma
Intraoosseous hemangioma
Onion skin appearance
Proliferative periostitis (Garres osteomyelitis) Ewing sarcoma
Diff dx of periapical radiolucency associated with vital teeth
Early COD
Osteoid osteoma
Well defined radiopacity with characteristic NOCTURNAL pain
Clinical types of FD
Monostotic
Polyostotic
Clinical features of FD
Painless unilateral bony hard swelling Slow growth generally (but can be accelerated in some cases) Maxilla > mandible Maxilla commonly involve adj bones (zygoma, ethmoid, sphenoid, frontal, temporal, occiput) - craniofacial FD - vision changes - hearing impairment - sinonasal congestion - airway obstruction
Polyostotic - craniofacial + other limbs
- cafe au lait (Jaffe-lichenstein syndrome)
- cafe au lait + endocrinopathies (McCune Albright)
- cafe au lait + myxomas (Mazabraud)
Coast of Maine - irregular borders of cafe au lait spots
Questions to ask with FD patients
Symptoms related to craniofacial
- vision disturbance
- sensory changes
- hearing impairment
- sinonasal congestion
- airway obstruction
Symptoms related to other skeletal parts
- bone pain in limbs
- limping
- hx of fracture?
Symptoms assoc with endocrinopathies
- early puberty?
- hyperthyroidism symptoms?
- cushings syndrome?
Cafe au lait spots?
Investigations for ptns suspected or diagnosed with FD
Diagnosis of FD - achieved by clinical, radiographic, trephine biopsy - bony hard swelling +/- pain, ground glass appearance, irregular shaped trabecular of immature bone in fibrous stroma
CT - to seen extension of disease
Bone scan whole body
- screen other FD in the body
- look for intramuscular myxomas (Mazbraud syndrome)
Serum levels of - phosphate - androgen - sex hormones - thyroid hormone - growth hormone - cortisol - parathyroid hormone (to rule of McCune albright syndrome)
Treatment of FD
Conservative mx - potential to stabilize and regress
Surgical contouring, shaving, debulking - continued growth with large or extensive lesions
Complete surgical removal with recons - very aggressive lesions or refractory to repeated debulking
Is there any risk of malignant transformation for FD
Yes. 1% developed osteosarcoma
Esp in
- McCune-Albright
- Mazabraud syndrome
- history of RT
Rapid growth with sudden onset of pain, neurosensory changes, marked changes in radiographic appearance
Diff dx of FD
Cementoosseous dysplasia Ossifying fibroma Osteoma Osteoblastoma Osteoid osteoma Osteosarcoma
Ossifying fibroma diff dx
Fibrous dysplasia (histologically similar but radiographically encapsulated - fd has no capsule) Late COD Osteoblastoma Osteoid osteoma Cementoblastoma/condensing osteitis
Types of OF
Conventional
Juvenile - more aggressive <15yrs of age
Tx of OF
Conventional - surgical enucleation and curettage
Juvenile - wide resection with 0.5cm margin
Pagets disease
Bone disease that causes resorption of bone and replacement of bone that is disorganized
Hence weaken the bone
Presentations of Pagets
Asymptomatic
Radiogrpahic changes - cotton wool appearance , late stage , elderly
Symptoms in craniofacial - vision changes, hearing impairment.
Pathologic fracture
Tx of Pagets
Bisphosphonates
Calcitonin
Surgery if fracture, bone deformity, degenerative arthritis
Osteosarcoma classic radiographic appearance
Sunburst appearance
Codman triangle
Garrington sign - widened PDL
clinical types of osteosarcoma
Central medullary OS
Peripheral OS (doesnt involve medulla) - better prognosis
- paraosteal (sorta exophytic
- periosteal (cause elevated perisoteum)
Treatment of osteosarcoma
Resection with 2cm margin
Chemotherapy
NO RT - radiation induced sarcona
NO Neck dissection - hematogenous spread
