Bone Pathology II Flashcards
Central giant cell granuloma
Etiology:
Clinical features:
–% cases occur before — years
–% —, — MC
uncertain; reactive process vs benign neoplasm
60, 30
70, mandible, anterior
Central giant cell granuloma
Nonaggressive lesions:
(4)
Smaller
Fewer symptoms
Slow growth
Discovered on routine radiographs
Central giant cell granuloma
Aggressive lesions:
(6)
Larger at dx
Pain, paresthesia
Rapid growth
Root resorption, displacement
Cortical perforation
Greater recurrence potential
Central giant cell granuloma
Radiographic findings:
Histopathology:
unilocular or multilocular RL, well-defined borders
Multinucleated giant cells in a background of
mesenchymal cells
Central giant cell granuloma
Treatment:
(4)
Curettage
Peripheral ostectomy
Intralesional corticosteroids, calcitonin
Recurrence rate: appx 20%
Cherubism
(3)
Developmental jaw disease
Mutation of SH3BP2
Appearance reminiscent of cherubs
Mutation of SH3BP2
Enhanced osteoclastic activity →lytic bone lesions
Cherubism
Clinical features:
(4)
First evident 2-5 years, mild cases dx 10-12
Alterations progress until puberty, then slowly regress
Bilateral expansion of the posterior mandible: Angle, rami, coronoid process
Involvement of inferior/lateral orbital wall →“eyes upturned to heaven”
Cherubism
Dental implications: (5)
Tooth displacement,
mobility,
failure of eruption,
impaired mastication,
speech difficulties
Cherubism
Radiographic findings:
(3)
Bilateral, multilocular, expansile RL
Resorption of adjacent tooth roots
Thinning of cortical bone
Cherubism
Histopathology:
(2)
Clinical and RG correlation essential
Multinucleated giant cells, vascular fibrous tissue
Cherubism
Treatment:
(4)
Lesions regress after puberty
Facial features appear normal by 4th decade
Conservative therapy (observation)
Surgical intervention for aggressive lesions, marked facial deformity
Fibro-osseous lesions of the jaw
Characterized by
Clinical, radiographic, and histopathologic correlation necessary to
establish specific diagnosis
replacement of normal bone by fibrous tissue and
mineralized product
Fibro-osseous lesions of the jaw
(3)
Fibrous dysplasia
Ossifying (cemento-ossifying) fibroma
Cemento-osseous dysplasia
Cemento-osseous dysplasia
(3)
periapical cemento-osseous dysplasia
focal cemento-osseous dysplasia
florid cemento-osseous dysplasia
Fibrous dysplasia
(3)
Developmental lesion
GNAS mutation
Replacement of normal bone by cellular fibrous connective tissue with
irregular bony trabeculae
Fibrous dysplasia
Clinical features:
Monostotic disease: —% of all cases
80 to 85
Dx in 2nd to 3rd decade
Maxilla (posterior) > mandible
Painless unilateral swelling
Fibrous dysplasia
Clinical features:
Polyostotic disease
(3)
Dx in 1st decade
Female predilection
Long bone involvement: pain, pathologic fracture, bowing deformity
Fibrous dysplasia
Polyostotic disease:
(2)
Jaffe-Lichtenstein syndrome:
McCune-Albright syndrome:
Jaffe-Lichtenstein syndrome:
café-au-lait pigmentation
McCune-Albright syndrome:
café-au-lait pigmentation, multiple endocrine
lesions
Fibrous dysplasia
Radiographic features:
(3)
fine, ground-glass opacification with poorly defined borders
Mandible: buccal-lingual expansion
Ill-defined lamina dura
Fibrous dysplasia
Treatment:
Minimal cosmetic or functional disturbances:
Large, extensive lesions:
—% show regrowth after surgical debulking
Complete surgical resection:
may not require surgery
Surgical debulking/contouring
20-50
monostotic lesions, refractory lesions
Cemento-osseous dysplasia
MC
Occurs in
Three variant:
fibro-osseous lesion
tooth-bearing areas of the jaw
periapical, focal, florid
Periapical cemento-osseous dysplasia
Clinical features:
(5)
Involves lower anterior periapical region
Usually multiple foci present
Marked female predilection: 10:1
70% cases affect blacks
Dx: 30-50 years of age
Periapical cemento-osseous dysplasia
Radiographic features:
Early lesions:
Older lesions:
End stage:
circumscribed periapical radiolucency
mixed RL-RO
circumscribed radiopacity, with radiolucent rim
Focal cemento-osseous dysplasia
Clinical features:
(5)
Involves a single site
MC in posterior mandible
90% females
MC in blacks
Dx: 3rd–6th decade
Focal cemento-osseous dysplasia
Radiographic findings:
Same as periapical COD, but focal
Florid cemento-osseous dysplasia
Clinical features:
(4)
Multifocal involvement, may involve all 4 quadrants
MC black females
Dx: 3rd–6th decade
Usually asymptomatic, may have dull pain
Florid cemento-osseous dysplasia
Radiographic features:
(2)
similar in progress to other types of COD
Multifocal involvement
Cemento-osseous dysplasia
Treatment:
(4)
Not required; periapical COD is especially distinct
Periodic observation
Focal COD less specific, bx may be needed to confirm
Prone to necrosis (especially sclerotic phase) - avoid unnecessary bx
Ossifying fibroma
(2)
True neoplasm, significant growth potential
Resemble cemento-osseous dysplasia
Ossifying fibroma
Clinical features:
age
location
Small lesions:
Large tumors:
Broad age range: peek in 3rd to 4th decade
Mandible (posterior) > maxilla
often asymptomatic
painless jaw swelling
Ossifying fibroma
Radiographic features:
(3)
Mixed RL-RO lesion, or well-defined unilocular lesion
Buccal lingual expansion common
Downward bowing of inferior cortex
Ossifying fibroma
Treatment:
(3)
Often circumscribed, facilitates easy removal
Large lesions may require surgical resection
Recurrence uncommon
