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Pathology 2 > Bone Pathology II > Flashcards

Bone Pathology II Flashcards

1
Q

Central giant cell granuloma
 Etiology:
 Clinical features:
 –% cases occur before — years
 –% —, — MC

A

uncertain; reactive process vs benign neoplasm

60, 30
70, mandible, anterior

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2
Q

Central giant cell granuloma
 Nonaggressive lesions:
(4)

A

 Smaller
 Fewer symptoms
 Slow growth
 Discovered on routine radiographs

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3
Q

Central giant cell granuloma
 Aggressive lesions:
(6)

A

 Larger at dx
 Pain, paresthesia
 Rapid growth
 Root resorption, displacement
 Cortical perforation
 Greater recurrence potential

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4
Q

Central giant cell granuloma
 Radiographic findings:
 Histopathology:

A

unilocular or multilocular RL, well-defined borders

Multinucleated giant cells in a background of
mesenchymal cells

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5
Q

Central giant cell granuloma
 Treatment:
(4)

A

 Curettage
 Peripheral ostectomy
 Intralesional corticosteroids, calcitonin
 Recurrence rate: appx 20%

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6
Q

Cherubism
(3)

A

 Developmental jaw disease
 Mutation of SH3BP2
 Appearance reminiscent of cherubs

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7
Q

 Mutation of SH3BP2

A

 Enhanced osteoclastic activity →lytic bone lesions

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8
Q

Cherubism
 Clinical features:
(4)

A

 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”

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9
Q

Cherubism
 Dental implications: (5)

A

 Tooth displacement,
mobility,
failure of eruption,
impaired mastication,
speech difficulties

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10
Q

Cherubism
 Radiographic findings:
(3)

A

 Bilateral, multilocular, expansile RL
 Resorption of adjacent tooth roots
 Thinning of cortical bone

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11
Q

Cherubism
 Histopathology:
(2)

A

 Clinical and RG correlation essential
 Multinucleated giant cells, vascular fibrous tissue

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12
Q

Cherubism
 Treatment:
(4)

A

 Lesions regress after puberty
 Facial features appear normal by 4th decade
 Conservative therapy (observation)
 Surgical intervention for aggressive lesions, marked facial deformity

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13
Q

Fibro-osseous lesions of the jaw
 Characterized by
 Clinical, radiographic, and histopathologic correlation necessary to
establish specific diagnosis

A

replacement of normal bone by fibrous tissue and
mineralized product

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14
Q

Fibro-osseous lesions of the jaw
(3)

A

 Fibrous dysplasia
 Ossifying (cemento-ossifying) fibroma
 Cemento-osseous dysplasia

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15
Q

Cemento-osseous dysplasia
(3)

A

 periapical cemento-osseous dysplasia
 focal cemento-osseous dysplasia
 florid cemento-osseous dysplasia

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16
Q

Fibrous dysplasia
(3)

A

 Developmental lesion
 GNAS mutation
 Replacement of normal bone by cellular fibrous connective tissue with
irregular bony trabeculae

17
Q

Fibrous dysplasia
 Clinical features:
 Monostotic disease: —% of all cases

A

80 to 85

 Dx in 2nd to 3rd decade
 Maxilla (posterior) > mandible
 Painless unilateral swelling

18
Q

Fibrous dysplasia
 Clinical features:
 Polyostotic disease
(3)

A

 Dx in 1st decade
 Female predilection
 Long bone involvement: pain, pathologic fracture, bowing deformity

19
Q

Fibrous dysplasia
 Polyostotic disease:
(2)

A

 Jaffe-Lichtenstein syndrome:
 McCune-Albright syndrome:

20
Q

 Jaffe-Lichtenstein syndrome:

A

café-au-lait pigmentation

21
Q

 McCune-Albright syndrome:

A

café-au-lait pigmentation, multiple endocrine
lesions

22
Q

Fibrous dysplasia
 Radiographic features:
(3)

A

 fine, ground-glass opacification with poorly defined borders
 Mandible: buccal-lingual expansion
 Ill-defined lamina dura

23
Q

Fibrous dysplasia
 Treatment:
 Minimal cosmetic or functional disturbances:
 Large, extensive lesions:
 —% show regrowth after surgical debulking
 Complete surgical resection:

A

may not require surgery
Surgical debulking/contouring
20-50
monostotic lesions, refractory lesions

24
Q

Cemento-osseous dysplasia
 MC
 Occurs in
 Three variant:

A

fibro-osseous lesion
tooth-bearing areas of the jaw
periapical, focal, florid

25
Q

Periapical cemento-osseous dysplasia
 Clinical features:
(5)

A

 Involves lower anterior periapical region
 Usually multiple foci present
 Marked female predilection: 10:1
 70% cases affect blacks
 Dx: 30-50 years of age

26
Q

Periapical cemento-osseous dysplasia
 Radiographic features:
 Early lesions:
 Older lesions:
 End stage:

A

circumscribed periapical radiolucency
mixed RL-RO
circumscribed radiopacity, with radiolucent rim

27
Q

Focal cemento-osseous dysplasia
 Clinical features:
(5)

A

 Involves a single site
 MC in posterior mandible
 90% females
 MC in blacks
 Dx: 3rd–6th decade

28
Q

Focal cemento-osseous dysplasia
 Radiographic findings:

A

 Same as periapical COD, but focal

29
Q

Florid cemento-osseous dysplasia
 Clinical features:
(4)

A

 Multifocal involvement, may involve all 4 quadrants
 MC black females
 Dx: 3rd–6th decade
 Usually asymptomatic, may have dull pain

30
Q

Florid cemento-osseous dysplasia
 Radiographic features:
(2)

A

 similar in progress to other types of COD
 Multifocal involvement

31
Q

Cemento-osseous dysplasia
 Treatment:
(4)

A

 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

32
Q

Ossifying fibroma
(2)

A

 True neoplasm, significant growth potential
 Resemble cemento-osseous dysplasia

33
Q

Ossifying fibroma
 Clinical features:
age
location
 Small lesions:
 Large tumors:

A

 Broad age range: peek in 3rd to 4th decade
 Mandible (posterior) > maxilla
often asymptomatic
painless jaw swelling

34
Q

Ossifying fibroma
 Radiographic features:
(3)

A

 Mixed RL-RO lesion, or well-defined unilocular lesion
 Buccal lingual expansion common
 Downward bowing of inferior cortex

35
Q

Ossifying fibroma
 Treatment:
(3)

A

 Often circumscribed, facilitates easy removal
 Large lesions may require surgical resection
 Recurrence uncommon

Pathology 2 (12 decks)

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