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
