Bone Pathology IV - Neoplasms Flashcards
Describe the features of Benign neoplasms of the bone
Asymptomatic Grows slowly and by expansion Displaces teeth and expands the cortex Symmetrical DOES NOT metastasize
Cortication = Slow growing = benign
Describe the features of Malignant neoplasms of bone
Usually symptomatic Grows rapidly Invades and destroys adjacent structures Asymmetrical Ragged or poorly defined borders and destroys cortex Lays down bone outside cortex Capable of Metastasis
*FLOATING TEETH
Root Resorption
Name the Benign neoplasms of Osseous origin
Exostoses - not neoplastic
Ossifying fibroma (odontogenic tumor)
Osteoid osteoma
Osteoblastoma
Name the Benign neoplasms of Cartilaginous origin
Chondroma
Chondromyxoid fibroma
Benign chondroblastoma
Name the Benign neoplasms of Fibrous origin
Desmoplastic fibroma
Name the Malignant neoplasms of Osseous origin
Osteosarcoma, Osteogenic sarcoma
Name the malignant neoplasms of Cartilaginous origin
Chondrosarcoma
Name the Malignant neoplasms of marrow origin
Ewing’s sarcoma
Multiple myeloma
Metastatic disease
Define Exostosis
A localized proliferation of bone that arises from the cortical plate
Characteristics of Exostosis
Minimal to no medullary bone involvement Single or multiple Sporadic sites Site specific locations - Torus palatinus - Torus mandibularis
Clinical features of Exostosis
Buccal area of the maxillary or mandibular alveolar ridge is most common site
- often bilateral
- Can also occur on lingual/palatal areas
Adults
Bony hard, elevated, nodular lesion
Location of Torus Palatinus
Always located in the midline of the hard palate
Etiology of Torus palatinus
Probably multifactorial
- Genetic? Environmental?
Clinical appearance of Torus Palatinus
Bony hard, elevated, nodular lesion
- May be lobulated when large
- asymptomatic
- thin overlying mucosa may ulcerate easily
Wide variation in size from small to large
Location of Torus Mandibularis
Lingual premolar area of the mandible
Etiology of Torus mandibularis
Probably multifactorial
- Genetic? Environmental?
Clinical appearnce of Torus Mandibulris
Bony hard, elevated, nodular lesions
- *90% are bilateral!
- Asymptomatic
- Thin overlying mucosa may ulcerate easily
- May be lobulated when large
Wide variation in size from small to large
Define Osteoma
A localized proliferation of bone
- Involves the medullary bone or cortical bone (may appear like tori)
Osteoma may be a manifestation of what?
Gardner’s syndrome
*Describe the general characteristics of Gardner’s Syndrome
Inherited disease
- Multiple osteomas
- Jaws (angle of mandible)
- Frontal bone
- Frontal and ethmoid sinuses
- Supernumerary teeth
** ~100% incidence of malignant transformation
Osteoid Osteoma
True neoplasm of bone
RARE;
Demographic patterns of Osteoid Osteoma
Wide age range
Usually less than 30 years of age (85%)
**Clinical presentation of Osteoid Osteoma
- *Nocturnal pain
* *Relieved by aspirin
Radiographic appearance of a “target” in Osteoid Osteoma
Small lesion, less than 1 cm in diamter
Central opacity
Peripheral radiolucent halo
Corticated rim
Osteoblastoma
True neoplasm of bone
Rare;
Most common site of Osteoblastoma
Mandible
Demographics of Osteoblastoma
Wide age range
Usually less than 30 years of age
Males 2:1
Clinical characteristics of Osteoblastoma
Pain
Not nocturnal
Not relieved by aspirin
Chondroma
Adults (20-40 yrs), in extremities
Rare in Head and Neck region
Desmoplastic Fibroma
Benign locally aggressive fibrous boney neoplasm
Bone equivalent of soft tissue fibromatosis (desmoid tumors)
Demographic pattern of desmoplastic fibroma
Children and young adults
85% in mandible
Posterior mandible and ascending ramus
radiographic findings of Desmoplastic fibroma
Radiolucency
Unilocular to multilocular
Borders well defined or poorly defined
Treatment of Desmoplastic fibroma
Curettage with 70% recurrence, resection with 20% recurrence
Osteosarcoma
A malignant neoplasm of osteoblastic cells
Produces osteoid matrix that may or may not calcify
What is the most common primary malignancy of bone
Osteosarcoma
7% occur in the jaws
Demographic patterns of Osteosarcoma
Wide age range from young to old
Males slightly more often affected
Mandible = maxilla
Clinical features of Osteosarcoma
Swelling and pain
- loosening of adjacent teeth
- paresthesia/anesthesia
Radiographic features of Osteosarcoma
Ill defined lesion
blends into surrounding bone
Specific features of OSteosarcoma
- Symmetrical widening of the PDL space
- Alveolar bone production above the level of the normal alveolar crest
- Irregular root resorption or a spiked root form
- Sunburst or sun-ray appearance
Juxtacortical Osteosarcoma
Osteosarcoma arising on the cortical surface rather than in an intramedullary location
Chondrosarcoma
Malignant bone neoplasm producing cartilage but not bone
- Relatively unusual lesion in the jaws. Normal cartilage is largely absent in the jaws.
Demographic pattern of Chondrosarcoma
Wide age range, most over 50 (6-7 decades)
Males slightly more affected
Maxillary greater than mandible
Symptoms of Chondrosarcoma
Usually non-painful
Loosening of adjacent teeth
Paresthesia/anesthesia
Radiographic features of Chondrosarcoma
Poorly defined, asymmetric lesion
Completely lucent to mixed to predominantly opaque
Treatment and prognosis of Chondrosarcoma
Radical surgical ablation
- Local recurrence is challenge
Ewing’s sarcoma
Unique translocation 11;22
6-10% of all primary bone tumors
Pelvic bones and femur account for >50% of all cases
