Bone Pathology IV - Neoplasms Flashcards by Kyle Tuttle

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

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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

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Name the Benign neoplasms of Osseous origin

Exostoses - not neoplastic
Ossifying fibroma (odontogenic tumor)
Osteoid osteoma
Osteoblastoma

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Name the Benign neoplasms of Cartilaginous origin

Chondroma
Chondromyxoid fibroma
Benign chondroblastoma

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Name the Benign neoplasms of Fibrous origin

Desmoplastic fibroma

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Name the Malignant neoplasms of Osseous origin

Osteosarcoma, Osteogenic sarcoma

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Name the malignant neoplasms of Cartilaginous origin

Chondrosarcoma

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Name the Malignant neoplasms of marrow origin

Ewing’s sarcoma
Multiple myeloma
Metastatic disease

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Define Exostosis

A localized proliferation of bone that arises from the cortical plate

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Characteristics of Exostosis

Minimal to no medullary bone involvement
Single or multiple
Sporadic sites
Site specific locations 
   - Torus palatinus
   - Torus mandibularis

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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

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Location of Torus Palatinus

Always located in the midline of the hard palate

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Etiology of Torus palatinus

Probably multifactorial

- Genetic? Environmental?

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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

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Location of Torus Mandibularis

Lingual premolar area of the mandible

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Etiology of Torus mandibularis

Probably multifactorial

- Genetic? Environmental?

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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

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Define Osteoma

A localized proliferation of bone

- Involves the medullary bone or cortical bone (may appear like tori)

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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