Bone pathology Part 2

Question 1

Ossifying Fibroma

Answer 1

• True neoplasm w/growth potential
  
  • mostly women
  • 3rd-4th decade
• Mandible
  
  • premolar/molar area
• commonly identified in pt w/Hyperthyroidism-Jaw Tumor

Question 2

Juvenile Ossifying Fibroma

Answer 2

• no mutation on GRPT2 or GNAS genes
• Males
• 2 types: Both involve maxilla
  
  • Trabecular
    
    • primarily jaw
    • younger patients than other type
  • Psammomatoid
    
    • craniofacial skeleton (paranasal sinuses and orbit region)
• Radiograph:
  
  • “Ground glass” Opacification or….
  • honeycomb patern

Question 3

Osteomas

Answer 3

• Benign Tumors
  
  • dense area of compact or cancellous bone
• Arise from:
  
  • bone surface
  • in medullary bonoe
  • extra skeletal osteomas (Osteoma Cutis)
• Mainly Mandible body and Condyle
• Condylar Osteomas
  
  • causes chin to move/shift
• Radiograph:
  
  • circumscribed sclerotic masses

Question 4

Gardner Syndrome

Answer 4

• rare
• Intestinal Polyps
  
  • untreated→colorectal cancer
• Abnormalitiies
  
  • Osteomas- common
    
    • puberty
    • angel of the mandible
    • before polyps
  • Dental:
    
    • Odontomas
    • supernumerary teeth
  • Skin:
    
    • Epidermoid cyst (of the skin)
    • Desmoid tumors (12-18%)

Question 5

osteoblastoma vs Osteoid Osteoma

Answer 5

• Osteoblastoma:
  
  • > 2cm
  • Pain
    
    • not relieved by NSAIDs
  • Posterior Mandible
  • < 30 y.o.
  • aggressive osteoblastomas
    
    • >4cms
    • >30 y.o.
• Osteoid Osetomas:
  
  • < 2cm
  • Nocturnal Pain
    
    • relieved by NSAIDs
  • Central Radiopacity w/target-like appearance

Question 6

Cementoblastoma

Answer 6

• Benign
• aggressive behavior
  
  • bony expansion
• Pain and swelling=common
• Radiograph:
  
  • radiopaque mass fused to one or more tooth roots
  • surrounded by thin radiolucent rim

Question 7

Chondroma

Answer 7

• Benign
  
  • mature hyaline cartilage
• Types:
  
  • Endochondroma
    
    • arise in medullary bone
  • Periosteal chondroma:
    
    • below periosteum
  • Gnathic Chondroma
    
    • arise from vestigial cartilage rests
• Can be multiple (mainly 1)
  
  • Ollie disease
    
    • sporadic
    • unilateral
  • Maffucci Disease
    
    • sporadic
    • soft tissue angiomas

Question 8

Synovial Chondromatosis

Answer 8

• cartilage nodules in synovial membrane
• Female
• Classified as:
  
  • Primary synovial chondromatosis
    
    • unknown etiology
  • Secondary
    
    • due to trauma, joint overuse, inflammatory joint disease, or noninflammatory arthropaty
• Radiograph:
  
  • Loos bodies (Joint Mice) in joint
    
    • free floating pieces
  • CT & MRI-most sensitive
• Clinical Features:
  
  • Periarticular swelling
  • pain
  • crepitus (Cracking/popping sound)
  • limit joint motion

Question 9

Desmoplastic Fibroma

Answer 9

• associated w/Tuberosclerosis
• Location:
  
  • Posterior Mandible (80%)
  • femur
  • tibis
  • radius
  • humerus
  • pelvis

Question 10

Osteosarcoma

Answer 10

• Malignant mesenchymal tumor
  
  • cells produce osteoid (immature bone)
• arise in distal femur and proximal tibial metaphyses
• 10-20 y.o.→most common
• Increased prevalence with:
  
  • Paget’s disease
  • radiation exposure

Question 11

osteosarcoma of the Jaw

Answer 11

• Male
• Slow growing
• Symptoms:
  
  • Pain & swelling (most common)
  • loose teeth
  • parasthesia
  • nasal obstruction

Question 11

osteosarcoma of the Jaw