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Oral Pathology > Bone Pathology Spring 2022 > Flashcards

Bone Pathology Spring 2022 Flashcards

1
Q

Nasopalatine Duct Cyst: Description

A

Unilocular radiolucency between maxillary central incisors

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2
Q

Nasopalatine Duct Cyst: Asymptomatic or symptomatic?

A

Small lesions are asymptomatic and large lesions can cause palatal swelling, drainage and pain.

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3
Q

Nasopalatine Duct Cyst: Diameter

A

Must be more than 6 mm to be considered a nasopalatine duct cyst rather than normal incisive foramen

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4
Q

Nasopalatine Duct Cyst: Population affected

A

Most common in the 4th-6th decades, male predilection

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5
Q

Nasopalatine Duct Cyst: Etiology

A

Nasopalatien canal (incisive canal) contains remnants of the nasopalatine duct. These epithelium remnants can undergo cystic degeneration -> nasopalatine duct cyst.

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6
Q

Most common non-odontogenic cyst of the oral cavity

A

Nasopalatine duct cyst

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7
Q

Nasopalatine Duct Cyst: Treatment

A

Surgical enucleation

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8
Q

Nasopalatine Duct Cyst: Prognosis

A

-Recurrence after enucleation is rare. -Malignant transformation is extremely rare.

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9
Q

Median Palatal Cyst: Occurrence

A

Rare

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10
Q

Median Palatal Cyst: How does this lesion appear on an occlusal film?

A

Unilocular radiolucency midline hard palate

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11
Q

Median Palatal Cyst: Description

A

Symmetric fluctuant swelling posterior to palatine papilla along midline of the hard palate and there is no communication with the incisive canal.

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12
Q

Median Palatal Cyst: Etiology

A

Develops from epithelium entrapped along the embryonic line of fusion of the lateral palatal shelves of the maxilla

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13
Q

Median Palatal Cyst: Treatment

A

Biopsy for diagnosis, follow with surgical enucleation

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14
Q

Focal Osteoporotic Marrow Defect: Etiology

A

Area of hematopoietic marrow that is large enough in size to cause radiolucency

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15
Q

Focal Osteoporotic Marrow Defect: What sex does it occur most in? Location? Symptomatic?

A

3/4 adult females
3/4 occur in posterior mandible
Asymptomatic

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16
Q

Focal Osteoporotic Marrow Defect: Radiographic Features

A

Non-expansile radiolucency
Majority are well-circumscribed
Non-corticated borders
Central trabeculation

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17
Q

Focal Osteoporotic Marrow Defect: Treatment

A

Radiology is characteristics but not entirely specific.
May consider biopsy for definitive diagnosis
No association with anemia or other hematologic disorders

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18
Q

Stafne Defect: Describe lesion and location

A

Focal concavity in the cortical bone on the lingual surface of the mandible

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19
Q

Stafne Defect: Cause

A

Concavity caused by entrapped normal salivary gland tissue and is considered a developmental defect

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20
Q

Stafne Defect: Population Affected

A

Middle aged and older adults; strong male predilection (80-90%)

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21
Q

Stafne Defect: Where are most of these defects detected?

A

In PANS

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22
Q

Stafne Defect: Classic Presentation

A

Asymptomatic radiolucency below the mandibular canal in the posterior mandible

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23
Q

Stafne Defect: Where does this occur between?

A

Between mandibular molar teeth and the angle of the mandible

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24
Q

Stafne Defect: Describe lesion in CT

A

Well-defined cupped-out lingual cortical defect

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25
Q

Stafne Defect: Where can this also present other than the posterior mandible?

A

Anterior mandible associated with the sublingual gland

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26
Q

Stafne Defect: Size Variation over time

A

May remain stable in size, but few may show increase in size overtime.

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27
Q

Stafne Defect: Treatment for Posterior mandible lesions

A

Clinically diagnostic-> if unsure on PAN can confirm characteristic features with additional imaging: CBCT, MRI, sialogram
No treatment necessary

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28
Q

Stafne Defect: Treatment for anterior mandible lesions

A

Difficult to discern from other radiolucent pathology
Biopsy is typically necessary to confirm diagnosis
Once diagnosis is established, no further treatment is necessary

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29
Q

Idiopathic Osteosclerosis AKA Dense Bone Island: Etiology/Background

A

Area of dense bone with unknown cause

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30
Q

Idiopathic Osteosclerosis AKA Dense Bone Island: Radiographic Features

A

Focal area of icnreased radiopacity/radiodensity

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31
Q

Idiopathic Osteosclerosis AKA Dense Bone Island: Most common site

A

Posterior mandible; particularly 1st molar area

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32
Q

Idiopathic Osteosclerosis AKA Dense Bone Island: Symptoms and how is it detected

A

Asymptomatic and incidental finding on radiology

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33
Q

Idiopathic Osteosclerosis AKA Dense Bone Island: Population affected

A

Usually first detected in adolescence or early adulthood.

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34
Q

Idiopathic Osteosclerosis AKA Dense Bone Island: Prevelance

A

5 percent of the population

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35
Q

Idiopathic Osteosclerosis AKA Dense Bone Island: Treatment & Prognosis

A

Differentiate from condensing osteitis if closely approximating the tooth roots.
Conduct vitality testing to determine tooth origin
No treatment necessary

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36
Q

Simple Bone Cyst: Describe Lesion

A

-Empty or fluid filled bone cavity; pseudocyst

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37
Q

Simple Bone Cyst: Cause

A

Unknown, multiple theories

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38
Q

Simple Bone Cyst: How it is detected?

A

Usually an incidental radiographic finding

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39
Q

Simple Bone Cyst: How does it look on a radiograph?

A

-Well-delineated unilocular radiolucency (few cases of multiloceular lesions)
-Radiolucent defect SCALLOPS upwards between roots of adjacent teeth
-Teeth adjacent are vital
-Minimal to no expansion in most cases

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40
Q

Simple Bone Cyst: What are the most common oral sites?

A

Premolar, molar, and symphyseal region of the mandible

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41
Q

Simple Bone Cyst: Treatment

A

-Radiographic features are characteristic but not diagnostic; requires surgical exploration with biopsy.

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42
Q

Simple Bone Cyst: What can be found during surgical exploration?

A

On surgical exploration, the cavity may be empty or contain thin fluid -> submit whatever tissue can be obtained from curettage.

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43
Q

Simple Bone Cyst: What can surgical exploration and curettage help regenerate? Is there a low recurrence rate?

A

Bone; low recurrence rate, excellent prognosis

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44
Q

Aneurysmal Bone Cyst: Define Lesion

A

Intraosseous accumulation of variable-size, blood-filled spaces
Pseudocyst

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45
Q

Aneurysmal Bone Cyst: Cause

A

Exact cause unknown; many cases have a specific molecular alteration suggesting the lesion is neoplastic rather than reactive

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46
Q

Aneurysmal Bone Cyst: Reactive refers to ____ and neoplastic refers to ______

A

Functional Keratosis; epithelial dysplasia

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47
Q

Aneurysmal Bone Cyst: Clinical Features

A

Painful, rapidly enlarging swelling

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48
Q

Aneurysmal Bone Cyst: Radiographic Appearance

A

Unilocular or multilocular radiolucency with marked cortical expansion and thinning, borders may be well-defined or poorly defined

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49
Q

Aneurysmal Bone Cyst: Most common site

A

Posterior mandible and ascending ramus

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50
Q

Aneurysmal Bone Cyst: What can maxillary lesions cause?

A

Bulge into sinus and cause nasal obstruction and proptosis and diplopia

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51
Q

Aneurysmal Bone Cyst: Age range of occurrence

A

Most occur in young patients (peak in second decade)

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52
Q

Aneurysmal Bone Cyst: Treatment

A

Enucleation and curettage

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53
Q

Aneurysmal Bone Cyst: Intraoperative appearance

A

Blood-soaked sponge

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54
Q

Central Giant Cell Granuloma: Describe lesion

A

Intraosseous lesion of unknown etiology

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55
Q

Central Giant Cell Granuloma: Population affected

A

Over a broad age range (but majority occur before age 30)

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56
Q

Central Giant Cell Granuloma: Where does this typically occur?

A

70% occur in the mandible and more common in anterior jaws

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57
Q

Central Giant Cell Granuloma: Radiographic Appearance

A

Unilocular or multilocular R/L with well-delineated but usually non-corticated borders

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58
Q

Central Giant Cell Granuloma: Size Ranges

A

5 mm to 10 cm; sufficiently large lesions cause clinical swelling

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59
Q

Central Giant Cell Granuloma: Aggressiveness; growth pattern

A

Non-aggressive; slow growth, few to no symptoms

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60
Q

Central Giant Cell Granuloma: Describe rare cases and patient symptoms

A

Aggressive lesions characterized by pain, rapid growth, and cortical perforation

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61
Q

Central Giant Cell Granuloma: Initial Treatment

A

Biopsy for definitive diagnosis

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62
Q

Central Giant Cell Granuloma: Definitive Treatment

A

Curettage, intralesional corticosteroid injections, bisphosphonates, monocloal antibody denosumab and others

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63
Q

Central Giant Cell Granuloma: What happens if there is recurrence? Recurrence rate?

A

En bloc resection; 20 percent, lesions with aggressive features show higher recurrence rates

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64
Q

Central Giant Cell Granuloma: Key histology

A

Multinucleated giant cells

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65
Q

Brown Tumor: Describe reason for name

A

Named due to having a brown color of the lesion seen during biopsy/excision

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66
Q

Brown Tumor: Describe how hyperparathyroidism plays a role

A

Hyperparathyroidism is an excess production of PTH -> PTH is secreted in response to low calcium levels

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67
Q

Brown Tumor: Primary Cause

A

Uncontrolled production PTH, usually 2/2 parathyroid adenoma/hyperplasia or carcinoma

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68
Q

Brown Tumor: Secondary Cause

A

PTH produced in response to chronic low levels of serum calcium

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69
Q

Brown Tumor: Population affected

A

> 60 years old, F>M

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70
Q

Brown Tumor: Classical Symptoms

A

Classic symptom triad of hyperparathyroidism: “Stones, bones, abdominal groans” which mean kidney stones, alteration in bone density and duodenal ulcers

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71
Q

Brown Tumor: Radiographic presentation

A

Radiographically well-defined unilocular or multilocular R/L
Striking enlargement of the jaws with “ground glass” radiographic pattern

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72
Q

Brown Tumor: Lesion commonly affects what part of the body?

A

Mandible

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73
Q

Brown Tumor: What do most patients with this also have?

A

End stage renal failure and hyperparathyroidism

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74
Q

Brown Tumor: What type of lesions are brown tumors identical to? How can they be deciphered?

A

Histologically idential to CGCG
Diagnosis can only be made with clinical context; clinical history and pertinent lab studies are indicated for definitive diagnosis

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75
Q

Cherubism: Define

A

Rare developmental jaw condition that can be inherited or occur sporadically.

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76
Q

Cherubism: Most cases are caused by

A

Mutation in SH3BP2

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77
Q

Cherubism: Inheritance Pattern

A

Autosomal dominant with variable expressity

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78
Q

Cherubism: Inheritance Pattern

A

Autosomal dominant with variable expressiveness

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79
Q

Cherubism: Classic Presentation

A

Painless (usually) bilaterally symmetric posterior expansion that begins in young childhood, progresses until puberty, and then slowly regresses

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80
Q

Cherubism: Describe how this lesion affects the mandible

A

Involves angles, ascending rami, coronoid processes

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81
Q

Cherubism: Describe how lesion affects maxilla

A

Maxillary tuberosity up to the entire maxilla

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82
Q

Cherubism: Describe what tool can appropriately diagnose

A

Radiographic appearance is virtually diagnostic

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83
Q

Cherubism: What can this lesion cause?

A

Tooth displacement, mobility, failure of eruption

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84
Q

Cherubism: What can this lesion cause in severe cases?

A

Airway obstruction, vision and/or hearing loss

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85
Q

Cherubism: Histologically, what is this lesion identical to? How do we properly diagnose?

A

CGCG and Brown tumor; clinical context is necessary for definitive diagnosis

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86
Q

Cherubism: Treatment & Prognosis

A

Most cases spontaneously regress with near normal appearance by fourth decade

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87
Q

What are three benign fibro-osseous lesions that are microscopically identical?

A
  1. Cemento-osseous dysplasia
  2. Fibrous dysplasia
  3. Ossifying fibroma
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88
Q

What does BFOL mean?

A

Common fibro-osseous lesions of the jaws include fibrous dysplasia, cemento-osseous dysplasia, and ossifying fibroma.

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89
Q

Cemento-osseous dysplasia (COD): Define

A

Non-neoplastic replacement of the bone by first fibrous connective tissue, and later with subsequent deposition of bone and/or cementum

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90
Q

What is the most common BFOL?

A

COD

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91
Q

What does BFOL stand for?

A

benign fibro-osseous lesion

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92
Q

Cemento-osseous dysplasia (COD): where does this lesion occur?

A

In tooth bearing areas near the apices of teeth

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93
Q

Cemento-osseous dysplasia (COD): What does an early lesion look like radiographically?

A

Radiolucent

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94
Q

Cemento-osseous dysplasia: What does a middle phase of this lesion look like radiographically?

A

Mixed radiolucent/radiopaque

95
Q

Cemento-osseous dysplasia: What does a late lesion look like radiographically?

A

Radiopaque

96
Q

Cemento-osseous dysplasia: What are the three types based on sites affected?

A
  1. Periapical cemento-osseous dysplasia
  2. Focal cemento-osseous dysplasia
  3. Florid cemento-osseous dysplasia
97
Q

Periapical COD: Describe where it is seen

A

Seen at apices of VITAL mandibular incisors (usually multiple)

98
Q

Periapical COD: Radiographic Features in initial appearance and later appearance

A

-Initial: Well circumscribed RL
-R/L can merge to form a linear R/L involving multiple teeth
-Later: Mixed/ R/O with thin radiolucent rim
PDL in tact

99
Q

Periapical COD: Describe how to diagnose

A

Clinical and radiographic features are clincally diagnostic- biopsy not indicated

100
Q

Periapical COD: Treatment

A

Observation

101
Q

Focal Cod: Most common location

A

Posterior mandible at apex of a tooth or extraction site

102
Q

Focal COD: Symptoms

A

Asymptomatic

103
Q

Focal COD: What lesions is similar in radiographic features?

A

periapical cod

104
Q

Focal COD: Radiographic features (Initial, later, how does PDL present?)

A

-Initial: Well defined, somewhat irregular border R/L
-Later: Mixed/ RO with thin radiolucent rim
-PDL remains intact

105
Q

Focal COD: Diagnosis; what does it rule out?

A

Biopsy indicated to rule out:
1. Ossifying Fibroma
2. Ossifying Fibroma shell out during biopsy
3. Other lesions that can present as unlocular radiolucencies in the posterior mandible

106
Q

Focal COD: Treatment

A

After confirming diagnosis -> observation, focal COD can be the early form of florid COD

107
Q

Florid COD: Describe location and regions involved

A

-Multifocal involvement (multiple quadrants)
-Dentulous and edentulous regions

108
Q

Florid COD: What kind of expansion can this cause?

A

Cortical Expansion

109
Q

Florid COD: Radiographic Features

A

Similar to periapical COD
Ranges R/L to mixed RL/RO to R/O
PDL intact, but can fuse at end-stage

110
Q

Florid COD: Diagnosis

A

Clinical and radiographic features are diagnostic; not biopsy indicated

111
Q

Florid COD: Treatment

A

Observation
Avoid bony manipulation at involved sites

112
Q

Florid COD: What is dense bone more prone to? What do we want to avoid

A

Poor healing and secondary infection
No implants
Avoid extraction/currettage of involved sites if possible
Antbiotics if secondary infection occurs (osteomyelitis)

113
Q

Paget Disease: Define lesion

A

Abnormal resoprtion and deposition of bone rsulting in disotrtion and weakening of affected bones

114
Q

Paget Disease: Cause

A

Unknown

115
Q

Paget Disease: Population affected

A

1/100 to 1/150 person over age of 45 have subclinical disease; male predilection

116
Q

What is the second most common metabolic bone disorder after osteoporosis?

A

Paget Disease

117
Q

Paget Disease: What kind of pain is associated with lesion?

A

Dull bone pain

118
Q

Paget Disease: Are both jaws affected?

A

Either monostotic (1 bone affected) vs polyostotic (more than 1 bone affected)

119
Q

Paget Disease: Bones most often affected

A

Lumbar vertebra, pelvis, skull, femur

120
Q

Paget Disease: What aspect of jaw is affected? How is it affected?

A

Maxillary affected more than mandible; alveolar ridges become symmetrically enlarged.

121
Q

Paget Disease: Clinically, how does this disease affect tooth spacing?

A

Spacing of teeth occurs of ridge expansion, denture becomes too small.

122
Q

Paget Disease: Describe early lesions

A

-Affected bone exhibits decreased radiodensity and a coarse trabecular pattern
-In the skull, large cirumscribed radiolucencies may be present and are terms osteoporosis circumscripta

123
Q

Paget Disease: Describe late lesions

A

-Osteoblastic phase= patchy areas of sclerotic bone
-Giving the cotton wool appearance
-Teeth demonstrate hypercementosis
-Can resemble florid COD

124
Q

Paget Disease: Diagnosis

A

Made on a summation of clinical, radiographic and laboratory findings

125
Q

Paget Disease: Laboratory Findings

A

Increased alkaline phosphatase
Normal calcium and phosphorus
High hydroxyproline

126
Q

Paget Disease: Treatment

A

Limited involvement= no treatment
Symptomatic bone pain controlled with NSAIDs
More severe cases: antiresorptive therapy, calcitonin, bisphosphonates -> reduce bone turnover and improve biochemical abnormalities

127
Q

Paget Disease: Prognosis

A

Chronic and slowly progressive: seldom a cause of death
Audio/visual disturbances possible
Increased risk for developing osteosarcoma

128
Q

Fibrous Dysplasia: Define

A

Developmental disorder caused by a specific mutation (GNAS-1 gene) during embryonic development

129
Q

Fibrous Dysplasia: What replaces what with this disease?

A

Normal bone replaced by abnormal fibrous connective tissue

130
Q

Fibrous Dysplasia: Population affected

A

Young usually diagnosed by the third decade of life

131
Q

Fibrous Dysplasia: Describe progression of disease

A

Asymptomatic, slow, progressive clinical enlargement of affected bones

132
Q

Fibrous Dysplasia: Radiographic appearance

A

Ground glass appearance
Causes bone expansion but expansion characteristically maintains its shape

133
Q

Fibrous Dysplasia: What can this disease displace?

A

May cause superior displacement of the IA canal

134
Q

Fibrous Dysplasia: Diagnosis

A

Often a clinical diagnosis based on clinical and radiographic features

135
Q

Fibrous Dysplasia: Treatment

A

Delay until completion of growth
Depending on patient, lesions can be self limiting and regress on their own

136
Q

Fibrous Dysplasia: How are serious cases treated?

A

Surgical debulking

137
Q

Fibrous Dysplasia: Reccurence

A

Younger patients more commonly have regrowth after surgery

138
Q

Fibrous Dysplasia: How is the extent determined?

A

Depends on when the GNAS mutation occurs

139
Q

Fibrous Dysplasia: Describe Early mutation

A

Early mutation affected pluripotent stem cell causing abnormalities in osteoblasts, melanocytes, and endocrine cells.

140
Q

Fibrous Dysplasia: Describe late mutations

A

Only affects osteoblasts

141
Q

Fibrous Dysplasia: Describe monostotic FD

A

One bone affected

142
Q

Fibrous Dysplasia: Describe polyostotic FD

A

Multiple bones affected

143
Q

Fibrous Dysplasia: Three associated syndromes

A

-Jaffe-Lichtenstein Syndrome
-McCune-Albright Syndrome
-Mazabraud Syndrome

144
Q

Fibrous Dysplasia: Describe Jaffe-Lichtenstein syndrome characterizations

A

Characterized by polyostotic fibrous dysplasia and cafe au lait pigmentation

145
Q

Fibrous Dysplasia: Describe McCune-Albright Syndrome characteristics

A

Characterized by polyostotic fibrous dysplasia, cafe au lait pigmentation, and multiple endocrinopathies

146
Q

Fibrous Dysplasia: Describe Mazabraud syndrome characteristics

A

Characterized by fibrous dysplasia and intramuscular myxomas

147
Q

Fibrous Dysplasia: How do we determine if a patient with fibrous dysplasia has an associated syndrome?

A

If one bone is affected -> patient most likely does not have associate syndrome.
Associated syndrome are typically diagnosed at very young ages

148
Q

Ossifying Fibroma: Define

A

True neoplasm of bone with significant growth potential

149
Q

Ossifying Fibroma: Describe area affected

A

Mandible more often than maxilla premolar/molar area

150
Q

Ossifying Fibroma: Symptoms

A

Painless, expansion of involved bone

151
Q

Ossifying Fibroma: Clinical Features

A

Can cause asymmetry and can reach very large size

152
Q

Ossifying Fibroma: Radiographic

A

-Well defined unilocular, +/- sclerotic border
-Can be completely R/L (rare), usually mixed RL/RO
-Can cause root divergence or resorption

153
Q

Ossifying Fibroma: Describe Surgical features

A

When opening for biopsy this lesion will typically shell out; this is unique from other BFOL lesions and is a helpful diagnostic feature in some cases

154
Q

Ossifying Fibroma: Treatment

A

Enucleation
Surgical resection and bone grafting for large lesions

155
Q

Ossifying Fibroma: Prognosis

A

Recurrenec is rare after removal and no malignant potential has been shown

156
Q

Osteoid Osteoma & Osteoblastoma: Define

A

Closely related benign tumors of osteoblast origin

157
Q

Osteoid Osteoma & Osteoblastoma: How to determine which one?

A

Osteoid Osteoma: Less than 2 cm
Osteoblastoma: More than 2 cm

158
Q

Osteoid Osteoma & Osteoblastoma: Symptoms

A

Painful

159
Q

Osteoid Osteoma: Location

A

Most occur in femur, tibia, phalanges, rarely jaw

160
Q

Osteoid Osteoma: Population affected

A

Most common between ages of 4-25 years old; male 3:1

161
Q

Osteoid Osteoma: Symptoms

A

Nocturnal pain (dull, throbbing) alleviated by NSAIDs

162
Q

Osteoid Osteoma: Radiographic Presentation

A

Circumscribed, mixed radiolucent radiopaque lesions. Central radiolucent nidus and surrounding radiopaque sclerosis

163
Q

Osteoblastoma: Prevlance

A

Rare overall

164
Q

Osteoblastoma: Population affected

A

Young 85% before age 30
Female predilection

165
Q

Osteoblastoma: Area affected

A

Slight mandibular predilection

166
Q

Osteoblastoma: Symptoms

A

Pain, tenderness, swelling
Pain is not worse at night

167
Q

Osteoblastoma: What does not relive pain?

A

NSAIDs

168
Q

Osteoblastoma: Radiographic presentation

A

Circumscribed, mixed radiolucent, radiopaque lesions

169
Q

Osteoid Osteoma & Osteoblastoma: Treatment

A

Local excision or curettage
Recurrence following complete excision is rare

170
Q

Osteoid Osteoma & Osteoblastoma: Which type has malignant transformation?

A

Osteoblastoma

171
Q

Osteoma: Define

A

Benign tumor (neoplasm) of mature compact or cancellous bone

172
Q

Osteoma: Areas affected

A

Usually affect the craniofacial skeleton, can also occur in the soft tissue
Predilection for mandibular body and condyle

173
Q

Osteoma: What are not considered osteomas?

A

Tori and exostoses

174
Q

Osteoma: Population affected

A

Adults

175
Q

Osteoma: Symptoms

A

Asymptomatic lesion

176
Q

Osteoma: Features

A

Solitary, slow-growing

177
Q

Osteoma: Radiographic features

A

Well-circumscribed sclerotic (radiopaque) mass

178
Q

Osteoma: Treatment

A

Small asymptomatic lesions can be radiographically monitored
Conservative excision for large symptomatic lesions [condylar lesions and paranasal sinus lesions frequently symptomatic]

179
Q

Osteoma: Recurrence; malignant transformation

A

Rare; malignant transformation has been reported

180
Q

If your patient has multiple osteomas, what could they have?

A

Gardner Syndrome

181
Q

Gardner Syndrome: Define

A

Syndrome characterized by intestinal polyps and disorders of bone, skin, teeth and other sites

182
Q

Gardner Syndrome: Describe inheritance pattern

A

AD

183
Q

Gardner Syndrome: Describe when polyps develop and what that means

A

Colorectal polyps develop in the second decade and are premalignant

184
Q

Gardner Syndrome: What happens if polyps remain untreated?

A

If untreated will transform to adenocarcinoma is nearly 100 percent of cases

185
Q

Gardner Syndrome: What do 90% of patients also have?

A

Skeletal abnormalities; most common is multiple osteomas

186
Q

Gardner Syndrome: When are osteomas discovered?

A

Osteomas are usually first noted at puberty and often present before colon polyps

187
Q

Gardner Syndrome: Dental anomalies

A

Odontomas, supernumerary teeth, impacted teeth

188
Q

Gardner Syndrome: Skin manifestations; what term categorizes all these lesions?

A

Epidermoid cysts
Lipomas, fibromas, neurofibromas, leiomyomas, desmoid tumors
; Benign mesincaraol tumors

189
Q

Gardner Syndrome: Causes increased risk of multiple malignancies

A

Thyroid carcinoma, adrenal carcinoma, hepatoblastoma, pancreatic adenocarcinoma, brain tumor

190
Q

Gardner Syndrome: What can occur without treatment

A

Without treatment, fifty percent of patients develop colorectal cancer by age 30; appraoches one hundred percent by age 50

191
Q

Gardner Syndrome: Treatment

A

Require close surveillance, clinical trials ongoing for chemoprevention
Removal of sympatomatic osteomas

192
Q

Gardner Syndrome: Dental Management

A

Surgical extracton of impacted teeth, Removal of odonotomas, and prosth treatment

193
Q

Cementoblastoma: Define

A

Benign odontogenic neoplasma of cementoblasts

194
Q

Cementoblastoma: Prevalance

A

Rare/ Less than 1% of odontogenic tumors

195
Q

Cementoblastoma: Site

A

More than 75% occur in mandible; 90% occur in molar/PM region

196
Q

Cementoblastoma: Population affected

A

No sex predilection; children and young adults
50% before age 20
75% before age 30

197
Q

Cementoblastoma: Symptoms

A

Pain and swelling in two thirds of cases

198
Q

Cementoblastoma: Radiographic features

A

Can show aggressive behavior (bone expansion, cortical expansion, displacement of adjacent teeth)
Radiopaque mass fused to one or more tooth roots, surrounded by thin RL rim
Loss of PDL space

199
Q

Cementoblastoma: Histology

A

Closely resembles an osteoblastoma/osteoid osteoma so distinguished by fusion to the root

200
Q

Cementoblastoma: Treatment

A

Surgical extraction of tooth with mass or amputate involved root and RCT the remaining tooth

201
Q

Cementoblastoma: Recurrence

A

Rate ranges up to 22% [thought to be a feature of incomplete removal]

202
Q

General body features concerning for malignancy

A
  • Ill-defined or Moth-eaten borders
  • Sun-burst periosteal reaction
  • Rapid bony destruction
  • Multiple “punched-out” radiolucencies
  • Specific pattern of multiple myeloma
  • Signs of pain and/or paresthesia
  • Apparent periapical pathology with
    repeat endodontic therapy and no resolution * Submit apicoectomies
  • Rare cases of metastatic disease
  • Biopsy is always required for definitive diagnosis
203
Q

Osteosarcoma: Define

A

Malignancy of mesenchymal cells capable at producing osteoid

204
Q

Osteosarcoma: Increased risk in what disease and therapy?

A

Increased risk in paget disease and post radiation therapy

205
Q

Osteosarcoma: Most common in ___

A

Post radiation sarcoma

206
Q

Osteosarcoma: Population

A

Wide age range, but mean age is 33 years old

207
Q

Osteosarcoma: Sites affected

A

Maxilla and mandible equally affected

208
Q

Osteosarcoma: Clinical Featues

A

Mass or swelling with pain, parasthesia, loosening of teeth

209
Q

Osteosarcoma: Radiographic Features

A

Lytic and or sclerotic area with irregular, poorly defined borders
Moth eaten pattern
Sunburnst pattern
Symmetrical widening of PDL space early

210
Q

Osteosarcoma: Histologic Features

A

Production of malignant osteoid

211
Q

Osteosarcoma: Treatment

A

Surgery plus or minus chemo

212
Q

Osteosarcoma: Survival rate

A

30-70% survival rate with local spread being the biggest concern

213
Q

Osteosarcoma: Describe how disease progresses

A

Begins in the bone, but when expands can perforate through the cortex and create a soft tissue swelling

214
Q

Chondrosarcoma: Define

A

Malignancy of mesenchymal cells capable at producing malignant cartilage

215
Q

Chondrosarcoma: Prevalance

A

Rare 0.1% of H&N malignancies

216
Q

Chondrosarcoma: Site affected

A

Maxilla most common gnathic site

217
Q

Chondrosarcoma: Population affected

A

Wide age range, peak in 7th decade

218
Q

Chondrosarcoma: Symptoms

A

Painless mass/swelling most common sign
usually slow growing
Loosening of teeth, nasal obstruction, epistaxis

219
Q

Chondrosarcoma: Radiographic findings

A

Uni or multilocular radiolucencies +/- radiopacities
Ill-defined borders
Possible sunburst pattern
+/- root resorption and widening of PDL

220
Q

Chondrosarcoma: Treatment

A

Radical surgical excision +/- radiation/chemo

221
Q

Chondrosarcoma: Prognosis

A

Head and neck chrodrosarcoma 5 and 10 year survival: 87% and 70% respectively

222
Q

Ewing Sarcoma: Define

A

A malignant neoplasm composed of small, undifferentiated round cells

223
Q

Ewing Sarcoma: Origin

A

Neuroectodermal origin

224
Q

Ewing Sarcoma: Cause

A

85-90% of cases reciprocal translocation between chromosomes 11 and 12

225
Q

What is the third most common osseous malignancy?

A

Ewing Sarcoma

226
Q

Ewing Sarcoma: Population

A

Young, eighty percent of patients are less than 20 years old; male predominance

227
Q

Ewing Sarcoma: Symptoms

A

Pain, swelling, parasthesia, loosening of teeth

228
Q

Ewing Sarcoma: What does this commonly perforate?

A

Cortex

229
Q

Ewing Sarcoma: Areas affected

A

Jaw involvement is rare, but more common than mandible

230
Q

Ewing Sarcoma: Radiographic appearance

A
  • Irregular, lytic bone destruction, ill-defined margins
  • +/- cortical destruction/expansion
  • “ONIONSKIN” periosteal reaction *common in long bones and NOT SEEN in jaw lesions
231
Q

Ewing Sarcoma: Histology

A

Small round cells in sheets with no distinct pattern

232
Q

Ewing Sarcoma: Treatment

A

Surgery, radiotherapy and multidrug chemo

233
Q

Ewing Sarcoma: Prognosis

A

40-80% survival rate

Oral Pathology (7 decks)

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