Bone Tumours Flashcards
Exostoses?
- A clinical term used to describe some bony non-neoplastic overgrowths.
- Developmental, in response to chronic trauma (reactive
exostosis) or following surgery.
Torus?
- An exostosis which occurs at a specific location:
- Midline of the palate (torus palatinus).
- Lingual surface of the mandible in the premolar region
(torus mandibularis).
Top vs bottom image?
Torus palatinus
Torus lingualis
What is more common torus palatinus or torus lingualis?
Torus palatinus
Torus palatinus malignant or benign?
Benign
Features of bony exostosis?
Cortical bone or cancellous with. a shell of cortical bone
Tori shown here?
Buccal exostoses
Maxillary buccal alveolus, in molar region
Dense bone island?
- Localized area of sclerotic bone.
- Idiopathic osteosclerosis.
- Chance finding on radiographs.
Location of dense bony island?
Mandibular molar- premolar region.
Features of dense bone island?
Well defined dense sclerotic areas.
Can any cells become neoplastic?
Any cells
Cartilage
Blood cells
Bone cells
What is shown?
Enostosis - dense bone island
Well defined dense sclerotic areas.
What to differentiate dense bone island from?
Differentiation from lesions resulting from periapical
inflammation and from cemento-osseous dysplasia.
Benign Bon tumours?
- Osteoma
- Osteoblastoma
- Chondroma
- Chondromyxoid fibroma
- Chondroblastoma
- Ossifying fibroma
- Haemangioma
(hamartoma)
Malignant tumours of bone?
- Osteosarcoma
- Ewing’s sarcoma
- Chondrosarcoma
- Myeloma
- Langerhans cell
histiocytosis (tumour like) - Metastatic tumours
Being in bone forming tumours?
osteoma and osteoblastoma
Malignant bone forming tumours?
osteosarcoma
Benign cartilage forming tumours?
Chondroma
Malignant cartilage forming tumours?
Chondrosarcoma
Osteoma?
- Benign slow growing tumour.
- Well differentiated mature bone.
- Central or subperiosteal lesion.
- most frequent in paranasal sinuses.
- Majority diagnosed in adult life.
Tumour
Osteoma
Most frequent Osteoma location?
Paranasal sinus
Bone type of Osteoma?
Mature bone
Hstopathology of Osteoma?
Compact:
* A mass of dense lamellar bone with few marrow
spaces.
Cancellous:
* interconnecting trabeculae enclosing fatty or fibrous
marrow.
Compact Osteoma
What is Gardner syndrome?
OSTEOMA
- Rare autosomal dominant disorder.
- Multiple osteomas of the jaws.
- Polyposis coli with a marked tendency for malignant change.
- Multiple fibrous tumours.
- Epidermal, sebacaeous cysts of the skin.
- Multiple impacted permanent and supernumerary teeth.
What is shown?
2 compact Osteoma
Osteoblastoma?
- Osteoid osteoma.
- Rare in the jaws.
- Clinical presentation: Swelling and nocturnal pain.
- Radiography: Rounded well defined radiolucent or speckled
lesion. - Histopathology: plump osteoblasts and broad trabeculae of
unmineralized osteoid.
Clinical presentation of osteoblastoma?
Swelling and nocturnal pain.
What tumour is shown?
Benign bone forming tumour
Osteoblastoma
Histopathology ofosteoblastoma?
plump osteoblasts and broad trabeculae of unmineralized osteoid.
Most common malignant bone tumour?
Osteosarcoma
Age group for osteosarcoma?
Children and adolescents, but many in patients around 30 (a
decade later than the rest of the body.
* Could present later in life with Paget’s disease of bone.
Clinical presentation of osteosarcoma?
- Swelling
- Pain
- Parasthesia
Radiographs presentation of osteosarcoma?
Radiolucent, radiopaque or mixed.
Bone tumour shown?
Osteosarcoma
Bone tumour shown
Osteosarcoma
Osteosarcoma develop slowly or fast?
Fast
Bone tumour shown?
Osteosarcoma
Histopatholgy of osteosarcoma?
- Formation of abnormal osteoid or bone by malignant
osteoblasts. - May arise centrally within the jaws or peripherally, in
relation to the periosteum. - Central and periosteal osteosarcomas are high- grade
neoplasms. - Telangiectatic osteosarcomas, present as rapidly
expanding, high- grade tumours containing blood- filled
spaces. - Parosteal osteosarcoma is less aggressive.
Management of osteosarcoma?
- High- grade osteosarcomas have a high rate of metastasis.
- Patients are staged using imaging prior to treatment.
- Chemotherapy is normally used first and then the primary
tumour is excised. - Response to the drug can then be assessed; sometimes the resected tumour is completely necrotic.
Ewing’s sarcoma?
Distinctive bone tumours form part of the ‘small, dark, round
cell’ neoplasms occurring in children and adolescents.
* Rare in the jaws and when diagnosed at that site, they are
often part of disseminated disease.
* Treated by chemotherapy followed by resection.
* Over 50% show complete response to treatment.
How to treat Ewing’s sarcoma?
Chemo followed by resection
Chondroma and chondrosarcoma?
Rare in jaws
- Chondroma:
- Benign tumour with mature cartilage formation.
- Chondrosarcoma:
- High degree of cellularity.
- Plump binucleate cells.
- Less differentiated lesions show more signs of
malignancy.
Myeloma a tumour of what?
A neoplasm composed of plasma cells
Arises in bone marrow - B plasma cells
Producing lost of mutated plasma cells
Production of large amounts of a single clone of immunoglobulin
Bone tumour shown?
Chondroma
Myeloma appears as multiple or as solitary lesions?
Multiple myeloma more common
Clinical presentation of myeloma?
50-70 years.
* Skull, vertebrae, sternum, ribs and pelvic bones. - bone arrow bones
Tumour?
Myeloma
Radiographs appearance of myeloma?
- Sharply demarcated, round or oval osteolytic lesions.
- Punched out appearance.
Histopathology of myeloma?
- Densly cellular lesions.
- Sheets of myeloma cells that resemble mature plasma
cells or their precursors. - Binucleate and multinucleate forms.
Management of myeloma?
- Chemotherapy and bone marrow transplant.
- Long term bisphosphonates treatment (risk of
MRONJ).
What do bisphosphonates cause?
Inhibit osteoclasts and as risk of causing MRONJ
What is ossifying fibroma?
- Well demarcated, occasionally encapsulated benign tumour.
- Fibrous tissue containing various amounts of bony trabiculae
and round calcified bodies. - Its demarcated nature is an important feature distinguishing
it from fibrous dysplasia
Clinical presentation of ossifying fibroma?
Slow growing.
* Swelling.
* Premolar- molar region of the mandible.
What is shown?
Ossifying fibroma
Radiograph is appearance of ossifying fibroma?
Variation according to the lesion’s maturation.
Tumour shown?
Ossifying fibroma
Langerhans cells?
APC immune cells
Tumour shown?
Ossifying fibroma
Histopathology of ossifying fibroma?
- Cellular fibrous tissue.
- Trabecular and psammomatous subtypes (both patterns
of mineralization may occur together) - Psammoma bodies: Round acellular calcified material.
Tumour shown?
Ossifying fibroma
Ossifying fibroma slow or fast growing?
What is the recurrence rate?
Majority slow
Negligible recurrence rate
Recurrence rate of juvenile ossifying fibroma?
more aggressive with 30-60% recurrence rate.
Management of ossifying fibroma?
- Surgical treatment should aim to remove the tumour
with a margin of normal tissue. - Rare cases of association with hereditary
hyperparathyrodism (hyperparathyroidism jaw tumour
syndrome).
What is langerhans cell histocytosis?
- Abnormalities resulting from the abnormal proliferation of
Langerhans cells or their precursors.
3 clinical forms of langerhans cell histocytosis?
A spectrum of disease, but presents in 3 clinical forms:
- Eosinophilic granuloma (unifocal).
- Hand-Schuler-Christian disease (multifocal).
- Letterer-Siwe disease (disseminates multi-organ).
Clinical presentation of langerhans cell histiocytosis?
Eosinophilic granuloma:
* Appears in the skeleton mainly, sometimes in the soft tissue.
* Any bone can be affected, cranium and jaws are common sites.
* More common in the mandible.
* Mostly in children and young adults.
* Males affected twice as commonly as females.
* Jaw lesions may cause bony swelling, soft tissue masses, gingivitis,
bleeding gingivae, pain and ulceration.
* Loosening of teeth (floating teeth appearance due to bone
destruction).
* Tooth sockets do not heal normally.
* May develop to an aggressive multifocal disease.
Langerhans cell histiocytosis aka?
Eosinophilia granuloma
Tumour shown?
Eosinophilia granuloma
Tumour shown?
Eosinophilia granuloma
Floating tooth
Clinical presentation of Langerhans’ Cell Histiocytosis (Hand Schuller-Christian disease)
- Hand Schuller-Christian disease:
- Multiple lesions (craniofacial bones, orbit, and
posterior pituitary gland). - Diabetes insipidus.
- Exophthalmos.
Clinical presentation of langerhans cell hstiocytosis (Letterer-Siwe disease:)
- Letterer-Siwe disease:
- Affects infants under 2 years of age.
- High mortality.
- Soft tissue and bone lesions are disseminated all over
the body. - Skin and pulmonary lesions may be present, as well as
infiltration of the gingiva by neoplastic Langerhans cells.
Tumour shown?
Langerhans cell histiocytosis
Osteolytic vs osteoblasts?
Osteolytic = radiolucency and bone resorption
What tumour is shown?
Langerhans cell histiocytosis
Radiographs appearance of langerhans cell histiocytosis?
- Solitary or multiple osteolytic lesions.
- Extensive destruction and loss and loosening of teeth.
- Teeth floating in air.
Histopathology of langerhans cell histiocytosis?
- Sheets and aggregates of Langerhans cells, which strongly
express CD1a and Langerin. - Large numbers of eosinophils, hence the term ‘eosinophilic
granuloma’.
Management of langerhans cell histiocytosis?
- Single lesions may respond to curettage and/ or localized radiotherapy.
- Multifocal disease is managed by haematologists.
- BRAF mutations are present in over half of cases and there are clinical trials evaluating BRAF- targeted therapies
Mutataion in langerhans cell histiocytosis?
BRAF
Haemangioma?
Abnormal blood vessel formation in normal location i.e. bone already has blood vessels
How to diagnose Haemangioma of Bone?
Aspiration reveals fresh blood
Radiograph is appearance of Haemangioma of Bone?
Multilocular honeycomb appearance
What tumour is shown?
Haemangioma of Bone
Histopathology of Haemangioma of Bone?
- Jaw lesions are mainly of the cavernous type.
- Dilated, thin- walled, vascular chambers expanding the marrow cavity.
Metastatic tumours?
- 1% of malignant tumours in the oral cavity.
- Metastasis to bone more common than to soft tissues.
- Mandible more frequently affected than the maxilla.
- Carcinomas of the lung, bowel, breast, prostate, and
kidney. - Pain, loose teeth, swelling, parasthesia or lip
anaesthesia. - Could be asymptomatic.
- Osteolytic mostly but could be osteoblastic.
What tumour is shown?
Metastatic tumour
