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BDS3 Oral Pathology > Bone Tumours > Flashcards

Bone Tumours Flashcards

1
Q

Exostoses?

A
  • A clinical term used to describe some bony non-neoplastic overgrowths.
  • Developmental, in response to chronic trauma (reactive
    exostosis) or following surgery.
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2
Q

Torus?

A
  • 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).
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3
Q

Top vs bottom image?

A

Torus palatinus

Torus lingualis

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4
Q

What is more common torus palatinus or torus lingualis?

A

Torus palatinus

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5
Q

Torus palatinus malignant or benign?

A

Benign

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6
Q

Features of bony exostosis?

A

Cortical bone or cancellous with. a shell of cortical bone

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7
Q

Tori shown here?

A

Buccal exostoses

Maxillary buccal alveolus, in molar region

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8
Q

Dense bone island?

A
  • Localized area of sclerotic bone.
  • Idiopathic osteosclerosis.
  • Chance finding on radiographs.
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9
Q

Location of dense bony island?

A

Mandibular molar- premolar region.

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10
Q

Features of dense bone island?

A

Well defined dense sclerotic areas.

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11
Q

Can any cells become neoplastic?

A

Any cells

Cartilage

Blood cells

Bone cells

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12
Q

What is shown?

A

Enostosis - dense bone island

Well defined dense sclerotic areas.

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13
Q

What to differentiate dense bone island from?

A

Differentiation from lesions resulting from periapical
inflammation and from cemento-osseous dysplasia.

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14
Q

Benign Bon tumours?

A
  • Osteoma
  • Osteoblastoma
  • Chondroma
  • Chondromyxoid fibroma
  • Chondroblastoma
  • Ossifying fibroma
  • Haemangioma
    (hamartoma)
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15
Q

Malignant tumours of bone?

A
  • Osteosarcoma
  • Ewing’s sarcoma
  • Chondrosarcoma
  • Myeloma
  • Langerhans cell
    histiocytosis (tumour like)
  • Metastatic tumours
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16
Q

Being in bone forming tumours?

A

osteoma and osteoblastoma

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17
Q

Malignant bone forming tumours?

A

osteosarcoma

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18
Q

Benign cartilage forming tumours?

A

Chondroma

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19
Q

Malignant cartilage forming tumours?

A

Chondrosarcoma

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20
Q

Osteoma?

A
  • Benign slow growing tumour.
  • Well differentiated mature bone.
  • Central or subperiosteal lesion.
  • most frequent in paranasal sinuses.
  • Majority diagnosed in adult life.
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21
Q

Tumour

A

Osteoma

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22
Q

Most frequent Osteoma location?

A

Paranasal sinus

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23
Q

Bone type of Osteoma?

A

Mature bone

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24
Q

Hstopathology of Osteoma?

A

Compact:
* A mass of dense lamellar bone with few marrow
spaces.

Cancellous:
* interconnecting trabeculae enclosing fatty or fibrous
marrow.

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25
Q
A

Compact Osteoma

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26
Q

What is Gardner syndrome?

A

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.
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27
Q

What is shown?

A

2 compact Osteoma

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28
Q

Osteoblastoma?

A
  • 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.
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29
Q

Clinical presentation of osteoblastoma?

A

Swelling and nocturnal pain.

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30
Q

What tumour is shown?

A

Benign bone forming tumour

Osteoblastoma

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31
Q

Histopathology ofosteoblastoma?

A

plump osteoblasts and broad trabeculae of unmineralized osteoid.

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32
Q

Most common malignant bone tumour?

A

Osteosarcoma

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33
Q

Age group for osteosarcoma?

A

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.

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34
Q

Clinical presentation of osteosarcoma?

A
  • Swelling
  • Pain
  • Parasthesia
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35
Q

Radiographs presentation of osteosarcoma?

A

Radiolucent, radiopaque or mixed.

36
Q

Bone tumour shown?

A

Osteosarcoma

37
Q

Bone tumour shown

A

Osteosarcoma

38
Q

Osteosarcoma develop slowly or fast?

A

Fast

39
Q

Bone tumour shown?

A

Osteosarcoma

40
Q

Histopatholgy of osteosarcoma?

A
  • 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.
41
Q

Management of osteosarcoma?

A
  • 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.
42
Q

Ewing’s sarcoma?

A

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.

43
Q

How to treat Ewing’s sarcoma?

A

Chemo followed by resection

44
Q

Chondroma and chondrosarcoma?

A

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.
45
Q

Myeloma a tumour of what?

A

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

46
Q

Bone tumour shown?

A

Chondroma

47
Q

Myeloma appears as multiple or as solitary lesions?

A

Multiple myeloma more common

48
Q

Clinical presentation of myeloma?

A

50-70 years.
* Skull, vertebrae, sternum, ribs and pelvic bones. - bone arrow bones

49
Q

Tumour?

A

Myeloma

50
Q

Radiographs appearance of myeloma?

A
  • Sharply demarcated, round or oval osteolytic lesions.
  • Punched out appearance.
51
Q

Histopathology of myeloma?

A
  • Densly cellular lesions.
  • Sheets of myeloma cells that resemble mature plasma
    cells or their precursors.
  • Binucleate and multinucleate forms.
52
Q

Management of myeloma?

A
  • Chemotherapy and bone marrow transplant.
  • Long term bisphosphonates treatment (risk of
    MRONJ).
53
Q

What do bisphosphonates cause?

A

Inhibit osteoclasts and as risk of causing MRONJ

54
Q

What is ossifying fibroma?

A
  • 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
55
Q

Clinical presentation of ossifying fibroma?

A

Slow growing.
* Swelling.
* Premolar- molar region of the mandible.

56
Q

What is shown?

A

Ossifying fibroma

57
Q

Radiograph is appearance of ossifying fibroma?

A

Variation according to the lesion’s maturation.

58
Q

Tumour shown?

A

Ossifying fibroma

59
Q

Langerhans cells?

A

APC immune cells

60
Q

Tumour shown?

A

Ossifying fibroma

61
Q

Histopathology of ossifying fibroma?

A
  • Cellular fibrous tissue.
  • Trabecular and psammomatous subtypes (both patterns
    of mineralization may occur together)
  • Psammoma bodies: Round acellular calcified material.
62
Q

Tumour shown?

A

Ossifying fibroma

63
Q

Ossifying fibroma slow or fast growing?

What is the recurrence rate?

A

Majority slow

Negligible recurrence rate

64
Q

Recurrence rate of juvenile ossifying fibroma?

A

more aggressive with 30-60% recurrence rate.

65
Q

Management of ossifying fibroma?

A
  • 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).
66
Q

What is langerhans cell histocytosis?

A
  • Abnormalities resulting from the abnormal proliferation of
    Langerhans cells or their precursors.
67
Q

3 clinical forms of langerhans cell histocytosis?

A

A spectrum of disease, but presents in 3 clinical forms:

  • Eosinophilic granuloma (unifocal).
  • Hand-Schuler-Christian disease (multifocal).
  • Letterer-Siwe disease (disseminates multi-organ).
68
Q

Clinical presentation of langerhans cell histiocytosis?

A

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.

69
Q

Langerhans cell histiocytosis aka?

A

Eosinophilia granuloma

70
Q

Tumour shown?

A

Eosinophilia granuloma

71
Q

Tumour shown?

A

Eosinophilia granuloma

Floating tooth

72
Q

Clinical presentation of Langerhans’ Cell Histiocytosis (Hand Schuller-Christian disease)

A
  • Hand Schuller-Christian disease:
  • Multiple lesions (craniofacial bones, orbit, and
    posterior pituitary gland).
  • Diabetes insipidus.
  • Exophthalmos.
73
Q

Clinical presentation of langerhans cell hstiocytosis (Letterer-Siwe disease:)

A
  • 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.
74
Q

Tumour shown?

A

Langerhans cell histiocytosis

75
Q

Osteolytic vs osteoblasts?

A

Osteolytic = radiolucency and bone resorption

76
Q

What tumour is shown?

A

Langerhans cell histiocytosis

77
Q

Radiographs appearance of langerhans cell histiocytosis?

A
  • Solitary or multiple osteolytic lesions.
  • Extensive destruction and loss and loosening of teeth.
  • Teeth floating in air.
78
Q

Histopathology of langerhans cell histiocytosis?

A
  • Sheets and aggregates of Langerhans cells, which strongly
    express CD1a and Langerin.
  • Large numbers of eosinophils, hence the term ‘eosinophilic
    granuloma’.
79
Q

Management of langerhans cell histiocytosis?

A
  • 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
80
Q

Mutataion in langerhans cell histiocytosis?

A

BRAF

81
Q

Haemangioma?

A

Abnormal blood vessel formation in normal location i.e. bone already has blood vessels

82
Q

How to diagnose Haemangioma of Bone?

A

Aspiration reveals fresh blood

83
Q

Radiograph is appearance of Haemangioma of Bone?

A

Multilocular honeycomb appearance

84
Q

What tumour is shown?

A

Haemangioma of Bone

85
Q

Histopathology of Haemangioma of Bone?

A
  • Jaw lesions are mainly of the cavernous type.
  • Dilated, thin- walled, vascular chambers expanding the marrow cavity.
86
Q

Metastatic tumours?

A
  • 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.
87
Q

What tumour is shown?

A

Metastatic tumour

BDS3 Oral Pathology (31 decks)

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