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Oral Pathology > Chapter 14 > Flashcards

Chapter 14 Flashcards

1
Q

Benign bone neoplasia

A

Asymptomatic

Slow growth – displaces teeth and expands the cortex of bone

Symmetrical

Does not metastasize

Corticated rim

(Expanded cortex –> slow pressure: osteoclasts remove bone and signal to osteoblasts to lay down new bone)

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2
Q
A

Benign lesion

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3
Q

Malignant bone neoplasia

A

Symptomatic

Grows RAPIDLY - bone resorption

Asymmetrical

Ragged or poorly defined margins

Destroys cortex

Lay bone down outside of the cortex

Capable of metastasis

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4
Q

Osteogenesis Imperfecta

A

Defect in COLLAGEN TYPE I maturation

(most common type of inherited bone disease)

Bone has –>

Thin cortex

Fine trabeculation

Diffuse osteoporosis

Bone healing may occur – but may be inappropriate healing

Signs and symptoms:

Bone fragility

Blue sclera

Altered teeth – blue/brown opalescent teeth, premature pulpal obliteration, Class III malocclussion (simmilar to dentinogenesis imperfecta)

Hearing loss

Long bone and spine deformitites

Joint hyperextensibility

Xrays: Osteopenia (low bone density), Bowing, Wormian bone of skull

patients may be on BISPHOSPHONATES

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5
Q

Xray features of osteogenesis imperfecta

A

Osteopenia (low bone density)

Bowing

Wormian bones in the skull

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6
Q

Oral cavity findings in osteogenesis imperfecta

A

Teeth - blue to brown translucence

Premature pulpal obliteration

class II malocclusion

Similar tooth look to dentinogenesis imperfecta

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7
Q

What is defective in osteogeneis imperfecta?

A

Type I collagen maturation

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8
Q
A

Blue sclera!

Unique to osteogenesis imperfecta

( Bowing of bones – another symtom)

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9
Q

Osteopetrosis

A

Marble bone disease

Skeletal disorder with a marked increase in BONE DENSITY (no bone is broken down)

** Defect in remodeling caused by FAILURE of normal OSTEOCLAST function **

VERY radio-opaque radiographs

Loss of marrow space – loss of nutrients (blood supply) –> may becoe osteomyelitits

Usually class III

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10
Q
A

Osteopetrosis

Failure of normal osteoclast function

May develp osteomyelitis

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11
Q

Cleidocranial Dysplasia

A

Characterized by clavicle and dental abnormatlities

Clavicles – varying degress of hypoplasia (unusual mobility of shoulders)

Appearance (DIAGNOSTIC): Short stature, big head. Pronounced frontal bossing, Occular hypertelorism, broad base of nose

Oral ->

HIGH arched palates.

increased prevalance of cleft palate

Prolonged retention of deciduous teeth

Delay or failure of eruption or permanent teeth

Abnormally shaped teeth

**Numerous unerrupted permanent teeth and supernumerary teeth **

No treatment

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12
Q

Moveable shoulders

A

Cleidocranial Dysplasia

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13
Q

Oral complications of cleidocranial dysplasia

A

High arched palate

INCREASED prevalence of cleft palate

Prolonged retention of deciduous teeth

Delayed or failure of eruption of permanent teeth

Abnormally shaped teeth

Numerous unerupted permanent and supernumerary teeth

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14
Q

Focal osteoporotic marrow defect

A

Area of hematopoietic marrow – producing a radiography lucency (varies in size)

Marrow has pushed the bone away creating a defect

NOT PATHOLOGY - asymptomatic and incidental finding on radiograph

Radiolucency - ill defined borders with fine central trabeculations (multilocular)

Occurs in posterior mandible typically

NO jaw expansion

Biopsy is required for diagnosis – will just have bone marrow

No treatment necessary

No association with any hematologic disorder

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15
Q
A

Focal osteoporotic marrow defect

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16
Q

Idiopathic osteosclerosis

A

Focal area of increased radiodensity

UNKOWN cause

Typically associated with a healthy tooth

Can be present with NO teeth – after extraction

ASYMPTOMATIC

No cortical expansion

Diagnosis – history, clinical findings, radiographic findings

Biopsy is considered if symptomatic

If found in adolescence – periodic XRAYS are prudent until the area stabilizes. No treatment necessary.

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17
Q

Idiopathic osteosclerosis XRAY manifestations

A

Well defined - Round or Elliptical

Radiopaque

Usually associated with root apex

NO radiolucent rim

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18
Q
A

Idiopathic osteosclerosis

Healthy tooth

Radioopaque

Well defined

NO radiolucent rim

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19
Q

Condensing osteitis vs idiopathic osteosclerosis

A

Condensing osteitis –> associated with infection

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20
Q

Cemento-osseous dysplasia vs idiopathic osteosclerosis

A

Cemento-osseeous dysplasia –> Radiolucent rim

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21
Q

Cementoblastoma vs idiopathic osteoscelerosis

A

Cementoblastoma –> fused with the tooth

NO PDL SPACE

bulges out

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22
Q

Massive osteolysis

A

Gorham Disease

spontaneous and progressive destruction of one or more bones - affected area does not regenerate or repair

Destroyed bone is initially replaced by vascular proliferation

Eventually filled with dense fibrous tissue

No known cause

Mandible affected more than maxilla

Treatment: Surgical and bisphosphonates

Surgical + bone graft –> bone graft will undergo osteolysis (not a successful treatment)

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23
Q

Massive osteolysis signs and symptoms

A

Mobile teeth

Pain

Malocclusion - movement of teeth

Deviation of the mandible

Clinically obvious deformity

Pathologic fracture

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24
Q

Massive osteolysis xray manifestation

A

Radiolucent foci of varying size with indistinct margins

Coalesce to become larger - involve cortical bone

Large prortions of invovled bone disappear

Loss of lamina dura

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25
Q

Paget’s Disease

A

Abnormal resorption and deposition of bone

Relatively common

Distortion and weakening of affected bones

UNKOWN cause

Affects older adults

Affects more than one bone - Polyostotic

Symptoms: bone pain, bone distortion, and weakening of bones, bowing deformity, increase circumference of head

* enlargment of midde 1/3 of face – resulting in Leontiasis ossea (lionlike facial deformity)*

Most common bones affected –> vertebrae, pelvis, skull, femur.

Maxilla > mandible

Generalized hypercementosis

Slow and chronically progressive – rarely leads to death

Treatment - NSAIDS for pain, Bisphosphonates

INCREASED risk of developing a malignant bone tummor – OSTEOSARCOMA

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26
Q

Head and neck symptoms of Paget’s Disease

A

Increased circumference of head

Enlargement of middle 1/3 face – Leontiasis ossea (lionlik facial deformity)

Alveolar ridges are symmetrical – grossly enlarged (dentures no longer fit)

Hypercementosis

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27
Q

Diagnostic of Paget’s Disease

A

Cotton wool appearance on xray

Generlized hyper cementosis

HIGH serum alkaline phosphatase levels

NORMAL calcium and phosphorus levels

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28
Q

What medications are Paget disease patients typically taking?

A

BISPHOSPHONATES

NSAIDS

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29
Q

Paget disease patients have an increased risk of developing?

A

Malignant bone tumors - Osteosarcoma

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30
Q

Xray manifestatsion of Paget’s Disease

A

Cotton wool bone appearance

Generalized hypercementosis

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31
Q

Generalized hyper cementosis

A

Paget’s Disease

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32
Q

Dentures don’t fit anymore

Hat has seemed a little tight lately

A

Paget’s Disease

Increased head circumference - ill fitting hat

Gross bone expansion – ill fitting dentures

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33
Q
A

Lentiasis ossea

Lionlike facial deformity

SEVERE case of Paget’s disease of the jaw - enlargement of middle 1/3 of face.

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34
Q

Giant Cell Granuloma

A

Painless bone expansion

Non-neoplastic lesion

Some – aggresive behavior (associated with pain, paresthesia, and perforation of cortical plate)

Discoverd during xrays or painless bone expansion

More common in ANTERIOR jaw - frequently cross the midline

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35
Q

Central Giant Cell Granuloma - XRAY manifestations

A

Not diagnositc!!

Radiolucent lesion – multilocular OR unilocular

Well delineated

Noncorticated margins

Histo – similar to brown tumor of hyperparathyroidism and lesions of cherubism

(patients must be evaluated for hyperparathyroidism)

Cellular, vascular stroma, prominent multinucleated giant cells

Treatment: Curettage with recurrence (20% of the time)

No risk of metastasis

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36
Q

Central Giant Cell Granuloma

A

NONNEOPLASTIC lesion (no unlimited growth)

Some may demonstrate aggressive behavior – and act like a neoplastic lesion

ANTERIOR JAW – CROSSES MIDLINE

(Most things tend to NOT cross the midline)

Young adults

Painless bone expansion – some can cause pain (minority)

Xray:

RL lesion with multilocular or unilocular

Well delineated

Noncorticated margins

Histo:

Identical to brown tumor of hyperparathyroidism and lesions of cherubism

Giant cell

Treatment:

Curettage – liklihood of recurrence

Good long term prognosis

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37
Q

What lesions most commonly crosses the midline?

A

Central giant cell granuloma

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38
Q

What are the xray features of Central Giant Cell Granuloma (4)

A

Not diagnostic

RL lesion – multilocular or unilocular

Well delineated

Noncorticated margins (aggressive growth)

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39
Q

What is the histology of central giant cell granuloma similar to?

A

Brown tumor of hyperparathyroidism

Lesions of cherubism

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40
Q

Nonneoplastic

A

Central Giant Cell Granuloma

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41
Q

Cherubism

A

AD inherited condition

Bilateral involvement of posterior mandible that produces chubby cheeks.

Due to overgrowth of GIANT CELLS – will displace bone. Will regress after puberty.

Symptoms:

Eyes turned to heaven - wide rim of exposed sclera below iris

(due to infraorbital rim involvment)

Enlarged cheeks - due to displace bone in posterior mandible

Stretching of upper facial skin

May lead to failure of toot eruption

Mandibular lesions – painless, bilateral, posterior, expansile

Maxillary – posterior involvemed

Marked widening and distortion of the alveolar ridges

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42
Q

Cherubism Xray features:

A

Multilocular

Expansile

Radiolucent

(Identical to those in central giant cell granuloma)

43
Q

Cherubism treatment

A

Typically regresses after puberty

BUT…

Early surgical curretage may lead to good results or rapid regrowth with worsening deformaty

NO radiation indicated –> due to postirradation sarcoma

44
Q
A

Cherubism

45
Q
A

Cherubism

46
Q

Traumatic Bone Cyst

A

“simple bone cyst”

benign, EMPTY or fluid filled cavity within bone

NOT a true cyst – lesion does not have an epithelial lining

Trauma hemorrhage theory

Young patients

Xray:

Well delineated

RL

Margins ill or well defined

Dome like projections - SCALLOP between roots

teeth are VITAL

Treatment: surgical exploration is necessary. Typically curative.

Cause bleeding and new bone will form to fill in the void

47
Q

Traumatic Bone Cyst – Trauma hemorrhage theory

A
48
Q
A
49
Q
A

Traumatic Bone Cyst

EMPTY cavity when surgically explored

50
Q

Aneurysmal Bone Cyst

A

Intraosseus accumulation of blood filled spaces surrounded by CT

** NOT a true cyst – no epithelial lining**

Posterior Mandible

Clinical manifestation –> Swelling that develops rapidly, Painful

Xray:

RL lesion – marked cortical expansion and thinning (ballooning)

Uniloculuar - can be multilocular

Variable borders

Described as “BLOW OUT” – ballooning distention of affected bone

Surgical exploration: Surgical soaked sponge

Treatment: Curretage or enucleation

No need for bone graft - new bone formation

Good prognosis

51
Q

Blood soaked Sponge

A

Aneurysmal bone cyst

52
Q

Ballooning distention of cortical bone

A

Aneurysmal Bone Cyst

53
Q
A

Ballooning distention

Aneurysmal Bone Cyst

54
Q

Fibrous osseous lesions

A

Replacement of NORMAL bone by fibrous tissue containing mineralized product

(No fibrous CT in bone normally)

Clinical and radiographic findings are necessary to establish a diagnosis.

Benign Fibro-osseus lesions:

Fibrous dysplasia

Cemento-osseus dysplasia

Ossifying fibroma

55
Q

Examples of Benign Fibro-osseus lesion

A

Fibrous dysplasia

Cemento-osseus dysplasia

Ossifying fibroma

56
Q

Fibrous Dysplasia

A

Tumor like condition

Fibrous CT intermixed with bone

POST ZYGOTIC MUTATION

Depending on when the mutation takes place the process involve:

1 bone –>monostotic

multople bones –> polyostotic

Skin

Endocrine system

Two types: Monostotic, polyostotic

57
Q

Fibrous Dysplasia – MONOSTOTIC

A

Majority of fibrous dysplasia cases

JAW –> mx >mn

Teenage years

Painless, slow growing swelling

Involvement of MANDIBLE –> leads to expansion of both BUCCAL and LINGUAL plates

Involvement of MAXILLA – can lead to maxillary sinus

Xray:

Ground Glass Opacification

Poorly calcified bone in a disorganize fashion

Not well demarcated –> margins blend into adjacent normal bone

58
Q

What type of fibrous dysplasia accounts for the majority of cases?

A

Monostotic

59
Q

Radiographic appearance of Ground Glass

A

Monostotic Fibrous Dysplasia

60
Q
A

Fibrous Dysplasia – Monostotic

Ground Glass Appearance

61
Q

Fibrous Dysplasia – Polystotic

A

Involvement of two or more bones

Two Disease: Jaffe-Lichtenstein and McCune - Albright Syndrome

Clinical management - challenging

Disease tends to stabilize and stop growing at skeletal maturity

No radiation therapy

Surgical removal - best option

62
Q

Cemento Osseeous Dysplasia

A

Tooth bearing areas of the jaw

MOST COMMON - fibrous osseous lesion encounterd in practice

Three types:

Focal

Periapical

Florid

63
Q

Three types of Cemento osseous dysplasia

A

Focal

Peripheral

Florid

64
Q

Jeffe-Lichtenstein Syndrome

A

Type of fibrous dysplasia POLYSTOTIC

Cafe au lait spots (coast of main - rough)

65
Q

McCune- Albright Syndrome

A

Polystotic fibrous dysplasia

Cafe au late (coast of maine)

multiple endocrinopathies

Multiple endocrinopathies:

Sexual percocity

Pituitary adenoma

hyperthyroid

66
Q

Multiple endocrinopathies of McCune Albright Syndrome

A

Sexual precocity – early onset puberty

Pituitary adenoa

Hyperparathyroidism

67
Q

Focal Cemento Osseous Dysplasia

A

SINGLE site of involvement

Females, 40, caucasians

POSTERIOR mandible

Asymptomatic

Xray:

Completely radiolucent – Densely radiopaque

(depends on calcification: less – RL, more –RO)

Radiolucent rim

Commonly mixed RL and RO pattern

Lession is usually well defined

68
Q
A

Focal Cemento osseous dysplasia

posterior mandible – common

RL rim, RO or RL lesion

69
Q

Periapical Cemento - Osseous Dysplasia

A

Periapical region of ANTERIOR MANDIBLE

MULTIPLE foci

40, female, AA

Teeth are vital

Asymptomatic

Early lesions –> circumscribed areas of RL involving apex of tooth

End stage lesion –> densely RO with RL rim

PDL will be intact – the lesion will not fuse to the tooth

(FUSION to tooth – cementoblastoma)

Self limiting– NO progressive growth

70
Q
A

Periapical Cemento osseuos dysplasia

71
Q

Also associated with a ground glass appearance

A

Fibrous dysplasia monostotic

Involvment o mandible –> leads to expansion of buccal and lingual cortical plates

72
Q

Florid Cemento - osseous dysplasia

A

MULTIPLE focal involvment – NOT limited to anterior mandible

Female, AA

Bilateral and symmetrical

Asymptomatic

Xray:

Lesions demonstrate identical patterns of maturation

Initial lesion – RL

Overtime become RO -RL mixed

End stage – predominately RO

DON’T extract the tooth – don’t want to open bone to cause further infection

73
Q
A

Florrid Cemento-Osseous Dysplasia

Mutlifocal

Bilateral and symmetrical

74
Q

Ossifying Fibroma

A

NEOPLASM with significant growth potential

fibrous CT containing variable mixture of bone and cementum

Wide range of age

Female Mandibular

Small lesions – do not cause symptoms and are detected by xray

LARGE TUMORS – painless swelling

Xray:

Well defined

Unilocular

Completely RL or more commonly RL-RO mix

Root divergence or resorption of roots occur

DOWNWARD bowing of the INFERIOR CORTEX of mandible

Treatment –> enucleation

Prognosis good, recurrnece rare

DO NOT undergo malignant transformation

75
Q
A

Ossifying Fibroma

Mandible

Downward bowing of inferior cortex of mandible

Root divergence

Unilocular

LARGE tumor

76
Q

Juvenile (active) ossifying fibroma

Distinguised from ossifying fibroma because of.. (3)

A

Distinguished from ossifying fibroma:

Age

Common sites

Clinical behavior

77
Q

Juvenile (acitve) ossifying fibroma

A

Slowly progressive growth – some exhibit Rapid growth

Well circumscribed

Lesions are typically –> RL with central RO

Two types: TRABECULAR and PSAMMOMATOID (more common)

MALE MAXILLARY

The younger the pt –> MORE aggressive the tumor

Treatment – curettage (small lesions), wide resectio (rapid large lesions)

NO malignant transformation

Recurrence may occur (30-60%)

78
Q

Two types of Juvinille Ossifying Fibroma

A

Psammomatoid

Trabecular

BOTH occur in MALES in the MAXILLA

79
Q
A

Juvinille Ossifying Fibroma

MAXILLARY - large and aggressive

RL with RO center

80
Q

Osteoma

A

Benign tumors of mature bone

ARISE on the surface of bone or withing medullary bone

Head and Neck –> Inferior border of mandible, forehead. Somewhere on the head and skull.

More commonly in the SINUS (looks radiographically the same as antral pseudocyst

Attached mucosa –> tori

May cause pain, swelling, sinusitis, or nasal discharge

Can continue to GROW

Treatmet –> conservative excision

Rarely reoccur

ASSOCIATED WITH GARDNER’S SYNDROME

81
Q

Gardner Syndrome

A

Bowel Polyps – will transform into adenocarcinoma (around 30yrs)

Osteomas (skull, sinus, and mandible), multiple

Supernumerary teeth

Impacted teeth

Odontomas

Prophylacticlly –> will REMOVE the colon

82
Q
A

Osteoma

83
Q

What 2 syndromes have supernumerary teeth?

A

Cleidocranial Dysplasia

Gardner Syndrome

84
Q

Osteoblastoma vs Osteoid Osteoma

A

Closely related

BENIGN bone tumors

arise from OSTEOBLASTS

Histo –> identical

Produce prostaglandins –> OSTEOID OSTEOMA is smaller and produces less therfore pain can be relieved by ASPIRIN

Osteoid osteoma –> smaller than 2 cm

Osteoblastoma –> larger than 2 cm

Treatment –> local excision or curretage

Malignant transformation is rare

85
Q

Osteoblastoma

A

RARE, occurs in the jaws

MD>MX

Posterior>anterior

2-4 cm

Pain, tenderness, and swelling

pain is NOT relieved by aspirin

86
Q

Osteoid Osteoma

A

Rare in the jaw

PAIN – nocturnal and relieved by aspiring

Xray:

Well circuscribed

RL

Less than 1 cm

Small RO nidus –> TARGET LIKE APPEARANCE

87
Q
A

Osteoid Osteoma

Nocturnal pain relieved by aspirin

88
Q
A
89
Q

Cementoblastoma

A

Odontogenic neoplasm of cementoblasts

MANDIBLE - molar and premolar region

Typically on permanent teeth

Xray:

RO mass fused to tooth root – NO PDL

Outline of root is obscured

Surrounded by RL rim

Treatment –> surgical extraction of the tooth with calcified mass

90
Q
A

Cementoblastoma

91
Q

Chondroma

A

Benign tumor of cartilage

Diagnosis of jaw with skepticism – most examples occur in condyle or anterior maxilla

RL with a central RO

May be a potential CHONDROSARCOMA

92
Q

Synovial Chonromatosis

A

Rare

Benign

Nonneoplastic

Develpment of cartilaginous nodules within the synovial membrane

Can affect the TMJ

middle aged

xray:

loose bodies seen (joint mice)

Treatment –> removal of synovium and loose bodies

Low recurrance

93
Q
A

Synovial Chondromatosis

Loose bodies – joint mice

94
Q

Osteosarcoma

A

MESENCHYMAL malignancy

Production of osteiod or immature bone through uncontrolled growth

One of the most common malignancy to originate in the bone (besides leukemia and langerhans histocytosis)

Intramedullary

Juxtacortical

Extraskeletal

Extragnathic osteosarcomas – 10-20 years old, 50 years old

Jaw osteosarcoma –> 7% of all osteosarcomas

Mandibular – posterior jaw

Maxillary – inferiorly ( alveolar ridge, sinus floor, palate)

Symptoms: Pain and Swelling

Jaw lesions–> less likely to metastasize

95
Q

Osteosarcoma Radiographic Appearance

A

Spiking resorption of roots – Tappered narrowing of root

SUNBURST APPEARANCE - best seen withan occlusal xray

Codman’s Triangle – triangular elevation of periosteum

Early finding –> SYMMETRICAL widening of the PDL or one or more teeth

96
Q

Most common location for osteosarcoma in young adults

A

Distal femur

Proximal Tibia

97
Q
A

Osteosarcoma

SUNBURST appearance

Spikin resorption

98
Q

Postirradiation Bone Sarcoma

A

Sarcoma arising in the bone that has been previously subjected to radiation therapy

Well recognized phenomenon

_May develop 3 years – 15 years_ following radiation

99
Q

Chondrosarcoma

A

MALIGNANT bone tumor of Cartilage

MAXILLARY>mandibular

Painless mass or swelling

May be associated with separation or loosening of teeth

RL poorly defined borders

Variable amounts of RO foci

+/- root resorption, symmetrical PDL widening

Demonstrate extensive infiltration between osseous trabeculae or preexisting bone without causing significant resorption - tumor is difficult to determine the extent radiographically

Death – due to direct extension into vital structures rather than metastases.

Best treatment – tumor resection

100
Q

Ewing Sarcoma

A

Primary MALIGNANT tumor of bone

3rd most common osseous neoplasm – osteosarc and chondrosarc

Translocation in chromosome 11 and 12

Long bones - Jaws affect 2% of the time

PAIN, swelling

Parasthesia and loosening of teeth are common findings in oral

Xray:

Irregular RL with ill-defined margins

Onionskin periosteal reaction

Frequently metastasize

101
Q

Metastaic Tumors to the Jaws

A

Metastatic carcinoma is the MOST COMMON form of cancer involving bone

Most common origin of gnathic mets:

Breast

Lung

Thyroid

Prostate

Kidney

Affects older patients

Majority occurs in the MANDIBLE

Symptoms:

Pain

Swelling

Loosening of teeth

Parasthesia

Numb-chin syndrome

Mets may be discoverd in a nonhealing ext site

MOTH EATEN – worrisome category of bone lesions

POOR prognosis - stage IV disease

5 year survival is exceedling rare

succumb to cancer within a new year

102
Q

Moth-eaten: Worrisome Category of bone lesions

A

Metastatic Tumors of the jaw

103
Q
A

Codman Triangle

Osteosarcoma

Oral Pathology (17 decks)

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