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Oral and Maxillofacial Pathology > Chapter 14: Bone Pathology part II > Flashcards

Chapter 14: Bone Pathology part II Flashcards

1
Q

as periapical cemento osseous dysplasia lesions “mature” over time, how do they appear radiographically?

A
  • they will go from a circumscribed area of radiolucency involving the apex of the tooth (early) to having a mixed RL-RO appearance
  • end-stage lesions are densely RO with a RL rim
    • the PDL will be intact; the pesion will NOT fuse to the tooth
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2
Q
A

ossifying fibroma

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3
Q

microscopic fibro-osseous lesions are very similar among the different types of fibro-osseous lesions, so ___ and ___ are necessary to establish a diagnosis

A

clinical and radiographic findings

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4
Q

fibrous dysplasia is a sporadic condition resulting from a ___ mutation

A

postzygotic

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5
Q

describe the pain associated with osteoid osteoma

A
  • nocturnal
  • relieved by aspirin
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6
Q

are teeth affected by periapical cemento-osseous dysplasia invariably vital or devital?

A

vital

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7
Q

periapical cemento osseous dysplasia lesions are asymptomatic, and discovered how?

A

when radiographs are taken for other reasons

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8
Q

gardner syndrome is a symptom complex characterized by what 7 conditions?

A
  • colonic polyps/adenosarcoma
  • skeletal abnormalities (90%)
  • dental abnormalities (20%)
  • apidermoid cysts
  • dermoid tumors (10%)
  • thyroid carcinoma
  • pigmented lesions of the ocular fundus (90%)
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9
Q

describe mccune-albright syndrome

A
  • polyostotic fibrous dysplasia
  • cafe au lait (coast of Maine)
  • multiple endocrinopathies
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10
Q

chondromas typically arise in patients of what age range? male or female predilection?

A
  • 20-30s
  • M=F
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11
Q
A

osteoid osteoma

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12
Q
A

periapical cemento-osseous dysplasia

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13
Q

osteoblastomas are rare, especially in the ___

A

jaws

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14
Q

what are 4 things that osteomas can cause?

A

pain, swelling, sinusitis, or nasal discharge

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15
Q

an ossifying fibroma (is/is not) a true neoplasm with significant ___ potential

A
  • is a true neoplasm
  • growth
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16
Q

what is the treatment of cementoblastomas?

A

surgical extraction of the tooth with the calcified mass

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17
Q

skeletal abnormalities in gardner syndrome precede what other characteristic of gardner syndrome?

A

bowel polyps

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18
Q
A

cementoblastoma

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19
Q

most chondromas are found in the ___ or ___

A

condyle or anterior maxilla

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20
Q

what is the chief radiographic feature of monostotic fibrous dysplasia?

A

“ground glass” opacification; a result of superimposition of poorly calcified bone in a disorganized fashion

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21
Q

juvenile (active) ossifying fibroma is distinguished from ossifying fibroma on the basis of what 3 things?

A
  • age of patient
  • most common sites of involvement
  • clinical behavior
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22
Q

___ is a diverse group fo processes characterized by replacement of normal bone by fibrous tissue containing a mineralized product

A

fibro-osseous lesions

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23
Q

what are the common features of synovial chondromatosis?

A

swelling, pain, crepitus, and limitation of motion

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24
Q

ossifying firbomas occur across a wide age range. are they more prominent in males or females? mandible or maxilla?

A

F>M

mandible > maxilla

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25
Q

do ossifying fibromas undergo malignant transformation?

A

no

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26
Q

which type of cemento-osseous dysplasia involves multiple periapical regions of the anterior mandible, with multiple foci usually present?

A

periapical cemento osseous dysplasia

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27
Q

florid cemento osseous dysplasia has a marked tendency to be ___ or ___. is it typically symptomatic or asymptomatic?

A
  • bilateral or assymetrical
  • may be completely asymptomatic
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28
Q

___ is an odontogenic neoplasm of cementoblasts

A

cementoblastoma

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29
Q

focal cemento osseous dysplasia lesions are smaller than ___

A

1.5 cm

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30
Q

most juvenile (active) ossifying fibroma tumors has a ___ progressive growth, but some exhibit ___

A
  • slowly
  • rapid enlargement
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31
Q

biopsy of florid cemento osseous dysplasia could lead to ___

A

necrosis due to hypovascularity

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32
Q

at are the three types of cemento-osseous dysplasia?

A

focal, periapical, florid

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33
Q
A

monostotic fibrous dysplasia

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34
Q

radiographically, how do chondromas present?

A

RL with a central RO

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35
Q

how do osteoblastomas present radiographically?

A
  • well-defined or ill-defined
  • radiolucent with varying degrees of central RO
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36
Q

any chondroma of the jaws should be considered as possibly representing a potential ___

A

chondrosarcoma

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37
Q

do small ossifying fibroma lesions cause symptoms? how are they detected?

A
  • no
  • they are detected via radiograph
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38
Q

the skeletal abnormalities associated with gardner syndrome affect which bones? how many lesions do most patients typically have?

A
  • skull, paranasal sinuses, and mandible
  • 3-6 lesions
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39
Q

how are osteoblastomas and osteoid osteomas treated? what is the prognosis?

A
  • typically both lesions are treated by local excision or curettage
  • prognosis is good
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40
Q

___% of florid cemento osseous dysplasia cases are female, and ___% are african americans. what age patient is most common?

A
  • 90%
  • 90%
  • middle-aged to older adults
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41
Q

how do osteomas present radiographically?

A
  • circumscribed masses
  • impossible to differentiate from small foci of sclerotic bone on initial radiograph
  • osteomas will exhibit continued growth
    • usually RO (compact bone), but can be RL with central RO (cancellous bone)
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42
Q

are synovial chondromatosis lesions of the TMJ more common in males or females?

A

females

this is different from other joints

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43
Q

___ and ___ are closely related, benign bone tumors that arise from osteoblasts

A

osteoblastomas and osteoid osteomas

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44
Q

what are the dental abnormalities associated with gardner syndrome?

A
  • supernumerary teeth
  • impacted teeth
  • odontomas
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45
Q

what are examples of benign fibro-osseous lesions?

A
  • fibrous dysplasia
  • cemento-osseous dysplasia
    • focal, periapical, florid
  • ossifying fibroma
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46
Q

the bowel polyps in gardner syndrome develop during the ___ years and WILL transform into ___

A
  • develop during teen years
  • adenocarcinoma
    • 50% by age 30
    • 100% in “older” patients
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47
Q

which type of fibrous dysplasia involves two or more bones and can involve up to 75% of the skeleton?

A

polyostotic

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48
Q

___ is a rare, bening, nonneoplastic development of cartilagenous nodules within the synovial membrane

A

synovial chondromatosis

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49
Q

is focal cemento osseous dysplasia symptomatic of asymptomatic?

A

asymptomatic

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50
Q

___ is a benign tumor of cartilage

A

chondroma

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51
Q

if chondromas occur, they likely arise from ___

A

cartilaginous rests

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52
Q

what are the common features of osteoblastomas?

A
  • pain, tenderness, and swellings are important and common presenting features
  • pain is NOT relieved by aspirin
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53
Q

the ___ features of osteoblastomas and osteoid osteomas are identical

A

histopathological

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54
Q

what is the prognosis of synovial chondromatosis? recurrence?

A

good with a low frequency of recurrence

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55
Q

how are large or symptomatic osteomas treated?

A

conservative excision

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56
Q

if the jaw is involved in polyostotic fibrous dysplasia, ___ may result

A

facial asymmetry

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57
Q

ossifying fibroma is a neoplasm composed of fibrous tissue that contains a variable mixture of ___ and ___

A

bone and cementum

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58
Q

most patients affected by synovial chondromatosis are what age?

A

middle-aged

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59
Q

synovial chondromatosis most commonly affects ___

A

large joints, but can affect the TMJ

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60
Q

which type of dysplasia occurs in tooth-bearing areas of the jaws and is the most common fibro-osseous lesion encountered in clinical practice?

A

cemento-osseous dysplasia

61
Q

is juvenile (active) ossifying fibroma (both types - psammomatoid and trabecular) more common in males or females? maxilla or mandible? both of these characteristics are opposite of ___

A
  • M>F
  • maxilla > mandible
  • opposite of ossifying fibroma
62
Q

osteomas are ___, ___ lesions found in what age patient?

A
  • asymptomatic, solitary
  • young adults
63
Q

are osteomas malignant or benign? do they recur?

A

they are completely benign with extremely rare recurrence

64
Q

are chondromas painful? fast or slow growing?

A

painful and slow-growing

65
Q

is radiation therapy common in the treatment of polyostotic fibrous dysplasia?

A

no, it is contraindicated

66
Q

osteomas:

___ lesions are more common than ___ lesions

A

paranasal sinus lesions are more common than gnathic lesions

67
Q

because fibrous dysplasia is a sporadic condition resulting from a postzygotic mutation, depending on when the mutation takes place, the process may involve what 4 things?

A
  • one bone (monostotic)
  • multiple bones (polyostotic)
  • skin
  • endocrine system
68
Q

involvement of the maxilla in monostotic fibrous dysplasia leads to ___

A

obliteration of the maxillary sinus

69
Q
A

florid cemento-osseous dysplasia

70
Q

___ are among the most commonly affected sites for monostotic fibrous dysplasia

71
Q

what is the prognosis of ossifying fibromas? what is the recurrence?

A
  • very good prognosis
  • recurrence is very rare
72
Q
A

juvenile (active) ossifying fibroma

73
Q

what is the treatment of synovial chondromatosis?

A

surgical removal of the synovium and all loose bodies

74
Q

how are small, asymptomatic osteomas treated?

A

probably do not need to be treated but should be observed and removed if lesions become large (interfere with function or esthetics) or symptomatic

75
Q
A

monostotic fibrous dysplasia

76
Q

a ___ is a benign tumor of mature bone that is restricted to the craniofacial skeleton

77
Q
A

florid cemento-osseous dysplasia

78
Q

good oral hygiene should be encouraged in those with which type of cemento osseous dysplasia, so that they keep their teeth (extraction could lead to necrosis)

A

periapical or florid

79
Q

how does florid cemento osseous dysplasia present radiographically?

A
  • lesions demonstrate an identical pattern of maturation noted in both focal and periapical forms
  • initially, lesions are predominantly RL
    • over time, become mixed RL-RO
    • end-stage lesions are predominantly radiopaque with athin peripheral RL rim
80
Q

is monostotic fibrous dysplasia more common in the maxilla or mandible?

81
Q

monostotic fibrous dysplasia accounts for ___% of all cases

82
Q

large ossifying fibromas of the mandible demonstrate a characteristic downward bowing of the ___

A

inferior cortex of the mandible

83
Q

what is the most common feature of monostotic fibrous dysplasia?

A

painless, slow-growing swelling of the affected area

84
Q

what is the range of recurrence for juvenile (active) ossifying fibroma?

85
Q
A

periapical cemento-osseous dysplasia

86
Q
A

monostotic fibrous dysplasia

87
Q

what is the most common location of focal cemento osseous dysplasia?

A

posterior mandible

88
Q

if there are multiple chondroma lesions, what syndromes should be ruled out?

A

ollier and maffucci

89
Q

what are the radiographic features of ossifying fibromas?

A
  • well-defined
  • typically unilocular
  • can be completely radiolucent or, more commonly, mixed RL-RO
    • depends on amount of calcified material
  • root divergence or resorption of roots can occur
90
Q

how do large ossifying fibroma lesions present?

A

painless swelling

91
Q

how does synovial chondromatosis present radiographically?

A
  • loose bodies are seen
  • irregularly shaped, variably sized RO structures
  • sometimes called joint mice
92
Q
93
Q

what is the average age for focal cemento-osseous dysplasia? what population is it more common in? (boards vs. real life)

A
  • age 40
  • boards - caucasians
  • real life - african americans
94
Q
A

florid cemento-osseous dysplasia

95
Q

which type of cemento-osseous dysplasia exhibits a single sight of involvement and occurs mostly in females (90%)?

A

focal cemento-osseous dysplasia

96
Q

is there a likelihood of malignant transformation in juvenile (active) ossifying fibroma?

97
Q

other than the ground glass opacification, describe the radiographic presentation of monostotic fibrous dysplasia

A
  • lesions are not well demarcated - they blend imperceptibly into the adjacent normal bone
  • PA radiographs may show narrowing of PDL with an ill-defined lamina dura
98
Q
A

polyostotic fibrous dysplasia

99
Q

cartilagenous rests that can give rise to chondromas are found in what 4 areas?

A

anterior maxilla, symphysis, coronoid process, and condyle

100
Q

do cementoblastomas typically affect primary or permanent teeth?

101
Q

involvement of the mandible in monostotic fibrous dysplasia leads to ___

A

expansion of the buccal and lingual plates

102
Q

are osteoid osteomas common in the jaws?

103
Q

where do osteomas arise?

A

on the surface of bone or within medullar bone

104
Q
A

gardner syndrome

105
Q

85% of osteoblastomas occur before age ___. male or female predilection?

106
Q

___% of periapical cemento-osseous dysplasia cases are female, and ___% occur in african americans, with an overall average age of ___ years

A
  • 90%
  • 70%
  • 40
107
Q

75% of cementoblastomas occur before what age?

108
Q
A

synovial chondromatosis

109
Q

each periapical cemento osseous dysplasia lesion is ___, and ___ does not occur

A
  • self limiting
  • progressive growth
110
Q

what are the most common skeletal abnormalities associated with gardner syndrome? when are they noted?

A

osteomas noted during puberty

111
Q

what size are osteoblastomas?

A

between 2-4cm

112
Q

polyostotic fibrous dysplasia tends to stabilize and stop growing at ___

A

skeletal maturity

113
Q

describe jaffe-lichtenstein syndrome

A
  • polyostotic fibrous dysplasia
  • cafe au lait spots (coast of Maine)
114
Q

do osteoblastoma and osteoid osteomas regress? do they recur? is there malignant transformation?

A
  • sometimes lesions will regress after incomplete excision
  • lesions typically don’t recur unless they are aggressive osteoblastomas
    • 50% recur
  • malignant transformation has been reported, but it is very rare
115
Q

although osteoblastoma lesions are rare in the jaws, where do they tend to occur when they are in the jaws?

A
  • mandible > maxilla
  • posterior > anterior
116
Q

why should diagnosis of chondroma in the jaws be viewed with skepticism?

A

many so-called benign chondromas have recurred and behave in a malignant fashion

117
Q

what are the endocrinopathies associated with mccune-albright syndrome?

A
  • sexual pecocity, pituitary adenoma, and/or hyperthyroidism
    • sexual pecocity is the most common
      • menstrual bleeding, breast development, and pubic hair appear in females within the first few years of life
118
Q

osteoid osteomas produce ___, and the pain is relieved by ___

A
  • prostaglandins
  • aspirin (NSAIDs)
119
Q

gardner syndrome is present in 1 in ___

120
Q

how do cementoblastomas present radiographically?

A
  • RO mass that is fused to one or more tooth roots
  • outline of the root or roots is usually obscured
  • surrounded by a thin RL rim
121
Q

what is the treatment of chondromas?

A

total surgical removal

122
Q

when is monostotic fibrous dysplasia usually diagnosed? gender predilection?

A

teenage years

M=F

123
Q

what is the treatment of gardner syndrome?

A
  • prophylactic colectomy
  • long-term prognosis depends on the development and behavior of bowel adenocarcinomas
124
Q

75% of cementoblastoma lesions arise in the ___, almost always in the ___ region

A
  • mandible
  • molar/premolar region
125
Q

what is the general rule related to age for patients with juvenile (active) ossifying fibroma? how can lesions be treated?

A
  • the younger the patient is, the more aggressive the tumor
    • smaller lesions can be treated with local excision or curettage
    • wide resection is required for rapidly enlarging or large lesions
126
Q

ossifying fibroma lesions can typically be ___ easily

A

enucleated

127
Q
A

periapical cemento-osseous dysplasia

128
Q

describe the radiographic presentation of osteoid osteoma

A
  • well-circumscribed
  • radiolucent defect
  • usually less than 1cm (anything less than 2cm still indicates this lesion is an osteoid osteoma)
  • small RO nidus may be present, resulting in a “target-like” appearance
129
Q
A
  • polyostotic fibrous dysplasia - jaffe-lichtenstein syndrome
  • polyostotic fibrous dysplasia - mccune-albright syndrome (if associated with sexual precocity, pituitary adenoma, and/or hyperparathyroidism
130
Q

chondromas are common bone tumors, usually found in the ___ and ___

A

hands and feet

131
Q

which type of cemento osseous dysplasia is characterized by multiple focal involvement not limited to the anterior mandible, in which patients may jsut have lesions in the posterior jaws, but may also have lesions throughout

A

florid cemento osseous dysplasia

132
Q
A

focal cemento-osseous dysplasia

133
Q
A

osteoblastoma

notice it is >2cm

134
Q

involvment of florid cemento osseous dysplasia is unrelated to the presence or absence of ___

135
Q

what are the radiographic features of focal cemento osseous dysplasia?

A
  • vary from completely radiolucent to densely radiopaque
  • lesions will have a thin radiolucent rim
    • differentiates from idiopathic osteosclerosis and condensing osteitis
  • most commonly, there is a mixed radiolucent-radiopaque pattern
  • lesion is usually well-defined
136
Q
137
Q

radiographically, juvenile (active) ossifying fibroma lesions are typically ___ with central ___

A

radiolucent with central radiopacity

138
Q

describe early periapical cemento osseous dysplasia lesions

A

circumscribed areas of radiolucency involving the apex of a tooth - this lesion looks identical to that of a periapical granuloma or cyst

139
Q

___ is a tumorlike condition characterized by replacement of normal bone by fibrous conenctive tissue intermixed with bone

A

fibrous dysplasia

140
Q

which type of cemento osseous dysplasia may require surgical investigation because the features are less specific?

141
Q

how can you distinguish between osteoblastomas and osteoid osteomas?

A

size of the lesion

  • osteoid osteomas are SMALLER than 2cm
  • osteoblastomas are larger
142
Q

what are the two types of fibrous dysplasia?

A
  • monostotic
  • polyostotic
    • jaffe-lichtenstein syndrome
    • mccune-albright syndrome
143
Q

pain and swelling are present in what fraction of cementoblastoma cases?

144
Q
A

monostotic fibrous dysplasia

145
Q

juvenile (active) ossifying fibroma is ___-growing and ___-circumscribed

A
  • rapidly
  • well
146
Q

describe the clinical management of polyostotic fibrous dysplasia

A
  • clinical management is a major problem
  • smaller lesions of the mandible may be resected
  • diffuse and large nature of most lesions precludes this option
  • may reduce surgically, but up to 50% recur
147
Q

for periapical or florid cemento osseous dysplasia, diagnosis can be made from ___

A

the distinctibe clinical and radiographic findings - do NOT need biopsy

148
Q

which two different neoplasms have been reported under juvenile (active) ossifying fibroma? which is more common?

A
  • trabecular
  • psammomatoid
  • psammatoid:trabecular 4:1
149
Q

what is the cause of synovial chondromatosis?

Oral and Maxillofacial Pathology (45 decks)

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