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

Chapter 14: Bone Pathology part III Flashcards

1
Q

what is the prognosis for jaw osteosarcoma lesions? what is it when using initial radical surgery?

A
  • depending on the study, the prognosis for jaw lesions is 30-70%
  • can approach 80% using initial radical surgery
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2
Q

death in chondrosarcoma cases is usually due to what?

A

direct extension into vital structures rather than metastasis

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3
Q

___ is a primary malignant tumor of bone and is the 3rd most common osseous neoplasm (after osteosarcoma and chondrosarcoma)

A

ewing sarcoma

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4
Q

what is numb-chin syndrome as it relates to metastatic tumors of the jaw?

A

a distinctive pattern of anesthesia characterized as an unexplained loss of sensation in the lower lip and chin that can occur with metastatic tumors to the mandible with involvment of the inferior alveolar nerve

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5
Q

what is the treatment for ewing sarcoma?

A

combined surgery, radiotherapy, and chemotherapy

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6
Q

what are the two types of juxtacortical osteosarcoma found in long bones?

A

parosteal and periosteal

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7
Q

are osteosarcomas of the jaw more common in the maxilla or mandible?

A

they are equal

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8
Q
A

chondrosarcoma

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9
Q

why is the tumor extent of chondrosarcomas difficult to determine radiographically?

A

chondrosarcomas often demonstrate extensive infiltration between osseous trabeculae of preexisting bone without causing significant resorption

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10
Q

juxtacortical osteosarcoma is also called ___

A

peripheral osteosarcoma

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11
Q

___ is the most common form of cancer involving bone

A

metastatic carcinoma

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12
Q
A

osteosarcoma

notice the widening of the PDL

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13
Q

___ is a malignant bone tumor of cartilage, in which up to 3% arise in the head and neck

A

chondrosarcoma

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14
Q

what is the most common symptom associated with ewing sarcoma? what additional symptoms if it involves the jaws?

A
  • pain with associated swelling
  • if it involves the jaws, parasthesia and loosening of the teeth are common
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15
Q

___ osteosarcomas have a bimodal age distribution:

more common between 10-20

after 50

A

extragnathic

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16
Q

what is the male/female predilection of ewing sarcoma? what about the caucasian/african american predilection?

A
  • M>F
  • C>AA
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17
Q
A

osteosarcoma

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18
Q

describe the parosteal type of juxtacortical osteosarcoma

A
  • lobulated nodule attached to the cortex by a short stalk
  • no elevation of periosteum
  • no peripheral periosteal reaction
  • better prognosis than both intramedullar and periosteal osteosarcomas
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19
Q

osteosarcoma tumors in the maxilla are common ___ rather than ___

A

inferiorly rather than superiorly

  • inferior - alveolar ridge, sinus floor, palate
  • superior - zygoma, orbital rim
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20
Q

what is the most common place for osteosarcomas to arise in young patients?

A

distal femur and proximal tibia

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21
Q

___ is a sarcoma in a bone that has been previously subjected to radiation therapy, and is a well-recognized phenomenon

A

postirradiation bone sarcoma

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22
Q

radiographically, extensive osteosarcomas may only show ___ changes

A

minimal and subtle changes

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23
Q

what are the possible histopathologic subtypes of osteosarcoma?

A

osteoblastic, chondroblastic, fibroblastic, etc.

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24
Q
A

osteosarcoma

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25
Q

how does ewing sarcoma present radiographically?

A
  • irregular RL with ill-defined margins
  • characteristic “onionskin” periosteal reaction (usually only seen in long bones; rarely in the jaws)
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26
Q

what is the most common presenting sign of chondrosarcoma? what is it associated with?

A

painless mass or swelling which may be associated with separation or loosening of teeth

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27
Q

what are the 3 types of postirradiation bone sarcomas?

A
  • osteosarcoma is the most common type (50%)
  • fibrosarcoma composes 40%
  • almost all the rest are chondrosarcomas
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28
Q

what is the 5-year survival of metastatic tumors to the jaw?

A

exceedingly rare; patients typically succumb to cancer within a year

29
Q

osteosarcomas of the jaws comprise ___% of all osteosarcomas, and occur around age ___

A
  • 7%
  • 33 - this is 10-15 years older than osteosarcoma of the long bones
30
Q

jaws are only involved in ___% of ewing sarcomas

A

2%

31
Q

80% of jaw metastatic tumors occur in the ___

A

mandible

32
Q

describe the periosteal type of juxtacortical osteosarcoma

A
  • sessile lesion arising from within the cortex
  • elevates the periosteum, which provokes peripheral periosteal reaction
  • better prognosis than intramedullar osteosarcomas; worse than parosteal
33
Q

80% of patients with ewing sarcoma are younger than ___

A

20

34
Q

chondrosarcomas in the head and neck:

what is the maxilla:mandible ratio? average age patient? male/female or race predilection?

A
  • maxilla:mandible 4:1
  • average age is 40
  • no sex or race predilection
35
Q

what are the radiographic features of osteosarcoma?

A
  • may be RO, RL with RL border, mixed, or RL
  • the peripheral border is ill-defined
  • “spiking resorption” - tapered narrowing of the root if root resorption occurs
  • classic sunburst appearance
  • codman’s triangle - triangular elevation of the periosteum
  • symmetrical widening of the PDL space around one or more teeth - important early finding
36
Q

though periapical, occlusal, and pano xrays can lead to the diagnosis of osteosarcoma, ___ are used to determine the extent of the tumor most accurately

A

CT scans

37
Q

radiographically, metastatic tumors to the jaw show features typicla of a ___

A

malignancy

38
Q

what are the symptoms of metastatic tumors of the jaw?

A

pain, swelling, loosening of teeth, and paresthesia

39
Q

does ewing sarcoma metastasize?

A

yes, frequently

40
Q

osteosarcomas may be ___, ___, or ___

A

intramedullary, juxtacortical, or extraskeletal

41
Q

the symmetrical widening of the PDL space in osteosarcoma is due to ___

A

tumor infiltration

this is not specific to osteosarcoma; seen in other malignancies too

42
Q
A

ewing sarcoma

43
Q

what are the radiographic features of metastatic tumors to the jaw that are typical of a malignancy?

A
  • ill-defined borders (moth-eaten)
  • widening of the PDL
  • some may stimulate new bone formation, resulting in mixed RL-RO
44
Q

what are the common symptoms of osteosarcoma?

A

pain and swelling

45
Q

the classic sunburst appearance of osteosarcoma are only found in ___% and are due to ___. they are best appreciated with what type of radiograph?

A
  • 25%
  • bony projections on the surface of the lesion
  • occlusal
46
Q

what are the most common origins of gnathic metastatic tumors?

A

breast, lung, thyroid, prostate, kidney

47
Q

metastatic tumors to the jaws affect older or younger patients?

A

older

48
Q

postirradiation sarcomas may develop how long after radiation?what is the average?

A

may develop as soon as 3 years after radiation, but the average is 15 years after therapy

49
Q

osteosarcoma tumors in the mandible are more likely to be in what location?

A

posterior

50
Q

what is the treatment for osteosarcoma in long bones? what is the survival rate?

A
  • preoperative chemotherapy
  • radical surgical excision
  • +/- postoperative chemotherapy
  • survival rates approach 80%
51
Q

___ is a mesenchymal malignancy in which cells have the ability to produce osteoid or immature bone

A

osteosarcoma

52
Q

radiographically, chondrosarcoma tumors show features suggestive of ___

A

malignancy

53
Q

juxtacortical osteosarcoma is most commonly found in ___

A

long bones

54
Q

originated in the thyroid

A

metastatic tumor to the jaws

55
Q

___ and ___ are the sites most commonly affected by osteosarcoma

A

brain and lung

56
Q

what are the radiographic features of chondrosarcoma that are suggestive of malignancy?

A
  • RL with poorly defined borders
  • the RL area contains variable amounts of RO foci
  • +/- root resorption, symmetrical PDL widening
57
Q

metastatic tumors to the jaw may be discovered in a ___

A

nonhealing extraction site

58
Q

excluding hematopoietic neoplasms, ___ is the most common type of malignancy to originate within bone

A

osteosarcoma

59
Q

what treatment types are less effective for chondrosarcoma compared to osteosarcoma?

A

radiation and chemo

60
Q

the most important prognostic indicator for osteosarcoma is the ability to achieve ___

A

initial complete surgical removal

therefore, in general, mandibular lesions have a better prognosis

61
Q

what are the 5-year, 10-year, and 15-year survival rates for chondrosarcoma?

A
  • 5-year = 85%
  • 10-year = 70%
  • 15-year = 50%
62
Q

what are the most common sites of origin of metastatic tumors to the jaws?

A

vertebrae, ribs, pelvis, skull

63
Q

what bones are most affected by ewing sarcomas?

A

long bones, pelvis, and ribs

64
Q

what is the prognosis of metastatic tumors to the jaw?

A

poor (stage IV disease)

65
Q

describe the recurrence of chondrosarcoma

A

it is a late sequelae and patients must be followed for life

66
Q

what is the most important factor in determining the prognosis of chondrosarcomas? why?

A

tumor location - this is because complete resection is the most effective treatment

67
Q

for osteosarcoma lesions, ___ lesions have a less tendency to metastasize than ___ lesions

A
  • jaw lesions
  • long bone lesions
68
Q

___ osteosarcoma lesions originate on the cortex of the bone and grow outward

A

juxtacortical

69
Q

in extragnathic bones, chondrosarcoma is considered a tumor of ___

A

adulthood - almost all patients are older than 50

Oral and Maxillofacial Pathology (45 decks)

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