Chapter 14: Bone Pathology part III Flashcards
what is the prognosis for jaw osteosarcoma lesions? what is it when using initial radical surgery?
- depending on the study, the prognosis for jaw lesions is 30-70%
- can approach 80% using initial radical surgery
death in chondrosarcoma cases is usually due to what?
direct extension into vital structures rather than metastasis
___ is a primary malignant tumor of bone and is the 3rd most common osseous neoplasm (after osteosarcoma and chondrosarcoma)
ewing sarcoma
what is numb-chin syndrome as it relates to metastatic tumors of the jaw?
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
what is the treatment for ewing sarcoma?
combined surgery, radiotherapy, and chemotherapy
what are the two types of juxtacortical osteosarcoma found in long bones?
parosteal and periosteal
are osteosarcomas of the jaw more common in the maxilla or mandible?
they are equal
chondrosarcoma
why is the tumor extent of chondrosarcomas difficult to determine radiographically?
chondrosarcomas often demonstrate extensive infiltration between osseous trabeculae of preexisting bone without causing significant resorption
juxtacortical osteosarcoma is also called ___
peripheral osteosarcoma
___ is the most common form of cancer involving bone
metastatic carcinoma
osteosarcoma
notice the widening of the PDL
___ is a malignant bone tumor of cartilage, in which up to 3% arise in the head and neck
chondrosarcoma
what is the most common symptom associated with ewing sarcoma? what additional symptoms if it involves the jaws?
- pain with associated swelling
- if it involves the jaws, parasthesia and loosening of the teeth are common
___ osteosarcomas have a bimodal age distribution:
more common between 10-20
after 50
extragnathic
what is the male/female predilection of ewing sarcoma? what about the caucasian/african american predilection?
- M>F
- C>AA
osteosarcoma
describe the parosteal type of juxtacortical osteosarcoma
- 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
osteosarcoma tumors in the maxilla are common ___ rather than ___
inferiorly rather than superiorly
- inferior - alveolar ridge, sinus floor, palate
- superior - zygoma, orbital rim
what is the most common place for osteosarcomas to arise in young patients?
distal femur and proximal tibia
___ is a sarcoma in a bone that has been previously subjected to radiation therapy, and is a well-recognized phenomenon
postirradiation bone sarcoma
radiographically, extensive osteosarcomas may only show ___ changes
minimal and subtle changes
what are the possible histopathologic subtypes of osteosarcoma?
osteoblastic, chondroblastic, fibroblastic, etc.
osteosarcoma
how does ewing sarcoma present radiographically?
- irregular RL with ill-defined margins
- characteristic “onionskin” periosteal reaction (usually only seen in long bones; rarely in the jaws)
what is the most common presenting sign of chondrosarcoma? what is it associated with?
painless mass or swelling which may be associated with separation or loosening of teeth
what are the 3 types of postirradiation bone sarcomas?
- osteosarcoma is the most common type (50%)
- fibrosarcoma composes 40%
- almost all the rest are chondrosarcomas
what is the 5-year survival of metastatic tumors to the jaw?
exceedingly rare; patients typically succumb to cancer within a year
osteosarcomas of the jaws comprise ___% of all osteosarcomas, and occur around age ___
- 7%
- 33 - this is 10-15 years older than osteosarcoma of the long bones
jaws are only involved in ___% of ewing sarcomas
2%
80% of jaw metastatic tumors occur in the ___
mandible
describe the periosteal type of juxtacortical osteosarcoma
- sessile lesion arising from within the cortex
- elevates the periosteum, which provokes peripheral periosteal reaction
- better prognosis than intramedullar osteosarcomas; worse than parosteal
80% of patients with ewing sarcoma are younger than ___
20
chondrosarcomas in the head and neck:
what is the maxilla:mandible ratio? average age patient? male/female or race predilection?
- maxilla:mandible 4:1
- average age is 40
- no sex or race predilection
what are the radiographic features of osteosarcoma?
- 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
though periapical, occlusal, and pano xrays can lead to the diagnosis of osteosarcoma, ___ are used to determine the extent of the tumor most accurately
CT scans
radiographically, metastatic tumors to the jaw show features typicla of a ___
malignancy
what are the symptoms of metastatic tumors of the jaw?
pain, swelling, loosening of teeth, and paresthesia
does ewing sarcoma metastasize?
yes, frequently
osteosarcomas may be ___, ___, or ___
intramedullary, juxtacortical, or extraskeletal
the symmetrical widening of the PDL space in osteosarcoma is due to ___
tumor infiltration
this is not specific to osteosarcoma; seen in other malignancies too
ewing sarcoma
what are the radiographic features of metastatic tumors to the jaw that are typical of a malignancy?
- ill-defined borders (moth-eaten)
- widening of the PDL
- some may stimulate new bone formation, resulting in mixed RL-RO
what are the common symptoms of osteosarcoma?
pain and swelling
the classic sunburst appearance of osteosarcoma are only found in ___% and are due to ___. they are best appreciated with what type of radiograph?
- 25%
- bony projections on the surface of the lesion
- occlusal
what are the most common origins of gnathic metastatic tumors?
breast, lung, thyroid, prostate, kidney
metastatic tumors to the jaws affect older or younger patients?
older
postirradiation sarcomas may develop how long after radiation?what is the average?
may develop as soon as 3 years after radiation, but the average is 15 years after therapy
osteosarcoma tumors in the mandible are more likely to be in what location?
posterior
what is the treatment for osteosarcoma in long bones? what is the survival rate?
- preoperative chemotherapy
- radical surgical excision
- +/- postoperative chemotherapy
- survival rates approach 80%
___ is a mesenchymal malignancy in which cells have the ability to produce osteoid or immature bone
osteosarcoma
radiographically, chondrosarcoma tumors show features suggestive of ___
malignancy
juxtacortical osteosarcoma is most commonly found in ___
long bones
originated in the thyroid
metastatic tumor to the jaws
___ and ___ are the sites most commonly affected by osteosarcoma
brain and lung
what are the radiographic features of chondrosarcoma that are suggestive of malignancy?
- RL with poorly defined borders
- the RL area contains variable amounts of RO foci
- +/- root resorption, symmetrical PDL widening
metastatic tumors to the jaw may be discovered in a ___
nonhealing extraction site
excluding hematopoietic neoplasms, ___ is the most common type of malignancy to originate within bone
osteosarcoma
what treatment types are less effective for chondrosarcoma compared to osteosarcoma?
radiation and chemo
the most important prognostic indicator for osteosarcoma is the ability to achieve ___
initial complete surgical removal
therefore, in general, mandibular lesions have a better prognosis
what are the 5-year, 10-year, and 15-year survival rates for chondrosarcoma?
- 5-year = 85%
- 10-year = 70%
- 15-year = 50%
what are the most common sites of origin of metastatic tumors to the jaws?
vertebrae, ribs, pelvis, skull
what bones are most affected by ewing sarcomas?
long bones, pelvis, and ribs
what is the prognosis of metastatic tumors to the jaw?
poor (stage IV disease)
describe the recurrence of chondrosarcoma
it is a late sequelae and patients must be followed for life
what is the most important factor in determining the prognosis of chondrosarcomas? why?
tumor location - this is because complete resection is the most effective treatment
for osteosarcoma lesions, ___ lesions have a less tendency to metastasize than ___ lesions
- jaw lesions
- long bone lesions
___ osteosarcoma lesions originate on the cortex of the bone and grow outward
juxtacortical
in extragnathic bones, chondrosarcoma is considered a tumor of ___
adulthood - almost all patients are older than 50
