Diseases of Bone 4

Question 1

_________ is the most common malignant neoplasm located in bone

Answer 1

Metastatic carcinoma

Question 2

_____________ is the most common malignant neoplasm arising within bone

Answer 2

Multiple myeloma

Question 3

____________ is the most common malignant neoplasm arising from bone

Answer 3

Osteosarcoma

Question 4

What are the types of intra-osseous malignant neoplasms?

Answer 4

• Metastatic carcinoma
• Multiple myeloma
• Osteosarcoma

Question 5

What are the features of osteosarcoma?

Answer 5

• A malignant neoplasm in which either bone or osteoid is directly produced by the malignant stroma
• Osteosarcoma may also produce:
  — Chondroid - chondroblastic osteosarcoma
  — Collagen - fibroblastic osteosarcoma

Question 6

Where is the most common site of steosarcoma?

Answer 6

• Most common site is long bones around knee
• Head & neck <10%

Question 7

What are the signs and symptoms of osteosarcoma?

Answer 7

• Pain – earliest symptom
• Swelling
• Pain and Swelling - 50%
• Frequent history of dental extraction

Question 8

Answer 8

osteosarcoma

Question 9

What is the radiographic appearance of osteosarcoma?

Answer 9

• Lytic or sclerotic
• Ill-defined margins
• Variable sunburst pattern - osteophytes
• Variable localized symmetrical widening of
  periodontal ligament space (PDL)

Question 10

DD

Answer 10

osteosarcoma
scleroderma

Question 11

What is the treatment for osteosarcoma?

Answer 11

• Combination surgery and chemotherapy
  — Neo-adjuvant (preoperative) chemotherapy
  — Radical surgical resection
  — Adjuvant (postoperative) chemotherapy

Question 12

What is the prognosis of osteosarcoma?

Answer 12

3-Year survival rates
- 1970 20%
- 1985 65%

Question 13

__________ bone exhibits higher incidence of benign and malignant neoplasms

Answer 13

Pagetic

Question 14

Osteosarcoma is the most common sarcoma complicating _______ disease

Answer 14

Paget

Question 15

What is a post-irradiation bone sarcoma?

Answer 15

• Frequency related to radiation dose
• Osteosarcoma most common type of post-irradiation sarcoma
  — Fibrosarcoma, chondrosarcoma
• Histologic features and prognosis identical for de novo tumors

Question 16

What is a chondrosarcoma?

Answer 16

• A malignant neoplasm in which cartilage is directly produced by the malignant stroma
• Osteoid is not produced

Question 17

Where are chondrosarcomas more common: mand or max?

Answer 17

Maxilla

Question 18

Answer 18

chondrosarcoma

Question 19

Answer 19

chondrosarcoma

Question 20

What is ewing sarcoma?

Answer 20

• Young people, 5 to 20 years
• Pain and swelling
• Constitutional symptoms - may mimic an inflammatory process
• Mimics infection with fever, leukocytosis, elevated ESR
• Pelvis and lower extremity are the most common sites; rare in craniofacial bones

Question 21

Answer 21

ewing sarcoma

Question 22

What type of lesions have the sunburst appearance?

Answer 22

any interosseous malignant neoplasm

Question 23

Answer 23

ewing sarcoma

Question 24

What is the genetic component of ewing sarcoma?

Answer 24

CHROMOSOMAL TRANSLOCATION T(11;22)

Question 25

____% of ewing sarcoma exhibit the chromosomal translocation t(11;22)

Answer 25

85%

Question 26

How do you detect a translocaion in ewing sarcoma?

Answer 26

Fluorescent In-Situ Hybridization (FISH)

Question 27

What is the treatment/prognosis of ewing sarcoma?

Answer 27

- Systemic chemotherapy followed by local therapy (surgery or radiation therapy) - 50% five-year survival in the absence of metastasis

Question 28

What is multiple myeloma?

Answer 28

- Older adults - Disseminated neoplasm of terminally-differentiated B lymphocytes (plasma cells) - Multifocal lytic bone lesions, hypercalcemia, bone pain - Myelophthisic anemia, predisposition to infections

Question 29

Answer 29

multiple myeloma (old people) or langerhans histocytosis (young people)

Question 30

What are the oral findings of mulitple myeloma?

Answer 30

- Lytic lesions, - Loose teeth, - Pain, - Paresthesia, - Pathologic fracture - Macroglossia - amyloidosis

Question 31

What does this histology show of multiple myeloma?

Answer 31

monoclonal, abnormal plasma cells using kappa and lambda light chains

Question 32

What are the laboratory findings in multiple myeloma?

Answer 32

- Elevated serum calcium, protein, immunoglobulins - Elevated erythrocyte sedimentation rate (ESR) - Rouleaux formation - Monoclonal gammopathy - M-spike - Bence-Jones proteinuria - immunoglobulin light chains

Question 33

What are complications associated with multiple myeloma?

Answer 33

- Renal failure - Infection - Anemia

Question 34

DD

Answer 34

- metastatic disease - osteosarcoma - Langerhans histocytosis