Exam 2: 2/27: Benign non-odontogenic tumors

Question 1

Coronoid hyperplasia:

Answer 1

rare developmental, osteoma or osteochondroma, esp male, uni or bi lateral, limits man move, painless, treat w coronoidectomy ro coronoidectomy

Question 2

Condylar hyperplasia

Answer 2

uncommon, female:male:3:1, facial asymmetry, prognathism, cross + open bite, treat: condylectomy or osteotomy

Question 3

TF? Both Condylar hyperplasia and coronoid hyperplasia:present w facial asymmetry.

Answer 3

F, only condylar hyperplasia

Question 4

Bifid condyle:

Answer 4

rare, developmental, double headed condyle, usually unilateral, asymptomatic, may have pop or click of TMJ, no tx

Question 5

Condylar hypoplasia:

Answer 5

underdeveloped condyle, congenital or acquired, syndromes (mandibulofacial dysostosis)

Question 6

Condylar aplasia:

Answer 6

no development of condyle or ramus

Question 7

Exostoses:

Answer 7

localized nodular bony protuberance, non-neoplastic*, developmental, very common, genetic or env factors, rarely symptomatic, single or multiple

Question 8

How to name exostoses:

Answer 8

Buccal, palatal, torus palatinus, mandibularis, other sites: simple exostoses

Question 9

More likely to be bilateral, buccal or palatal exostoses:

Answer 9

buccal

Question 10

Buccal exostoses:

Answer 10

bilateral, max and/or mand, esp pos, male=female, 1/1000 adults

Question 11

Palatal exostoses:

Answer 11

lingual of max tuberosities, bi or unilateral, 30-69%, esp males

Question 12

Ddx, exostoses:

Answer 12

osteoma

Question 13

Torus palatinus:

Answer 13

sessile, nodular bony mass along midline, 2:1 female, genetic? simple dominant? esp Asians and Inuits, 20-35%

Question 14

Torus mandibularis:

Answer 14

sessile, single or multiple, nodular bony mass, usually bilateral, on lingual cortical bone, cuspid/ premolar area, female = male, esp Asians and Inuits, 7-10%

Question 15

Histo of tori:

Answer 15

dense cortical bone, sclerosis, loss of marrow spaces

Question 16

When to treat tori:

Answer 16

interfere w dentures, freq trauma, interfere w taking X-rays

Question 17

Bony mass that may develop from alveolar bone rest bone beneath the pontic of a pos bridge:

Answer 17

reactive subpontine exostosis

Question 18

2 variants of exostoses:

Answer 18

reactive subpontine exostosis, following skin graft vestibuloplasty gingival grafts

Question 19

Osteoma:

Answer 19

benign neoplasm of mature compact or cancellous bone, 20’s-50s, 2:1 male, mainly craniofacial skeleton, inc jaw,

Question 20

Osteoma on surface of bone:

Answer 20

periosteal osteoma

Question 21

Osteoma that developed centrally within bone

Answer 21

endosteal osteoma

Question 22

Osteoma that developed within muscle or dermis:

Answer 22

osteoma cutis

Question 23

Osteoma cx ft:

Answer 23

asymptomatic unless in some locations, slow growing bony mass, body of man or condyle, paranasal sinus osteomas are more common than gnathic, can lead to asymmetry, solitary except w Gardner’s s, for sure dx must have hx of sustained growth

Question 24

Most common location of osteoma:

Answer 24

premolar on L surface

Question 25

RG appearance of osteoma:

Answer 25

well-c, sclerotic, RGO mass

Question 26

Ddx, osteoma:

Answer 26

exostosis, complex odontoma, focal sclerosing osteomyelitis, osteoid osteoma, osteoblastoma, ossifying fibroma

Question 27

2 variant of osteoma:

Answer 27

compact w sparse marrow tissue, cancellous w abundant fibrofatty marrow space

Question 28

Recurrence rate of osteoma following removal:

Answer 28

don't recur

Question 29

How to dx osteoma:

Answer 29

surgical excision

Question 30

Tx for small asymptomatic osteoma:

Answer 30

periodic observation

Question 31

Multiple osteomas is aka:

Answer 31

Gardner's syndrome

Question 32

Inheritance pattern and mutation of Gardner's Syndrome:

Answer 32

autosomal dominant, APC tumor suppressor gene, chromo 5 (5q21)

Question 33

Gardner's syndrome is characterized by:

Answer 33

intestinal polyposis (premalignant, adenocarcinoma), benign soft tissue tumors of skin (fibroma, lipomas, neurofibromas, leiomyomas), odontomas, supernumerary teeth and impacted teeth, epidermoid cyst of skin, congenital hypertrophy of the retinal pigment epi

Question 34

benign soft tissue tumors of skin:

Answer 34

fibroma, lipomas, neurofibromas, leiomyomas

Question 35

Chondroma:

Answer 35

benign tumor of mature hyaline cartilage, anterior maxilla, symphysis, coronoid process and condyle, excise, may be a chondrosarcoma if in jaw

Question 36

Central giant cell granuloma;

Answer 36

benign, almost only in max and man, usually single RGL in man or max

Question 37

Cx ft, CGCG:

Answer 37

64-75% before 30yo, females 2:1, usually man ant to molars, freq crosses midline, typically painless expansion or swelling, non-aggressive or aggressive

Question 38

CGCG RG presentation:

Answer 38

uni or multilocular RGL, well-d, non-corticated margins, distinct pattern of outer cortical plate expansion, septae at right angles to cortex

Question 39

Histo of CGCG:

Answer 39

multinucleated giant cells throughout CT, proliferation of spindle fibroblasts, many small vascular channels, hemosiderin-laden macs

Question 40

Peripheral giant cell granuloma:

Answer 40

CGCG soft tissue lesion, microscopically similar lesion on gingival tissues, no RG findings, sometimes "cupping resorption"

Question 41

How to determine tx for CGCG:

Answer 41

whether it is aggressive or not

Question 42

Tx for nonaggressive CGCG:

Answer 42

surgery, aggressive curettage, good px, low recurrence

Question 43

Tx for aggressive CGCG:

Answer 43

tendency to recur after conservative surgical tx - corticosteroids, calcitonin or interferon alfa-2a

Question 44

Cx findings of aggressive CGCG:

Answer 44

may cause pain, rapid growth, root resorption, perforation of cortical bone

Question 45

Ddx, CGCG if solitary multilocular RGL:

Answer 45

Ameloblastoma, odontogenic myxoma, OKC, aneurysmal bone cyst

Question 46

Ddx, CGCG if solitary unilocular RGL:

Answer 46

cystic processes of the jaw

Question 47

Ddx, CGCG if Brown tumor of primary hyperparathyroidism:

Answer 47

check?

Question 48

How to differentiate bw CGCG and 1' hyperparathyroidism:

Answer 48

blood test

Question 49

TF? Blood tests will be normal for CGCG.

Answer 49

T

Question 50

Blood work for pt w 1' hyperparathyroidism:

Answer 50

inc PTH, Ca and alkaline phosphatase, dec phosphorous

Question 51

Central hemangioma, aka:

Answer 51

hemangioma of the bone

Question 52

Central hemangioma:

Answer 52

uncommon intraosseous lesion of proliferating BV's, may be true neoplasm, also a soft tissue type, most developmental or traumatic in origin

Question 53

Cx ft, Central hemangioma:

Answer 53

1/2 in pos man, female 2:1, 20's, either venous or arteriovenous malformation, usually firm, slow-growing, asymmetric expansion of man or max, paresthesia or pain, +/- mobility, spontaneous bleeding, bruits or pulsation of large hemangiomas or arteriovenous malformations may be detected w careful auscultation or palpation of the thinned cortical plates

Question 54

RG ft, CH:

Answer 54

varies greatly, 50%+ multilocular RGL w soap bubble appearance, rounded RGL in ant max w coarse patten, bony trabeculae radiate from center

Question 55

Ddx, CH, multilocular:

Answer 55

Ameloblastic fibroma, aneurysmal fibroma, OKC, ameloblastoma, odontogenic myxoma, CGCG

Question 56

This can help in dx of CH:

Answer 56

angiography to show vascular proliferation

Question 57

Histo, CH:

Answer 57

proliferation of BVs: large, cavernous vessels or small, capillary vessels, or mix of both

Question 58

Tx of CH:

Answer 58

Needle aspiration 1st!, could be of vascular origin, then biopsy. Tx: surgery, radiation, sclerosing agents, cyrotherapy, presurgical embolization techs

Question 59

Consequence of extraction in area involved by a central vascular lesion:

Answer 59

potentially fatal bleeding

Question 60

Presentation of both Osteoblastoma and osteoid osteoma:

Answer 60

benign neoplasia, vertebrae- long bones, tooth bearing region of the max and man, 20's, male 2:1, bony cortices may be expanded, pain, well-c, RGMixed, osteoid and immature bone, prominent vascular network, tx: local excision or curettage, rarely recur - aggressive osteoblastoma

Question 61

How to differentiate bw Osteoblastoma and osteoid osteoma:

Answer 61

blastoma: greater that 1.5cm, pain not well-relieved by aspirin, osteoid osteoma: less than 1.5cm, produce prostaglandins, pain is relieved by aspirin, nocturnal pain

Question 62

Ddx, Osteoblastoma and osteoid osteoma:

Answer 62

Cementoblastoma, osteoma, ossifying fibroma, fibrous dysplasia

Question 63

Fibro-osseous lesions of jaw:

Answer 63

replacement of normal bone by fibrous tissue w a newly formed mineralized product, inc developmental lesions, reactive or dysplastic processes and neoplasias, Cx, RG, and histo correlations, tx varies from none to surgical re-contouring to complete removal

Question 64

Benign fibro-osseous lesions:

Answer 64

ossifying fibroma, fibrous dysplasia, cemento-osseous dysplasia

Question 65

Ossifying fibroma is aka:

Answer 65

cemento-ossifying fibroma

Question 66

3 types of cemento-osseous dysplasia:

Answer 66

focal cemento-osseous dysplasia, periapical cemento-osseous dysplasia, florid cemento Osseous dysplasia

Question 67

Fibous dysplasia:

Answer 67

developmental, tumor-like, medullary bone replaced by abnormal fibrous CT intermixed w irregular bony trabeculae, sporadic, results in post-zygotic mutation in GNAS gene (carried in blasts melanocytes and endocrine cells)

Question 68

3 categories of fibrous dysplasia:

Answer 68

monocystic, polycystic, polycystic and cafe au lait: Jeffe-Lichtenstsein syndrome

Question 69

What determines which type of fibrous dysplasia will progress?

Answer 69

timing of the mutation

Question 70

Which fibrous dysplasia is which, early mutation in a stem cell, mutation in skeletal progenitor cells at later stage of embryonic development, or mutation during postnatal life:

Answer 70

monocystic: postnatal, polycystic: later stage of embryonic development, poly w cafe au lait: early mutation in a stem cell

Question 71

What gene is the early mutation in a stem cell of with PFD w cafe au lait?

Answer 71

GNAS 1, carried in blasts, melanocytes, and endocrine cells

Question 72

The fibrous dysplasia lead to endocrine disturbances

Answer 72

PFD w cafe au lait

Question 73

Cx ft of fibrous dysplasia:

Answer 73

mono or polycystic, Jaffe-Lichtenstein syndrome, McCune-Albright syndrome, Mazabraud syndrome (MFD or PFD and intramuscular myxomas)

Question 74

Monocystic fibrous dysplasia:

Answer 74

Limited to single bone, 80-85% of all cases of fibrous dysplasia, jaws commonly affected, more common in max, 20's male = female., asymptomatic, slow growing , usually unilateral, teeth do not become mobile, facial asymmetry

Question 75

Cx ft, Monocystic fibrous dysplasia:

Answer 75

When in max often affect adjacent bones like zygoma, sphenoid, and occiput = craniofacial fibrous dysplasia

Question 76

Monocystic fibrous dysplasia, RG ft:

Answer 76

diffuse RGO, ground glass or orange peel. In earlier stages, may be largely RGL or mottled

Question 77

Ddx, Monocystic fibrous dysplasia:

Answer 77

Ossifying fibroma, chronic osteomyelitis, Paget's disease

Question 78

Histo, Monocystic fibrous dysplasia:

Answer 78

Foci or irregularly shaped trabceulae or woven (immature) bone, the bony trabeculae assume irregular shapes "Chinese script writing", long standing lesions show lamellar maturation of bone

Question 79

Can Monocystic fibrous dysplasia be dx wo biopsy?

Answer 79

yes, should biopsy small lesions though