Malignant Bone Neoplasms Flashcards
What is the tissue of origin for Chondrosarcoma?
cartilage
True or False: Most chondrosarcomas are seen in adult males in the 4th-6th decade (30s-50s).
True
Which bones are most often affected by chondrosarcoma?
femur
pelvis
ribs
What percentage of chondrosarcomas occur in the head and neck region? Is there pain or swelling?
10%
there may be pain, swelling, or loose teeth
Radiographically, chondrosarcoma of the head and neck would appear as a poorly defined ______ with variable amounts of ______. Any alterations to the teeth?
radiolucency with varying radiopacity
may see widened PDL in the area of the tumor
loss of lamina dura
teeth test vital!
How does chondrosarcoma appear histologically?
invasive lobules of atypical cells showing cartilaginous differentiation
- low stage = hyperchromatic cells spread out
- high stage = hyperchromatic cells clumped together
What is the treatment for chondrosarcoma?
radical surgery (that’s the only treatment)
True or False: The prognosis of chondrosarcoma is good.
False, generally its considered poor
- location in relation to vital structures determines prognosis because RADICAL surgery is the only treatment option
- death = direct extension of tumor into vital structures
Osteosarcoma is a malignancy of bone which shows production of ______ by tumor cells.
osteoid
True or False: Osteosarcoma is the most common primary bone malignancy.
True
** “PRIMARY” IS KEY**
the most common bone malignancy is metastatic disease…then multiple myeloma
Primary disease: osteosarcoma>chondrosarcoma
Of the 900 new cases of osteosarcoma that occur annually in the Unites States, what percentage of these affect the jaws?
7%
Osteosarcoma develops in the long bones, around the _____ area at a mean age of 18 years.
knee
Patients with osteosarcoma of the jaws have a mean age of _____ years.
28
True or False: Osteosarcoma of the jaws has a different presentation epidemiologically compared to osteosarcoma of the long bones.
True
What is the skeletal distribution of osteosarcoma?
80% knee
15% pelvis
10% shoulder
8% jaws
(remember, chondrosarcoma = femur, ribs, pelvis)
What is the initial sign/complaint of osteosarcoma?
PAIN… then swelling, loose teeth, and paresthesia
chondro may not have pain
True or False: The “sun burst” pattern is common for osteosarcoma of the jaws
False, uncommon
*mixed radiopaque-radiolucent
Clinically, osteosarcoma appears as a ______ expansive mass and radiographically with loss of lamina dura.
bone-hard mass
Histopathologically, osteosarcoma presents with infiltrating sheets of malignant _______-shaped cells.
spindle
Prior treatment for osteosarcoma was radical surgery, now there has been an induction of ______ then surgery to remove the tumor.
chemotherapy
What is the 5 year survival for osteosarcoma (historically)?
30-50%
Osteosarcoma can metastasize via the _____ into the ___, ____, and ____.
blood
lung, liver, and brain
What is the most common malignancy of bone?
METASTATIC DISEASE
True or False: Metastatic disease commonly affects the jaws.
False, only about 1% are oral
Only 1% of metastatic tumors are in the oral cavity. Then why is it so important to be aware of the disease?
Batson’s Paravertebral Plexus of Veins!!!!
*metastatic deposits below the neck can spread through retrograde, valveless circulation that bypasses filtration
Batson’s Plexus is _______ and connects the deep pelvic veins to the thoracic veins in the internal ______ plexus.
valveless
Over half of patients affected by metastatic disease are over _____ years of age.
50% over 50 years old
50/50
Of the intraoral cases of metastatic disease, what percentage are in the mandible, maxilla, or soft tissue?
mandible: 61%
maxilla: 24%
soft tissue: 15%
True or False: The tongue is the most common intraoral soft tissue site of metastatic disease.
False, GINGIVA 54%….tongue 22.5%
If a tooth socket does not heal after extraction, what are the three possible considerations?
- granulation tissue
- lymphoma
- metastatic disease
Histopatholocally, metastatic lesions appear as scattered clusters of lesional cells that give it a _____ effect. Lesions will carry the pattern of the _______.
“seeded” effect
primary malignancy from which they arose
**Common Primary Sites** breast lung colon thyroid prostate kidney melanomas
Metastatic disease appears as a poorly defined _____.
radiolucency
less commonly: moth eaten radiopacity
True or False: Radiation therapy for metastatic disease is curative.
False, most patients die within one year of diagnosis
How is metastatic disease treated?
palliation (usually radiation)
_____% of jaw metastases represent the initial manifestation of the malignant process of metastatic disease.
22%
