Malignant Bone Neoplasms

Question 1

What is the tissue of origin for Chondrosarcoma?

Answer 1

cartilage

Question 2

True or False: Most chondrosarcomas are seen in adult males in the 4th-6th decade (30s-50s).

Answer 2

True

Question 3

Which bones are most often affected by chondrosarcoma?

Answer 3

femur
pelvis
ribs

Question 4

What percentage of chondrosarcomas occur in the head and neck region? Is there pain or swelling?

Answer 4

10%

there may be pain, swelling, or loose teeth

Question 5

Radiographically, chondrosarcoma of the head and neck would appear as a poorly defined ______ with variable amounts of ______. Any alterations to the teeth?

Answer 5

radiolucency with varying radiopacity

may see widened PDL in the area of the tumor
loss of lamina dura
teeth test vital!

Question 6

How does chondrosarcoma appear histologically?

Answer 6

invasive lobules of atypical cells showing cartilaginous differentiation

• low stage = hyperchromatic cells spread out
• high stage = hyperchromatic cells clumped together

Question 7

What is the treatment for chondrosarcoma?

Answer 7

radical surgery (that’s the only treatment)

Question 8

True or False: The prognosis of chondrosarcoma is good.

Answer 8

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

Question 9

Osteosarcoma is a malignancy of bone which shows production of ______ by tumor cells.

Answer 9

osteoid

Question 10

True or False: Osteosarcoma is the most common primary bone malignancy.

Answer 10

True
** “PRIMARY” IS KEY**
the most common bone malignancy is metastatic disease…then multiple myeloma
Primary disease: osteosarcoma>chondrosarcoma

Question 11

Of the 900 new cases of osteosarcoma that occur annually in the Unites States, what percentage of these affect the jaws?

Answer 11

7%

Question 12

Osteosarcoma develops in the long bones, around the _____ area at a mean age of 18 years.

Answer 12

knee

Question 13

Patients with osteosarcoma of the jaws have a mean age of _____ years.

Answer 13

28

Question 14

True or False: Osteosarcoma of the jaws has a different presentation epidemiologically compared to osteosarcoma of the long bones.

Answer 14

True

Question 15

What is the skeletal distribution of osteosarcoma?

Answer 15

80% knee
15% pelvis
10% shoulder
8% jaws

(remember, chondrosarcoma = femur, ribs, pelvis)

Question 16

What is the initial sign/complaint of osteosarcoma?

Answer 16

PAIN… then swelling, loose teeth, and paresthesia

chondro may not have pain

Question 17

True or False: The “sun burst” pattern is common for osteosarcoma of the jaws

Answer 17

False, uncommon

*mixed radiopaque-radiolucent

Question 18

Clinically, osteosarcoma appears as a ______ expansive mass and radiographically with loss of lamina dura.

Answer 18

bone-hard mass

Question 19

Histopathologically, osteosarcoma presents with infiltrating sheets of malignant _______-shaped cells.

Answer 19

spindle

Question 20

Prior treatment for osteosarcoma was radical surgery, now there has been an induction of ______ then surgery to remove the tumor.

Answer 20

chemotherapy

Question 21

What is the 5 year survival for osteosarcoma (historically)?

Answer 21

30-50%

Question 22

Osteosarcoma can metastasize via the _____ into the ___, ____, and ____.

Answer 22

blood

lung, liver, and brain

Question 23

What is the most common malignancy of bone?

Answer 23

METASTATIC DISEASE

Question 24

True or False: Metastatic disease commonly affects the jaws.

Answer 24

False, only about 1% are oral

Question 25

Only 1% of metastatic tumors are in the oral cavity. Then why is it so important to be aware of the disease?

Answer 25

Batson’s Paravertebral Plexus of Veins!!!!

*metastatic deposits below the neck can spread through retrograde, valveless circulation that bypasses filtration

Question 26

Batson’s Plexus is _______ and connects the deep pelvic veins to the thoracic veins in the internal ______ plexus.

Answer 26

valveless

Question 27

Over half of patients affected by metastatic disease are over _____ years of age.

Answer 27

50% over 50 years old

50/50

Question 28

Of the intraoral cases of metastatic disease, what percentage are in the mandible, maxilla, or soft tissue?

Answer 28

mandible: 61%
maxilla: 24%
soft tissue: 15%

Question 29

True or False: The tongue is the most common intraoral soft tissue site of metastatic disease.

Answer 29

False, GINGIVA 54%….tongue 22.5%

Question 30

If a tooth socket does not heal after extraction, what are the three possible considerations?

Answer 30

• granulation tissue
• lymphoma
• metastatic disease

Question 31

Histopatholocally, metastatic lesions appear as scattered clusters of lesional cells that give it a _____ effect. Lesions will carry the pattern of the _______.

Answer 31

“seeded” effect
primary malignancy from which they arose

**Common Primary Sites**
breast
lung
colon
thyroid
prostate
kidney
melanomas

Question 32

Metastatic disease appears as a poorly defined _____.

Answer 32

radiolucency

less commonly: moth eaten radiopacity

Question 33

True or False: Radiation therapy for metastatic disease is curative.

Answer 33

False, most patients die within one year of diagnosis

Question 34

How is metastatic disease treated?

Answer 34

palliation (usually radiation)

Question 35

_____% of jaw metastases represent the initial manifestation of the malignant process of metastatic disease.

Answer 35

22%