Malignant Bone Tumors Of The Jaw Flashcards
Benign bone tumors
Osteoblastoma
Osteoma
Osteochondroma
Malignant bone tumor
Osteosarcoma
Chondrosarcoma
Signs and symptoms of malignancy in the jaw
Paresthesia
Pain
Tooth mobility
Tooth resorption
Rapid growth
Acquired malocclusion
Radiographic changes
Uniformly widened PD membrane space
Ill-defined lesion
Unilateral coronoid hyperplasia
Osteochondroma
Benign neoplasm forming a bony projection with a cartilagenous cap, with continuity between the marrow cavity of the tumor and underlying bone
Osteochondroma
Painless, facial asymmetry, trismus, TMJ dysfunction
Osteochondroma
Localization: coronoid process, mandibular condyle
Onset at puberty
Osteochondroma
Benign cartilagenous tumor of unknown cause. Rarely seen
Appears as painless, slowly progressive swelling
Chondroma
Chondroma that airses in the maxillary region usually found in?
Anterior region, where cartilaginous remnants of development are located
Location of mandibular chondromas
Body and symphysis area. Coronoid process and condyle
Equal gender predilection
Majority of tumors appear before age of 50
Chondroma
Irregular radiolucent. Foci of calcification within the radiolucent lesion
Chondroma
__ pharyngeal arch does meckel’s cartilage originate
First
A cartilage that forms in the embryonic development of lower jaw
Meckel’s cartilage
Well defined lobules of mature hyaline cartilage
Contains single regular nuclei
Chondroma
exhibits a heterogeneous pattern with cytologically
atypical and irregularly spaced chondrocytes.
Chondrosaroma
Treatment of chondroma
Surgical excision
3rd most common bone malignancy after myeloma and osteosarcoma
Chondrosarcoma
30 - 60 yo with 75% in men.
1% occur in skeleton
Chondrosarcoma
60% occur in maxillofacial region and 40% in mandible
Chondrosarcoma
Mandibular chondrosarcoma occus most often in
Premolar and molar region
Symphysis and coronoid process
Maxillary chondrosarcoma occurs in
Lateral incisor - canine region
Palate
No gender predilection
60yo
Chondrosarcoma
Common signs: painless swelling, bone expansion - loosening of teeth or dentures, pain, visual disturbances, nasal signs and headache
Chondrosarcoma
Moth-eaten radiolucencies that are solitary or multilocular to diffusely opaque lesions
Localized widening of the PDL space
Chondrosarcoma
Preferred method to image chondrosarcoma
computed tomography
DD of chondrosarcoma
Chondroma
Chondroblastic variant of osteosarcoma
Chondromyxoid fibroma
Have a lobular achitecture
Increased number if chondrocytes
Grade 1 - well differentiated chondrosarcoma
Enlarged chondrocyte nuclei displaying occasional mitotic figures.
Increased cellularity at the periphery of the cartilaginous lobules
Grade 2 - intermediate chondrosarcoma
Markedly cellular, often with a spindle cell component.
Mitotic figures may be numerous
Grade 3 - poorly differentiated
5 year Survival rate and metastasis in chondrosarcoma
GRADE 1 - 78%; 4%
GRADE 2 - 53%; 10%
GRADE 3 - 22%; 70% - metastasis in lungs
Most common primary bone tumor (5%)
Osteosarcoma
Exits in other bone disease: paget’s disease, fibrous dysplasia, multiple osteochondromas, osteomyelitis, osteogenesis imperfecta
3-4 onset of symptoms prior to diagnosis
Osteosarcoma
Etiology of osteosarcoma
Gene that may be altered -
p53
Rb
Amet
fos
sas
mdm2
cdk4
c-myc
Swelling, pain, pdl invasian, tooth mobility
35 age: range from 8 to 85yo
= gender predilection
60 % Mandible > maxilla
Osteosarcoma
Osteosarcoma can a,so arise in two cancer susceptibility syndromes __ and __
They sre both inherited and acquired forms of Rb
Hereditaryvretinoblastoma (Rb) and Li-Fraumeni syndrome
Comon site of osteosarcoma
Body and angle of mandible, symphysis, ascending ramus, tmj
Cardinal sign of malignancy
Paresthesia, caused by compression or infiltration of adjacent nerves by tumor
Radiographically, early osteosarcoma shows what characteristics?
Localized swelling in pdl of one or two teeth (due to tumor invasion)
Histologic subtype: when malignant cartilage predominates
Chondroblastic osteosarcoma
Histologic subtype: when malignant bone and osteoid predominates
Osteoblastic osteosarcoma
Histologic subtype: when spindle cells predominate
Fibroblastic osteosarcoma
Rare variant, that microscopically, resembles fibrous dysplasia because of the minimally atypical spindle cell proliferation with occasional mitotic figures and bone spicules
Central low-grade osteosarcoma
A useful immunohistochemistry marker to identify low grade osteosarcoma
CDK4 AND MDM2
Is CDK4 and MDM2 positive in high grade osteosarcoma?
No
Most common subtype of osteosarcoma
Chondrobastic osteosarcoma
(Maybe misdiagnosed as chondrosarcoma)
Treatment of osteosarcoma
Radical surgery, chemo and radio
Osteosarcoma that arise at the periphery of bone at the periosteal surface
Uncommon neoplasm
Juxtacortical osteosarcoma
Peak incidence 39 yo
Most common: distal femoral, metaphysis
3:2 female predominance. If jaw, male
Parosteal osteosarcoma
long-standing, slow-growing, swelling or palpable mass,
often accompanied by a dull, aching sensation
Attached to the external surface of bone by a broad sessile base
Radiopaque at the base than the periphery
Parosteal osteosarcoma
20 yo peak incidence
2:1 male
Involve upper tibial metaphysis
Very rare
Periosteal osteosarcoma
Codman’s triangle
Periosteal osteosarcoma
Consistent imagine features, tumor cells producing immature osteod premative invasion, entrapment of healthy host bone
Osteosarcoma
Malignant tumor with cartilaginous matrix, entrapped pre-existing bone, lack of neoplastic bone or osteoid formation
Chondrosarcoma
Soft tissue mass composed off nodules of cartilage, hyaline or myxoid matrix that may calcify, few mitosis
Chondroma
Pedunculated eor broad-based exostosis, cartilaginous cap with a growth plate-like architecture, continuity with underlying bone cortex and marrow
Osteochondroma
Osteobladtic riming
Ossifying fibroma
Osteoblastoma
Associated with gardner syndrome
Osteoma
