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Module 7 > ORAL PATH bone pathology > Flashcards

ORAL PATH bone pathology Flashcards

1
Q

how are diagnoses of bone diseases achieved?

A

a combination of clinical, radiological, histological and biochemical investigations

biochemical: serum levels of calcium, phosphorus and alkaline phosphatase

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2
Q

list the types of giant cell lesions and bone cysts?

A

central giant cell granuloma
peripheral giant cell granuloma
cherubism
aneurysmal bone cyst
simple bone cyst

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3
Q

describe a central giant cell granuloma?

A

localised benign (but can be aggressive) lesion
common in the mandible
often asymptomatic

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4
Q

what factor leads to the progression of central giant cell granuloma to peripheral giant cell granuloma?

A

if the cortical plate perforates = peripheral

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5
Q

histopathology of central giant cell granuloma?

A

large numbers of multi-nucleate osteoclast like giant cells
set in vascular fibrous stroma
areas of haemorrhage and haemosiderin

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6
Q

what bone lesions are indistinguishable histologically?

A

cherubism
brown tumour of hyperparathyroidism
giant cell tumour
aneurysmal bone cyst
central giant cell granuloma

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7
Q

what is cherubism?

A

rare inherited autosomal dominant disease which causes distension of the jaws

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8
Q

describe symptoms of cherubism?

A

between age 2-4 painless bilateral swelling of the jaws
symmetrical
enlarge until age 7
may regress by adulthood

lesions cause fullness of cheeks and in severe cases maxillary swellings cause eyes to look upward - cherub-like appearance

may have dental anomilies

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9
Q

histopathology of cherubism?

A

lesions consist mainly of cellular and vascular fibrous tissue - contain varying numbers of multinucleate giant cells

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10
Q

as activity in cherubism decreases, what happens to the lesions?

A

become progressively more fibrous and numbers of giant cells decrease

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10
Q

list the types of fibro-osseous tumours and dysplasias?

A

cemento-osseous dysplasia
fibrous dysplasia
juvenile trabecular ossifying fibroma
psammomatoid ossifying fibroma
familial gigantiform cementoma

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11
Q

what are all fibro-osseous lesions histologically characterised by?

A

replacement of normal bone by cellular fibrous tissue within which islands and trabeculae of metaplastic bone develop

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12
Q

what is cemento-osseous dysplasia?

A

fibro-osseous lesion occurring in tooth bearing areas of jaws

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13
Q

what is the most common fibro-osseous lesion of jaws?

A

cemento-osseous dysplasia

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14
Q

cemento-osseous dysplasia symptoms?

A

often asymptomatic
involved teeth remain vital

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15
Q

what is cemento-osseous dysplasia characterised by?

A

replacement of normal bone by fibrous tissue and varying amounts of metaplastic bone and cementum-like material

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16
Q

who is predilected to cemento-osseous dysplasia?

A

middle-aged african/ african-american females

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17
Q

what are the 4 forms of cemento-fibrous dysplasia?

A

periapical cemento-osseous dysplasia
focal cemento-osseous dysplasia
florid cemento-osseous dysplasia
familial florid cemento-osseous dysplasia

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18
Q

where do you find periapical cemento-osseous dysplasia?

A

involves apical incisor region of mandible
several adjacent teeth involved

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19
Q

what differs focal from florid cemento-osseous dysplsia?

A

focal - single tooth
florid - multifocal/ multiquad

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20
Q

treatment for cemento-osseous dysplasia?

A

surgery only if symptomatic

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21
Q

what is fibrous dysplasia of bone?

A

fibro-osseous lesion of growing bones
sporadic condition
GNAS1 mutation

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22
Q

what are the 2 types of fibrous dysplasia of bone?

A

monostotic - involving one bone
polyostotic - involving several bones

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23
Q

what type of fibrous dysplasia is more common?

A

monostotic

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24
Q

describe symptoms of monostotic fibrous dysplasia?

A

painless bony swelling, facial asymmetry
usually starts in childhood, arrests in adulthood

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25
Q

where do you find monostotic fibrous dysplasia?

A

maxilla> mandible
maxillary lesions often involve adjacent bones (craniofacial fibrous dysplasia)

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26
Q

describe monostotic fibrous dysplasia lesions radiographically?

A

orange-peel/ ground glass effect

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27
Q

what abnormalities are associated with polyostotic fibrous dysplasia?

A

skin pigmentation and endocrine abonormalities

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28
Q

what syndrome comprises of polyostotic fibrous dysplasia?

A

albrights syndrome

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29
Q

histopathology of fibrous dysplasia?

A

irregularly shaped slender trabeculae of woven bone lying in very cellular fibrous tissue
fuses directly with normal bone at edges of lesion

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30
Q

treatment for fibrous dysplasia?

A

aesthetic surgery

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31
Q

can malignant change occur in fibrous dysplasia?

A

rare - if it does it is typically osteosarcoma

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32
Q

what are the 3 types of ossifying fibroma?

A

cemento-ossifying fibroma
juvenile trabecular ossifying fibroma
psammomatoid ossifying fibroma

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33
Q

clinical features of cemento-ossifying fibroma?

A

occurs in tooth-bearing areas of jaws
slow, painless expansion of jaw
F>M
mandible> maxilla

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34
Q

what is an important features in distinguishing fibrous dysplasia and cemento-ossifying fibroma?

A

cemento-ossifying fibroma - well demarcated

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35
Q

treatment for cemento-ossifying fibroma?

A

enucleation and curettage or resection
can recur

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36
Q

clinical features of juvenile trabecular ossifying fibroma?

A

painless rapid expansion of the jaw
children and adolescents
mandible = maxilla

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37
Q

treatment for juvenile trabecular ossifying fibroma?

A

enucleation and curettage or resection
can recur

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38
Q

clinical features of psammomatoid ossifying fibroma?

A

usually painless fast bone expansion
can occur in jaws but most arise in craniofacial bones around paranasal sinuses and orbit
M>F

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39
Q

treatment for psammomatoid ossifying fibroma?

A

complete excision
can recur

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40
Q

what is familial gigantiform cementoma?

A

rare form of fibro-osseous lesion of jaws
early onset of fast growing multifocal/ multiquadrant expansive lesions
may be massive with facial deformity

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41
Q

treatment for familial gigantiform cementoma?

A

surgery - difficult!!

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42
Q

what is segmental odontomaxillary dysplasia?

A

rare developmental disorder
sporadic
unilateral

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43
Q

what is segmental odontomaxillary dysplasia characterised by?

A

segmental maxillary and soft tissue enlargement with dento-osseous abnormalities
can be ipsilateral cutaneous manifestations

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44
Q

segmental odontomaxillary dysplasia clinical features?

A

painless palatal and buccal expansion
dental abnormalities and failure of tooth eruption

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45
Q

list benign maxillofacial bone and cartilage tumours?

A

osteoma
osteochondroma
osteoblastoma
chrondroblastoma
chrondomyxoid fibroma
desmoplastic fibroma of bone

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46
Q

what is an osteoma?

A

benign slow growing tumour consisting of well-differentiated mature bone

usually solitary lesion

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47
Q

where do you find osteomas?

A

mostly in adults M>F
mandible>maxilla

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48
Q

what type of syndrome may you find multiple osteoma lesions?

A

gardeners syndrome - a rare AD disorder

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49
Q

histopathologically, what are the 2 types of osteomas?

A

compact type - mass of dense lamellar bone with few marrow spaces
cancellous type - interconnecting trabeculae enclosing fatty or fibrous marrow

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50
Q

treatment for osteomas?

A

lesions removed if symptomatic or causing problems with fit of denture

51
Q

what is an osteochondroma?

A

bony projection with a cap of cartilage which is continuous with underlying bone

rare in maxillofacial bones

52
Q

treatment for osteochondroma?

A

complete excision

53
Q

what is an osteoblastoma?

A

benign but aggressive bone forming tumour

54
Q

what is a chondroblastoma?

A

benign tumour of bone composed of chondroblasts

55
Q

what is a chondromyxoid fibroma?

A

benign chondroid tumour

56
Q

what is a desmoplastic fibroma of bone?

A

locally aggressive fibroblastic/ myofibroblastic tumour

57
Q

list malignant maxillofacial bone and cartilage tumours?

A

osteosarcoma of the jaw
chrondrosarcoma family of tumours
mesenchymal chondrosarcoma
rhabdomyosarcoma with TFCP2 rearrangement

58
Q

what is osteosarcoma of the jaw?

A

rare group of malignant bone neoplasms in which the cells produce immature bone

59
Q

what are chrondrosarcoma family of tumours?

A

malignant bone neoplasm that produces a cartilaginous matrix - rare

60
Q

what are mesenchymal chondrosarcomas?

A

rare high grade biphasic malignant cartilaginous neoplasm

61
Q

what are rhabdomyosarcoma with TFCP2 rearrangement?

A

high grade rhabdomyosarcoma with specific gene rearrangement - most occur in bone

62
Q

list inherited disorders of bone?

A

osteogenesis imperfecta
osteopetrosis
cleidocranial dysplasia
achondroplasia

63
Q

osteogenesis imperfecta aetiology?

A

hereditary : AD and AR and sporadic

64
Q

what is osteogenesis imperfecta?

A

impairment of collagen maturation
collagen is component of bone, ligaments, sclerae, dentine and skin

65
Q

what is the most common type of osteogenesis imperfecta?

A

type I mild

66
Q

what are some clinical features of osteogenesis imperfecta?

A

easily fractured, osteoporotic bone
affected teeth appear as in dentinogenesis imperfecta
malocclusion may be a problem

67
Q

what is osteopetrosis?

A

(marble bone disease)
increase in bone density due to failure of normal osteoclast activity and absence of normal modelling resorption

68
Q

what are the 2 forms of osteopetrosis?

A

infantile and adult forms

69
Q

what disorder is common in people with osteopetrosis and why?

A

anaemia - marrow space deficiency

70
Q

what is a complication of osteopetrosis? why is this important to dentists?

A

osteomyelitis - high risk when dental infection present

71
Q

what is cleidocranial dysplasia?

A

rare genetic disorder: AD and sporadic
abnormalities of many bones - notable defective formation of clavicles, delayed closure of fontanelles and sometimes retrusion of maxilla

72
Q

what dental anomalies are common in patients with cleidocranial dysplasia?

A

delayed eruption of permanent dentition
supernumerary teeth

narrow, high-arched palate

73
Q

what is achondroplasia?

A

abnormality in endochondral ossification
head and trunk normal but limbs are excessively short

74
Q

dental features of achondroplasia?

A

defective growth at base of skull leads to retrusive maxilla, resulting in severe malocclusion

75
Q

list metabolic and endocrine disorders of bone?

A

osteoporosis
hyperparathyroidism
rickets and osteomalacia
acromegaly

76
Q

describe osteoporosis bones?

A

excessive bone lose or apposition of bone is reduced
bone is of normal composition but is reduced in quantity
cortex is thinned and more marrow spaces in the cancellous bone associated with thin trabeculae

77
Q

what type of patients is osteoporosis most common in?

A

post menopausal women
present in cushings syndrome, thyrotoxicosis, and primary hyperparathyroidism

78
Q

what medication do people with osteoporosis tend to take?

A

bisphosphonates

79
Q

what is hyperparathyroidism?

A

overproduction of parathormone, PTH

80
Q

What causes primary hyperparathyroidism?

A

hyperplasia or adenoma of parathyroids

81
Q

what causes secondary hyperparathyroidism to develop?

A

parathormone is produced in response to chronic low levels of calcium - often seen in chronic renal disease

82
Q

what does a hyperparathyroidism patient present with?

A

stones - renal calculi
bones - various bone lesions including ‘brown tumour’ of hyperparathyroidism
abdominal groans - duodenal ulcers

83
Q

how may hyperparathyroidism present in dental patients?

A

cyst-like swelling of the jaw - has histological features of a giant-cell lesion

84
Q

what is rickets?

A

deficiency or resistance to the action of vitamin D

85
Q

what is rickets adult counterpart?

A

osteomalacia

86
Q

dental defects in rickets/ osteomalacia pts?

A

rarely seen except in severe cases when hypocalcification of dentine and enamel hypoplasia occur
may also be a delay in tooth eruption

87
Q

what is acromegaly caused by?

A

prolonged and excessive secretion of growth hormone - due to the anterior pituitary tumour developing after epiphyses have closed

88
Q

what occurs in acromegaly?

A

renewed growth of the bones of the jaws, hands and feet with soft tissue overgrowth also

89
Q

what are the dental features of acromegaly?

A

enlarged jaw
protrusive jaw
spacing between teeth
thickening of facial soft tissues

90
Q

list inflammatory diseases of bone?

A

alveolar osteitis (dry socket)
osteomyelitis
radiation injury and osteoradionecrosis
MRONJ
Pagets disease of bone (osteitis deformans)

91
Q

when may a patient experience alveolar osteitits?

A

complication of XLA - particularly in lower molars

92
Q

how does alveolar osteitis occur?

A

failure of blood clot to form or dislodgment or breakdown of clot
bone socket becomes infected and necrotic

93
Q

how is alveolar osteitis localised to the walls of the socket?

A

inflammatory reaction in the adjacent marrow

94
Q

if alveolar osteitis wasnt localised to the socket, what would occur?

A

osteomyelitis

95
Q

what is osteomyelitis?

A

spectrum of inflammatory and reactive changes in bone and periosteum
typically in mandible of adults

96
Q

what are the different forms of osteomyelitis?

A

acute and chronic suppurative
non-suppurative and sclerotic forms

97
Q

what factors change the severity of osteomyelitis?

A

nature and severity or the irritant
host defences
local and systemic predisposing factors

98
Q

describe radiation injury and osteoradionecrosis?

A

radiation affects the vascularity of bone
the non vital bone is very susceptible to infection and trauma
infection can spread rapidly through irradiated bone, resulting in osteomyelitis and painful necrosis of bone

99
Q

why is ORN serious in the mandible?

A

its end artery supply - ID artery or its branches become thrombosed

100
Q

what drugs can cause MRONJ?

A

bisphosphonates
anti-angiogenic drugs

101
Q

bisphosphonate mode of action?

A

inhibit osteoclasts

102
Q

anti-angiogenic drug mode of action?

A

restrict vascularisation (of tumours)

103
Q

what disease are bisphosphonates used for?

A

some cancers
pagets disease
osteoporosis

104
Q

define MRONJ?

A

exposed bone, or bone that can be probed through an intraoral or extraoral fistula, in the maxillofacial region that has persisted for more than 8 weeks in patients
with a history of tx with anti-resorptive/ anti-angiogenic drugs
and where there has been no history of radiation therapy to the jaw and no obvious metastatic disease to the jaws

105
Q

what are risk factors for MRONJ?

A

high dose
IV administration

106
Q

MRONJ symptoms?

A

delayed healing following XLA and other oral surgery
pain
soft tissue infection and swelling
numbness
paraesthesia
exposed bone

107
Q

histological features of MRONJ?

A

fragments of non vital bone often with prominent bacterial colonisation

108
Q

what is pagets disease of bone (osteitis deformans)?

A

a form of osteodystrophy characterised by disorganised formation and remodelling of bone unrelated to functional requirements

109
Q

what does pagets disease affect?

A

single or multiple bones
sacrum, spine, feroma and pelvis most common
maxilla more common that mandible

110
Q

what happens to the affected bones in Pagets disease?

A

affected bones are thickened but weaker and pathological fractures occur
progressive enlargement of skull and facial bones - hats dont fit, dentures dont fit
narrowing of foramina - cranial nerve deficits

111
Q

dental features of pagets disease?

A

in dentate, derangement of occlusion and spacing of the teeth can occur
hypercementosis and akylosis of teeth - xla difficulty
osteosarcoma - rare complication
giant cell tumours may arise in bones

112
Q

what are the 3 progressive and overlapping phases of Pagets disease?

A
  1. initial predominately osteolytic phase
  2. active stage of mixed osteolysis and osteogenesis
  3. predominately osteoblastic or sclerotic phase
113
Q

what is the main histopathological feature of pagets disease?

A

(varies with phase)
- irregular pattern of reversal lines
- many osteoblasts and osteoclasts
- fibrosis of marrow spaces and increased vascularity

‘mosaic’ pattern in the bone due to turnover

114
Q

describe early stage of pagets disease?

A

more resorption than osteblastic activity

115
Q

describe late stage of pagets disease?

A

bones are thick, cortex and medulla are obliterated and the whole bone is spongy in texture

116
Q

treatment for pagets disease?

A

calcitonin
bisphosphonates

117
Q

what are exostoses?

A

localised bony protuberances - non-neoplastic

118
Q

aetiology of exostosis?

A

developmental
chronic trauma

119
Q

what is a torus?

A

an exostosis which occurs at a characteristic site, either in midline of palate or lingual surface of mandible
usually premolar region above the mylohyoid line

120
Q

what type of bone makes up exostosis?

A

may be entirely dense cortical bone
or
cancellous bone with a shell of cortical bone

121
Q

what are the most common primary tumours which metastasise to bone?

A

jaws
breast
bronchus
prostate
thyroid
kidney

122
Q

what are jaw metastases indicative of?

A

life-threatening disease

123
Q

symptoms of jaw metastases?

A

jaw pain, swelling and paraesthesia/ anaesthesia

124
Q

what is the radiographic appearance of jaw metastases?

A

moth-eaten appearance

125
Q

where are the most common oral sites for metastases?

A

oral mucosa of the gingiva
alveolar mucosa
tongue

Module 7 (62 decks)

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