Oral Path Exam 1 - Bone Lesion Radiolucencies Part 2 Flashcards
What type of tumor?
Derived from/classified by presence of odontogenic epithelium and odontogenic ectomesenchyme
Odontogenic tumor
What is the tumor classification for the following?
Ameloblastoma
Adenomatoid odontogenic tumor
Calcifiying epithelial odontogenic tumor
Odontogenic epithelium
What is the tumor classification for the following?
Odontogenic fibroma
Odontogenic myxoma
Cementoblastoma
Odontogenic ectomesenchyme
What is the tumor classification for the following?
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Compound or complex odontoma
Mixed (epithelium + ectomesenchyme)
What type of tumor?
Locally invasive benign odontogenic epithelial tumor
Ameloblastoma
What type of tumor?
Wide age range; most commonly found in the posterior mandible
Ameloblastoma
What type of tumor?
Slow-growing
Painless
Unicystic or multicystic/solid (“conventional”) tumor
Ameloblastoma
Describe a “conventional” ameloblastoma
Multicystic/solid
What type of tumor?
Unilocular or multilocular radiolucency
Cortical expansion & thinning
Looks like soap bubbles
Can resorb or displace roots
Can be associated w/ impacted tooth
Ameloblastoma
What type of tumor?
Variety of patterns of enamel organ-like odontogenic epithelium; cystic formation is common
Ameloblastoma
In ameloblastomas, peripheral cells resemble _____________
ameloblasts
Columnar shaped cells with palisaded nuclei away from BM; has “reverse nuclear polarity”
Ameloblasts
In ameloblastomas, central cells are more spindled and resemble ___________ ___________
stellate reticulum
What type of tumor?
Often extends beyond radiographic margin
Ameloblastoma
What type of tumor?
Recurrence is common when treated with curettage, particuarly for larger lesions
Ameloblastoma
What type of tumor?
Smaller lesions are treated with aggressive curettage and peripheral ostectomy (bur the bone)
Ameloblastoma
What type of tumor?
Larger lesions are treated with marginal or segmental resection (1-2 cm beyond border)
Ameloblastoma
What type of tumor?
Follow pt for recurrence; rare malignant transformation
Ameloblastoma
What type of tumor?
Unilocular lesion that is entirely cystic; no solid component
Unicystic ameloblastoma
What type of tumor?
Pericoronal to unerupted 3rd molar
Unicystic ameloblastoma
What type of tumor?
Tx = decompression tube is used to shrink the cyst and thicken the epithelial lining to allow easier enucleation
Unicystic ameloblastoma
What type of tumor?
10-20% recurrence with enucleation and curettage, so it is less aggressive than a conventional ameloblastoma
Unicystic ameloblastoma
What type of tumor?
Painless nodule of alveolar or gingival mucosa
Peripheral ameloblastoma
Within the bone
Central
In soft tissue, outside the bone
Peripheral
What type of tumor?
Very rare; any odontogenic cyst or tumor can do this
Peripheral ameloblastoma
What type of tumor?
Tx = excision with limited recurrence, so tx is similar to POF and PG
Peripheral ameloblastoma
What type of tumor?
Found in posterior jaws in pts under 20 years of age
Unilocular radiolucency associated with an impacted tooth
Solid tumor
Ameloblastic fibroma
When should you add ameloblastic fibroma to your differential?
If it’s a young patient and it’s NOT a 3rd molar
What type of tumor?
Found in both jaws and affects a wide age range
Odontogenic fibroma
There are malignant odontogenic tumors, but you can also have a malignant transformation of an odontogenic cyst. How do you distinguish from benign?
Pain + paresthesia
Ill-defined border w/ cortical destruction (rather than just thinning/expansion)
What type of lesion?
Intrabony lesion of unknown cause
Central giant cell granuloma
What type of lesion?
Reactive: some are small with no symptoms and slow growing (non-aggressive)
Central giant cell granuloma
What type of lesion?
Neoplastic: some are fast growing and destructive with cortical perforation, root resorption or displacement, can cause pain/paresthesia and extend into soft tissue (aggressive)
Central giant cell granuloma
What type of lesion?
60% occur in patients under 30
Central giant cell granuloma
What type of lesion?
Affects the mandible, often in the anterior and can cross midline
Central giant cell granuloma
What type of lesion?
Most often painless, expansile, unilocular/multilocular radiolucency that can displace and resorb teeth
Central giant cell granuloma
Central giant cell granulomas have multinucleated __________ cells, fibroblasts, monocyte/mac type cells, RBCs, and hemosiderin
giant
What does central mean? What does peripheral mean?
Central = in bone
Peripheral = in soft tissue
In central giant cell granulomas, what color is the tissue?
Dark brown
What should you always rule out if you see something that looks like a central giant cell granuloma?
Brown tumor of hyperparathyroidism
What type of lesion?
Tx = aggressive curettage if isolated
Central giant cell granuloma
What type of lesion?
Developmental depression in the bone due to normal salivary gland tissue (pseudocyst)
Stafne defect
What type of lesion?
Asymptomatic
Well-defined radiolucency
Sclerotic border of posterior mandible below IAN canal (submandibular gland) or anterior teeth (sublingual gland)
Stafne defect
What type of lesion?
Strong majority occur in men
Stafne defect
What type of lesion?
Although this is developmental, it occurs in middle-aged to older adults
Stafne defect
What type of lesion?
Diagnosed by CBCT
Tx = none
Stafne defect
What type of lesion?
Found in the posterior mandible within the mandibular canal
Schwannoma/neurofibroma
What type of lesion?
Well-defined
Unilocular/multilocular radiolucency
Pain + paresthesia may occur
Benign
Schwannoma/neurofibroma
What type of lesion?
Tx = conservative excision, little tendency to recur
Schwannoma/neurofibroma
What type of lesion?
May be associated with other conditions or syndromes
Bony vascular malformation
What type of lesion?
Has a direct connection of arterial and venous channels
Arteriovenous malformation
What type of lesion?
If high pressure/flow is maintained, biopsy or trauma can cause life-threatening hemorrhage
Arteriovenous malformation
What type of lesion?
Ill-defined
Cyst-like radiolucent defect
Multilocular
May detect pulsation on palpation or bruit (abnormal sound) on ascultation
Arteriovenous malformation
What type of lesion?
Overlying skin is warm
Arteriovenous malformation
What type of lesion?
Yields bright red blood on aspirate
Arteriovenous malformation
What type of lesion?
Tx = embolization +/- excision
Arteriovenous malformation
What should you do before opening into any radiolucent lesion?
Aspirate!!!
What should be your differential diagnosis?
Unilocular or multilocular periocoronal radiolucency in the jaws
Dentigerous cyst
OKC
Ameloblastoma
Other benign odontogenic tumor
What should be your differential diagnosis?
Unilocular or multilocular periapical/periradicular radiolucency in the jaws
OKC
Ameloblastoma
Other benign odontogenic tumor
(do NOT put PA cyst/granuloma -> they are always unilocular!)
What type of lesion?
Asymptomatic
Ill-defined radiolucency
Found in body of mandible at old ext site
Focal osteoporotic marrow defect
What type of lesion?
May resemble metastatic disease, biopsy is sometimes necessary
Focal osteoporotic marrow defect
What type of lesion?
Fatty and hematopoietic marrow seen microscopically
Focal osteoporotic marrow defect
What patients are typically affected by Focal osteoporotic marrow defects?
Middle-aged females
Is treatment needed for Focal osteoporotic marrow defects?
No!
(not connected with a hematologic disorder)
Lesions _________ the IAN canal are in the alveolar bone, and are usually tooth related
above
Lesions _________ the IAN canal are usually NOT tooth related
below
Lesions _________ the IAN canal have a vascular or neural origin
within
What are the following symptoms indicative of?
Pain (mimics a toothache)
Tooth mobility
Paresthesia (numb chin sign)
Rapid growth/expansion
Ill-defined
Radiolucent malignancies involving bone
What are the 4 radiolucent malignancies involving bone in children?
Leukemia
Lymphoma
Rhabdomyosarcoma
Ewing sarcoma
What are the 3 radiolucent malignancies involving bone in adults?
Metastatic carcinoma (mandible)
Lymphoma
Multiple myeloma
What type of malignancy?
Extranodal disease
May be isolated, or evidence of widespread disease
Non-Hodgkin Lymphoma
What type of malignancy?
In soft tissue:
Non-tender, diffuse swelling
Buccal vestibule, posterior hard palate or gingiva
Normal to red/purple, possibly ulcerated, with a boggy consistency
Non-Hodgkin Lymphoma
What type of malignancy?
In the jaws:
Vague pain (toothache-like)
Paresthesia, numb chin sign
Ill-defined
Expansion and perforation into soft tissue
Non-Hodgkin Lymphoma
What type of malignancy?
A common lymphoid malignancy; median age is 70 yrs old
Multiple myeloma
What type of malignancy?
Involves bone marrow with lytic lesions; often “punched-out” radiolucencies throughout the skeleton (vertebrae, ribs, skull)
Multiple myeloma
What type of malignancy?
Most frequent M protein is IgG
Multiple myeloma
What type of malignancy?
If kappa or lambda light chains are produced, their small size allows excretion in the urine (Bence-Jones proteins)
Multiple myeloma
What is the treatment for Multiple myeloma?
Chemotx
Bisphosphonates
What happens if you don’t treat Multiple myeloma?
Death in a year
Used to treat Multiple myeloma; proteasome inhibitors
Chemotx
Used to treat Multiple myeloma; inhibits bone resorption, reduces fractures and hypercalcemia
Bisphosphonates
A form of Multiple myeloma that may be asymptomatic for many years
Smoldering myeloma
