Oral Path Exam 1 - Mixed Lesions and Radiolucent or Mixed Lesions Part 1

Question 1

Mixed lesions always have a ____________ element and a _____________ element

Answer 1

radiopaque; radiolucent

Question 2

The radiopaque component of the mixed lesion represents some sort of ___________

Answer 2

calcification

Question 3

Where is the following calcification seen in a mixed lesion derived from?

Bone or cartilage

Answer 3

Bone

Question 4

Where is the following calcification seen in a mixed lesion derived from?

Tooth-related material

Answer 4

Cementum, dentin, and/or enamel

Question 5

Where is the following calcification seen in a mixed lesion derived from?

Dystrophic calcification

Answer 5

Pathologic

(if the tissue is dead, degenerative, or scarred)

Question 6

What type of lesion?

Rare neoplasm that arises from the PDL

Answer 6

Cementoblastoma

Question 7

What type of lesion?

Affects young adults
Found in the posterior mandible, especially the 1st permanent molar

Answer 7

Cementoblastoma

Question 8

What type of lesion?

Symptoms = pain + swelling

Answer 8

Cementoblastoma

Question 9

What type of lesion?

Looks like an opaque mass fused to root(s) and has a thin radiolucent rim around the mass in mature lesions

Answer 9

Cementoblastoma

Question 10

What type of lesion?

Tx = conservative excision w/ either tooth root amputation and endo, or just ext

Answer 10

Cementoblastoma

Question 11

Does cementoblastoma have a low or high recurrence?

Answer 11

Low recurrence

Question 12

What type of lesion?

Histologically: cellular cementum with plump cementoblasts

Answer 12

Cementoblastoma

Question 13

What type of lesion?

Histologically: often a periphery of radiating columns of calcified material

Answer 13

Cementoblastoma

Question 14

What type of lesion may be mistaken for osteosarcoma?

Answer 14

Cementoblastoma

Question 15

What is the most common odontogenic tumor?

Answer 15

Odontoma

Question 16

What type of lesion?

Detected before 20 yrs, frequently associated with an unerupted tooth

Answer 16

Odontoma

Question 17

What type of lesion?

Typically asymptomatic

Answer 17

Odontoma

Question 18

What are the 2 types of odontomas?

Answer 18

Compound
Complex

Question 19

What type of odontoma?

Found in anterior jaw

Answer 19

Compound odontoma

Question 20

What type of odontoma?

May be associated with unerupted tooth

Answer 20

Compound odontoma

Question 21

What type of odontoma?

Resembles small teeth (toothlets/denticles)

Answer 21

Compound odontoma

Question 22

What type of odontoma?

Found in posterior jaw

Answer 22

Complex odontoma

Question 23

What type of odontoma?

Dense radiopaque mass surrounded by radiolucent rim, usually pericoronal to impacted tooth

Answer 23

Complex odontoma

Question 24

What type of odontoma?

Has odontogenic tissues, but does NOT form small tooth-appearing structures

Answer 24

Complex odontoma

Question 25

What type of lesion? Tx = enucleation, no recurrence

Answer 25

Odontoma

Question 26

Benign or malignant/infectious/inflammatory? Odontogenic cyst w/ calcification

Answer 26

Benign

Question 27

Benign or malignant/infectious/inflammatory? Odontogenic tumor w/ calcification

Answer 27

Benign

Question 28

Benign or malignant/infectious/inflammatory? Paget disease of bone

Answer 28

Benign

Question 29

Benign or malignant/infectious/inflammatory? Fibro-osseous lesions like fibrous dysplasia, cemento-osseous dysplasia, central ossifying fibroma

Answer 29

Benign

Question 30

What type of lesion? Also called the Gorlin cyst

Answer 30

Calcifying odontogenic cyst

Question 31

What type of lesion? Wide age range Found in anterior jaw Root resorption/divergence can be seen

Answer 31

Calcifying odontogenic cyst

Question 32

What type of lesion? Usually a unilocular radiolucency, but up to 50% can have calcifications (mixed appearance)

Answer 32

Calcifying odontogenic cyst

Question 33

What type of lesion? Tx = enucleation + curettage; unlikely recurrence

Answer 33

Calcifying odontogenic cyst

Question 34

___________ odontogenic tumors can be radiolucent or mixed

Answer 34

Yellow

Question 35

What are the 3 odontogenic tumor classifications?

Answer 35

Odontogenic epithelium Odontogenic ectomesenchyme Mixed (epithelium + ectomesenchyme)

Question 36

What type of odontogenic tumor w/ calcification? Looks identical to complex odontoma

Answer 36

Ameloblastic fibro-odontoma

Question 37

All of the benign odontogenic cysts and tumors are asymptomatic or present with a slow growing swelling/expansion with either a unilocular or a multilocular presentation and +/- root divergence and resorption. Unless secondarily infected, pain would only be expected with what?

Answer 37

Cementoblastoma

Question 38

What are the 3 lesions that are clear cut features of a mixed appearance?

Answer 38

Compound odontoma Complex odontoma Ameloblastic fibro-odontoma

Question 39

In lesions where you see calcification in the tooth-bearing portions of the jaws or in association with an unerupted/impacted tooth that can’t clearly be separated by presentation, how you can simplify the diff. dx?

Answer 39

Benign odontogenic cyst or tumor w/ calcification

Question 40

What disease? Also called osteitis deformans

Answer 40

Paget Disease of bone

Question 41

What disease? Increased/uncontrolled bone remodeling, resulting in thickened but distorted and weakened bones

Answer 41

Paget Disease of bone

Question 42

What disease? Unknown cause Found in people older than 40 Anglo-Saxon ancestry

Answer 42

Paget Disease of bone

Question 43

What disease? May have bone pain, possible fractures, deafness, and blindness

Answer 43

Paget Disease of bone

Question 44

What disease? Most cases are polyostotic and affect the pelvis, femur, lumbar vertebrae, skull (hat doesn't fit), and tibia

Answer 44

Paget Disease of bone

Question 45

What disease? When jaw is affected, causes symmetric enlargement (dentures don't fit) and spaces develop between the teeth

Answer 45

Paget Disease of bone

Question 46

What jaw is more often affected in Paget Disease of bone?

Answer 46

Maxillary

Question 47

What disease? Elevated total serum alkaline phosphatase (marker of osteoblastic activity)

Answer 47

Paget Disease of bone

Question 48

What disease? Chronic progression from vascular phase to late lesions that show patchy sclerosis (cotton-wool) appearance w/ thickened cortices

Answer 48

Paget Disease of bone

Question 49

What disease? Extensive hypercementosis of teeth

Answer 49

Paget Disease of bone

Question 50

What disease? Tx = NSAIDs for mild pain, bisphosphonates to slow bone turnover, and monitor pts for development of bone tumors

Answer 50

Paget Disease of bone

Question 51

What type of bone tumor could a patient with Paget Disease of bone develop later?

Answer 51

Osteosarcoma

Question 52

What disease? Exts can be hard due to hypercementosis and ankylosis

Answer 52

Paget Disease of bone

Question 53

What disease? Place implants with caution!

Answer 53

Paget Disease of bone

Question 54

What disease? Surgical bleeding risk during vascular lytic phase

Answer 54

Paget Disease of bone

Question 55

What disease? Poor wound healing with risk for osteomyelitis during sclerotic phase

Answer 55

Paget Disease of bone

Question 56

Non-specific term that describes a group of processes, with different pathogeneses, where normal bone is replaced by fibrous tissue with a newly formed mineralized product

Answer 56

Fibro-osseous lesions

Question 57

Accurate diagnosis requires correlation of the clinical and radiographic features with the microscopic features because they can look very similar microscopically

Answer 57

Fibro-osseous lesions

Question 58

What are the 3 fibro-osseous lesions of the jaws?

Answer 58

Fibrous dysplasia Cemento-osseous dysplasia Central ossifying fibroma

Question 59

What type of fibro-osseous lesion? Developmental, tumor like lesion due to a stimulatory G protein gene mutation (GNAS)

Answer 59

Fibrous dysplasia

Question 60

What type of fibro-osseous lesion? Presents in 20s or 30s Slowly growing + painless swelling

Answer 60

Fibrous dysplasia

Question 61

What type of fibro-osseous lesion? Usually monostotic; jaws are affected If polyostotic, can see cafe au lait pigmentation and endocrine issues

Answer 61

Fibrous dysplasia

Question 62

What type of fibro-osseous lesion? Maxillary lesions that involve adjacent facial bones can cause facial deformity

Answer 62

Fibrous dysplasia (craniofacial)

Question 63

What type of fibro-osseous lesion? Early lesions look radiolucent or mottled, followed by classic "ground glass" pattern with blending margins

Answer 63

Fibrous dysplasia

Question 64

What type of fibro-osseous lesion? Tx = surgical reduction if significant cosmetic or functional deformity; conservative management is advised!!

Answer 64

Fibrous dysplasia

Question 65

What type of fibro-osseous lesion? Benign neoplasm derived from bone, but often has cementum-like material in it as well

Answer 65

Central ossifying fibroma

Question 66

What type of fibro-osseous lesion? Most often found in the posterior mandible

Answer 66

Central ossifying fibroma

Question 67

What type of fibro-osseous lesion? Asymptomatic when small Large lesions have painless swelling

Answer 67

Central ossifying fibroma

Question 68

What type of fibro-osseous lesion? Well-defined, unilocular, expansile, radiolucent or mixed

Answer 68

Central ossifying fibroma

Question 69

What type of fibro-osseous lesion? When mixed, it has a central radiopacity with a radiolucent periphery

Answer 69

Central ossifying fibroma

Question 70

What type of fibro-osseous lesion? May cause divergence or resorption of roots

Answer 70

Central ossifying fibroma

Question 71

What type of fibro-osseous lesion? During surgical exploration, lesion shells out as one potato-like mass

Answer 71

Central ossifying fibroma

Question 72

What type of fibro-osseous lesion? Made up of cellular fibrous CT w/ interspersed trabeculae or spherules of mineralized tissue that resembles bone and/or cementum (need x-rays and history to diagnose!)

Answer 72

Central ossifying fibroma

Question 73

What type of fibro-osseous lesion? Tx = enucleation

Answer 73

Central ossifying fibroma

Question 74

What type of fibro-osseous lesion? Found in middle-aged females greater than 30, often in blacks

Answer 74

Cemento-osseous dysplasia

Question 75

What type of fibro-osseous lesion? Painless No expansion Found around tooth roots/apices

Answer 75

Cemento-osseous dysplasia

Question 76

Are teeth vital or non-vital in cemento-osseous dysplasia?

Answer 76

Vital!

Question 77

What type of fibro-osseous lesion? Well-defined, irregular borders, unilocular radiolucency that develops a central radiopacity over time

Answer 77

Cemento-osseous dysplasia

Question 78

What type of fibro-osseous lesion? Tissue looks easily fragmented, gritty, red/brown early on; becomes more dense as it matures

Answer 78

Cemento-osseous dysplasia

Question 79

What type of fibro-osseous lesion? Tx = vitality testing to prevent doing RCT, take pano to check for multiple lesions, follow-up is all that is needed

Answer 79

Cemento-osseous dysplasia

Question 80

What are the 3 variants of cemento-osseous dysplasia?

Answer 80

Focal PA Florid

Question 81

Which variant of cemento-osseous dysplasia? Solitary lesion in posterior mandible

Answer 81

Focal

Question 82

Which variant of cemento-osseous dysplasia? Mimics central ossifying fibroma, so it requires biopsy

Answer 82

Focal

Question 83

Which variant of cemento-osseous dysplasia? Multiple lesions in anterior jaw

Answer 83

PA

Question 84

Which variant of cemento-osseous dysplasia? Found in bilateral mandible (anterior + posterior) and can affect all 4 quadrants

Answer 84

Florid

Question 85

Which variant of cemento-osseous dysplasia? Dense radiopacities that CAN fuse to roots

Answer 85

Florid

Question 86

Which variant of cemento-osseous dysplasia? Bone exposure can cause secondary infection and sequestration

Answer 86

Florid