pathology and radio overlap

Question 1

condensing osteitis

Answer 1

RP

teeth are non-vital need to do vitalility testing to differentiate between this and osteosclerosis

most likely MD M and PM

no RL rim

widening PDL because this is a chronic inflammatory response

Question 2

osteosclerosis

idiopathic osteosclerosis

Answer 2

RP

teeth are vital need this to diff between this and condensing osteitis

most likely MD M and PM

asymptomatic

well defined - a bit more well defined RP than condensing osteitis

NO RL BORDER.

variant: socket sclerosis when TE and excess sclerotic bone deposited

Question 3

periapical cemento-osseous dysplasia

Answer 3

periapical RP (initial-RL, intermediate- mixed, mature- RP)

teeth are VITAL

RL RIM condensing osteitis and osteosclerosis DO NOT have this

single or multiple

most common in ant md

no tx teeth vital

**COMMON IN MID AGED AFRICAN AMERICAN AND ASIAN WOMAN

Question 4

Focal cemento-osseous dysplasia

Answer 4

periapical RP (initial- RL, intermediate- mixed, mature- RP)

sclerotic border around lesion, THIN RL rim

most likely in post md

no tx

traumatic bone cysts may be associated with some COD –> florid

Question 5

florid cemento osseous dysplasia

Answer 5

a generalized RP of the JAW

assymptomatic, possible dull/low grade pain

multifocal often bilateral and symmetrical, needs to be in 2 or more quadrants to be considered florid

periapical and focal can become florid.

associated with traumatic bone cyst and these can be extensive

VITAL TEETH

no tx

Question 6

cementoblastoma

Answer 6

periapical RP, common around the md 1M but also PM

solitary lesion and expansile

tooth VITAL

often PAINFUL

will destroy ROOT will see the RP on the apex of the tooth osteoscleorosis doesnt seem to damage the rooth.

highest seen in young adults.

histo: benign cemento-like tissue. RP bc lots of cementum.

Tx: remove neoplasm, cementum and tooth will all be fused together

Question 7

hypercementosis

Answer 7

periapical RP

teeth VITAL

PDL, lamina dura are all in tact.

Gives the apex of root a bulbous-shape

**seen in Paget’s ds (pagets ds has an increased risk for developing osteosarcoma*)

Question 8

tori palatinus

Answer 8

solitary RP

an outgrowth of normal bone

seen superimposed with mx sinus

Question 9

exostoses

Answer 9

solitary RP

looks simi in histo to tori

no tx

Question 10

subpontic hyperostosis

Answer 10

solitary RP

outgrowth of bone could lead to soft tissue inflammation

seen underneath pontic of FPD

tx: removal of hyperostosis

Question 11

osteoma

Answer 11

solidarity RP

outgrowth of normal bone

jaw involvement - mostly mand

seen in Garderners Syndrome.

in males: compact osteoma

in females: cancellous osteoma

tx: remove if interefering with function

Question 12

odontoma

Answer 12

solitary RP

THE MOST COMMON ODONTOGENIC TUMOR basically a malformed tooth

can be compound (@ant) or complex (@post)

• Compound has a RL rim, more distinguishable while Complex looks like a large RP mass*
  tx: enucleation.

Question 13

root fragment

Answer 13

~radio only~

solitary RP

will be in the shape of a root

main diff dx for retained root tip = osteosclerosis

tx: removal if available, if it is in the bone with no path, leave and montior.

Question 14

fibrous dysplasia - monocystic

Answer 14

solitary RP

has ground glass appearnance, “fingerprint” pattern

ASYMMETRICAL

ill-defined borders

may have tooth displacement

tx: no radiation therapy, wait for the pt to stop growin bc that is when the lesion will stop too.

Question 15

fibrous dysplasia - polystotic

Answer 15

generalized RP

has ground glass appearnance, “fingerprint” pattern

ASYMMETRICAL

ill-defined borders, in more than one bone. can extend into mx sinus and may expand into ptyergoid process

may have tooth displacement

**skin has cafe au lait skin pigmentation, shepard cane bones and facial assymetry.

**Craniofacial FD, Jaffe-Lichtenstein Syndrome has FD, McCune-Albright Syndrome has FD

tx: no radiation therapy, wait for the pt to stop growin bc that is when the lesion will stop too.

Question 16

Pagets ds

Answer 16

generalized RP

lucent, mixed or RP

ground glass/loss of lamina dura

has abnormal resporption/appositon of bone. looks simi to florid FD, but Pagets has the entire mx and expansion is more uniform

**at high risk for developing osteosarcoma

• has generalized hypercementosis
  tx: control pain and try to decrease bone turnover inolved in lesion. Sx if in the way of funt. Calcitonin, bisphos.

Question 17

osteopetrosis two types

Answer 17

autosomal recessive: malignant. Seen in utero or infantile

autosomal dom: benign. Not present until adulthood.

involves reduces osteoclast bone resportion so bone density is increased, results in symmetric skeletal sclerosis. Bones are dense but abnormally brittle and fracture easily.

diffuse involvement

tx: bone marrow transplant, systemic steroids, ab and hyperbaric oxygent for osteomyelitis.

jawbones can delay tooth eruption and osteomyelitis

Question 18

chronic osteomyelitis

radio only

Answer 18

RL of variable size with irregular border

**moth-eaten appearance

**sequestra = pockets of necrotic bone

island of dead bone with RL surrouding it

inflammation of bone marrow (most commonly froma dental infection)

symptoms less severe than acute. More than 30 days (4weeks) for chronci

pt will have intermittent swelling, pain, low grade fever, lymphadenopathy, atrophic erythematous mucousa, denuded bone

tx: drain and irrigate region, ab therapy, debridement

Question 19

diffuse scleorosing osteomyelitis

*more heavy in radio*

Answer 19

RP will look like sclerotic bone chronic or acute osteomyelitis looked more like RL.

a chronic form of osteomylitis with a pronounched sclerotic response

tx: antibiotics wn work, need to get O2 in this area.

Question 20

tonsilloliths

Answer 20

RP outside the jaw

chronic inflammation with large calcifications

found in mid ramus area (lingual to ramus -> Palatine tonsil calcificaiton, bucall to ramus -> parotid sialoliths)

Question 21

antral pseudocyts

Answer 21

RP outside of the Jaw, in mx sinus

dome shaped, well defined RP near floor of mx sinus

You can see it pushing down the floor of max sinus. It looks a bit deformed. MAKE SURE TO COMPARE IT TO THE OTHER SIDE TOO.

pseduocyt -> no epithelial lining

usually asymptomatic. Can make a dx based off of XR.

tx: resolves spontaneously, no tx.

Question 22

ossifying fibroma

Answer 22

mixed RL/RP lesions

well demarcated, circumferential with expansion and thinning of corticies

asymptomatic, slow growing, expansive lesion

histo: hyperplastic fibrous CT and areas of mineralizations
tx: enucleaiton

Question 23

calcifying epithelial odontogenic tumor vs calcifying odontogenic cyst

aka Pindborg tumor

most seen at md M-R region.

Answer 23

~50% of these lesions are pericoronal RL but then ~50% are central bone lesions and not associated with an impacted tooth

Question 24

osteosarcoma

(osteogenic sarcoma)

Answer 24

early- RL, ragged margins

teeth are VITAL

moderate- mixeed “ragged margins and moth-eaten” RL , irregular and perforated corticees (see moth eaten patterin in chronic osteomyelitis)

advanced- “sun-ray” appearance

XR clue: “spiking of resportion” looking to see if there is a sharp root edge.

Question 25

chondrosarcoma

Answer 25

mixed RL and RP

diffuse, ragged, RL with ill-defined borders, isolated widening of the PDL too

malignant neoplasm of chondroblasts or chondrocytes

cartilage ONLY is produced by lesion

most commonly seen in MX(path) there is NO PREVALENT JAW SITE (radio)

Question 26

osteomyelitis with proliferative periostitis

Answer 26

onion skin pattern

facial assymetry and swelling is bony hard

Question 27

triad of osteoradionecrosis

Answer 27

radiation therapy

trauma (necrotic pulp, mucosal ulceration, fracture)

infection

Question 28

osteoradionecrosis (ORN)

radio only

Answer 28

decreased vascularity and cellularity due to radiation

its diffuse, ragged

areas of increased RD intersoersed with osteolytic regions

Question 29

primary intra-alveolar epidermoid carcinoma

central squamous cell carcinoma/primary epidermoid carcinoma.

in cancellous bone bc took path of least resistance

looks like floating teeth. like on the pic.

WILL PERFORATE THROUGH JAW INSTEAD OF EXPANDIN IN CORTEX.

Question 30

metastatic carcinoma

Answer 30

the most common maligant neoplasm located in bone, but secondary malignancy in bone.

ill-defined with ragged borders, may be expansive

Question 31

nevoid basal cell carcnioma cell syndrome

NBCCS (path only)

Answer 31

mutation to PTCH tumor suppresor gene

manifestations: bifid ribs, multiple OKCS, skin tumors, neoplasms, palmar pitting.