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5th Oral Disease -Histology Lectures > Fibro-Osseous and Giant Cell Lesions > Flashcards

Fibro-Osseous and Giant Cell Lesions Flashcards

1
Q

What is a fibrous-osseous lesion?

A

Lesion where normal bone is replaced by fibrous tissue in which abnormal bone is laid down

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2
Q

What are the stages radiographically in fibro-osseous lesion?

A

Initially will be radiolucent lesion as bone is lost

Then will become classic mixed lesion as abnormal bone is laid down

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3
Q

What is classic radiographic appearance of fibre-osseous lesion?

A

Mixed radiopaque and Lucent lesion

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4
Q

What are 4 types of fibro-osseous lesions?

A

RIDN

Reactive
Idopathic
Developmental
Neoplastic

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5
Q

Give example of reactive fibro-osseous lesion?

A

Cemento osseous dysplasia

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6
Q

Give example of idiopathic fibro-osseous lesion?

A

Paget’s

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7
Q

Give example of developmental fibro-osseous lesion?

A

Fibrous dysplasia

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8
Q

Give example of neoplastic fibro-osseous lesion?

A

Ossifying fibroma

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9
Q

What is ossifying fibroma?

A

Benign neoplastic fibro-osseous lesion

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10
Q

What is ossifying fibroma composed of?

A

Benign neoplasm composed of fibrous tissue w/ spicules/ islands or cementicles of bone

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11
Q

Who does ossifying fibroma affect?

A

Average 35yrs - 20-50yrs

Females > males

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12
Q

Where does ossifying fibroma affect?

A

Mandible most common site

Often premolar/ molar region

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13
Q

What would you expect to see from the histology of ossifying fibroma?

A

Lesion have well-defined margin and be separate from cortical plate
Fibrous tissue
Pattern of bone and cellularity will be variable

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14
Q

Pt management of those with ossifying fibroma?

A

Conservative enulceation

Resection

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15
Q

Will ossifying fibroma recur?

A

Low recurrence rate

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16
Q

What is fibrous dysplasia?

A

Developmental disorder of the bone

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17
Q

How is fibrous dysplasia caused?

A

Mutation GNAS1 - not inherited

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18
Q

What is the frequency of fibrous dysplasia affecting H&N?

A

25%

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19
Q

Who does fibrous dysplasia affect?

A

15-30yrs

Males = females

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20
Q

What see in fibrous dysplasia?

A

Painless smooth enlargement/ swelling

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21
Q

Where is most common to see fibrous dysplasia in H&N?

A

Maxilla

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22
Q

What see radiograph of fibrous dysplasia?

A

Poorly demarcated radiopacity

Strippled ‘orange peel’ - bone look granular which merges w/ bone

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23
Q

What see in histology of fibrous dysplasia?

A

Irregular strands of bone interconnecting

Large amount fibrous tissue

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24
Q

What are the clinical variants of fibrous dysplasia?

A

Monostotic - one bone involved

Polyostotic - multiple bones involved

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25
Q

Most common sites for monostotic F.D?

A

Ribs and femur

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26
Q

What proportion of those w/ monostotic F.D will have H&N lesions?

A

25%

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27
Q

What proportion of those w/ polyostotic F.D will have H&N lesions?

A

50%

28
Q

What gender is more likely to have polyostotic F.D?

A

75% female

29
Q

What syndrome can polyostotic F.D be related to?

A

McCune-Albright

30
Q

How manage patients with fibrous dysplasia?

A

Growth will stabilise w/ skeletal maturity
Can debulk/ contour bone - will recur if during growth phase/ pregnancy
Surgical removal
May need orthodontics

31
Q

Can fibrous dysplasia become malignant?

A

Small risk of malignant transformation

32
Q

How differentiate ossifying fibroma and fibrous dysplasia?

A

O.F - well defined margins which are clear, F>M, often mandible

F.D - poorly defined margins, M=F, maxilla

33
Q

Who does cemento-osseous dysplasia affect?

A

Those 30-50yrs

Often females

34
Q

What see in cemento-sseous dysplasia radiographically?

A

Multiple opacities in tooth bearing areas of jaw

35
Q

What see in cements-osseous dysplasia?

A

Irregular trabeculae of woven bone and cementum in fibrous stroma

36
Q

What are the classifications of cements-osseous dysplasia?

A

FPF

Florid
Periapical
Focal

37
Q

What is florid cemento-osseous dysplasia?

A

Multiple lesions

38
Q

What is focal cemento-osseous dysplasia?

A

Single lesion

39
Q

What is periapical cemento-osseous dysplasia?

A

Multiple lesions at apex teeth

40
Q

What is familial gigantiform cementoma?

A

Variant florid OD

41
Q

What see in histology of cements-osseous dysplasia?

A

Can see osteoclast
Evidence haemorrhage
More blue bone/ cementum appearance

42
Q

What can cemento-osseous dysplasia look similar to histologically?

A

Ossifying fibroma - irregular bony fragments in fibrous tissue

43
Q

What is Paget disease?

A

Rare bone disorder affecting all bones

44
Q

What happens in Paget’s disease?

A

Increased bone turnover

45
Q

What are the early stages of Paget’s and what is risk?

A

Bones become very vascular

Increased risk of heart failure

46
Q

What are the late stages of Paget’s and what would you see?

A

Bones become sclerotic

can see reversal and resting lines

47
Q

What clinical features might you see in Paget’s?

A

Legs become bowed

Enlargement of skull - contrition of foramen (death)

48
Q

What is feature of Paget’s you might see in dental setting?

A

Enlargement of jaw - tooth become spaced/ dentures don’t fit

49
Q

Dental implications of Paget’s?

A

Bone scerosis - diff XLA, infection

Hypercementosis - diff XLA

50
Q

What are those with Paget’s at risk of?

A

Osteosarcoma/ bone malignancy

51
Q

What medication should you be aware of in those with Paget’s?

A

Bisphosphonates

52
Q

What characterises a giant cell lesion?

A

The replacement of bone by fibrous tissue which contains numerous multi-ncuelate cells

53
Q

What is example of multi-nucleate cell?

A

Osteoclast

54
Q

What examples of giant cell lesions?

A

Cherubism
Central giant granuloma
Hyperparathyroidism

55
Q

What is cherubism?

A

Developmental condition - autosomal dominant inheritance

56
Q

Clinical features of cherubism?

A

Bilateral expansion of posterior mandible

57
Q

What see radiographically in cherubism?

A

Large multilocular radiolucent lesion at angle of mandible

58
Q

What are giant cell lesions?

A

Benign giant cell lesion which can be reactive or hyper plastic

59
Q

Who is most likely to be affected by giant cell lesion?

A

Age 10-60

F>M

60
Q

Where see giant cell lesions?

A

In mandible

61
Q

What is classic radiographic appearance giant cell lesions?

A

Well demarcated radiolucency

May see destruction

62
Q

How manage pt with giant cell lesions?

A

Blood biochemistry - serum calcium initally
Currettage
Resection

63
Q

Example of primary hyperparathyroidism lesion?

A

Parathyroid adenoma

64
Q

What is often caused by hyperparathyroidism?

A

Renal failure and malabsorption

65
Q

What see in blood chemistry of those with hyperparathyroidism?

A

Increased alkaline phosphates
Parathyroid hormone
Calcium phosphate

66
Q

Management of those w/ hyperparathyroidism?

A

Treat hyperparathyroidism

5th Oral Disease -Histology Lectures (11 decks)

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