Benign Non-Odontogenic Lesions Flashcards Preview

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Flashcards in Benign Non-Odontogenic Lesions Deck (156):
1

Cemento-Ossifying Fibroma clinical features

3-4th decade 5:1 female predilection Common in mandible

2

Cemento-Ossifying Fibroma radio appearance

Well-demarcated lesion Radiolucent to mixed appearance

3

Cemento-Ossifying Fibroma histo appearance

Potato-like mass that usually comes out in one chunk Lots of connective tissue and bone/cementum interspersed. NO inflammation seen

4

Cemento-Ossifying Fibroma treatment

Enucleation This is a TRUE neoplasm.

5

Fibrous Dysplasia Types of Lesion

Polyostotic Monostotic

6

Fibrous Dysplasia clinical features

MAXILLA more common Bones have fracture risk because they are weaker. Can have a hockey stick discrepancy. One leg longer than the other Will see SWELLING over time. Can see expansion.

7

Fibrous Dysplasia radio appearance

Ground glass appearance with ill-defined borders Narrowing PDL space and the lamina dura hard to make out

8

Fibrous Dysplasia histo appearance

Irregular shaped woven bone (Chinese characters) Bone has NO OSTEOBLAST around it. Distinctive feature. Bone arises in slide via metaplasia from fibroblasts Woven bone becomes more lamellar over time

9

Fibrous Dysplasia treatment

Resection, but not in children. Lesion will regress over time maybe to 70% of size. Remove at skeletal maturity. Radiation is CONTRAINDICATED. It may actually cause malignant transformation to osteosarcoma.

10

Fibrous Dysplasia age

Stage of fetal development determines if polyostotic or monostotic (MOST cases are monostotic) 1-2nd decade (YOUNGER) population

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Fibrous Dysplasia types of polyostotic involvement

Jaffe Type

  • Cafe au lait spots on the trunk and thigh
  • Multiple bone involvements

McCune-Albright Type 

  • Cafe au lait spots
  • Endocrine hyperfunction
  • Precocious puberty

12

Types of cemento-osseous dysplasias

Periapical

Focal

Florid

13

Clinical features of periapical osseous dysplasias

14:1 Black female predilection

30-50 years old

14

Clinical features of focal osseous dysplasias

80% in Caucasian females

4-5th decade

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Clinical features of florid osseous dysplasias

Black females

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Location of periapical osseous dysplasias

Mandibular anterior

Multiple lesions

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Location of focal osseous dysplasias

Posterior mandible ONE lesion

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Location of florid osseous dysplasias

More than one quadrant

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Radiograph of periapical osseous dysplasias

Start as RL then add more osteoid and become RO

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Radiograph of focal osseous dysplasias

RL to RO. RL rim remains over time

21

Radiograph of florid osseous dysplasias

Multiple “cotton-wool” radiopacities

22

Treatment of periapical osseous dysplasias

NONE needed. No biopsy

23

Treatment of focal osseous dysplasias

Biopsy to rule out cemento-ossifying fibroma

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Treatment of florid osseous dysplasias

MAINTAIN DENTITION. Normal alveolar bone will resorb, but dysplastic bone will not and osteomylitis could occur.

25

Clinical features of all osseous dysplasias

Occur in tooth-bearing areas. Not outside the jaws Reactive lesions with cause unknown All types have the same histology, but are a spectrum along the process. No expansion seen Asymptomatic NO teeth displacement and teeth remain vital

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Histo of all osseous dysplasias

Come out as coffee grounds

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Clinical features of osteoblastoma

Pain NOT relieved by aspirin

28

Clinical features of osteoid osteoma

NOCTURNAL PAIN relieved by aspirin

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Radiograph of osteoid osteoma

Well-circumscribed with radiolucent rim and central radiopacity.

Less than 2cm in diameter

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Radiograph of osteoblastoma

Similar location to OO (outside the jaws)

Greater than 2cm

Can have a RL rim with a mixed center

31

Histo of osteoid osteoma and OO

Lots of woven bone, NOT lamellar bone in a fibrovascular stroma Both can resemble low-grade osteosarcoma (malignancy) This similarity contributes to their misdiagnosis

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TX of osteoid osteoma and OO

Local excision

Curettage

33

Types of osteoma

Periosteal Endosteal

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Clinical features of osteoma

Simply a benign bone lesion Paranasal sinuses are the most common, but can happen in bone

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Radiograph of osteoma

Radiopaque

36

Histo of osteoma

Dense bone combined with cancellous bone

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TX of osteoma

Surgical excision or just observation over time

38

Clinical presentation of Gardner syndrome

Epidermoid cysts GI polyps with 50% becoming malignant by age 30 Desmoid tumors: locally aggressive benign fibrous proliferations at incision site of colectomy Ocular -- hypertrophy retinal pigment Oral -- impacted supernumerary teeth and odontomas

39

Key indicator of Gardner syndrome

If you see multiple osteomas think about this lesion

40

Radiograph of Gardner syndrome

Osteomas

NO radiolucent rim

Supernumerary teeth

41

Heredity of Gardner syndrome

Autosomal dominant condition

42

TX of Gardner syndrome

Prophylactic colectomy as GI polyps will become malignant

43

Age of central giant cell granuloma

2-4th decade with a 2:1 female predilection

44

Location of central giant cell granuloma

Presents in posterior mandible 70% of time CROSSES MIDLINE

45

Radiograph of central giant cell granuloma

Radiolucency Start off as unilocular and over time become more multilocular and expansile Displacement of teeth Resorption of teeth possible

46

Histology of central giant cell granuloma

Granulation tissue Giant cells (frequently around the periphery) Reactive bone around periphery → body is trying to wall off the lesion; bone not made by lesion Extravasated RBC’s

47

DDX of central giant cell granuloma

ABC

  • Typically in children and doesn’t cross the midline Has blood-filled spaces in lesions with GC around the periphery of lesion

Brown tumor

  • Need to rule out hyperparathyroidism Have calcium levels checked

Giant cell tumor of bone

  • Most common in distal tibia and femur area not jaws

48

TX of central giant cell granuloma

Curettage Resection if the lesion recurs

49

Clinical features of Hemangioma of Bone (Vascular Malformation)

Pain and swelling when larger Sulcular bleeding Bruit or pulse if has a artery component. If only venous, no bruit present.

50

Location of Hemangioma of Bone (Vascular Malformation)

Seen in posterior mandible

51

Age of Hemangioma of Bone (Vascular Malformation)

2nd and 3rd decades most common

52

Radiograph of Hemangioma of Bone (Vascular Malformation)

Multilocular Presents as a mixed to radiolucent lesion Occasional sunburst pattern Cortical expansion

53

Histology of Hemangioma of Bone (Vascular Malformation)

Cavernous and capillary vessels

54

TX of Hemangioma of Bone (Vascular Malformation)

Make sure to aspirate the lesion before biopsy Pre-surgery embolization with resection, curettage

55

Types of Langerhans Cell Disease

Acute disseminated (Letterer-Siwe Disease) Chronic disseminated (Hand-Schuller-Christian Disease) Eosinophilic granuloma of bone

56

Features of Letterer-Siwe Disease

Most severe manifestation of disease Seen in infants and very young children. Usually FATAL. Lesions seen on (SOB) skin, organs, and bone

57

Features of Hand-schuller-Christian Cell Disease

(SOB) skin, organs, bone also involved, but organ involvement NOT as severe TRIAD: Bone lesions Exophthalmos → histiocytic cells accumulate around the eyeball Diabetes insipidus → histiocytic proliferation involves the posterior pituitary gland

58

Features of Eosinophilic granuloma of bone

MOST COMMON presentation of this disease

BONE ONLY (solitary or multiple lesions)

No skin or visceral involvement

59

Location of Langerhans Cell Disease

Skull and mandible in the head/neck area

60

What is Langerhans Cell Disease

Benign neoplasm consisting of histiocytic cells

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What does Langerhans Cell Disease look like on radiograph

Radiolucency Usually well-defined and non-corticated Significant bone destruction Mobile teeth from bone loss

62

Histology of Langerhans Cell Disease

Large number of mononuclear histiocytic cells Large numbers of eosinophils Diagnosis NOT made only on light microscopy. Need immunohistochemistry with S100 stain. Histiocytes can appear as a coffee bean Look for birbeck cells in histiocytes (Langerhans cells)

63

TX of Langerhans Cell Disease

Curettage Low dose radiation of intralesional chemo NO ORGAN INVOLVEMENT WINS Acute is fatal. Chronic not as much.

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Types of Osteomyelitis

ACUTE and CHRONIC

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Common site of Osteomyelitis

Mandible

66

Clinical features of acute osteomyelitis

Will see acute inflammatory response Fever, leukocytosis, lymphadenopathy, pain, and swelling Will see chunks of bone out of lesion Drainage of pus

67

Clinical features of chronic osteomyelitis

Granulation tissue seen (Fibroblasts and BV’s) Swelling, pain, and discharge seen

68

Etiology of Osteomyelitis

Odontogenic infections

Fractures

Immunocompromised patients (poorly controlled diabetics)

Decrease vascularity of bone

69

Radiograph of acute osteomyelitis

Typically radiolucent POORLY defined

70

Radiograph of chronic osteomyelitis

Mixed radiolucent, radiopaque lesion

71

Histo of acute osteomyelitis

Lots of neutrophils (HALLMARK cell of acute inflammation) Necrotic bone

72

Histo of chronic osteomyelitis

Chronic inflamed fibrous tissue Sequestra

73

TX of acute osteomyelitis

Oral antibiotics -- amoxicillin

74

TX of chronic osteomyelitis

IV antibiotics. Oral antibiotics can’t reach the tissue. Harder to treat because granulation tissue can encase the necrotic bone

75

Clinical features of Condensing Osteitis

Usually asymptomatic A bony reaction to pulpal inflammation.

76

What is Condensing Osteitis

This is a reaction to a low grade infection (large caries or non-vital teeth)

77

Radiograph of Condensing Osteitis

Periapical radiopacity

78

TX of Condensing Osteitis

Treat source of infection and it will regress

79

Clinical features of Proliferative Periostitis (Garres Osteomyelitis)

Reactive bone formed along the cortex of bone Seen with caries or periodontal infection

80

Ages of Proliferative Periostitis (Garres Osteomyelitis)

Seen in younger children

81

Radiograph of Proliferative Periostitis (Garres Osteomyelitis)

Onion skin radiopacity This ALSO seen in Ewing’s sarcoma

82

Histo of Proliferative Periostitis (Garres Osteomyelitis)

Cellular reactive bone seen

83

TX of Proliferative Periostitis (Garres Osteomyelitis)

NO Biopsy performed Resolve the infection and this goes away

84

Age and predilection of Osteosarcoma of Jaws

2:1 MALE predilection 34 years old

85

Clinical features Osteosarcoma of Jaws

MOST common primary malignancy of bone Pain and swelling Pick up on widening of the PDL before other symptoms

86

Etiology of Osteosarcoma of Jaws

Previous radiation Usually occur 10 years after radiation Osteitis deformans (Paget’s Disease) If the patient is over 50 and has osteosarcoma, check if they have Paget’s Disease. Very rare to not have Paget’s.

87

Radiograph of Osteosarcoma of Jaws

Uniform widening of the PDL Mixed lesion on radiograph Resorption, but not displacement of teeth Sun burst pattern

88

Clinical features Osteosarcoma of Jaws

Plump spindle-shaped cells (osteoblasts) Haphazard osteoid in sample Malignant osteoid Three cellular types

89

TX of Osteosarcoma of Jaws

Radical surgery Maxillary tumors worse prognosis than mandible because harder to resect the full tumor Best predictor of success is clean resection Can do preoperative chemo to shrink the tumor and then resect Check to see if tumor is susceptible to chemo

90

Age of Chondrosarcoma

50-60 years old (OLDER than osteosarcoma) Rare in less than 45 years old

91

Clinical features of Chondrosarcoma

2nd most common malignancy of the jaws More commonly painless than osteosarcoma Maxilla more than mandible Can show nasal obstruction and nose epitaxis

92

Radiograph of Chondrosarcoma

Poorly defined radiolucency and can have calcified material develop over time Lower grade have more Radiopaque Widened PDL and resorption

93

Histo of Chondrosarcoma

Histo determines prognosis Grade 1: mimic chondroma, prominent calcification/ossification Grade 2: increased cellularity and nuclear size; myxoid matrix Grade 3: even more cellular; spindle shaped cells; cartilage rare Variants Clear cell (low grade) Dedifferentiated (high grade)

94

TX of Chondrosarcoma

RADIO AND CHEMO RESISTANT Surgical excision Difficult in the maxilla

95

Age of Ewing's Sarcoma

Usually in KIDS (60% male)

96

Location of Ewing's Sarcoma

Posterior mandible most common site

97

Genetic cause of Ewing's Sarcoma

85% have a t(11;22) translocation

98

What is Ewing's Sarcoma

Poorly-differentiated PNET → “small round cell blue tumor”

99

Clinical features of Ewing's Sarcoma

Fever and leukocytosis (high WBC’s) Increased ESR Tend to penetrate the cortex and cause loose teeth

100

Radiograph of Ewing's Sarcoma

Ill-defined radiolucency Onion skin Resorption of teeth not displacement

101

Histo of Ewing's Sarcoma

Sheets of small round cells Necrosis and hemorrhage Cytoplasmic glycogen granules CD99 staining also see in Ewing’s Must do FISH to diagnose it Shows the translocation of genes

102

TX``` of Ewing's Sarcoma

Surgery Radiation and chemo. Usually MULTI-agent chemo Lung, liver, lymph node, bone mets are common metastatic sites Distal lesions have better prognosis since radical excision ca`n be accomplished easier

103

Predilection of multiple myeloma

63 average age African American males most common

104

What is multiple myeloma

Plasma cell neoplasm in which a monoclonal Ig light chain is produced (Lambda or Kappa)

105

Clinical symptoms of multiple myeloma

Bone pain most common presenting symptom Swelling + expansion Pathologic fracture Paresthesia and loose teeth Weakness and anemia → thrombocytopenia and lymphopenia Amyloidosis deposition (WAXY nodules or plaques)

106

Test results of multiple myeloma

Bence-Jones proteinuria: monoclonal light chains in your piss Can see an “M spike” in monoclonal gammopathy

107

Radiograph of multiple myeloma

Multiple well-defined punched out radiolucencies

108

Histo of multiple myeloma

Sheet-like monoclonal proliferation of plasma cells

109

TX of multiple myeloma

Chemo, steroids, radiation Can do a bone marrow transplant in healthier patients

110

Predilection of solitary plasmacytoma

50 years average age Male predilection

111

Clinical features of solitary plasmacytoma

Rare in jaws, but angle of mandible is most common site HIGH risk to develop multiple myeloma Pain swelling and pathologic fracture seen ONE LESION

112

Test results of solitary plasmacytoma

NO M spike

Most cases do not have IgG in piss like in MM

Normal peripheral blood picture 

113

Radiograph of solitary plasmacytoma

Well-defined radiolucency.

Lytic lesion of the bone

Destruction of cortical bone possible

114

Histo of solitary plasmacytoma

Identical to multiple myeloma, but there is only 1 lesion

115

TX of solitary plasmacytoma

Complete bone scan to make sure not MM Radiation to the area Curette the lesion

116

Criteria for diagnosis of metastatic disease

Histologically verified primary tumor Metastatic deposit same as primary No possibility of direct extension Important in salivary gland tumors

117

Age of metastatic disease

50 years or older

118

Location of metastatic disease

Mandible (60%) maxilla (25%) of lesions

119

Radiograph of metastatic disease

Usually poorly defined radiolucency Radiopacity if breast of prostate cancer

120

Histo of metastatic disease

Variable depending on primary tumor Usually a carcinoma, NOT sarcoma

121

TX of metastatic disease

Palliative as these lesions are STAGE 4

122

122

122

122

What is this?

Q image thumb

Hemangioma of bone

122

What is this? 

Q image thumb

Cemento-ossifying fibroma

123

What is this?

Q image thumb

Fibrous dysplasia

124

What is this

Q image thumb

Hemangioma of bone

125

What is this

Q image thumb

Central giant cell granuloma

126

What is this?

Q image thumb

Central giant cell granuloma

127

What is this? 

Q image thumb

Cemento-osseous dysplasia

128

What is this

Q image thumb

Langerhans Cell Disease

129

What is this

Q image thumb

Electron microscope

Langerhans Cell Disease

130

What is this

Q image thumb

Osteosarcoma

131

What is this

Q image thumb

Chronic osteomyelitis

132

What is this? 

Q image thumb

Acute osteomyelitis

133

What is this?

Q image thumb

Ewing's sarcoma

134

What is this?

Q image thumb

Chondrosarcoma

135

What is this? 

Q image thumb

Ewing's sarcoma

136

What is this? 

Q image thumb

Multiple myeloma

137

What is this? 

Q image thumb

Chondrosarcoma

138

What lesions have onion skin appearance on radiograph?

  1. Garres osteomyelitis (proliferative periostitis)
  2. Ewings sarcoma

139

what is this

Q image thumb

cemento ossifying fibroma

140

what is this

Q image thumb

fibrous dysplasia

141

what is this 

Q image thumb

fibrous dysplasia

142

what is this

Q image thumb

focal osseous dysplasia

143

what is this 

Q image thumb

hemangioma of bone

144

what is this 

Q image thumb

langerhans cell disease

145

what is this

Q image thumb

acute osteomyelitis 

146

what is this 

Q image thumb

osteosarcoma

147

what is this 

Q image thumb

ewing's sarcoma

148

what is this 

Q image thumb

metastatic cancer

149

CK7 positive histo means what 

Carcinoma from the lung

150

what immunostain is used for langerhans cell disease

CD1aaaaa

151

what does langerhans cell disease look like on radiograph

large bone destruction 

multiple radiolucent lesions in the skull and jaws

152

patient complaints with langerhans cell disease

Pain, swelling, and loose teeth