Black & White Pathology

Question 1

What is an area of hematopoietic bone marrow that produces a radiolucency, typically in the posterior mandible?

Answer 1

Focal Osteoporotic Marrow Defect

Question 2

What are the characteristics of benign neoplasms of bone?

Answer 2

1. asymptomatic
2. slow growth
3. expands the cortex instead of going through it
4. symmetrical
5. does not metastasize

Question 3

What are characteristic of malignant neoplasms of bone?

Answer 3

1. symptomatic
2. grows faster
3. invades/destroys structures like the cortex
4. asymmetrical
5. poorly defined margins
6. deposits bone outside of cortex
7. can metastasize

Question 4

This is a benign (non-neoplastic) radiographic finding in a female. These are usually seen in the posterior mandible. Dx?

Answer 4

focal osteoporotic marrow defect

Question 5

if this were a focal osteoporotic marrow defect, what would be your next step?

Answer 5

Incisional biopsy is necessary to get definitive dx

Question 6

Don’t really know why this is here but what do you think it is?

Answer 6

Idiopathic osteosclerosis

Question 7

What is an area of radiodensity with unknown cause and cannot be identified as anything else?

Answer 7

idiopathic osteosclerosis

Question 8

New patient that hasn’t had an infection there. Dx?

Answer 8

idiopathic osteosclerosis

Question 9

What is your possible differential dx?

Answer 9

1. Condensing osteitis: associated with an infection
2. Idiopathic osteosclerosis: unknown cause
3. Focal cemento-osseous dysplasia: will have a radiolucent rim
4. Cementoblastoma: fused with the tooth

*bolded pathology is definitive dx

Question 10

Tooth has Hx of infection. Dx?

Answer 10

condensing osteitis

Question 11

What is an asymptomatic radiolucent lesion that is usually seen crossing the midline of the mandible?

Answer 11

Central giant cell granuloma

Question 12

What radiolucent lesion is usually seen in the posterior mandible of women?

Answer 12

Focal osteoporotic marrow defect

Question 13

What lesion is usually seen across the anterior/midline of the mandible in women?

Answer 13

central giant cell granuloma

Question 14

Female patient. Non-neoplastic lesion. Dx?

Answer 14

Central Giant Cell Granuloma

Question 15

What is your differential? Female patient. Asymptomatic.

Answer 15

1. Central Giant Cell Granuloma
2. Brown Tumor (of hyperparathyroidism)
3. Aneurysmal Bone Cyst
4. Odontogenic Keratocyst

Question 16

Upturned eyes and big, plump cheeks. Dx?

Answer 16

Cherubism

Question 17

What syndrome features odontogenic keratocysts?

Answer 17

Gorlin Syndrome

Question 18

What is your differential dx?

Answer 18

1. odontogenic keratocyst
2. aneurysmal bone cyst
3. traumatic bone cyst
4. Brown’s tumor

Question 19

Pt recently experienced trauma. What’s your dx?

Answer 19

traumatic bone cyst (AKA simple bone cyst)

Question 20

What radiographic feature is suggestive of traumatic bone cysts?

Answer 20

Scalloping of bone between the roots

Question 21

Dx?

Answer 21

Traumatic bone cyst

Question 22

What is your differential?

Answer 22

1. Odontogenic keratocyst
2. Traumatic bone cyst
3. Aneurysmal bone cyst
4. Ameloblastoma

*bolded pathology is definitive

Question 23

What is an intraosseous blood-filled cavity surrounded by connective tissue lining?

Answer 23

Aneurysmal bone cyst

Question 24

Why is an aneurysmal bone cyst not a true cyst?

Answer 24

It doesn’t have an epithelial lining. (lined by connective tissue)

Question 25

What are three examples of benign fibro-osseous lesions?

Answer 25

1. fibrous dysplasia 2. cemento-osseous dysplasia 3. ossifying fibroma

Question 26

Fine, ground glass appearance. Dx?

Answer 26

Fibrous dysplasia

Question 27

What two syndrome are associated with polyostotic fibrous dysplasia?

Answer 27

1. McCune-Albright syndrome 2. Jaffe-Lichtenstein syndrome

Question 28

What is the most common fibro-osseous lesion encountered in clinical practice?

Answer 28

Cemento-osseous dysplasia

Question 29

Dx?

Answer 29

Focal Cemento-Osseous Dysplasia

Question 30

Lesion later calcifies. Dx?

Answer 30

Focal cemento-osseous dysplasia

Question 31

Dx?

Answer 31

Focal cemento-osseous dysplasia

Question 32

Asymptomatic teeth that test vital. Dx?

Answer 32

Periapical Cemento-Osseous Dysplasia

Question 33

Dx?

Answer 33

Periapical cemento-osseous dysplasia

Question 34

Dx? How do these lesions appear in early stages and late stages?

Answer 34

Dx: periapical cemento-osseous dysplasia Early: radiolucent lesion Late: radiodense lesion with radiolucent rim

Question 35

Usually, occurs in the posterior mandible of women. Dx?

Answer 35

Florid cemento-osseous dysplasia

Question 36

Differential dx?

Answer 36

1. **Florid cemento-osseous dysplasia** 2. Odontogenic keratocyst 3. Traumatic bone cyst \*bolded pathology is definitive

Question 37

What are the demographics of florid cemento-osseous dysplasia?

Answer 37

90% women, 90% black

Question 38

Are men or women more likely to have cemento-osseous dysplasia?

Answer 38

90% women

Question 39

These fibro-osseous lesions will expand the inferior cortex of the mandible. Dx?

Answer 39

ossifying fibroma

Question 40

Is ossifying fibroma more likley in males/females and mandible/maxilla?

Answer 40

**F**\>M **Md** \> Mx

Question 41

Usually, these lesions are mixed RO/RL. The inferior border in expanding. Dx?

Answer 41

ossifying fibroma

Question 42

These mixed RO/RL lesions are usually seen in women and in the mandible, but this time. Dx?

Answer 42

ossifying fibroma

Question 43

Outline of root is obscured. Dx?

Answer 43

Cementoblastoma

Question 44

What is your differential?

Answer 44

1. **_Cementoblastoma_**: cannot see normal shape of tooth 2. _Condensing osteitis_: follows infection 3. _Idiopathic osteosclerosis_: unknown cause 4. _Focal cemento-osseous dysplasia_: starts as purely RO lesion \*bolded is definitive dx

Question 45

25% of the time these present with a sunburst appearance.

Answer 45

osteosarcoma

Question 46

What is the most common malignancy to originate in the bone?

Answer 46

osteosarcoma

Question 47

Pt has pain, unilateral swelling of the face, and moth eaten bone upon radiograph. Provisional dx?

Answer 47

osteosarcoma

Question 48

What is the most common cancer involving bone?

Answer 48

Metastatic tumor of the bone