Bone Disorders Flashcards
1
Q
most common primary bone malignancy
A
osteosarcoma
2
Q
most common general location of osteosarcoma
A
long bones
3
Q
most common dental relevant location of osteosarcoma
A
mandible
4
Q
most common age for osteosarcoma
A
10-25 (jaw lesions a decade later)
5
Q
osteosarcoma symptoms
A
- pain, paresthesia in mandible
- nasal obstruction, epistaxis (nose bleeds) in maxilla
6
Q
radiographic features - osteosarcoma
A
- sunburst radiopaque lesions
- PDL widening
7
Q
osteosarcoma histology
A
- sarcomatous stroma
- production of osteoid and bone
8
Q
osteosarcoma - differential diagnosis
A
- chondrosarcoma
- osteoblastoma
- ossifying fibroma
9
Q
how can you tell the difference between osteosarcoma and chondrosarcoma?
A
- histologically chondrosarcoma has cartlaginous structures and does NOT have osteoid and bone in the stroma
- chondrosarcoma does not show distinctive deomographics like osteosarcoma
10
Q
osteosarcoma - treatment
A
radiation & chemotherapy
11
Q
chondrosarcoma
A
malignant neoplasm devoid of osteoid and bone with cartlagenous structures
12
Q
is chondrosarcoma common or rare?
A
rare
13
Q
chondrosarcoma clinical features
A
- expansion
- loose teeth
- nasal discharge
- pain may be present
14
Q
chondrosarcoma histological features
A
- fully developed cartilage
- NO osteoid or bone
- very large nuclei
15
Q
chondrosarcoma radiographic features
A
- “cotton wool” calcifications
- widened PDL may be present
16
Q
mesenchymal chondrosarcoma
A
dental relevant subtype of chondrosarcoma - more commonly occurs in the mandible
17
Q
fibrosarcoma
A
malignant neoplasm of fibroblastic cells
18
Q
fibrosarcoma: common or rare
A
rare
19
Q
fibrosarcoma - age
A
over 40
20
Q
what is an important clinical treatment that could potentially cause fibrosarcoma?
A
radiation therapy
21
Q
clinical features of fibrosarcoma
A
- same as any malignancy - NOT characteristic
- mass or swelling common
- pain, paresthesia
- trismus
- MIMICS: SCC which is much more common
22
Q
can fibrosarcoma occur in children
A
yes (childhood head and neck fibrosarcoma is a distinct entity)
23
Q
fibrosarcoma - histological features
A
- interlacing connective tissue cells (looks like interlaced cable wires)
- cells arranged in fascicles often with a “heringbone” pattern
24
Q
what are the two forms of fibrosarcoma in children
A
- desmoplastic
- medullary
25
which childhood form of fibrosarcoma behaves like the adult form?
desmoplastic fibrosarcoma
26
which childhood form of fibrosarcoma is less aggressive
medullary fibrosarcoma
27
how do you treat fibrosarcoma?
complete excision (get it out, radical resection advised)
28
fibrosarcoma prognosis
not good
29
langerhans cell histocytosis (LCH)
neoplastic proliferation of langerhans cells with a wide spectrum of biologic behavior
30
what are the three categories of LCH?
1. chronic focal/"eosinophilic granuloma"/unifocal
2. chronic disseminated/"Hand-Schüller-Christian disease"/multifocal unisystemic
3. acute disseminated/"Letterer-Siwe disease"/multifocal multiple system
_need to know the different names_
31
characteristics of the _chronic focal/ "eosinophilic granuloma"/unifocal_ type of LCH
* _solitary_ granuloma
* no soft tissue or organ involvement
* easily treatable
* **M** \> F
* children & young adults
* radiographically - teeth appear to "float in air", unilocular lesions in skull appear "punched out"
* simple excision or curettage
32
characteristics of chronic disseminated/ "Hand-Schüller-Christian disease"/multifocal unisystemic type of LCH
* multifocal (affects multiple bones & organs)
* multiple lesions
* multiple sites
* diabetes insipidus
* hisotlogiccally - histocytes & eosinophils
* surgery, radiation, chemotherapy, steroids
33
characteristics of acute disseminated/"Letterer-Siwe syndrome"/mulitifocal multiple system type of LCH
* **_infants_**
* **_lethal_** form
* multiple organ involvement
* histologically - "foamy" cytoplasm
* chemotherapy
34
immunohistochemistry - LCH will stain positive for?
CD1
35
what is the name of the staging system for LCH
Kemp staging system
36
central giant cell granuloma of jaw
distinct diagnostic entity
37
central giant cell granuloma - demographics
* children and _young adults_
* **F** \> M
38
central giant cell granuloma - location
anterior mandible (may cross midline, can occur in maxilla)
39
central giant cell granuloma - clinical features
* _local_ swelling
* pain
* paresthesia - UNCOMMON
40
central giant cell granuloma - radiographic features
* **root displacement or resorption**
* unilocular or multilocular
* expansion without perforation of cortial plates
41
central giant cell granuloma - histology
**multinucleated giant cells** (unique but not specific)
42
central giant cell granuloma - differential diagnosis
* **_Hyperparathyroidism “Brown Tumors"_**
indistinguishable from central giant cell granuloma
this is **systemic**
MUST differentiate before treatment!
* **Aneurysmal Bone Cyst - cavernous blood filled spaces**
43
central giant cell granuloma
curettage and complete excision
44
cherubism
**rare** hereditary disease of **_mandible_**
45
cherubism - demographics
* **children**
* **M** \> F
46
cherubism - preferred location
**mandible**
(bilateral rami; bilateral rami & posterior mandible; maxilla and madible)
47
cherbuism - radiographic features
**thinig of corticies**
(easy to diagnose if in all for quadrants of MX & MN, otherwise may require genetic screening, thins the cortex but rarely penetrates)
48
cherubism - treatment
**slow regression after puberty**, don't over treat
may move teeth, but tends to reslove itself
**radiotherapy contraindicated**
49
fibrous dysplasia
skeletal abnormaliy of poorly mineralized bone (bone never gets hard - spongiosum replaced with fibro-osseous tissue)
50
two patterns of fibrous dysplasia
1. monostotic
2. polystotic
51
monostotic fibrous dysplasia
one bone
52
polystotic fibrous dysplasia
**several bones**
associated with **Albright syndrome** (several bones + endocrine abnormalities - may see precocious puberty)
53
which form of fibrous dysplasia is most common
monostotic
54
fibrous dysplasia - age
**late childhood**
become quiesent after puberty
55
fibrous dysplasia - genetics
GNAS1 gene
56
fibrous dysplasia - clinical findings
* **unilateral**
* painless
* slow onset
57
fibrous dysplasia - preferred location
mandible
58
fibrous dysplasia - radiograpic features
* eliptically shapped (unilaterally)
* **"gound glass,"**"orange peel," fuzzy appearance
* diffuse, like "driven snow"
59
fibrous dysplasia - histology
non-specific histology (requires combo of histo, radiology, and clinical findings)
osteoid and calcified bone ("Chinese characters")
60
fibrous dysplasia - prognosis
good
61
fibrous dysplasia - treatment
**monitor**
commonly "burns out" around puberty
sugery only if it becomes obstructive
62
fibrous dysplasia - differential diagnosis
**ossifying fibroma**
* ossifying fibroma - the cortex is hard and has to be drilled through to get to lesion
* fibrous dysplasia - the cotex is soft and can easily be cut through to get to lesion
63
can you treat fibrous dysplasia with radiation therapy?
NO
## Footnote
**radiation therapy is contraindicated**
64
osteoma
rare slow growing neoplasm of compact or cancellous bone
65
osteoma - M?F
males
66
what syndrome are osteomas associated with?
Gardner's syndrome
| (associated with _multiple_ osteomas)
67
osteoma - differential diagnosis
* osteoblastoma
* osteoid osteoma
these grow more _rapidly_, show more cellularity, and are associated with _pain_ compared to osteomas
68
do osteomas contain tooth remants/structures
yes
69
osteoma - treatment
monitor and meaure risk
excsision if necessary (i.e. obstruction)
70
exostoses/tori
not a neoplasm
reaction to bone stress
71
ossifying fibroma
slow growing, well-demarcated, benign fibrou-osseous lesion of bone
72
ossifying fibroma - origin
PDL cells
73
ossifying fibroma - preferred location
mandible
| (posterior to canine)
74
aggressive form of ossifying fibroma
**juvenile** **active ossifying fibroma**
(ages 6-20, can grow very rapidly, need to monitor closely)
**aggressive intervention required**
75
ossifying fibroma - M?F
females
76
ossifying fibroma
lyctic lesion with **radiopaque foci**, usually has _radiopaque border_
looks like a marble
77
ossifying fibroma - histology
mixture of fibrous and calcified tissue
"cementoid" calcifications
78
ossifying fibroma - differential diagnosis
fibrous dysplasia
79
ossifying fibroma - treatment
excision, curettage, enucleation
radiotherapy contraindicated
80
osteoblastoma
**rare**, benign neoplasm associated with **_pain_**
(need to recognize that although incredibly rare if you are delaing with something that looks like an osteoma but is painful you could be dealing with this rare neoplasm)
