Bone Lesions I

Question 1

How does bone remodeling occur?

Answer 1

Bone remodeling occurs through the process of destruction by osteoclasts and formation by osteoblasts.

Question 2

What is the normal serum calcium and phosphorus and phosphatase enzyme level?

Answer 2

The normal serum calcium level is 9-11 mg/dl.
phosphorus level is 2.5-4.5 mg/dl
alkaline phosphatase enzyme level is 30-130 IU/I.

Question 3

What characterizes fibro-osseous lesions?

Answer 3

characterized by the replacement of normal bone by cellular fibrous tissue from which new immature calcified tissue subsequently forms by metaplasia.بيكون عظم غير طبيعي

Question 4

Is Fibrous dysplasia of bone inherited?

Answer 4

No, it is a developmental tumor-like condition but is not inherited.

Question 5

What are some possible etiologies of Fibrous dysplasia?

Answer 5

Possible etiologies include
glandular dysfunction,
liver damage, infection, developmental factors
, and genetic bases (GNAS1 gene).

Question 6

What are the two types of fibrous dysplasia?

Answer 6

The two types are Monostotic and Polyostotic fibrous dysplasia.

Question 7

Describe Monostotic fibrous dysplasia.

Answer 7

Monostotic fibrous dysplasia is limited to a single bone and accounts for about 80-85% of all cases.
Site in jaws. Limp
more common in the maxilla than in the mandible.
sex predilection ( male = female

Question 8

Describe Polyostotic fibrous dysplasia.

Answer 8

more than one bone
It is more common in females than males (2-3 times).
Patients with severe polyostotic disease are usually diagnosed in childhood.

symptoms related to long bones pathologic
fractures with resulting pain and deformity because of the
involvement of the upper portion of the femur “ hockey
stick deformit

Question 9

What syndromes may Polyostotic fibrous dysplasia be part of?

Answer 9

It may be part of Jaffe’s syndrome or Albright’s syndrome.

Question 10

What is included in Jaffe’s syndrome?

Answer 10

Jaffe’s syndrome includes fibrous dysplasia involving a variable number of bones
(most of the skeleton is normal) and Café-au-lait pigmentations.

Question 11

What is included in Albright’s syndrome?

Answer 11

involving most of the skeleton, Café-au-lait pigmentations, and endocrinal disorders such as precocious puberty (especially in females), acromegaly, hyperthyroidism, hyperparathyroidism, and hyperprolactinemia.

Question 12

What are the clinical features of fibrous dysplasia in the jaws?

Answer 12

increase in facial asymmetry and maxillary swelling.
Maxillary lesions may involve the maxillary sinus and floor of the orbit and are considered more serious than mandibular ones.
Mandibular lesions are typically monostotic and occur most frequently in the premolar and molar regions.

Question 13

How can fibrous dysplasia affect teeth?

Answer 13

Teeth may be displaced,
interfering with occlusion
, and there may be failure of eruption due to loss of normal bone support.

Question 14

Describe the radiographic appearance of fibrous dysplasia in the early stage.

Answer 14

In the early stage,
the lesion may be largely radiolucent (cyst-like radiolucency).

Question 15

Describe the radiographic appearance of fibrous dysplasia in the mixed stage.

Answer 15

In the mixed stage, there is coarse mottling (“smoke screen pattern”) produced by irregular radio-opaque masses in a radiolucent background.

Question 16

Describe the radiographic appearance of fibrous dysplasia in the final stage.

Answer 16

ill-defined radio-opaque مهم . The appearance can also be described as “Orange peel appearance”.مهم

Question 17

What are the histopathological features of fibrous dysplasia?

Answer 17

normal bone is replaced by fibrous tissue containing thin, irregular, immature (woven) bone islands and trabeculae. Small foci of osteoclastic multinucleated giant cells may be present. The fibrous tissue can be cellular with a whorled pattern دوامه or consist of thick collagen bundles. The newly formed trabeculae often have bizarre curvilinear shapes resembling Chinese script writing. The lesional bone fuses directly to normal bone at the periphery without a capsule or line of demarcation.

Question 18

Who is most commonly affected by Ossifying fibroma?
Age
Sex

Answer 18

Ossifying fibroma is seen in children and adults, with a definite female predominance.

Question 19

Where does Ossifying fibroma most often arise?

Answer 19

It arises in tooth-bearing regions of the jaws, most often in the mandible.

Question 20

What are the signs and symptoms of Ossifying fibroma?

Answer 20

Signs and symptoms include a localized, hard, painless, and non-tender swelling of the jaw with slow growth and gradual increase in facial deformity. Displacement of teeth may also occur.

Question 21

What is the most important radiographic feature of Ossifying fibroma?

Answer 21

The most important radiographic feature is the well-circumscribed, sharply defined borders. Will define.

Question 22

How does the radiographic appearance of Ossifying fibroma vary?

Answer 22

The appearance varies depending on the maturation or amount of calcification present.

Question 23

What are the histopathological features of Ossifying fibroma?

Answer 23

The lesion is well encapsulated
varying numbers of uniform spindle or stellate cells.
Variable calcific deposits in the form of irregular woven bone trabeculae, lamellar bone, small ovoid to globular basophilic deposits,
or cementum-like material

Question 24

What characterizes Giant Cell Lesions?

Answer 24

Giant Cell Lesions are characterized by the presence of multinucleated giant cells (MNGCs).

Question 25

What is the origin of multinucleated giant cells?

Answer 25

They may be of monocytic/macrophage origin or osteoclastic origin. They may be physiologic like (???) Or pathologic. Physiologic osteoclast

Question 26

What was CGCG once thought to represent, and how is it classified now? Central giant cell granuloma (CGCG). اسبابه

Answer 26

زمان كان بيعدق انو استجابه لإلتهاب ام دلوقتي اتنصف a benign neoplasm. The etiology is unknown.

Question 27

What is the typical age range for CGCG? Sex

Answer 27

children and young adults, with two-thirds of cases occurring before the age of 30. Female/males 2/1

Question 28

Where is CGCG most frequently located in the jaws?

Answer 28

It occurs more frequently in the mandible than in the maxilla and is more common in the anterior portions of the jaws.مهم

Question 29

What are the signs and symptoms of the non-aggressive type of CGCG?

Answer 29

The non-aggressive type produces a painless, slowly growing expansion or swelling of the affected jaw, with thinning of the cortical plates.مهمه

Question 30

What are the signs and symptoms of the aggressive type of CGCG?

Answer 30

النوع العدواني (Aggressive type): * بيسبب ألم وبينمو بسرعة. * ممكن يسبب لخلخة في الأسنان بسبب إن جذورها بتدوب (root resorption). * ممكن يعمل تنميل أو فقدان إحساس (paresthesia). * ممكن يسبب خرم في العظم ويمتد للأنسجة الرخوة اللي حواليه وده يعمل قرحة على سطح الغشاء المخاطي (mucosal surface).

Question 31

Describe the radiographic features of CGCG.

Answer 31

unilocular or multilocular radiolucent defects with relatively well-demarcated margins, often presenting a scalloped border. Involved teeth may be displaced, and their roots may show resorption (seen only in aggressive types).

Question 32

Describe the histopathological features of CGCG.

Answer 32

large numbers of multinucleated giant cells in a vascular stroma rich in small, spindle-shaped cells. The giant cells may be arranged around vascular channels or areas of hemorrhage or be scattered throughout the lesion. Foci of extravasated RBCs and hemosiderin صبغة pigment granules are common. Sparse collagen fibers may subdivide the lesion,

Question 33

Is Peripheral giant cell granuloma a bony lesion?

Answer 33

No, it is not a bony lesion. relatively common hyperplastic connective tissue response to injury of gingival tissues i.e., tumor like growth

Question 34

What is the etiology of PGCG?

Answer 34

The pathogenesis is unknown, but it is generally accepted as a reactive hyperplasia caused by local irritation or trauma.

Question 35

What is the typical age range for PGCG?

Answer 35

It occurs over a wide age range, with the average age of presentation between 30 and 40 years.

Question 36

Is there a sex for PGCG?

Answer 36

more frequently in females than in males.

Question 37

Where can PGCG arise?

Answer 37

anywhere most commonly anterior to the molar teeth.

Question 38

What are the signs and symptoms of PGCG?

Answer 38

painless nodular swelling . It may appear red, dark red, reddish These lesions are soft with a high tendency for bleeding. They can be pedunculated or sessile. In dentate areas, they often arise interdentally with an hourglass shape.ساعه رمليه المهمه فيهم

Question 39

Describe the radiographic features of PGCG.

Answer 39

When on the edentulous ridge, it may show a superficial cup-shaped radiolucency. In dentate areas, there may be superficial erosion of the interdental bone crest. Radiographs are essential for diagnosis, especially if a CGCG has perforated the cortex and presents as a peripheral swelling.

Question 40

Describe the histopathological features of PGCG.

Answer 40

PGCG consists of focal collections of multinucleated giant cells around blood vessels or areas of hemorrhage, These cells are within a richly vascular and cellular stroma. resulting in hemosiderin pigment deposits. Islands of metaplastic bone مهمه may be seen. Variable numbers hyperplastic keratinized stratified squamous epithelium, which may be ulcerated in about 50% of casesمهمه.

Question 41

What is the etiology of Brown tumor of hyperparathyroidism?

Answer 41

It is caused by hyperparathyroidism. قراءة فرط أولي (Primary Hyperparathyroidism): يعني المشكلة جاية من الغدة نفسها: • غالبًا بيكون فيه ورم حميد (adenoma) في الغدة. • أو تضخم في كل الغدد (hyperplasia). • أو نادرًا سرطان في الغدة. ٢. فرط ثانوي (Secondary Hyperparathyroidism): المشكلة مش في الغدة، لكن في حاجة تانية بتخلي الغدة تشتغل زيادة: • زي مثلًا فشل كلوي مزمن (الكلى مبتقدرش تظبط الكالسيوم والفوسفور). • أو نقص فيتامين D. • أو مشاكل في الامتصاص من الأمعاء

Question 42

Who is most commonly affected by Brown tumor?

Answer 42

It is more common in females older than 60 years.

Question 43

What are the common sites for Brown tumor? Symptoms

Answer 43

Common the ends and shafts of long bones (tibia, femur), mandible, clavicles, ribs, and pelvis. They can be solitary or multiple. g the classic triad (G B S) احفظها كده

Question 44

What are the chief oral findings of Brown tumor?

Answer 44

1- ممكن يظهر كمنطقة سودة في الأشعة (radiolucency) متحددة المعالم وشبه الكيس في الفك، ممكن تكون فراغ واحد أو كذا فراغ. 2- شكل عظم الفك العلوي والسفلي ممكن يبان كأنه فيه هشاشة في العظم (Osteoporotic appearance)، وده بيدل على إن الحالة دي منتشرة في الجسم كله، وده بيخلي شكل الآفة في الأشعة مش واضح أوي. 3- ممكن يحصل لخلخة في الأسنان بسبب فقدان الـ lamina dura اللي حوالين الجذر. 4- ممكن يحصل انسداد في عصب السن (Pulpal obliteration) وتكلس كامل لتجويف العصب وقنوات الجذر. 5- نادراً ما بيتشاف تكلسات في الغشاء المخاطي بتاع الفم (Metastatic calcification of the oral mucosa).

Question 45

Describe the radiographic features of Brown tumor.

Answer 45

Monocular or multiple eye radiation. This is accompanied by other radiological manifestations of primary hyperthyroidism.

Question 46

Describe the histopathological features of Brown tumor.

Answer 46

Microscopically, it is identical to the Central giant cell granuloma of the jaw. It is composed of focally distributed multinucleated giant cells around blood vessels or areas of hemorrhage within a highly cellular and vascular fibroblastic background.مهمه There is much hemosiderin pigment and extravasated RBCs, contributing to the brown color seen macroscopically.

Question 47

How is the diagnosis of Brown tumor made?

Answer 47

The possibility of hyperparathyroidism should be considered in patients with recurrent or multiple giant cell epulis. Biochemical changes هرومنات الغده الدرقية يعني of hyperparathyroidism must be demonstrated for confirmation. لازم نحدد ونحط في عين الاعتبار هو عنده Clinical and radiographic features are helpful, as is a biopsy.

Question 48

What is Cherubism?

Answer 48

Cherubism is a hereditary benign condition of the maxilla and mandible transmitted as an autosomal dominant gene.جين سائد بينتقل وارثي

Question 49

What is the typical age of onset for Cherubism? Sex

Answer 49

The disease usually occurs between the age of 2-5 years. more common in females than males.

Question 50

Where does the bony expansion typically occur in Cherubism?

Answer 50

The bony expansion is most frequently bilateral

Question 51

Why was the term "cherub" ملاك chosen to describe this condition?

Answer 51

The term was chosen due to the marked fullnessامتلاء of the jaws and cheeks ("chubby face" or "moon face") and upward turned eyeballs, مقله العين للأعلي which give a cherubic appearance.

Question 52

What enhances the chubbiness of the face in Cherubism?سمين الوجه

Answer 52

Fullness of the submandibular space due to enlargement of the submandibular lymph nodes enhances the facial chubbiness. Cervical lymph nodes may also be involved.

Question 53

Describe the appearance of the jaws in Cherubism.

Answer 53

The jaws appear to have hard, irregular masses bulging outwards from the surface, which are not painful.

Question 54

What are the dental implications of Cherubism?

Answer 54

Dental implications include premature loss of primary teeth, displacement of developing tooth follicles, failure of development and eruption of many permanent teeth (especially second 2and third 3mandibular molars), ectopic eruption, and malocclusion.

Question 55

What is the behavior of Cherubism?

Answer 55

Cherubism is a self-limited condition. Lesions increase rapidly in size up to age 7, then become static and begin to regress with progressive reduction in facial deformity as the patient reaches adulthood.

Question 56

Describe the radiographic features of Cherubism.

Answer 56

Radiographically, there is expansion by multiloculated radiolucency. The loculi are sharply defined and transversed by few bony septa, giving a "Soap bubble appearance".

Question 57

Describe the histopathological features of Cherubism.

Answer 57

vessels may be surrounded by a cuff of hyaline, eosinophilic collagen, which is considered pathognomonic