Bone Neoplasms (3)

Question 1

List three malignant neoplasms of bone?

Answer 1

1. Chondrosarcoma
2. Osteosarcoma
3. Metastatic disease

Question 2

Which syndrome is associated with central ossifying fibroma?

Answer 2

Hyperparathyroidism-jaw tumor syndrome

Question 3

Which syndrome is associated with an osteoma?

Answer 3

Gardner syndrome

Question 4

Which syndrome is associated with giant cell granuloma?

Answer 4

1. Hyperparathyroidism

2. Renal osteodystrophy

Question 5

Most authorities consider a central ossifying fibroma to be an _______________.

Answer 5

Osteogenic neoplasm

Question 6

T/F: Central ossifying fibromas are benign tumors that are sometimes seen outside of the jaw.

Answer 6

True

Question 7

Where are central ossifying fibromas often found?

Answer 7

Mandibular molar/pre-molar region

Female predilection (3rd-4th decade)

Question 8

T/F: Jaw expansion and facial asymmetry is possible with central ossifying fibroma.

Answer 8

True

Question 9

T/F: Central ossifying fibroma will show radiographically as completely radiolucent.

Answer 9

False

Can be totally radiolucent or have radiopacity within it

Question 10

What type of tissue is seen in a central ossifying fibroma?

Answer 10

Fibrous tissue with mix of bony and cementum like material

Question 11

What is the treatment and prognosis for central ossifying fibroma?

Answer 11

Enucleation as one mass

Excellent

Question 12

T/F: Tori and exostoses are considered osteomas.

Answer 12

False

They are histopathologically identical, but osteomas do not stop growing

Question 13

T/F: Osteomas can occur on the surface of bone or within the bone.

Answer 13

True

Question 14

Where are the most common places for osteomas?

Answer 14

Paranasal sinuses

Question 15

Where is the most common place to get a gnathic osteoma?

Answer 15

Mandibular body and condyle… often see on lingual premolar/molar area

Question 16

What will an osteoma look like radiographically?

Answer 16

Circumscribed radiopaque mass

Those within bone may appear similar to idiopathic osteosclerosis/condensing osteitis

Question 17

T/F: Osteomas are filled with bone marrow.

Answer 17

False

Minimal marrow or trabeculae

Question 18

What is the treatment/prognosis of osteomas?

Answer 18

Nothing… excision if symptomatic

Good, recurrence rare

Question 19

T/F: Gardner syndrome is autosomal dominant and highly penetrant.

Answer 19

True

If you have the mutation, will most likely get the disease

Question 20

Multiple Epidermoid cysts and osteomas can lead to what possible diagnosis?

Answer 20

Gardner syndrome

High risk for intestinal polyps that will transform to adenocarcinoma

Question 21

What is the prognosis for Gardner syndrome?

Answer 21

Guarded

50% Patients develop adenocarcinoma by 30 years old

Question 22

T/F: Central giant cell granulomas are more common in older patients.

Answer 22

False

Mostly females under 30

Question 23

What is the most common location for a central giant cell granuloma?

Answer 23

Usually in the anterior mandible crossing the midline

Question 24

T/F: Central giant cell granulomas can break through bone and into soft tissue.

Answer 24

True

Typically asymptomatic but can be more aggressive

Question 25

What is the treatment and prognosis for central giant cell granuloma?

Answer 25

Aggressive curettage/osteotomy Good, recurs 15-20% of the time

Question 26

What are the two types of hyperparathyroidism?

Answer 26

Primary - parathyroid hyperplasia, parathyroid adenoma or carcinoma -> inappropriate secretion of PTH Secondary - renal failure -> altered vitamin D -> poor calcium retention

Question 27

T/F: PTH activates osteoblasts.

Answer 27

False PTH activates osteoclasts to break down bone calcium and increase blood calcium

Question 28

What is often seen in dental radiographs of a patient with hyperparathyroidism?

Answer 28

Loss of lamina dura and “ground glass” appearence

Question 29

What tumor is associated with Hyperparathyroidism and what is it similar to?

Answer 29

Brown tumors Similar to peripheral giant cell granuloma, CGCG, and giant cell tumor of bone

Question 30

What oral manifestations will be seen with Hyperparathyroidism patients with renal osteodystrophy that may be on dialysis?

Answer 30

Prominent enlargement of the jaw(s)

Question 31

What is the treatment/prognosis for hyperparathyroidism?

Answer 31

Primary - remove source Secondary - better control, renal transplant Fair

Question 32

What is the 2nd most common bone malignancy?

Answer 32

Chondrosarcoma Still rare however

Question 33

Chondrosarcoma is a malignancy of _____________ differentiation.

Answer 33

cartilaginous

Question 34

What are the most likely places to see a chondrosarcoma?

Answer 34

Femur, pelvis, ribs

Question 35

What percentage of chondrosarcoma are seen in head and neck?

Answer 35

10%

Question 36

T/F: Chondrosarcoma in the head and neck can mimic dental infection.

Answer 36

True

Question 37

T/F: Chondrosarcoma will present as a well defined radiolucency.

Answer 37

False Poorly defined radiolucency with some radiopacity

Question 38

What is the histopathological features of chondrosarcoma?

Answer 38

Invasive lobules of atypical cells with cartilaginous differentiation

Question 39

What is the treatment/prognosis for chondrosarcoma?

Answer 39

Radical surgery Generally poor, depends on location and grade Metastasis to lung

Question 40

What is the most common primary bone malignancy?

Answer 40

Osteosarcoma

Question 41

What percentage of osteosarcoma affect the jaws?

Answer 41

8%

Question 42

Where do most osteosarcomas occur?

Answer 42

In the long bones at the knee

Question 43

What are the clinical features of an osteosarcoma in the jaws?

Answer 43

Swelling, loose teeth, parasthesia

Question 44

T/F: Osteosarcoma in the jaws often shows as a “sun burst” pattern radiographically.

Answer 44

False Less common in the jaw Will see mixed radiopaque/radiolucent lesion instead

Question 45

What types of cells will be seen in an osteosarcoma?

Answer 45

Osteoblastic, chondroblastic, and fibroblastic cells producing osteoid

Question 46

T/F: Radical surgery is the only treatment for osteosarcoma.

Answer 46

False Induction chemotherapy, then surgery to remove tumor

Question 47

What is the prognosis for osteosarcoma?

Answer 47

Fair 5 year survival 30-50% Metastasis to lung

Question 48

What is the most common form of cancer involving the bone?

Answer 48

Metastatic disease

Question 49

T/F: Jaws are often affected with metastatic disease.

Answer 49

False 1% of all oral malignancies are metastatic disease

Question 50

What is the significance of Batson’s plexus?

Answer 50

Valveless vertebral venous plexus allows spread of tumor cells against gravity up to the jaws

Question 51

Which jaw is most commonly affected with metastatic disease?

Answer 51

Mandible

Question 52

T/F: Metastatic disease is most commonly seen as a poorly defined radiolucency.

Answer 52

True

Question 53

What are the most common metastatic diseases?

Answer 53

Breast, lung, colon, thyroid, prostate, kidney, melanoma

Question 54

What is the treatment and prognosis of metastatic disease?

Answer 54

Palliative with radiation therapy Very poor, most die within a year 22% of jaw metastases are initial manifestation