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Oral Pathology > Bone Neoplasms > Flashcards

Bone Neoplasms Flashcards

1
Q

What are the 3 benign lesions of bone?

A
  1. central ossifying fibroma
  2. osteoma
  3. central giant cell granuloma
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2
Q

What are the 3 malignant lesions of bone?

A
  1. chondrosarcoma
  2. osteosarcoma
  3. metastatic disease
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3
Q

What is an uncommon benign neoplasm with questionable PDL or odontogenic origin?

A

central ossifying fibroma

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4
Q

In the past, what other disorder was central ossifying fibroma confused with?

A

focal cemento-osseous dysplasia

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5
Q

Central ossifying fibroma is seen in the mandibular ___/___ region in adult ___ of the ___ or ___ decade.

A

premolar/molar; females; 3rd; 4th

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6
Q

Central ossifying fibroma is a well-circumscribed ___ with variable amount of ___ ___.

A

radiolucency; central opacity

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7
Q

In Central ossifying fibroma, the range is almost purely radiolucent to very ___ with a defined ___ border.

A

radiodense; lucent

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8
Q

Histologically, central ossifying fibroma has central fibrous CT containing mineralized trabeculae and ___ of material that may resemble cellular cementum or woven bone.

A

spherules

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9
Q

T/F. Microscopically, central ossifying fibroma is different from fibrous dysplasia, so radiographs are often necessary.

A

Microscopically, central ossifying fibroma is SIMILAR to fibrous dysplasia, so radiographs are often necessary.

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10
Q

How is central ossifying fibroma treated? What is the prognosis?

A

enucleation - lesion tends to shell out as one mass.

Prognosis is excellent and recurrence is very uncommon

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11
Q

What disease has multiple jaw lesions that histopathologically are consistent with central ossifying fibroma?

A

hyperparathyroidism-jaw tumor syndrome

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12
Q

Osteoma is a ___ osseous tumor usually affecting the ___ bone.

A

benign; membranous

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13
Q

Osteoma is a pain___, slowly enlarging tumor that may arise on the bone surface or in the bone (___).

A

less; enostosis

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14
Q

T/F. Gnathic lesions are more common than paranasal involvement with osteomas.

A

False, paranasal sinus (frontal, ethmoid and maxillary) is more common than gnathic lesions.

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15
Q

T/F. Common palatal tori, mandibular tori and buccal exostoses are all considered different types of osteomas because they are histopathologically identical

A

False, Common palatal tori, mandibular tori and buccal exostoses are NOT CONSIDERED osteomas altough they are histopathologically identical.

osteomas can be confirmed by documentation of continued growth

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16
Q

An osteoma is composed of ___ bone, with only minimal ___ elements.

A

dense; marrow

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17
Q

Osteomas of the jaw are most often detected in ___ (children/adults) with predilection for the mandibular ___ and ___.

A

adults; body; condyle

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18
Q

What are the less common mandibular locations of osteomas?

A

angle (particularly at the inferior border)
coronoid process
ramus

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19
Q

Osteoma lesions involvling the mandibular ___ are frequently found on the ___ surface adjacent to the ___ or ___.

A

body; lingual; premolars; molars

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20
Q

With osteomas, ___ involvement may limit mouth opening or cause ___, with midline deviation and chin toward the ___ side. Pain and facial swelling are possible.

A

condylar; malocclusion; unaffected

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21
Q

T/F. Radiographically, osteomas are circumscribed sclerotic masses.

A

True

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22
Q

___ osteomas may show a uniformly sclerotic pattern or may demonstrate a sclerotic periphery with central trabeculation.

A

Periosteal

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23
Q

Endosteal osteomas may appear similar/identical to ___ ___ or ___ ___.

A

condensing osteitis; idiopathic osteosclerosis

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24
Q

T/F. Gardner syndrome is an autosomal dominant trait - uncommon.

A

True.

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25
Q

Gardner syndrome has intestinal ___, osteomas of ___ bones; abnormalities of teeth and ___ cysts and ___ tumors.

A

polyps; facial; epidermoid; desmoid

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26
Q

In Gardner syndrome, impacted supernumerary teeth are found in ___% of patients and odontomas are found in ___%of patients.

A

35; 10

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27
Q

What could gardner syndrome resemble radiographically?

A

florid cemento-osseous dysplasia or osteitis deformans

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28
Q

What is the most significant aspect of Gardner syndrome?

A

the development of precancerous polyps of the colon

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29
Q

When do colorectal polyps typically develop?

A

by the 2nd decade of life

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30
Q

___% of patients develop adenocarcinoma of the colon by ___ years of age.

A

50%; 30

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31
Q

How is Gardner syndrome managed? What is the prognosis?

A
  1. prophylactic colectomy
  2. removal of cosmetically problematic cysts and osteomas
  3. genetic counseling

guarded prognosis with frequent followup visits

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32
Q

What is a benign, somewhat controversial lesion of the jaws that appears in the 2nd to 4th decade? Why?

A

central giant cell granuloma

Some pathologist feel it is the same as giant cell tumor of bone, which is typically in long bones, particularly the knee area

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33
Q

Central giant cell granuloma is more common in ___ (females/males) and usually affects the ___, often crossing the ___.

A

females; mandible; midline

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34
Q

T/F. Central giant cell granuloma is multilocular when lesions are small.

A

False, unilocular when small, larger lesions are multilocular

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35
Q

T/F. Central giant cell granuloma can become expansile.

A

True.

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36
Q

What disease has proliferation of vascular granulation tissue with numerous multinucleated giant cells scattered throughout the tissue.

A

central giant cell granuloma

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37
Q

Central giant cell granuloma has the same histological appearance as what diseases? Therefore, what test is needed?

A
  1. brown tumor of hyperparathyroidism
  2. peripheral giant cell granuloma
  3. giant cell tumor of bone

blood test for parathyroid hormone (PTH) levels

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38
Q

Treatment of central giant cell granuloma consist of aggressive ___ that may include peripheral ___.

A

curettage; osteotomy

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39
Q

Prognosis of Central giant cell granuloma is ___ and the recurrence rate is ___-___%

A

good; 15-20

40
Q

___ hyperparathyroidism is due to parathyroid hyperplasia, parathyroid adenoma, parathyroid carcinoma and results in inappropriate secretion of ___.

A

Primary; parathormone

41
Q

What is secondary hyperparathyroidism caused by?

A

renal failure, altered vit D metabolism which is responsible for poor calcium retention

42
Q

What are the actions of PTH?

A
  1. osteoclastic activation
  2. increased Ca2+ uptake by kidneys
  3. increased vit D synthesis (kidneys) which promotes Ca2+ absorption from the gut
43
Q

T/F. In primary hyperparathyroidism, kidney failure leads to inadequate production of vit D, which is needed to absorb calcium from the gut.

T/F. This results in increased serum Ca2+.

A

False, this describes secondary hyperparathyroidism. Primary hyperparathyroidism has inappropriate secretion of PTH leading to increased serum Ca2+.

True

44
Q

T/F. Both primary and secondary hyperparathyroidism leads to increased serum Ca2+.

A

True.

45
Q

With hyperPTH, radiographically, there is loss of ___ ___ and “___ ___” trabecular pattern

A

lamina dura; ground glass

46
Q

In hyperPTH, unilocular or multilocular radiolucencies may develop into “___ ___”.

A

brown tumor

47
Q

What is renal osteodystrophy?

A

When hyperPTH patients have enlargement of jaws due to long standing renal failure, (often seen in patients on longterm renal dialysis

48
Q

What disease is described by “Bones, stones groans and moans”?

A

hyperPTH

also thrones, constipation and polyuria

49
Q

Brown tumors show ___ granulation tissue with extravasated ___ and numerous benign multinucleated ___ cells.

A

vascular; erythrocytes; giant

50
Q

T/F. Microscopically, hyperPTH is identical to central giant cell granuloma, peripheral giant cell granuloma and giant cell tumor of bone.

A

True.

51
Q

What unusual hyperplastic response happens to patients with poorly controlled secondary hyperPTH?

A

renal osteodystrophy

52
Q

How is hyperPTH treated? What is the prognosis?

A

remove the source of the hormone secretion if primary (remove parathyroid)

if secondary, better control serum calcium (parathyroidectomy or renal transplant may be necessary)

prognosis: fair

53
Q

What is a rare malignancy of cartilaginous differentiation?

A

chondrosarcoma

54
Q

Chondrosarcoma is mostly seen in adult ___ (4th to 6th decade) and affects the ___, ___ or ___.

A

males; femur; pelvis; ribs

55
Q

What percentage of chondrosarcoma occurs in the head and neck region?

A

10%

56
Q

Describe the radiograph of chondrosarcoma.

A

poorly defined radiolucency with variable amounts of radiopacity
larger lesions appear multilocular
widened PDL of the teeth in area of tumor, similar to osteosarcoma

57
Q

Which of the following is true of chondrosarcoma?

  1. vague lucency/opacity
  2. loss of lamina dura
  3. widened PDL
  4. teeth test vital
A

All are true.

58
Q

Chondrosarcoma can displace the ___ and break thru ___. It metastasizes to the ___.

A

tongue; bone; spine

59
Q

Histopathologically, chondrosarcoma is characterized by invasive ___ of atypical cells showing ___ differentiation.

A

lobules; cartilaginous

60
Q

What is the treatment for chondrosarcoma?

A

radical surgery

61
Q

What does prognosis depend on for chondrosarcoma? What is the prognosis?

A

location and histopathologic grade

poor

62
Q

T/F. Death of chondrosarcoma is usually due to direct extension of tumor, involving vital structures.

A

True

63
Q

What malignancy shows produciton of osteoid by tumor cells?

A

osteosarcoma

64
Q

What is the most common PRIMARY bone malignancy?

A

osteosarcoma

65
Q

T/F. Osteosarcoma is not as common as chondrosarcoma.

A

False, it is TWICE as common as chondrosarcoma

66
Q

___ ___ is the most common malignancy in bone, followed by ___ ___.

A

Metastatic disease; multiple myeloma

67
Q

Of the ___ new cases of osteosarcoma in the US annually, only ___% of these affect the jaws.

A

900; 7

68
Q

Match the following skeletal distributions of osteosarcoma.

A. knee
B. shoulder
C. hip
D. jaw

  1. 8%
  2. 10%
  3. 15%
  4. 60%
A

1 - D
2 - B
3 - C
4 - A

69
Q

How is osterosarcoma of the jaw different from osteosarcoma of the long bones?

A

it has a different presentation epidemiologically

long bones - knee, 18 yo
jaw - 28 yo

70
Q

What is the initial complaint of osteosarcoma? What is it followed by?

A

pain, followed by swelling, loose teeth or paresthesia

71
Q

What is a mixed radiopaque/radiolucent lesion with ill-defined borders?

A

osteosarcoma

72
Q

T/F. There is asymmetrical widening of the PDL in osteosarcoma

A

False, there is symmetrical widening of the PDL

73
Q

T/F. The “sunburst” pattern is commonly seen in osteosarcoma of the jaws.

A

False, it is uncommonly seen

74
Q

What condition has root resorption, mottled bone, widened PDL and loss of lamina dura?

A

osteosarcoma

75
Q

Histopathology of osteosarcoma is infiltrating sheets of malignant ___-shaped or ___ lesional cells; direct production of osteoid or bone; mitotic activity and ___, ___, ___ differentiation.

A

spindle; angular; osteoblastic; chondroblastic; and fibroblastic

76
Q

How is osteosarcoma treated?

A

induction chemotherapy then surgery to remove the tumor. If areas of necrosis are found, continue chemotherapy; if not use alternative chemotherapeutic agent

77
Q

Historically, 5-yr survival has been in the ___-___% range, better prognosis for ___. One study, using radical surgery had an ___% 5-yr survival for osteosarcoma.

A

30-50; 80

78
Q

What is death from osteosarcoma usually due to ?

A

uncontrolled local disease

79
Q

How does osteosarcoma metastasize?

A

via the blood to lung, liver and brain

80
Q

What is the most common malignant process to involve bone?

A

metastatic disease

jaws are occasionally affected

81
Q

Metastatic tumors to the oral cavity are ___% of all oral malignancies.

A

1

82
Q

How would metastatic deposits from malignancies below the neck affect the jaws?

A

through Batson’s paravertebral plexus of veins

83
Q

___ ___ is a valveless vertebral venous plexus that might allow ___spread of tumor cells, bypassing filtration through the ___.

A

Batson plexus; retrograde; lungs

84
Q

What does Batson plexus connect?

A

deep pelvic veins and thoracic veins in the internal vertebral venous plexuses

85
Q

With metastatic disease, over half of affected patients are over ___ years of age.

A

50

86
Q

Match the following as it relates to metastatic disease.

A. mandibule
B. maxilla
C. Soft tissue

  1. 15%
  2. 24%
  3. 61%
A

A - 3
B - 2
C - 1

87
Q

___ is the most common soft tissue metastatic sites (___%) followed by the ___ (___%).

A

Gingiva; 54%; tongue; 22.5%

88
Q

Paresthesia, tooth mobility, swelling, hemorrhage, pathologic fracture and trismus are all signs seen with what diesease?

A

metastatic disease

89
Q

With lack of healing in a tooth socket, what should one clinically consider?

A

granulation tissue; lymphoma; metastatic disease

90
Q

T/F. Metastatic disease has a poorly defined radiolucency; “moth eaten” less commonly, radiopacity

A

True

91
Q

T/F. Histopathologically, lesions in metastatic disease have the pattern of the primary malignancy from which they arose.

A

True

92
Q

In metastatic disease, ___ clusters of lesional cells give a “___” effect

A

scattered; seeded

93
Q

What are some of the more common primary sites of metastatic disease?

A

breast, lung, colon, thyroid, prostate, kidney, melanoma

94
Q

How is metastatic disease treated?

What is the prognosis?

A

palliation, usually with radiation therapy

very poor; most patients die within one year of the diagnosis

95
Q

___ of jaw metastases represent the initial manifestation of the malignant process.

A

22

Oral Pathology (5 decks)

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