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Oral Path 2, Exam 3 > Bone Neoplasms > Flashcards

Bone Neoplasms Flashcards

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1
Q

3 Benign neoplasms of the bone

A
  1. Central ossifying fibroma
  2. Osteoma
  3. Central Giant Cell Granuloma
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2
Q

3 Malignant neoplasms of the bone

A
  1. Chondrosarcoma
  2. Osteosarcoma
  3. Metastatic disease
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3
Q

Syndrome associated with central ossifying fibroma

A

Hyperparathyroidism-jaw tumor syndrome

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4
Q

Syndrome associated with osteoma

A

Gardner syndrome

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5
Q

Conditions associated with central giant cell granuloma

A

Hyperparathyroidism and Renal osteodystrophy

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6
Q

Uncommon benign neoplasm that is seen in female adults, primarily in the mandibular molar/pre-molar region

A

Central ossifying fibroma

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7
Q

True/False: Central ossifying fibroma may cause jaw expansion

A

True

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8
Q

Central ossifying fibroma resembles ___ ___-___ ___

A

Focal cemento-osseous dysplasia

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9
Q

Microscopically, central ossifying fibroma is similar to ___ ___. Because of this, you need a ____ for correlation

A

Fibrous dysplasia

Radiograph

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10
Q

Treatment for central ossifying fibroma

A

Enucleation - lesion tends to shell out as one mass

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11
Q

Multiple jaw lesions that histopathologically are consistent with central ossifying fibroma

A

Hyperparathyroidism-jaw tumor syndrome

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12
Q

Hyperparathyroidism leads to _____

A

Hypercalcemia

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13
Q

Patients with hyperparathyroidism-jaw tumor syndrome are at an increased risk for development of ___ ___

A

Parathyroid carcinoma

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14
Q

Although they are histopathologically identical, palatal tori, mandibular tori, and buccal exostoses are NOT considered to be ____

A

Osteomas

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15
Q

Osteomas are composed of what types or bone?

A

Compact or cancellous

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16
Q

How are osteomas confirmed?

A

By continuous growth

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17
Q

___ ___ involvement is more common than gnathic lesions for osteomas

A

Paranasal sinus

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18
Q

Gnathic involvement is most often in the ___ ___ and ___

A

Mandibular body and condyle

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19
Q

Osteomas on the body of the mandible are often in the ___ ___/___ area

A

Lingual pre-molar/molar area

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20
Q

What may happen to a patient with an osteoma if the condyle is involved?

A

Limited opening - malocclusion - deviation of midline and chin to unaffected side

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21
Q

Describe what periosteal (exostoses) in osteomas appear like radiographically?

A

Uniformly sclerotid or have central trabeculations

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22
Q

Describe what endosteal (enostoses) in osteomas appear like radiographically?

A

Similar/identical to idiopathic osteosclerodid or condensing osteitis

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23
Q

Overall, osteomas have ___ bone, minimal marrow or ____ and ____ marrow

A

Dense
Trabeculae
Fibrofatty

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24
Q

What is the osteoma treatment if the lesion is small? What if it’s bigger?

A

Small - no treatment

Bigger - conservative excision

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25
Are condylar osteomas usually symptomatic or asymptomatic? What is their treatment?
Symptomatic - local resection or condylectomy
26
What must be ruled out if the patient has multiple osteomas?
Gardner syndrome
27
Is Gardner syndrome autosomal dominant or recessive?
Dominant
28
What is the most significant aspect of Gardner syndrome
The development of precancerous polyps of the colon
29
What type of cases does Gardner syndrome typically refer to?
Cases in which extraintestinal manifestations are especially prominent
30
What do colorectal polyps ultimately transform into?
Adenocarcinoma
31
When does Gardner syndrome develop?
Around puberty
32
Locally aggressive fibrous neoplasms of soft tissue
Desmoid tumors
33
Tooth abnormalities related to Gardner syndrome
1. Impacted teeth 2. Sueprnumerary teeth 3. Odontomas
34
Gardner syndrome can resemble :
Florid cemento-osseous dysplasia or fibrous displasia
35
Treatment for Gardner Syndrome
Prophylactic colectomy and removal of cosmetically problematic cysts and osteomas
36
Prognosis for Gardner syndrome
Guarded - half will develop adenocarcinoma of the colon
37
Central Giant Cell Granuloma has a ____ predilection
Female
38
Where is a Central Giant Cell Granuloma normally seen?
In the mandible, often crosses midline - more common in the anterior
39
Central Giant Cell Granuloma can cause root ____
Divergence
40
What does root divergence suggest? What about root resorption?
Divergence - benign | Resorption - aggressive
41
Central Giant Cell granuloma has the same histologic appearance as what other conditions? What must you have to distinguish them?
Brown tumor of hyperparathyroidism, peripheral giant cell granuloma, and giant cell tumor of bone Radiographic correlation and blood test for PTH
42
Treatment for Central Giant Cell Granuloma?
Aggressive curettage/peripheral osteotomy
43
2 types of hyperparathyroidism
1. Primary | 2. Secondary
44
Primary hyperparathyroidism
Parathyroid hyperplasia, parathyroid adenoma or carcinoma --> inappropriate secretion of PTH
45
Secondary hyperparathyroidism
Renal failure --> altered vitamin D metabolism --> poor calcium retention
46
Actions of PTH
1. Osteoclast activity 2. Increased Ca uptake by kidney 3. Increased vitamin D synthesis (kidneys) which promotes Ca from the gut
47
Actions of inappropriate secretion of PTH in primary hyperparathyroidism results in increased serum ___
Ca
48
Kidney failure in secondary hyperparathyroidism leads to inadequate production of vitamin D. What does this lead to?
Increased serum Ca
49
Clinical features of hyperparathyroidism
Bones, stones, groans, moans
50
Radiographic feature of hyperparathyroidism
Loss of lamina dura, ground glass trabecular pattern
51
Unusual hyperplastic response of bone in patients with poorly controlled secondary hyperparathyroidism
Renal osteodystrophy
52
Renal osteodystrophy is often seen in patients on long term ___ ___ and may manifest as prominent ___ ___
Renal dialysis | Jaw enlargement
53
Treatment for primary and secondary hyperparathyroidism
Primary - remove source of hormone secretion | Secondary - better control of serum calcium
54
Malignancy of cartilaginous differentiation
Chondrosarcoma
55
2nd most common primary bone malignancy
Chondrosarcoma
56
Chondrosarcoma has a _____ predilection
Male
57
Where are chondrosarcomas mainly seen?
Femur, pelvis, or ribs
58
This malignancy may mimic a dental infection (+/- pain, swelling, loose tooth)
Chondrosarcoma
59
The teeth will test ____ (vital/non-vital) with a Chondrosarcoma
Vital
60
Treatment for Chondrosarcoma
Radical surgery - "one chance for cure"
61
Prognosis for Chondrosarcoma
Generally poor - death usually due to tumor expansion into vital structures - metastasis esp. to the lungs
62
Most common primary bone malignancy (2x as common as chondrosarcoma)
Osteosarcoma
63
Where are most osteosarcomas found? What percent?
In the knee (60%) | 8% in the jaw
64
Are patients with osteosarcoma typically old or young?
``` Long bone (knee) = Young - mean age ~ 18 Jaw = Older - mean age ~28 ```
65
What is often the initial complaint for patients with osteosarcoma?
Pain
66
Radiographic features of osteosarcoma
"Sun-burst" pattern (uncommon in jaws) | Symmetrically widened PDL of teeth
67
Why does a parosteal osteosarcoma have a better prognosis?
Because it is peripheral
68
What do the tumor cells produce in osteosarcoma?
Osteoid
69
Treatment for osteosarcoma
Chemotherapy and then surgery for removal
70
Where can osteosarcoma often metastasize?
The lung
71
What is the common cause of death in patients with osteosarcoma?
Death usually due to uncontrolled disease
72
Overall, where do metastases typically go?
To the bone
73
What is the most common form of cancer involving bone? What is the second most common?
Metastatic disease - most common | Multiple myeloma - 2nd most common
74
Metastasis from below the neck may affect jaws via ___ ___ ___ of ____
Batson's paravertebral plexus of veins
75
What is Batson's plexus?
A VALVELESS vertebral venous plexus (may allow retrograde spread of tumor cells), bypassing filtration through the lungs
76
What does Batson's plexus connect?
Deep pelvic veins and thoracic veins in the internal vertebral venous plexuses
77
Are patients with metastatic disease typically older or younger?
Older - over 1/2 are > 50 yo
78
Most cases of metastases in the jaws involve the _____ (maxilla/mandible). What is the 2nd most common site?
Mandible - second site is the gingiva
79
If a tooth socket is not healing, what three things should you consider?
Granulation tissue, lymphoma, metastatic disease
80
Radiographic appearance of metastatic disease
"Moth-eaten"
81
Most common metastatic diseases:
Breast, lung, colon, thyroid, prostate, kidney, melanoma
82
Treatment for metastatic disease
Palliation, usually with radiation
83
Prognosis for metastatic disease
Very poor

Oral Path 2, Exam 3 (6 decks)

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