Bone Pathology Spring 2022 Flashcards
1
Q
Nasopalatine Duct Cyst: Description
A
Unilocular radiolucency between maxillary central incisors
2
Q
Nasopalatine Duct Cyst: Asymptomatic or symptomatic?
A
Small lesions are asymptomatic and large lesions can cause palatal swelling, drainage and pain.
3
Q
Nasopalatine Duct Cyst: Diameter
A
Must be more than 6 mm to be considered a nasopalatine duct cyst rather than normal incisive foramen
4
Q
Nasopalatine Duct Cyst: Population affected
A
Most common in the 4th-6th decades, male predilection
5
Q
Nasopalatine Duct Cyst: Etiology
A
Nasopalatien canal (incisive canal) contains remnants of the nasopalatine duct. These epithelium remnants can undergo cystic degeneration -> nasopalatine duct cyst.
6
Q
Most common non-odontogenic cyst of the oral cavity
A
Nasopalatine duct cyst
7
Q
Nasopalatine Duct Cyst: Treatment
A
Surgical enucleation
8
Q
Nasopalatine Duct Cyst: Prognosis
A
-Recurrence after enucleation is rare. -Malignant transformation is extremely rare.
9
Q
Median Palatal Cyst: Occurrence
A
Rare
10
Q
Median Palatal Cyst: How does this lesion appear on an occlusal film?
A
Unilocular radiolucency midline hard palate
11
Q
Median Palatal Cyst: Description
A
Symmetric fluctuant swelling posterior to palatine papilla along midline of the hard palate and there is no communication with the incisive canal.
12
Q
Median Palatal Cyst: Etiology
A
Develops from epithelium entrapped along the embryonic line of fusion of the lateral palatal shelves of the maxilla
13
Q
Median Palatal Cyst: Treatment
A
Biopsy for diagnosis, follow with surgical enucleation
14
Q
Focal Osteoporotic Marrow Defect: Etiology
A
Area of hematopoietic marrow that is large enough in size to cause radiolucency
15
Q
Focal Osteoporotic Marrow Defect: What sex does it occur most in? Location? Symptomatic?
A
3/4 adult females
3/4 occur in posterior mandible
Asymptomatic
16
Q
Focal Osteoporotic Marrow Defect: Radiographic Features
A
Non-expansile radiolucency
Majority are well-circumscribed
Non-corticated borders
Central trabeculation
17
Q
Focal Osteoporotic Marrow Defect: Treatment
A
Radiology is characteristics but not entirely specific.
May consider biopsy for definitive diagnosis
No association with anemia or other hematologic disorders
18
Q
Stafne Defect: Describe lesion and location
A
Focal concavity in the cortical bone on the lingual surface of the mandible
19
Q
Stafne Defect: Cause
A
Concavity caused by entrapped normal salivary gland tissue and is considered a developmental defect
20
Q
Stafne Defect: Population Affected
A
Middle aged and older adults; strong male predilection (80-90%)
21
Q
Stafne Defect: Where are most of these defects detected?
A
In PANS
22
Q
Stafne Defect: Classic Presentation
A
Asymptomatic radiolucency below the mandibular canal in the posterior mandible
23
Q
Stafne Defect: Where does this occur between?
A
Between mandibular molar teeth and the angle of the mandible
24
Q
Stafne Defect: Describe lesion in CT
A
Well-defined cupped-out lingual cortical defect
25
Stafne Defect: Where can this also present other than the posterior mandible?
Anterior mandible associated with the sublingual gland
26
Stafne Defect: Size Variation over time
May remain stable in size, but few may show increase in size overtime.
27
Stafne Defect: Treatment for Posterior mandible lesions
Clinically diagnostic-> if unsure on PAN can confirm characteristic features with additional imaging: CBCT, MRI, sialogram
No treatment necessary
28
Stafne Defect: Treatment for anterior mandible lesions
Difficult to discern from other radiolucent pathology
Biopsy is typically necessary to confirm diagnosis
Once diagnosis is established, no further treatment is necessary
29
Idiopathic Osteosclerosis AKA Dense Bone Island: Etiology/Background
Area of dense bone with unknown cause
30
Idiopathic Osteosclerosis AKA Dense Bone Island: Radiographic Features
Focal area of icnreased radiopacity/radiodensity
31
Idiopathic Osteosclerosis AKA Dense Bone Island: Most common site
Posterior mandible; particularly 1st molar area
32
Idiopathic Osteosclerosis AKA Dense Bone Island: Symptoms and how is it detected
Asymptomatic and incidental finding on radiology
33
Idiopathic Osteosclerosis AKA Dense Bone Island: Population affected
Usually first detected in adolescence or early adulthood.
34
Idiopathic Osteosclerosis AKA Dense Bone Island: Prevelance
5 percent of the population
35
Idiopathic Osteosclerosis AKA Dense Bone Island: Treatment & Prognosis
Differentiate from condensing osteitis if closely approximating the tooth roots.
Conduct vitality testing to determine tooth origin
No treatment necessary
36
Simple Bone Cyst: Describe Lesion
-Empty or fluid filled bone cavity; pseudocyst
37
Simple Bone Cyst: Cause
Unknown, multiple theories
38
Simple Bone Cyst: How it is detected?
Usually an incidental radiographic finding
39
Simple Bone Cyst: How does it look on a radiograph?
-Well-delineated unilocular radiolucency (few cases of multiloceular lesions)
-Radiolucent defect SCALLOPS upwards between roots of adjacent teeth
-Teeth adjacent are vital
-Minimal to no expansion in most cases
40
Simple Bone Cyst: What are the most common oral sites?
Premolar, molar, and symphyseal region of the mandible
41
Simple Bone Cyst: Treatment
-Radiographic features are characteristic but not diagnostic; requires surgical exploration with biopsy.
42
Simple Bone Cyst: What can be found during surgical exploration?
On surgical exploration, the cavity may be empty or contain thin fluid -> submit whatever tissue can be obtained from curettage.
43
Simple Bone Cyst: What can surgical exploration and curettage help regenerate? Is there a low recurrence rate?
Bone; low recurrence rate, excellent prognosis
44
Aneurysmal Bone Cyst: Define Lesion
Intraosseous accumulation of variable-size, blood-filled spaces
Pseudocyst
45
Aneurysmal Bone Cyst: Cause
Exact cause unknown; many cases have a specific molecular alteration suggesting the lesion is neoplastic rather than reactive
46
Aneurysmal Bone Cyst: Reactive refers to ____ and neoplastic refers to ______
Functional Keratosis; epithelial dysplasia
47
Aneurysmal Bone Cyst: Clinical Features
Painful, rapidly enlarging swelling
48
Aneurysmal Bone Cyst: Radiographic Appearance
Unilocular or multilocular radiolucency with marked cortical expansion and thinning, borders may be well-defined or poorly defined
49
Aneurysmal Bone Cyst: Most common site
Posterior mandible and ascending ramus
50
Aneurysmal Bone Cyst: What can maxillary lesions cause?
Bulge into sinus and cause nasal obstruction and proptosis and diplopia
51
Aneurysmal Bone Cyst: Age range of occurrence
Most occur in young patients (peak in second decade)
52
Aneurysmal Bone Cyst: Treatment
Enucleation and curettage
53
Aneurysmal Bone Cyst: Intraoperative appearance
Blood-soaked sponge
54
Central Giant Cell Granuloma: Describe lesion
Intraosseous lesion of unknown etiology
55
Central Giant Cell Granuloma: Population affected
Over a broad age range (but majority occur before age 30)
56
Central Giant Cell Granuloma: Where does this typically occur?
70% occur in the mandible and more common in anterior jaws
57
Central Giant Cell Granuloma: Radiographic Appearance
Unilocular or multilocular R/L with well-delineated but usually non-corticated borders
58
Central Giant Cell Granuloma: Size Ranges
5 mm to 10 cm; sufficiently large lesions cause clinical swelling
59
Central Giant Cell Granuloma: Aggressiveness; growth pattern
Non-aggressive; slow growth, few to no symptoms
60
Central Giant Cell Granuloma: Describe rare cases and patient symptoms
Aggressive lesions characterized by pain, rapid growth, and cortical perforation
61
Central Giant Cell Granuloma: Initial Treatment
Biopsy for definitive diagnosis
62
Central Giant Cell Granuloma: Definitive Treatment
Curettage, intralesional corticosteroid injections, bisphosphonates, monocloal antibody denosumab and others
63
Central Giant Cell Granuloma: What happens if there is recurrence? Recurrence rate?
En bloc resection; 20 percent, lesions with aggressive features show higher recurrence rates
64
Central Giant Cell Granuloma: Key histology
Multinucleated giant cells
65
Brown Tumor: Describe reason for name
Named due to having a brown color of the lesion seen during biopsy/excision
66
Brown Tumor: Describe how hyperparathyroidism plays a role
Hyperparathyroidism is an excess production of PTH -> PTH is secreted in response to low calcium levels
67
Brown Tumor: Primary Cause
Uncontrolled production PTH, usually 2/2 parathyroid adenoma/hyperplasia or carcinoma
68
Brown Tumor: Secondary Cause
PTH produced in response to chronic low levels of serum calcium
69
Brown Tumor: Population affected
>60 years old, F>M
70
Brown Tumor: Classical Symptoms
Classic symptom triad of hyperparathyroidism: "Stones, bones, abdominal groans" which mean kidney stones, alteration in bone density and duodenal ulcers
71
Brown Tumor: Radiographic presentation
Radiographically well-defined unilocular or multilocular R/L
Striking enlargement of the jaws with "ground glass" radiographic pattern
72
Brown Tumor: Lesion commonly affects what part of the body?
Mandible
73
Brown Tumor: What do most patients with this also have?
End stage renal failure and hyperparathyroidism
74
Brown Tumor: What type of lesions are brown tumors identical to? How can they be deciphered?
Histologically idential to CGCG
Diagnosis can only be made with clinical context; clinical history and pertinent lab studies are indicated for definitive diagnosis
75
Cherubism: Define
Rare developmental jaw condition that can be inherited or occur sporadically.
76
Cherubism: Most cases are caused by
Mutation in SH3BP2
77
Cherubism: Inheritance Pattern
Autosomal dominant with variable expressity
78
Cherubism: Inheritance Pattern
Autosomal dominant with variable expressiveness
79
Cherubism: Classic Presentation
Painless (usually) bilaterally symmetric posterior expansion that begins in young childhood, progresses until puberty, and then slowly regresses
80
Cherubism: Describe how this lesion affects the mandible
Involves angles, ascending rami, coronoid processes
81
Cherubism: Describe how lesion affects maxilla
Maxillary tuberosity up to the entire maxilla
82
Cherubism: Describe what tool can appropriately diagnose
Radiographic appearance is virtually diagnostic
83
Cherubism: What can this lesion cause?
Tooth displacement, mobility, failure of eruption
84
Cherubism: What can this lesion cause in severe cases?
Airway obstruction, vision and/or hearing loss
85
Cherubism: Histologically, what is this lesion identical to? How do we properly diagnose?
CGCG and Brown tumor; clinical context is necessary for definitive diagnosis
86
Cherubism: Treatment & Prognosis
Most cases spontaneously regress with near normal appearance by fourth decade
87
What are three benign fibro-osseous lesions that are microscopically identical?
1. Cemento-osseous dysplasia
2. Fibrous dysplasia
3. Ossifying fibroma
88
What does BFOL mean?
Common fibro-osseous lesions of the jaws include fibrous dysplasia, cemento-osseous dysplasia, and ossifying fibroma.
89
Cemento-osseous dysplasia (COD): Define
Non-neoplastic replacement of the bone by first fibrous connective tissue, and later with subsequent deposition of bone and/or cementum
90
What is the most common BFOL?
COD
91
What does BFOL stand for?
benign fibro-osseous lesion
92
Cemento-osseous dysplasia (COD): where does this lesion occur?
In tooth bearing areas near the apices of teeth
93
Cemento-osseous dysplasia (COD): What does an early lesion look like radiographically?
Radiolucent
94
Cemento-osseous dysplasia: What does a middle phase of this lesion look like radiographically?
Mixed radiolucent/radiopaque
95
Cemento-osseous dysplasia: What does a late lesion look like radiographically?
Radiopaque
96
Cemento-osseous dysplasia: What are the three types based on sites affected?
1. Periapical cemento-osseous dysplasia
2. Focal cemento-osseous dysplasia
3. Florid cemento-osseous dysplasia
97
Periapical COD: Describe where it is seen
Seen at apices of VITAL mandibular incisors (usually multiple)
98
Periapical COD: Radiographic Features in initial appearance and later appearance
-Initial: Well circumscribed RL
-R/L can merge to form a linear R/L involving multiple teeth
-Later: Mixed/ R/O with thin radiolucent rim
PDL in tact
99
Periapical COD: Describe how to diagnose
Clinical and radiographic features are clincally diagnostic- biopsy not indicated
100
Periapical COD: Treatment
Observation
101
Focal Cod: Most common location
Posterior mandible at apex of a tooth or extraction site
102
Focal COD: Symptoms
Asymptomatic
103
Focal COD: What lesions is similar in radiographic features?
periapical cod
104
Focal COD: Radiographic features (Initial, later, how does PDL present?)
-Initial: Well defined, somewhat irregular border R/L
-Later: Mixed/ RO with thin radiolucent rim
-PDL remains intact
105
Focal COD: Diagnosis; what does it rule out?
Biopsy indicated to rule out:
1. Ossifying Fibroma
2. Ossifying Fibroma shell out during biopsy
3. Other lesions that can present as unlocular radiolucencies in the posterior mandible
106
Focal COD: Treatment
After confirming diagnosis -> observation, focal COD can be the early form of florid COD
107
Florid COD: Describe location and regions involved
-Multifocal involvement (multiple quadrants)
-Dentulous and edentulous regions
108
Florid COD: What kind of expansion can this cause?
Cortical Expansion
109
Florid COD: Radiographic Features
Similar to periapical COD
Ranges R/L to mixed RL/RO to R/O
PDL intact, but can fuse at end-stage
110
Florid COD: Diagnosis
Clinical and radiographic features are diagnostic; not biopsy indicated
111
Florid COD: Treatment
Observation
Avoid bony manipulation at involved sites
112
Florid COD: What is dense bone more prone to? What do we want to avoid
Poor healing and secondary infection
No implants
Avoid extraction/currettage of involved sites if possible
Antbiotics if secondary infection occurs (osteomyelitis)
113
Paget Disease: Define lesion
Abnormal resoprtion and deposition of bone rsulting in disotrtion and weakening of affected bones
114
Paget Disease: Cause
Unknown
115
Paget Disease: Population affected
1/100 to 1/150 person over age of 45 have subclinical disease; male predilection
116
What is the second most common metabolic bone disorder after osteoporosis?
Paget Disease
117
Paget Disease: What kind of pain is associated with lesion?
Dull bone pain
118
Paget Disease: Are both jaws affected?
Either monostotic (1 bone affected) vs polyostotic (more than 1 bone affected)
119
Paget Disease: Bones most often affected
Lumbar vertebra, pelvis, skull, femur
120
Paget Disease: What aspect of jaw is affected? How is it affected?
Maxillary affected more than mandible; alveolar ridges become symmetrically enlarged.
121
Paget Disease: Clinically, how does this disease affect tooth spacing?
Spacing of teeth occurs of ridge expansion, denture becomes too small.
122
Paget Disease: Describe early lesions
-Affected bone exhibits decreased radiodensity and a coarse trabecular pattern
-In the skull, large cirumscribed radiolucencies may be present and are terms osteoporosis circumscripta
123
Paget Disease: Describe late lesions
-Osteoblastic phase= patchy areas of sclerotic bone
-Giving the cotton wool appearance
-Teeth demonstrate hypercementosis
-Can resemble florid COD
124
Paget Disease: Diagnosis
Made on a summation of clinical, radiographic and laboratory findings
125
Paget Disease: Laboratory Findings
Increased alkaline phosphatase
Normal calcium and phosphorus
High hydroxyproline
126
Paget Disease: Treatment
Limited involvement= no treatment
Symptomatic bone pain controlled with NSAIDs
More severe cases: antiresorptive therapy, calcitonin, bisphosphonates -> reduce bone turnover and improve biochemical abnormalities
127
Paget Disease: Prognosis
Chronic and slowly progressive: seldom a cause of death
Audio/visual disturbances possible
Increased risk for developing osteosarcoma
128
Fibrous Dysplasia: Define
Developmental disorder caused by a specific mutation (GNAS-1 gene) during embryonic development
129
Fibrous Dysplasia: What replaces what with this disease?
Normal bone replaced by abnormal fibrous connective tissue
130
Fibrous Dysplasia: Population affected
Young usually diagnosed by the third decade of life
131
Fibrous Dysplasia: Describe progression of disease
Asymptomatic, slow, progressive clinical enlargement of affected bones
132
Fibrous Dysplasia: Radiographic appearance
Ground glass appearance
Causes bone expansion but expansion characteristically maintains its shape
133
Fibrous Dysplasia: What can this disease displace?
May cause superior displacement of the IA canal
134
Fibrous Dysplasia: Diagnosis
Often a clinical diagnosis based on clinical and radiographic features
135
Fibrous Dysplasia: Treatment
Delay until completion of growth
Depending on patient, lesions can be self limiting and regress on their own
136
Fibrous Dysplasia: How are serious cases treated?
Surgical debulking
137
Fibrous Dysplasia: Reccurence
Younger patients more commonly have regrowth after surgery
138
Fibrous Dysplasia: How is the extent determined?
Depends on when the GNAS mutation occurs
139
Fibrous Dysplasia: Describe Early mutation
Early mutation affected pluripotent stem cell causing abnormalities in osteoblasts, melanocytes, and endocrine cells.
140
Fibrous Dysplasia: Describe late mutations
Only affects osteoblasts
141
Fibrous Dysplasia: Describe monostotic FD
One bone affected
142
Fibrous Dysplasia: Describe polyostotic FD
Multiple bones affected
143
Fibrous Dysplasia: Three associated syndromes
-Jaffe-Lichtenstein Syndrome
-McCune-Albright Syndrome
-Mazabraud Syndrome
144
Fibrous Dysplasia: Describe Jaffe-Lichtenstein syndrome characterizations
Characterized by polyostotic fibrous dysplasia and cafe au lait pigmentation
145
Fibrous Dysplasia: Describe McCune-Albright Syndrome characteristics
Characterized by polyostotic fibrous dysplasia, cafe au lait pigmentation, and multiple endocrinopathies
146
Fibrous Dysplasia: Describe Mazabraud syndrome characteristics
Characterized by fibrous dysplasia and intramuscular myxomas
147
Fibrous Dysplasia: How do we determine if a patient with fibrous dysplasia has an associated syndrome?
If one bone is affected -> patient most likely does not have associate syndrome.
Associated syndrome are typically diagnosed at very young ages
148
Ossifying Fibroma: Define
True neoplasm of bone with significant growth potential
149
Ossifying Fibroma: Describe area affected
Mandible more often than maxilla premolar/molar area
150
Ossifying Fibroma: Symptoms
Painless, expansion of involved bone
151
Ossifying Fibroma: Clinical Features
Can cause asymmetry and can reach very large size
152
Ossifying Fibroma: Radiographic
-Well defined unilocular, +/- sclerotic border
-Can be completely R/L (rare), usually mixed RL/RO
-Can cause root divergence or resorption
153
Ossifying Fibroma: Describe Surgical features
When opening for biopsy this lesion will typically shell out; this is unique from other BFOL lesions and is a helpful diagnostic feature in some cases
154
Ossifying Fibroma: Treatment
Enucleation
Surgical resection and bone grafting for large lesions
155
Ossifying Fibroma: Prognosis
Recurrenec is rare after removal and no malignant potential has been shown
156
Osteoid Osteoma & Osteoblastoma: Define
Closely related benign tumors of osteoblast origin
157
Osteoid Osteoma & Osteoblastoma: How to determine which one?
Osteoid Osteoma: Less than 2 cm
Osteoblastoma: More than 2 cm
158
Osteoid Osteoma & Osteoblastoma: Symptoms
Painful
159
Osteoid Osteoma: Location
Most occur in femur, tibia, phalanges, rarely jaw
160
Osteoid Osteoma: Population affected
Most common between ages of 4-25 years old; male 3:1
161
Osteoid Osteoma: Symptoms
Nocturnal pain (dull, throbbing) alleviated by NSAIDs
162
Osteoid Osteoma: Radiographic Presentation
Circumscribed, mixed radiolucent radiopaque lesions. Central radiolucent nidus and surrounding radiopaque sclerosis
163
Osteoblastoma: Prevlance
Rare overall
164
Osteoblastoma: Population affected
Young 85% before age 30
Female predilection
165
Osteoblastoma: Area affected
Slight mandibular predilection
166
Osteoblastoma: Symptoms
Pain, tenderness, swelling
Pain is not worse at night
167
Osteoblastoma: What does not relive pain?
NSAIDs
168
Osteoblastoma: Radiographic presentation
Circumscribed, mixed radiolucent, radiopaque lesions
169
Osteoid Osteoma & Osteoblastoma: Treatment
Local excision or curettage
Recurrence following complete excision is rare
170
Osteoid Osteoma & Osteoblastoma: Which type has malignant transformation?
Osteoblastoma
171
Osteoma: Define
Benign tumor (neoplasm) of mature compact or cancellous bone
172
Osteoma: Areas affected
Usually affect the craniofacial skeleton, can also occur in the soft tissue
Predilection for mandibular body and condyle
173
Osteoma: What are not considered osteomas?
Tori and exostoses
174
Osteoma: Population affected
Adults
175
Osteoma: Symptoms
Asymptomatic lesion
176
Osteoma: Features
Solitary, slow-growing
177
Osteoma: Radiographic features
Well-circumscribed sclerotic (radiopaque) mass
178
Osteoma: Treatment
Small asymptomatic lesions can be radiographically monitored
Conservative excision for large symptomatic lesions [condylar lesions and paranasal sinus lesions frequently symptomatic]
179
Osteoma: Recurrence; malignant transformation
Rare; malignant transformation has been reported
180
If your patient has multiple osteomas, what could they have?
Gardner Syndrome
181
Gardner Syndrome: Define
Syndrome characterized by intestinal polyps and disorders of bone, skin, teeth and other sites
182
Gardner Syndrome: Describe inheritance pattern
AD
183
Gardner Syndrome: Describe when polyps develop and what that means
Colorectal polyps develop in the second decade and are premalignant
184
Gardner Syndrome: What happens if polyps remain untreated?
If untreated will transform to adenocarcinoma is nearly 100 percent of cases
185
Gardner Syndrome: What do 90% of patients also have?
Skeletal abnormalities; most common is multiple osteomas
186
Gardner Syndrome: When are osteomas discovered?
Osteomas are usually first noted at puberty and often present before colon polyps
187
Gardner Syndrome: Dental anomalies
Odontomas, supernumerary teeth, impacted teeth
188
Gardner Syndrome: Skin manifestations; what term categorizes all these lesions?
Epidermoid cysts
Lipomas, fibromas, neurofibromas, leiomyomas, desmoid tumors
; Benign mesincaraol tumors
189
Gardner Syndrome: Causes increased risk of multiple malignancies
Thyroid carcinoma, adrenal carcinoma, hepatoblastoma, pancreatic adenocarcinoma, brain tumor
190
Gardner Syndrome: What can occur without treatment
Without treatment, fifty percent of patients develop colorectal cancer by age 30; appraoches one hundred percent by age 50
191
Gardner Syndrome: Treatment
Require close surveillance, clinical trials ongoing for chemoprevention
Removal of sympatomatic osteomas
192
Gardner Syndrome: Dental Management
Surgical extracton of impacted teeth, Removal of odonotomas, and prosth treatment
193
Cementoblastoma: Define
Benign odontogenic neoplasma of cementoblasts
194
Cementoblastoma: Prevalance
Rare/ Less than 1% of odontogenic tumors
195
Cementoblastoma: Site
More than 75% occur in mandible; 90% occur in molar/PM region
196
Cementoblastoma: Population affected
No sex predilection; children and young adults
50% before age 20
75% before age 30
197
Cementoblastoma: Symptoms
Pain and swelling in two thirds of cases
198
Cementoblastoma: Radiographic features
Can show aggressive behavior (bone expansion, cortical expansion, displacement of adjacent teeth)
Radiopaque mass fused to one or more tooth roots, surrounded by thin RL rim
Loss of PDL space
199
Cementoblastoma: Histology
Closely resembles an osteoblastoma/osteoid osteoma so distinguished by fusion to the root
200
Cementoblastoma: Treatment
Surgical extraction of tooth with mass or amputate involved root and RCT the remaining tooth
201
Cementoblastoma: Recurrence
Rate ranges up to 22% [thought to be a feature of incomplete removal]
202
General body features concerning for malignancy
* Ill-defined or Moth-eaten borders
* Sun-burst periosteal reaction
* Rapid bony destruction
* Multiple “punched-out” radiolucencies
* Specific pattern of multiple myeloma
* Signs of pain and/or paresthesia
* Apparent periapical pathology with
repeat endodontic therapy and no resolution * Submit apicoectomies
* Rare cases of metastatic disease
* Biopsy is always required for definitive diagnosis
203
Osteosarcoma: Define
Malignancy of mesenchymal cells capable at producing osteoid
204
Osteosarcoma: Increased risk in what disease and therapy?
Increased risk in paget disease and post radiation therapy
205
Osteosarcoma: Most common in ___
Post radiation sarcoma
206
Osteosarcoma: Population
Wide age range, but mean age is 33 years old
207
Osteosarcoma: Sites affected
Maxilla and mandible equally affected
208
Osteosarcoma: Clinical Featues
Mass or swelling with pain, parasthesia, loosening of teeth
209
Osteosarcoma: Radiographic Features
Lytic and or sclerotic area with irregular, poorly defined borders
Moth eaten pattern
Sunburnst pattern
Symmetrical widening of PDL space early
210
Osteosarcoma: Histologic Features
Production of malignant osteoid
211
Osteosarcoma: Treatment
Surgery plus or minus chemo
212
Osteosarcoma: Survival rate
30-70% survival rate with local spread being the biggest concern
213
Osteosarcoma: Describe how disease progresses
Begins in the bone, but when expands can perforate through the cortex and create a soft tissue swelling
214
Chondrosarcoma: Define
Malignancy of mesenchymal cells capable at producing malignant cartilage
215
Chondrosarcoma: Prevalance
Rare 0.1% of H&N malignancies
216
Chondrosarcoma: Site affected
Maxilla most common gnathic site
217
Chondrosarcoma: Population affected
Wide age range, peak in 7th decade
218
Chondrosarcoma: Symptoms
Painless mass/swelling most common sign
usually slow growing
Loosening of teeth, nasal obstruction, epistaxis
219
Chondrosarcoma: Radiographic findings
Uni or multilocular radiolucencies +/- radiopacities
Ill-defined borders
Possible sunburst pattern
+/- root resorption and widening of PDL
220
Chondrosarcoma: Treatment
Radical surgical excision +/- radiation/chemo
221
Chondrosarcoma: Prognosis
Head and neck chrodrosarcoma 5 and 10 year survival: 87% and 70% respectively
222
Ewing Sarcoma: Define
A malignant neoplasm composed of small, undifferentiated round cells
223
Ewing Sarcoma: Origin
Neuroectodermal origin
224
Ewing Sarcoma: Cause
85-90% of cases reciprocal translocation between chromosomes 11 and 12
225
What is the third most common osseous malignancy?
Ewing Sarcoma
226
Ewing Sarcoma: Population
Young, eighty percent of patients are less than 20 years old; male predominance
227
Ewing Sarcoma: Symptoms
Pain, swelling, parasthesia, loosening of teeth
228
Ewing Sarcoma: What does this commonly perforate?
Cortex
229
Ewing Sarcoma: Areas affected
Jaw involvement is rare, but more common than mandible
230
Ewing Sarcoma: Radiographic appearance
* Irregular, lytic bone destruction, ill-defined margins
* +/- cortical destruction/expansion
* “ONIONSKIN” periosteal reaction *common in long bones and NOT SEEN in jaw lesions
231
Ewing Sarcoma: Histology
Small round cells in sheets with no distinct pattern
232
Ewing Sarcoma: Treatment
Surgery, radiotherapy and multidrug chemo
233
Ewing Sarcoma: Prognosis
40-80% survival rate
