Chapter 14: Bone Pathology part II Flashcards
1
Q
as periapical cemento osseous dysplasia lesions “mature” over time, how do they appear radiographically?
A
- they will go from a circumscribed area of radiolucency involving the apex of the tooth (early) to having a mixed RL-RO appearance
- end-stage lesions are densely RO with a RL rim
- the PDL will be intact; the pesion will NOT fuse to the tooth
2
Q
A
ossifying fibroma
3
Q
microscopic fibro-osseous lesions are very similar among the different types of fibro-osseous lesions, so ___ and ___ are necessary to establish a diagnosis
A
clinical and radiographic findings
4
Q
fibrous dysplasia is a sporadic condition resulting from a ___ mutation
A
postzygotic
5
Q
describe the pain associated with osteoid osteoma
A
- nocturnal
- relieved by aspirin
6
Q
are teeth affected by periapical cemento-osseous dysplasia invariably vital or devital?
A
vital
7
Q
periapical cemento osseous dysplasia lesions are asymptomatic, and discovered how?
A
when radiographs are taken for other reasons
8
Q
gardner syndrome is a symptom complex characterized by what 7 conditions?
A
- colonic polyps/adenosarcoma
- skeletal abnormalities (90%)
- dental abnormalities (20%)
- apidermoid cysts
- dermoid tumors (10%)
- thyroid carcinoma
- pigmented lesions of the ocular fundus (90%)
9
Q
describe mccune-albright syndrome
A
- polyostotic fibrous dysplasia
- cafe au lait (coast of Maine)
- multiple endocrinopathies
10
Q
chondromas typically arise in patients of what age range? male or female predilection?
A
- 20-30s
- M=F
11
Q
A
osteoid osteoma
12
Q
A
periapical cemento-osseous dysplasia
13
Q
osteoblastomas are rare, especially in the ___
A
jaws
14
Q
what are 4 things that osteomas can cause?
A
pain, swelling, sinusitis, or nasal discharge
15
Q
an ossifying fibroma (is/is not) a true neoplasm with significant ___ potential
A
- is a true neoplasm
- growth
16
Q
what is the treatment of cementoblastomas?
A
surgical extraction of the tooth with the calcified mass
17
Q
skeletal abnormalities in gardner syndrome precede what other characteristic of gardner syndrome?
A
bowel polyps
18
Q
A
cementoblastoma
19
Q
most chondromas are found in the ___ or ___
A
condyle or anterior maxilla
20
Q
what is the chief radiographic feature of monostotic fibrous dysplasia?
A
“ground glass” opacification; a result of superimposition of poorly calcified bone in a disorganized fashion
21
Q
juvenile (active) ossifying fibroma is distinguished from ossifying fibroma on the basis of what 3 things?
A
- age of patient
- most common sites of involvement
- clinical behavior
22
Q
___ is a diverse group fo processes characterized by replacement of normal bone by fibrous tissue containing a mineralized product
A
fibro-osseous lesions
23
Q
what are the common features of synovial chondromatosis?
A
swelling, pain, crepitus, and limitation of motion
24
Q
ossifying firbomas occur across a wide age range. are they more prominent in males or females? mandible or maxilla?
A
F>M
mandible > maxilla
25
do ossifying fibromas undergo malignant transformation?
no
26
which type of cemento-osseous dysplasia involves multiple periapical regions of the anterior mandible, with multiple foci usually present?
periapical cemento osseous dysplasia
27
florid cemento osseous dysplasia has a marked tendency to be ___ or \_\_\_. is it typically symptomatic or asymptomatic?
* bilateral or assymetrical
* may be completely asymptomatic
28
\_\_\_ is an odontogenic neoplasm of cementoblasts
cementoblastoma
29
focal cemento osseous dysplasia lesions are smaller than \_\_\_
1.5 cm
30
most juvenile (active) ossifying fibroma tumors has a ___ progressive growth, but some exhibit \_\_\_
* slowly
* rapid enlargement
31
biopsy of florid cemento osseous dysplasia could lead to \_\_\_
necrosis due to hypovascularity
32
at are the three types of cemento-osseous dysplasia?
focal, periapical, florid
33
monostotic fibrous dysplasia
34
radiographically, how do chondromas present?
RL with a central RO
35
how do osteoblastomas present radiographically?
* well-defined or ill-defined
* radiolucent with varying degrees of central RO
36
any chondroma of the jaws should be considered as possibly representing a potential \_\_\_
chondrosarcoma
37
do small ossifying fibroma lesions cause symptoms? how are they detected?
* no
* they are detected via radiograph
38
the skeletal abnormalities associated with gardner syndrome affect which bones? how many lesions do most patients typically have?
* skull, paranasal sinuses, and mandible
* 3-6 lesions
39
how are osteoblastomas and osteoid osteomas treated? what is the prognosis?
* typically both lesions are treated by local excision or curettage
* prognosis is good
40
\_\_\_% of florid cemento osseous dysplasia cases are female, and \_\_\_% are african americans. what age patient is most common?
* 90%
* 90%
* middle-aged to older adults
41
how do osteomas present radiographically?
* circumscribed masses
* impossible to differentiate from small foci of sclerotic bone on initial radiograph
* osteomas will exhibit continued growth
* usually RO (compact bone), but can be RL with central RO (cancellous bone)
42
are synovial chondromatosis lesions of the TMJ more common in males or females?
females
this is different from other joints
43
\_\_\_ and ___ are closely related, benign bone tumors that arise from osteoblasts
osteoblastomas and osteoid osteomas
44
what are the dental abnormalities associated with gardner syndrome?
* **supernumerary teeth**
* impacted teeth
* odontomas
45
what are examples of benign fibro-osseous lesions?
* fibrous dysplasia
* cemento-osseous dysplasia
* focal, periapical, florid
* ossifying fibroma
46
the bowel polyps in gardner syndrome develop during the ___ years and WILL transform into \_\_\_
* develop during teen years
* adenocarcinoma
* 50% by age 30
* 100% in "older" patients
47
which type of fibrous dysplasia involves two or more bones and can involve up to 75% of the skeleton?
polyostotic
48
\_\_\_ is a rare, bening, nonneoplastic development of cartilagenous nodules within the synovial membrane
synovial chondromatosis
49
is focal cemento osseous dysplasia symptomatic of asymptomatic?
asymptomatic
50
\_\_\_ is a benign tumor of cartilage
chondroma
51
if chondromas occur, they likely arise from \_\_\_
cartilaginous rests
52
what are the common features of osteoblastomas?
* pain, tenderness, and swellings are important and common presenting features
* pain is NOT relieved by aspirin
53
the ___ features of osteoblastomas and osteoid osteomas are identical
histopathological
54
what is the prognosis of synovial chondromatosis? recurrence?
good with a low frequency of recurrence
55
how are large or symptomatic osteomas treated?
conservative excision
56
if the jaw is involved in polyostotic fibrous dysplasia, ___ may result
facial asymmetry
57
ossifying fibroma is a neoplasm composed of fibrous tissue that contains a variable mixture of ___ and \_\_\_
bone and cementum
58
most patients affected by synovial chondromatosis are what age?
middle-aged
59
synovial chondromatosis most commonly affects \_\_\_
large joints, but can affect the TMJ
60
which type of dysplasia occurs in tooth-bearing areas of the jaws and is the **most common** fibro-osseous lesion encountered in clinical practice?
cemento-osseous dysplasia
61
is juvenile (active) ossifying fibroma (both types - psammomatoid and trabecular) more common in males or females? maxilla or mandible? both of these characteristics are opposite of \_\_\_
* M\>F
* maxilla \> mandible
* opposite of ossifying fibroma
62
osteomas are \_\_\_, ___ lesions found in what age patient?
* asymptomatic, solitary
* young adults
63
are osteomas malignant or benign? do they recur?
they are completely benign with extremely rare recurrence
64
are chondromas painful? fast or slow growing?
painful and slow-growing
65
is radiation therapy common in the treatment of polyostotic fibrous dysplasia?
no, it is contraindicated
66
osteomas:
\_\_\_ lesions are more common than ___ lesions
paranasal sinus lesions are more common than gnathic lesions
67
because fibrous dysplasia is a sporadic condition resulting from a postzygotic mutation, depending on when the mutation takes place, the process may involve what 4 things?
* one bone (monostotic)
* multiple bones (polyostotic)
* skin
* endocrine system
68
involvement of the maxilla in monostotic fibrous dysplasia leads to \_\_\_
obliteration of the maxillary sinus
69
florid cemento-osseous dysplasia
70
\_\_\_ are among the most commonly affected sites for monostotic fibrous dysplasia
jaws
71
what is the prognosis of ossifying fibromas? what is the recurrence?
* very good prognosis
* recurrence is very rare
72
juvenile (active) ossifying fibroma
73
what is the treatment of synovial chondromatosis?
surgical removal of the synovium and all loose bodies
74
how are small, asymptomatic osteomas treated?
probably do not need to be treated but should be observed and removed if lesions become large (interfere with function or esthetics) or symptomatic
75
monostotic fibrous dysplasia
76
a ___ is a benign tumor of mature bone that is restricted to the craniofacial skeleton
osteoma
77
florid cemento-osseous dysplasia
78
good oral hygiene should be encouraged in those with which type of cemento osseous dysplasia, so that they keep their teeth (extraction could lead to necrosis)
periapical or florid
79
how does florid cemento osseous dysplasia present radiographically?
* lesions demonstrate an identical pattern of maturation noted in both focal and periapical forms
* initially, lesions are predominantly RL
* over time, become mixed RL-RO
* end-stage lesions are predominantly radiopaque with athin peripheral RL rim
80
is monostotic fibrous dysplasia more common in the maxilla or mandible?
maxilla
81
monostotic fibrous dysplasia accounts for \_\_\_% of all cases
80%
82
large ossifying fibromas of the mandible demonstrate a characteristic downward bowing of the \_\_\_
inferior cortex of the mandible
83
what is the most common feature of monostotic fibrous dysplasia?
painless, slow-growing swelling of the affected area
84
what is the range of recurrence for juvenile (active) ossifying fibroma?
30-60%
85
periapical cemento-osseous dysplasia
86
monostotic fibrous dysplasia
87
what is the most common location of focal cemento osseous dysplasia?
posterior mandible
88
if there are multiple chondroma lesions, what syndromes should be ruled out?
ollier and maffucci
89
what are the radiographic features of ossifying fibromas?
* well-defined
* typically unilocular
* can be completely radiolucent or, more commonly, mixed RL-RO
* depends on amount of calcified material
* root divergence or resorption of roots can occur
90
how do large ossifying fibroma lesions present?
painless swelling
91
how does synovial chondromatosis present radiographically?
* loose bodies are seen
* irregularly shaped, variably sized RO structures
* sometimes called joint mice
92
chondroma
93
what is the average age for focal cemento-osseous dysplasia? what population is it more common in? (boards vs. real life)
* age 40
* boards - caucasians
* real life - african americans
94
florid cemento-osseous dysplasia
95
which type of cemento-osseous dysplasia exhibits a single sight of involvement and occurs mostly in females (90%)?
focal cemento-osseous dysplasia
96
is there a likelihood of malignant transformation in juvenile (active) ossifying fibroma?
no
97
other than the ground glass opacification, describe the radiographic presentation of monostotic fibrous dysplasia
* lesions are not well demarcated - they blend imperceptibly into the adjacent normal bone
* PA radiographs may show narrowing of PDL with an ill-defined lamina dura
98
polyostotic fibrous dysplasia
99
cartilagenous rests that can give rise to chondromas are found in what 4 areas?
anterior maxilla, symphysis, coronoid process, and condyle
100
do cementoblastomas typically affect primary or permanent teeth?
permanent
101
involvement of the mandible in monostotic fibrous dysplasia leads to \_\_\_
expansion of the buccal and lingual plates
102
are osteoid osteomas common in the jaws?
no
103
where do osteomas arise?
on the surface of bone or within medullar bone
104
gardner syndrome
105
85% of osteoblastomas occur before age \_\_\_. male or female predilection?
* 30
* F\>M
106
\_\_\_% of periapical cemento-osseous dysplasia cases are female, and \_\_\_% occur in african americans, with an overall average age of ___ years
* 90%
* 70%
* 40
107
75% of cementoblastomas occur before what age?
30
108
synovial chondromatosis
109
each periapical cemento osseous dysplasia lesion is \_\_\_, and ___ does not occur
* self limiting
* progressive growth
110
what are the most common skeletal abnormalities associated with gardner syndrome? when are they noted?
osteomas noted during puberty
111
what size are osteoblastomas?
between 2-4cm
112
polyostotic fibrous dysplasia tends to stabilize and stop growing at \_\_\_
skeletal maturity
113
describe jaffe-lichtenstein syndrome
* polyostotic fibrous dysplasia
* cafe au lait spots (coast of Maine)
114
do osteoblastoma and osteoid osteomas regress? do they recur? is there malignant transformation?
* sometimes lesions will regress after incomplete excision
* lesions typically don't recur unless they are aggressive osteoblastomas
* 50% recur
* malignant transformation has been reported, but it is very rare
115
although osteoblastoma lesions are rare in the jaws, where do they tend to occur when they are in the jaws?
* mandible \> maxilla
* posterior \> anterior
116
why should diagnosis of chondroma in the jaws be viewed with skepticism?
many so-called benign chondromas have recurred and behave in a malignant fashion
117
what are the endocrinopathies associated with mccune-albright syndrome?
* sexual pecocity, pituitary adenoma, and/or hyperthyroidism
* sexual pecocity is the most common
* menstrual bleeding, breast development, and pubic hair appear in females within the first few years of life
118
osteoid osteomas produce \_\_\_, and the pain is relieved by \_\_\_
* prostaglandins
* aspirin (NSAIDs)
119
gardner syndrome is present in 1 in \_\_\_
10,000
120
how do cementoblastomas present radiographically?
* RO mass that is fused to one or more tooth roots
* outline of the root or roots is usually obscured
* surrounded by a thin RL rim
121
what is the treatment of chondromas?
total surgical removal
122
when is monostotic fibrous dysplasia usually diagnosed? gender predilection?
teenage years
M=F
123
what is the treatment of gardner syndrome?
* prophylactic colectomy
* long-term prognosis depends on the development and behavior of bowel adenocarcinomas
124
75% of cementoblastoma lesions arise in the \_\_\_, almost always in the ___ region
* mandible
* molar/premolar region
125
what is the general rule related to age for patients with juvenile (active) ossifying fibroma? how can lesions be treated?
* the younger the patient is, the more aggressive the tumor
* smaller lesions can be treated with local excision or curettage
* wide resection is required for rapidly enlarging or large lesions
126
ossifying fibroma lesions can typically be ___ easily
enucleated
127
periapical cemento-osseous dysplasia
128
describe the radiographic presentation of osteoid osteoma
* well-circumscribed
* radiolucent defect
* usually less than 1cm (anything less than 2cm still indicates this lesion is an osteoid osteoma)
* small RO nidus may be present, resulting in a "target-like" appearance
129
* polyostotic fibrous dysplasia - jaffe-lichtenstein syndrome
* polyostotic fibrous dysplasia - mccune-albright syndrome (if associated with sexual precocity, pituitary adenoma, and/or hyperparathyroidism
130
chondromas are common bone tumors, usually found in the ___ and \_\_\_
hands and feet
131
which type of cemento osseous dysplasia is characterized by multiple focal involvement not limited to the anterior mandible, in which patients may jsut have lesions in the posterior jaws, but may also have lesions throughout
florid cemento osseous dysplasia
132
focal cemento-osseous dysplasia
133
osteoblastoma
notice it is \>2cm
134
involvment of florid cemento osseous dysplasia is unrelated to the presence or absence of \_\_\_
teeth
135
what are the radiographic features of focal cemento osseous dysplasia?
* vary from completely radiolucent to densely radiopaque
* lesions will have a thin radiolucent rim
* **differentiates from idiopathic osteosclerosis and condensing osteitis**
* most commonly, there is a mixed radiolucent-radiopaque pattern
* lesion is usually well-defined
136
osteoma
137
radiographically, juvenile (active) ossifying fibroma lesions are typically ___ with central \_\_\_
radiolucent with central radiopacity
138
describe early periapical cemento osseous dysplasia lesions
circumscribed areas of radiolucency involving the apex of a tooth - this lesion looks identical to that of a periapical granuloma or cyst
139
\_\_\_ is a tumorlike condition characterized by replacement of normal bone by fibrous conenctive tissue intermixed with bone
fibrous dysplasia
140
which type of cemento osseous dysplasia may require surgical investigation because the features are less specific?
focal
141
how can you distinguish between osteoblastomas and osteoid osteomas?
size of the lesion
* osteoid osteomas are SMALLER than 2cm
* osteoblastomas are larger
142
what are the two types of fibrous dysplasia?
* monostotic
* polyostotic
* jaffe-lichtenstein syndrome
* mccune-albright syndrome
143
pain and swelling are present in what fraction of cementoblastoma cases?
2/3
144
monostotic fibrous dysplasia
145
juvenile (active) ossifying fibroma is \_\_\_-growing and \_\_\_-circumscribed
* rapidly
* well
146
describe the clinical management of polyostotic fibrous dysplasia
* clinical management is a major problem
* smaller lesions of the mandible may be resected
* diffuse and large nature of most lesions precludes this option
* may reduce surgically, but up to 50% recur
147
for periapical or florid cemento osseous dysplasia, diagnosis can be made from \_\_\_
the distinctibe clinical and radiographic findings - do NOT need biopsy
148
which two different neoplasms have been reported under juvenile (active) ossifying fibroma? which is more common?
* trabecular
* psammomatoid
* psammatoid:trabecular 4:1
149
what is the cause of synovial chondromatosis?
unknown
