fml giannina

Question 1

cemento-ossifying fibroma (COF)

1) age
2) sex predilection
3) assym?
4) location?
5) radiogrph?
6) neoplasm?
7) displace teeth?
8) D/D
9) clinical symptoms
10) surgical presentation
11) histo
12) txt? recur?

Answer 1

1) 3-4th decade
2) 5F : 1M
3) assymptomatic IF SMALL
4) MN in PM/M
5) Well demarcated, unilocular, expansible/bowing of jaw if large, and radiolucent or mixed (more cementum=more opaque)
* ALWAYS has lucent border*
6) true neoplasm, monoclonal set of cells
7) NO
8) Cementoblastoma (MN 1M) but you know it’s not since it’s not attached to a tooth
9) Overlying mucosa is eroded and massively expansible in nature
10) Its characeter that COF comes out as a single mass, and a potato like mass (incisional biopsy tunrs into excisional)
11) potato like mass, CT and interspersed bone/cementum
12) Enucleation, and no, we do not expect recurrence

Question 2

Fibrous Dysplasia (FD)

1) what is it?
2) 80-85% location?
3) high risk of?
4) radiograph
5) craniofacial FD?
6) age?
7) sex?
8) clinic?
9) % of FD polystotic cases?
10) histo
11) background stroma
12) txt and recur
13) malignant transform?

Answer 2

1) one disorder where fibrous tissue develops in place of bone -NOT a true neoplasm, a developmental tumor
2) Monostotic, jaws (MX) and long bones
3) bone fracture, hockey stick legs
4) Ground glass or orange peal radiopacity, poorly demarcated, no lucent border
5) not mono or polystatic bc no contagious bone in FD of face
6)1- decade
7_ F=M
8) painless swelling
9) 15-20%
10) Chinese characters appearance, NO osteoblasts in periphery, massive amoutns of fibrous tissue with immature trabeculae with no specific orientation
11) Background stroma is uninflamed; Will be replaced by cortical or llameler bone as lesion matures
12) No treatment unless there is severe cosmetic deformities since it will be recurrent 25-50%
13) RARE, most cases follow radiation txt

Question 3

What are the two types of polystotic fibrous dysplasia?

Answer 3

1) Jaffe – multi bone involvement, skin

2) Mccune Albright – café au liat macules, ENDOCRINE hyperfunction, pituitary adenoma

Question 4

Cemento-Osseous Dysplasia

1) neoplasm?``
2) location
3) etiology

Answer 4

1) no
2) tooth bearing areas of the jaw in ONLY DENTATE patients
3) reactive, unknkown pathogenesis

Question 5

Types of Cemento-Osseous Dysplasia? Do they look different in hito?

Answer 5

Type determined by location/extent  
--Periapical 
--Florid 
--Focal  
Histo looks the same

Question 6

Periapical Cemento-Osseous Dysplasia (PCOD)

1) occurs in? sex, age
2) lamina dura
3) radio
4) tooth vital?
5) D/D
6) txt

Answer 6

1) anterior MN, AA, 14F:1M, 30-50 yrs
2) Lamina dura is in tact with no widening due to the fact that this is not proliferative
3) Starts out as a radiolucent lesions that is well corticated but over time the lesion will become radiopaque
4) VITAL TOOTH
5) COF (PCOD does NOT cause expansion and has vital teeth with no resorption, multi fragments to remove)
6) none, multiple fragments if removed

Question 7

Focal Cemento-Osseous Dysplasia (FCOD)

1) sex, age, location
2) location
3) txt and radio

Answer 7

1) 80% female, white, 4-5th decade
2) post MN, asymptomatic, no expansion
- -NOT in anterior
3) must biopsy to rule out COF bc opaque with lucent border

Question 8

Florid Cemento-Osseous Dysplasia (FOD or FCOD)

1) defining feature
2) sex, age, location
3) asym or sym?
4) radio
5) D/D
6) Associated with?
7) txt

Answer 8

1) bilateral AND multiple quadrants
2) young AA females
3) asym unless mucosa isn’t intact- need good hygeine, possible but unlikely expansion
4) cotton-wool
5) Look like osteomas but these do not have the radiolucent rim
6) Traumatic bone cysts
7) Antibiotics with debridement if s2nd infected

Question 9

Osteoid Osteoma AND Osteoblastoma

1) histo? confused with?
2) benign or malignant?
3) differenciate the two?
4) commonality?
5) age and sex
6) cytokinetic tool
7) txt
8) recur
9) malignant transform

Answer 9

1) Immature osteoid and trabeculae of bone with a bluish look to it, fibrovascular stroma, basophilic
* *Osteoblasts look dysmorphic so it can be confused with osteosarcoma
2) benign
3) only by size, site and symptoms (histo and radio the same)
4) rare <1% of primary bone tumors
5) 11-29 yrs and 2M : 1F
6) FOS and FOSB gene rearrangements, chromosome 19 - distingushed from every other LESION and osteosarcoma
7) local excision curettage
8) Yes, go back and do another curettage
9) Reported but not very common

Question 10

Osteoid Osteoma

1) size
2) location
3) charactistic? why and relieved by?
4) radio
5) types
6) most common site

7) histo
8) txt

Answer 10

1) <1.5cm or less than 2
2) long bones ( femur, tibia, phalanges)
3) nocturnal pain that is relieved by aspirin - no prostaglandins produced
* *Osteoblastoma also causes pain, which means tumor does not produce prostaglandins *
4) Well circumscribed radiolucency with a central radiopacity and reactive sclerosis
5) periosteal and endosteal (contained within bone)
6) paranasal sinuses
7) compact dense bone (cancellous) trabeculae of bone and fibro–fatty marrow with osteoblasts in periphery
8) no need to txt but excision

Question 11

Osteoblastoma

1) size
2) location
3) pain?

Answer 11

1) >1.5cm or greater than 2
2) Vertebral column, femur, tibia, mandibula
3) Yes, not relieved with a aspirin since prostaglandins not produced

Question 12

Gardner Syndrome (GS)

1) what is it?
2) genetic?
3) location
4) confused with
5) complications
6) main complication
7) txt

Answer 12

1) type of familial adenomatous polyp disease that is AD that presents with polyps, epidermoid cysts, as well as multiple osteomas of the jaw
2) autosomal dominant on chromosome 5
3) any bone with limited growth
4) Confused with florid cementoosous dyplasia, but know its not it since there is no radiolucent rim - cotton roll appearance - remember, osteomas are totally radiopaque
5) -50-60% EPIDERMOID benign cysts
- DERMOID tumors in 15-30%
- 85% ocular congenital hypertrophic retinal pigment epithelium
- oral: 35% impacted/supernumerary teeth and 10% odontomas
6) *GI polyps which 50% become malignant by 30yrs
7) Prophylactic colectomy to prevent the development of adenocarcinoma, and genetic counseling

Question 13

Central Giant Cell Granuloma (CGCG)

1) what is it?
2) neoplasm?
3) location? most common?
4) age and sex?
5) radio
6) unique bc?
7) D/D
8) teeth vital
9) true granuloma?
10) histo
11) Why do we see a brown globular material?
12) txt and recur

Answer 13

1) a reactive, benign, non neoplastic lesion of the jaw
2) No
3) Post MN and ascending ramus- typically crosses midline 70% MN most common
4) 2-4 decade and Female
5) Unilocular radiolucent, become multilocular over time, B-L expansion with thinning of the cortex -MACHO
6) crosses midline
7) GOC bc it also crosses midline
- - Aneurysmal Bone Cyst (ABC)
- - Brown Tumor of hyperparathyroidism look the same
- - Giant cell tumor of bone - does not occur in jaws, occur sin distal femur proximal tibia
8) should be; depends on resorption
9) no
10) Granulation tissue (blood vessels and fibroblasts), Large multinucleated osteoclast giant cells, endothelial and blood cells
11) There are blood cells due to endothelial cells, and this leads to the break down of heme leading to the deposition of brown globular material
12) curettage, calcitonin injections, interferon alpha and 15-20% recur

Question 14

Granulation tissue means?

Answer 14

blood vessels and fibroblasts

Question 15

Hemangioma of Bone (Vascular Malformation)

1) what is it?
2) neoplasm
3) location
4) arteries or veins?
5) age and sex
6) clinical signs
7) radio
8) resorption?
9) histo
10) txt
11) D/D

Answer 15

1) vascular malformation that occurs within the bone
2) not a neoplasm
3) skull, vertebra, jaw-MN mostly)
4) both
5) 2-3 decade and Females
6) Pain, swelling, mobility, sulcular bleeding and bruit
7) radiolucent and multiocular (MACHO) with a sunburst pattern in response to expansion of bone
8) yes plus expansion
9) cavernous (large) or capillary (small)
10) Pretreatment aspiration FIRST - do not want to embolize the lesion so want to aspirate first
11) aspirate + blood= vascular malfomation
- straw colored fluid= mandibular cyst
- cheesey/white keratin= CGCG or OKC
- –also, CGCG will have large central cells instead of spaces, no bruit, doesn’t happen in skull/vertebra

Question 16

bruit

Answer 16

Refers to a pulse

• you can expect a pulse with hemeangioma of the bone lesions.
• More so seen in arterial lesions over venous lesions

Question 17

Langerhans cell disease

1) what is the disease?
2) neoplasm?
3) what are the cells?
4) what proliferates in LCD?
5) 3 forms of LCD?
6) another name for LCD?
7) age and sex
8) radio
9) most commonly affected bones?
10) pain
11) histo… must see what two cells?
12) ID Langerhan cells
13) txt
14) prognosis?

Answer 17

1) disease that deals with the proliferation of histocyte-like cells
2) no, it is benign
3) found in mucosa, epidermis;antigen presenting
4) other white blood cells, especially eosinophils
5) Letterer-Siwe Disease,Hand Schuller Christian Disease, Eosinophilic granuloma of bone
6) Histiocytosis X
7) <10yrs for 50% of cases; Men
8) Severe bone destruction, well and poorly defined radiolucency
9) Skull, ribs, vertebrae and mandible
10) dull pain or tender
11) Infiltration of mononuclear cells, expect a ton of eosinophils..plasma, lymphocytes, multinucleated
* *MUST SEE Langerhan and eosinophils**
12) *Immunohistochemistry = can use S100 which is a neural marker OR *electron microscopy= Birbeck granules or these tehnnis racket shaped granules (pathogenic)
13) conservative with currettage
* * low dose radiation and chemo has been used because of the neoplastic origin that is thought - remember this!!!
14) good prognosis is no visceral involvement
* Chronic= morbidity
* Acute= death (Letterer Sewe disease)

Question 18

Letterer-Siwe Disease vs Hand Schuller Christian Disease vs Eosinophilic granuloma of bone

Answer 18

• all are Langerhans cell disease
  Letterer-Siwe Disease- most FATAL and skin, organ and bone marrow involvement

Hand Schuller Christian Disease- chronic disseminated disease (bone, skin and viscera) with classic TRIAD (bone lesions, exophthalmos, and diabetes), chronic

• bone lesions generalized but jaw most common
• exophthalmos is Langerhan cells in retro-orbital space

Eosinophilic granuloma of bone- most COMMON, CHRONIC, refers to solitary or multiple lesions only, no visceral involvment

Question 19

morbidity

Answer 19

morbidity refers to the level of the general wellness and health of a person. Over time, morbidity can increase your chances of mortality

Question 20

osteomyelitis

1) what is it?
2) two types
3) etiology

Answer 20

1) inflammation of the bone
2) acute or chronic
3) odontogenic infections with bacteria is most common, fractures, chronic diseases, immunocompromised, decreased vascularity

Question 21

immunocompromised means?

Answer 21

less than 200 CD4

Question 22

acute vs chronic osteomyelitis

radio?
histo?
common cells?
txt?

Answer 22

acute

• neutrophil ONLY is hallmark cell
• fever, leukocytes, lymphadenopathy, pain, swelling
• radioLUCENTdefect, no cortication and poorly defined
• necrotic bone, PMNs
• txt with ORAL antibiotics and drainage

chronic

• neutrophils AND fibroblasts
• lasts a month or more
• granulation tissue -> SCAR
• swelling, pain, discharge
• MIXED radiolucent/ radiopaque
• chronic or subacutely inflamed fibrous tissue, sequestra
• • chunks of dead bone, inflammed granulation and fibrous tissue
• txt with surgery, IV antibiotics, hyperaric O2, bone grafts, polymethymethacrylate with antibiotics

Question 23

Condensing Osteitis aka Focal Sclerosing Osetomylitis

1) etiology
2) radio
3) most common area
4) Focal Sclerosing Osetomylitis means?
5) symptoms?
6) txt?
7) % of regression?

Answer 23

1) Rxn to low grade infection - typically a pulpal infection aka reversible or irreversible pulpitis
2) Periapical radiopacity which is more radiopaque near the tooth
* *Not expansible
3) MN M or PM with a restored or decayed tooth
4) ocal (one area) sclerosing (reactive bone to inflammation) osteomyelitis (inflammation of the bone)
5) NO- asymptomatic
6) txt infection source
7) 85% regress

Question 24

Condensing Osteitis VS Idiopathic focal osteosclerosis

Answer 24

condensing osteitis

• PULPAL INFLAM
• some lamina dura disruption/widening
• NEW bone being formed

Idiopathic focal osteosclerosis

• healthy pulp, no pulpitis at all
• dense bone island
• iniformly radiopaque and demarcated
• normal lamina dura

Question 25

Prliferative Periostitis aka Garres Osteomyelitis 1) what is it 2) location 3) age 4) etiology 5) radio 6) histo 7) txt

Answer 25

1) chronic osteomyelitis with a proliferative periostitis, no suppuration, collagen depostion 2) MN M or PM 3) young ppl! 13 yrs 4) caries or perio infection in the MN * ** proliferative periostitis is not a source of the infection, but rather a reaction to it *** 5) ONION skin radiopacity with reactive bone depositing - to remember this and the age predliecton, think back to this image and remember the occlusal radiograph, which is primarly used in yougner patients 6) cellular reactive bone 7) Remove the source of infection and this will cure the tooth, and it will resolve in 6-12 MONTHS for the mandible undergo natural remodeling

Question 26

``` Osteosarcoma of the Jaws 1) the most common ____ tumor? 2) Osteosarcoma of the Jaws sex and age... binmodal? 3) location 4) clinical signs 5) etiology 6) radio 7) most important radio feature? 8) sunburst most commonly seen in? 9) histo... 3 types? 10) define osteoid 11) histo subtype change prognosis? 12) prognosis 13) cause of death 14) txt 15) response to chemo and surgery ```

Answer 26

1) most common malignant bone tumor (excluding blood cancers) 2) 2M>1F, 34 yrs average * * BIMODAL between 18 and 50... if above 50 then probably due to Pagets disease 3) MX = MN * occurs in long bones 4) pain, Swelling that can lead to violation of the soft tissue leading to ulceration 5) -osteitis deformans = Pagets disease of the bone, a chronic bone disorder that typically results in enlarged and deformed bones - Chronic Osteomyelitis, Fibrous dysplasia - Radiation - can induce osteosarcoma 10 years after therapy - Genetics 6) Radiolucent, radiopaque, or mixed with poorly defined borders and the classic sun burst appearance 7) Look for non-uniform widening of the PDL space - most IMPORTANT - this happens because the cells take the path of least resistance and will infiltrate this space 8) sunburst in LONG bones due to reactive bone that is deposited due to a reation of the expansible aspect of osteosarcoma (25% in jaw) 9) malignant, SPINDLE shaped cell that produces an osteoid 1. chondroblast- most COMMON in JAW with cartilage differentiation 2. osteoblastic- malignant bone being formed 3. fibroblastic- minimal areas of bone formation 10) osteoid is the unmineralized, organic portion of the bone matrix that forms prior to the maturation of bone tissue 11) NO, txt and prognosis the same regardless of subtype 12) prognosis is 40% 5 year survival... 80% survival with radical surgery 13) local recurrence is the main cause of death 14) RADICAL SURGERYy, also called radical dissection, refers to the removal of blood supply, lymph nodes and sometimes adjacent structures of a diseased organ or tumor during surgery 15) responds better to chemo than chondrosarcoma - - preop to shrink tumor - - post operative if it responded in pre * *MN responds better to surgery bc it has less surrounding vital structures

Question 27

List the common bone tumors in order of most prevalent

Answer 27

1) Osteosarcoma of the Jaws 2) Chondrosarcoma 3) Ewing's Sarcoma

Question 28

Chondrosarcoma 1) what is it? 10% of what? 2) clinical signs 3) Jaw predilection? 4) age *BIG D/D BETWEEN* 5) radio 6) histo for grade 1 vs 2 vs 3 7) does histo determine prognosis? what else affects prognosis 8) low grade vs high grade 9) variants of chondrosarcoma? 10) txt 11) metastasis 12) cause of death

Answer 28

1) Second most common tumor in the bone after osteosarcoma. This is a mesenchymal tumor involving the chondroblasts -10% of primary bone tumors 2) presents as a painless mass, mobile teeth, nasal obstruction and epistaxis (whereas osteosarcoma will present with a painful mass) *Very rarely will affect the jaws* 3) MX > MN (whereas osteosarcoma had no preference and this makes most sense since chondrosarcoma is of the cartilage, and that's where most of the cartilage is in the skull) 4) 50-60 yrs *rare to find under 45yrs (osteosarcoma was bimodal and 34 yrs) 5) A poorly defined radiolucency with scattered radiopacities (due to ossification of the malignant cartilage) as well as a widened PDL space 6) * GRADE 1: well differentiated = mimics a chondroma with rare mitoses and prominent calcification or ossification - this mimics a chondroma - can be mistaken for a benign tumor for this reason * GRADE 2: intermediate = increased cellularity and nuclear size, few mitoses and more myxoid (glycosaminoglycans) * GRADE 3: poorly differenciated with less cartilage... cellular with spindle cells 7) YES! histo tells you prognosis and recurrence **Size and location are important - MX is harder to deal with than MN DUE TO VITAL STRUCTURES 8) low grade is good because this means it looks like normal cells and high grade is bad with worse prognosis 9) clear cell (low grade) and dedifferentiated (high grade) which resembles fibrosarcoma 10) txt with radical surgery, does NOT respond to chemo or radiation like osteosarcoma does 11) metastatsis is RARE 12) local recurrance

Question 29

Ewing's Sarcoma 1) previously considered? 2) considered now? 3) age 4) What percent of all primary bone malignancies? genetic aberrations? 5) location? 6) sex 7) clinical signs 8) cortical penetration in MX or MN 9) radio 10) Is this the neoplastic deposition of the bone or is it reactive? 11) histo 12) What is the FISH Break apart probe? color signals? 13) what glycoprotein is over expressed? 14) D/d for children 15) D/d for older patient 16) txt, survival? 17) concern with radiation? 18) metastasis? 19) location vs prognosis

Answer 29

1) A poorly differenciated primitive neuroectodermal tumor (PNET)- a tumor that arises from the neural crest cells 2) primarily a pediatric tumor Now it is considered a small, round, blue cell tumor which means histologically, they have a large hyperchromic nuclei with a thin rim of cytoplasm 3) KIDS -80% - occur in the 1st and 2nd decades 4) Of all tumors in the bone, this one occurs 6-10% of the time * 85% of the time, it's due to a t(11:22) swap EWSR1-FLI-1 * 5-10% of the time, due to a t(21;22) swap 5) 50% in femur and pelvis... 3% in jaw 6) 60% males 7) Pain, swelling, fever, leukocytosis, increase in the erythrocyte sedimentation rate, and cortical perforation, parasthesia and loose teeth - Ewings sarcoma is just going to be very inflammatory 8) MN > MX 9) ill defined multiocular radiolucency with onion skin as reactive response to advancing tumor 10) reactive! 11) SHEET of small, round cells aka lymphocytes (remember, blue round cell tumor) with a lobular pattern (due to fibrosepte) * Necrosis can be noted in the central aspect of the lobules - whenever you see necrosis, you are dealing with cancer. The reason this happens is because the tumor is growing so fast that you do not get nutrients in the cells * hemorrhage * cytoplasmic glycogen granules 12) A probe looking for t(11:22) swap EWSR1-FLI-1. If red and green are separated, then the there is the translocation, but if they are together, then there is no translocation 13) CD99 membrane glyocproein that is over expressed in Ewings sarcoma although NOT specific for Ewings, only able to rule out other tumors that do not have it 14) PEMS (all seen in children) - PNET - Embryonal rhabdomyosarcoma - most common pediatric mesenchymal malignancy that occurs in the head and neck - Metastatic neuroblastoma - Small cell osteosarcoma 15) D/d for older patient is metastatic cell carcinoma 16) Surgery, radiation, and chemotherapy with a 40-80% survival, use multi txt so you do not create a subset of resistance 17) Controversial since dealing with kids - do not want to induce a sarcoma 18) Lung, liver, lymph node, and bone METS 19) Pelvis is MOST commonly involved, but with the poorest prognosis - distal lesions like the MN, tibia and femur have better prognosis

Question 30

Multiple Myeloma 1) what is it 2) how do we know it is monoclonal? 3) which Ig light chain is most common 4) Where do the lesions present in the body? And what are the two types they present as? 5) What is plasmacytoma? 6) age, race and sex 7) extramedullary plasmacytoma commonly involves what location? 8) solitary plasmacytoma vs multiple myeloma occurance in jaws? 9) oral presentations 10) systemic symptoms 11) electrophoresis 12) what is Systemic amyloidosis? %? 13) Bence Jones proteineuria %? 14) radio 15) histo 16) D/d 17) special stain for MM? 18) txt 19) what is Combotherapy? 20) What is the median survival age for stage 1 ? stage 3? 21) prognosis?

Answer 30

1) Plasma cell NEOPLASM meaning it's a true neoplasm meaning it will have a MONOclonal form of proliferation 2) They will produce a monoclonal Ig with restrictions on the light chain to kappa or lambda 3) kappa is the more common restriction 4) They present as bone (solitary lytic lesion known aka punched out as plasmacytoma of the bone) or soft tissue (extramedullary plasmacytoma) * extramedullary involvement is indicative of an aggressive form of the disease 5) This is a solitary form of MM in one site, whether in the bone or outside of the bone 6) early 60s, NO younger patients, Africans, MALES 7) 80% head and neck 8) solitary plasmacytoma is RARE and multi is 70-95% MX or MN 9) asymptomatic or BONE PAIN as early sign, swelling, expansion, paresthesia, tooth mobility, pathologic FRACTURE 10) weak, weight loss, anemia bc competing out other cell types, hyperviscosity syndromes due to all the B-cells, thrombocytopenia 11) An monoclonal gammopathy (or M spike) where there is decreased amounts of other types of immunoglobulin with LOTS of IgG or IgA 12) 10% Systemic amyloidosis is a disorder in which abnormal proteins build up in tissues and organs, presents as waxy nodules on tongue 13) Bence Jones protein is a monoclonal globulin protein or immunoglobulin light chain found in the urine, with a molecular weight of 22-24 kDa. Detection of Bence Jones protein may be suggestive of multiple myeloma or Waldenström's macroglobulinemia. 14) multiple punched out radiolucency 15) Sheet like monoclonal proliferation of plasma cells, Hyperchromatic nuclei, mitosis 16) Metabolic Calcium, lymphoma, Langerhans cells disease 17) stain for Kappa and lambda light chains (2:1) 18) Chemo, steroids (prednisone) and radiation therapy 19) * Chemo - but this risks wiping out bone marrow so then you have to do a bone marrow tarnsplant * Bone marrow transplant for those that are older - will not do * Proteasome Inhibitor such as interferon alpha inhibitors 20) stage 1 = 5 years and stage 3 = 23 months 21) Prognosis determined by myeloma cell burden

Question 31

Bence Jones proteineuria and amyloidosis think...?

Answer 31

multiple myeloma

Question 32

solitary plasmacytoma 1) What is solitary plasmacytoma like? 2) sex and age 3) locatoin 4) What percent progresses to MM? 5) clinical signs 6) To make the diagnoses, what do you need? 7) Do we see the monoclonal M spike or Bence Jones like we see with MM ? 8) radio 9) How does the peripheral blood exam compare to those with MM? 10) will you see Ig in serum? means what? 11) histo 12) txt 13) local recurrence? 14) survival?

Answer 32

1) MM 2) males and 50 yrs (remember average age for MM is 63) 3) rarely occur in jaws but if it does its in angle of MN 4) 30-75% progresses to MM? 5) Pain, swelling and pathological fracture 6) Basically, when you do a radiographic scan, you should only see a lesion ONLY in the jaw, but no where in the body 7) NO 8) Well defined radiolucency with destruction of the cortical bone like a punched out lucency with no cortication 9) Unlike those with MM, patients with sollitary plasmacytoma will have a NORMAL peripheral blood picture and normal chemistry profile 10) 25% have monoclonal IG in serum/urine, more likely to turn in MM 11) looks like MM 12) txt with local radiation and surgery 13) recurs 10-15% 14) survival rate of 10 years

Question 33

Metastatic Disease 1) what is it? 2) this is the most common? 3) How do you know something is metastatic? 4) metastasis where... radio? 5) age 6) compare % involvement of MX, MN and soft tissue 7) Clinical signs and symptoms? 8) histo 9) txt... WHY? 10) How do carcinomas tend to go - in clusters or in sheets? 11) If something is glandular, how does it look? 12) rule of thumb for lesion at extraction site?

Answer 33

1) These are situations where malignancies in other parts of the body have deposited their cancerous fuck selves in an neighborhood they do not belong, BIULD THAT WALL 2) most common MALGINANT PROCESS 3) histologically and metastatic deposit it will look like a primary tumor with no possibility of direct extension 4) Breast, lung, prostate, renal cell/kidney, thyroid, colon/rectal ** Most will be poorly defined radiolucent but prostate with widening PDL and breast will be mixed lesions, and the reason for this is because they are osteoblastic 5) greater than 50 years 6) MX= 25%, MN= 60%, soft tissue= 15% 7) Parasthesia, tooth mobility (due to removal of bone), and swelling and pathological fracture 8) histo depends on primary tumor, SEEDED PATTERN 9) is palliative meaning to relieve pain without dealing with cause... if they present with metastasis then it is ALREADY STAGE 4 and there is nothing you can do 10) They tend to grow in. clusters Sarcomas tend to grow in sheets - (remember S and S) 11) it will look like a adenoma, a postive mucicamine test to check for mucous 12) malignant

Question 34

Pankeratin? If this stains positively, what does this mean?

Answer 34

This is a stain that tests for many types of keratin in a tissue (low molecular weight, high molecular weight) If it stains epi cells and keratinocytes POSITIVE it means you have a carcinoma

Question 35

CK7+ CK20- vs CK7- CK20+

Answer 35

CK7+ CK20- * primary * indicates lung or breast CK7- CK20+ * rules out lung or breast

Question 36

most common cancer for NON-smokers?

Answer 36

adenocarcinoma (F>M)

Question 37

palatal torus 1) what is it? 2) sex 3) age 4) etiology 5) clinical sign 6) radio 7) txt

Answer 37

1) Exophytic growth of normal compact bone 2) F> M 3) adults... do NOT see in children 4) genetic 5) midline of the palate, single or lobulated, mucosa is thin and so it can be traumatized otherwise asymptomatic, gradual development 6) well defined opaque mass on radiograph 7) no txt unless it interferes with prosthesis, speech or swallowing

Question 38

mandibular torus 1) What is a mandibular tori? 2) Where does it typically present location wise? 3) Is it unilateral or bilateral? 4) Treatment?

Answer 38

1) Typically compact bone 2) presents on the lingual aspect of the mandible in the premolar region 3) Typically bilateral , may appear fused, lobulated or nodular, radiopaque, does NOT involve roots 4) Only for prosthetic reasons

Question 39

exostosis 1) what is is 2) clicial signs... location 3) sex and age 4) mucosa 5) txt

Answer 39

1) This is a nodule of normal bone - like the tori, but on the BUCCAL surface 2) asymptomatic, buccal of alveolar ridges, firm 3) M=F, adults 4) thin, not as easy to traumatize due to location, looks blanched 5) none unless for prosth