Nonneoplastic Diseases of Bone

Question 1

What does dysplasia mean?

Answer 1

Refers to the abnormal and disorderred production of cementum and bone

Not to be confused w/ dysplasia in the context of epithelial dysplasia (premalignant condition affecting squamous epithelium)

Question 2

What are the benign fibro-osseous lesions?

Answer 2

• Periapical cemento-osseous dysplasia
• Focal cemento-osseous dysplasia
• Florid cemento-osseous dysplasia
• Fibrous dysplasia

Question 3

Characteristics of periapical cemento-osseous dysplasia

Answer 3

• Common disease of unknown cause that affects periapical bone
• Occurs in anterior mandible of female pts >30yrs typically afrifcan american
• Asymptomatic and usually found on radiographs
• Well circumscribed and radiolucent but become increasingly calcified over time
• Teeth are vital- no treatment

Question 4

Characteristics of florid cemento-osseous dysplasia

Answer 4

• Asymptomatic fibro-osseous lesion
• Condition of disordered cementum and bone development
• Clinically: occurns mostly in black women >40yrs, typically in multiple quads, isolated, well-circumscribed radiolucent to radiopaque
• Best diagnosed using pt history, radiographs and clinica presentation
• Asymptomatic and no treatment

Question 5

Characteristics of focal cemento-osseous dysplasia

Answer 5

• Occurs in women 30-50 years old
• Similar appearance to periapical cemento-osseous dysplasia and florid cemento-osseous dysplasia
• More common in white women
• Occurs in posterior mandible
• Less that 1.5cm in size
• Biopsy usually necessary for diagnosis
• Composed of numerous gritty pieces of soft and hard tissue: fibrous connective tissue interspersed w/ bone trabeculae and cementum-like material

Question 6

What is fibrous dysplasia?

Answer 6

• Characteized by replacement of bone w/ abnormal fibrous connective tissue interspersed w/ varying amounts of calcification
• Benign fibro-osseous lesion, with vascularized cellular fibrous CT interspersed w/ irregular trabeculae of bone

Question 7

Types of fibrous dysplasia

Answer 7

• Monostotic fibrous dysplasia
• Polyostotic fibrous dysplasia

Question 8

Characteristics of monostotic fibrous dysplasia

Answer 8

• Involvement of a single bone
  Maxilla more frequently involved than mandible
• Most commonly diagnosed in children and young adults- no sex prediliction
• Clinical exam reveals painless swelling or bulging of buccal plate

Question 9

Characteristics of polyostotic fibrous dysplasia

Answer 9

• Involvement of more than one bone
• Typically occuring in children w/ female prediliction
• Long bones may bow and have a dull aching pain. May create and enlargement in the maxilla or mandible
• Pts mayhave skin lesions appearing as light-brown macues called cafe au lait spots
• Typically painless, progressive and unilateral
• Radiographic appeaace is a diffuse radiopacity looking like “gound glass”

Question 10

Types of polyostotic fibrous dysplasia

Answer 10

• Craniofacial fibrous dysplasia
• Jaffe type
• Albright syndrome

Question 11

What does craniofacial fibous dysplasia involve?

Answer 11

Maxilla w/ extension into the sinuses and adjacent zygoma, sphenoid and occipital bones

Question 12

What does the Jaffe type involve?

Answer 12

Multiple bones along w/ cafe au lait macules

Question 13

What is albright syndrom characterized by?

Answer 13

• Endocrine abnomalities
• Precocious puberty in females (breasts, menses, pubic hair in children as young as 2)
• Stunting or deformity of skeletal growth in both sexes as a result of premature closing of the epiphyseal plates
• Cafe au lait spots

Question 14

Characteristics of Paget Disease of Bone

Answer 14

• Chronic metabolic bone disease
• Interferes w/ the body’s normal bone recycling process
• Unknown cause
• More in men >50yrs
• Maxill more commonly affected
• Enlargement of affected bone
• Pt often complains of pain
• Spaces btw teeth may increase as jaw enlarges
• Radiogaphically:
  -Patchy radiolucency and radiopacity “cotton wool”
  -Hypercementosis, loss of lamina dura, obliteration of PDL

Question 15

Characteristics of central giant cell granuloma

Answer 15

• Composed of well-vascularized CT containing many multinucleated giant cells
• Occurs in tissue (peripheral) and bone (central) locations
• Moe in women <30yrs
• Pin can occur but not common
• Slow-growing
• Destructive
• Sclerotic or ill-defined borders
• Unilocular or multilocular radiolucency
• Divergence of roots
• Treated w/ surgical excision

Question 16

What is an aneurysmal bone cyst?

Answer 16

• Pseudocyst
• Consists of blood-filled spaces surrounded by multinucleated giant cells and fibrous CT
• Radiographically: “Honeycomb” or “soap bubbles”
• Treated w/ surgical excision and cryotherapy

Question 17

What is osteomalacia?

Answer 17

• Disease of bone that develops over a long period as the result of a calcium deficiency
• Rickets: softening and weakening of bones in children
• Maybe inherited vit D deficiency (hypophosphatemia vit D resistant rickets)
• Clinical characteristics:
  -Delayed tooth eruption
  -Periodontal disease
  -Pathologic featues
• Treatment is based on cause

Question 18

What is the term used for abnormal and disordered production of cementum and bone?

Answer 18

Dysplasia

Question 19

What is the term used to explain abnormal bone metabolism, including resorption, osteoblastic repair and remineralization of the involved bone?

Question 20

What is the disease that develops over a long period of time as a result from calcium deficiency?

Answer 20

Osteomalacia

Question 21

What condition is seen here?

Answer 21

Aneurysmal bone cyst

Question 22

What condition is seen here?

Answer 22

Central giant cell granuloma

Question 23

What condition is seen here?

Answer 23

Paget disease

Question 24

What condition is seen here?

Answer 24

Polyostotic fibrous dysplasia

Question 25

What condition is seen here?

Answer 25

Florid cemento-osseous dysplasia

Question 26

What condition is seen here?

Answer 26

Periapical cemento-osseous dysplasia