Pathology #15 - Bone Lesions

Front 1

Define OSTEOMA:

Back 1

benign tumour composed of mature, compact or cancellous bone

Front 2

What are the two types of OSTEOMAS?

Back 2

Periosteal osteoma
Endosteal osteoma

Front 3

Define PERIOSTEAL OSTEOMA:

Back 3

- lesions that arise on the surface of bone and present as painless, slowly enlarging, hard masses

Front 4

Define ENDOSTEAL OSTEOMA:

Back 4

- lesions that develop centrally within the bone, and may be discovered during routine radiographic examination

Front 5

Define OSSEOUS CHORISTOMA:

Back 5

extraskeletal osteoma - mostly arising in foramen caecum area of the tongue

Front 6

What age range are OSTEOMAS most commonly found in?

Back 6

Young adults

Front 7

Multiple OSTEOMAS are common in what syndrome?

Back 7

Gardner's syndrome

Front 8

What is the most common site of OSTEOMA?

Back 8

PARANASAL SINUSES > frontal sinus > ethmoid > maxillary

Front 9

How do OSTEOMAS present radiographically?

Back 9

- circumscribed
- sclerotic masses
- smaller osteomas are difficult to differentiate from condensing osteitis or idiopathic sclerosis

Front 10

What is the treatment of OSTEOMA?

Back 10

- surgical excision.
- good prognosis

Front 11

Define GARDNER'S SYNDROME:

Back 11

Rare disorder inherited as an autosomal dominant trait with complete penetrance and variable expressivity. The genetic defect is found in small region on the LONG ARM OF CHROMOSOME FIVE.

Front 12

What are the GASTROINTESTINAL CLINICAL FEATURES of GARDNER'S?

Back 12

- polyps of the colon and rectum
- marked tendency for malignant transformation

Front 13

What are the SKELETAL CLINICAL FEATURES of GARDNER'S?

Back 13

- multiple osteomas

Front 14

What are the INTRAORAL CLINICAL FEATURES of GARDNER'S?

Back 14

- impacted teeth
- supernumerary teeth
- odontomas

Front 15

What are the SOFT TISSUE CLINICAL FEATURES of GARDNER'S?

Back 15

- epidermoid cysts (skin)
- desmoid tumours (soft tissue)
- hypertrophic retinal pigment epithelium

Front 16

Define OSTEOSARCOMA:

Back 16

- malignancy of mesenchymal cells that have the ability to produce osteoid or immature bone

Front 17

Which is the most common type of malignancy to originate within bone?

Back 17

OSTEOSARCOMA

Front 18

What are the most common sites for OSTEOSARCOMA to occur?

Back 18

- distal femur
- proximal tibia

Front 19

Define PRIMARY OSTEOSARCOMA:

Back 19

arise de novo without pre-existing bone pathology or identifiable predisposing factors

Front 20

Define SECONDARY OSTEOSARCOMA:

Back 20

arise against a background of either PRE-EXISTING BONE DISEASE such as PAGET's DISEASE, FIBROUS DYSPLASIA, and OSTEOGENESIS IMPERFECTA
- some have been preceded by radiation therapy to the affected bone for unrelated or antecedent disease

Front 21

What are the three classifications of OSTEOSARCOMA?

Back 21

- CONVENTIONAL (medullary) : 70% of them
- EXTRA MEDULLARY (soft tissue): rare
- PERIPHERAL JUXTACORTICAL: parosteal and periosteal

Front 22

What are the most common symptoms of OSTEOSARCOMA OF THE JAWS?

Back 22

- swelling and pain
- paresthesia and loosening of the teeth may be noticed

Front 23

What is an important early radiographic feature of OSTEOSARCOMA OF THE JAWS?

Back 23

- symmetric widening of periodontal ligament space

Front 24

What is the treatment of OSTEOSARCOMA?

Back 24

radical surgery

Front 25

Define CHONDROMA:

Back 25

Benign tumour of mature hyaline cartilage

Front 26

Where are CHONDROMAS most often located?

Back 26

Short tubular bones of hands and feet

Front 27

CHONDROMA diagnosis for a jaw tumour should be regarded as suspicious why?

Back 27

Most of these lesions eventually prove to be CHONDROSARCOMAS.

Front 28

What is the treatment of CHONDROMA/

Back 28

directed towards total surgical removal of the tumour

Front 29

Define CHONDROSARCOMA:

Back 29

- rare malignant bone tumour in which the malignant cells produce abnormal cartilage exclusively and no osteoid or bone

Front 30

What is the SECOND most common malignancy of bone?

Back 30

CHONDROSARCOMA

Front 31

CHONDROSARCOMA is more prevalent in which sex?

Back 31

Male

Front 32

CHONDROSARCOMA is more prevalent in which age groups?

Back 32

FOURTH to SIXTH DECADE

Front 33

What are the usual radiographic features of CHONDROSARCOMA?

Back 33

- radiolucency with poorly defined (moth eaten) borders
- solitary or multilocular
- scattered radiodensities to diffusely opaque lesions
- extensive infiltration between osseous trabeculae of pre-existing bone without causing appreciable resorption
- root resorption or localized symmetric widening of PDL space
- penetration of cortex can result in sunburst pattern

Front 34

Define MESENCHYMAL CHONDROSARCOMA:

Back 34

aggressive form of chondrosarcoma

Front 35

Define FIBROUS DYSPLASIA:

Back 35

developmental tumor-like condition characterized by replacement of normal bone by an excessive proliferation of cellular fibrous connective tissue intermixed with tissue non-functional trabeculae-like osseous structures

Front 36

What are the two types of FIBROUS DYSPLASIA?

Back 36

Monostotic fibrous dysplasia
Polyostotic fibrous dysplasia

Front 37

Define MONOSTOTIC FIBROUS DYSPLASIA:

Back 37

- limited to a single bone (80-85% of cases)

Front 38

Define POLYOSTOTIC FIBROUS DYSPLASIA:

Back 38

- affecting several bones

Front 39

What are the radiographic features of MONOSTOTIC FIBROUS DYSPLASIA?

Back 39

- poorly-defined radiographic mass with margins blending into normal bone
- diffuse opacification often described as "ground glass" or "orange peel"

Front 40

Define JAFFE-LICHTENSTEIN SYNDROME:

Back 40

- polyostotic fibrous dysplasia
- multiple cafe au lait spots

Front 41

Define MCCUNE-ALBRIGHT SYNDROME:

Back 41

- polyostotic fibrous dysplasia,
- multiple cafe au lait spots (irregular, resembling the coastline of Maine)
- endocrine abnormalities (sexual precocity in females, pituitary adenoma or hyperthyroidism)

Front 42

Define PAGET'S DISEASE of the bone?

Back 42

Characterized by uncoordinated resorption and deposition of the bone resulting in distortion and weakening of the affected bone

Front 43

What are the clinical features of PAGET'S DISEASE?

Back 43

- most often POLYOSTOTIC
- MALE predilection 2:1
- more common in WHITES
- asymptomatic to quite severe symptoms (Bone pain)
- weight-bearing bones leads to bowing deformity "simian stance"
- Maxilla most commonly involved out of jaws
- enlargement of middle third of face results in "lion-like" facial deformation
- alveolar enlargement causes diastemas in dentulous patients
- early radiographic: decreased radiodensity and alteration of trabecular pattern
- late radiographic: patchy sclerotic areas having "cotton wood" pattern
- often hypercementosis and loss of lamina dura may be seen

Front 44

What are the treatments for PAGET'S DISEASE?

Back 44

-BONE PAIN: aspirin and analgesics
-PARATHYROID HORMONE ANTAGONISTS: calcitonin and bisphosphanates can reduce turnover and improve biochemical abnormalities
-NEUROLOGIC: deafness, visual disturbances, paralysis

Front 45

What are the DENTAL COMPLICATIONS of PAGET'S DISEASE?

Back 45

- difficulties of extractions of teeth with hypercementosis
- edentulous patients may required new and larger dentures periodically
- late-jaw fracture
- osteomyelitis
- during active disease OS may result in hemorrhage

Front 46

What is the most severe complication of PAGET'S DISEASE?

Back 46

- increased incidence of sarcoma (osteosarcoma)

Front 47

Define OSTEOID OSTEOMA and OSTEOBLASTOMA:

Back 47

closely related benign tumours that arise from osteoblasts, with similar histopathology

Front 48

What are the features of OSTEOID OSTEOMA:

Back 48

- most often femur, tibia, phalanges
- RARE IN JAWS
- usually smaller than 2cm diameter
- NOCTURNAL PAIN common symptoms, alleviated by salicylates
- RADIOG: well-circumscribed radiolucent defect with surrounding zone of sclerosis (reactive) of varying thickness, a small central radiopaque nidus may produce "target-like" lesions

Front 49

What are the features of OSTEOBLASTOMA:

Back 49

- often in vertebral column, femur, tibia, fibular, and MANDIBLE
- larger than 2 cm
- PAIN is common, but less often nocturnal, not relieved by aspirin
- RADIOG: well defined or illdefined radiolucency with variable radiopaque areas within the lesion, sometimes with sclerotic border

Front 50

What is the treatment of OSTEOBLASTOMA/OSTEOID

Back 50

local excision or curettage

Front 51

Histologically, cemento-osseous dysplasias consist of what?

Back 51

- fibrous tissue
- bone
- cementum like calcifications

Front 52

What are the most common fibro-osseous lesions encountered in clinical practice?

Back 52

cemento osseous dysplasias

Front 53

What are the clinical features of PERIAPICAL CEMENTO-OSSEOUS DYSPLASIA:

Back 53

- periapical region of ANTERIOR MANDIBLE
- MULTIPLE lesions more frequent
- FEMALES
- BLACKS
- 30-50 years
- asymptomatic lesion discovered accidentally on radiographs
- teeth are VITAL and usually without restorations
- RADIOG: Initially radiolucent, mature over time creating mixed radiolucent and radiopaque appearance
- self-limiting
- NO TREATMENT REQUIRED

Front 54

What are the clinical features of FOCAL CEMENTO-OSSEOUS DYSPLASIA:

Back 54

- POSTERIOR MANDIBLE
- usually SOLITARY
- FEMALES
- WHITES
- 30-60 years
- typically asymptomatic
- dentulous or edentulous areas
- easily fragmented gritty tissue
- little tendency to progress

Front 55

What are the clinical features of FLORID CEMENTO OSSEOUS DYSPLASIA:

Back 55

- multifocal lesions with tendency for bilateral/symmetric involvement
- BLACK MIDDLE AGED FEMALES
- asymptomatic
- sometimes pt complains of dull pain and alveolar mucosal fistula
- simple bone cyst may be associated with it
- FCOD lesions are not treated unless secondary infection that results in osteomyelitis

Front 56

What are the clinical features of FAMILIAL GIGANTIFORM CEMENTOMA?

Back 56

- mostly caucasians
- no sex predilection
- first decade of life
- rapid / expansive growth
-

Front 57

What are the clinical features of CEMENTO-OSSIFYING FIBROMA?

Back 57

- 3rd to 4th decades
- FEMALE
- MANDIBLE (premolar area)
- small lesions seldom cause symptoms
- large lesions result in painless swelling of involved bone
- radiographically well defined unilocular lesion, amount of calcified material varies, some show sclerotic border, large lesions may show "downward bowing" of the inferior cortex of the mandible

Front 58

What are the clinical features of JUVENILE OSSIFYING FIBROMA:

Back 58

- children and young adults
- orbital, frontal bones, and paranasal sinuses more common than jaws
- maxilla more common than mand
- well demarcated radiolucency with central radiopacities

Front 59

Whatis the most common site of CENTRAL GIANT CELL GRANULOMA?

Back 59

anterior mandible

Front 60

Which bone lesions frequently cross the midline?

Back 60

- Central giant cell granuloma
- Simple Bone Cyst

Front 61

Define CHERUBISM:

Back 61

- rare developmental jaw condition that is generally inherited as autosomal dominant trait with high penetrance but variable expressivity

Front 62

What are the clinical features of CHERUBISM?

Back 62

- bilaterally affects posterior mandible
- children 2-5 years of age
- painless, bilateral swelling, "chubby" facial appearance

Front 63

Why is radiation contraindicated in CHERUBISM?

Back 63

Risk of development of post-irradiation bone sarcoma

Front 64

Which bone lesions are generally associated with pain?

Back 64

- aneurysmal bone cyst
- osteoid osteoma
- osteoblastoma
- florid cemento-osseous dysplasia

Front 65

What is the most common presenting sign of ANEURYSMAL BONE CYST?

Back 65

swelling that has developed rapidly

Front 66

Which bone disease has a characteristic "ballooning" or "blow-out" distention of the affected bone?

Back 66

Aneurysmal bone cyst

Front 67

What is the treatment of Aneurysmal bone cyst?

Back 67

curettage or enucleation

Front 68

SIMPLE BONE CYST may be associated with what other conditions?

Back 68

- cemento-osseous dysplasia
- other fibro-osseous tumours

Front 69

What is the most common site of SIMPLE BONE CYST?

Back 69

- mandible posterior pre-molar and molar area
- may be bilateral
- may cross midline

Front 70

What are some theories for etiology of FOCAL OSTEOPOROTIC MARROW DEFECT?

Back 70

- aberrant bone regenration after tooth extraction
- persistence of fetal marrow
- marrow hyperplasia in response to increased demand for erythrocytes

Front 71

OSTEOPOROTIC MARROW DEFECT is more commonly found in:

Back 71

adult women
posterior mandible

Front 72

Which findings are usually incidental (asymptomatic) and found on routine radiograph taking?

Back 72

- focal osteoporotic marrow defect
- idiopathic osteosclerosis
- focal cemento-osseous dysplasia
- periapical cemento-osseous dysplasia
- cemento-ossifying fibroma
- central giant cell granuloma

Front 73

What is the most common site of IDIOPATHIC OSTEOSCLEROSIS?

Back 73

- posterior mandible

Front 74

How is a diagnosis of IDIOPATHIC OSTEOSCLEROSIS made?

Back 74

- history
- clinical
- radiographic findings

Front 75

Which condition has a "chinese script writing" appearance on histology?

Back 75

FIBROUS DYSPLASIA

Front 76

What is the most common site of DENSE BONE ISLAND?

Back 76

posterior mandible

Front 77

Define OSTEOGENESIS IMPERFECTA:

Back 77

heterogenous group of inheritable disorders characterized by impairment of collagen maturation.

Front 78

OSTEOGENESIS IMPERFECTA results from a mutation of gene that guides formation of what?

Back 78

TYPE I COLLAGEN

Front 79

Which condition has CLASS III malocclusion tendency and why?

Back 79

OSTEOGENESIS IMPERFECTA. because of maxillary hypoplasia

Front 80

What is the treatment of OSTEOGENESIS IMPERFECTA?

Back 80

- no specific treatment
- management of fractures
- management focused on preservation of the teeth
- full crown coverage may be required
- prognosis can range from good to very poor

Front 81

Define OSTEOPETROSIS:

Back 81

rare hereditory skeletal disorder characterized by a marked increase in bone density resulting from a defect in bone remodeling caused by failure of normal osteoclast function

Front 82

What are the two major forms of OSTEOPETROSIS?

Back 82

INFANTILE: malignant, fatal in early life [autosomal recessive]
ADULT: benign [autosomal dominant]

Front 83

What are the oral features of CLEIDOCRANIAL DYSPLASIA?

Back 83

- narrow high-arched palate
- increased prevalence of cleft palate
- retention of deciduous teeth
- delay or complete failure of eruption of permanent teeth and supernumerary teeth
- mid-facial skeletal hypoplastic (relative prognathism)

Front 84

What is the most common form of cancer involving bone?

Back 84

METASTATIC CARCINOMA

Front 85

How does metastatic carcinoma sread?

Back 85

Hematogenous route

Front 86

Bone metastases arise from which primary carcinomas most commonly?

Back 86

- breast
- lung
- thyroid
- prostate
- kidney