PL - OPath2 - Non-odontogenic tumors

other terms for ossifying fibroma

Cementifying fibroma

Cemento-ossifying fibroma

Psammomatoid ossifying fibroma

where is ossifying fibroma located

head and neck: seen in the jaws and craniofacial bones

mandible: premolar-molar regions

Age for ossifying fibroma

3rd and 4th decade of life

sex predilection for ossifying fibroma

Female

slow-growing tumor

asymptomatic

expansile lesion: causing thinning of buccal and lingual cortical plates

OSSIFYING FIBROMA

Composed of fibrous connective tissue with well-differentiated spindled fibroblast.

OSSIFYING FIBROMA

well-circumscribed sharply defined border (lucent).

exhibiting foci of calcified masses and producing expansion of left maxillary sinus. A similar appearance may sometimes be seen in fibrous dysplasia.

OSSIFYING FIBROMA

Treatment for ossifying fibroma

Surgical removal using curettage or enucleation

Is a condition in which normal medullary bone is replaced by an abnormal fibrous connective tissue proliferation in which new non-maturing bone is formed.

The nature of this condition has not been firmly established

FIBROUS DYSPLASIA

where is fibrous dysplasia located

More often in the maxilla done in the mandible.

May extend to involve the maxillary sinus, zygoma (cheekbone), sphenoid bone and floor of the orbit.

age for fibrous dysplasia

1st or 2nd decade of life

sex predilection for fibrous dysplasia

No sex predilection

asymptomatic

Low enlargement

Present as a unilateral swelling

As the lesion grows, facial asymmetry becomes evident and may be the initial presenting complaint

Displacement of teeth, malocclusion, interference with tooth eruption may occur.

FIBROUS DYSPLASIA

Fibrous dysplasia that involves one bone

Much more common (80%) than polyostotic form

Monostotic Fibrous Dysplasia

Monostotic Fibrous Dysplasia is common in

Body of the mandible

sex predilection for Monostotic Fibrous Dysplasia

Equal sex predilection

Fibrous dysplasia that involves more than one bone

Disease that involves this form:

Mc-Cune-Albright syndrome

Jaffe-Lichtenstein syndrome

Polyostotic fibrous dysplasia

sex predilection for Polyostotic fibrous dysplasia

females

consist of light to moderate cellular fibrous connective tissue stroma.

fibrillar bony trabecular bone that is supposed to be characteristic of this condition.

FIBROUS DYSPLASIA

radiolucent lesion to a uniformly radiopaque mass

Radiopaque change that imparts a "ground glass" or "peau d' orange" (not pathognomonic)

FIBROUS DYSPLASIA

Most commonly seen in patient with long standing disease, is a mottled radiolucent and radiopaque appearance

Fingerprint bone pattern and superior displacement of the mandibular canal in mandibular lesion

"poorly defined radiographic" and clinical margins of the lesion

FIBROUS DYSPLASIA

Treatment for SMALL FIBROUS DYSPLASIA

no treatment other than biopsy confirmation and periodic follow-up

Treatment for LARGE FIBROUS DYSPLASIA

surgical recontouring

uncommon primary lesion of bone

lesion GREATER than 1.5 cm in diameter

Osteoblastoma

represent a smaller version

lesion LESS than 1.5cm in diameter

Osteoid Ostoma

where is Osteoblastoma/Osteoid Ostoma located?

arise most often in vertebrae and long bones

usual sites of jaw involvement in Osteoblastoma/Osteoid Ostoma

posterior tooth-bearing regions of the maxilla and mandible

Age for Osteoblastoma/Osteoid Ostoma

2nd decade of life

90% of lesions presenting before the age of 30 years

sex predilection for Osteoblastoma/Osteoid Ostoma

Male (2:1)

well circumscribed and have a mixed lucent-opaque pattern

a thin radiolucency may be noted surrounding a calcified central tumor mass

OSTEOBLASTOMA/OSTEOID OSTEOMA

composed of irregular trabeculae of osteoid and immature bone with a stroma

OSTEOBLASTOMA/OSTEOID OSTEOMA

Treatment for Osteoblastoma/Osteoid Ostoma

Conservative surgical approach (curettage or local excision)

Benign tumor that consist of mature, compact, or cancellous bone

Rare in the jaws

cause is unknown

OSTEOMA

suffix used for malignant tumor

"-sarcoma"

suffix used for malignant tumor with epithelial in origin

"-carcinoma"

Where is osteoma located?

may arise in maxilla and mandible:

facial and skull bones

within the paranasal sinuses

Age for osteoma

2nd and 5th decade of life

sex predilection for osteoma

Male

Osteoma that arises on the surface of the bone

PERIOSTEAL OSTEOMA

Osteoma that develops centrally within the bone

ENDOSTEAL OSTEOMA

what kind of osteoma is asymptomatic, slow-growing, bony (hard masses), asymmetry (when lesions enlarge) ,slowly growing hard mass that enlarges

PERIOSTEAL OSTEOMA

what kind of osteoma is discovered during routine radiographic examination, as dense, well-circumscribed radiopacities

ENDOSTEAL OSTEOMA

a histopathological feature of osteoma that is composed of relatively dense, compact bone with sparse marrow tissue

compact bone

a histopathological feature of osteoma that consists of lamellar trabecullae of cancellous bone with abundant fibrofatty marrow

cancellous bone

Treatment for osteoma

Surgical excision

benign cartilaginous tumor of unknown cause

Painless

Slowly progressive growing swelling

Rarely results in mucosal ulceration

CHONDROMA

Where is chondroma located?

maxilla - anterior region

mandible: body of mandible and symphysis, coronoid process, condyle

Radiographic appearance of this tumor is variable but often presents as an irregular radiolucent area

CHONDROMA

Tumor that consists of well-defined lobules of mature hyaline cartilage

CHONDROMA

Treatment for chondroma

Surgical excision

Benign proliferation of fibroblast and multinucleated giant cells that occurs almost exclusively within the jaws

Soap bubble appearance

its etiology is the reparative response to infrabony hemorrhage and inflammation

CENTRAL GIANT CELL GRANULOMA

Where is CGCG located

Maxilla and mandible (jaws anterior to the permanent molars)

Age for CGCG

children and young adults 75% presenting before the age of 30 years

Sex predilection for CGCG

Female (2:1)

Produces a painless expansion or swelling of the affected jaws

Cortical plates are thinned

CENTRAL GIANT CELL GRANULOMA

Consists of multilocular or unilocular radiolucency of bone

Margins of the lesion are well demarcated. Often presenting scalloped border

CENTRAL GIANT CELL GRANULOMA

What kind of CGCG may cause pain and exhibit rapid growth, root resorption, perforation of cortical bone

"aggressive" CGCG

What kind of CGCG increases in size and thinning of cortical plate

"Non-aggressive" CGCG

Composed of uniform fibroblasts in a stroma containing collagen

Presence of multinucleated giant cells

CENTRAL GIANT CELL GRANULOMA

Treatment for CGCG

Excision or curettage followed by removal of the peripheral bone margins

Prognosis for children with CGCG

higher rate of recurrence

Distinct entity from CGCG (rare in the jaws)

Exhibits slow growth and bone

Expansion or produce rapid growth

Pain

Paresthesia

GIANT CELL CARCINOMA

Where is GCC located?

arises most commonly in long bones especially in the knee joint

other areas: head and neck (sphenoid, ethmoid, temporal bones)

Characterized by the presence of numerous multinucleated giant cells dispersed evenly among mononuclear fibroblast

GIANT CELL CARCINOMA

Treatment for GCC

Surgical excision

Prognosis for GCC

Greater tendency to recur after treatment

30% of the lesions in long bones recur after surgery

Fair prognosis

Osteosarcoma is also known as

Osteogenic sarcoma

Account for approximately 20% of all sarcoma

5% occur in the jaws with the incidence of 1:1.5 million people per year

Arises in preexisting bone abnormalities

Vast majority of this tumor involve the tubular bones, especially those adjacent to the knees

OSTEOSARCOMA

Type of osteosarcoma that arises within the medullary cavity

Conventional Type

Type of osteosarcoma that arises within the periosteal surface

Juxtacortical Tumor

Type of osteosarcoma that arises rarely in soft tissue

Extraskeletal Osteosarcoma

malignant counterpart of osteosarcoma

OSTEOMA

Where is osteosarcoma located?

Mandible is more commonly affected (7:1)

60% arises in the body of the mandible

Age for osteosarcoma

2nd decade of life

Those arising from the jaws present 1 to 2 decades later

Mean age for osteosarcoma

31 years (8 to 85)

sex predilection for osteosarcoma

Slight predilection for males

Conventional for males

Tumor where you experience swelling, pain, loosening and displacement of teeth, paresthesia , mucosal alteration - seen at late stage with the average duration of symptoms - 3 to 4 months before diagnosis

OSTEOSARCOMA

early tumor:

localized widening of periodontal ligament space

resorption of the surrounding alveolar bone

advance tumor - "moth-eaten" radiolucencies or irregular, poorly marginated radiopacities

"sun-ray" or "sunbursts" radiopaque appearance due to periosteal reaction (not a pathognomonic)

OSTEOSARCOMA

All ____ have a sarcomatous stroma that directly produces tumor osteoid

Histologic patterns:

Chondroblastic (most common)

Osteoblastic

Fibroblastic

Telangiectatic

OSTEOSARCOMA

Treatment for osteosarcoma

Surgical procedure and chemotherapy

Prognosis for osteosarcoma

5-year survival rates of 25% to 40%

Radical surgery - superior survival rate of 80% as compared with local or conservative surgery (25%)

commonly recur (40%-70%) with a metastatic rate of 25% to 50%

peak incidence age for Parosteal osteosarcoma

39 years old

In Parosteal osteosarcoma, it is considered female predilection when

long bones are affected

In Parosteal osteosarcoma, it is considered male predilection when

jaws are affected

commonly involves the distal femoral metaphysis

slow-growing swelling or palpable mass

often accompanied by a dull, aching sensation

Parosteal osteosarcoma

histopathologic features: well-differentiated

radiographic features: radiodense and attached to the external surface of bone

Parosteal osteosarcoma

occurs much less common often than parosteal osteosarcoma

commonly involve the UPPER TIBIAL METAPHYSIS

rare in the jaws

Periosteal osteosarcoma

Peak age for Periosteal osteosarcoma

20 years old

sex predilection for Periosteal osteosarcoma

Male (2:1)

Treatment for juxta

Bloc resection

Radical excision - Over-all 5 year survival rate: 80%

Deadly tumor

CHONDROSARCOMA

Chondrosarcoma is located in

Maxillofacial area: 60% - usually involve the anterior region (lateral incisor-canine region)

Mandible: 40% - premolar and molar regions.

symphysis, coronoid process and condylar process

Age for Chondrosarcoma

adulthood and old age

Jaw lesions: 3rd and 4th decades of life

Mean age for Chondrosarcoma

60 years old

Sex predilection for Chondrosarcoma

No sex predilection

Painless swelling

Expansion of the affected bones - resulting to loosening of teeth

varies from moth-eaten radiolucencies that are solitary or multilocular or diffusely opaque lesions

Chondrosarcoma

Histopathologic feature of chondrosarcoma that increases numbers of chondrocytes

Grade I

Histopathologic feature of chondrosarcoma that has myxoid stroma with enlarged chondrocyte nuclei

Grade II

Histopathologic feature of chondrosarcoma that marked cellular with spindle cell component

Grade III

Treatment for Chondrosarcoma

wide local or radical surgical excision

radioresistant