1 BENIGN NON-ODONTOGENIC TUMORS

ossifying fibroma, fibrous dysplasia, osteoblastoma, osteoid osteoma, osteoma, desmoplastic fibroma, chondroma, central/peripheral giant cell granuloma, giant cell tumor, hemangioma of the bone, langerhans cell disease, tori, exostoses, coronoid hyperplasia

14 benign non-odontogenic tumors (OFOOO, DCCGH, LTEC)

OSSIFYING FIBROMA

A benign neoplasm of bone that has the potential for excessive growth & bone destruction.

OSSIFYING FIBROMA (clinical features)

CLINICAL FEATURES

• Third & fourth decade of life

• Slow growing, asymptomatic & expansile lesion

• Most often seen in the mandibular premolar area

Juvenile (aggressive) ossifying fibroma

another type of ossifying fibroma that;

• occurs in children & young adults

• causes exophthalmos (popping out of the eyes), proptosis (causes eye displacement), sinusitis (inflammation of the sinus) & nasal symptoms

OSSIFYING FIBROMA (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Composed of fibrous connective tissue with well differentiated spindled fibroblast

• Collagen fibers

OSSIFYING FIBROMA (radiographic features)

RADIOGRAPHIC FEATURES

• Well circumscribed, sharply defined border unilocular or multilocular radiolucencies

OSSIFYING FIBROMA (differential diagnosis)

DIFFERENTIAL DIAGNOSIS

• Fibrous dysplasia

• Osteoblastoma

• Focal cementoosseous dysplasia

• Focal osteomyelitis

OSSIFYING FIBROMA (treatment and prognosis)

TREATMENT

• Curettage or enucleation

• could be done with a rare recurrence rate after removal of the lesion

PROGNOSIS

• Recurrence is rare after removal

FIBROUS DYSPLASIA

A condition in which normal medullary bone is replaced by an abnormal fibrous connective tissue proliferation in which new, non-maturing bone is formed (There is the presence of dense connective tissue in the area that does not mature)

FIBROUS DYSPLASIA (clinical features)

CLINICAL FEATURES

• Slow progressive enlargement of the affected jaw

• Usually painless & typically presents as a unilateral swelling

• (The jaw bone does not develop or mature that is why the affected part of the jaw stops on growing causes):

  • Facial asymmetry

  • Displacement of teeth

FIBROUS DYSPLASIA (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Consist of a slight to moderate cellular fibrous connective tissue stroma that contains foci of irregularly shaped trabeculae of immature bone

• Fibroblast exhibit uniform spindle shaped nuclei

FIBROUS DYSPLASIA (radiographic features)

RADIOGRAPHIC FEATURES

• Ranges from a radiolucent lesion to a uniformly radiopaque mass

FIBROUS DYSPLASIA (differential diagnosis)

DIFFERENTIAL DIAGNOSIS

• Ossifying fibroma

• Chronic osteomyelitis

FIBROUS DYSPLASIA (treatment and prognosis)

TREATMENT

• Small lesion – no treatment needed (it only cause minimal tooth displacement –orthodontic treatment)

• Large lesion – surgical recontouring (surgical recontouring)

• Malignant transformation radiation therapy – (do the radiation therapy as surgical contouring is not enough)

OSTEOBLASTOMA (clinical features)

CLINICAL FEATURES

• Is an uncommon primary lesion of bone that occasionally arises in the maxilla or the mandible (jaw)

• Lesion measuring 1.5 cm. in diameter

• Usual sites is in the posterior tooth bearing regions of the maxilla & mandible

• Occur during second decade before the age of 30

• Nocturnal pain is common (salient features) – feeling of pain at night on a supine position

OSTEOBLASTOMA (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Irregular trabeculae of osteoid and immature bone within a stroma containing a prominent vascular network

OSTEOBLASTOMA (radiographic features)

RADIOGRAPHIC FEATURES

• Well circumscribed or spherical

• Thin radiolucency surrounding a variably calcified central tumor mass

• radiopaque at the center and lined with a thin radiolucent line

OSTEOBLASTOMA (differential diagnosis)

DIFFERENTIAL DIAGNOSIS

• Cementoblastoma

• Ossifying fibroma

• Fibrous dysplasia

• Osteosarcoma

OSTEOBLASTOMA (treatment and prognosis)

TREATMENT

• Curettage or local excision

PROGNOSIS

• Recurrence not common

OSTEOID OSTEOMA

Represent a smaller version of osteoblastoma

OSTEOID OSTEOMA (clinical features)

CLINICAL FEATURES

• Lesion is lesser than 1.5 cm. in diameter

• Occur during second decade of life

• Pain is relieved by aspirin (nocturnal pain at night)

OSTEOID OSTEOMA (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Basophilic bony trabeculae surrounded by plump hyperchromatic osteoblasts and some multinucleated giant cells

OSTEOID OSTEOMA (radiographic features)

RADIOGRAPHIC FEATURE

• Well circumscribed and has a mixed lucent-opaque pattern

OSTEOID OSTEOMA (differential diagnosis)

DIFFERENTIAL DIAGNOSIS

• Cementoblastoma

• Ossifying fibroma

• Fibrous dysplasia

• Osteosarcoma

OSTEOID OSTEOMA (treatment and prognosis)

TREATMENT

• Curettage or local excision

PROGNOSIS

• Recurrence not common

OSTEOMA (clinical features)

CLINICAL FEATURES

• Consist of mature, compact, or cancellous bone

• 2 types:

  • Periosteal osteoma – arise on the surface of bone, asymptomatic (no pain) slow growing bony hard masses

  • Endosteal osteoma – develop centrally within the bone

• Associated with Gardners syndrome (autosomal dominant disorder)

• Arise in the maxilla or mandible as well as in facial & skull bones & within paranasal sinuses

• Headaches, recurrent sinusitis & ophthalmologic complains (symptoms)

• Since it is an overgrowth of the bone within the facial area, it causes impingement of the nerve in the facial area resulting in pain that is felt by the patient.

Periosteal osteoma, Endosteal osteoma

2 types of osteoma

Periosteal osteoma

type of osteoma that arise on the surface of bone, asymptomatic (no pain) slow growing bony hard masses

Endosteal osteoma

type of osteoma that develop centrally within the bone

OSTEOMA (histopathologic features)

HISTOPATHOLOGIC FEATURES

Two variants:

• Composed of relatively dense, compact bone with sparse marrow tissue

• Consist of lamellar trabeculae of cancellous bone with abundant fibrofatty marrow

OSTEOMA (radiographic features)

RADIOGRAPHIC FEATURES

• Periosteal osteoma: well circumscribed radiopacities

• Endosteal osteoma: seen is the ramus of the mandible

OSTEOMA (differential diagnosis)

DIFFERENTIAL DIAGNOSIS

• Exostoses

OSTEOMA (treatment and prognosis)

TREATMENT

• Surgical excision

PROGNOSIS

• No recurrence

gardner’s syndrome

Mixture of endosteal and periosteal osteoma

DESMOPLASTIC FIBROMA

Locally aggressive lesion of bone that can be considered the bony counterpart of fibromatosis

Fibromatosis

a condition where there are fibrous overgrowth of dermal and subcutaneous connective tissue

DESMOPLASTIC FIBROMA (clinical features)

CLINICAL FEATURES

• Occur in patient under the mean age of 30, with a mean age of 14 years

• Body or ramus of the mandible is more affected than the maxilla

• Swelling of the jaw with displacement of teeth

DESMOPLASTIC FIBROMA (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Lesion consists of interlacing bundles & whorled aggregates of densely collagenous tissue that contains uniform spindled & elongated fibroblast (rubbery to firm tissue - consistency)

DESMOPLASTIC FIBROMA (differential diagnosis)

DIFFERENTIAL DIAGNOSIS

• Odontogenic cyst

• Odontogenic tumor

• Odontogenic fibroma

• Fibrosarcoma

DESMOPLASTIC FIBROMA (treatment and prognosis)

TREATMENT

• Surgical resection & curettage

PROGNOSIS

• Curettage alone with significant recurrence (both resection & curettage)

CHONDROMA

Cartilaginous tumor of unknown cause

CHONDROMA (clinical features)

CLINICAL FEATURES

• Present as a painless, slowly progressive swelling

• Arise in the nasal septum (bone that separates the nasal cavity from the brain located at the roof of the nasal membrane) & ethmoid sinuses

• Anterior of the maxilla are most often location

• Mandible most often location is in the body & symphysis area

• Appear before 50 years of age

CHONDROMA (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Consist of well-defined lobules of mature hyaline cartilage

• Chondrocytes are small & contain single, regular nuclei

CHONDROMA (differential diagnosis)

DIFFERENTIAL DIAGNOSIS

• Chondrosarcoma

CHONDROMA (treatment and prognosis)

TREATMENT

• Surgical excision

PROGNOSIS

• Recurrence is unusual

CENTRAL/PERIPHERAL GIANT CELL GRANULOMA

• Benign proliferation of fibroblast & multinucleated giant cells that occurs almost exclusively within the jaw

• Depends on the location:

  • Central = located at the center of the affected tissue structure

  • Peripheral = located at the periphery or lining of the affected tissue structure

CENTRAL/PERIPHERAL GIANT CELL GRANULOMA (clinical features)

CLINICAL FEATURES

• Before 30 years of age

• Females are more affected

• Almost exclusively in the maxilla & mandible

• Lesion tend to involve the jaws anterior to the permanent teeth (they are commonly seen in the facial area of both the anterior and posterior teeth --- when we say anterior to the permanent teeth facial area its either the labial surface of the anterior teeth or the buccal surface of the posterior teeth)

• Produces painless expansion or swelling

CENTRAL/PERIPHERAL GIANT CELL GRANULOMA (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Salient features: Hemosiderin-laden macrophages & extravasated erythrocytes are usually evident

• Multinucleated giant cells are present throughout connective tissue stroma

CENTRAL/PERIPHERAL GIANT CELL GRANULOMA (radiographic features)

RADIOGRAPHIC FEATURES

• Consist of multilocular less commonly locular radiolucency of the bone present as scalloped border (it follows the roof of the tooth)

CENTRAL/PERIPHERAL GIANT CELL GRANULOMA (differential diagnosis)

DIFFERENTIAL DIAGNOSES

• Ameloblastoma

• Odontogenic myxoma

• Odontogenic keratocyst

CENTRAL/PERIPHERAL GIANT CELL GRANULOMA (treatment and prognosis)

TREATMENT

• Excision or curettage

GIANT CELL TUMOR

• A giant cell tumor is a rare, aggressive non-cancerous tumor. It usually develops near a joint at the end of the bone.

• Occurs mostly in the long bones of the legs and arms.

GIANT CELL TUMOR (clinical features)

CLINICAL FEATURES

• Commonly in long bones especially in the knee joint

• Rare in the jaw

• Seen in third & fourth decades of life

• Exhibit slow growth & bone expansion or sometimes they produce rapid growth, pain or paresthesia

GIANT CELL TUMOR (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Numerous multinucleated giant cells dispersed evenly among mononuclear fibroblast

GIANT CELL TUMOR (radiographic features)

RADIOGRAPHIC FEATURES

• Large, expansile well-defined mass extending to sub-chondral surface

• Produces radiolucent image

GIANT CELL TUMOR (treatment and prognosis)

TREATMENT

• Surgical excision or curettage

PROGNOSIS

• 30% recurrence noted after curettage

HEMANGIOMA OF THE BONE

Rare intraosseous vascular malformation that can mimic both odontogenic & non-odontogenic lesion

cavernous type, capillary type

2 types of hemangioma of the bone

HEMANGIOMA OF THE BONE (clinical features)

CLINICAL FEATURES

• Occur in the mandible especially in the posterior region

• Second decade of life

• Spontaneous bleeding around the teeth

• Paresthesia or pain are evident

• Bruits or pulsation of large lesion may be detected

HEMANGIOMA OF THE BONE (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Represents proliferation of blood vessels

• Two types:

  • Cavernous type – large caliber vessels

  • Capillary type – small caliber vessels

Cavernous type

• type of hemangioma of the bone

• large caliber vessels

Capillary type

• type of hemangioma of the bone

• small caliber vessels

HEMANGIOMA OF THE BONE (radiographic features)

RADIOGRAPHIC FEATURES

• Multilocular radiolucency that have a characteristic of soap bubble appearance

• Large lesions can have the sunray appearance of an osteosarcoma.

• Root resorption of adjacent teeth is common. Developing teeth may be larger and erupt earlier.

• When the lesion involves the inferior dental canal the canal can be enlarged

HEMANGIOMA OF THE BONE (differential diagnosis)

DIFFERENTIAL DIAGNOSES

• Ameloblastoma

• Central giant cell granuloma

• Aneurysmal bone cyst

• Odontogenic myxoma

• Odontogenic keratocyst

Aspiration of the lesion

______________ is an important diagnostic tool (to

rule out hemangioma of the bone)

HEMANGIOMA OF THE BONE (treatment and prognosis)

TREATMENT

• surgery

• radiation therapy

• sclerosing agents

• cryotherapy

• presurgical embolization technique

LANGERHANS CELL DISEASE

• Formerly known as histiocytosis X & idiopathic histiocytosis

• Proliferation of cells exhibiting phenotypic characteristics of langerhans cells (presence of langerhans cell)

LANGERHANS CELL DISEASE (clinical features)

CLINICAL FEATURES

• Clinical signs of inflammation are present. There is multiple dental loss, attachment loss, spontaneous gingival bleeding and deep periodontal pockets.

• Ranges from solitary or multiple bone lesion to dessiminated visceral, skin, & bone lesion

• "Condition of children & young adult

• Tenderness & pain swelling are common

• Loosening of teeth on the affected area

• Inflammation of gingival tissue, hyperplastic & ulcerated (that makes it similar to the clinical signs and symptoms of severe periodontal disease)

• Three disorders:

  • Eosinophilic granuloma (chronic localized)

  • Hand-schuller- Christian syndrome (chronic dessiminated)

  • Letterer-siwe disease (acute dessiminated)

Eosinophilic granuloma (chronic localized), Hand-schuller- Christian syndrome (chronic dessiminated), Letterer-siwe disease (acute dessiminated)

three disorders associated with langerhans cell disease

LANGERHANS CELL DISEASE (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Tumor cells show unique rod shape cytoplasmic structure which are identical to birbeck granules

• Oval to reniform nuclei

LANGERHANS CELL DISEASE (radiographic features)

RADIOGRAPHIC FEATURES

• Periapical radiographs showing well-defined radiolucent images comprising alveolar bone, providing the radiographic image of "floating teeth".

• Exhibit solitary radiolucent lesion

• Sharp circumscribed punched out appearance

LANGERHANS CELL DISEASE (treatment and prognosis)

TREATMENT

• Chemotherapeutic agents

• Surgical or low dose therapy

PROGNOSIS

• Poor prognosis

• Patient survival is 10 to 15 years

TORI

• Inherited condition

• Two types:

  • Torus palatinus - sessile, nodular mass of bone that presents along the midline of the hard palate (palatinus = palate)

  • Torus mandibularis - bony exophytic growth that present along the lingual aspect of the mandible superior to the mylohyoid ridge (seen on the lingual area)

Torus palatinus, Torus mandibularis

2 types of tori

Torus palatinus

• type of tori

• sessile, nodular mass of bone that presents along the midline of the hard palate

• Occur in females twice as often in males (2:1 ratio)

• Appear during second or third decade of life

• Exhibit slow growth generally asmptomatic

• Formed various configuration nodular, spindled, lobular or flat

Torus mandibularis

• type of tori

• bony exophytic growth that present along the lingual aspect of the mandible superior to the mylohyoid ridge (seen on the lingual area)

• Present along the lingual aspect of the mandible superior to the mylohyoid ridge

• Almost always bilateral occurring in premolar region

• Appear during the second or third decades of life

TORI (clinical features)

CLINICAL FEATURES

• Torus palatinus = center of the palate

  • Occur in females twice as often in males (2:1 ratio)

  • Appear during second or third decade of life

  • Exhibit slow growth generally asmptomatic

  • Formed various configuration nodular, spindled, lobular or flat

• Torus mandibularis = lingual aspect of the mandible

  • Present along the lingual aspect of the mandible superior to the mylohyoid ridge

  • Almost always bilateral occurring in premolar region

  • Appear during the second or third decades of life

TORI (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Composed of hyperplastic bone consisting of mature cortical and trabecular bone.

• Outer surface exhibits a smooth rounded contour

TORI (radiographic features)

RADIOGRAPHIC FEATURES

• Large tori may be evident as diffuse radiopaque lesion

TORI (treatment and prognosis)

TREATMENT

• No treatment needed

• Surgical removal for prosthetic purposes (if there’s problem on the retention of the denture of a patient = surgical removal)

PROGNOSIS

• No recurrence

EXOSTOSES

• Multiple or single bony excrescences that occur less commonly than do tori

• Unknown etiology

EXOSTOSES (clinical features)

CLINICAL FEATURES

• Asymptomatic bony nodules

• Present along the buccal aspect of the alveolar bone

• Most often in the posterior portion of both the maxilla & the mandible (present in the buccal aspect of the bone)

• Reported as rare occurrence following skin graft vestibuloplasty, gingival grafts, as well as beneath the pontic of a fixed bridge (cause by a pressure from a fixed bridge)

EXOSTOSES (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Composed of hyperplastic bone consisting of mature cortical & trabecular bone

EXOSTOSES (radiographic features)

RADIOGRAPHIC FEATURES

• Well defined radiopacity that resembles periosteal osteoma (outgrowth of bone that is seen along the surface of the bone)

EXOSTOSES (treatment and prognosis)

TREATMENT

• Surgical removal for prosthetic purposes

PROGNOSIS

• Rare recurrence after surgical excision

CORONOID HYPERPLASIA

• An uncommon condition that is often associated with limitation of mandibular motion

• Unknown etiology

CORONOID HYPERPLASIA (clinical features)

CLINICAL FEATURES

• Painless not associated with facial asymmetry

• Most often in young males

• Age onset is around puberty

• Two types:

  • Unilateral – unilateral coronoid hyperplasia

  • Bilateral – results in limitation of mandibular movement which is progressive over time (most common coronoid hyperplasia)

unilateral, bilateral

2 types of coronoid hyperplasia

unilateral

• type of coronoid hyperplasia

• unilateral coronoid hyperplasia

bilateral

• type of coronoid hyperplasia

• results in limitation of mandibular movement which is progressive over time (most common coronoid hyperplasia)

CORONOID HYPERPLASIA (histopathologic features)

HISTOPATHOLOGIC FEATURES

• Bilateral – consist of mature hyperplastic bone

• Bone may be partially covered by cartilaginous & fibrous connective tissue

CORONOID HYPERPLASIA (radiographic features)

RADIOGRAPHIC FEATURES

• Unilateral type – results in misshapen or mushroom shaped coronoid process on radiographs

CORONOID HYPERPLASIA (differential diagnosis)

DIFFERENTIAL DIAGNOSIS

• Osseous & chondroid neoplasm

CORONOID HYPERPLASIA (treatment and prognosis)

TREATMENT

• Surgical excision

PROGNOSIS

• Recurrence is rare