Oral Pathology 1 Bone Neoplasms

cell of origin = osteocyte; neoplasm is benign

osteoma

cell of origin = osteoblast; neoplasm is benign

osteoblastoma

cell of origin = cementoblast; neoplasm is benign

cementoblastoma

cell of origin = osteoblast; neoplasm is malignant

osteosarcoma

cell of origin = chondroblast; neoplasm is malignant

chondrosarcoma

cell of origin = primitive neuroectodermal cells (?); neoplasm is malignant

ewing sarcoma

osteoma

benign bone tumor that continues to grow (vs. exostosis)

Osteoma primarily involves the __

craniofacial skeleton

if multiple osteomas are present, consider __ syndrome

Gardner

most common location of osteoma

mandibular body

well circumscribed radipaque lesion

osteoma

autosomal dominant, mutation chromosome #5 (APC)

Gardner syndrome

colorectal (adenoma) polyps which can become malignant (100% if not tx); multiple osteoma, 20% have supernumerary teeth

clinical features of Gardner syndrome

Gardner syndrome

which of the following is CORRECT for osteoma?

typically small, slow-growing, and found in the skull

all of the following are part of Gardner syndrome EXCEPT:

cafe au lait spots

osteoblastoma

benign bone tumors from osteoblasts, rare

larger than 2-4 cm and NOT relieved by aspirin; pain and swelling

osteoblastoma

__% of osteoblastoma occur before the age of 30

85

osteoblastoma is more common in the __

posterior mandible

cementoblastoma

benign odontogenic neoplasm of cementoblasts

__% of cementoblastoma occur before the age of 30

75

__% of cementoblastoma occur in the mandible; almost always in molar/premolar region

75

RO mass that is fused to one or more tooth roots; outline of the root or roots is usually obscured; surrounded by a thin RL rim

cementoblastoma

pain and swelling are present in __ of cementoblastoma

2/3

ossifying fibroma

true bone neoplasm with significant growth potential composed of fibrous tissue that contains a variable mixture of bone and cementum (central vs peripheral)

large tumors result in painless swelling

ossifying fibroma

ossifying fibroma most commonly occurs in the __

mandible

well-defined; commonly mixed RL/ RO; root divergence or resorption of roots can occur

ossifying fibroma

characteristic of ossifying fibroma

downward bowing of the inferior cortex of the mandible

which of the following is INCORRECT for cementoblastoma?

radiolucent mass

which of the following statements about osteoblastoma is FALSE?

relieved by aspirin

most common location is the distal femur and proximal tibia (60%)

osteosarcoma

osteosarcoma has a __ distribution (10-20, common; after 50)

bimodal age

osteosarcoma is best appreciated with an __ x-ray

occlusal

symmetrical widening of the PDL space

important early finding of osteosarcoma

occurs in ~25% of osteosarcoma due to bony projections on the surface of the lesion

sunburst pattern

ill-defined peripheral borders seen in osteosarcoma

moth eaten pattern

a triangular elevation of periosteum in osteosarcoma

Codman’s triangle

tapered roots seen in osteosarcoma

spiking resorption

which of the following radiographic features is NOT typically associated with osteosarcoma?

radiolucent halo rim

chondrosarcoma

malignant bone tumor of cartilage

extensive infiltration, poorly defined borders, RL/ RO varies, +/ - root resorption, symmetrical PDL widening

chondrosarcoma

most common in long bones (3% in head and neck); painless mass or swelling of the jaw

clinical manifestation of chondrosarcoma

Ewing sarcoma

primarily malignant tumor of bone

Ewing sarcoma is highly __ and know to __

leathal; metastasize

Ewing sarcoma is the __ most common osseous neoplasm

3rd

Ewing sarcoma is most common in __

white males

Ewing sarcoma occurs in __% less than 20 years old

80

Ewing sarcoma is most commonly located in __

long bones

complete resection (resistant to chemo and radiation)

treatment of chondrosarcoma

__ radiographic appearance seen in Ewing sarcoma (periosteal reaction “like Garre’s osteomyelitis”)

onion skin

__ radiographic appearance seen in Ewing sarcoma (“like osteosarcoma”)

sunray

jaws are only involved 2%; mand > max

Ewing sarcoma

post radiation bone sarcoma

arises in bone that has previously been subjected to radiation therapy

post radiation sarcoma may develop 3 yrs after radiation, but the average is __ years after therapy

15

__ is the most common type of post radiation bone sarcoma (50%)

osteosarcoma

__ of metastatic carcinoma are in bone (80% mand > max)

2/3

__ of metastatic carcinoma are in soft tissue

1/3

symptoms of metastatic disease in the mouth mimic a __

toothache

which of the following statements about metastatic disease to the head and neck is FALSE?

more common location is gingiva

focal osteoporotic bone marrow defect

area of hematopoietic marrow that produces a radiolucency

no jaw expansion; NOT pathology, multi-locular RL

focal osteoporotic bone marrow defect

75% in adult women; typically post mand

focal osteoporotic bone marrow defect

focal osteoporotic bone marrow defect may mimic __; biopsy to rule out pathology

botryoid cyst, OKC, ameloblastoma

idiopathic osteosclerosis

focal area of increased radiodensity that is of unknown cause and cannot be attributed to anything else

In idiopathic osteosclerosis affected teeth are __

vital and asymptomatic

no decay or pulpal involvement, tooth is sound; RO lesion, no RL rim; no cortical expansion

idiopathic osteosclerosis

__% of idiopathic osteosclerosis occurs in the mandible (molar/ premolar)

90

associated with decay or pulpal involvement (infection)

condensing osteitis

will be fused with the tooth and have a radiolucent halo

cementoblastoma

adult F, periapical, florid, focal, no pain, teeth vital

focal COD

young, 2/3 pain, 1st or 2nd molar, halo rim

cementoblastoma

large restoration, infection, borders ill defined

condensing osteitis

borders ill defined, tooth is vital, does not have to be in a tooth bearing area

idiopathic osteosclerosis

central giant cell granuloma

considered a non-neoplastic lesion of unknown etiology; some demonstrate aggressive behavior and can break through bone

__% of central giant cell granulomas occur before 30 years old

60

__% of central giant cell granuloma occurs in the mandible

70

anterior jaw; frequently crosses the midline, expansile

central giant cell granuloma

radiolucent lesions; multilocular or unilocular; well defined non-corticated

central giant cell granuloma

can be seen in central giant cell granuloma

root divergence

root resorption suggests __ behavior, root divergence suggests __ process (central giant cell granuloma)

aggressive; benign

the histopathology of central giant cell granuloma is identical to __

cherubism

recurrence of central giant cell granuloma is __%

20

which of the following is not a multilocular lesion?

cementoblastoma

onion skin is associated with

Ewing sarcoma

which of the following is FALSE regarding ossifying fibroma?

no expansion

which of the following is NOT a neoplasm?

condensing osteitis

All of the following are RO lesions EXCEPT:

focal osteoporotic bone marrow defect

which of the following is TRUE for focal osteoporotic bone marrow defect?

multilocular