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28 Cards in this Set
- Front
- Back
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BFOL definition and types
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Benign Fibro-osseous lesions
- Normal bone architecture is replaced by fibroblasts and collagen fibers with variable mineralization - A process, and not a specific diagnosis Fibrous dysplasia Ossifying fibroma - Juvenile ossifying fibroma Cemento-osseous dysplasia - Florid - Focal - Periapical |
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Fibrous dysplasia cause, types, radiographic appearance and cause, histology, treatment
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Mutation of the GNAS 1 gene
Monostotic: 80-85%. Can become Craniofacial fibrous dysplasia of MX is involved and extend to other bones Polyostotic: up to 75% of skeleton. Pathologic fractures and hockeystick leg deformity. Females more common. Jaffe syndrome & McCune-Albright syndrome Radiographic: Radiolucent Early Cystic, mid Sclerotic, Late phase Mixed "pagetoid" - Characteristic poorly circumscribed radiopacity like "ground glass" or "orange peel". - Opacity cased by superimposition of disorganized bone trabeculae - Shows superior displacement of inferior alveolar canal with narrowing or loss of PDL*** Histology shows immature woven bone with no osteoblasts. - Bone matrix arises from metaplasia of fibrous tissue. -Shows curvilinear shapes like "Chinese characters." - Small lesions can be excised - Large polyostotic lesions are monitored and shaved down. 20% have regrowth - Radiation is contraindicated due to risk of post-radiation sarcoma |
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Jaffe vs McCune Albright syndrome
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Jaffe syndrome:
Polyostotic fibrous dysplasia with cafe au lait pigmentation McCune Albright syndrome - Polyostotic fibrous dysplasia with cafe au lait pigmentation and multiple endocrinopathies. |
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Central Ossifying fibroma
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- True neoplasm with 90% mandible and 5x Female predicament
- Presents with a painless downward bowing of the inferior cortex - histology shows well demarcation from surrounding bone. May have fibrous capsule so more easily removed than fibrous dysplasia. |
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Juvenile Ossifying fibroma characteristics, clinical signs, and histology
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More aggressive than central ossifying fibroma
- Maxilla more often - Can cause exophthalmos and proptosis - Histology shows small strands or "seams" of osteoid matrix as clusters of multinucleated giant cells |
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Periapical Cemento-osseous dysplasia characteristics, radiographic appearance, histology
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- Most common in the apices of mandibular incisors
- Up to 14x female predicament - Teeth are invariably vital Radiographic - Early lesions are well demarcated radiolucencies - Then becomes mix of osteolytic and osteoblastic lesions Histology - Mature lesions show more calcification - No evidence of inflammation |
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Focal Cemento-Osseous dysplasia
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- Usually seen in posterior mandible and found more often in females
- May be uni-quadrant florid cemento osseous dysplasia. - Doesn't separate cleanly from bone |
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Florid Cemento-Osseous dysplasia characteristics, etiology
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Limited to Jaws and may be multiquadrant. Can become infected to cause confusion with chronic sclerosing osteomyelitis
- Simple bone cysts may develop within these lesions - Calcified material is dense and avascular prone to poor healing and osteomyelitis - Etiology is an abnormal reaction in bone. |
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Cherubism characteristics, radio, histology
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Painless bilateral expansion of jaws
- Autosomal dominant and early onset at about 7yrs then stabilize after puberty Radiographic - Most commonly see multiquadrant multilocular radiolucencies Histology - Fibrous connective tissue stroma with multinucleated giant cells and RBCs with eosinophilic deposites - In differential with CGCG, brown tumor, and ABC but cherubism shows Eosinophilic cuff like deposits around small blood vessels |
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Multilocular radiolucencies involving multiple quadrants
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Cherubism
Nevoid basal cell carcinoma syndrome |
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Proliferative Periostitis
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Periosteal reaction to the presence of inflammation
- Presents as several layers of reactive vital bone that parallel each other and expand the surface cortex - Occlusal radiograph shows onion skinning but with an intact cortex. If unintact, suspect neoplastic rather than inflammatory process |
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Hyperparathyroidism osseous changes, triad, Histology
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Osseous
- Generalized loss of lamina dura - Brown tumor showing up as a uni or multilocular radiolucency - Osteitis fibrosa cystica develops in long standing brown tumors Traid - Stones: Kidney - Groans: Duodenal ulcers - Moans: Mental disturbances Brown tumors consist of scattered multinucleated giant cells with extravasated RBCs. So must determine if patient has hyeprparathyroid in central giant cell lesions. |
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Paget's disease characteristics, radiographic, d/d, histology, treatment & prognosis
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Presents as aching bone pain
- Shows leontiasis ossea due to enlargement of maxilla more than mandible - Elevated serum alkaline phosphatase Radiographic - Shows cotton wool appearance of bone - Hypercementosis and Loss of lamina dura - May look like fibrous dysplasia when maxilla is expanded. But pagets in 40's while FD in less than 20yr Histology - Shows basophilic reversal lines resulting in jigsaw puzzle or mosaic pattern - See resorptive and osteoblastic phase Treatment for pain is asprin - May see spontaneous development of malignancy and form a sarcoma 1-13% of time |
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Osteopetrosis characteristics, types
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Defect in osteoclast function
- Thickening of cortical bone and sclerosis of cancellous bone Infantile(Malignant) - Diffuse sclerosis with marrow failure. Delayed tooth eruption and osteomyelitis of jaws are common complications. Adult(Benign) - Axial skeleton with significant sclerosis with little or no effect on long bones |
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Langerhans Cell disease characteristics, types, histology
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aka Histiocytosis X, Langerhans cell granuloma
- Associated pain or tenderness beginning in posterior jaws as loss of alveolar bone Types - Acute disseminated form: multisystem, infants, and high mortality - Chronic disseminated form: Unisystem, children. Presents radiographically with punched out radiolucencies and teeth floating in air. Triad of exopthalmos, Diabetes insipidus, and lytic defects of bone. - Eosinophilic granuloma: Solitary lesions without visceral involvement. Adults and low mortality Histology - Diffused infiltrate of mononuclear cells with kidney shaped nuclei and variable eosinophils - Also show rod shaped Birbeck granules in cytoplasms of Langerhans cells |
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Alveolar bone loss in children
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Juvenile periodontitis
Langerhans cell histiocytosis Papillon-Lefevre syndrome Burkitt's lymphoma Cyclic neutropenia/agranulocytosis |
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Palmoplantar Keratodermans
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Autosomal recessive Germline mutation in capthepsin C gene
- Includes Papillion Lefevre syndrome and Haim Munk syndrome - Associated with premature periodontal disease and appears as teeth floating in air |
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Multiple Myeloma characteristics, radiology, clinical
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Monoclonal expansion of malignant plasma cells in older 63yr olds
- Presents with Bone pain and pathologic fractures - Kappa light chain Bence-Jones proteins in urine - Punched out radiolucencies with no sclerotic margin - Hyperglobulinema mostly IgG - Macroglossia due to deposition of amyloid in tissues |
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Osteoma types
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Endosteal - Have to become large before causing cortical expansion
- Clinical D/D includes odontoma, condensing osteitis or any calcifying odontogenic lesion Periosteal - Asymptomatic hard swelling on bone surface that presents radiographically like a mushroom **- Multiple osteomas syspect Gardner syndrome. |
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Gardner Syndrome
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Have APC gene associated with Familial adenomatous polyposis syndromes
- Multiple osteomas of face and jaw and supernumerary teeth |
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Osteoid Osteoma/Osteoblastoma characteristic differences, radio, histology
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- Benign tumors of osteoblasts
Osteoid - Less than 2cm and alleviated by asprin. Most often in leg bones Osteoblastoma - Greater than 2cm and not relieved by asprin. Most common in vertebrae. *- Can grow at an alarming rate and presents as a sunburst type RO/RL lesion. Often confused with osteosarcoma * - Same histology attached to a tooth would be a cementoblastoma |
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Central Giant Cell Granuloma clinical, histology
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Presents as displaced teeth* Different from Myxoma which grows around roots and ameloblastoma which resorbs roots
- 15%-20% recurrence - Same histology as brown tumor of hyperparathyroidism, and wall of aneurysmal bone cyst. Must look at PTH levels to rule out hyperparathyroidism |
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Central Hemangioma characteristics, radio, histology, types, treatment
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Slowly expanding swellings that show mobility and bleeding.
- Shows multilocular radiolucencies - Unencapsulated lesion composed of multiple endothelial lined vascular channels Cavernous - Large dilated vessels. Majority Capillary - Small vessels Can use angiogram to identify feeder vessels and tie them off or sclerose them. Commonly facial artery and internal maxillary artery - All central lesions that look like hemangiomas must be aspirated prior to biopsy or surgical resection |
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Desmoplastic fibroma characteristics, histology, treatment
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Osseous counterpart of soft tissue fibromatosis
- 50% in metaphysis of humerus and tibia. Mandibule is 4th place - Presents as a painless swelling - Classified as benign and acts locally aggressive. Radical surgery may be required |
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Chondroma & Chondrosarcoma characteristics, radio, histology, treatment,
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Cartilaginous tumor that can recur many times and eventually metastasize
Chondrosarcoma - Symmetric widening of PDL* Present in both chondrosarcoma and Osteosarcoma. Also poorly defined radiolucency - Cartilage shows varying degrees of cellularities with two or more cells in a lacuna. - Don't respond to radiation or chemotherapy or radiation. Radical surgical excision is required for all cartilagenous tumors arising in the jaws. Can metastasize to lung or bone. |
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Osteosarcoma characteristics, clinical signs, radio, histology, treatment,
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Most common primary malignant bone tumors under 40
- 2nd most common after multiple myeloma - Presents with swelling and pain. - MD>MX, Male>Female - Classic sunburst pattern and symmetric widening of PDL - Osteosarcoma must demonstrate osteoid arising directly from a sarcomatous stroma - Unlike chondrosarcoma, Osteosarcoma is treated with chemo and surgery. Radiation is not enough. |
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Peripheral Osteosarcoma characteristics, type,
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Arises on surface of bone, usually long bones
- Parosteal: Well differentiated but will recurr with less than en bloc surgery. Mushroom like growth on bone surface with no elevation of periosteum - Periosteal: Higher grade with prominent cartilaginous component. Prognosis is better than medullary osteosarcoma but worse than parosteal. |
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Ewing's Sarcoma characteristics, clinical, histology, treatment
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Disease of children and adolescents. More common in mandible and caucasians
Very malignant tumor that presents with pain, swelling, fever, and may mimic an infection or osteomyelitis - Paresthesia and loosening of teeth are common findings in jaw lesions - Cells contain glycogen granules in the cytoplasm so immunohistochemical stains are needed to confirm the diagnosis. - Combined therapy with radiotherapy, chemo and surgery. Gnathic Ewing's sarcoma has a lower mortality rate |
