Oral Pathology Exam 4 Bone

Front 1

What are the 4 malignant BONE tumors we learned about?

Back 1

1. Osteosarcoma (Osteogenic Sarcoma)
2. Chondrosarcoma
3. Ewing Sarcoma
4. Metastatic Tumors to the Jaws

Front 2

What's another name for Osteosarcoma?

Back 2

Osteogenic Sarcoma.

Front 3

What's another name for Osteogenic Sarcoma?

Back 3

Osteosarcoma

Front 4

What is the MOST COMMON Primary Malignancy of bone?

Back 4

Osteosarcoma.

Front 5

Osteosarcomas of the jaw are rare. T/F?

Back 5

True- Osteosarcoma is the MOST common primary malignancy of bone. Regardless, osteosarcomas of the Jaw are rare- accounting for only 6-8% of osteosarcomas.

Front 6

List the 3 contributing factors for Osteosarcoma:

Back 6

1. Paget Disease- 2 to 5% of Paget cases develop osteosarcoma.
2. Prior irradiation treatment for benign soft tissue or bone lesions.
3. Osteogenesis imperfecta

Front 7

Osteogenesis Imperfecta is a contributing factor for Osteosarcoma. T/F?

Back 7

True- along with
1. Paget Disease- 2 to 5% of Paget cases develop osteosarcoma.
2. Prior irradiation treatment for benign soft tissue or bone lesions.

Front 8

Paget Disease is not a contributing factor for Osteosarcoma. T/F?

Back 8

False- it is!
1. Paget Disease- 2 to 5% of Paget cases develop osteosarcoma.
2. Prior irradiation treatment for benign soft tissue or bone lesions.
3. Osteogenesis imperfecta

Front 9

Smoking is a contributing factor for Osteosarcoma. T/F?

Back 9

False. These 3 are:
1. Paget Disease- 2 to 5% of Paget cases develop osteosarcoma.
2. Prior irradiation treatment for benign soft tissue or bone lesions.
3. Osteogenesis imperfecta

Front 10

Your patient has been treated for benign soft tissue lesions in the past with radiation as therapy. This form of treatment is a contributing factor for what type of Malignant Bone Tumor?

Back 10

Osteosarcoma (Osteogenic Sarcoma)

Front 11

What is the age predilection for Osteosarcoma?

Back 11

3rd and 4th decades.

Front 12

The 2nd & 3rd decades are the age predilection for Osteosarcoma. T/F?

Back 12

False- 3rd and 4th decades.

Front 13

The 4th & 5th decades are the age predilection for Osteosarcoma. T/F?

Back 13

False- 3rd and 4th decades.

Front 14

What is the average age for Osteosarcoma?

Back 14

33 years old- this is 10-15 year older than for skeletal lesions.

Front 15

Is the average age for Osteosarcoma older or younger than for skeletal lesions? What is this average age?

Back 15

The average age for Osteosarcoma is 33 years old- this is 10-15 years older than for skeletal lesions! Most are 18-22 years old.

Front 16

The maxilla is more commonly affected in Osteosarcoma. T/F?

Back 16

False- mandible & maxilla are about equally affected.

Front 17

The mandible is more commonly affected in Osteosarcoma. T/F?

Back 17

False- mandible & maxilla are about equally affected.

Front 18

What is the site of predilection for Osteosarcoma?

Back 18

Mandible & maxilla are about equally affected.

Front 19

What are the most common symptoms of Osteosarcoma?

Back 19

Pain and swelling

Front 20

Pain, Swelling and toothache are the most common symptoms of Osteosarcoma. T/F?

Back 20

False- Pain and swelling are the most common symptoms of Osteosarcoma. Toothache is a symptom, but not one of the most common.

Front 21

Pain and swelling are the most common symptoms of which Malignant Bone Tumor?

Back 21

Osteosarcoma.

Front 22

Your patient presents with pain, swelling, loose teeth, toothache, and paresthesia. Because you know your S/S of diseases like the back of your hand you automatically think that these 5 symptoms beautifully correlate with which Malignant Bone Tumor?

Back 22

Osteosarcoma

Front 23

Pain and swelling are the most common symptoms of Osteosarcoma. What are the other 3 symptoms/signs present?

Back 23

1. Loose Teeth
2. Toothache
3. Paresthesia

Front 24

How does Osteosarcoma present radiographically?

Back 24

1. Bony expansion with opaque to mixed lucency/opacity pattern.
2. Sunburst pattern - 25% - from peripheral new bone formation
3. Widened PDL space- may be the earliest sign!

Front 25

What may be the earliest sign of Osteosarcoma?

Back 25

A widened PDL space

Front 26

Your patient presents with pain, swelling, loose teeth, toothache, paresthesia and now a widened PDL space. What do you suspect?

Back 26

Osteosarcoma

Front 27

A sunburst pattern is seen in osteosarcoma which is from Periphernal new bone formation. What % is this?

Back 27

25%

Front 28

24% of Osteosarcomas show the Sunburst Pattern. Where does this come from?

Back 28

From peripheral new bone formation

Front 29

There is bony expansion seen in Osteosarcoma. T/F?

Back 29

True- with opaque to mixed lucency/opacity pattern.

Front 30

Histologically, what does Osteosarcoma look like?

Back 30

1. Atypical, bizzarre Osteoblasts
2. Osteoblasts in disorderly array around cellular bony trabeculae
3. May also have atypical chondroid elements

Front 31

What is the treatment of choice for osteosarcoma is?

Back 31

Radical Surgical Excision

Front 32

Chemotherapy is used for Osteosarcoma. T/F?

Back 32

True- it may be used to control metastases. Pulmonary metastases is seen in 50% of patients!

Front 33

Radiation therapy is very effective for Osteosarcoma & chemotherapy as well. T/F?

Back 33

False- Radiation therapy is NOT very effective for osteosarcoma. However, chemotherapy is used to control metastases.

Front 34

Prognosis is : good, bad, poor
for Osteosarcoma?

Back 34

Very POOR for both skeletal and jaw lesions, however with newer tx moalities 5 yr survival rates for skeletal lesions have improved to 60%. Jaw lesions currently is not as good as for skeletal lesions.

Front 35

Survival rates for jaw lesions seen in osteosarcoma vary from ___% to ___%, depending on study. Up to ___% survival has been reported with initial radical surgery.

Back 35

Survival rates for jaw lesions seen in osteosarcoma vary from 30 % to 70 %, depending on study. Up to 80% survival has been reported with initial radical surgery.

Front 36

A malignancy of mesenchymal cells having the ability to produce osteoid or immature bone (aka malignancy of osteoblasts) that most often occurs in 20-40 year olds is seen in your patient. Upon examining her xray you see triangular elevation of the periosteum (Codman's Triangle) as well as opaque spiking at crestal bone ("spiking" resorption = resorption of roots making roots looking very tapered and narrow) as well as a symmetrical widening of the PDL space. What does your patient have and how will you tx her?

Back 36

Osteosarcoma.
Tx = RADICAL SURGICAL EXCISION & CHEMOTHERAPY to control metastases.

Front 37

A systemic Dz defined as an absolute decrease in the amount of bone below the levels required for adeuqate mechanical support is known as?

Back 37

Osteoporosis

Front 38

Metabolic bone resorption causes Osteoporosis. It is seen in the elderly and particularly affects postmenopausal females. It can be severe enough to produce radiographically detectable changes in bone. What diagnostic radiographic jaw changes do we see?

Back 38

We do NOT see any diagnostic radiographic changes in osteoporosis!

Front 39

What is a generic term that refers to increased amounts of calcified bone?

Back 39

Osteosclerosis (NOS- not otherwise specified)

Front 40

Osteosclerosis may be seen in patients with:
1. Metastatic tumors- prostrate & breast
2. Lead poisoning
3. Hypothyroidism(helps preserve bone mass- a good consequence).
T/F?

Back 40

True

Front 41

Idiopathic Osteosclerosis of the Jaws is a distinct clinicopathologic disorder. T/F?

Back 41

True

Front 42

What are 2 other names for Hyperparathyroidism of the bone?

Back 42

1. Osteitis Fibrosa Cystica
2. Von Recklinghausen's Dz of Bone

Front 43

Osteitis Fibrosa Cystica is another name for what?

Back 43

Hyperparathyroidism of the Bone (and von Recklinghausen's Dz of Bone)

Front 44

What is characterized by generalized bone loss (diffuse bony changes seen in all 4 quadrants!) and replacement by fibrous tissue, has predilection for MIDDLE AGED females and ground glass appearance with loss of lamina dura?

Back 44

Hyperparathyroidism of the Bone

Front 45

Primary Hyperparathyroidism of the Bone is caused by what?

Back 45

Primary Hyperparathyroidism of the Bone is caused by a FUNCTIONAL BENIGN PARATHYROID ADENOMA.

Front 46

In Primary Hyperparathyroidsm of the Bone we see an increase in PTH secretion which leads to elevated serum calcium. This is associated with Bone RESORPTION and bone lesions as Calcium is liberated from the skeleton. What 3 other findings are important? (They all rhyme)

Back 46

1. Stones = urolithiasis, nephrolithiasis & cholelithiasis
2. Moans = abdominal pain from Peptic Ulcer Dz
3. Groans = Psychiatric changes

Front 47

Peptic Ulcer Dz can cause what feature of Primary Hyperparathyroidism of Bone?

Back 47

Moans

Front 48

Secondary Hyperparathyroidism of Bone is caused by Poor renal function as seen in Chronic Renal Failure. This results in a lack of what Vitamin?

Back 48

Vitamin D3 which causes a decreased Calcium ABSORPTION. Calcium may be also lost in the urine.

Front 49

Calcium is lost in the urine in which type of Hyperparathyroidism?

Back 49

Secondary

Front 50

In Secondary Hyperparathyroidsim there is retention of PO4 occurs as well as parathyroid hyperplasia with increased output of PTH occuring to compensate for what?

Back 50

Compensate for the low levels of serum calcium. As calcium is mobilized from the bones, bone lesions develop from EXCESSIVE resorption.

Front 51

Pathologic bone fractures occur in Hyperparathyroidism of the Bone and are Common in the Jaws. There also may be a shifting of teeth. T/F?

Back 51

FALSE- pathologic fractures DO occur but are NOT common in the Jaws.

TRUE- shifting of teeth may occur.

Front 52

Radiographically we see:
1. Ground glass appearance
2. Loss of Lamina Dura
3. Multilocular Radiolucencies
It occurs in Middle-aged females and has a generalized bone loss and replacement of Fibrous Tissue. What disease is this?

Back 52

Hyperparathyroidism of Bone

Front 53

Histologically we see:
1. Cellular fibrous stroma, much like granulation tissue
2. Very vascular and thus associated with FOCI OF HEMORRHAGE, giving lesion a BROWN COLOR GROSSLY. Hence lesions are referred to as what?
3. Multinucleated Giant Cells
4. Scattered Bone Trabeculae (residual)
This is what Dz?

Back 53

Hyperparathyroidism of the Bone.

Lesions are referred to as BROWN TUMORS of HYPERPARATHYROIDSM

Front 54

Tx for primary & secondary Hyperparathyroidism of bone is?

Back 54

primary = remove parathyroid adenoma. Brown Tumor can complete resolve!
Secondary = attempt to control contributing factors- chronic renal Dz

Front 55

Can brown tumors completely resolve in primary hyperparathyroidism?

Back 55

Yes!

Front 56

Hyperparathyroidsm:
1. All 4 quads involved
2. Older Adults
3. Ground glass
Compare these 3 features to Fibrous Dysplasia

Back 56

Fibrous Dysplasia
1. One quad
2. Young person
3. Ground glass

Front 57

What are the 3 metabolic Bone Diseases we learned?

Back 57

1. Osteoporosis
2. Osteosclerosis
3. Hyperparathyroidism- primary & secondary

Front 58

What are the inherited Dz of Bone that we learned?

Back 58

1. Osteopetrosis
2. Cherubism
3. Tori & Exostoses

Front 59

Osteopetrosis is a rare genetic Dz. What are the 3 other names for it?

Back 59

1. Marble Bone Dz
2. Albers-Schonberg Dz
3. Osteosclerosis Fragilis Generalista

Front 60

Osteopetrosis is also known as Marble Bone Dz because it is dense and hard. Basic Features include:
1. Normal Bone Apposition
2. Abnormal to NO bone RESORPTION = increase density of bone throughout the skeleton- affects the WHOLE body!
3. Blue Sclera
4. Bone marrow gets narrow & vascularity is diminished
What Laboratory Finding will be increased in the Benign form?

Back 60

Benign form shows Increased Serum Acid Phosphatase

Front 61

Benign Osteopetrosis has a middle age to older onset vs the Malignant form which has Neonatal onset. Which one is Dominant and which is recessive?

Back 61

Benign = Hereditary- Dominant
Malignant = Recessive- death by 20 yrs, no known survivers

Front 62

Your patient is a 30 yr male who claims to have Malignant Osteopetrosis. He acquired it as a neonate. Common manifestations he had were:
1. Optic atropy
2. Hepatosplenomegaly
3. Loss of Hearing
4. Pathologic Fractures
5. Secondary Infection.
What do you tell him?

Back 62

Those manifestations are true
(1. Optic Atrophy
2. Hepatosplenomegaly
3. Loss of hearing
4. Pathologic fractures
5. Secondary Infection)
however it doesn't make sense that he is still alive bc death is supposed to be by 20 years and here are NO known survivors.

Front 63

Benign Osteopetrosis' common manifestations include:
1. Multiple Patholgic fractures (40% cases)
2. Pain- bc pressure on sensory nerves
3. Cranial Nerve Palsy- common
4. Osteomyelitis.
What is the age of onset?

Back 63

Middle aged to older onset

Front 64

Your patient is a middle aged woman who presents with:
1. Multiple pathologic fractures
2. Pain
3. Cranial Nerve Palsy
4. Osteomyelitis.
She acquired this Dz through Mendelian Dominant fashion and her lab results show an increased serum acid Phosphatase.
She said her previous doc said she had some bone Dz. Based on these findings what does she have?

Back 64

Benign Osteopetrosis

Front 65

Your 5 year old pt presents with a bone dz involving most of her skeleton. She presents with:
1. Pathologic Fractures
2. Secondary infections
3. Loss of hearing
4. Hepatosplenomegaly
5. Optic Atrophy
What Dz does she have?

Back 65

Malignant Osteopetrosis

Front 66

Upon doing a Comp Oral Eval you see:
1. Bone sclerosis due to delayed eruption
2. Premature exfoliation due to defect in the PDL
3. Enamel hyPOplasia
4. Predisposition to Osteomyelitis
5. Pathologic Jaw Fracture.
What Dz does your pt have?

Back 66

Osteopetrosis

Front 67

Osteopetrosis predisposes to Osteomyelitis. T/F?

Back 67

True

Front 68

You will see Enamel Hyperplasia in Osteopetrosis. T/F?

Back 68

FALSE- you will see enamel HYPOplasia in Osteopetrosis

Front 69

Radiographically you see:
1. Dense Homongenous Milky Opaque changes
2. Increase Cortical Thickening
3. Tooth Roots may be obscured by Dense Bone
Your pt has blue sclera.
What Dz does she have?

Back 69

Osteopetrosis

Front 70

Histologic Features of Osteopetrosis include:
1. Decreased Osteoclasts- younger pts = Malignant
2. Osteoclasts may be deficient in what?
3. Adults = abnormal collagen matrix.

Back 70

RNA

Front 71

Tx for Ostepetrosis is?

Back 71

There is NO effective Tx!
Increased PTH has caused some resorption

Front 72

There is no effective TX for Osteopetrosis. What can you give your pt to cause some resoprtion?

Back 72

Increase PTH

Front 73

Penetrance for males having Cherubsim is 50-75%. T/F?

Back 73

FALSE- Males have 100% penetrance.

Females have 50-75% penetrance

Front 74

Cherubism is a genetic abnormality that is inheretied as an Autosomal Dominant mendelian Disorder. 100% penetrance in males (male dominance) and 50-75% prenetrancein females. Mutations have been mapped to which chromosome?

Back 74

Chromosome 4p16

Front 75

Mutation in Cherubism involves which gene?

Back 75

SH3BP2- it codes for a protein involved insignal transduction to upregulate osteoblastic and clastic activity. Mutation may lead to pathologic acitivation of OSTEOCLASTs and disruption of morphogenesis in jaws

Front 76

Clinical features of Cherubism include:
1. Bilateral symmetrical swelling of mandible
2. Maxilla-displacemnt of orbits looking up
3. Pigmented skin lesions
What age is the onset?

Back 76

Childhood- ages 3 to 4 yrs

Front 77

Dental finding in Cherubism include:
1. Premature Loss of Deciduous Teeth
2. Defective Permanent teeth which include---

Back 77

1. Missing
2. Displacesd
3. Lack of eruption

Front 78

Radiogrpahic features noted:
1. Soap bubble pattern of multilocular lucency-classic
2. Lesions bilateral and symmetric, involving mandible and the max
3. Teeth may be dsiplaced or "floating in the air"
what Dz?

Back 78

Cherubsim

Front 79

Histologic Features of Cherubism include:
1. Fibrovascular stroma with scattered ginant cells
2. Perivascular eosinophilic cuffing
3. Very similar to what type of granuloma?

Back 79

Central Giant Cell Granuloma

Front 80

Cherubism can bed tx with Radiation. T/F?

Back 80

FALSE- do NOT tx with radiation!

Front 81

Pathologica fractrues is expected in Cherubism. T/F?

Back 81

False- is NOT expected

Front 82

Surgical recontrouing in Cherubism is postmponed until when?

Back 82

Skeletal growth is complete

Front 83

There may be some regression at puberty in Cherubism. T/F?

Back 83

true