Path 11: Inflammatory And Malignant Jaw Lesions

Front 1

Osteomyelitis:

1) What is it?
2) Is progressive osteomyelitis of the jaws common?
3) Age/gender/location

Back 1

1) Acute or chronic inflammatory process of bone marrow or cortex
2) NO
3) All ages, male, mandible

Front 2

Acute osteomyelitis:

1) What defines it as acute?
2) Symptoms?
3) How does it look radiographically?

Back 2

1) Signs/symptoms <1 month in duration
2) Fever, tenderness, soft tissue swelling + lymphadenopathy, parasthesia of lower lip, drainage, or exfoliation of SEQUESTRUM
3) Unremarkable or ill-defined

Front 3

Chronic osteomyelitis:

1) Symptoms?
2) What is it composed of?
3) Radiographically?
4) D/D?

Back 3

1) Swelling/pain/sinus formation, purluent discharge, sequestrum, pathologic fracture. Acute exacerbations or decreased pain w/ chronic smoldering progression
2) Granulation tissue then scar tissue, encircled dead space reservoir for bacteria
3) Patchy, ragged, ill-defined radiolucency often w/ central radiopacity (sequestra)
4) Metastasis

Front 4

Histology of:

1) Acute osteomyelitis
2) Chronic osteomyelitis

Back 4

1) Necrotic bone loss of osteocyttes from lacunae, peripheral resorption, bacterial colonization. Inflammatory infiltrate of NEUTROPHILS (PMNs)
2) Chronic - inflamed fibrous CT filling intertrabecular area
See FIBROUS TISSUE replacing FATTY MARROW

Front 5

Tx and prognosis of?

1) Acute osteomyelitis
2) Chronic osteomyelitis
3) Why is it so hard to tx chronic? What is mandatory? What is beneficial?

Back 5

1) Antibiotics and drainage
2) Difficult to manage medically
3) Pockets of dead bone - organisms protected from antibiotics by wall of fibrous CT. Remove all infected tissue down to bleeding bone, hyperbaric oxygen beneficial - delivery antibiotic impregnated polymethyl-methacrylate beads

Front 6

Proliferative periostitis (Garre's osteomyelitis)

1) What happens?
2) Who does it affect? Where does it affect?
3) Most frequent cause?
4) What do you see histopathologically?
5) Tx?
6) How long does it take layers of bone to consolidate?

Back 6

1) Periosteal reaction to inflammation => periosteum forms several rows of reactive vital bone parallel to each other expanding the bone
2) ~13 y/o, pre-molar/molar mandible
3) Dental caries w/ periapical inflammation
4) Hyperplasia along lower border of mandible (buccal cortical involvement also common), parallel rows of highly cellular + reactive woven bone, individual trabeculae oriented perpendicular to surface.
5) Eliminate source of infection (ext or endo)
6) 6-12 months

Front 7

Osteosarcoma:

1) Most common ____
2) What are the most frequent sites?
3) Mean age for jaw? Long bones?
4) Most common symptoms?
5) Peripheral border? What happens to roots of teeth?
6) How does it look radiographically? Early radiographic changes?
7) Most common tx?
8) Cause of death?
9) T or F: jaw osteosarcomas metastasize more

Back 7

1) Primary malignant tumor of bone
2) Distal femur and proximal tibia
3) 33 y/o (15 y/o for long bones)
4) Swelling + pain
5) Ill-defined and indistinct. Spiking resorption.
6) Classic sunburst or sun-ray 25%. EARLY SYMMETRIC WIDENING OF PDL + pain + discomfort
7) Radical surgery
8) Local uncontrolled disease cause of death >> than distant metastases
9) F - less tendency to metastasize

Front 8

Chondrosarcoma:

1) What is it?
2) Average age?
3) Most common presenting sign?
4) What is more painful, chondrosarcoma or osteosarcoma?
5) What do you see radiographically?

Back 8

1) Malignant cartilage forming tumor
2) 33
3) Painless mas or swelling
4) Osteosarcoma
5) Radiolucent lesion w/ poorly defined borders, scattered radiopaque foci), root resorption + symmetric widening of PDL

Front 9

D/D for smal-round cell malignancy:

Back 9

1) Ewing's sarcoma
2) Lymphoma
3) Leukemia

Front 10

Ewing's Sarcoma:

1) Gene rearrangements
2) Tx principles?

Back 10

1) EWS/ETC gene rearrangements
2) Metastasis screen/ifosfamide + doxorubicin, radiotherapy, surgical excision, post-op chemo

Front 11

Multiple myeloma:

1) Rare malignancy of?
2) Plasma cells are monoclonal/polyclonal
3) If metastatic disease is excluded, accounts for 50% of?
4) What age normally affected?
5) Most characteristic presenting symptom?
6) Present with what else caused by tumor destruction of bone?
7) What does it look like radiographically?
8) What kind of proteins?
9) What's in soft tissue? Sites affected?
10) Histo?
11) Tx + prognosis

Back 11

1) Plasma cells
2) Monoclonal
3) 50% of malignancies that involve bone
4) ~70 y/o (older men)
5) Bone pain similar to arthritic pain
6) Pathologic fractures caused by tumor destruction of bone
7) Multiple well-defined, punched out ragged radiolucent lesions
8) Bence-Jones proteins
9) Amyloid, TONGUE
10) Sheets of neopalstic plasmacytoid cells invade normal tissue
11) Chemo, poor

Front 12

Burkitt's Lymphoma:

1) What is it caused by? Malignancy of what origin?
2) 50-70% what form present in jaws? What part of jaws affected?
3) Where does the American form affect?
4) Signs/symptoms?
5) Radiographic?
6) What kind of lymphoma is this?
7) Classic pattern and why?
8) Tx?
9) Why do most die?

Back 12

1) EBV - malignancy of B-lymphocyte origin, represents undifferentiated lymphoma
2) African - posterior jaw segments, maxilla > mandible
3) Abdomen
4) Facial swelling + proptosis. Pain/tenderness/paresthesia minimal
5) Radiolucency w/ ragged, ill-defined borders
6) Undifferentiated, small, noncleaved B-cell lymphoma
7) Starry-sky - presence of benign macrophges within the tumor
8) Chemo + cyclophosphamide
9) Recur + die of the disease

Front 13

Metastatic tumors to the jaws

1) Symptoms?
2) What metastasizes most?
3) Radiographically?

Back 13

1) Pain, swelling, loosening of teeth, presence of mass, paresthesia
2) Breast > lung > GI
3) Radiolucent, well or ill-defined (moh eaten), sometimes mixed b/c prostate + breast osteoblastic