Path 12: Benign Non-Odontogenic Tumors Of The Jaws

Front 1

Ossifying fibroma (Cemento-ossifying fibroma):

1) What kind of neoplasm is it? What is it composed of?
2) How does this differ from cemento-osseous dysplasia?
3) Ages usually affected? Males or females?
4) Location in the jaw?
5) How do smaller lesions present? Larger symptoms?
6) Radiographic features? What do large lesions demonstrate?
7) How does the lesion compare to surrounding bone?
8) What kind of tissue does the lesion consist of?
9) Tx?

Back 1

1) Well-demarcated and occasionally encapsulated neoplasm, fibrous tissue w/ bone and cementum
2) COD won't cause expansion of the jaw, COF will
3) 20-40 y/o, FEMALES (5:1 ratio)
4) Premolar-molar, mandible
5) Smaller lesions asymptomatic, detected on routine radiography. Larger tumors - bone swelling or expansion (96%)
6) Well-defined, unilocular, most mixed radiolucent/radiopaque, large lesions demonstrate "downward bowing" of inferior cortex of the mandible
7) Well-demarcated, easily separating from surrounding normal bone
8) Cellular fibrous CT with cementum/bony calcifications
9) Complete enucleation (because it's circumscribed, easy) or conservative surgical excision. Prognosis good.

Front 2

Fibrous dysplasia:

1) What kind of lesion is it?
2) Monostotic or polystotic? What parts commonly involved in all 3 forms?
3) Etiology?
4) Ages?

Back 2

1) Developmental tumor-like lesion
2) Monostotic (single bone) in 85% of cases. Skull and jaws commonly involved in all 3 forms
3) Sporadic mutation in GNAS 1
4) 10-20 y/o

Front 3

Monostotic Fibrous Dysplasia:

1) Most common symptoms?
2) Borders?
3) What's more commonly affected, maxilla or mandible?
4) If it's in the lesion, what is it called? What kind of bones does it involve?
5) Histologically, what differentiates it from other fibroosseous conditions?
6) What does it look like radiographically?

Back 3

1) Painless swelling
2) Poorly defined, margins blend in imperceptibly into adjacent bone
3) Maxilla
4) Craniofacial fibrous dyplasia - involves adjacent bones like zygoma, sphenoid, occiput
5) See osteoid like areas but do not see cementum/osteoblastic rimming. Otherwise, histology not specific
6) Ground-glass

Front 4

Florid cemento-osseous dysplasia:

1) Formerly known as?
2) Who does it normally affect?
3) How does it present symmetry-wise? Unilateral or bilateral?
4) How does it present radiographically?
5) What should be AVOIDED in these pts?
6) Histologically, how does it look?

Back 4

1) Sclerosing osteomyelitis
2) Adult BLACK females
3) Bilateral, symmetrical
4) Highly radiopaque and lobular "cotton-wool" opacity
5) Biopsy and extractions!
6) "Ginger-root" trabeculation, "acellular cementum", "woven bone", "lamellar bone" "gritty/sandy/bony" chunks

Front 5

Cemento-osseous dysplasias:

1) Where is affected?
2) Most common _____
3) 3 groups?

Back 5

1) Tooth-bearing areas of jaws
2) Most common type of fibro-osseous lesions
3) Periapical, focal, florid

Front 6

Periapical cemental dysplasia:

1) Predominantly affects what area of the mouth?
2) Single or multiple lesions?
3) Who is usually affected?
4) Associated teeth are usually in what condition?
5) Symptomatic or asymptomatic?
6) How does it look radiographically as it matures?
7) Does it require tx?

Back 6

1) Lower anterior PA region
2) Multiple
3) 30-50 y/o BLACK FEMALES
4) VITAL, seldom restored
5) Asymptomatic - discovered on routine x-ray
6) Matures over time, leading to mixed lucent/opaque appearance
7) No

Front 7

Focal Cemento-osseous dysplasia:

1) How does it compare to PA and florid CODs?
2) Most common?
3) Who is most commonly affected?
4) Predominant site?
5) Symptoms?
6) X-ray features?
7) Biopsy? Progression?
8) How does it differ from a cementoblastoma radiographically?

Back 7

1) In the middle between
2) Fibro-osseous lesion
3) 40-50 y/o white females
4) Posterior mandible
5) Asymptomatic, detected on routine x-ray
6) Completely lucent => densely opaque, mixed
7) Often partially removed at biopsy, shows little or no tendency for progression
8) This has a good demarcation from the the tooth root. In a cementoblastoma, it will be a completely fused root

Front 8

Central giant cell granuloma:

1) Benign or neoplastic?
2) Age? Gender?
3) Most cases occur where in the mouth? How do they behave?
4) Unilocular or multilocular?
5) T or F: multilocular can't be radiographically distinguished from ameloblastomas or OKCs
6) Histology? What does it closely resemble?
7) Tx and prognosis? Recurrence rates?

Back 8

1) Most common non-neoplastic but larger lesions have aggressive behavior
2) Most in females under 30 y/o
3) Anterior mandible, crosses midline
4) Both
5) T
6) Multinucleated giant cells in spindle shaped mesenchymal background - giant cells probably osteoclasts . Closely resembles cherubism or brown tumor of hyperparathyroidism
7) Aggressive curettage and removal of associated teeth, inject steroids or salmon calcitonon. 11-50%

Front 9

Langerhans cell disease:

1) Also known as?
2) Group of disorders that show what?
3) How many?
4) What are the chronic and acute forms called?
5) >50% are in pts under the age of?
6) Frequent sites affected?
7) What happens in the jaw?
8) Tx?
9) T or F: the acute disseminated form is fatal
10) What does it resemble?
11) D/Ds?

Back 9

1) Histiocytosis X - eosinophilic granuloma
2) Proliferation of histiocyte-like cells with varying numbers of eosinophils
3) Solitary or multiple - eosinophilic granuloma of bone
4) Chronic - Hand-Schuller-Christian disease. Acute - Letterer-Siwe disease
5) 10
6) Skull, ribs, vertebrae, mandible (10%)
7) Alveolar bone affected, bone loss and loosening of teeth, ***"floating in air"*** appearance
8) Curettage, low doses of radiation
9) T
10) Aggressive periodontal disease
11) Severe perio disease, osteosarcoma, myeloma, lymphoma, metastatic disease