Oral Pathology Final Diseases Of Bone

Front 1

This patient has a long history of anemia, infections and some neurological deficits. The panorex shows a generalized radiopacity. Which of the following is the most likely which of the following?
a) Osteopetrosis
b) Osteoporosis
c) Paget disease
d) Osteomalacia
e) Fibrous dysplasia

Back 1

Osteopetrosis

Front 2

Which of the following is the most likely diagnosis of the peripheral radiopacity observed at the apex of this non-vital tooth?
a) Idiopathic osteosclerosis
b) Focal sclerosing osteomyelitis
c) Cementoblastoma
d) Focal cemento-osseous dysplasia
e) Hypercementosis

Back 2

Cementoblastoma

Front 3

This 53 year old black female was a new patient admit. Her health was described as very good and the generalized radiopacity of the jaws did not cause jaw expansion and was entirely asymptomatic. Which of the following is the most likely diagnosis of her condition?
a) Osteopetrosis
b) Florid cemento osseous dysplasia
c) Chronic osteomyelitis
d) Osteoblastic osteosarcoma
e) Multiple complex odontomas

Back 3

Osteopetrosis

Front 4

This asymptomatic radiolucency is most likely which of the following?
a) Traumatic bone cyst
b) Static bone cyst (Stafne)
c) Aneurysmal bone cyst
d) Residual cyst
e) Primordial cyst

Back 4

Static bone cyst (Stafne)

Front 5

The patient in this case was a 64 year old male, whose chief complaint was bone pain. This brief history coupled with the radiographic appearance of his skull film suggests which of the following disease entities should head the list of differential diagnoses?
a) Langerhans cell disease
b) Paget disease
c) Osteosarcoma of the skull
d) Either multiple myeloma or metastatic carcinoma
e) Osteomalacia

Back 5

Either multiple myeloma or metastatic carcinoma

Front 6

This projection shows three examples of multiple socket sclerosis. This condition has been associated with which of the following?
a) Paget disease
b) Renal disease
c) Cleidocranial dysplasia
d) Gardner syndrome
e) McCune-Albright syndrome

Back 6

Paget disease

Front 7

Which of the following is the most common Primary Malignant tumor of bone in patients less than 40 years of age?
a) Melanoma
b) Chondrosarcoma
c) Osteosarcoma
d) Osteoma
e) Squamous cell carcinoma

Back 7

Osteosarcoma

Front 8

Which of the following is a common component of McCune Albright syndrome?
a) Polyostotic fibrous dysplasia
b) Multiple basal cell carcinomas
c) Multiple oral papillomas
d) Multiple odontogenic keratocysts
e) Adenocarcinomas of the colon

Back 8

Polyostotic fibrous dysplasia

Front 9

Which of the following is true of focal cemento osseous dysplasia?
a) It is commonly associated with vital teeth
b) It occurs most commonly in females
c) It is more common in Whites than Blacks
d) All of the above
e) A & C

Back 9

All of the above

Front 10

What are the symptoms of Osteogenesis Imperfecta?

Back 10

1. Osteopenia - decrease in amount of bone mass
2. Bone Fragility - fractures
3. Blue sclera - collagen in eyes is thin so vitreous humor shows
4. Dentinogenesis imperfecta
5. Hypoacusis (hearing loss)
6. Long bone and spine deformity
7. Joint hyperextensibility
8. Maxillary HypOplasia w/class III maloclussion
9. Radiographic lesions similar to osseous dysplasia
10.Long bone & spine deformity
11. Joint hyperextensibility

Front 11

What is the most common type of heritable bone disease?

Back 11

Osteogenesis imperfecta

Front 12

What is a heterogeneous group of heritable disorders characterized by impairment of Collagen Maturation?

Back 12

Osteogenesis Imperfecta
- Collagen is the matrix into which ossification occurs. So, where there is a problem in collagen, it leads to defective bone maturation. Mutation of COL1A1 or COL1A2

Front 13

What is a group of Rare hereditary skeletal defects of Increased Bone Density resulting from defective remodeling due to failure in osteoclast function?

Back 13

Osteopetrosis (Albers-Schonberg Disease, Marble Bone)

Front 14

What is this mechanism for?
Bone forms, but doesn't remodel. This is a problem because the bone marrow space becomes obliterated. These patients develop severe anemia, thrombocytopenia and leukopenia, because of the lack of marrow.
Endochondral, Endosteal, and Periosteal growth without concomitant Resorption results in thickening of bone.
There is bone growth but NO Remodeling.

Back 14

Osteopetrosis (Albers-Schonberg Disease, Marble Bone)

Front 15

What are two forms of Osteopetrosis?

Back 15

Infantile (Malignant form)
Adult (Benign form)

Front 16

What hereditary disease is the result of mutated CBFA1 gene (6p21), resulting in osteoblastic differentiation and bone formation?

Back 16

Cleidocranial Dysplasia
(named for the malformed clavicle & skull)

Front 17

What are the characteristics of Cleidocranial Dysplasia?

Back 17

Short stature, Large head with frontal & parietal bossing, hypertelorism (wide set eyes). depressed nasal bridge
Narrow, High arched palate
Supernumerary teeth
Unerupted permanent teeth

Front 18

What rare development condition do you see a progressive change in the jaws. You see gradual expansion of Max&Mand, in which there are multinucleated giant cells that look just like Central Giant Cell Granuloma and Hyperparathyroidism. It occurs most often in All Four Posterior Quadrants Simultaneously. Unlike CGCG it runs a clinical course until puberty, then is stable. Bilateral Symmetric Multilocular Expansion.

Back 18

Cherubism

Front 19

What are the dental implications of Cherubism?

Back 19

Involved bone produces widening & distortion of Alveolar Ridge
Tooth displacement
Altered eruption
Impaired mastication & speech difficulties

Front 20

What is a rare inherited disorder within the spectrum of familiar colorectal polyposis that produces Osteomas, Supernumerary teeth, & Adenomatous colonic polyps > colon cancer?

Back 20

Gardner Syndrome

Front 21

What happens to patients with Gardner syndrome who do not have their polyps removed?

Back 21

50-50 chance of developing colon cancer by age 30

Front 22

What are the symptoms of Gardner Syndrome?

Back 22

Osteomas of any bone, skull, paranasal sinuses and mandible common
Supernumerary teeth in 20%
Adenomatous colonic polyps > colon cancer
Epidermoid cysts of the skin (these are benign but common cystic lesions of the skin)
Desmoid tumor of skin (these are benign fibrous tumors)
Pigmented lesions of ocular fundus
100x increase in thyroid cancer in females

Front 23

How is Gardner Syndrome Treated?

Back 23

Colonectomy
Elective prophylactic thyroidectomy
Elective removal of osteomas
Cysts & other tumors

Front 24

What are 5 Inherited Bone Diseases?

Back 24

Cherubism
Osteopetrosis
Gardner's syndrome
Osteogenesis imperfecta
Cleidocranial dysplasia

Front 25

What are the features of Metastatic Tumors to the Jaws?

Back 25

1.Jaws are an uncommon site for metastasis
2. 80% of cases are in Mandible
3. Pain, loosening of tooth, a mass or paresthesia (Numb-Chin Syndrome)
4. Radiolucent either well-defined or moth-eaten
5. Stage IV cancer (Not oral) of whatever primary cancer
6. Adults: breast, lung, colon, prostate, kidney, thyroid, testis
7. Children: Adrenal Neuroblastoma, embronal rhabdomyosarcoma, Wilms' tumor

Front 26

T/F
Aneurysmal Bone Cyst is a True Cyst

Back 26

False, no epithelial lining

Front 27

What is a non-neoplastic lesion that may result from Trauma, vascular malformation or associated neoplasm that disrupts the normal hemodynamics of bone?

Back 27

Aneurysmal Bone Cyst

Front 28

What are the important features to remember about Aneurysmal Bone Cyst?

Back 28

Microscopically, we find some Sinusoidal Spaces
Shaft of long bones
Unilocular or Multilocular radiolucency with cortical expansion
Ballooning "vlow-out" distension of bone contour
Radiopaque trabeculae
At surgery lesion is described as Blood-Soaked Sponge
20% of jaw lesions associated w/CGCG

Front 29

Where do Central Giant Cell Granulomas occur most frequently?

Back 29

70% in Anterior 2/3 Mandible

Front 30

What Lesion has the following features?
Non-neoplastic lesion of the jaws
<30 year old Females
Asymptomatic
Radiographically lesions are 5cm-10cm (Huge)
Unilocular or Multilocular
Histopathologically consist of multinucleated giant cells in a stroma of spindle shaped fibroblasts and small vessel that hemorrhage and leak blood.
Rule out other causes for giant cell lesions

Back 30

Central Giant Cell Granuloma
Indistinguishable from Hyperparathyroidism, Cherubism, & Aneurysmal bone cyst

Front 31

What is the Most common Primary malignancy of bone (non-hematopoietic)?

Back 31

Osteosarcoma
(primary meaning originating from bone as a tissue)

Front 32

T/F
If a person has breast cancer or colon cancer and it metastasizes to bone, it is still breast cancer or colon cancer. It is NOT bone cancer

Back 32

True

Front 33

What accounts for 6-8% of all osteosarcomas, have a mean age of 33, swlling & pain, loosening of teeth, paresthesia & nasal obstruction, spiking of roots, WIDENING of PDL (common), osteophytic reaction.

Back 33

Osteosarcoma of Jaws
Widening of PDL can also occur in trauma, periodontitis, or systemic sclerosis

Front 34

What ages are most commonly affected by osteosarcoma?

Back 34

10-20 Located in distal femur or proximal tibia (around the knee)
Secondary group >50 associated w/Paget's disease located in axial skeleton
33 Osteosarcoma of the Jaws

Front 35

What are the subvarieties of Osteosarcoma?

Back 35

Chondroblastic Osteosarcoma
Osteoblastic Osteosarcoma
Giant Cell Osteosarcoma

Front 36

What type of osteosarcoma is involved in producing cartilage in their array of microscopic features?

Back 36

Chondroblastic osteosarcoma

Front 37

What type of osteosarcoma primarily produce osteoid?

Back 37

Osteoblastic osteosarcomas

Front 38

What type of osteosarcoma are tumors of osteoclasts?

Back 38

Giant Cell osteosarcomas

Front 39

What is the treatment for osteosarcoma?

Back 39

Take an aggressive approach. Can metastasis to regional nodes, lung, and brain (> for long bones than jaw)

Front 40

What primary malignancy of bone of uncertain histogenesis with recent evidence of neuroendocrine origin, reciprocal translocation t(11;22) (q24;q12)?

Back 40

Ewing's Sarcoma

Front 41

Who is most affected by Ewing's Sarcoma?

Back 41

<20 years old
males slightly>females
Rare in blacks

Front 42

What kind of primary malignancy of bone has Onion skin periosteal reaction of long bones?

Back 42

Ewing's Sarcoma
concentric layers of bone on the cortex

Front 43

What is a malignant neoplasm of bone characterized by the formation of cartilage?

Back 43

Chondrosarcoma

Front 44

What are Benign tumors of mature compact or cancellous bone that are restricted to the craniofacial skeleton?

Back 44

Osteomas

Front 45

What are two subcategories of osteomas?

Back 45

Periosteal lesions
Endosteal lesions

Front 46

What is a benign neoplasm of hyaline cartilage?

Back 46

Chondroma

Front 47

T/F
Chondromas are Uncommon in the jaw

Back 47

True
Because this is so rare in the jaws a diagnosis of chondroma should always be regarded by the clinician as a mistaken diagnosis. Microscopic distinction from low-grade chondrosarcomas are difficult, therefore possible misdiagnosis.

Front 48

What is a benign, empty or fluid-filled cavity within bone devoid of epithelial lining?

Back 48

Simple bone cyst (IDIOPATHIC BONE CAVITY, traumatic bone cyst, hemorrhagic bone cyst, solitary bone cyst)

Front 49

Who is affected by Simple bone cyst/idiopathic bone cavity?

Back 49

10-20 year olds
Mandible
Males (prone to trauma)

Front 50

What are the manifestations of simple bone cyst/idiopathic bone cavity?

Back 50

Well delineated radiolucency, usually in PM-M region of mandible, often Scalloped upward between the roots of teeth
Associated w/cementoosseous dysplasia

Front 51

Who is affected by paget's disease?

Back 51

>40 years old
Males
Whites
Maxilla > Mand

Front 52

How does Paget's disease manifest?

Back 52

Idiopathic disorder of abnormal anarchic resorption & deposition of bone (abnormal remodeling)
Polyostotic (multiple bones affected)
Maxilla 17%
Progressive alveolar ridge expansion, spacing of teeth, dental appliances that no longer fit the mouth.
Altered trabecular pattern initially from decreased bone density evolves to Patchy sclerotic areas having a Cotton Wool radiographic appearance

Front 53

T/F
Paget's disease Increases the risk of Osteosarcoma and giant cell tumors of the bone

Back 53

True
Slightly 1%

Front 54

What bone condition presents microscopically as alternating resorption and formation of bone producing MOSAIC pattern and marrow replaced by highly vascular fibrous connective tissue**test question

Back 54

Paget's Disease

Front 55

In Paget's disease when is serum alkaline phosphatase treated?

Back 55

If elevated more than 25-50%

Front 56

What is used to treat Paget's disease?

Back 56

Calcitonin and Bisphosphates (things that will slow down the abnormal remodeling)

Front 57

What condition should be suspected if a tooth is extracted and instead of the extraction site filling in within new bone, it fills in with bone marrow, which could be either hematopoietic marrow or fatty marrow?

Back 57

Focal Osteoporotic Marrow Defect

Front 58

Who & what location is affected by Focal Osteoporotic Marrow Defect?

Back 58

Females
<50
Posterior Mandible

Front 59

What is the problem with Focal Osteoporotic Marrow Defect?

Back 59

No problem other than a Persistent Radiolucency of mandibular X-rays

Front 60

What is a Focal area of increased RadioDensity of unknown cause?

Back 60

Idiopathic Osteosclerosis
common 5% of population
20 years old
Mandible

Front 61

T/F
Giant Cell Tumors (not CGCG) are considered a True Neoplasm usually found in long bones (Not in jaw). Histologically indistinguishable from CGCG. Has a higher recurrence rate and 10% rate of matastasize (this is Not how CGCGs behave)

Back 61

True

Front 62

T/F
Fibrous dysplasia and Cemento-osseous dysplasia look similar under the microscope but do NOT behave in the same clinical manner

Back 62

True

Front 63

Is Fibrous dysplasia a polyostotic disease or a monostotic disease?

Back 63

Both
Early embryonic mutation produces polyostotic disease (This is the more serious form; McCune Albright syndrome is associated with this form)
Postnatal mutation is a monostotic disease (most common form, Maxilla, radiographic ground glass, narrow PDL w/indistinct lamina dura, IA nerve canal displaced superiorly & can appear larger than usual)

Front 64

What condition histopathologically consists of trabeculae of woven bone in a cellular, fibrous stroma (Chinese characters)

Back 64

Fibrous Dysplasia

Front 65

What condition has a mutation in the GNAS 1 gene?

Back 65

Fibrous dysplasia

Front 66

What condition specifically is most common variation, Max>mand, radiographic ground-glass apearance, PDL narrow & lamina dura indistinct, IA nerver displaced superiorly and can appear larger than normal?

Back 66

Fibrous Dysplasia Postnatal mutation: Monostotic Disease

Front 67

What is the prognosis for fibrous dysplasia?

Back 67

Good
It will run its course for many years then stabilize
25-50% regrowth after shave down

Front 68

What is a Non-neoplastic fibro-osseous alteration of bone in the tooth bearing areas of the jaws. (these do not occur in other bones)

Back 68

Cemento-osseous dysplasia

Front 69

What does the cellular components of cemento-osseous dysplasia contain?

Back 69

Cellular connective tissue containing a mixture of woven bone, lamellar bone and cementum-like particles; ratio of fibrous tissue decreases over time as it becomes slerotic by fusion of calcified elements

Front 70

What are 3 distinct radiographic/clinical patterns that share a common histopathologic appearance in Cemento-osseous dysplasia?

Back 70

Focal cemento-osseous dysplasia - Young to middle aged WHITE Females, Solitary radiolucent to radiopaque lesion, Post Mand, near root of tooth

Periapical cemento-osseous dysplasia - Black Females, Anterior Mand, Multifocal,periapical to Vital teeth, Must Pulp Test (can look like periapical granuloma or cyst)

Florid cemento-osseous dysplasia - Middle aged to Older Black Females

Front 71

What type of cemento-osseous dysplasia occurs most frequently in White Females, Posterior Mandible, Near root of the tooth?

Back 71

Focal cemento-osseous dysplasia

Front 72

What type of cemento-osseous dysplasia occurs most frequently in Black Females 30-50 years old, Anterior Mandible, Multifocal?

Back 72

Periapical cemento-osseous dysplasia

Front 73

What type of cemento-osseous dysplasia occurs most frequently in Middle aged to Older Black Females?

Back 73

Florid cemento-osseous dysplasia

Front 74

How do you treat Periapical cemento-osseous dysplasia?

Back 74

No Tx needed tooth is perfectly sound

Front 75

Which form of cemento-osseous dysplasia requires pulp testing to distinguish it from a periapical granuloma or cyst?

Back 75

Periapical cemento-osseous dysplasia, these are found on vital teeth

Front 76

What type of cemento-osseous dysplasia is a solitary radiolucent to radiopaque lesio, less than 1.5 cm that may appear opaque with a thin radiolucent rim?

Back 76

Focal cemento-osseous dysplasia

Front 77

Which type of cemento-osseous dysplasia can be associated with osteomyelitis?

Back 77

Florid cemento-osseous dysplasia

Front 78

What is a true neoplasm of an admixture of fibrous tissue & bony trabeculae, cementum-like spherules, or both, clinically they grow in a spherical mass that keeps enlarging. Females in 30-40 age range. Most frequent site is Premolar to Molar region of Mandible?

Back 78

Ossifying Fibroma (Cemento-ossyfying fibroma)

Front 79

What type of ossyfying fibroma is in younger patients, Maxilla, and is rapid?

Back 79

Juvenile Ossifying Fibroma

Front 80

Which of the following statements is true of Gardner syndrome?
a) Gnathic osteomas may occur in the mandible
b) Dental abnormalities in Gardner syndrome often include Supernumerary Teeth
c) The major problem for patients with Gardner syndrome is the development of an adenocarcinoma of the bowel
d) All of the above
e) A&amp;C

Back 80

All of the above