slide 12 +13 bone tumors 2

8/3/2019 Slide 12 +13 Bone Tumors 2

1/73

Bone Tumors 3 and 4Dr. Rima Safadi


2/73

Tumors of Bone

Source: marrow, cartilage, bone,fibrous, vascular

Benign and malignant


3/73

Benign tumors

Osteoma

Osteoblastoma

Chondroma


4/73

Osteoma

Benign slow growing tumor

Mature bone

Mandible>maxilla

Sub periosteal or central

Usually solitary

D/D: dense bone island (centralosteoma), exostosis (subperiostealosteoma) Osteoma: persistent and slowly growing

Radiographically: well defined


5/73


6/73

Histology: compact (few marrowspaces) or cancellous


7/73

Osteoma

Multiple osteomas of the jaws inGardner syndrome

AD

Polyposis coli marked tendency formalignant change

Fibrous tumors Sebacous cysts of the skin

Multiple impacted and supernumeraryteeth


8/73


9/73


10/73

Osteoblastoma

Histologically andradiographicallyresembling

cementoblastoma However: not

related to the rootsof teeth


11/73


12/73

Cementoblastoma


13/73

Osteosarcoma

Most common primary malignanttumor in jaws

Age of onset around 30

May be central, or in relation toperiosteum

Juxtacortical have better prognosis thanintramedullary


14/73

Osteosarcoma

Presenting signs and symptoms

Swelling

Pain, toothache

Loose or displaced teeth

Bleeding

Paresthesia

Increased incidence in Pagetsdisease


15/73


16/73

Osteosarcoma

Radiographic Features

Radiolucent, radiopaque, or mixed

Margins are poorly defined


17/73

Osteosarcoma


18/73

Sun-ray appearance:

Present in only 25% of cases andnot unique to osteosarcoma.


19/73

Osteosarcoma


20/73

Early feature: localizedsymmetrical widening ofperiodontal ligament space


21/73

Osteosarcoma

Microscopic: abnormal osteoblastsand bone

Treatment and Prognosis

Radical surgery, radiation therapy,chemotherapy

Mandibular lesions have better

prognosis


22/73


23/73


24/73

Chondrosarcoma

Clinical Features

Chondrosarcoma is more common thanchondroma

slower growth rate than other sarcomas ofbone

Maxilla (anterior part)>mandible (posteriorpart, condylar process)

Radiographic Features Radiolucent, radiopaque or mixed

Poorly defined


25/73

Chondrosarcoma

Microscopic Features

Abnormal chondroblasts and cartilage

May be difficult to distinguish from

chondroma

Treatment and Prognosis

Radical surgery

Better prognosis for mandibular lesionsthan maxillary

Chondroma


26/73

Chondromabenign tumor, form mature

cartilage

Chondrosarcoma


27/73

Chondrosarcomahigh cellularity, plump cells,

binucleation


28/73

Questions/Comments??


29/73

Multiple Myeloma

Malignant neoplasm of plasma cells

Solitary: plasmacytoma

Jaw lesions in both


30/73

Multiple Myeloma

Monoclonal proliferation ofplasma cells

Production of large amounts ofsingle type of Ig

Most commonly IgG

Increased level in serum: paraprotein or M protein


31/73


32/73


33/73

Multiple Myeloma

Clinical picture:

50-70 year

Skull, vertebrae, sternum, ribs andpelvic most commonly affected


34/73

Multiple Myeloma

Diagnosis Electrophoreses

Bence Johns proteins: light chains in50% of patients identified in urine

Hypercalcimia

Amyloidosis

Treatment: chemotherapy


35/73

Multiple Myeloma

Radiographic features:

Sharply demarcated, punched outradiolucent lesions


36/73


37/73


38/73


39/73

M spike


40/73

Multiple Myeloma

Microscopic features:

Sheets of malignant plasma cells

Binucleation or multinucleation


41/73


42/73


43/73



44/73

Langerhans Cell Histiocytosis

Langerhans cells: epidermis, lymphnodes, mucosa, bone marrow

APC

Proliferation of Langerhans cellsaccompanied by: eosinophils, plasmacells and multinucleated giant cells

Monoclonal..neoplastic


45/73

Langerhans cell histiocytosis

3 clinical forms:

1. Solitary eosinophilic granuloma ofbone

2. Multifocal: bone and other organs

Craniofacial, orbit, posterior pituitarygland: Hand Schuller Christian

syndrome (triad) Skull defects, exophthalmus and diabetes

insipidus


46/73


3. Disseminated histiocytosis, boneskin and viscera (chronic and acute)

Letterer Siewe disease

Fatal, < 2yrs of age


47/73

Langerhans Cell histiocytosis

Unifocal and multifocal

Skull and jaws

female

Mandible>maxilla


48/73

Langerhans Cell histiocytosis

Clinically: loosening of teeth, gingivalulceration, or enlargement

May simulate a periapical lesion

Radiographically: floating in air.


49/73


50/73


51/73


Histopathologically:

Large, pale staining cells resemblehistiocytes, round indented nuclei

Variable number of eosinophils

Electron microscope: Birbek granules

Immunohistochemistry: surface Ag:CD1-a


52/73


53/73

Birbek granules


54/73

Langerhans Cell Histiocytosis

Treatment:

Curettage

Radiotherapy

Intralesional injection with steroid?


55/73



56/73

Hemangioma of Bone

Multilocular radiolucency

Aspiration: fresh blood

Biopsy: cavernous type


57/73

Hemangioma


58/73

Hemangioma


59/73

Central hemangioma


60/73

Ossifying Fibroma


61/73

Ossifying Fibroma(cemento-ossifying fibroma)

Benign neoplasm, true neoplasm

Fibrous tissue, bone, roundedcalcified bodies

Demarcated with occasionalencapsulation

Ossifying Fibroma


62/73

Ossifying Fibroma

Clinically:

Swelling, enlarging

Mandible

Sinonasal complex and orbit

Female more?

Radiographically: RL, RL and RO,


63/73

Ossifying Fibroma


64/73

Ossifying Fibroma

Histopathology:

Fibrous tissue, well demarcated,trabeculae of bone, osteoblastic rimming

Acellular calcified material (resemblingcementum)

If predominant it is calledpsammomatoid variant (sand-like)

D/D: fibrous dysplasia and cemento-osseous dysplasia


65/73

Ossifying Fibroma


66/73

Ossifying Fibroma

Prognosis:

Slowly growing or rapidly growing

May be associated with hereditaryhyperparathyroidism

Juvenile ossifying fibroma

Richly cellula, mitotically active, immature wovenbone

D/D: osteosarcoma 30-60% recurrence rate


67/73


68/73


69/73

Metastatic carcinoma


70/73

Metastatic carcinoma


71/73

Metastatic disease


72/73

Mts


73/73

slide 12 +13 bone tumors 2

Documents