Bone Tumors

Benign Bone Tumors Etiology Clinical



Ossifying Fibroma


 Adults and young adults
 Variant: juvenile ossifying
fibroma
 Younger patients,
 More aggressive

 Typical in body of mandible
 Slow growth  overlying mucosa and cortical
plate always intact
 Early sign: teeth displacement
 Microscopic: fibroblastic stroma with new bony
islands/trabeculae
 Similar to cementifying fibroma
 CCF = cementoblasts
 COF = osteoblasts with bone formation
Treatment
 Curettage/excision, recurrence not common

Radiograph
 Depends on stage, always well-circumscribed
radiolucency
 Early: radiolucent
 Late: radiopaque



Osteoma


 Idiopathic: embryologic,
traumatic or infectious
 Most common benign neoplasm of nose and sinuses
 Slow growing tumor with well-differenatied mature bone
 Facial pain, headache, infection from duct obstruction, ocular signs
 Two types: compact/cancellous
 Compact: few marrow spaces
 Cancellous: trabeculae with fatty/fibrous marrow
 Commonly associated with Gardner’s syndrome

Osteoblastoma
 Unknown
 Young adults
 Can be similar to osteoid osteoma or aggressive.
 Circumscribed opaque mass of bone and osteoblasts
 50% have pain, less intense pain, not relieved by aspirin
 Treat: surgical excision, few occurrences.
Malignant Bone Tumors
Overview: frequent symptoms: numb lips
Most common to least common: osteosarcoma > chondrosarcoma > fibrosarcoma > Ewing’s sarcoma
Malignant Bone Tumors Etiology Clinical

Osteosarcoma

Differential for jaw
osteosarcoma
 Chondrosarcoma
 Metastatic carcinoma
 Pindborg tumor
 Ossifying subperiosteal
hemangioma
 Peripheral odontogenic
fibroma
 Scleroderma
 Chronic osteomyelitis

 Unknown
 Specific gene alterations
 M>F. 35 years. Range: 10-
85
 Peak before epiphyseal
fusion (10-25
 2⁰ = later peak

Secondary osteosarcoma
 Paget’s
 Chronic osteomyelitis
 Previous radiotherapy
Classification
Radiograph
 Sclerotic: sunburst and Codman’s
triangle from periosteal elevation
 Lytic: irregular radiolucency
 Mixed
 Intraoral: symmetrical, widened PDL
around 1 or more teeth

Treatment
 Resection and neoadjuvant chemo
(preoperative)
 Adjuvant chemo (postoperative)

Cell type
 Osteoblastic,
 chondroblastic
 fibroblastic
Origin
 Conventional: medullary cavity
 Juxtacortical: periosteal surface
 Extraskeletal: soft tissue
Symptoms
 Pain, swelling, paresthesia, loose teeth, bleeding
 Long bones: proximal tibia/humerus, distal femur
 Mandible > maxilla
Prognosis
 5 year: 20-40% Mandible > maxilla
 Initial radical surgery: 80%

Ewing’s Sarcoma
Differential
 Neuroblastoma
 Reticulum cell sarcoma
 Translocation of 11 and 22
chromosomes
 Rare “round cell”
malignancy in children
 Boys, 10-20 years
 Highly lethal, from bone marrow
 Pelvis, thigh and trunk. Oral: ramus
 Earliest: intermittent pain and swelling
 Fever and leukocytosis
Differential: Ewing’s cells contain glycogen
Radiograph
 Moth-eaten radiolucency of medulla
 Erosion of cortex with expansion
 Periosteal “onion-skin” reaction

Metastatic Carcinoma
Breast > lung > kidney >
thyroid > prostate > colon
 Least likely from brain
 Mandible > maxilla
 Most common malignancy affecting skeletal bone
 Asymptomatic, usually paresthesia / anesthesia of lip and chin
 Extruded teeth (mainly molar region)
 Swelling/ jaw expansion

Multiple Myeloma
Plasma cell myeloma

 Patients > 40
 M>F 2x
 Vertebrae, ribs and skull
 Molar-ramus area
 Pain in lumbar or thoracic
 Intraoral: swelling, pain, loose teeth, paresthesia
Lab
 Hypergammaglobulinemia (IgG)
 Bence-Jones proteinuria
Radiograph
 Punched out radiolucencies
 Best viewed with lateral skull

Treatment
 Chemo and radiation
 Poor prognosis. Median survival: 2-3 years


Benign Bone tumors
1. Juvenile ossifying fibroma
(a) Benign central neoplasm common in yoiung adults
(b) Predilection for mandible
(c) Radiolucent in early stages, calcification occurs until relatively uniform radiopaque mass

Malignant Bone tumors
2. Multiple myeloma
(a) Common in patients over 50
(b) More in nasopharynx, nasal cavity and tonsils
(c) Tumors have been reported in gingiva, palate, floor of mouth and tongue
(d) Noncorticated radiolucent areas of bone destruction in jaw.
3. Ewing’s sarcoma: undifferentiated small cells  resemble mesenchymal chondrosarcoma but Ewing’s does nto have alternating areas of cartilage
(a) Moth-eaten radiolucency and erosion of cortex with expansion
(b) Onion skin periosteum
(c) 5-30 years
(d) The younger the patient, the poorer the prognosis
(e) When jaws are involved, predilection for ramus
4. Adenocarcinoma: most common type of metastatic tumor found in jaw