Non-Odontogenic Bone Tumors Overview

Non-Odontogenic Bone Tumors

Non-odontogenic bone tumors are those that do not originate from tooth structures.
Evaluating bone pathology requires age, localization, and radiographic findings.
A thorough clinical history significantly improves diagnosis accuracy.
Multidisciplinary evaluation, including a bone council, is often recommended.
Malignant tumors often exhibit hematogenous metastases (e.g., to the lung) which are often noted rather than local spread/distant metastases.
Correct diagnosis and treatment are important
For benign conditions, the most common treatment is curettage plus grafting.
Some malignant conditions can be treated by neoadjuvant CT+surgery (OS) or Ewing's Sarcoma and CT/RT therapy for lymphoma, myeloma.
Surgery alone is the treatment for low-grade conditions like OS, chondrosarcoma.

Benign Bone Tumors

Ossifying Fibroma: Slow-expanding, typically found in the jaw near teeth, affecting 30-40-year-olds. Bone matrix forms in fibrous tissue.
Fibrous Dysplasia: Fibrous tissue causes bone metaplasia, typically in the maxilla. The condition is characterized by slow expansion and deformity. Often shows up in the 10-20-year-old age group and is frequently monostotic or polyostotic, sometimes causing craniofacial fibrous dysplasia
Osteoblastoma: Rare condition; located most often in the mandible; posterior tooth area; causes pain; typically a lytic (absorbing bone) and sclerotic (hardening bone) lesion; larger than 1 cm; often includes osteoblasts (bone-forming cells) and giant cells alongside bone formation; bone formation continues in normal bone tissue.
Osteoid Osteoma: Rare condition; involves the maxilla or mandible; causes nocturnal pain; responds to aspirin; microscopic appearance is similar to osteoblastoma. It is usually less than 2 cm.
Central Giant Cell Granuloma: Common in young adults and children (females twice as frequent as males); primarily occurs in the mandible and then the maxilla; frequently located in the anterior part of the mandible near the molar teeth; painless swelling; consists of spindle cells, abundant blood vessels, and the presence of giant cells in bleeding areas.
Giant Cell Tumor: Commonly found in people aged 30-40; craniofacial is most common in the jawbones but can occur in any bone; presents as a lytic, expandable mass; mononuclear cells are found along with large numbers of giant cells with multiple nuclei.
Aneurysmal Bone Cyst: Generally occurs in young adults <30 and often affects females more than males. A primary or secondary condition; frequently secondary to fibrous dysplasia, osteoblastoma, giant cell tumor, or osteosarcoma; mainly found in the mandible, then in the maxilla. It mostly consists of blood-filled cavities resembling a sponge that has absorbed blood, reparative tissue, and reactive bone around it.
Hemangioma: Mostly found in the posterior mandible; the female-to-male ratio is 2:1; the condition causes expansion and/or deformity and hemorrhage; it presents as a variable lytic lesion, usually cavernous or capillary in nature.
Langerhans Cell Histiocytosis: Affects children and young adults. It is localized, multifocal, or disseminated. Affects any bone. Pain, swelling and fever can occur. It includes eosinophils, typical histiocyte-like cells, and sometimes multinuclear giant cells.
Osteoma: Typically seen in people aged 20-50; frequently occurs in the sinuses of any bone; is represented by compact sclerotic bone and density; may consist of mature or young bone; contains cortical, trabecular, or mixed types of bone.
Chondroma: Usually seen in adults and is rare in the jaw. It can be located inside the nasal septum, ethmoid sinus, maxilla, or mandible and includes mature hyaline cartilage; diagnosis can be challenging due to similarities with chondrosarcoma, and thorough surgical margins are needed.
Torus and Exostosis: Nodular protrusions from the bone surface. Hereditary and affects 16-25% of the U.S. population. Consist of torus palatinus, torus mandibularis, and exostosis (a protrusion in the part of the alveolar bone); the bone is mature cortical and trabecular.

Malignant Bone Tumors

Osteosarcoma: 5% of all osteosarcomas occur in the jaw. It can be preceded by conditions like Paget's disease, osteomyelitis, fibrous dysplasia, giant cell tumors, or bone infarction. Common in the mandible with a higher occurrence in males. Often appears around the age of 34, though the maxilla occurrence is similar to the mandible. A mixture of surface osteosarcoma, parosteal, and periosteal forms occur. Forms osteoid matrix; could also be chondroblastic, fibroblastic, aneurysmal, or small cell.
Chondrosarcoma: Very rare in the jaw, predominantly found in the maxillofacial region's anterior and palate regions, affects adults and older ages; Cartilage tissue with an increasing level of cellularity, compared to grade I normal cartilage-like chondroma, is noted. Trapped bone and infiltration are common characteristics.
Ewing's Sarcoma: Affects children and young adults, particularly affecting long and flat bones. Commonly found in the mandibular ramus. Characterized by a very aggressive, large soft tissue mass; it can metastasize to other bones; radiologically can be confused with osteomyelitis; the tissue shows uniform round cells.
Burkitt's Lymphoma: Primarily affects children, especially those under three years old, involving the head and neck lymphoid tissues, especially in the jawbones. A malignant B-lymphocyte neoplasia, it aggressively grows and often creates problems with the airway and circulation.
Plasma Cell Neoplasms: Typically diagnosed after 50, with an average age of 63. It includes multiple myeloma and plasmacytoma; it causes pain, dental issues, and rarely presents as a prominent mass; 10% show amyloidosis; includes lytic lesions, like a punchhole. Mature plasma cells, monoclonal.
Metastatic Tumors: Rare from epithelial tumors to the maxilla and mandible. More commonly originates from tumors such as breast, kidney, lung, colon, prostate, and thyroid.