Oral Pathology Case Study

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Questions and Answers

What is the most prevalent odontogenic tumor?

Adenomatoid Odontogenic Tumor

Ameloblastoma (correct)

Calcifying Epithelial Odontogenic Tumor

Odontoma

At what age are ameloblastomas most commonly seen?

Children and teenagers

Patients between 20 and 50 years of age (correct)

Patients under 10 years of age

Patients over 60 years of age

What is the characteristic of ameloblastoma?

Painless and asymptomatic (correct)

Bone loss and fracture

Painful and tender to touch

Fever and swelling

What is the most common location of ameloblastoma?

Mandibular molar region Signup and view all the answers

What is the type of ameloblastoma that tends to occur during teenage years?

Unicystic variant of ameloblastoma Signup and view all the answers

What is the most likely diagnosis for the 33-year-old woman with a swelling on palate for 2 months?

Calcified epithelial odontogenic tumor Signup and view all the answers

What is the name of the term introduced by Paul Broca in 1867 to describe odontogenic tumors of mixed tissue origin?

Mixed tumors odontoma Signup and view all the answers

What is the characteristic radiographic feature of calcified epithelial odontogenic tumors?

Multilocular cystic lesion with radiopaque flecks Signup and view all the answers

What is the difference between compound and complex odontoma?

Compound odontoma has multiple small radiopaque masses, while complex odontoma has a single large mass Signup and view all the answers

What is the likely association of about 50% of the cases of calcified epithelial odontogenic tumors?

Unerupted teeth Signup and view all the answers

What is the characteristic radiographic feature of osteosarcoma?

Ill-defined borders with no peripheral sclerosis Signup and view all the answers

Which of the following is a clinical feature of ulcer-proliferative growth?

Variable pain with secondary infection Signup and view all the answers

What is the characteristic difference between benign and malignant lesions on radiographs?

Benign lesions have well-corticated borders, while malignant lesions have ill-defined borders Signup and view all the answers

Which of the following is a characteristic of osteoid production in osteosarcoma?

Osteoid is produced directly by the malignant stroma Signup and view all the answers

What is the association of osteosarcoma with Paget's disease?

Paget's disease is a risk factor for developing osteosarcoma Signup and view all the answers

What is the most common radiographic feature of an ameloblastoma?

Multilocular radiolucency with septae Signup and view all the answers

What is the typical age group affected by an ameloblastoma?

Around 40 years Signup and view all the answers

What is the characteristic clinical feature of an ameloblastoma?

Facial asymmetry due to gradual jaw expansion Signup and view all the answers

What is the most likely diagnosis for a 37-year-old man with a swelling on the right body of the mandible and a multilocular radiolucency on a panoramic radiograph?

Ameloblastoma Signup and view all the answers

What is the name of the rare lesion that affects the same age group as an ameloblastoma, with a predilection for the mandible?

Calcifying epithelial odontogenic tumor Signup and view all the answers

What is the characteristic arrangement of the enamel, dentin, cementum, and pulp in a compound odontoma?

Haphazard and unorganized Signup and view all the answers

What is the typical radiographic appearance of an odontoma?

Radiopaque mass with a radiolucent line Signup and view all the answers

In which jaw segment is a complex odontoma more likely to occur?

Posterior mandible Signup and view all the answers

What is the origin of an odontogenic myxoma?

From the mesenchymal portions of the tooth bud Signup and view all the answers

What term may be used when a significant amount of collagen is evident in an odontogenic myxoma?

Myxofibroma Signup and view all the answers

What is the typical age range for the occurrence of odontogenic myxoma?

Between 10 and 30 years Signup and view all the answers

What is the characteristic radiographic appearance of odontogenic myxoma?

Radiolucent with delicate septa and a multilocular appearance Signup and view all the answers

What is the most common location of odontogenic myxoma?

Mandible, especially the body and posterior portion Signup and view all the answers

What is the clinical feature of odontogenic myxoma?

It is asymptomatic, but some patients complain of pain Signup and view all the answers

What can be associated with odontogenic myxoma?

Impacted teeth Signup and view all the answers

Where are osteomas most frequently found?

Posterior aspect of the mandible Signup and view all the answers

What is a characteristic of malignant tumors of the jaw?

Uncontrolled growth of tissue Signup and view all the answers

What is a common clinical feature of malignant tumors of the jaw?

Displaced teeth and loosening over a shorter period Signup and view all the answers

What is a radiographic feature of malignant tumors of the jaw?

Ill-defined borders Signup and view all the answers

What is the most common site for squamous cell carcinoma of the jaw?

Lateral border of the tongue Signup and view all the answers

What is a characteristic of squamous cell carcinoma of the jaw?

Malignant tumor of epithelial origin Signup and view all the answers

What is a clinical feature of malignant tumors of the jaw?

Pain and rapid swelling without obvious dental cause Signup and view all the answers

What is a radiographic feature of osteomas?

Uniform radiopacity Signup and view all the answers

What is a characteristic of osteomas?

Displace adjacent soft tissues and cause dysfunction Signup and view all the answers

What is a common location for osteomas?

Inferior border of the mandible below the molars Signup and view all the answers

What is the characteristic radiographic feature of Periapical Cemental Dysplasia in the intermediate stage?

Radiolucent with patchy opacity within the radiolucency Signup and view all the answers

What is the composition of Periapical Cemental Dysplasia?

Cementum or abnormal bone Signup and view all the answers

What is the effect of Periapical Cemental Dysplasia on adjacent teeth?

They are not displaced or resorbed Signup and view all the answers

What is the characteristic radiographic feature of Cemento-Ossifying Fibroma?

Mixed radiolucent and radiopaque density Signup and view all the answers

What is the age range for the occurrence of Juvenile Ossifying Fibroma?

First two decades of life Signup and view all the answers

What is the most common location for Cemento-Ossifying Fibroma in the mandible?

Inferior to the premolars and molars Signup and view all the answers

What is the characteristic of the borders of Cemento-Ossifying Fibroma?

Well-defined with a radiolucent line Signup and view all the answers

What is the characteristic internal structure of Cemento-Ossifying Fibroma?

Mixed radiolucent and radiopaque density Signup and view all the answers

What is the result of fibrous dysplasia in normal bone metabolism?

Replacement of cancellous bone by fibrous tissue Signup and view all the answers

What is the characteristic of fibrous dysplasia on radiographs?

Poorly defined with margins merging imperceptibly with adjacent normal bone Signup and view all the answers

What is the most common site for solitary fibrous dysplasia?

Maxilla Signup and view all the answers

What is the characteristic of cemento-osseous dysplasia?

Formation of cementum and bone in the jaws Signup and view all the answers

What is the difference between periapical cemental dysplasia and florid osseous dysplasia?

Number of teeth involved Signup and view all the answers

What is the characteristic of bone dysplasias?

Bone deformity and abnormal growth Signup and view all the answers

What is the age range for multiple bone involvement in fibrous dysplasia?

Young children < 10 years Signup and view all the answers

What is the association of fibrous dysplasia with McCune-Albright syndrome?

Multiple bone involvement Signup and view all the answers

What is the characteristic radiographic appearance of Fibrous Dysplasia?

Hazy or ground glass appearance Signup and view all the answers

What is the primary characteristic of Periapical Cemental Dysplasia?

Replacement of normal bone with fibrous tissue and cementum-like material Signup and view all the answers

Which of the following is a common effect of Fibrous Dysplasia?

Displacement of adjacent teeth Signup and view all the answers

What is the typical age range for the occurrence of Periapical Cemental Dysplasia?

Middle age Signup and view all the answers

What is the characteristic of Periapical Cemental Dysplasia in terms of tooth vitality?

The involved teeth are vital Signup and view all the answers

What is the primary difference between Periapical Cemental Dysplasia and Florid Osseous Dysplasia?

Number of teeth affected Signup and view all the answers

What is the characteristic of the lesion in Periapical Cemental Dysplasia?

A localized change in normal bone metabolism Signup and view all the answers

What is the most common presentation of Periapical Cemental Dysplasia?

An incidental finding on a radiographic examination Signup and view all the answers

What is the primary effect of Fibrous Dysplasia on the surrounding bone?

Expansion of the surrounding alveolar bone Signup and view all the answers

What is the characteristic of the radiographic appearance of Periapical Cemental Dysplasia in advanced stages?

A gradual increase in radiopacity Signup and view all the answers

What is the characteristic of fibrous dysplasia in normal bone metabolism?

Replacement of cancellous bone by fibrous tissue Signup and view all the answers

What is the primary site of involvement in polyostotic fibrous dysplasia?

Ribs Signup and view all the answers

What is the radiographic feature of fibrous dysplasia?

Poorly defined lesion with merging imperceptibly with adjacent normal bone Signup and view all the answers

What is Cherubism?

A type of bone dysplasia Signup and view all the answers

What is Paget's Disease?

A type of bone dysplasia Signup and view all the answers

What is Aneurysmal Bone Cyst?

A type of bone cyst Signup and view all the answers

What is Central Giant Cell Granuloma?

A type of bone cyst Signup and view all the answers

What is the characteristic internal structure of Cemento-Ossifying Fibroma?

A mixed radiolucent-radiopaque density with a pattern dependent on the amount of manufactured calcified material Signup and view all the answers

What is Cemento-Ossifying Fibroma?

A type of bone tumor Signup and view all the answers

What is the characteristic radiographic feature of Cemento-Ossifying Fibroma?

Mixed radiolucent-radiopaque density with a pattern dependent on the amount of manufactured calcified material Signup and view all the answers

What is the characteristic effect of Cemento-Ossifying Fibroma on adjacent teeth?

No effect on adjacent teeth Signup and view all the answers

What is the characteristic of Cherubism?

A type of fibro-osseous lesion Signup and view all the answers

What is the characteristic radiographic feature of Aneurysmal Bone Cyst?

A radiolucent lesion with a cortical boundary Signup and view all the answers

What is the characteristic of Paget's Disease?

A type of metabolic bone disorder Signup and view all the answers

What is the characteristic of Central Giant Cell Granuloma?

A type of benign bone tumor Signup and view all the answers

What is the characteristic of the borders of Cemento-Ossifying Fibroma?

Well-defined radiolucent line Signup and view all the answers

What is the initial radiodensity of fibrous dysplasia?

Radiolucent Signup and view all the answers

What is the characteristic arrangement of bone trabeculae in fibrous dysplasia?

Disorganized Signup and view all the answers

What is the effect of fibrous dysplasia on adjacent teeth?

Displacement Signup and view all the answers

What is the characteristic radiographic feature of fibrous dysplasia?

All of the above Signup and view all the answers

What is the result of fibrous dysplasia in normal bone metabolism?

Replacement of normal bone with fibrous tissue and cementum-like material Signup and view all the answers

What is the age range for the occurrence of Periapical Cemental Dysplasia?

Middle age Signup and view all the answers

What is the sex predilection of Periapical Cemental Dysplasia?

Female Signup and view all the answers

What is the characteristic of the involved teeth in Periapical Cemental Dysplasia?

Vital Signup and view all the answers

What is the radiographic feature of Periapical Cemental Dysplasia in advanced stages?

Expansion of the alveolar process Signup and view all the answers

What is the difference between Periapical Cemental Dysplasia and Florid Osseous Dysplasia?

Radiographic appearance Signup and view all the answers

What is the characteristic of Cemento-Ossifying Fibroma?

A type of fibro-osseous lesion Signup and view all the answers

What is Central Giant Cell Granuloma?

A type of fibro-osseous lesion Signup and view all the answers

What is the characteristic of Aneurysmal Bone Cyst?

A rapidly expanding blood-filled cyst Signup and view all the answers

What is Paget's Disease?

A metabolic bone disease Signup and view all the answers

What is the common characteristic of fibro-osseous lesions?

Unknown etiology Signup and view all the answers

What is the characteristic radiographic feature of fibrous dysplasia?

Poorly defined with merging imperceptibly with adjacent normal bone Signup and view all the answers

What is the characteristic radiographic feature of fibrous dysplasia?

Ground glass appearance Signup and view all the answers

What is the effect of Periapical Cemental Dysplasia on adjacent teeth?

Displacement but not resorption Signup and view all the answers

What is the characteristic of bone trabeculae in fibrous dysplasia?

Disorganized and poorly calcified Signup and view all the answers

What is the result of fibrous dysplasia in normal bone metabolism?

Replacement of normal bone with fibrous tissue Signup and view all the answers

What is the characteristic of Periapical Cemental Dysplasia?

A localized change in normal bone metabolism Signup and view all the answers

What is the characteristic of the alveolar process in Periapical Cemental Dysplasia?

Expansion of the alveolar process Signup and view all the answers

What is the characteristic shape of Periapical Cemental Dysplasia radiographically?

Round or oval Signup and view all the answers

What is the characteristic effect of Cemento-Ossifying Fibroma on the surrounding bone?

No expansion of the jaw Signup and view all the answers

What is the characteristic radiographic feature of Central Giant Cell Granuloma?

Radiolucent lesion Signup and view all the answers

What is the characteristic of Paget's Disease?

A metabolic bone disorder Signup and view all the answers

What is the characteristic age range for the occurrence of juvenile ossifying fibroma?

First two decades of life Signup and view all the answers

What is the characteristic location of Aneurysmal Bone Cyst?

No specific location Signup and view all the answers

Study Notes

Fibro-Osseous Lesions

A group of disorders that may have common characteristics, including clinical, radiographic, and microscopic features
Most are of unknown etiology, making diagnosis challenging

Classification

Bone Dysplasias:
- Fibrous dysplasia
- Cemento-osseous dysplasias
  - Periapical Cemental Dysplasia
  - Florid Osseous Dysplasia
Other Lesions of Bone:
- Cemento-Ossifying Fibroma
- Central Giant Cell Granuloma
- Aneurysmal Bone Cyst
- Cherubism
- Paget's Disease

Fibrous Dysplasia

Results from a localized change in normal bone metabolism
Replaces cancellous bone with fibrous tissue and varying amounts of abnormal bone
May be solitary (monostotic) or multiple (polyostotic)
Common sites: ribs, femur, tibia, maxilla, and mandible
Radiographic features: poorly defined margins, not corticated

Periapical Cemental Dysplasia

A common bone dysplasia that typically occurs in middle age
Occurs nine times more often in females than in males
Involved teeth are vital, with no history of pain or sensitivity
Radiographic features: radiolucent, with a round, oval, or irregular shape
Effects: adjacent teeth are not displaced or resorbed, no expansion of the jaw

Cemento-Ossifying Fibroma

A type of fibro-osseous lesion
Consists of highly cellular, fibrous tissue with varying amounts of abnormal bone or cementum-like tissue
Juvenile ossifying fibroma is a very aggressive form that occurs in the first two decades of life
Common sites: mandible, typically inferior to premolars and molars, and maxilla, in the canine fossa and zygomatic arch area
Radiographic features: well-defined borders, mixed radiolucent-radiopaque density

Odontogenic Tumors

Classification:
- Epithelial: ameloblastoma, calcifying epithelial odontogenic tumor, adenomatoid odontogenic tumor
- Mixed: odontoma, ameloblastic fibroma, ameloblastic fibro-odontoma
- Odontogenic ectomesenchyme origin: odontogenic myxoma, benign cementoblastoma, central odontogenic fibroma

Ameloblastoma

A locally aggressive, slow-growing, epithelial odontogenic neoplasm
Arises from remnants of the dental lamina, enamel organ, and cell rests of Malassez
Common sites: posterior mandible, but may also arise in the maxilla and anterior aspect of the jaws
Age: most cases occur in patients between 20 and 50 years old
Radiographic features: multilocular or unilocular radiolucency with extremely delicate septa, giving it a honeycomb appearance

Odontogenic Myxoma

A rare, locally aggressive, epithelial odontogenic neoplasm
Arises from the mesenchymal portions of the tooth bud
Common sites: posterior mandible, but may also arise in the maxilla
Age: most cases occur in patients between 10 and 30 years old
Radiographic features: multilocular radiolucency with straight septae, forming rectangular spaces (tennis racket appearance)### Fibro-Osseous Lesions
Fibro-osseous lesions are a group of disorders with common characteristics, including clinical, radiographic, and microscopic features, but most have unknown etiology.
These lesions can be challenging to diagnose and do not fit into well-defined diseases.

Bone Dysplasias

Fibrous dysplasia results from a localized change in normal bone metabolism, replacing cancellous bone with fibrous tissue and abnormal bone.
Fibrous dysplasia can be solitary (monostotic) or multiple (polyostotic), affecting different ages:
- Solitary: affects older age groups
- Multiple: affects young children (<10 years) and is associated with McCune-Albright syndrome
Most common sites affected: ribs, femur, tibia, maxilla, and mandible

Radiographic Features of Fibrous Dysplasia

Poorly defined margins, merging with adjacent normal bone
No cortication
Radiolucent with a round, oval, or irregular shape
Composed of cementum or abnormal bone
Swirling pattern of cementum-like material
Radiodensity:
- Early stage: radiolucent
- Intermediate stage: radiolucent with patchy opacity
- Late stage: densely radiopaque with a thin radiolucent line

Effects of Fibrous Dysplasia

Adjacent teeth are not displaced or resorbed
Teeth are vital, with an intact periodontal ligament space, but lamina dura may be discontinuous
No expansion of the jaw

Other Lesions of Bone

Cemento-Ossifying Fibroma

A type of fibro-osseous lesion, consisting of highly cellular, fibrous tissue with abnormal bone or cementum-like tissue
Borders are well-defined with a radiolucent line
Internal structure: mixed radiolucent-radiopaque density, depending on the amount and form of calcified material

Juvenile Ossifying Fibroma

A very aggressive form of COF, occurring in the first two decades of life
Appears almost exclusively in the facial bones, commonly in the mandible (inferior to premolars and molars) and maxilla (canine fossa and zygomatic arch area)

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Description

Identify the oral pathology condition based on the radiographic features and symptoms described. A 33-year-old woman reported to the dental clinic with a swelling on palate. What is the diagnosis?