ONCOLOGY MIDTERMS NOTES PDF

MIDTERMS: BENIGN NON-ODONTOGENIC TUMOR BENIGN NON-ODONTOGENIC TUMOR: Are seen along the oral epiphyseal region but does not arise from the dental epithelial and the mesenchymal. OSSIFYING FIBROMA ETIOLOGY: undetermined CLINICAL FEATURES A...

MIDTERMS: BENIGN NON-ODONTOGENIC TUMOR BENIGN NON-ODONTOGENIC TUMOR: Are seen along the oral epiphyseal region but does not arise from the dental epithelial and the mesenchymal. OSSIFYING FIBROMA ETIOLOGY: undetermined CLINICAL FEATURES A benign neoplasm of bone third & fourth decade of life in women slow growing, asymptomatic & expansile lesion that has the potential for most often in the mandibular premolar area excessive growth & bone VARIANTS: destruction. Juvenile (aggressive) ossifying fibroma A. occurs in children & young adults younger than 15 years of age B. causes exopthalmus, proptosis,sinusitis & nasal symptoms ○ Involves the paranasal sinuses and periorbital bones. Cemento/Psammomatoid ossifying fibroma ○ Spherical islands of bone (cementum) HISTOPATHOLOGIC FEATURES Composed of fibrous connective tissue with well differentiated spindled fibroblast; Collagen fibers RADIOGRAPHIC FEATURES well circumscribed, sharply defined border. unilocular or multilocular radiolucencies DIFFERENTIAL DIAGNOSIS: fibrous dysplasia osteoblastoma focal cementoosseous dysplasia focal osteomyelitis TREATMENT: Curettage or enucleation / excision PROGNOSIS: Recurrence is rare after removal FIBROUS DYSPLASIA CLINICAL FEATURES Slow progressive enlargement of the affected jaw usually painless & typically presents as: a unilateral swelling facial asymmetry; displacement of teeth maxilla - ribs, femur and tibia also is affected asymptomatic; self limiting a condition in which normal HISTOPATHOLOGIC FEATURES medullary bone is replaced by consist of a slight to moderate cellular fibrous connective an abnormal fibrous tissue stroma that contains foci of irregularly shaped connective tissue proliferation trabeculae of immature bone in which new, non-maturing fibroblast exhibit uniform spindle shaped nuclei bone is formed. RADIOGRAPHIC FEATURES ranges from a radiolucent lesion to a uniformly radiopaque mass radiopaque: “ground glas” / “peak d’orange” effect DIFFERENTIAL DIAGNOSIS:  ossifying fibroma chronic osteomyelitis TREATMENT: Small lesion no treatment Large lesion surgical recontouring Malignant transformation (rare) - radiation therapy Note: Minimal tooth displacement, untreated benign fibrous dysplasia will lead to a malignant counterpart OSTEOBLASTOMA CLINICAL FEATURES Lesion measuring 1.5 cm. in diameter usual sites is in the posterior tooth bearing regions of the maxilla & mandible occur during second decade before the age of 30 Nocturnal pain is common, dull pain at night likely the same to a periapical abscess. HISTOPATHOLOGIC FEATURES an uncommon primary lesion of bone that occasionally arises in the maxilla or the mandible. (tooth bearing regions of both jaw) Irregular trabeculae of osteoid and immature bone within a stroma containing a prominent vascular network RADIOGRAPHIC FEATURES Well circumscribed or spherical Thin radiolucency surrounding a variably calcified central tumor mass DIFFERENTIAL DIAGNOSIS: Cementoblastoma Ossifying fibroma Fibrous dysplasia Osteosarcoma TREATMENT: Curettage or local excision PROGNOSIS: Recurrence not common OSTEOID OSTEOMA CLINICAL FEATURES: lesion is lesser than 1.5cm in diameter occur during second decade of life pain is relieved by aspirin HISTOPATHOLOGIC FEATURES Basophilic bony trabeculae surrounded by plump represent a smaller version of hyperchromatic osteoblasts and some multinucleated giant osteoblastoma (a variant) cells RADIOGRAPHIC FEATURE Well circumscribed and has a mixed lucent-opaque pattern Common on long bones DIFFERENTIAL DIAGNOSIS: Cementoblastoma Ossifying fibroma Fibrous dysplasia Osteosarcoma TREATMENT: Curettage or local excision PROGNOSIS: Recurrence not common OSTEOMA - consist of TYPES: mature, compact, or 1. Periosteal osteoma - arise on the surface of bone, cancellous bone asymptomatic slow growing bony hard masses 2. Endosteal osteoma - develop centrally within the bone CLINICAL FEATURES: associated with GARDNER’S SYNDROME (autosomal  dominant disorder) arise in the maxilla or mandible as well as in facial & skull bones & within paranasal sinuses headaches, recurrent sinusitis & ophthalmologic complains (symptoms) HISTOPATHOLOGIC FEATURES: Two variants (a) composed of relatively dense, compact bone with sparse marrow tissue (b) consist of lamellar trabeculae of cancellous bone with abundant fibrofatty marrow RADIOGRAPHIC FEATURE Periosteal osteoma: well circumscribed radiopacities Endosteal osteoma: found mainly in the ramus of the mandible. GARDNER’S SYNDROME DIFFERENTIAL DIAGNOSIS: Exostoses TREATMENT: Surgical excision PROGNOSIS: No recurrence DESMOPLASTIC Note: FIBROMA Fibromatosis is a condition where there are fibrous overgrowths of dermal and subcutaneous connective tissue. CLINICAL FEATURES: occur in patient under the age of 30, with a mean age of 14 years locally aggressive lesion of body or ramus of the mandible is more affected than the bone that can be considered maxilla the bony counterpart of swelling of the jaw with displacement of teeth fibromatosis HISTOPATHOLOGIC FEATURES: Lesion consists of interlacing bundles & whorled aggregates of densely collagenous tissue that contains uniform spindled & elongated fibroblast (rubbery to firm tissue) DIFFERENTIAL DIAGNOSES: Odontogenic cyst Odontogenic tumor Odontogenic fibroma Fibrosarcoma TREATMENT: Surgical resection & curettage PROGNOSIS: Curettage alone with significant recurrence CHONDROMA - cartilaginous CLINICAL FEATURES tumor of unknown cause present as a painless, slowly progressive swelling arise in the nasal septum & ethmoid sinuses anterior of the maxilla are most often location mandible most often location is in the body & symphysis area appear before 50 years of age HISTOPATHOLOGIC FEATURES  consist of well defined lobules of mature hyaline cartilage chondrocytes are small & contain single; regular nuclei DIFFERENTIAL DIAGNOSIS: Chondrosarcoma TREATMENT: Surgical excision PROGNOSIS: Recurrence is unusual CENTRAL / CLINICAL FEATURES PERIPHERAL GIANT CELL before 30 years of age; females are more affected GRANULOMA - benign almost exclusively in the maxilla & mandible; more common in proliferation of fibroblast & the mandible multinucleated giant cells that lesion tend to involve the jaws anterior to the permanent teeth occurs almost exclusively produces painless expansion or swelling within the jaw RADIOGRAPHIC FEATURE consist of multilocular less commonly locular radiolucency of the bone; present as scalloped border. HISTOPATHOLOGIC FEATURES hemosiderin-laden macrophages and extravasated erythrocytes are usually evident multinucleated giant cells are present throughout connective tissue stroma. DIFFERENTIAL DIAGNOSES: ameloblastoma odontogenic myxoma odontogenic keratocyst TREATMENT: Excision or curettage GIANT CELL TUMOR CLINICAL FEATURES commonly in long bones especially in the knee joint rare in the jaw seen in third & fourth decades of life exhibit slow growth & bone expansion or sometimes they produce rapid growth, pain or paresthesia. HISTOPATHOLOGIC FEATURES Numerous multinucleated giant cells dispersed evenly among mononuclear fibroblast RADIOGRAPHIC FEATURES: Produces radiolucent image TREATMENT: Surgical excision or curettage PROGNOSIS: 30% recurrence noted after curettage HEMANGIOMA OF THE CLINICAL FEATURES BONE - rare intraosseous occur in the mandible especially in the posterior region; vascular malformation that can second decade of life mimic both odontogenic & spontaneous bleeding around the teeth nonodontogenic lesion. paresthesia or pain are evident bruits or pulsation of large lesion may be detected. HISTOPATHOLOGIC FEATURES Represents proliferation of blood vessels; Two types: (a) cavernous type - large caliber vessels (b) capillary type- small caliber vessels RADIOGRAPHIC FEATURES Multilocular radiolucency that have a characteristic of soap bubble appearance Large lesions can have the sun ray appearance of an osteosarcoma. Root resorption of adjacent teeth is common. Developing teeth may be larger and erupt earlier. When the lesion involves the inferior dental canal, the canal can be enlarged.  DIFFERENTIAL DIAGNOSES: Ameloblastoma Central giant cell granuloma aneurysmal bone cyst Odontogenic myxoma Odontogenic keratocyst Aspiration of the lesion is a important diagnostic tool TREATMENT: Surgery, radiation therapy, sclerosing agents, cryotherapy & presurgical embolization technique LANGERHANS CELL CLINICAL FEATURES DISEASE - formerly known as Clinical signs of inflammation are present. There is multiple histiocytosis X & idiopathic dental loss, attachment loss, spontaneous gingival bleeding histiocytosis; proliferation of and deep periodontal pockets. cells exhibiting phenotypic ranges from solitary or multiple bone lesion to dessiminated characteristics of langerhans visceral, skin, & bone lesion cells condition of children & young adult tenderness & pain swelling are common loosening of teeth on the affected area inflammation of gingival tissue, hyperplastic & ulcerated THREE DISORDERS: 1. Eosinophilic granuloma (chronic localized) ○ Solitary or multiple bone lesions only 2. Hand-schuller- Christian syndrome (chronic disseminated) 3. Letterer - siwe disease (acute disseminated) ○ Malignant HISTOPATHOLOGIC FEATURES tumor cells show unique rod shape cytoplasmic structure which are identical to birbeck granules oval to reniform nuclei RADIOGRAPHIC FEATURES Periapical radiographs showing well defined radiolucent images comprising alveolar bone, providing the radiographic image of "floating teeth”. exhibit solitary radiolucent lesion sharp circumscribed punched out appearance DIFFERENTIAL DIAGNOSES: Juvenile or diabetic periodontitis; Agranulocytosis Hypophosphatasia Leukemia Periapical cyst or granuloma Primary or metastatic malignant neoplasm Cyclic neutropenia Multiple myeloma TREATMENT: Localized disease: ○ Surgical or low dose therapy ○ Chemotherapeutic agents ○ Curettage Disseminated disease: ○ Immunosuppressive agents and corticosteroids PROGNOSIS: Poor prognosis Patient survival is 10 to 15 years TORI / TORUS - inherited TWO TYPES: condition Torus palatinus - sessile, nodular mass of bone that presents along the midline of the hard palate. Torus mandibularis - bony exophytic growth that present along the lingual aspect of the mandible superior to the  mylohyoid ridge CLINICAL FEATURES Torus palatinus ○ occur in females twice as often in males ○ appear during 2nd or 3rd decade of life ○ exhibit slow growth generally asymptomatic ○ formed various configuration nodular, spindled, lobular or flat HISTOPATHOLOGIC FEATURES Bilateral, Composed of hyperplastic bone consisting of mature cortical and trabecular bone. Outer surface exhibits a smooth rounded contour RADIOGRAPHIC FEATURES Large tori may be evident as diffuse radiopaque lesion TREATMENT: No treatment needed Surgical removal for prosthetic purposes PROGNOSIS: No recurrence EXOSTOSES - multiple CLINICAL FEATURES orsingle bony excrescences asymptomatic bony nodules that occur less commonly than present along the buccal aspect of the alveolar bone do tori with an unknown most often in the posterior portion of both the maxilla & the etiology mandible reported as rare occurrence following skin graft vestibuloplasty, gingival grafts, as well as beneath the pontic of a fixed bridge HISTOPATHOLOGIC FEATURES Composed of hyperplastic bone consisting of mature cortical & trabecular bone. RADIOGRAPHIC FEATURES Well defined radiopacity that resembles periosteal osteoma TREATMENT: Surgical removal for prosthetic purposes PROGNOSIS: Rare recurrence after surgical excision CORONOID CLINICAL FEATURES: HYPERPLASIA - uncommon painless not associated with facial asymmetry condition that is often most often in young males associated with limitation of age onset is around puberty. mandibular motion 2 types: unilateral, bilateral – results in limitation of mandibular unknown etiology movement which is progressive overtime. HISTOPATHOLOGIC FEATURES Bilateral - consist of mature hyperplastic bone Bone may be partially covered by cartilaginous & fibrous connective tissue RADIOGRAPHIC FEATURES Unilateral type- results in misshapen or mushroom shaped coronoid process on radiographs. DIFFERENTIAL DIAGNOSIS: osseous & chondroid neoplasm TREATMENT: Surgical excision PROGNOSIS: Recurrence is rare  MALIGNANT NON-ODONTOGENIC TUMOR MALIGNANT NON-ODONTOGENIC TUMOR seen along the hard tissues and marrow cavity of mandible and maxilla. Malignancies of the jaws: ○ OSTEOSARCOMA ○ PAROSTEAL SARCOMA ○ PERIOSTEAL SARCOMA ○ CHONDROSARCOMA Mesenchymal chondrosarcoma ○ EWINGS SARCOMA & PRIMITIVE NEUROECTODERMAL TUMOR ○ BURKITT’S LYMPHOMA ○ PLASMA CELL NEOPLASM Multiple Myeloma Solitary Plasmacytoma of the bone ○ METASTATIC CARCINOMA OSTEOSARCOMA - Second Site of origin: most common primary bone 1. Conventional – arise within medullary cavity tumor. 2. Juxtacortiical – arise from periosteal surface 3. Extraskeletal – arise in soft tissue CLINICAL FEATURES: Swelling and localized pain Loosening and displacement of teeth Mandibular paresthesia: ○ inferior alveolar nerve involved Swelling and localized pain; maxillary paresthesia: ○ infraorbital nerve, epistaxis, nasal obstruction, or eye problems RADIOGRAPHIC FEATURES: Variable, depending on degree of calcification. More calcified = more radiopaque HISTOPATHOLOGIC FEATURES: Sarcomatous stroma directing producing tumor osteoid Variable histopathologic patterns: ○ Osteoblastic Chondrosarcoma – most common in the jaws Fibroblastic Telangiectatic — multiple aneurysmal blood-filled spaces lined by malignant cells. More differentiated in jaw than those in the skeleton, better prognosis DIFFERENTIAL DIAGNOSIS: Scleroderma – widening of periodontal ligament space Chronic Osteomyelitis, other malignancies, several benign neoplasms- moth eaten radiographic appearance Pindborg tumor and metastatic carcinomassclerotic radiographic appearance Chondrosarcoma, fibrosarcoma of the bone, aneurysmal bone cyst or giant cell tumor. TREATMENT: Radical mandibulectomy or maxillectomy Radiotherapy and chemotherapy for recurrences, soft tissue extension, metastatic disease Presurgical insertion of radium needles for mandibular osteosarcoma - 76% 5-year-survival rate PROGNOSIS: Overall, 5 year survival rate for 35 to 40% of jaw osteosarcoma Mandibular tumor better than maxillary tumors Rarely metastasize to lymph nodes Most common sites of metastasis: ○ lung and brain; 6 months survival rate Local recurrences - surgical excision and chemotherapy Juxtacortical Osteosarcoma 1. Parosteal – no elevation of periosteum and no bone formation 2. Periosteal - arise the periphery of bone at the periosteal  surface note: Distinct clinical, histological, biologic and radiographic features Usually of parosteal and rarely of periosteal subtype. PAROSTEAL CLINICAL FEATURES: OSTEOSARCOMA Female predominance Most commonly involves distal femoral metaphysis Slow-growing swelling or palpable mass, dull aching sensation RADIOGRAPHIC FEATURES: Radiodense and attached to the external of the bone by a broad sessile base. HISTOPATHOLOGIC FEATURES: Well differentiated, has spindle shape stroma with minimal atypia and rare mitotic figures separating irregular trabeculae of woven bone having foci of osteoid and cartilage Periphery is ossified than the base, may have lobulated cartilaginous cap or may be irregular because extensions into soft tissue DIFFERENTIAL DIAGNOSIS: Osteoma Osteochondroma Heterotopic ossification and myositis ossificans TREATMENT: En bloc resection PROGNOSIS: Significant local recurrence underlying cortical bone PERIOSTEAL CLINICAL FEATURES: OSTEOSARCOMA Occurs much less than parosteal osteosarcoma Location: Upper tibial metaphysis Rarely seen in jaw Male predominance - 20 years RADIOGRAPHIC FEATURES: Cortex of involved bone radiographically intact and sometimes thickened, with no tumor involvement of underlying marrow cavity radiolucent with poorly define periphery HISTOPATHOLOGIC FEATURES: Lobules of poorly differentiated malignant cartilage with central ossification, minimal tumor infiltration into cortical bone without medullary involvement DIFFERENTIAL DIAGNOSIS: Chondroblastic intramedullary osteosarcoma TREATMENT: En bloc resection or radical excision PROGNOSIS: Local recurrence rate can be expected CHONDROSARCOMA CLINICAL FEATURES: Maxillofacial area (60%) — lateral incisors and canine region and palate. Pain, visual disturbances, nasal signs and headache may result from extension of chondrosarcomas from jaw bones to contiguous structures. Mandibular area (40%) – premolar, molar, symphysis coronoid and condylar process Adulthood and old age Painless swelling and expansion of affected bones Loosening of teeth or ill-fitting dentures RADIOGRAPHIC FEATURES: Variable: Moth-eaten radiolucency, or diffusely opaque lesins, unilocular or multilocular May contain mottle densities – areas of calcification  DIFFERENTIAL DIAGNOSIS: Chondroblastic type of osteosarcoma Cartilaginous tumors of bone Synovial chondromatosis involving TMJ TREATMENT: Wide local radical surgical excision PROGNOSIS: Death – local recurrence and extension into adjacent vital structures Metastasis – lungs or bone EWINGS SARCOMA - highly ETIOLOGY: Unknown lethal round cell sarcoma CLINICAL FEATURES: Bones of lower extremity of pelvis Book: PRIMITIVE Ramus of mandible — Pain and swelling, mucosal ulcers NEUROECTODERMAL TUMOR Facial deformity, destruction of alveolar bone with loosening of teeth. RADIOGRAPHIC FEATURES: Non-specific May stimulate infectious process as well as malignant process Moth eaten destructive radiolucency medullary and erosion of cortex with expansion HISTOPATHOLOGIC FEATURES: Proliferation of uniform, closely packed cells that may be compartmentalized by fibrous bands Round to oval nuclei have finely dispersed chromatin inconspicuous nucleoli Cytoplasm has glycogen – stains with Schiff DIFFERENTIAL DIAGNOSIS: Lymphoma/leukemia Metastatic carcinoma Metastatic neuroblastoma Mesenchymal Chondrosarcoma Small Cell Osteosarcoma TREATMENT: Multiple method protocols – surgery and radiation for local control; chemotherapy for systematic micrometastases. PROGNOSIS: Metastatic to lungs, other bones and lymph nodes Poor prognosis for patient below 30 year old, metastasis, systemic symptoms, high erythrocytes sedimentation rate, elevated serum lactate dehydrogenase value (indication of a patient with liver disease, heart disease, anemia or infection such as meningitis, encephalitis and HIV) and thrombocytosis (excessive number of platelets in the blood) BURKITT’S LYMPHOMA CLINICAL FEATURES: Translocation of the distal High-grade non-Hodgin’s lymphoma is endemic in Africa part of chromosome 8 to and sporadic in North America. chromosome 14 RADIOGRAPHIC FEATURES: Enhanced tumor cell Moth-eaten radiolucency proliferation of Burkitt’s HISTOPATHOLOGIC FEATURES: Neoplastic B cell proliferation lymphoma DIFFERENTIAL DIAGNOSIS: Also called African jaw Subtypes of non-Hodgkin’s lymphoma, undifferentiated lymphoma. carcinoma and sarcoma, metastatic neuroblastoma, acute leukemia TREATMENT: Combination chemotherapy PROGNOSIS: Potentially curable PLASMA CELL NEOPLASM Types: Multiple Myeloma Solitary Plasmacytoma of the bone ETIOLOGY: Derived from bone marrow stem cell of B lymphocytes lineage, functionally differentiated in their ability to produce and secrete immunoglobulins  Tumor derived from a single neoplastic clone single neoplastic clone, associated with the production of monoclonal immunoglobulin components. CAUSE: Multiple myeloma occurs spontaneously. Patients exposed to ionizing radiation and the pesticide dioxin may develop the disease Infections with some viruses (HIV and human herpes 8) has also been associated with multiple myeloma. No known risk factors are inherited. SYMPTOMS: Patients usually complain of bone pain. Fatigue, feeling ill, fever, night sweats Weight loss is not common in the early stages. Physically, patients ae pale with diffuse bone tenderness, especially around the sternum (breastbone) and pelvis (hips) Pathologic fractures (fractures caused by tumors) occur frequently. Thirty percent of patients will have their multiple myeloma first discovered when they develop this kind of fracture Pathologic fractures (fractures caused by tumors) occur frequently. The spine is the most common location for pathological fracture. It can also happen in the ribs and pelvis. Compression of the spinal cord occurs in 10% to 15 % of patients. This This causes pain in the back and legs and numbness and weakness in the legs Patients who have high levels of calcium in the blood may experience nausea, fatigue, confusion, constipation, and frequent urination. Patients with anemia may experience fatigue, weakness, and shortness of breath with exercise In advance cases, patients typically have recurrent infections and can have kidney failure. PATIENTS MAY ALSO HAVE: Anemia (low red blood cell count) Leukopenia (low white blood cell count) Thrombocytopenia (low platelet count) Hypercalcemia (high calcium level in the blood) RADIOGRAPHIC FEATURES: Multiple myeloma appears as decreased bone density with a lot of “punched out” holes in the bone. These destructive lesions are not surrounded by the white rim of bone seen in other types of destructive lesions. Diagnosis is made when a large number of abnormal plasma cells are found in the patient’s bone marrow. The doctor obtains this marrow through a bone biopsy. A blood test can confirm the diagnosis. The patient’s blood is checked for abnormal antibodies produced by myeloma cells. Some forms of multiple myeloma produce proteins that can be detected with a urine analysis TREATMENT: Multiple myeloma is currently not curable. Chemotherapy may prolong life expectancy and decrease symptoms expectancy and decrease symptoms CHEMOTHERAPY: The standard treatment medications are melphalan and prednisone. The median survival rate is three years with this treatment alone. For patients in whom this therapy is ineffective, alternatives include: VBMCP (vincristine, carmustine, melphalan, cyclophosphamide and prednisone) VAD (vincristine, adriamycine and dexamethasone) These treatments may cause severe muscle weakness. They may also increase the chance of infections. Thalidomide and interferon are also sometimes used. Fortunately, a recent advancement in treatment of multiple myeloma has increased response rates and survival. This treatment consists of high-dose chemotherapy, followed by autologous stem cell transplantation. With this treatment, patients have a 20 percent chance of living longer than 10 years. This stem cell transplantation involves: Harvesting a patient’s own blood cells. Conditioning them with very high doses of melphalan Re-infusing the blood cells back into the patient Radiation therapy: Radiation therapy is reserved for decreasing the size of symptomatic bone lesions Surgical Treatment: Surgery will not multiple myeloma. Surgery is used to treat fractures and impending fractures in the spine, pelvis, hip, and shoulder. The goal of these surgeries is to decrease pain and maintain function. Internal fixation augmented with cement is frequently recommended, as are joint replacements and vertebroplasties (for spine fractures).  Operative intervention does not alter the survival rate, but it does not alter the survival rate, but it does increase the quality of life. SUPPORTIVE CARE: Supportive care is critical. This includes comfort measures, pain control, and interventions that maintain functions. Supportive care includes managing the bone anemia, infections, kidney failure, and pain associated with multiple myeloma Bisphosphonates (medication) can prevent destructive bone lesions and spine fractures. Erythropoietin or occasional blood transfusions can manage anemia Antibody infusions and vaccinations can help patients with recurrent infections. Corticosteroids and hydration can be used to treat high blood calcium concentrations (from bone loss) and dehydration. Narcotics can address the pain associated with bone lesions. Operative intervention may be required to control the pain associated with bone fractures. MULTIPLE MYELOMA CLINICAL FEATURES: - under plasma cell Rarely seen before fifth decade, male predominance neoplasm Asymptomatic ar may have pain, swelling, expansion, numbness, mobility of the teeth, or pathologic fractures Soft tissue mass Weakness, weight loss, anemia and hyperviscosity May develop systemic amyloidosis. RADIOGRAPHIC FEATURES: Variable Punch out appearance, but non-corticated radiolucent are of bone in jaw and many of hematopoietic marrow containing bones of the skeleton Maybe expansile and osteosclerotic HISTOPATHOLOGIC FEATURES: Monotonous proliferation of pure plasma cells. Wide range if differentiated from mature to less differentiated forms DIFFERENTIAL DIAGNOSIS: Metastatic carcinoma Lymphoma Idiopathic histiocytosis (LCD) Carcinoma Neuroblastoma TREATMENT: Chemotherapy with local radiation PROGNOSIS: Death due to infection Renal failure Disseminated myeloma Cardiac complications Hemorrhage of thrombosis Poor prognosis for patients with severe azotemia, hypercalcemia, anemia SOLITARY PLASMACYTOMA CLINICAL FEATURES: OF BONE - under plasma cell Disease of adulthood, male predominance. neoplasm Rare in jaws; but occur in angle of mandible Diagnosis: radiographic bone survey and random marrow aspirate and biopsy Pain, swelling, pathologic fracture RADIOGRAPHIC FEATURES: Well defined lytic lesions May be multinodular, resembling central giant cell granuloma May destroy cortical bone and spread into adjacent soft tissue HISTOPATHOLOGIC FEATURES: Similar to multiple myeloma: monotonous proliferation of neoplastic plasma cells DIFFERENTIAL DIAGNOSIS: Multiple myeloma TREATMENT: Radiotherapy PROGNOSIS: Local recurrence in 10% of cases May progress to multiple myeloma METASTATIC CARCINOMA PATHOGENESIS: - Most common From primary carcinomas of the breast, kidney, lung, colon, malignancy affecting prostate, thyroid gland. skeletal bones CLINICAL FEATURES: Older age group (50-70), average of 45 years old Common location – angle and body of mandible Bone pain, loosening of teeth, lip paresthesia, bone swelling, gingival mass, and pathologic fracture RADIOGRAPHIC FEATURES: Poorly marginated, radiolucent, irregular, moth-even, expansile defects Even moth-eaten radiolucency rarely expands cortical bone. HISTOPATHOLOGIC FEATURES: Extremely variable, depending on tumor type and grade of tumor differentiation DIFFERENTIAL DIAGNOSIS: Anaplastic sarcoma Lymphoma Melanotic melanoma TREATMENT: Surgical excision Chemoradiotherapy PROGNOSIS: Dismissal 10% 5-year-survival, 2/3 dead within a year. CYST OF THE JAWS AND NECK ODONTOGENIC CYST a. Periapical Cyst b. Lateral periodontal Cyst c. Botryoid Odontogenic Cyst d. Gingival Cyst e. Gingival Cyst of the Newborn f. Dentigerous Cyst g. Eruption Cyst h. Glandular Odontogenic Cyst i. Odontogenic Keratocyst j. Calcifying Odontogenic Cyst NON-ODONTOGENIC CYST a. Globulomaxillary Cyst / Lesion b. Nasolabial Cyst c. Median Mandibular Cyst d. Nasopalatine Canal Cyst PSEUDOCYST a. Aneurysmal Bone Cyst b. Traumatic Bone Cyst c. Static (Stafne’s) Bone Cyst d. Focal Osteoporotic Bone Marrow Defect SOFT TISSUE CYSTS OF THE NECK a. Branchial Cyst / Cervical Lymphoepithelial Cyst b. Dermoid cyst c. Thyroglossal Tract Cyst ODONTOGENIC CYSTS PERIAPICAL CYSTS Clinical feature: (Apical Periodontal Cyst) Most common cyst in the oral and perioral region Asymptomatic cause bone resorption and associated with non-vital tooth occurs at any age peaks at 3rd decade of life commonly seen at anterior maxillary region and posterior  mandibular region. Etiology: periapical granuloma Location: Commonly seen at anterior maxillary region or anterior muccobuccal fold. Radiographic Feature: round to ovoid radiolucency with narrow opaque margin that is continuous with lamina dura. Note that it may vary in sizes; if it is seen on the posterior area the measurement is above 1 cm and above. Histopathologic Feature: Lined by stratified squamous epithelium, polymorphonuclear leukocytes, few lymphocytes Epithelial lining are residues from rest of malassez Differential Diagnosis: A. Anterior Region ○ Periapical scar ○ Periapical granuloma ○ Periapical cemento osseous dysplasia B. Posterior Region ○ Traumatic bone cyst ○ Giant cell lesion ○ Metastatic disease Treatment and Prognosis: Extraction and curettage of the apical zone RCT with apicoectomy (removal of the apical thirds of the root of the infected tooth) Extraction only w/o curettage will lead to the development of a residual cyst that can weaken the bone LATERAL PERIODONTAL Clinical feature: CYST (unilocular) Adults older than 21 yrs; male predilection Associated with vital teeth; nonmobile and may show root divergence Bluish discoloration when large; reflection of the fluid content of the cyst Small soft tissue swelling within or slightly inferior to the interdental papilla Etiology: dental lamina remnants within the bone Location: mandibular premolar and cuspid region Radiographic Feature: well-delineated, round or teardrop shaped unilocular radiolucency between teeth Histopathologic Feature: lined by nonkeratinized epithelium With glycogen containing clear cells Differential Diagnosis: Botryoid odontogenic cyst Odontogenic keratocyst Squamous odontogenic tumor BOTRYOID Presents as a multilocular radiolucency between teeth (mandibular ODONTOGENIC CYST canine and premolar) like a grape cluster A variant of lateral periodontal cyst (multilocular) Multilocular cyst lined by thin stratified squamous epithelium. Treatment and prognosis: Enucleation is curative No recurrence potential Bone regeneration is over 6 mos to 1 year Root divergence normalizes even with out orthodontic tooth movement GINGIVAL CYSTS Clinical feature: A soft tissue counter part of lateral periodontal cys. Small soft tissue swelling (1cm or less) within the dental papilla or in midcrestal area in edentulous ridges Etiology: dental lamina remnants in soft tissue between oral epithelium and periosteum (rest of serres) Location: mandibular premolar area and maxillary incisor and canine area Radiographic Feature: No radiographic evidence of bone resorption Histopathologic Feature: Same as lateral periodontal cyst Lined by a thin layer of keratinized squamous epithelium Differential Diagnosis: Gingival mucocoele Fordyce's granules Peripheral odontogenic tumor Treatment and prognosis: Local excision Recurrence is not seen GINGIVAL CYST OF THE Clinical feature: NEW BORN Multiple nodules along the alveolar ridge in neonates. Appear as a small nodules that are white in color due to the presence of keratin in the lumen. They are mistakenly seen as neonatal teeth Location: alveolar ridge (Bohn's nodules) midline of the palate (Epstein's pearls or palatine cyst of the newborn) Histopathologic Feature: Lined by keratinized stratified squamous epithelium with keratin in the lumen. Treatment and Prognosis: No treatment needed. Cysts rupture in the oral cavity before patient is 3 months of age DENTIGEROUS CYST Etiology: (cyst containing teeth) accumulation of fluid between remnants of enamel organ partial enamel organ degeneration leads to cyst development due to separation of elements of enamel epithelium 2nd most common odontogenic cyst next to the periapical cysts Most common developmental cyst of the jaws. Clinical feature: Greater incidence in males Occurs in the 2nd or 3rd decades of life  Asymptomatic Late eruption or impaction of permanent tooth Location: 3rd molars and maxillary canine no Radiographic feature: presence of radiolucency associated with crown of impacted teeth Histopathologic feature: lined by non-keratinized stratified squamous epithelium Differential Diagnosis: Odontogenic keratocyst Ameloblastoma Adenomatoid odontogenic cyst Treatment and prognosis: removal of the associated tooth and enucleation of the soft tissue component ERUPTION CYST Clinical Feature: Bluish discoloration on gums Eruption hematoma is also used when there is bleeding within the cyst due to surface trauma. (There’s blood content; not bluish fluid or discoloration). Etiology: Reduced enamel epithelium Histopathologic feature: Fragments of thin epithelium can be seen lining the fibrous tissue, which has become compressed by the eruption cyst Differential Diagnosis: Dentigerous cyst Treatment and Prognosis : No treatment needed Subsequent to eruption, the cyst disappears spontaneously without complications. If necessary, uncover the erupting tooth to marsupialize the cyst and to facilitate tooth eruption. ○ marsupialization - cutting a slit to the cyst and suture together to form a permanently opened pocket or pouch that allows fluid to drain easily. GLANDULAR aka SIALO-ODONTOGENIC CYST a mucous producing salivary gland ODONTOGENIC CYST tumor. (Sialo-odontogenic cyst) Clinical feature: adults that causes jaw expansion either jaw, anterior mandible favored crossing the midline Location: along the submandibular gland Radiographic feature: multiloculated radiolucency margins may be well defined and sclerotic Histopathologic feature: The epithelium is often squamous, but a distinct layer of cuboidal to columnar cells with eosinophilic cytoplasm is seen. These are mucous producing and some may have cilia in the surface  Differential Diagnosis: Mucoepidermoid carcinoma Treatment and Prognosis : surgical management periapical curettage/marginal excision long term follow-up aggressive type has a recurrence potential ODONTOGENIC Clinical feature: KERATOCYST asymptomatic but can cause jaw expansion and tooth mobility of affected area Occur at any age, peak 2nd and 3rd decades Occurs in children as part of basal cell nevus syndrome ○ Basal cell nervous syndrome is an inherited condition of the skin. Commonly affected is the posterior portion of the body of the ramus of the mandible and maxillary canine and 3rd molar area Two basic types: Primordial-origin keratocyst (60% Dentigerous-origin keratocyst of cases) (40% of cases) Originated from the dental Originated from the tooth lamina bearing area Radiographic feature: well circumscribed radiolucency with smooth radiopaque rim Histopathologic features: Keratinizing odontogenic cyst showing orthokeratin, a granular cell layer, and flattened basal cell Typical odontogenic keratocyst shows parakeratinized corrugated surface, hyperchromatic palisaded basal cells. Differential Diagnosis: Dentigerous cyst Adenomatoid odontogenic cyst Ameloblastoma Lateral periodontal cyst Residual cyst Treatment and Prognosis: Marsupialization and an unerupted tooth that is associated with the cyst is guided into the arch Enucleation and curettage for small cysts Resection for Large multilocular keratocyst  Resection if multiple recurrences occurs after enucleation and curettage. There’s placement of brace after the surgical treatment to stabilize the jaw and promotes bone regeneration. CALCIFYING Clinical feature: ODONTOGENIC CYST from odontogenic epithelial remnants within the gingival area of either jaw peak 2nd decade ○ individuals younger than 40 ○ predilection from females ○ expansion of alveolar bone or soft tissues ○ absence of tenderness Location: maxilla Radiographic feature: unilocular or multilocular radiolucency opacities may produce a "salt and pepper" type of pattern Histopathologic feature: Ghost cell Keratinization characteristic microscopic feature Well delineated cystic proliferations with fibrous CT wall Differential Diagnosis: Calcifying epithelial odontogenic tumoR Peripheral ossifying fibroma Adenomatoid odontogenic tumor Treatment and Prognosis: Enucleation and no recurrence potential NON-ODONTOGENIC CYST GLOBULOMAXILLARY CLINICAL FEATURES: CYST / LESION Non Specific designation for any lesion in the globulomaxillary area (between maxillary lateral incisor and canine) Asymptomatic: teeth vital; divergence of roots. RADIOGRAPHIC FEATURES: Inverted pear shaped radiolucency TREATMENT AND PROGNOSIS: Usually surgical enucleation NASOLABIAL CYST CLINICAL FEATURES: Usually appears as a swelling of the upper lip lateral to the midline Soft tissue cysts of the upper lip Incidence noted in the 4th and 5th decade Distinct in female 3:1 ratio Common in the canine region or the mucobuccal fold. HISTOPATHOLOGIC FEATURES: Epithelial lining is a pseudo stratified columnar type with numerous goblet cells. DIFFERENTIAL DIAGNOSIS: Canine space abscess Benign salivary gland tumors TREATMENT AND PROGNOSIS:  Complete surgical excision; Recurrence is rare MEDIAN MANDIBULAR DESCRIPTION: CYST fissural origin was based on the no-longer-tenable theory of epithelial entrapment in the midline of the mandible during the fusion of each half of the mandibular arch. RADIOGRAPHIC FEATURES: well-circumscribed along the mandibular arch TREATMENT AND PROGNOSIS: Surgical Excision NASOPALATINE CANAL CLINICAL FEATURES: CYST Developmental in origin Arises from embryological remnants of the nasopalatine duct Intraosseous lesions usually present in the midline of the anterior maxilla near the incisive foramen. Many are inflamed ; pain, pressure, drainage and swelling can occur. RADIOGRAPHIC FEATURES: Well circumscribed oval or heart-shaped radiolucency of the midline of the anterior maxilla superior to and between the roots of the central incisors smooth cortical border HISTOPATHOLOGIC FEATURES: Lined by: ○ Respiratory epithelium or ○ Stratified squamous epithelium or ○ Combination of respiratory and stratified squamous epithelium DIFFERENTIAL DIAGNOSIS: Periapical granuloma Radicular cyst Incisive canal cyst TREATMENT AND PROGNOSIS: Surgical enucleation PSEUDOCYST ANEURYSMAL BONE ETIOLOGY: CYST Unknown, maybe related to altered hemodynamics on abnormal healing of bone hemorrhage CLINICAL FEATURES: Adults affected. Teenagers and young adults affected. This lesion occurs in younger patients usually below 20 years of age. The mandibular – Appears to be more commonly affected than maxilla. The posterior molar- bearing segments of the maxilla and mandible seem to be a more commonly affected region. Clinically these lesions are characterized by a non-pulsatile swelling of vertical duration. HISTOPATHOLOGIC FEATURES: Blood filled spaces lined by connective tissue and multinucleated giant cells. DIFFERENTIAL DIAGNOSIS: Central giant cell granuloma Hyperparathyroidism Cherubism TREATMENT AND PROGNOSIS: Excision and No recurrence TRAUMATIC BONE CYST ETIOLOGY: Unknown, trauma sometimes suggested Simple CLINICAL FEATURES: an empty infra only cavity Maybe related to bleeding in the jaw with clot resorption that lacks epithelial lining Teenagers most commonly affected Age: 10-20 years old Location: along the mandibular area or common on the premolar to molar region. Male predilection Manifestation: asymptomatic and usually discovered  accidentally 20 % painless swelling Associated with vital teeth. At operation the lesion appears at an empty cavity. RADIOGRAPHIC FEATURES: Lucency discovered on routine examination. Well demarcated unilocular or multilocular radiolucency with scalloping around roots commonly found in the posterior mandible. DIFFERENTIAL DIAGNOSIS: Aneurysmal bone cyst Traumatic bone cyst Lateral periodontal cyst Odontogenic myxoma Unicystic ameloblastoma TREATMENT AND PROGNOSIS: Surgical intervention and curettage STATIC (STAFNE’S) BONE CLINICAL FEATURES: CYST Developmental defect Stafne’s Bone Defect Located below mandibular canal in molar region FOCAL OSTEOPOROTIC CLINICAL FEATURES: BONE MARROW DEFECT Uncommon lesions that typically present as asymptomatic. RADIOGRAPHIC FEATURES: Focal radiolucency in areas where hematopoiesis is normally seen (angle of the mandible and maxillary tuberosity. HISTOPATHOLOGIC FEATURES: Predominance of hematopoietic cells with relatively fewer flat cells. Small lymphoid aggregates may be found. TREATMENT AND PROGNOSIS: Incision biopsy is generally desirable SOFT TISSUES CYST OF THE NECK BRANCHIAL CYST / ETIOLOGY: CERVICAL entrapped epithelium in cervical lymph nodes during LYMPHOEPITHELIAL embryogenesis. CYST CLINICAL FEATURES: Location: lateral portion of the neck, usually anterior to the sternocleidomastoid muscle. Most common site of these lesions is in the floor of the mouth followed by the posterior lateral tongue. HISTOPATHOLOGIC FEATURES: Branchial cyst is lined with stratified squamous epithelium, pseudostratified columnar epithelium or both. DIFFERENTIAL DIAGNOSIS: Cervical Lymphadenitis Lymphangioma Skin inclusion cyst Tumor of the tail of the parotid TREATMENT AND PROGNOSIS: Surgical excision with good prognosis DERMOID CYST ETIOLOGY: Developmental entrapment of multi potential cells/ possibly implantation of epithelium CLINICAL FEATURES: Anterior portion of the floor of the mouth in the midline (oral cavity) Painless and slow growing No gender predilection Soft and doughy because of keratin and sebum in the lumen HISTOPATHOLOGIC FEATURES: Lined by stratified squamous epithelium supported by a  fibrous connective tissue wall. Numerous secondary skin structures. DIFFERENTIAL DIAGNOSIS: Ranula Sublingual space infection Sublingual salivary gland tumor. TREATMENT AND PROGNOSIS: Surgical Excision THYROGLOSSAL TRACT ETIOLOGY: CYST epithelial remnants of the thyroid gland as it grows downwards from the foramen caecum area to its permanent location in the neck. CLINICAL FEATURES: Most common developmental cyst of the neck, accounting for nearly ¾ of small lesions. Asymptomatic and occurs in patients older than 30 years of age. RADIOGRAPHIC FEATURES: HISTOPATHOLOGIC FEATURES: Stratified squamous epithelium at the level of the hyoid bone. Ciliated or columnar type of epithelium is usually found in cyst occurring below the hyoid bone DIFFERENTIAL DIAGNOSIS: Dermoid cyst Thyroid neoplasm Branchial cyst Sebaceous cyst. TREATMENT AND PROGNOSIS: Surgical excision with good prognosis.