Bone Tumors 2

Dr. Rima Safadi

28/7/2008
 Osteosarcoma
 Most common primary malignant
tumor in jaws
 Age of onset around 30
 May be central, or in relation to
periosteum
• Juxtacortical have better prognosis than
intramedullary
 Osteosarcoma
 Presenting signs and symptoms
• Swelling
• Pain, toothache
• Loose or displaced teeth
• Bleeding
• Paresthesia
 Increased incidence in Paget’s
disease
 Osteosarcoma
 Radiographic Features
• Radiolucent, radiopaque, or mixed

• Margins are poorly defined

Osteosarcoma
• “Sun-ray” appearance:
Present in only 25% of cases and not
unique to osteosarcoma.
Osteosarcoma
Early feature: localized
symmetrical widening of
periodontal ligament space
 Osteosarcoma
 Microscopic: abnormal osteoblasts
and bone
 Treatment and Prognosis
• Radical surgery, radiation therapy,
chemotherapy
• Mandibular lesions have better
prognosis
 Chondrosarcoma
 Clinical Features
• Chondrosarcoma is more common than
chondroma
• slower growth rate than other sarcomas
of bone
• Maxilla>mandible
 Radiographic Features
• Radiolucent, radiopaque or mixed
• Poorly defined
 Chondrosarcoma
 Microscopic Features
• Abnormal chondroblasts and cartilage
• May be difficult to distinguish from
chondroma
 Treatment and Prognosis
• Radical surgery
• Poorer prognosis than osteosarcoma of
jaws
Chondroma
Chondrosarcoma
Questions/Comments??
 Multiple Myeloma
 Malignant neoplasm of plasma cells
 Solitary: plasmacytoma
 Jaw lesions in both
 Multiple Myeloma
 Monoclonal proliferation of
plasma cells
• Production of a single type of Ig
 Most commonly IgG
• Increased level in serum:
paraprotein or M protein
 Multiple Myeloma
Clinical picture:
 50-70 year

 Skull, vertebrae, sternum, ribs and

pelvic most commonly affected

 Multiple Myeloma
Diagnosis
 Electrophoreses

 Bence Johns proteins: light chains in

50% of patients identified in urine

 Hypercalcimia

 Amyloidosis

Treatment: chemotherapy
 Multiple Myeloma
 Radiographic features:
 Sharply demarcated, punched out
radiolucent lesions
M spike
 Multiple Myeloma
 Microscopic features:
 Sheets of malignant plasma cells
• Binucleation or multinucleation
Questions/Comments??
 Langerhans Cell Histiocytosis
 Langerhans cells: epidermis, lymph
nodes, mucosa, bone marrow
 APC
 Proliferation of Langerhans cells
accompanied by: eosinophils, plasma
cells and multinucleated giant cells

• Monoclonal…..neoplastic
 Langerhans cell histiocytosis
3 clinical forms:
1. Monostotic, solitary eosinophilic
granuloma of bone

2. Multifocal: bone and other organs

• Craniofacial, orbit, posterior pituitary
gland: Hand Schuller Christian
syndrome
• Skull defects, exophthalmus and
diabetes insipidus
 Langerhans cell histiocytosis
3. Disseminated histiocytosis, bone
skin and viscera (chronic and acute)
• Letterer Siewe disease
• Fatal, < 2yrs
 Langerhans Cell histiocytosis
Unifocal and multifocal
Skull and jaws
<20 yrs
Male >female
Mandible>maxilla
 Langerhans Cell histiocytosis
Clinically: loosening of teeth, gingival
ulceration, or enlargement
 May simulate a periapical lesion

 Radiographically: floating in air ,

punched out radiolucency

 Langerhans cell histiocytosis
Histopathologically:
 Large, pale staining cells resemble

histiocytes, round indented nuclei

• Variable number of eosinophils
Electron microscope: Birbek granules
Immunohistochemistry: surface Ag:
CD1-a
Birbek granules
 Langerhans Cell Histiocytosis
Treatment:
 Curettage

 Radiotherapy

 Intralesional injection with steroid?

Questions/Comments??
 Hemangioma of Bone
 Multilocular radiolucency
 Aspiration: fresh blood
 Biopsy: cavernous type
Hemangioma
Hemangioma
Central hemangioma
 Ossifying Fibroma
(cemento-ossifying fibroma)
 Benign neoplasm, true neoplasm
 Fibrous tissue, bone, rounded
calcified bodies
 Demarcated with occasional
encapsulation
 Ossifying Fibroma

Clinically:
 Swelling, enlarging

 Mandible

 Sinonasal complex and orbit

 Female more?

 Radiographically:

 RL, RL and RO,

 Ossifying Fibroma

Histopathology:
 Fibrous tissue, well demarcated,

trabeculae of bone, osteoblastic

rimming
 Acellular calcified material

 D/D: fibrous dysplasia and cemento-

osseous dysplasia
 Ossifying Fibroma

Prognosis:
Slowly growing or rapidly growing
Juvenile ossifying fibroma:
D/D: osteosarcoma
30-60% recurrence rate
May be associated with hereditary
hyperparathyroidism
 Metastatic Tumors
 1% of oral cavity tumors

 Bone metastasis > soft tissue

 Mandible>maxilla
 Carcinoma: breast prostate lung,
bronchus, kidney

 Osteolytic vs osteoblastic (breast,

prostate)
Metastatic carcinoma
Metastatic carcinoma
Metastatic disease
Mts