Jaw bone disaese ii

Jaw bone Disease Jaw bone Disease IIII

Mazen Abood Bin ThabitMazen Abood Bin Thabit MD.FICPathMD.FICPath

Associate Prof .of PathologyAssociate Prof .of Pathology .. Senior lecturer of Oral pathologySenior lecturer of Oral pathology and and

oral histologyoral histology. .

Classification of bone Classification of bone diseasedisease

1.1. Inflammatory bone disease.Inflammatory bone disease.

2.2. Hereditary bone disease .Hereditary bone disease .

3.3. Metabolic bone disease . Metabolic bone disease .

4.4. Disease of unknown etiology .Disease of unknown etiology .

a. Paget’s disease .a. Paget’s disease .

b. Fibro-osseous disease b. Fibro-osseous disease

5.5. Bone tumors . Bone tumors .

Normal bone histologyNormal bone histology

Haversian system

Jaw bone tumorsJaw bone tumors

• Primary tumor of bone are uncommon lesion Primary tumor of bone are uncommon lesion in the jaws and the arises from different in the jaws and the arises from different type of cells type of cells

ClassificationClassification

1.1. Bone forming Bone forming tumor : tumor :

Benign Benign

a. Osteoma.a. Osteoma.

b. Osteoid b. Osteoid osteomaosteoma

c. c. Osteoblastoma.Osteoblastoma.

Malignant .Malignant .

a. a. Osteosarcoma Osteosarcoma

2.2. Cartilage forming Cartilage forming tumor tumor

Benign Benign

a. Chondroma .a. Chondroma .

b. b. OsteochondromaOsteochondroma

c. c. ChondroblastomaChondroblastoma

Malignant Malignant

a. a. ChondrosarcomaChondrosarcoma

ClassificationClassification

3.3. Giant cell tumor Giant cell tumor

4.4. Marrow tumors Marrow tumors

a. M.Myeloma .a. M.Myeloma .

b. Ewing’s sarcoma .b. Ewing’s sarcoma .

4.4. Langerhan’s cell Langerhan’s cell histiocytosishistiocytosis

5.5. Fibrous tumor Fibrous tumor Benign : Benign :

Ossifying Ossifying cementofibromacementofibroma

Malignant :Malignant :

FibrosarcomaFibrosarcoma

OsteomaOsteoma

• Benign slow Benign slow growing neoplasm growing neoplasm of mature osseous of mature osseous tissue tissue

1.Sub-periosteal.2.Endosteal

OsteomaOsteoma

• Clinical feature Clinical feature : : 1.1. More in adult .More in adult .

2.2. Male predominance . Male predominance .

3.3. More frequent in the More frequent in the mandiblemandible

4.4. In the jaw usually arise In the jaw usually arise from areas where tori dose from areas where tori dose not formed not formed

5.5. May arises in the skull , May arises in the skull , face and sinuses . face and sinuses .

6.6. Usually solitary .Usually solitary .

7.7. Multiple osteomas may Multiple osteomas may occur as feature of occur as feature of Gardener syndrome Gardener syndrome

OsteomaOsteoma

Osteoid osteomaOsteoid osteoma

• Rare benign tumor of Rare benign tumor of the bone share the bone share clinical , radiological clinical , radiological and histological feature and histological feature with osteoblasomawith osteoblasoma

• Clinical feature :Clinical feature :1.1. Young individual 2Young individual 2ndnd -3 -3rdrd

decade .decade .

2.2. Typically in the long bone Typically in the long bone ..

3.3. Rare in the jaw bone and Rare in the jaw bone and any area affected in the any area affected in the mandible and maxilla .mandible and maxilla .

4.4. Pain is characteristic .Pain is characteristic .

5.5. Pain worse at night and Pain worse at night and relived by Asprin relived by Asprin

6.6. Jaw bone expantion Jaw bone expantion

7.7. Growth has limited Growth has limited growth potential not growth potential not exceed 2cm exceed 2cm

Osteoid osteomaOsteoid osteoma

Radiography:Radiography: Well cercomseribed Well cercomseribed

lesion with central lesion with central radiolucency ( Nidus) radiolucency ( Nidus) surrounded by rim of surrounded by rim of sclertotic bone not sclertotic bone not exceed 2 cm . exceed 2 cm .

Histopathology: 1.The nidus consist trabeculae of bone within highly vascular stroma2.The periphery formed by mature compact bone

Nidus

OsteoblastomaOsteoblastoma

• Rare bone tumor Rare bone tumor described as giant described as giant osteoid osteomaosteoid osteoma

Osteoblastoma


1.1. Cementoblastoma is Cementoblastoma is an odontogenic an odontogenic equivalent .equivalent .

2.2. Long bones , in the Long bones , in the jaw mandible is more jaw mandible is more affected affected

3.3. Premolar and molar Premolar and molar region.region.

4.4. Localized swelling Localized swelling with or without pain .with or without pain .

5.5. Greater than 2 cm Greater than 2 cm

6.6. Mobility of teeth Mobility of teeth

Osteoblastoma


Histopathology: Histopathology: Irregular trabeculae of Irregular trabeculae of

osteoid and immature osteoid and immature bone in rich cellular bone in rich cellular stroma , the bone stroma , the bone trabeculae lined by trabeculae lined by plump osteoblast and plump osteoblast and multinucleated o multinucleated o osteoclast osteoclast

Radiography :Area of variable combination of radio-opaque and radiolucent more than 2cm surrounded by sclerotic

OsteosarcomaOsteosarcoma

• The commonest primary The commonest primary malignant tumor of the malignant tumor of the bone but is relatively rare bone but is relatively rare in the jaw. Characterized in the jaw. Characterized by direct formation of by direct formation of bone or osteoid by tumor bone or osteoid by tumor cells (WHO)cells (WHO)

Unknown cause


• The tumor may follow The tumor may follow pre-existing jaw bone pre-existing jaw bone condition:condition:

1.1.Radiation of head and Radiation of head and neck .neck .

2.2.Paget’s disease . Paget’s disease .

3.3.Fibrous dysplasia .Fibrous dysplasia .

4.4.Gaint cell tumor of bone .Gaint cell tumor of bone .

5.5.Osteochondroma .Osteochondroma .

6.6.Bone infarction .Bone infarction .

7.7.Chronic osteomyelitis Chronic osteomyelitis

8.8.Osteogenesis imperfectaOsteogenesis imperfecta


• Clinical feature : Clinical feature : 1.1. 20% of all sarcoma , 5% 20% of all sarcoma , 5%

occur in the jaw bones .occur in the jaw bones .

2.2. Young adult male .Young adult male .

3.3. More in the mandible .More in the mandible .( Symphysis , angle of ( Symphysis , angle of the ramus and near the the ramus and near the tempro-mandibular joint tempro-mandibular joint ) .) .

4.4. Maxillary lesion involve Maxillary lesion involve the alveolar ridge , the alveolar ridge , antrum and palate antrum and palate

5.5. Rapidly growing mass Rapidly growing mass accompanied with pain , accompanied with pain , numbness of lower lips numbness of lower lips trismus trismus


6.6. Loosening and Loosening and displacement of teeth .displacement of teeth .

7.7. Maxillry lesion may Maxillry lesion may cause nasal cause nasal obstruction , epistaxisobstruction , epistaxis

8.8. The overlying skin red The overlying skin red , inflamed with , inflamed with vascular prominence .vascular prominence .

9.9. Ulceration , Ulceration , hemorrhage and hemorrhage and pathological fracture pathological fracture are common are common


• Radiography:Radiography: 1.1. Early osteosarcoma may Early osteosarcoma may

produce widening of PD produce widening of PD space due to tumor space due to tumor invasion of PD and invasion of PD and resorption of alveolar resorption of alveolar bone.bone.

2.2. Advanced tumor produce Advanced tumor produce osteolytic lesion osteolytic lesion appears as irregular appears as irregular moth eaten radiolucent moth eaten radiolucent areas or irregular areas or irregular poorly demarcated poorly demarcated radio-opacities radio-opacities

Sunburst

Widening of PD


• Histopathology: Histopathology: 1.1. Sarcomatous stroma Sarcomatous stroma

with direct formation of with direct formation of osteoid by tumor cells osteoid by tumor cells ( Malignant osteoblast ) ( Malignant osteoblast ) ..

2.2. Neoplastic osteoblast Neoplastic osteoblast vary in shape and sized vary in shape and sized

3.3. Malignant giant cells Malignant giant cells may conspicuous.may conspicuous.

4.4. Osteosarcoma of jaw Osteosarcoma of jaw have better prognosis in have better prognosis in general general


Radical treatment

Final

OateochonderomaOateochonderoma• Rare in the jaw Rare in the jaw • Usually arise from Usually arise from

epiphyseal plat of long bone epiphyseal plat of long bone ..

• In the jaw arise from the In the jaw arise from the region of coronid process region of coronid process and mandibular condoyle.and mandibular condoyle.

• More common in childhood More common in childhood and adolescent .and adolescent .

• Tumor usually pedunculated Tumor usually pedunculated ..

• Consist of core of mature Consist of core of mature bone capped by hyaline bone capped by hyaline cartilage with active cartilage with active enchondral ossification at enchondral ossification at it’s junction it’s junction

• Tumor stop growing after Tumor stop growing after skeletal maturation skeletal maturation

Chondroma and Chondroma and chondrosarcomachondrosarcoma

• Chondroma and Chondroma and chondrosarcoma are rare chondrosarcoma are rare in jaw .in jaw .

• Distinction between benign Distinction between benign and malignant is difficult .and malignant is difficult .

• Diagnosis of chondroma in Diagnosis of chondroma in jaw should be avoided .jaw should be avoided .

• Chondrosarcoma Chondrosarcoma commonly in the maxilla .commonly in the maxilla .

• In the maxilla involve the In the maxilla involve the anterior region ( Lateral anterior region ( Lateral incisor and canine ) and incisor and canine ) and palate . palate .

• In the mandible affect the In the mandible affect the posterior part posterior part

Chondroma

Chondrosarcoma

Chondroma and Chondroma and chondrosarcomachondrosarcoma

• Common in adulthood Common in adulthood and old age . and old age .

• Painless swelling with Painless swelling with expansion of the jaw . expansion of the jaw .

• Loosening of teeth or Loosening of teeth or ill filling denture ill filling denture

• Maxillaryl lesion may Maxillaryl lesion may produce visual produce visual disturbance , nasal disturbance , nasal obstruction , epistaxis , obstruction , epistaxis , difficulty in breathing difficulty in breathing

ChondrosarcomaChondrosarcoma

• Radiography:Radiography: • Moth eaten or Moth eaten or

multilocular radiolucent multilocular radiolucent area with spotty area with spotty calcification calcification

Histopathology:Most of jaw lesion are of well differentiated and the neoplastic chondrocyte are pleomorphic , binucleated with mitosis

Neoplastic chondrocytes


• Clinical feature : Clinical feature : 1.1. 20% of all sarcoma , 5% 20% of all sarcoma , 5%

occur in the jaw bones .occur in the jaw bones .

2.2. Young adult male .Young adult male .

3.3. More in the mandible .More in the mandible .( Symphysis , angle of ( Symphysis , angle of the ramus and near the the ramus and near the tempro-mandibular joint tempro-mandibular joint ) .) .

4.4. Maxillary lesion involve Maxillary lesion involve the alveolar ridge , the alveolar ridge , antrum and palate antrum and palate

5.5. Rapidly growing mass Rapidly growing mass accompanied with pain , accompanied with pain , numbness of lower lips numbness of lower lips trismus trismus

Giant cell tumorGiant cell tumor

• More common in More common in long bone and rate long bone and rate in jaw .in jaw .

• It’s differ from more It’s differ from more common and similar common and similar but reactive lesion but reactive lesion of in the jaw of in the jaw ( Central giant cell ( Central giant cell granuloma) by the granuloma) by the following :following :

Giant cell tumor

Giant cell tumorGiant cell tumor

1.1. Occur in more older age .Occur in more older age .

2.2. More aggressive More aggressive

3.3. The giant cells uniformly The giant cells uniformly dispersed throughout the dispersed throughout the lesion .lesion .

4.4. Unusual to fined foci of Unusual to fined foci of bone or osteoid bone or osteoid formation.formation.

5.5. Stroma hemorrhage and Stroma hemorrhage and hemosedrin pigment are hemosedrin pigment are absentabsent

6.6. Small percentage have Small percentage have sarcomatous course with sarcomatous course with metastasis metastasis

7.7. Require radical treatment Require radical treatment Central giant cell

granuloma

Ewing’s sarcomaEwing’s sarcoma

• It is a rare highly It is a rare highly malignant primary malignant primary bone tumor , it is bone tumor , it is believed to be arise believed to be arise from from undifferentiated undifferentiated reticuloendothelial reticuloendothelial cells of bone marrow cells of bone marrow

Constitute 10 %of all malignant bone tumor


• Clinical feature: Clinical feature: 1.1. Younger individual ( 5-25 Younger individual ( 5-25

years ).years ).

2.2. Slight male predominance .Slight male predominance .

3.3. In the head and neck In the head and neck mandible is more affected mandible is more affected

4.4. Rapid jaw bone swelling Rapid jaw bone swelling associated with pain associated with pain

5.5. Facial deformity, Facial deformity, destruction of alveolar bone destruction of alveolar bone

6.6. Loosening of the teeth with Loosening of the teeth with mucosal ulceration .mucosal ulceration .

7.7. May associated with fever, May associated with fever, leucocytosis and high ESR leucocytosis and high ESR and indicate poor prognosisand indicate poor prognosis

Moth eaten destructive radiolucency

6.6. Loosening and Loosening and displacement of teeth .displacement of teeth .

7.7. Maxillry lesion may Maxillry lesion may cause nasal cause nasal obstruction , epistaxisobstruction , epistaxis

8.8. The overlying skin red The overlying skin red , inflamed with , inflamed with vascular prominence .vascular prominence .

9.9. Ulceration , Ulceration , hemorrhage and hemorrhage and pathological fracture pathological fracture are common are common


• Histopathology:Histopathology: • Proliferation of small Proliferation of small

uniform rounded uniform rounded cells ( Lymphocyte cells ( Lymphocyte like ) closly backed like ) closly backed and seperated by and seperated by fibrous bands into fibrous bands into sold masses sold masses

Ewing’s sarcoma

Langerhan’s cell Langerhan’s cell HistiocytosisHistiocytosis

• Histiocytosis X:Histiocytosis X: • Group of disorder Group of disorder

characterized histologically characterized histologically by proliferation of by proliferation of langerhan’s and antigen langerhan’s and antigen presenting cellpresenting cellss

Range from sever fatal to mild isolated form

Classified into 3 forms

I.I. Isolated Isolated (unifocal )eosinophilic (unifocal )eosinophilic

granuloamgranuloam1.1. Patient under 2o years .Patient under 2o years .

2.2. More common in male More common in male

3.3. More common in the skull More common in the skull , ribs and jaw, ribs and jaw

4.4. In the jaw more frequent In the jaw more frequent in mandible .in mandible .

5.5. Produce localized Produce localized destruction and expansion destruction and expansion oth the PD space with oth the PD space with loosening of teeth loosening of teeth

Produce round radiolucent area and teeth appears floating in air

Hand –Schüller –Christian Hand –Schüller –Christian diseasedisease

• Multfocal .Multfocal .• In the jaw mandible In the jaw mandible

affected with extensive affected with extensive destruction and teeth destruction and teeth exfoliationexfoliation

• He patosplenomegaly He patosplenomegaly and Lymphadenopathy and Lymphadenopathy

• Diabetes insibidus Diabetes insibidus

Latter –Siwe disease Latter –Siwe disease • Progressive ( acute) Progressive ( acute)

disseminated histiocytosis disseminated histiocytosis ..

• Fever . Skin rash , L.N, Fever . Skin rash , L.N, hepatosplenomegaly , hepatosplenomegaly , pancytopenia pancytopenia

• Loosening of teeth Loosening of teeth

Histopathology:1.Collection of histiocytes mixed with granulocytes and lymphocytes 2.Multinucleated giant cells are prominent Giant cells

Multiple myelomaMultiple myeloma

• Is a neoplasm of plasma Is a neoplasm of plasma with production of with production of monoclonal monoclonal immunoglobul ( IgG).immunoglobul ( IgG).

• Multiple bone or solitaryMultiple bone or solitary• Chronic progressive anf Chronic progressive anf

fatal disesae . fatal disesae . Osteolytic

Multiple myelomaMultiple myeloma

• Older individual .Older individual .• Mandible is more Mandible is more

affected affected • Bone pain .Bone pain .• Anemia .Anemia .• Pancytopenia Pancytopenia • infection infection • Paraproteinemia .Paraproteinemia .• Protein urea Protein urea • Amyloidosis Amyloidosis

Mature and immture plasma cell

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Jaw bone disaese ii