Jaw bone disaese ii
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Jaw bone disaese ii

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Jaw bone disaese ii

Jaw bone disaese ii

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Jaw bone disaese ii Jaw bone disaese ii Presentation Transcript

  • Jaw bone Disease II Mazen Abood Bin Thabit MD.FICPath . Associate Prof .of Pathology.Senior lecturer of Oral pathology and oral histology
  • Classification of bone disease1. Inflammatory bone disease.2. Hereditary bone disease .3. Metabolic bone disease .4. Disease of unknown etiology . a. Paget’s disease . b. Fibro-osseous disease5. Bone tumors .
  • Normal bone histology Haversian system
  • Jaw bone tumors• Primary tumor of bone are uncommon lesion in the jaws and the arises from different type of cells
  • Classification1. Bone forming tumor : 2. Cartilage forming tumor Benign Benign a. Osteoma. a. Chondroma . b. Osteoid osteoma b. Osteochondroma c. Osteoblastoma. c. Chondroblastoma Malignant . Malignant a. Osteosarcoma a. Chondrosarcoma
  • Classification3. Giant cell tumor4. Marrow tumors a. M.Myeloma . b. Ewing’s sarcoma .4. Langerhan’s cell histiocytosis5. Fibrous tumor Benign : Ossifying cementofibroma Malignant : Fibrosarcoma
  • Osteoma• Benign slow growing neoplasm of mature osseous tissue1. Sub-periosteal.2. Endosteal
  • Osteoma• Clinical feature :1. More in adult .2. Male predominance .3. More frequent in the mandible4. In the jaw usually arise from areas where tori dose not formed5. May arises in the skull , face and sinuses .6. Usually solitary .7. Multiple osteomas may occur as feature of Gardener syndrome
  • Osteoma
  • Osteoid osteoma• Rare benign tumor of the • Clinical feature : bone share clinical , 1. Young individual 2nd -3rd radiological and histological decade . feature with osteoblasoma 2. Typically in the long bone . 3. Rare in the jaw bone and any area affected in the mandible and maxilla . 4. Pain is characteristic . 5. Pain worse at night and relived by Asprin 6. Jaw bone expantion 7. Growth has limited growth potential not exceed 2cm
  • Osteoid osteoma Radiography: Well cercomseribed lesion with central radiolucency ( Nidus) surrounded by rim of sclertotic bone not exceed 2 cm . NidusHistopathology:1.The nidus consist trabeculae of bonewithin highly vascular stroma2.The periphery formed by maturecompact bone
  • Osteoblastoma• Rare bone tumor described as giant osteoid osteoma Osteoblastoma
  • Osteoblastoma1. Cementoblastoma is an odontogenic equivalent .2. Long bones , in the jaw mandible is more affected3. Premolar and molar region.4. Localized swelling with or Osteoblastoma without pain .5. Greater than 2 cm6. Mobility of teeth
  • OsteoblastomaHistopathology: Irregular trabeculae of osteoid and immature bone in rich cellular stroma , the bone trabeculae lined by plump osteoblast and multinucleated o osteoclastRadiography :Area of variable combination of radio-opaque and radiolucent more than2cm surrounded by sclerotic
  • Osteosarcoma• The commonest primary malignant tumor of the bone but is relatively rare in the jaw. Characterized by direct formation of bone or osteoid by tumor cells (WHO) Unknown cause
  • Osteosarcoma• The tumor may follow pre- existing jaw bone condition:1. Radiation of head and neck .2. Paget’s disease .3. Fibrous dysplasia .4. Gaint cell tumor of bone .5. Osteochondroma .6. Bone infarction .7. Chronic osteomyelitis8. Osteogenesis imperfecta
  • Osteosarcoma• Clinical feature :1. 20% of all sarcoma , 5% occur in the jaw bones .2. Young adult male .3. More in the mandible . ( Symphysis , angle of the ramus and near the tempro-mandibular joint ) .4. Maxillary lesion involve the alveolar ridge , antrum and palate5. Rapidly growing mass accompanied with pain , numbness of lower lips trismus
  • Osteosarcoma6. Loosening and displacement of teeth .7. Maxillry lesion may cause nasal obstruction , epistaxis8. The overlying skin red , inflamed with vascular prominence .9. Ulceration , hemorrhage and pathological fracture are common
  • Osteosarcoma• Radiography:1. Early osteosarcoma may produce widening of PD space due to tumor invasion of PD and resorption of alveolar bone.2. Advanced tumor produce osteolytic lesion appears as Widening of PD irregular moth eaten radiolucent areas or irregular poorly demarcated radio-opacities Sunburst
  • Osteosarcoma• Histopathology:1. Sarcomatous stroma with direct formation of osteoid by tumor cells ( Malignant osteoblast ) .2. Neoplastic osteoblast vary in shape and sized3. Malignant giant cells may conspicuous.4. Osteosarcoma of jaw have better prognosis in general
  • Osteosarcoma Radical treatment
  • Oateochonderoma• Rare in the jaw• Usually arise from epiphyseal plat of long bone .• In the jaw arise from the region of coronid process and mandibular condoyle.• More common in childhood and adolescent .• Tumor usually pedunculated .• Consist of core of mature bone capped by hyaline cartilage with active enchondral ossification at it’s junction• Tumor stop growing after skeletal maturation
  • Chondroma and chondrosarcoma• Chondroma and chondrosarcoma are rare in jaw .• Distinction between benign and malignant is difficult .• Diagnosis of chondroma in jaw should be avoided .• Chondrosarcoma commonly in Chondroma the maxilla .• In the maxilla involve the Chondrosarcoma anterior region ( Lateral incisor and canine ) and palate .• In the mandible affect the posterior part
  • Chondroma and chondrosarcoma• Common in adulthood and old age .• Painless swelling with expansion of the jaw .• Loosening of teeth or ill filling denture• Maxillaryl lesion may produce visual disturbance , nasal obstruction , epistaxis , difficulty in breathing
  • Chondrosarcoma• Radiography:• Moth eaten or multilocular radiolucent area with spotty calcification Histopathology: Most of jaw lesion are of well differentiated and the neoplastic chondrocyte are pleomorphic , binucleated with mitosis Neoplastic chondrocytes
  • Osteosarcoma• Clinical feature :1. 20% of all sarcoma , 5% occur in the jaw bones .2. Young adult male .3. More in the mandible . ( Symphysis , angle of the ramus and near the tempro-mandibular joint ) .4. Maxillary lesion involve the alveolar ridge , antrum and palate5. Rapidly growing mass accompanied with pain , numbness of lower lips trismus
  • Giant cell tumor• More common in long bone and rate in jaw .• It’s differ from more common and similar but reactive lesion of in the jaw ( Central giant cell granuloma) by the following : Giant cell tumor
  • Giant cell tumor1. Occur in more older age .2. More aggressive3. The giant cells uniformly dispersed throughout the lesion .4. Unusual to fined foci of bone or osteoid formation.5. Stroma hemorrhage and hemosedrin pigment are absent6. Small percentage have sarcomatous course with metastasis Central giant cell granuloma7. Require radical treatment
  • Ewing’s sarcoma• It is a rare highly malignant primary bone tumor , it is believed to be arise from undifferentiated reticuloendothelial cells of bone marrowConstitute 10 %of all malignantbone tumor
  • Ewing’s sarcoma• Clinical feature:1. Younger individual ( 5-25 years ).2. Slight male predominance .3. In the head and neck mandible is more affected4. Rapid jaw bone swelling associated with pain5. Facial deformity, destruction of alveolar bone6. Loosening of the teeth with mucosal ulceration .7. May associated with fever, Moth eaten destructive radiolucency leucocytosis and high ESR and indicate poor prognosis
  • 6. Loosening and displacement of teeth .7. Maxillry lesion may cause nasal obstruction , epistaxis8. The overlying skin red , inflamed with vascular prominence .9. Ulceration , hemorrhage and pathological fracture are common
  • Ewing’s sarcoma• Histopathology:• Proliferation of small uniform rounded cells ( Lymphocyte like ) closly backed and seperated by fibrous bands into sold masses Ewing’s sarcoma
  • Langerhan’s cell Histiocytosis• Histiocytosis X:• Group of disorder characterized histologically by proliferation of langerhan’s and antigen presenting cells Range from sever fatal to mild isolated form Classified into 3 forms
  • I. Isolated (unifocal )eosinophilic granuloam1. Patient under 2o years .2. More common in male3. More common in the skull , ribs and jaw4. In the jaw more frequent in mandible .5. Produce localized destruction and expansion oth the PD space with loosening of teeth Produce round radiolucent area and teeth appears floating in air
  • Hand –Schüller –Christian disease• Multfocal .• In the jaw mandible affected with extensive destruction and teeth exfoliation• He patosplenomegaly and Lymphadenopathy• Diabetes insibidus
  • Latter –Siwe disease• Progressive ( acute) disseminated histiocytosis .• Fever . Skin rash , L.N, hepatosplenomegaly , pancytopenia• Loosening of teethHistopathology:1.Collection of histiocytes mixedwith granulocytes and lymphocytes2.Multinucleated giant cells areprominent Giant cells
  • Multiple myeloma• Is a neoplasm of plasma with production of monoclonal immunoglobul ( IgG).• Multiple bone or solitary• Chronic progressive anf fatal disesae . Osteolytic
  • Multiple myeloma• Older individual .• Mandible is more affected• Bone pain .• Anemia .• Pancytopenia• infection• Paraproteinemia .• Protein urea• AmyloidosisMature and immture plasma cell