Jaw bone disaese ii

1. Jaw bone Disease II
Mazen Abood Bin Thabit MD.FICPath
. Associate Prof .of Pathology
.Senior lecturer of Oral pathology and oral histology

2. Classification of bone disease
1. Inflammatory bone disease.
2. Hereditary bone disease .
3. Metabolic bone disease .
4. Disease of unknown etiology .
a. Paget’s disease .
b. Fibro-osseous disease
5. Bone tumors .

3. Normal bone histology
Haversian system

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

5. Classification
1. 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

6. Classification
3. Giant cell tumor
4. Marrow tumors
a. M.Myeloma .
b. Ewing’s sarcoma .
4. Langerhan’s cell histiocytosis
5. Fibrous tumor
Benign :
Ossifying cementofibroma
Malignant :
Fibrosarcoma

7. Osteoma
• Benign slow growing
neoplasm of mature
osseous tissue
1. Sub-periosteal.
2. Endosteal

8. Osteoma
• Clinical feature :
1. More in adult .
2. Male predominance .
3. More frequent in the mandible
4. In the jaw usually arise from areas
where tori dose not formed
5. May arises in the skull , face and
sinuses .
6. Usually solitary .
7. Multiple osteomas may occur as
feature of Gardener syndrome

9. Osteoma

11. 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

12. Osteoid osteoma
Radiography:
Well cercomseribed lesion with
central radiolucency ( Nidus)
surrounded by rim of sclertotic
bone not exceed 2 cm .
Nidus
Histopathology:
1.The nidus consist trabeculae of bone
within highly vascular stroma
2.The periphery formed by mature
compact bone

13. Osteoblastoma
• Rare bone tumor described
as giant osteoid osteoma
Osteoblastoma

14. Osteoblastoma
1. Cementoblastoma is an
odontogenic equivalent .
2. Long bones , in the jaw
mandible is more affected
3. Premolar and molar region.
4. Localized swelling with or Osteoblastoma
without pain .
5. Greater than 2 cm
6. Mobility of teeth

15. Osteoblastoma
Histopathology:
Irregular trabeculae of osteoid
and immature bone in rich
cellular stroma , the bone
trabeculae lined by plump
osteoblast and multinucleated
o osteoclast
Radiography :
Area of variable combination of radio-
opaque and radiolucent more than
2cm surrounded by sclerotic

16. 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

17. 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 osteomyelitis
8. Osteogenesis imperfecta

18. 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
palate
5. Rapidly growing mass
accompanied with pain ,
numbness of lower lips trismus

19. Osteosarcoma
6. Loosening and displacement
of teeth .
7. Maxillry lesion may cause
nasal obstruction , epistaxis
8. The overlying skin red ,
inflamed with vascular
prominence .
9. Ulceration , hemorrhage and
pathological fracture are
common

20. 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

21. Osteosarcoma
• Histopathology:
1. Sarcomatous stroma with direct
formation of osteoid by tumor
cells ( Malignant osteoblast ) .
2. Neoplastic osteoblast vary in
shape and sized
3. Malignant giant cells may
conspicuous.
4. Osteosarcoma of jaw have better
prognosis in general

22. Osteosarcoma
Radical treatment

23. 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

24. 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

25. 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

26. 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

27. 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
palate
5. Rapidly growing mass
accompanied with pain ,
numbness of lower lips trismus

28. 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

29. Giant cell tumor
1. Occur in more older age .
2. More aggressive
3. 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
absent
6. Small percentage have
sarcomatous course with
metastasis
Central giant cell granuloma
7. Require radical treatment

30. Ewing’s sarcoma
• It is a rare highly
malignant primary bone
tumor , it is believed to
be arise from
undifferentiated
reticuloendothelial cells
of bone marrow
Constitute 10 %of all malignant
bone tumor

31. Ewing’s sarcoma
• Clinical feature:
1. Younger individual ( 5-25 years ).
2. Slight male predominance .
3. In the head and neck mandible
is more affected
4. Rapid jaw bone swelling
associated with pain
5. Facial deformity, destruction of
alveolar bone
6. Loosening of the teeth with
mucosal ulceration .
7. May associated with fever, Moth eaten destructive radiolucency
leucocytosis and high ESR and
indicate poor prognosis

32. 6. Loosening and displacement
of teeth .
7. Maxillry lesion may cause
nasal obstruction , epistaxis
8. The overlying skin red ,
inflamed with vascular
prominence .
9. Ulceration , hemorrhage and
pathological fracture are
common

33. 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

34. 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

35. I. Isolated (unifocal )eosinophilic
granuloam
1. Patient under 2o years .
2. More common in male
3. More common in the skull ,
ribs and jaw
4. 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

36. Hand –Schüller –Christian disease
• Multfocal .
• In the jaw mandible affected
with extensive destruction and
teeth exfoliation
• He patosplenomegaly and
Lymphadenopathy
• Diabetes insibidus

37. Latter –Siwe disease
• Progressive ( acute) disseminated
histiocytosis .
• Fever . Skin rash , L.N,
hepatosplenomegaly ,
pancytopenia
• Loosening of teeth
Histopathology:
1.Collection of histiocytes mixed
with granulocytes and lymphocytes
2.Multinucleated giant cells are
prominent
Giant cells

38. Multiple myeloma
• Is a neoplasm of plasma with
production of monoclonal
immunoglobul ( IgG).
• Multiple bone or solitary
• Chronic progressive anf fatal
disesae .
Osteolytic

39. Multiple myeloma
• Older individual .
• Mandible is more affected
• Bone pain .
• Anemia .
• Pancytopenia
• infection
• Paraproteinemia .
• Protein urea
• Amyloidosis
Mature and immture plasma cell