Non-odontogenic tumors

Benign
1)Osteogenic tumor- Osteoma Osteoid osteoma & Osteoblastoma 2)Cartilagenous tumor-Chondroma -Chondromyxoid fibroma 3)Fibrous tumor Desmoplastic fibroma 4) Vascular tumor Hemangioma 5)Unknown ORIGIN- Ewing s sarcoma 6)Metastatic tumor

Malignant
Osteosarcoma

Chondrosarcoma Fibrosarcoma

Non-odontogenic tumors

Osteogenic tumor

Benignancy Malignancy 1. Osteoma 3. Osteosarcoma 2. Osteoid osteoma& Osteoblastoma

Osteogenic Tumor
1. Osteoma Clinical & Radiographic Features slow growing,usually asymptomatic tumor periosteal or endosteal osteomas radiographically: presenting as a circumscribed sclerotic mass consistent with bone density depending on the tumor s component can be associated with Gardner s syndrome (multiple osteoma, intestinal polyposis leading to colon CA)

Histopathologic Features compact osteoma: dense bone with minimal marrow tissue cancellous osteoma: trabeculae with fibro-fatty marrow Treatment & Prognosis do not need to be treated, if no symptom

Compact osteoma

Compound osteoma

Multiple osteoma associated with Gardners syndrome

Osteogenic Tumor
2. OSTEOID OSTEOMA & OSTEOBLASTOMA

identical lesions, but distinguished from one another by location, size, and symptomatology

Clinical & Radiographic Features

Osteoid osteoma rare in the jaws most occurring in femur, tibia, phalanges usually presenting as pain in the night, alleviated by salicylate(aspirin) appearing as a well - circumscribed radiolucent defect,usually<1cm(not more than 2 cm) in diameter, with sclerotic rim a small radiopaque nidus may be present

Osteoblastoma
most often occurring in vertebral column, but may involve any bone, mandible:maxilla = 2:1 2-4cm in size, but may be as large as 10cm presenting with pain, but less often nocturnal and not relieved by aspirin may appear as a well- defined or ill - defined radiolucent lesion.

Histopathologic Features

anastomosing osteoid trabeculae in a cellular fibrovascular stroma the osteoid trabeculae, which often appearing basophillic surrounded by prominent osteoblasts

Treatment and Prognosis

local excision or curettage good prognosis

Nidus

Aggressive Osteoblastomas
more often in older patients common symptom: pain lesion: the features of conventional osteoblastomas but tend to be larger microscropically, characterized by the presence of large (epithelioid) osteoblasts with increased mitotic activity

Osteogenic Tumor
3. Osteosarcoma

The distal femur and proximal tibia: the most frequent sites 7% : occurring in the jaws

Clinical & Radiographic Features

most often occurring in the third and fourth decades of life males > females swelling and pain loosening of teeth, paresthesia, and nasal obstruction young children to the elderly varying from dense sclerosis to admixed sclerotic and radiolucent lesion, to an entirely radiolucent process, ill defined and indistinct margin

Histopathologic Features
production of osteoid by malignant m e s e n c h y m a l c e l l s o s t e o b l a s t i c c h o n d r o b l a s t i c f i b r o b l a s t i c T r e a t m e n t & P r o g n o s i s r a d i c a l s u r g i c a l e x c i s i o n s u p p l e m e n t e d : c h e m o t h e r a p y, radiation therapy or both

Typical sun-ray appearance

Osteogenic Tumor
Peripheral (juxtacortical) Osteosarcoma usually occurring in the long bones a few examples involving the jaws the parosteal type of osteosacroma is characterized by a high degree of structural differentiation the periosteal type of osteosacroma : a histopathologically higher grade of tumor with a prominent cartilaginous component

Osteogenic Tumor
Post - Irradiation Bone Sarcoma develop as early as 3 years after radiation, but the average latent period is about 14 years 0.2% Pt: receiving 7000 rad (cGy) osteosacroma is the most common type of Post - irradiation Bone Sacroma, accounting for 50% of all cases

Terry Fox 1958-1981

Benignancy Cartilagenous tumor

1. Chondroma

Malignancy
3. Chondrosarcoma

2. Chondromyxoid fibroma

Cartilagenous Tumor

1. Chondroma
mature hyaline cartilage most often located in the short tubular bones of the hand and the feet. rarely been reported in the jaws. Histopathological Features mature cartilage very difficult to distinguish from low grade chondrosarcoma

Chondroma

Treatment and Prognosis

total surgical removal of the tumor

2. Chondromyxoid Fibroma benign neoplasm.

most commonly located in the metaphyseal region of the long bones. rarely involving in the jaws.

Clinical and Radiographic Feature

age: 10 - 67 years old. most often: under age 25 years old. pain or expansion of the involved area. asymptomatic. presenting as a circumscribed radiolucent defect with sclerotic or scalloped margins calcification.

Histopathological Features
consisting of lobulated areas of spindle shaped or stellate cells and abundant myxoid or chondroid intercellular substance. spindle - shaped or round cells with varying numbers of multinucleated cells. focal areas of calcification and spicules of residual bone.

block excision as the initial treatment. curettage.

Treatment and Prognosis

3. Chondrosarcoma
malignant neoplasm. most commonly located in the metaphyseal region of the long bones. rarely involving in the jaws.

Clinical and Radiographic Feature

wide age range average age: 33 years the most common presenting as painless or swelling mass the maxilla and mandible involved with about equal frequency a radiolucent process with poorly defined borders containing scattered and variable amounts of radiopaque foci

Histopathological Features
consists of cartilage with varying degree of maturation and cellurarity, and showing lobulated growth pattern ossification, calcification and chondroid matrix

Treatment and Prognosis

r a d i c a l s u r g i c a l e x c i s i o n poorer prognosis than osteosarcoma of the jaws

Non-odontogenic tumors
Benignancy Fibrous tumor Desmoplastic fibroma Malignancy Fibrosarcoma

Fibrous Tumor
1. Desmoplastic Fibroma
rare tumor humerus and tibia > 50 %

Clinical and Radiographic Features

age: < 30 years old. 90% in the mandible: the molar - angle ascending - ramus area. Painless swelling. Unilocular or multiocular radiolucent area. well defined or ill defined Margins expanded cortex roots: resorption.

Histopathological Features
small elongated fibroblasts and abundant collagen fibers. plumper fibroblasts and less collagen. bone spicules may be present.

Treatment and Prognosis

locally aggressive fashion. radical surgery.

A. Odontogenic fibroma vs B. Desmoplastic fibroma

2. Fibrosarcoma of Bone
one of the least common types of primary bones sarcomas
Clinical and Radiographic Features a wide age rang ( average 40 years old) No gender predilection

most commonly occurring in the long tubular bones, particularly the femur and humerus 15% in the craniofacial bones, and mandible being the predominant site pain, swelling, paresthesia, and loosening of teeth presenting as lytic, destructive lesions

Histopathological Features
low - grade tumors characterized by abundant intercellular collagen with a herringbone pattern

Fibrosarcoma extending from the soft tissue to the bone

high - grade tumors showing cellular pleomorphism, increased mitotic activity, loss of the herringbone pattern, and less collagen formation

Treatment and Prognosis

radical resection
prognosis for tumors originating in the medullary portion of the bone being poorer than for those arising in a periosteal position

NonNon-Odontogenic Tumors Tumors

Vascular tumor

Hemangioma a

Vascular Tumor
Hemangioma of Bone
Central hemangiomas
Clinical and Radiographic Features
age: 10 - 20 years old. female > Male twice as often in the mandible as the maxilla. asymptomatic pain and swelling.

Clinical and Radiographic Features

a bruit or pulsation most commonly, a multilocular radiolucent defect. small (honeycomb appearance) or large (soap bubble appearance). ill - defined radiolucent area or a well - defined, cyst - like radiolucency. resorption of the roots cortical expansion, and occasionally a sunburst radiographic pattern is produced.

Cavernous hemangioma

Histopathological Features
fibrous connective tissue stroma supporting numerous vascular channels lined with a single layer of endothelial cells.

Treatment and Prognosis

potentially dangerous lesions because of the risk of severe bleeding. surgical resection or curettage, cryotherapy, radiation, or injections of sclerosing solution presurgical embolization. good prognosis.

NonNon-Odontogenic Tumors Tumors

Unknown origin

Benignancy Malignancy Ewing s sarcoma

Unknown Origin
Ewing s Sarcoma
Clinical and Radiographic Features
6-10% of all primary bone tumors femur and pelvic bones: nearly 50% of all cases < 3% involving jaws bones 80% occurring in 10-20 Y/O, male;female=3:2 mandible>maxilla paresthesia and loosening of teeth

irregular lytic bone destruction with ill-defined margin long bones onion-skin periosteal reaction: commonly observed in long bones

Histopathological Features small round with well-delineated nuclear outline and indistinct cellular border 75% of cases containing glycogen in tumor cells

Ewings sarcoma

Treatment and Prognosis

surgery, radiotherapy and chemotherapy leading to 40-80% survival rates

Metastatic Tumors to The Jaws

primary carcinomas of thyroid, breast, kidney, lung and prostate usually metastasizing to bones jaws bones: uncommon site for metastasis, but if occuring 80% found in the mandible