Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 1/61

Lab Paget`s Disease

and Bone TumorsDr. Rima Safadi

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 2/61

2

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 3/61

3

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 4/61

4

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 5/61

5

Torus palatinusEtiology: genetic versus environmentalArises at the midline of the hard palate

Can slowly increase in size

Peak prevalence is in adult- dynamic

Nodular torus Lobular torusSpindle torus and flat torus

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 6/61

6

Torus mandibularis

At the lingual aspectPresent above themylohyoid line90% bilateralVaries in sizeCan correlate with

bruxismTrt: surgical removalfor dentureconstruction

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 7/61

7

Exostoses

Buccalexostosis

Subpontine exostosis

Palatal exostosis

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 8/61

8

Exostosis

Histopathology

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 9/61

9

Dense Bone Island

IdiopathicosteosclerosisSclerotic bone

Premolar regionof the mandibleWell defined notsurrounded byradiolucent lineSeparated orattached to root

apex

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 10/61

10

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 11/61

11

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 12/61

12 Well defined radiolucent radioopaque

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 13/61

13

Ossifying fibroma

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 14/61

14

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 15/61

15

Ossifying fibroma

Fibrous stroma

Bone trabeculae

Osteoblastic rimming

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 16/61

16

Psammomatoid ossifying fibroma

Cementum like bodies

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 17/61

17

Ossifying fibroma

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 18/61

18

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 19/61

19

Loose teeth

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 20/61

20

Also gingival swelling

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 21/61

21

Differential diagnosis??

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 22/61

22

Floating in air teeth

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 23/61

23

Biopsy

Langehrans cell-malignanteosinophils

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 24/61

24

Diagnosis?

Langerhans cell histiocytosis

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 25/61

25

74 yr old hospitalized for low backpain

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 26/61

26

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 27/61

27

Punched out radiolucencies

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 28/61

28

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 29/61

29

Also present is gingival swelling

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 30/61

30

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 31/61

31

Malignant plasmacells

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 32/61

32

Malignant plasmacells

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 33/61

33

Immunohistochemistrykappa light chain (positive)

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 34/61

34

Immunohistochemistrylambda light chain(negative)

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 35/61

35

Diagnosis:

Multiple myeloma

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 36/61

36

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 37/61

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 38/61

38

Malignant osteoid

Malignantosteoblasts

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 39/61

39

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 40/61

40

Hemangioma

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 41/61

41

Central hemangioma

Cavernous blood spaces

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 42/61

42

Ill defined RL in anterior maxilla

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 43/61

43

Chondrosarcoma

Malignant chondroi

Malignant chondroblasts

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 44/61

44

Hard swelling at right angle ofmandible

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 45/61

45

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 46/61

46

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 47/61

47

Compact osteoma

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 48/61

48

Colonic biopsy

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 49/61

49

Adenoma

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 50/61

50

Diagnosis

Gardner Syndrome

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 51/61

51

Paget`s Disease of Bone

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 52/61

52

Paget`s Disease of Bone

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 53/61

53

Paget`s Disease of Bone

P ’ Di

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 54/61

54

Paget’s Disease Oral Features

When teeth areinvolved:Ankylosis

HypercementosisRoot resorption inosteolytic phase

Postextractionhemorrhage in activephaseMore prone to infectionin sclerotic phase

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 55/61

55

Paget`s Disease of Bone

Loss of diploeDense bone

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 56/61

56

Paget`s Disease of Bone

Reversal lines ciss-cross lines

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 57/61

57

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 58/61

58

Osteosarcoma

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 59/61

59

Metastatic carcinoma

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 60/61

60

Metastatic disease

8/3/2019 Lab 6 Paget`s Disease and Bone Tumors2010 Shorter

http://slidepdf.com/reader/full/lab-6-pagets-disease-and-bone-tumors2010-shorter 61/61

Mts