Non-odontogenic tumorsBenign1)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

MalignantOsteosarcoma

Chondrosarcoma Fibrosarcoma

Non-odontogenic tumors

Osteogenic tumor

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

Osteogenic Tumor1. 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 Tumor2. OSTEOID OSTEOMA & OSTEOBLASTOMA

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

Clinical & Radiographic FeaturesOsteoid 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 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 Featuresproduction 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 TumorPeripheral (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 TumorPost - 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 tumor1. Chondroma

Malignancy3. Chondrosarcoma

2. Chondromyxoid fibroma

Cartilagenous Tumor

1. Chondromamature 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 Prognosistotal 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 Featureage: 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 Featuresconsisting 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. Chondrosarcomamalignant neoplasm. most commonly located in the metaphyseal region of the long bones. rarely involving in the jaws.

Clinical and Radiographic Featurewide 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 Featuresconsists of cartilage with varying degree of maturation and cellurarity, and showing lobulated growth pattern ossification, calcification and chondroid matrix

Treatment and Prognosisr 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 tumorsBenignancy Fibrous tumor Desmoplastic fibroma Malignancy Fibrosarcoma

Fibrous Tumor1. Desmoplastic Fibromarare 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 Featuressmall elongated fibroblasts and abundant collagen fibers. plumper fibroblasts and less collagen. bone spicules may be present.

Treatment and Prognosislocally aggressive fashion. radical surgery.

A. Odontogenic fibroma vs B. Desmoplastic fibroma

2. Fibrosarcoma of Boneone of the least common types of primary bones sarcomasClinical 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 Featureslow - 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 Prognosisradical resectionprognosis 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 TumorHemangioma of BoneCentral hemangiomasClinical and Radiographic Featuresage: 10 - 20 years old. female > Male twice as often in the mandible as the maxilla. asymptomatic pain and swelling.

Clinical and Radiographic Featuresa 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 Featuresfibrous connective tissue stroma supporting numerous vascular channels lined with a single layer of endothelial cells.

Treatment and Prognosispotentially 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 OriginEwing s SarcomaClinical and Radiographic Features6-10% 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 Prognosissurgery, radiotherapy and chemotherapy leading to 40-80% survival rates

Metastatic Tumors to The Jawsprimary 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