Bone Pathology

Question 1

What does NIRDS stand for?

Answer 1

• N: Neoplastic
• I: Inflammatory/Infectious/Idiopathic
• R: Reactive
• D: Developmental
• S: Systemic

Question 2

What are some Neoplastic Benign Pathologies?

Answer 2

• Osteoma
• Osteoid Osteoma
• Ossifying Fibroma (BFOL)
• Chondroma
• Chondromyxoid Fibroma
• Desmoplastic Fibroma
• Central Hemangioma

Question 3

What are some Neoplastic Malignant Pathologies?

Answer 3

• Osteosarcoma
• Chdondrosarcoma
• Ewing Sarcoma
• Multiple Myeloma
• Langerhands Cell Histiocytosis
• Metastatic Disease

Question 4

What are some Inflammatory/Infectious/Idiopathic Pathologies?

Answer 4

• Osteomyelitis
• Osteoradionecrosis (ORN)
• Osteonecrosis of the jaw (ONJ)
• Paget’s Disease
• Idiopathic Osteosclerosis
• Idiopathic Bone Cavity

Question 5

What are some Reactive Pathologies?

Answer 5

• Central Giant Cell Lesion
• Aneurysmal Bone Cyst
• Cemento-Osseous Dysplasias

Question 6

What are some Developmental Pathologies?

Answer 6

• Osteogenesis Imperfecta
• Cleidocranial Dysplasia
• Cherubism
• Fibrous Dysplasia
• Osteopetrosis

Question 7

What is an example of Systemic Pathology?

Answer 7

Hyperparathyroidism

Question 8

What is a Focal Osteoporotic Marrow Defect?

Answer 8

• Not a pathologic Process - etiology unknown
• Area of hematopoietic marrow large enough to note on imagin
• Asymtomatic, incidental finding
• A few millimeters to several centimeters
• Somewhat ill-defined radiolucency containing fine trabeculations

Question 9

Where are Focal Osteoporotic Marrow Defects usually found?

Answer 9

• >75% female
• 70% posteiror mandible, often edentulous area - may occur elsewhere (skull)
• Histology: Normal Hematopoietic Bone
• Treatment: None necessary, other than possibly incisional biopsy ro rule out pathology

Question 10

What is a Stafne Defect?

Answer 10

• AKA static bone cyst (not a true cyst)
• Described by Safne in 1942
• Focal concavity on lingual of mandible
• Classically, radiolucency located below mandibular canal, between molars and angle of mandible
• May be located in anterior mandible
• Most patients are male

Question 11

What is the treatment for Stafne Bone Defect?

Answer 11

• No treatment necessary; biopsy to rule out other pathology
• May exhibit slow growth over time (not necessarily “static”)
• Developmental defect, but ot congenital
• Usually seen in middle age to older adults
• Defects usually contains salivary gland tissue (submandibular), but also reports of muscle adipose tissue, vascular tissue, lymphoid tissue, etc

Question 12

What are the main culprits in the pathology of Osteomyelitis?

Answer 12

• Bacterial Infection most commonly
• Dental Portal
• Mixed flora - Staph aureus, Strep, Actino; also may be mycobacterial, fungal, or viral
• Inflammatory Process
• Medullary &/or cortical bone
• Extends away from initial site of involvement

Question 13

How do you differentiate between acute and chronic Osteomyelitis?

Answer 13

• Acute (<1 month)
• Chroni (>1 month)
• Suppurative
• Diffuse sclerosing
• Focal sclerosing
• Osteomyelitits with proliferative periosititis (Garre’s)
• SAPHO syndrome: synovitis, acne, pustulosis, hyperososis, osteitis

Question 14

What is the treatment for Osteomyelitis?

Answer 14

• Identify cause and treat
• Prevent acute-to-chronic transition
• Culture & antibiotics sensitivity testing (3 culture tubes)
• Anerobic
• Aerobic
• Gram stain
• Order/set/OMFS/wound culture (1 & 3)
• I & D, surgical debridment
• Antibiotics (oral vs IV)

Question 15

What is Osteomyelitis with Proliferative Periositits also known as?

Answer 15

• AKA Garre’s osteomyelitis - Garre was a German physician who reported on osteomyelitis in 1893. He had no pathologic speciments for microscopic examination and did not mention a periosteal reaction in his original paper. Roentgen did not discover X-rays until 1895
• MEan age of 13 years (children and young aduults)
• Radiopaque laminations (onion-skinning)
• Most cases are due to periapical inflammatory disease

Question 16

What are Bisphosphonates used to treat?

Answer 16

• Symtomatic osteolytic lesions
• Multiple Myeloma
• Mets of solid tumors
• Paget’s disease of bone
• Prevention/progressionof osteoporosis
• Bisphosphotnate-related osteonecrosis (BRON, BRONJ)