2 BONE PATHOLOGY.LECTURE pathology .pptx

Bone

1. BONE PATHOLOGY

2. OUTLINE FIBRO-OSSEOUS LESIONS: CEMENTO-OSSEOUS DYSPLASIA CHERUBISM FIBROUS DYSPLASIA OSSIFYING FIBROMA

3. An asymptomatic regional alteration of bone in which the normal architecture is replaced by fibrous tissue and non functional trabecula like osseous structures Monostotic / polystotic With or without associated endocrine disorders FIBROUS DYSPLASIA

4. 2 types: Juvenile Adult Monostotic Polystotic FIBROUS DYSPLASIA

5. Early to late childhood Maxilla more affected No pain or discomfort Teeth become displaced rotated or malalligned Severe malocclusion Severe JFD, it becomes symptomatic reaching upto the floor of the orbit and nasal/ paranasal sinuses making breathing difficult and hindering the sight Facial deformity due to bone expansion JUVENILE FIBROUS DYSPLASIA

6. JUVENILE FIBROUS DYSPLASIA

7. RADIOGRAPHIC FEATURES: Varies with stage of maturity Mixed radiopaque / radiolucent lesion Ground glass appearance on radiograph No line of demarcation between the lesion and surrounding bone Bone expansion and displacement of tooth roots JUVENILE FIBROUS DYSPLASIA

8. JUVENILE FIBROUS DYSPLASIA

9. HISTOPATHOLOGICAL FEATURES: Irregular woven bone in a fibrous stroma Assumes a Chinese letter pattern Fuses with normal bone No line of demarcation Monotonous uniform pattern Bony trabaculae predominate the fibrous stroma JUVENILE FIBROUS DYSPLASIA

10. JUVENILE FIBROUS DYSPLASIA

11. JUVENILE FIBROUS DYSPLASIA

12. May be monostotic or polystotic ADULT FIBROUS DYSPLASIA

13. Resembles lesions seen in mature juvenile fibrous dysplasia Asymptomatic diffuse swelling Some movement of teeth may be seen Radiographically , mixed radiopaque - radiolucent appearance of bone Cotton ball appearance Individual lesions blend with adjacent bone Expansion and thinning of cortical bones in radiographs seen ADULT MONOSTOTIC FIBROUS DYSPLASIA

14. Histopathology is similar to JFD Treatment includes complete removal of the smaller lesions surgically ADULT MONOSTOTIC FIBROUS DYSPLASIA

15. Accompanied by skin pigmentation and endocrine dysfunctioning More than one bone is involved ( ribs, cranium, femur, tibia) May be confined to craniofacial area or may be distributed diffusely throughout the skeleton Small light brown pigmentation may be seen on the skin called café au lait spots These spots have jagged edges ADULT POLYSTOTIC FIBROUS DYSPLASIA

16. ADULT POLYSTOTIC FIBROUS DYSPLASIA

17. If the pigmentation is accompanied by endocrine dysfunction, it is called MC-CUNE ALBRIGHT SYNDROME If only pigmentation is present with out the endocrine problems is called JEFF syndrome Histopathology is similar to the one seen in fibrous dysplasia Treatment is towards fixing the functional disturbances and cosmetic surgery is done to recontoure ADULT POLYSTOTIC FIBROUS DYSPLASIA

18. Benign neoplasm 3 rd and 4 th decade most commonly effected by this tumour Female prediclation Mandible most commonly involved Mandibular molar/ premolar areas most common site Painless and asymptomatic swelling Larger lesions may cause excessive facial deformity OSSIFYING FIBROMA

19. OSSIFYING FIBROMA

20. RADIOGRAPHIC FEATURES: Well defined and unilocular raiolucency / radiopacity with a seclerotic border Root divergence may be seen if associated OSSIFYING FIBROMA

21. HISTOPATHOLOGICAL FEATURES: Well demarcated from the surrounding bone A fibrous capsule is seen Fibrous connective tissue stroma with varying degrees of mineralized material Mineralized material consists of osteoid trabaculae and cementum spherules Osteoblastic rimming is usually seen around the bony trabaculae OSSIFYING FIBROMA

22. OSSIFYING FIBROMA

23. OSSIFYING FIBROMA

24. TREATMENT: Enucleation of tumour Prognosis is good OSSIFYING FIBROMA

25. FIBROUS DYSPLASIA OSSIFYING FIBROMA 1 st and 2 nd decade 3 rd and 4 th decade Maxilla> mandible Mandible >maxilla Self limiting and stabalizes at puberty Continous growth and does not stabalise at puberty Fuses with bone Well demarcated No osteoblastic rimming Osteoblastic rimming around the trabaculae Monostotic / polystotic Single bone involved No cementum spherules Cementum spherules