Benign tumer

• Bone Neoplasms


  Primary tumors of bone that are uncommon lesions in the jaws, arising from different cells and tissues present in bone
• Types of primary bone tumors

  • Tumors of bone origin
  • Tumors of chondroid origin
  • Tumors of marrow origin
  • Tumors of fibrous tissue origin
  • Tumors of vascular origin
• Benign primary bone tumors


  • Osteoma
  • Osteoid osteoma
  • Chondroma
  • Desmoblastic fibroma
  • Haemangioma
• Malignant primary bone tumors

  • Osteosarcoma
  • Chondrosarcoma
  • Ewings sarcoma
  • Lymphoma
  • Multiple myeloma
  • Leukemia
• Metastatic bone tumors

  • Lung adenocarcinoma
  • Ovary
  • Prostate
  • Renal
• Osteoma


  Benign tumor composed of mature compact or cancellous bone, essentially restricted to the craniofacial skeleton
• Osteomas


  • They are benign and probably not a true neoplasm, may represent end stage of other conditions like fibrous dysplasia
  • The common palatal and mandibular tori are not considered to represent osteomas, although they are histopathologically identical
• Clinical features of osteomas

  • Most frequently diagnosed in 2nd to 4th decades of life, uncommon in 1st decade
  • May arise on the surface of the bone (periosteal) or in the medullary bone (endosteal)
  • Generally asymptomatic, solitary lesions or incidental finding
  • Most common sites are paranasal sinuses, cranial bones, and jaw bones
• Radiographic features of osteomas

  • Appear as a dense, opaque, sharply demarcated mass, usually broad based
  • Periosteal osteomas may show a uniform sclerotic pattern or a sclerotic periphery with a central trabecular pattern
  • Small endosteal osteomas are almost impossible to differentiate from foci of sclerotic bone
• Histopathological features of osteomas


  • Composed of hard, dense, compact lamellar bone, similar to cortical bone, with haversian systems present
• Gardner syndrome


  Rare disorder inherited as an autosomal dominant trait, characterized by adenomatous polyps of the large bowel, multiple osteomas of the skull and mandible, multiple keratinous cysts of the skin, and soft tissue neoplasms
• Clinical features of Gardner syndrome


  • Colonic polyps typically develop during the second decade
  • About 90% of patients demonstrate skeletal abnormalities, most commonly osteomas in the skull, paranasal sinuses, and mandible
  • Most patients show 3-6 osseous lesions
  • Increased prevalence of dental abnormalities like odontomas, supernumerary teeth, and impacted teeth
• Osteoid osteoma


  Benign bone neoplasm found more frequently in patients between 10 and 30 years of age, with a 2:1 male to female ratio, characterized by intense pain that is relieved by non-steroidal anti-inflammatory drugs
• Radiographic features of osteoid osteoma


  • Typical finding is a radiolucent central nidus, rarely larger than 1.5 cm, surrounded by a peripheral sclerotic reaction
• Microscopic features of osteoid osteoma


  • Sharply delineated central nidus composed of more or less calcified osteoid lined by plump osteoblasts and growing within highly vascularized connective tissue, without evidence of inflammation
• Osteoblastoma


  Tumor closely related to osteoid osteoma, distinguished by the larger size of the nidus and the absence or inconspicuousness of a surrounding area of reactive bone formation
• Clinical features of osteoblastoma

  • Rarely affect the jaw bone, with a slight mandibular predilection and mostly in the posterior regions
  • Slight male predominance, about 85% occur before age 30
  • Most lesions are between 2 to 4 cm but may be as large as 10 cm
  • Pain is a common presenting feature, unlike osteoid osteoma the pain is not relieved with aspirin
• Cementoblastoma


  An odontogenic tumor of cementoblasts, in histopathological features identical to bone tumors (osteoblastoma)
• Clinical features of cementoblastoma

  • Mostly occurs in the mandible, in the molar & premolar region mainly involving the first permanent molar
  • No significant sex predilection, predominantly in children & young adults
  • Pain & swelling may be present, signs of local aggressiveness behavior may be observed
• Cementoblastoma appears radiographically as a radio-opaque mass attached to the root of a tooth
• Lesions

  Between 2 to 4 cm, but may be as large as 10 cm
• Pain


  • Common presenting feature
  • Unlike osteoid osteoma, the pain is not relieved with aspirin
• In some cases it is difficult to distinguish between aggressive osteoblastoma and low grade osteosarcoma
• Treatment

  1. Complete en block resection, is curative

  2. If not possible, marginal resection, or curettage must be used with 10-20% recurrence rate
• Prognosis

  • Good
  • The lesion rarely recurs or transform into osteosarcoma
• Cementoblastoma


  • Mostly occurs in the mandible, in the molar & premolar region mainly involving the first permanent molar
  • No significant sex predilection, predominantly in children & young adults
  • Pain & swelling may be present, signs of local aggressiveness behavior may be observed, including boney expansion, cortical erosion or displacement of adjacent teeth
• Radiographic appearance of cementoblastoma

  Appears as a radioopaque mass that is fused to one or more tooth roots & surrounded by a thin radiolucent rim
• Some consider cementoblastoma and osteoblastoma to be identical, with one primary difference, which is fusion of the lesion to a tooth or not
• Histopathological features of cementoblastoma

  • Resembles closely osteoblastoma with primary distinguishing feature being tumor fusion with the involved tooth
  • Consists of sheets & thick trabeculae of mineralized material with irregularly placed lacunae & prominent reversal cellular fibrovascular tissue is present between mineralized trabeculae
  • The periphery of the lesion, corresponding to the radiolucent zone on the radiograph, is composed of uncalcified matrix, which often is arranged in radiating columns
• Treatment of cementoblastoma

  Surgical extraction of the tooth together with the attached calcified mass
• Desmoplastic fibroma


  A benign, locally aggressive lesion of bone that can be considered the bony counterpart of fibromatosis
• Desmoplastic fibroma


  • The tumor appears usually in long bones and the pelvis but may occasionally affect the jaws
  • The cause is unknown, but it may represent an exuberant reactive proliferation
  • Most cases occur in patients under the age of 30 years, with a mean age of 14 years
  • No gender predilection
  • The mandible, usually the bodyramus region, is affected more often than the maxilla
  • The lesions are slowly progressive and asymptomatic, eventually causing swelling of the jaw
• Radiographic appearance of desmoplastic fibroma

  May be unilocular or multilocular, with either well demarcated or poorly defined margins<|>Cortical perforation and root resorption may be seen
• Histopathology of desmoplastic fibroma

  • Consists of interlacing bundles and whorled aggregates of densely collagenous tissue that contains uniform spindled and elongated fibroblasts
  • Some areas may exhibit hypercellularity with plumper fibroblast nuclei
  • Cytologic atypia and mitotic figures are not found
  • Bone is not produced by lesional tissue
• Differential diagnosis of desmoplastic fibroma includes odontogenic cysts, odontogenic tumors, nonodontogenic lesions, and well-differentiated fibrosarcoma
• Treatment of desmoplastic fibroma

  Surgical resection of the lesion, as curettage alone has been associated with a significant recurrence rate
• Hemangioma of bone


  Rare intraosseous vascular malformations that, when seen in the jaws, can mimic both odontogenic and nonodontogenic lesions
• Hemangioma of bone


  • More than half occur in the mandible, especially the posterior region
  • Occurs approximately twice as often in females as in males
  • Peak age of discovery is the second decade of life
  • Presents as a firm, slow-growing, asymmetric expansion of the mandible or maxilla
  • Spontaneous gingival bleeding around teeth in the area may be noted
  • Paresthesia, pain, and vertical mobility of involved teeth may be evident
  • Bruits or pulsation of large lesions may be detected
  • Trophic effects on adjacent hard and soft tissues are common
  • May be present without any signs or symptoms
• Radiographic appearance of hemangioma of bone

  More than half appear as multilocular radiolucencies with a characteristic soap bubble appearance<|>A second form consists of a rounded, radiolucent lesion in which bony trabeculae radiate from the center, producing angular loculations<|>Less commonly, appear as cyst-like radiolucencies<|>May produce resorption of the roots of teeth in the area
• Histopathology of hemangioma of bone

  • Represent a proliferation of blood vessels, most commonly of the cavernous type (large-caliber vessels)