NON-ODONTOGENIC TUMOR OF

BONE/OSSEOUS TISSUE ORIGIN

• CONTENT
• BENIGN
1. OSTEOID OSTEOMA
2. TORAS MANDIBULARIS
3. TORAS PALATINUS
4. OSTEOBLASTOMA
5. OSTEOCLASTOMA

• MALIGNANT
1. OSTEOSARCOMA
2. EWING”S SARCOMA
 BENIGN
• 1. OSTEOID OSTEOMA
• OSTEOID OSTEOMA IS A BENIGN TUMOR OF BONE WHICH HAS SELDOM BEEN
DESCRIBED IN JAWS.

• ETIOLOGY
• THE EXACT CAUSE OF OSTEOID OSTEOMA IS UNKNOWN.
• THE TRUE NATURE OF THIS LESION IS UNKNOWN .JAFFE AND
LICHTENSTEIN HAVE SUGGESTED THAT LESION IS A TRUE NEOPLASM OF
OSTEOBLASTIC DERIVATION BUT OTHER WORKERS HAVE REPORTED THAT
THE LESION OCCURS AS A RESULT OF TRAUMA OR INFLAMMATION.
 CLINICAL FEATURES
1.It usually occurs in young persons and
develops after the age of 30 years.
2.It has been reported most frequently in the
femur/in tibia,although other bones throughout
the body have occasionally been involved.
3.One of the chief symptoms of the condition is
pain and pain is described as unrelenting and
sharp,worse at night.
 ORAL MANIFESTATION
• Greene and his associates have reviewed the
literature and added one more case, bringing
the total number of cases of osteoid osteoma
of jaws to seven.
• Of these,four have occurred in mandible and
three in maxilla.
• Of mandibular lesions , three were in the body
and condyle , while maxillary lesion involved
antrum.
 RADIOGRAPHIC FEATURES
• Radiographically, the osteoid osteoma
presents a pathognomonic picture
characterized by a sclerotic bone.
• The central radiolucency may exibit some
calcification.
• Lesion seldom is larger than 1cm in diameter,
but overlying cortex does become thickened
by subperiosteal new bone formation.
 HISTOLOGIC FEATURES
• The microscopic appearance of osteoid osteoma is
characterized and consist of a central nidus composed of
compact osteoid tissue, varying in degree of calcification.
• Formation of definite trabeculae, occurs particularly in
older lesions outlined by active osteoblasts.
• The overlying periosteum exhibits new bone formation ,
and in this interstitial tissue collection of lymphocytes
may be noted.
• TREATMENT – the treatment of osteoid osteoma consists
of surgical removal of the lesion.
 2.TORAS MANDIBULARIS
• It is an exostosis / outgrowth of bone found on the
lingual surface of the mandible.
• ETIOLOGY: etiology is actually unknown but their may
be due to-
• Suzuki and sakai have commented on its apparent
hereditary nature. Their studies shown that when
one/ both parents had either type of torus , frequency
of occurance of a torus in children ranged b/w 40 and
64%. When neither parents had a torus, the incidence
of a torus in children was only 5-8 %.
 CLINICAL FEATURES
• This growth on the lingual surface of the mandible
occurs above the mylohyoid line, usually opposite the
bicuspid teeth.
• Although the mandibular tori are usually bilateral ,they
are seen as a unilateral condition in about 20% of cases.
• Both unilateral and bilateral protuberances may be
single or multiple and they are frequently visible on
dental periapical radiographs.
• The bilateral bony growths on lingual of mandible may
be lobed or multiple.
 RADIOGRAPHIC FEATURES
• A large mandibular torus may appear on peripheral
radiograph as a radiopacity superimposed on the roots of
the teeth.
• HISTOLOGIC FEATURES: It consist primarily of a nodular
mass of dense, cortical lamellar bone .
• An inner zone of trabecular bone with associated fatty
marrow sometimes is visible.
• TREATMENT: Most mandibular tori are easily diagnosed
clinically, and no treatment is necessary, surgical removal
may be necessary , if a mandibular denture is planned.
 3.TORUS PALATINUS
• It is a slowly growing , flat-based bony
protuberance/ excrescence which occur in the
midline of the hard palate.
• ETIOLOGY:A study of suzuki and sakai offered
evidence that this is due to hereditary,
thought to follow a mendelian dominant
pattern.
 CLINICAL FEATURES
• Women are affected more frequently then men.
• It presents itself as an outgrowth in the midline of palate and
may assume variety of shapes.
• Clinically it has been classified as
• 1.Flat
• 2.Spindle shaped
• 3.Nodular
• 4.Lobular
• Torus itself may be composed either of dense compact bone or
shell of compact bone with a center of cancellous bone and thus
it is often visible on an intraoral palatal radiographs.
 RADIOGRAPHIC FEATURES
• Torus palatinus does not usually appear on
routine dental radiographs.
• Rarely it may be seen as a radiopacity on
peripheral films if the films is placed behind
the torus when the radiography is taken.
 HISTOPATHOLOGIC FEATURES
• Microscopic examination of the torus shows a mass of
dense, lamellar, cortical bone.
• An inner zone of trabeculae bone sometimes is seen.
• TREATMENT
• Most palatal tori can be diagnosed clinically, biopsy
rarely is necessary.
• In edentulous pt. torus may need to be removed
surgically to accommodate a denture base.
 4. OSTEOBLASTOMA ( GIANT OSTEOID
OSTEOMA)
• Osteoblastoma is a benign neoplasm of bone
that arises from osteoblasts.
• ETIOLOGY – The etiology of osteoblastoma is
unknown.
• CLINICAL FEATURE
1. The most frequently affected bones are vertebral
column, sacrum, calvarium , long bones and small
bones of hands and feet.
2.Pain is the common presenting features.
 RADIOGRAPHIC FEATURE
• It appear as a well defined/ill defined radiolucent lesion
with patchy distribution mineralization.
• HISTOLOGICAL FEATURES
• Histopathologically , it resembles osteoid osteoma
• It is made of up of spicules of woven bones.
• Many giant cell are seen in the tumor. Numerous
osteoblasts line these bony trabeculae.
• Many dilated capillaries are seen scattered throughout
the tissues.
• MANAGEMENT
• Osteoblastoma are treated by local excision/curettage.
 5. OSTEOCLASTOMA
• A tumor of bone characterized by massive
destruction of the end [epiphysis]of a long bone.
• ETIOLOGY : The exact cell of origin is unknown.
Several immunohistochemical studies have
suggested that mononuclear cell are histocytic
origin and that giant cells arises from their fusion.
• Multinucleated giant cells apparently results from
fusion of proliferating mononuclear cells.
 CLINICAL FEATURES
• In many series female patient are
predominant.
• Pain of variable severity is almost always
predominant symptom.
• More than three- fourth of patient had noted
swelling of affected area . Less common
symptoms were weakness, limitation of
motion of joint and pathologic fracture.
 HISTOLOGIC FEATURES
• The basic proliferating cell has round to oval or even spindle
shaped nucleus in the field i.e diagnostic of true giant cell
tumor.
• Mitotic figures can be found.
• Giant cell are usually scattered uniformly throughout the
lesion.
• Areas of infarction like necrosis are common in giant cell
tumors.
• Small collection of foam cells are common.
• TREATMENT: Removal of the tumor by curettage is most
widely accepted therapy.
 MALIGNANT
• 1. OSTEOSARCOMA[OSTEOGENIC SARCOMA]
• Osteosarcoma is the third most common
cancer in adolescence, occuring less
frequently than only lymphomas and brain
tumors.
• It is thought to arise from primitive
mesenchymal bone forming cell and is
characterized by the formation of osteoid.
 ETIOLOGY
• The exact cause is not known however a no. of risk
factors exist.
1. Exposure to radiation is only known
environmental risk factor.
2. A genetic predesposition may exist for e.g
a) Bone dysplasia including paget ‘s disease, fibrous
dysplasia increase the risk of osteosarcoma.
b) Li- Fraumeni syndrome.
c) Rothmund – Thomson syndrom .
 CLINICAL FEATURES
• 1. It is a bone tumor that can occur in any bone, most
common in the long bone of extremities near
metaphyseal growth plates.
• 2. Most common sites are Femur{42% with 75% of
tumor in distal femur} tibia 19% with 80% of tumor in
proximal tibia } & humerus 10% with 90% tumor is
proximal humurus }
• 3. Incidence is slightly higher in males than female.
• 4. Swelling and pain, particularly with activity of the
involved bone are early features of the neoplasm.
 ORAL MANIFESTATION
• The most common presenting symptoms of patient were
swelling of involved area, often producing facial
deformity and pain followed by loose teeth, paresthesia ,
toothache, bleeding , nasal obstruction.
• CLASSIFICATION
• According to location
• 1) Medullary
• 2)Periosteal
• 3) Paraosteal
• 4) Soft tissue
 ACCORDING TO RADIOGRAPHIC
CHARACTERISTIC
• 1) Osteolytic type
• 2) Osteoblastic type
• 3) Mixed type
• ACCORDING TO TUMOR HISTOLOGY
• 1) Osteoblastic
• 2) Chondroblastic
• 3)Fibroblastic
• 4) Telangiectatic
• VARIANTS OF OSTEOSARCOMA
• Multifocal synchronous
• Asynchronous
• Telangiectatic
• Small cell
• Intraosseous well differentiated
• Intracortical
• Periosteal
• Paraosteal
• High-grade surface.
 RADIOGRAPHIC FEATURES
• Cumulus cloud densities form within intramedullary and soft tissue
components.
• There are three features of osteosarcoma that are classic.
• 1)small streaks of bone radiate outward from app.25% of these tumors .
These produces a sunray[sunburst] pattern.
• 2) This tumor may grow within the periodontal membrane space causing
resorption of the adjacent bone resulting in uniform widening of the
space . Widening of periodontal membrane space may also be seen in
other condition like chondrosarcoma and scleroderma.
• In long bones affected with osteosarcoma periosteum is elevated over
expanding tumor mass in tent like fashion . At the point on bone where
the periosteum begins to merge an acute angle b/w the bone surface
and periosteum is created. This is called codman’s triangle.
 HISTOLOGIC FEATURES
• Gross tissue of osteoblastic osteosarcoma show
white-tan yellow in colour and firm in
consistency.
• Hemorrhage and necrosis are common.
• In general, characteristic feature is the presence
of osteoid formed by malignant osteoblasts in
the lesions.
• Stromal cells may be spindle shaped and atypical
with irregularly shaped nuclei.
 STAGING
• STAGES
• Stage 1: low grade lesions.
• Stage 2: High-grade lesions.
• Stage 3: metastatic disease.
• SUBSTAGES
• A: Intramedullary lesion.
• B:Local extramedullary spread.
• SITE OF PRIMARY
• Distal extremity- best prognosis.
• Distal femur- intermediate prognosis.
• Axial skeletal- worst prognosis.
• TREATMENT: In case of long bone involvement, amputation is a prime
requisite.
• Chemotherapy in combination with surgery.
 2.EWING’S SARCOMA[Endothelial
myeloma/ Round cell sarcoma]
• It is a sarcoma of the bone , there is
considerable clinical and histologic overlap
b/w this tumor and the primitive
neuroectodermal tumor[PNET].
• Ewing’s sarcoma arises within soft tissue and
PNET arise within the bone.
 CLINICAL FEATURES
• This disease occurs predominantly in children and young
adults .
• Pain usually of an intermittent nature and swelling of
involved bone are often earliest clinical signs and
symptoms.
• The bone most commonly affected are long bones of
extrimitis , although skull, clavicle, ribs and shoulder and
pelvic girdles may be involved, as well as maxilla and
mandible.
• Facial neuralgia and lip paresthesia have been reported in
cases of jaw involvement.
 HISTOLOGIC FEATURES
• Ewing’s sarcoma is an extremely cellular neoplasm
composed of solid sheets/ masses of small round cells
with very little stroma , although few connective tissue
septa may be present.
• Sarcoma cells are arranged in filigree pattern.
• Mitotic figures are common.
• Many tiny vascular channels may also be present
.Hemorrhage with vascular lakes/ sinuses may be seen.
• Geographic necrosis with perivascular sparing is a
common feature.
 RADIOGRAPHIC FEATURES
• A common characteristic radiographic feature
is the formation of layers of new subperiosteal
bone producing the so called onion skin
appearance on the film.
• Osteophyte formation may also be visible on
the radiograph and in such cases, may be
similar to the sun ray appearance of
osteosarcoma.
 TREATMENT
• This neoplasm is radiosensitive but
unfortunately, in the past , has been cured by
x-ray radiation.
• Radical surgical excision has been done, alone
and coupled with x- ray radiation.
• Five year survival with a combination of
surgery and chemotherapy is 74%.