Benign Oral Tumors Of Mesenchymal Tissue Origin
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Benign Tumors of Mesenchymal Origin
Fibroma/Irritation Fibroma: Description: a reactive tumor; reactive proliferation of cellular fibrous connective tissue Clinical Features: Risk Factors:local irritation (such as calculus or malalignment of teeth) Rarely recurs Differential Diagnosis: Pyogenic Granuloma Histopathology: Covered by stratified squamous epithelium with short and flat rete pegs Treatment: – excisional biopsy- deep to the underlying bone in order to eliminate the entire lesion. – Elimination of irritating stimuli 1
Fibroma
2
Fibroma
3
Benign Tumors of Mesenchymal Origin
Pyogenic Granuloma: The pyogenic granuloma is a relatively common, tumorlike, exuberant tissue response to localized irritation or trauma. “pyogenic granuloma” is a misnomer since the condition is not associated with pus and does not represent a granuloma histologically. Clinical Appearance: soft red nodule , ulcerated, and the lesion exhibits a lobular architecture. lesion that may develop on the gingival margin or in other sites Histopathology: large, thin walled blood vessels; with neutrophils; core of cellular fibrous connective tissue mixed with proliferating vascular channels and inflammatory infiltrate w/ neutrophils. This lesion is a reactive/inflammatory process. 4
Benign Tumors of Mesenchymal Origin
Treatment:conservative surgical excision.For gingival lesions, excising the lesion down to the periosteum and scaling adjacent teeth to remove any calculus and plaque that may be a source of continuing irritation is recommended. Pyogenic granuloma occasionally recurs, and a reexcision is necessary. The recurrence rate is higher for pyogenic granulomas removed during 5
Pyogenic Granuloma
6
Giant Cell Fibroma
Description:a localized reactive proliferation of fibrous (scar) tissue, much like the irritation fibroma. Clinical Features: small,may have broad base or thick stalk. It is painless and often has lobules or nodules on its surface.; may occur at any age; most commonly seen on gingiva Differs from irritation fibroma in 2 ways: – it contains giant cells (fibroblasts) with large, angular nuclei, beneath the overlying epithelium; – it has a greater tendency to recur. 7
Giant Cell Fibroma
Histopathologic Findings: – Diffuse, immature, avascular collagenic stroma with scattered fibroblasts – Fibroblasts: very large and angular, may have more than one nucleus--most numerous immediately beneath the covering epithelium. – The epithelium is usually normal but may have elongated and narrow rete ridges. – no capsule or pseudocapsule. Occasional lymphocytes may be seen beneath the epithelium or around capillaries. Treatment is conservative surgical
8
Giant Cell Fibroma
9
Giant Cell Fibroma
10
Peripheral Ossifying Fibroma
Description:A well-demarcated, encapsulated lesion ; also known as cementifying fibroma, cemento-ossifiying fibroma, fibrous osteoma and osteofibroma Clinical Features: no bone involvement Histopathologic findings: composed of highly cellular fibrous tissue with presence of spherical calcifications (osteoid) and irregular, randomly oriented bony structures. a well demarcated or less likely, encapsulated neoplasm composed of fibrous tissue with randomly distributed areas of calcified material. Treatment: complete enucleation though larger 11 lesions may necessitate surgical resection and
Peripheral Ossifying Fibroma
12
Peripheral Ossifying Fibroma
13
Peripheral Ossifying Fibroma
14
Central Ossifying Fibroma
Description: a true neoplasm of the medullary portion of the jaws. Benign, slow-growing arises from elements of the periodontal ligament Clinical Features: tend to occur in younger patients, most often in the premolar-molar region of the mandible. Small: asymptomatic but frequently grow to expand the jaw bone Histopathologic Findings: uniform fibroblasts and small irregularly mineralized masses resembling cementum Similar to fibrous dysplasia Radiographic Findings: well-defined unilocular radiolucent lesion which becomes increasingly calcified with maturation. The progression from the radiolucent to the radiopaque stage takes at least 6 years. 15 Treatment: surgical excision ; recurrence is uncommon.
Central Ossifying Fibroma
16
Central Ossifying Fibroma
17
Central Ossifying Fibroma
18
Peripheral Giant Cell Granuloma
Description: also called giant cell epulis Clinical Features: hemorrhagic appearance; with superficial erosion of bone Histologic Findings: multinucleated foreign bodytype giant cells embedded in cellular stroma containing both fibroblasts and endothelial cells. cellularity and plumpness of the cells contributes to aggressiveness and tendency for recurrence. 50100 nuclei per cell may be seen Treatment:Conservative excision is typically curative, although the lesion must be completely removed to prevent recurrence. In areas such as the maxillary gingivae where surgical removal may have a negative esthetic impact, the clinician may want to consider a gingival graft in conjunction with19 the excision of the lesion.
Peripheral Giant Cell Granuloma
20
Peripheral Giant Cell Granuloma
21
Peripheral Giant Cell Granuloma
22
Central Giant Cell Granuloma
Description:a neoplastic-like reactive proliferation of the jaws that accounts; rare: less than 7% of all benign lesions of the jaws in tooth-bearing areas. Clinical Features: commonly occurs in children and young adults with a slight female predilection. The lesion is more common in the mandible than maxilla underlying anterior or premolar teeth. Expansile lesions can cause root divergence or resorption. Lesions may be slow-growing and asymptomatic, or rapidly expanding with pain, facial swelling and root resorption. The fast growing variants have a high rate of recurrence.
23
Central Giant Cell Granuloma Radiographic appearance: ranges from unilocular to multilocular radiolucencies with either welldefined or irregular borders. With root resorption Histopathology:Multinucleated giant cells, dispersed throughout a hypercellular fibrovascular stroma often with bony trabeculae are present on histology.
24
Central Giant Cell Granuloma TREATMENT:
Treatment regimens for CGCG have historically included – curettage Small, nonaggressive lesions will usually respond to through excision with careful curettage with a recurrence rate of less than 15%. – segmental resection Larger, more aggressive lesions, which have higher recurrence rates, require more extensive surgery, which may include en bloc resection – Intralesional steroids have also been advocated 25 for managing CGCG in younger patients as a
Central Giant Cell Granuloma
26
Central Giant Cell Granuloma
27
Central Giant Cell Granuloma
28
Central Giant Cell Granuloma
29
Lipoma
Description:The lipoma is a benign tumor (neoplasm) of fatty tissue/neoplasms of adipocytes Clinical Features: usually arises from buccal fat pad area; lesion is soft and fluctuant to palpation; rare intraoral tumor; slow-growing, soft, smoothsurfaced mass of the submucosal tissues When superficial, there is a yellow surface discoloration benign neoplasm of brown fat= hibernoma Histologic Findings: well demarcated, encapsulated mass of mature fat cells enclosed within fine alveolar tissue:”signet ring appearance”. Cells are well-differentiated and contain abundant fatty material. Fat in the fat cells are different from normal fat Treatment:Conservative surgical removal is the treatment of choice for oral lipoma, with occasional 30 recurrences expected
Lipoma
31
Lipoma
32
Hemangioma
Description: a hamartoma or a proliferation of tissues indigenous to the tumor site Central Hemangiomas -occur within bone . Serious consequences result if teeth are extracted from involved areas. Possible loose teeth or oozing of blood around teeth are clues to the nature of the osseous lesion. The tongue is a common intraoral location of softtissue hemangiomas Histopathologic Findings:an ill-defined proliferation of blood vessels with blood cells inside. These may be capillary (capillary hemangioma) or they may be large thin-walled blood-filled vascular spaces(cavernous hemangioma). Solid endothelial cell proliferation (rosettes of endothelium) may be seen in the capillary type. 33
Capillary Hemangioma
34
Capillary Hemangioma
35
36
37
38
Hemangioma
Radiographic Findings: Central hemangiomas often feature a finely trabeculated radiolucent pattern; bone destruction seen Treatment: Therapy consists of surgery, cryotherapy or the use of sclerosing solutions. Large hemangiomas ones are difficult therapeutic problems and when they attain this size, therapy is not usually indicated unless the lesion affords the patient much difficulty or hemorrhage.
39
Syndromes assoc. w/ hemangiomas
Sturge-Weber Angiomatosis
Description: encephalotrigeminal angiomatosis; variant of hemangioma Congenital, not hereditary Clinical Features: Hemangioma in brain leads to mental retardation due to lack of blood flow Calcifications in meninges: “tram-line” or “train tracks” calcifications seen on xray Hemangioma on face (portwine nevus or nevi) found in ophthalmic and maxillary division of the trigeminal nerve (C.N. V) Nevus flammeus: hemangioma in the mouth (unilateral) stops at midline Treatment: neurosurgery of brain hemangiomas
40
41
Syndromes assoc. w/ hemangiomas Rendu-Osler-Weber disease
Hereditary Hemorrhagic Telangiectasia (HHT) A person with HHT has a tendency to form blood vessels that lack the capillaries between an artery and vein. This means that arterial blood under high pressure flows directly into a vein without first having to squeeze through the very small capillaries. This place where an artery is connected directly to a vein, tends to be a fragile site that can rupture and result in bleeding. We usually call a blood vessel that is abnormal in this way a telangiectasia. if it involves small blood vessels, it’s called an arterioveneous malformation (AVM) if involves larger blood vessels. AVM= a big telangiectasis. Congenital and hereditary Clinical Features:a telangiectasia or AVM has greater tendency to rupture and bleed than a 42 normal blood vessel. In the nose, skin, GI tract
43
Aneurysmal Bone Cyst
Description: not a true cyst, an aggressive reactive process. Clinical Features: a lesion of large vascular sinusoids, so blood can be aspirated with a syringe. No bruit (pulsing sound) due to the low pressures. It has a great potential for growth and can result in marked expansion and deformity. The mandible body is the most frequent site. Histologically, large blood-filled sinusoids lined by an endothelial layer with surrounding fibroblastic, hypercellular tissue is present. Radiographic Features:A multilocular radiolucency traversed by thin septae with cortical expansion Treatment: Simple enucleation is the preferred treatment. Recurrence is rare. 44
Lymphangioma
Description:occurs as an extensive developmental abnormality involving the face and neck; also known as "cystic hygroma." Clinical Features: The close association of the lesion with surface epithelium imparts the nodular configuration to the surface. Histopathologic Findings: there are numerous thin walled lymph channels extending in a diffuse pattern between skeletal muscle bundles. The pink material in the vessels is lymph. The lymphangiomatous proliferation generally extends to immediately beneath the epithelium and consists of many thin walled channels containing lymph fluid. Treatment: These are difficult to treat and often impair or compromise the patient's air space. 45
Lymphangioma
46
47
48
Odontogenic Myxoma
Description: from the dental papilla or follicular mesenchyme. one of the most rare odontogenic tumors Clinical Features: sometimes associated with impacted teeth. more common in the maxilla than the mandible and appears commonly in the second decade of life. It develops slowly and asymptomatically, provoking an expansion of the alveolar ridges and displacement of neighboring teeth. But it is aggressively invasive and may become quite large. Histopathologic Findings: spindle and stellate fibroblasts are associated with basophilic ground substance and myxomatous tissue. Radiographic Findings: radiolucent; multilocular and expansile, with coursing septae which look like a finely reticulated spider web or a honeycomb or mottled 49 appearance
Myxoma
50
Exostoses Description: exostosis = outgrowth of bone
Description: exostosis = outgrowth of bone Torus palatinus Torus palatinus is found at the midline of the palate. It is an extension of the bony process and not a well-defined neoplasm. Torus mandibularis Buccal exostoses Clinical Features: hard swellings covered by somewhat thin but essentially normal mucosa. If the overlying mucosa becomes irritated, ulceration is often slow to heal because of poor underlying vascularity. Radiographic Features: marked opacity and lack of bone resorption so it indicates an innocuous(harmless) condition. zones of 51 radiopacity with some superimposition over the
52
Osteoma
Description: Osteomas are considered to be benign neoplasms of bone forming tissue. An exophytic nodular growth of dense cortical bone on or within the jaws in locations other than those occupied by tori or exostoses. Clinical Features:Osteomas are less common than exostoses. Histopathologic findings: cellular and active lesion with areas of loose vascular connective tissue containing irregular bone trabeculae. with considerable osteoblastic activity. Radiographic findings: round opacity with central areas of radiolucency. This lesion is much less radiopaque than the typical exostosis Treatment: Treatment of osteomas is only necessary if they are symptomatic. 53
54
Osteoid Osteoma
Description:Osteoid osteoma is a benign skeletal neoplasm of unknown etiology that is composed of osteoid and woven bone. Clinical Features:Pain on palpation well-demarcated, encapsulated, expansile intraosseous lesion of the jaws Histopathology: Active central cellular nidus surrounded by zone of osteoid fomation Radiographic Features:A circular or ovoid lucent defect is seen in 75% of patients. This defect is usually smaller than 1.5 cm in diameter and is associated with sclerosis. Treatment:surgical excision
55
Fibroma/Irritation Fibroma: Description: a reactive tumor; reactive proliferation of cellular fibrous connective tissue Clinical Features: Risk Factors:local irritation (such as calculus or malalignment of teeth) Rarely recurs Differential Diagnosis: Pyogenic Granuloma Histopathology: Covered by stratified squamous epithelium with short and flat rete pegs Treatment: – excisional biopsy- deep to the underlying bone in order to eliminate the entire lesion. – Elimination of irritating stimuli 1
Fibroma
2
Fibroma
3
Benign Tumors of Mesenchymal Origin
Pyogenic Granuloma: The pyogenic granuloma is a relatively common, tumorlike, exuberant tissue response to localized irritation or trauma. “pyogenic granuloma” is a misnomer since the condition is not associated with pus and does not represent a granuloma histologically. Clinical Appearance: soft red nodule , ulcerated, and the lesion exhibits a lobular architecture. lesion that may develop on the gingival margin or in other sites Histopathology: large, thin walled blood vessels; with neutrophils; core of cellular fibrous connective tissue mixed with proliferating vascular channels and inflammatory infiltrate w/ neutrophils. This lesion is a reactive/inflammatory process. 4
Benign Tumors of Mesenchymal Origin
Treatment:conservative surgical excision.For gingival lesions, excising the lesion down to the periosteum and scaling adjacent teeth to remove any calculus and plaque that may be a source of continuing irritation is recommended. Pyogenic granuloma occasionally recurs, and a reexcision is necessary. The recurrence rate is higher for pyogenic granulomas removed during 5
Pyogenic Granuloma
6
Giant Cell Fibroma
Description:a localized reactive proliferation of fibrous (scar) tissue, much like the irritation fibroma. Clinical Features: small,may have broad base or thick stalk. It is painless and often has lobules or nodules on its surface.; may occur at any age; most commonly seen on gingiva Differs from irritation fibroma in 2 ways: – it contains giant cells (fibroblasts) with large, angular nuclei, beneath the overlying epithelium; – it has a greater tendency to recur. 7
Giant Cell Fibroma
Histopathologic Findings: – Diffuse, immature, avascular collagenic stroma with scattered fibroblasts – Fibroblasts: very large and angular, may have more than one nucleus--most numerous immediately beneath the covering epithelium. – The epithelium is usually normal but may have elongated and narrow rete ridges. – no capsule or pseudocapsule. Occasional lymphocytes may be seen beneath the epithelium or around capillaries. Treatment is conservative surgical
8
Giant Cell Fibroma
9
Giant Cell Fibroma
10
Peripheral Ossifying Fibroma
Description:A well-demarcated, encapsulated lesion ; also known as cementifying fibroma, cemento-ossifiying fibroma, fibrous osteoma and osteofibroma Clinical Features: no bone involvement Histopathologic findings: composed of highly cellular fibrous tissue with presence of spherical calcifications (osteoid) and irregular, randomly oriented bony structures. a well demarcated or less likely, encapsulated neoplasm composed of fibrous tissue with randomly distributed areas of calcified material. Treatment: complete enucleation though larger 11 lesions may necessitate surgical resection and
Peripheral Ossifying Fibroma
12
Peripheral Ossifying Fibroma
13
Peripheral Ossifying Fibroma
14
Central Ossifying Fibroma
Description: a true neoplasm of the medullary portion of the jaws. Benign, slow-growing arises from elements of the periodontal ligament Clinical Features: tend to occur in younger patients, most often in the premolar-molar region of the mandible. Small: asymptomatic but frequently grow to expand the jaw bone Histopathologic Findings: uniform fibroblasts and small irregularly mineralized masses resembling cementum Similar to fibrous dysplasia Radiographic Findings: well-defined unilocular radiolucent lesion which becomes increasingly calcified with maturation. The progression from the radiolucent to the radiopaque stage takes at least 6 years. 15 Treatment: surgical excision ; recurrence is uncommon.
Central Ossifying Fibroma
16
Central Ossifying Fibroma
17
Central Ossifying Fibroma
18
Peripheral Giant Cell Granuloma
Description: also called giant cell epulis Clinical Features: hemorrhagic appearance; with superficial erosion of bone Histologic Findings: multinucleated foreign bodytype giant cells embedded in cellular stroma containing both fibroblasts and endothelial cells. cellularity and plumpness of the cells contributes to aggressiveness and tendency for recurrence. 50100 nuclei per cell may be seen Treatment:Conservative excision is typically curative, although the lesion must be completely removed to prevent recurrence. In areas such as the maxillary gingivae where surgical removal may have a negative esthetic impact, the clinician may want to consider a gingival graft in conjunction with19 the excision of the lesion.
Peripheral Giant Cell Granuloma
20
Peripheral Giant Cell Granuloma
21
Peripheral Giant Cell Granuloma
22
Central Giant Cell Granuloma
Description:a neoplastic-like reactive proliferation of the jaws that accounts; rare: less than 7% of all benign lesions of the jaws in tooth-bearing areas. Clinical Features: commonly occurs in children and young adults with a slight female predilection. The lesion is more common in the mandible than maxilla underlying anterior or premolar teeth. Expansile lesions can cause root divergence or resorption. Lesions may be slow-growing and asymptomatic, or rapidly expanding with pain, facial swelling and root resorption. The fast growing variants have a high rate of recurrence.
23
Central Giant Cell Granuloma Radiographic appearance: ranges from unilocular to multilocular radiolucencies with either welldefined or irregular borders. With root resorption Histopathology:Multinucleated giant cells, dispersed throughout a hypercellular fibrovascular stroma often with bony trabeculae are present on histology.
24
Central Giant Cell Granuloma TREATMENT:
Treatment regimens for CGCG have historically included – curettage Small, nonaggressive lesions will usually respond to through excision with careful curettage with a recurrence rate of less than 15%. – segmental resection Larger, more aggressive lesions, which have higher recurrence rates, require more extensive surgery, which may include en bloc resection – Intralesional steroids have also been advocated 25 for managing CGCG in younger patients as a
Central Giant Cell Granuloma
26
Central Giant Cell Granuloma
27
Central Giant Cell Granuloma
28
Central Giant Cell Granuloma
29
Lipoma
Description:The lipoma is a benign tumor (neoplasm) of fatty tissue/neoplasms of adipocytes Clinical Features: usually arises from buccal fat pad area; lesion is soft and fluctuant to palpation; rare intraoral tumor; slow-growing, soft, smoothsurfaced mass of the submucosal tissues When superficial, there is a yellow surface discoloration benign neoplasm of brown fat= hibernoma Histologic Findings: well demarcated, encapsulated mass of mature fat cells enclosed within fine alveolar tissue:”signet ring appearance”. Cells are well-differentiated and contain abundant fatty material. Fat in the fat cells are different from normal fat Treatment:Conservative surgical removal is the treatment of choice for oral lipoma, with occasional 30 recurrences expected
Lipoma
31
Lipoma
32
Hemangioma
Description: a hamartoma or a proliferation of tissues indigenous to the tumor site Central Hemangiomas -occur within bone . Serious consequences result if teeth are extracted from involved areas. Possible loose teeth or oozing of blood around teeth are clues to the nature of the osseous lesion. The tongue is a common intraoral location of softtissue hemangiomas Histopathologic Findings:an ill-defined proliferation of blood vessels with blood cells inside. These may be capillary (capillary hemangioma) or they may be large thin-walled blood-filled vascular spaces(cavernous hemangioma). Solid endothelial cell proliferation (rosettes of endothelium) may be seen in the capillary type. 33
Capillary Hemangioma
34
Capillary Hemangioma
35
36
37
38
Hemangioma
Radiographic Findings: Central hemangiomas often feature a finely trabeculated radiolucent pattern; bone destruction seen Treatment: Therapy consists of surgery, cryotherapy or the use of sclerosing solutions. Large hemangiomas ones are difficult therapeutic problems and when they attain this size, therapy is not usually indicated unless the lesion affords the patient much difficulty or hemorrhage.
39
Syndromes assoc. w/ hemangiomas
Sturge-Weber Angiomatosis
Description: encephalotrigeminal angiomatosis; variant of hemangioma Congenital, not hereditary Clinical Features: Hemangioma in brain leads to mental retardation due to lack of blood flow Calcifications in meninges: “tram-line” or “train tracks” calcifications seen on xray Hemangioma on face (portwine nevus or nevi) found in ophthalmic and maxillary division of the trigeminal nerve (C.N. V) Nevus flammeus: hemangioma in the mouth (unilateral) stops at midline Treatment: neurosurgery of brain hemangiomas
40
41
Syndromes assoc. w/ hemangiomas Rendu-Osler-Weber disease
Hereditary Hemorrhagic Telangiectasia (HHT) A person with HHT has a tendency to form blood vessels that lack the capillaries between an artery and vein. This means that arterial blood under high pressure flows directly into a vein without first having to squeeze through the very small capillaries. This place where an artery is connected directly to a vein, tends to be a fragile site that can rupture and result in bleeding. We usually call a blood vessel that is abnormal in this way a telangiectasia. if it involves small blood vessels, it’s called an arterioveneous malformation (AVM) if involves larger blood vessels. AVM= a big telangiectasis. Congenital and hereditary Clinical Features:a telangiectasia or AVM has greater tendency to rupture and bleed than a 42 normal blood vessel. In the nose, skin, GI tract
43
Aneurysmal Bone Cyst
Description: not a true cyst, an aggressive reactive process. Clinical Features: a lesion of large vascular sinusoids, so blood can be aspirated with a syringe. No bruit (pulsing sound) due to the low pressures. It has a great potential for growth and can result in marked expansion and deformity. The mandible body is the most frequent site. Histologically, large blood-filled sinusoids lined by an endothelial layer with surrounding fibroblastic, hypercellular tissue is present. Radiographic Features:A multilocular radiolucency traversed by thin septae with cortical expansion Treatment: Simple enucleation is the preferred treatment. Recurrence is rare. 44
Lymphangioma
Description:occurs as an extensive developmental abnormality involving the face and neck; also known as "cystic hygroma." Clinical Features: The close association of the lesion with surface epithelium imparts the nodular configuration to the surface. Histopathologic Findings: there are numerous thin walled lymph channels extending in a diffuse pattern between skeletal muscle bundles. The pink material in the vessels is lymph. The lymphangiomatous proliferation generally extends to immediately beneath the epithelium and consists of many thin walled channels containing lymph fluid. Treatment: These are difficult to treat and often impair or compromise the patient's air space. 45
Lymphangioma
46
47
48
Odontogenic Myxoma
Description: from the dental papilla or follicular mesenchyme. one of the most rare odontogenic tumors Clinical Features: sometimes associated with impacted teeth. more common in the maxilla than the mandible and appears commonly in the second decade of life. It develops slowly and asymptomatically, provoking an expansion of the alveolar ridges and displacement of neighboring teeth. But it is aggressively invasive and may become quite large. Histopathologic Findings: spindle and stellate fibroblasts are associated with basophilic ground substance and myxomatous tissue. Radiographic Findings: radiolucent; multilocular and expansile, with coursing septae which look like a finely reticulated spider web or a honeycomb or mottled 49 appearance
Myxoma
50
Exostoses Description: exostosis = outgrowth of bone
Description: exostosis = outgrowth of bone Torus palatinus Torus palatinus is found at the midline of the palate. It is an extension of the bony process and not a well-defined neoplasm. Torus mandibularis Buccal exostoses Clinical Features: hard swellings covered by somewhat thin but essentially normal mucosa. If the overlying mucosa becomes irritated, ulceration is often slow to heal because of poor underlying vascularity. Radiographic Features: marked opacity and lack of bone resorption so it indicates an innocuous(harmless) condition. zones of 51 radiopacity with some superimposition over the
52
Osteoma
Description: Osteomas are considered to be benign neoplasms of bone forming tissue. An exophytic nodular growth of dense cortical bone on or within the jaws in locations other than those occupied by tori or exostoses. Clinical Features:Osteomas are less common than exostoses. Histopathologic findings: cellular and active lesion with areas of loose vascular connective tissue containing irregular bone trabeculae. with considerable osteoblastic activity. Radiographic findings: round opacity with central areas of radiolucency. This lesion is much less radiopaque than the typical exostosis Treatment: Treatment of osteomas is only necessary if they are symptomatic. 53
54
Osteoid Osteoma
Description:Osteoid osteoma is a benign skeletal neoplasm of unknown etiology that is composed of osteoid and woven bone. Clinical Features:Pain on palpation well-demarcated, encapsulated, expansile intraosseous lesion of the jaws Histopathology: Active central cellular nidus surrounded by zone of osteoid fomation Radiographic Features:A circular or ovoid lucent defect is seen in 75% of patients. This defect is usually smaller than 1.5 cm in diameter and is associated with sclerosis. Treatment:surgical excision
55
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