18 Odontogenic Cysts and Tumors Flashcards
1
Q
What does a dentigerous cyst develop from
A
Separation of follicle around a crown
2
Q
What percent of patients with unerupted teeth have a dentigerous cyst?
A
2.5%
3
Q
If you have not developed a dentigerous cyst by this age, you will likely never get one
A
35
4
Q
What type of border does the RL of a Dentigerous cyst have?
A
Well defined, around the crown of an impacted tooth
5
Q
In a dentigerous cyst, how far is the crown of the impacted tooth away from the edge of the RL?
A
Less than 3 mm
6
Q
Can a dentigerous cyst cause the resorption of the adjacent tooth?
A
Yes
7
Q
Are dentigerous cysts usually symptomatic or asymptomatic?
A
Asymptomatic
8
Q
Do dentigerous cysts cause expansion?
A
Rarely
9
Q
Are dentigerous cysts unilocular or multilocular?
A
Unilocular, although large ones may give the impression of multi due to persistent trabeculae
10
Q
What is the treatment for a dentigerous cyst?
A
Curettage with or without extraction of the impacted tooth
11
Q
Once treated, are dentigerous cysts expected to recur?
A
No
12
Q
How might a large Dentigerous cyst be treated?
A
Marsupialization
13
Q
What are the 4 most likely teeth to develop a dentigerous cyst?
A
- Mn 3rd Molar
- Mx Canines
- Mx 3rd Molar
- Mn 2nd PM
14
Q
What are the histological features of a dentigerous cyst?
A
Simple Squamos Epithelial Cyst wall devoid of inflammation
15
Q
What is an eruption cyst?
A
The soft tissue equivalent of a dentigerous cyst
16
Q
Where does an eruption cyst occur?
A
Within the soft tissue overlying alveolar bone
17
Q
What does an eruption cyst look like?
A
Soft, translucent swelling in the gingival mucosa
Overlying the crown of a tooth
18
Q
Who gets eruption cysts typically?
A
Children younger than 10 years old
19
Q
What might happen if the cyst receives trauma?
A
An eruption hematoma that might result in considerable bleeding
20
Q
Histologically, what is an eruption cyst like?
A
It is the roof of a dentigerous cyst
21
Q
What is the treatment for an eruption cyst
A
Simple excision of roof.
Might not be needed is spontaneous rupture occurs
22
Q
What percent of odontogenic development cysts become Odontogenic Keratocysts?
A
10%
23
Q
Where do OKC’s arise from?
A
Rests of dental lamina
24
Q
60% of OKC’s occur between these ages
A
10-40
25
60-80% of OKC's occur in this part of the oral cavity
Mandible (body and ascending ramus)
26
In what direction do OKC's grow?
Antero-posterior direction in medullary bone without expansion
27
What gender gets OKC's more often?
Males slightly more
28
What percentage of OKC cases involve an unerupted tooth?
25-40%
29
Do OKC's reoccur?
Yes, frequently
| 5-62%
30
What is the treatment for OKCs
Enucleation and curettage
Peripheral ostectomy
Chemical cauterization after cyst removal
Decompression
31
What are the signs/symptoms of Basal Cell Carcinoma Syndrome?
Multiple BCCa
OKCs
Rib and vertebral anomalies
Intracranial calcifications
Palmar and Plantar Pits
32
What is an example of a Rib anomaly in someone with BCCa?
Bifid rib
33
What are gingival cysts of Newborn's
Small superficial keratin-filled cysts on alveolar mucosa of infants
34
Where do GC of Newborns come from?
Remnants of dental lamina
35
What percent of newborns have gingival cysts?
1/2
36
What are gingival cysts of newborns called that arise on the hard and soft palate?
Hard = Epsteins Pearls
Soft = Bohn's Nodules
37
What is a gingival cyst
Soft tissue counterpart of LPC
38
Where does a gingival cyst occur?
Facial gingiva
39
What color can a gingival cyst be?
Bluish
40
What part of the facial gingiva do gingival cysts usually occur in?
75% in Mandibular Canine/Premolar area
41
Where are gingival cysts derived from
Rests of Serres (dental lamina)
42
What age group develops gingival cysts of the Adult
40-60 Year olds
| Rare before 30
43
How large are most gingival cysts?
Less than 1 cm
44
Where do Lateral Periodontal Cysts Arise From?
Rests of Dental Lamina
or
REE proliferation along lateral root
45
What percent of epithelial lined jaw cysts are Lateral Perio Cysts?
2%
46
Who gets Lateral Periodontal Cysts?
Males under 30
47
What region of the mouth are lateral periodontal cysts found in
Mandibular Canine/Premolar Region
Maxillary lesions are less common
48
What type of appearance might Lateral Periodontal Cysts Have?
Multilocular
49
Grossly and Microscopically, what do Lateral Perio Cysts look like
Grapelike clusters of small individual cysts
50
Do Lateral Periodontal Cysts re-occur
Rare, but more common with Botryoid odontogenic cysts
51
What type of histology can you expect with an LPC?
Cuboidal epithelial cells with foci of glycogen rich cells
52
Histologically, what happens to the epithelial lining with a Lateral Perio Cyst
Thickening
53
What are three types of Calcifying Odontogenic Cysts?
1. Gorlin Cyst
2. Dentigenic ghost cell tumor
3. Calcifying ghost cell odontogenic cyst
54
What is controversial about the classification of Calcifying Odontogenic Cysts?
Some feel that it is not a cyst, but a neoplasm
55
What is the dispersment of intraosseous vs. extraosseous Calcifying Odontogenic Cysts?
70% Intra
| 30% Extra
56
Are calcifying cysts more likely to occur in the mandible or maxilla?
Mandible = Maxilla
57
65% of Calcifying Odontogenic Cysts are found in this region
Incisor/Canine
58
What age people get calcifying odontogenic cysts
10-30 year olds (mean age = 33)
59
What type of Calcifying odontogenic tumor is associated with younger age of development?
COC's that are associated with odontomas
60
Describe the radiographic border of a COC
Unilocular, well-defined RL
Occasionally Multilocular
61
Describe the radiographic lesion in general
Radiopaque structures are either irregular calcifications or toothlike densities in 1/3-1/2 of cases
62
Describe the clinical look of extraosseous calcifying odontogenic cysts
Localized, sessile of pedunculated gingival masses with no distinctive features
63
What do COC's resemble clinically?
Gingival fibromas
Gingival Cysts
Peripheral Gingival Lesions
64
What percent of COC's are the cyst form?
85-98%
65
Describe the histology of a COC
Well defined cystic lesion with fibrous capsule
4-10 cell thick odontogenic epithelial lining
66
What is the most characteristic feature of the COC's histology?
Ghost Cells
67
What are ghost cells
Altered epithelial cells characterized by loss of nuclei with the preservation of cell outline
68
What percent of COCs are associated with Odontomas
20%
69
What percent of COCs are neoplastic?
2-16%
70
What is the treatment for a calcifying odontogenic cyst?
Simple enucleation
71
What are the clinical categories we look at when evaluating Odontogenic Tumors
```
Age
Radiographic Characteristics
Assoc. w/Unerupted teeth?
Location (mx v. mn)
Sex predilection
Induction v. No Induction
```
72
What is the most common clinically significant odontogenic tumor?
Ameloblastoma
73
What is the origin of an ameloblastoma
Cell rests of dental lamina
Developing enamel organ
Lining of odontogenic cysts
Basal cells of oral mucosa
74
What is misleading about an ameloblastoma on a radiograph?
The tumor islands can be as much as 1cm further than the radiographic images indicate
75
In what age group do ameloblastomas rarely develop in?
Under 10
| Uncommon in teens
76
What is the typical clinical presentation of ameloblastoma?
Painless swelling or expansion of jaw
77
What is not common, even in large tumors?
Pain and Paresthesia
78
What type of Radiographic lesion is an Ameloblastoma
Multilocular Radiolucency
79
What two radiographic image patterns are indicative of an ameloblastoma
Soap bubble and Honeycomb
80
What bone modifications are common in ameloblastomas?
Buccal and Lingual cortical expansion and root resorption
81
What is commonly associated with the ameloblastoma lesion?
Unerupted teeth, usually mandibular 3rd molars
82
What is the key histological feature of an ameloblastoma
Follicular pattern of islands of epithelium which resembles an enamel organ.
83
What are the Island of epithelium in an ameloblastoma made up of?
Loosely arranged angular cells resembling stellate reticulum
84
What type of histological pattern is indicative of Ameloblastoma?
Plexiform
85
What is the plexiform pattern made of?
Long anastomosing cords of odontogenic epithelium
86
Do ameloblastomas form cysts?
Not usually
87
Besides plexiform, what are the other four Histological patterns associated with ameloblastomas?
1. Acanthomatous
2. Granular cell
3. Desmoplastic
4. Basal cell
88
What percent of ameloblastomas are mandibular in origin
85%
89
What are 80% of maxillary Ameloblastomas associated with?
Molars and/or antrum
90
What does a unicystic ameloblastoma look like on x-ray
Circumscribed RL that surrounds the crown of an unerupted third molar
91
Where do almost all (90%) of unicystic ameloblastomas occor
Posterior mandible
92
What type of ameloblastoma arises from the rests of DL beneath the oral mucosa or from basal epithelial cells of the surface epithelium?
Peripheral Ameloblastoma
93
What is the treatment for a peripheral ameloblastoma
Local surgical excision
94
What is the average age of a patient that develops an ameloblastoma?
35
95
What are the Pattern of growth for ameloblastomas
1. Solid or Multicystic (86%)
2. Unicystic (13%)
3. Peripheral (1%)
96
What percent of ameloblastomas are radiographically multi-locular?
53%
97
Do ameloblastomas perforate the inferior border of bone?
Usually not
98
What is the growth profile of ameloblastomas?
Aggressive
99
These tumors make up 3-7% of odontogenic tumors and arise from enamel organ or remnants of dental lamina
Adenomatoid Odontogenic Tumors
100
What is an adenomatoid odontogenic tumor
Epithelial tumor with inductive effect on odontogenic ectomesenchyme
101
What gender does the adenomatoid odontogenic tumor have a predilection for?
Females (2x)
102
How do you treat an adenomatoid odontogenic tumor?
Enucleation
103
What region of the jaws do adenomatoid odontogenic tumors typically form in?
Anterior, and 2x as often found in maxilla
104
What is the presentation of 75% of Adenomatoid odontogenic tumors
Circumscribed unilocular RL that involves the crown of unerupted teeth
105
What is the most likely tooth crown to develop an Adenomatoid Odontogenic Tumor
Canine
106
How do you differentiate an Adenomatoid Odontogenic Tumor from a Dentigerous cyst?
Extends apically along root past CEJ
107
What type of calcifications are on Adenomatoid Odontogenic Tumors
Snowflake calcifications
108
These tumors may have rosettelike structures about a central space and may contain eosinophilic material
Adenomatoid odontogenic tumor
109
What type of calcifying tumor is also known as a pinborg tumor
Calcifying epithelial odontogenic tumor
110
How does a calcifying epithelial odontogenic tumor grow?
Painlessly and slow
111
What does a calcifying epithelial odontogenic tumor look like on an x-ray
Unilocular or multilocular RL defect that may contain calcified structures
112
What is the histology of a calcifying epithelial odontogenic tumor
Polyhedral epithelial cells in a fibrous stroma
Epithelial cells distinct with intercellular bridges noted
Nuclei can be bizarre
113
What kind of cellular material is present in a CEOT
Eosinophilic, hyalinized
114
What kind of distinctive calcifications are found in CEOTs
Concentric Liesegang ring calcifications
115
Which is more aggressive, CEOTs or Ameloblastomas
Ameloblastomas
116
A CEOT in this location must be treated more agressively
Posterior Maxilla
117
What is a mixed tumor of epithelial and mesenchymal elements
Ameloblastic Fibroma
118
Describe the radiographic margins of the ameloblastic fibroma
Unilocular or multilocular RL
Margins well defined and might be sclerotic
119
Ameloblastic fibromas may or may not have one of these
capsule
120
What is it called when an ameloblastic fibroma also has enamel and dentic
Ameloblastic Fibro-Odontoma
121
What does an Ameloblastic Fibro-Odontoma look like on a radiograph
Well circumscribed unilocular RL with a variable amount of calcified material with the radiodensity of tooth structure
122
What is the treatment and prognosis of an Ameloblastic Fibro-Odontoma
Conservative curettage, and the prognosis is excellent
123
What is the most common odontogenic tumor
Odontoma
124
What percent of odontomas are associated with an impacted tooth
48%
125
What is the radiographic appearance of an odontoma
Always radio-paque foci that has the density of enamel
Well defined border
126
When should an odontoma always be removed
when its blocking a tooth eruption
127
What is an odontogenic myxoma
a tumor that bears a close microscopic resemblance to mesenchymal portion of a developing tooth
128
Who gets odontogenic myxomas
Young adults 25-30
129
What is the radiographic presentation of an odontogenic myxoma
unilocular or multilocular RL that may displace or cause resorption of teeth
130
What other radiographic presentations indicate an odontogenic myxoma
Soap bubble
May contain thin wispy trabeculae of residual bone which are arranged at right angles to each other
131
What tissue is induced by dental lamina to become specialized cells capable of being induced further into odontogenic cells which differentiate and produce calcifIed dental tissues
Neuroectoderm
