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D2: 622 Oral Pathology > 18 Odontogenic Cysts and Tumors > Flashcards

18 Odontogenic Cysts and Tumors Flashcards

1
Q

What does a dentigerous cyst develop from

A

Separation of follicle around a crown

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2
Q

What percent of patients with unerupted teeth have a dentigerous cyst?

A

2.5%

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3
Q

If you have not developed a dentigerous cyst by this age, you will likely never get one

A

35

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4
Q

What type of border does the RL of a Dentigerous cyst have?

A

Well defined, around the crown of an impacted tooth

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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

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6
Q

Can a dentigerous cyst cause the resorption of the adjacent tooth?

A

Yes

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7
Q

Are dentigerous cysts usually symptomatic or asymptomatic?

A

Asymptomatic

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8
Q

Do dentigerous cysts cause expansion?

A

Rarely

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9
Q

Are dentigerous cysts unilocular or multilocular?

A

Unilocular, although large ones may give the impression of multi due to persistent trabeculae

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10
Q

What is the treatment for a dentigerous cyst?

A

Curettage with or without extraction of the impacted tooth

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11
Q

Once treated, are dentigerous cysts expected to recur?

A

No

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12
Q

How might a large Dentigerous cyst be treated?

A

Marsupialization

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13
Q

What are the 4 most likely teeth to develop a dentigerous cyst?

A
  1. Mn 3rd Molar
  2. Mx Canines
  3. Mx 3rd Molar
  4. Mn 2nd PM
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14
Q

What are the histological features of a dentigerous cyst?

A

Simple Squamos Epithelial Cyst wall devoid of inflammation

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15
Q

What is an eruption cyst?

A

The soft tissue equivalent of a dentigerous cyst

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16
Q

Where does an eruption cyst occur?

A

Within the soft tissue overlying alveolar bone

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17
Q

What does an eruption cyst look like?

A

Soft, translucent swelling in the gingival mucosa

Overlying the crown of a tooth

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18
Q

Who gets eruption cysts typically?

A

Children younger than 10 years old

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19
Q

What might happen if the cyst receives trauma?

A

An eruption hematoma that might result in considerable bleeding

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20
Q

Histologically, what is an eruption cyst like?

A

It is the roof of a dentigerous cyst

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21
Q

What is the treatment for an eruption cyst

A

Simple excision of roof.

Might not be needed is spontaneous rupture occurs

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22
Q

What percent of odontogenic development cysts become Odontogenic Keratocysts?

A

10%

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23
Q

Where do OKC’s arise from?

A

Rests of dental lamina

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24
Q

60% of OKC’s occur between these ages

A

10-40

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25
Q

60-80% of OKC’s occur in this part of the oral cavity

A

Mandible (body and ascending ramus)

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26
Q

In what direction do OKC’s grow?

A

Antero-posterior direction in medullary bone without expansion

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27
Q

What gender gets OKC’s more often?

A

Males slightly more

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28
Q

What percentage of OKC cases involve an unerupted tooth?

A

25-40%

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29
Q

Do OKC’s reoccur?

A

Yes, frequently

5-62%

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30
Q

What is the treatment for OKCs

A

Enucleation and curettage

Peripheral ostectomy

Chemical cauterization after cyst removal

Decompression

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31
Q

What are the signs/symptoms of Basal Cell Carcinoma Syndrome?

A

Multiple BCCa

OKCs

Rib and vertebral anomalies

Intracranial calcifications

Palmar and Plantar Pits

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32
Q

What is an example of a Rib anomaly in someone with BCCa?

A

Bifid rib

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33
Q

What are gingival cysts of Newborn’s

A

Small superficial keratin-filled cysts on alveolar mucosa of infants

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34
Q

Where do GC of Newborns come from?

A

Remnants of dental lamina

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35
Q

What percent of newborns have gingival cysts?

A

1/2

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36
Q

What are gingival cysts of newborns called that arise on the hard and soft palate?

A

Hard = Epsteins Pearls

Soft = Bohn’s Nodules

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37
Q

What is a gingival cyst

A

Soft tissue counterpart of LPC

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38
Q

Where does a gingival cyst occur?

A

Facial gingiva

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39
Q

What color can a gingival cyst be?

A

Bluish

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40
Q

What part of the facial gingiva do gingival cysts usually occur in?

A

75% in Mandibular Canine/Premolar area

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41
Q

Where are gingival cysts derived from

A

Rests of Serres (dental lamina)

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42
Q

What age group develops gingival cysts of the Adult

A

40-60 Year olds

Rare before 30

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43
Q

How large are most gingival cysts?

A

Less than 1 cm

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44
Q

Where do Lateral Periodontal Cysts Arise From?

A

Rests of Dental Lamina

or

REE proliferation along lateral root

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45
Q

What percent of epithelial lined jaw cysts are Lateral Perio Cysts?

A

2%

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46
Q

Who gets Lateral Periodontal Cysts?

A

Males under 30

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47
Q

What region of the mouth are lateral periodontal cysts found in

A

Mandibular Canine/Premolar Region

Maxillary lesions are less common

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48
Q

What type of appearance might Lateral Periodontal Cysts Have?

A

Multilocular

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49
Q

Grossly and Microscopically, what do Lateral Perio Cysts look like

A

Grapelike clusters of small individual cysts

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50
Q

Do Lateral Periodontal Cysts re-occur

A

Rare, but more common with Botryoid odontogenic cysts

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51
Q

What type of histology can you expect with an LPC?

A

Cuboidal epithelial cells with foci of glycogen rich cells

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52
Q

Histologically, what happens to the epithelial lining with a Lateral Perio Cyst

A

Thickening

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53
Q

What are three types of Calcifying Odontogenic Cysts?

A
  1. Gorlin Cyst
  2. Dentigenic ghost cell tumor
  3. Calcifying ghost cell odontogenic cyst
54
Q

What is controversial about the classification of Calcifying Odontogenic Cysts?

A

Some feel that it is not a cyst, but a neoplasm

55
Q

What is the dispersment of intraosseous vs. extraosseous Calcifying Odontogenic Cysts?

A

70% Intra

30% Extra

56
Q

Are calcifying cysts more likely to occur in the mandible or maxilla?

A

Mandible = Maxilla

57
Q

65% of Calcifying Odontogenic Cysts are found in this region

A

Incisor/Canine

58
Q

What age people get calcifying odontogenic cysts

A

10-30 year olds (mean age = 33)

59
Q

What type of Calcifying odontogenic tumor is associated with younger age of development?

A

COC’s that are associated with odontomas

60
Q

Describe the radiographic border of a COC

A

Unilocular, well-defined RL

Occasionally Multilocular

61
Q

Describe the radiographic lesion in general

A

Radiopaque structures are either irregular calcifications or toothlike densities in 1/3-1/2 of cases

62
Q

Describe the clinical look of extraosseous calcifying odontogenic cysts

A

Localized, sessile of pedunculated gingival masses with no distinctive features

63
Q

What do COC’s resemble clinically?

A

Gingival fibromas
Gingival Cysts
Peripheral Gingival Lesions

64
Q

What percent of COC’s are the cyst form?

65
Q

Describe the histology of a COC

A

Well defined cystic lesion with fibrous capsule

4-10 cell thick odontogenic epithelial lining

66
Q

What is the most characteristic feature of the COC’s histology?

A

Ghost Cells

67
Q

What are ghost cells

A

Altered epithelial cells characterized by loss of nuclei with the preservation of cell outline

68
Q

What percent of COCs are associated with Odontomas

69
Q

What percent of COCs are neoplastic?

70
Q

What is the treatment for a calcifying odontogenic cyst?

A

Simple enucleation

71
Q

What are the clinical categories we look at when evaluating Odontogenic Tumors

A 
Age
Radiographic Characteristics
Assoc. w/Unerupted teeth?
Location (mx v. mn)
Sex predilection
Induction v. No Induction
72
Q

What is the most common clinically significant odontogenic tumor?

A

Ameloblastoma

73
Q

What is the origin of an ameloblastoma

A

Cell rests of dental lamina

Developing enamel organ
Lining of odontogenic cysts
Basal cells of oral mucosa

74
Q

What is misleading about an ameloblastoma on a radiograph?

A

The tumor islands can be as much as 1cm further than the radiographic images indicate

75
Q

In what age group do ameloblastomas rarely develop in?

A

Under 10

Uncommon in teens

76
Q

What is the typical clinical presentation of ameloblastoma?

A

Painless swelling or expansion of jaw

77
Q

What is not common, even in large tumors?

A

Pain and Paresthesia

78
Q

What type of Radiographic lesion is an Ameloblastoma

A

Multilocular Radiolucency

79
Q

What two radiographic image patterns are indicative of an ameloblastoma

A

Soap bubble and Honeycomb

80
Q

What bone modifications are common in ameloblastomas?

A

Buccal and Lingual cortical expansion and root resorption

81
Q

What is commonly associated with the ameloblastoma lesion?

A

Unerupted teeth, usually mandibular 3rd molars

82
Q

What is the key histological feature of an ameloblastoma

A

Follicular pattern of islands of epithelium which resembles an enamel organ.

83
Q

What are the Island of epithelium in an ameloblastoma made up of?

A

Loosely arranged angular cells resembling stellate reticulum

84
Q

What type of histological pattern is indicative of Ameloblastoma?

85
Q

What is the plexiform pattern made of?

A

Long anastomosing cords of odontogenic epithelium

86
Q

Do ameloblastomas form cysts?

A

Not usually

87
Q

Besides plexiform, what are the other four Histological patterns associated with ameloblastomas?

A
  1. Acanthomatous
  2. Granular cell
  3. Desmoplastic
  4. Basal cell
88
Q

What percent of ameloblastomas are mandibular in origin

89
Q

What are 80% of maxillary Ameloblastomas associated with?

A

Molars and/or antrum

90
Q

What does a unicystic ameloblastoma look like on x-ray

A

Circumscribed RL that surrounds the crown of an unerupted third molar

91
Q

Where do almost all (90%) of unicystic ameloblastomas occor

A

Posterior mandible

92
Q

What type of ameloblastoma arises from the rests of DL beneath the oral mucosa or from basal epithelial cells of the surface epithelium?

A

Peripheral Ameloblastoma

93
Q

What is the treatment for a peripheral ameloblastoma

A

Local surgical excision

94
Q

What is the average age of a patient that develops an ameloblastoma?

95
Q

What are the Pattern of growth for ameloblastomas

A
  1. Solid or Multicystic (86%)
  2. Unicystic (13%)
  3. Peripheral (1%)
96
Q

What percent of ameloblastomas are radiographically multi-locular?

97
Q

Do ameloblastomas perforate the inferior border of bone?

A

Usually not

98
Q

What is the growth profile of ameloblastomas?

A

Aggressive

99
Q

These tumors make up 3-7% of odontogenic tumors and arise from enamel organ or remnants of dental lamina

A

Adenomatoid Odontogenic Tumors

100
Q

What is an adenomatoid odontogenic tumor

A

Epithelial tumor with inductive effect on odontogenic ectomesenchyme

101
Q

What gender does the adenomatoid odontogenic tumor have a predilection for?

A

Females (2x)

102
Q

How do you treat an adenomatoid odontogenic tumor?

A

Enucleation

103
Q

What region of the jaws do adenomatoid odontogenic tumors typically form in?

A

Anterior, and 2x as often found in maxilla

104
Q

What is the presentation of 75% of Adenomatoid odontogenic tumors

A

Circumscribed unilocular RL that involves the crown of unerupted teeth

105
Q

What is the most likely tooth crown to develop an Adenomatoid Odontogenic Tumor

106
Q

How do you differentiate an Adenomatoid Odontogenic Tumor from a Dentigerous cyst?

A

Extends apically along root past CEJ

107
Q

What type of calcifications are on Adenomatoid Odontogenic Tumors

A

Snowflake calcifications

108
Q

These tumors may have rosettelike structures about a central space and may contain eosinophilic material

A

Adenomatoid odontogenic tumor

109
Q

What type of calcifying tumor is also known as a pinborg tumor

A

Calcifying epithelial odontogenic tumor

110
Q

How does a calcifying epithelial odontogenic tumor grow?

A

Painlessly and slow

111
Q

What does a calcifying epithelial odontogenic tumor look like on an x-ray

A

Unilocular or multilocular RL defect that may contain calcified structures

112
Q

What is the histology of a calcifying epithelial odontogenic tumor

A

Polyhedral epithelial cells in a fibrous stroma

Epithelial cells distinct with intercellular bridges noted

Nuclei can be bizarre

113
Q

What kind of cellular material is present in a CEOT

A

Eosinophilic, hyalinized

114
Q

What kind of distinctive calcifications are found in CEOTs

A

Concentric Liesegang ring calcifications

115
Q

Which is more aggressive, CEOTs or Ameloblastomas

A

Ameloblastomas

116
Q

A CEOT in this location must be treated more agressively

A

Posterior Maxilla

117
Q

What is a mixed tumor of epithelial and mesenchymal elements

A

Ameloblastic Fibroma

118
Q

Describe the radiographic margins of the ameloblastic fibroma

A

Unilocular or multilocular RL

Margins well defined and might be sclerotic

119
Q

Ameloblastic fibromas may or may not have one of these

120
Q

What is it called when an ameloblastic fibroma also has enamel and dentic

A

Ameloblastic Fibro-Odontoma

121
Q

What does an Ameloblastic Fibro-Odontoma look like on a radiograph

A

Well circumscribed unilocular RL with a variable amount of calcified material with the radiodensity of tooth structure

122
Q

What is the treatment and prognosis of an Ameloblastic Fibro-Odontoma

A

Conservative curettage, and the prognosis is excellent

123
Q

What is the most common odontogenic tumor

124
Q

What percent of odontomas are associated with an impacted tooth

125
Q

What is the radiographic appearance of an odontoma

A

Always radio-paque foci that has the density of enamel

Well defined border

126
Q

When should an odontoma always be removed

A

when its blocking a tooth eruption

127
Q

What is an odontogenic myxoma

A

a tumor that bears a close microscopic resemblance to mesenchymal portion of a developing tooth

128
Q

Who gets odontogenic myxomas

A

Young adults 25-30

129
Q

What is the radiographic presentation of an odontogenic myxoma

A

unilocular or multilocular RL that may displace or cause resorption of teeth

130
Q

What other radiographic presentations indicate an odontogenic myxoma

A

Soap bubble

May contain thin wispy trabeculae of residual bone which are arranged at right angles to each other

131
Q

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

A

Neuroectoderm

D2: 622 Oral Pathology (36 decks)

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