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Oral medicine > Bone lesions and cysts - radiology and histology > Flashcards

Bone lesions and cysts - radiology and histology Flashcards

1
Q

How to describe a lesion on an x-ray (6)

A 
Site
Size
Shape
margins
radio density
effects on surrounding structures
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2
Q

What is the definition of a cyst

[3]

A

Pathological cavity filled w fluid, semi-fluid or gaseous contents.
Not filled with pus.
Has a wall, a lining (epithelium) and a lumen.

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3
Q

3 things/steps needed for a cyst to form

A
  1. A source of epithelium
  2. A stimulus for proliferation
  3. Growth and bony resorption
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4
Q

Types of cysts in the jaws
[10]
Cysts technically not in bone [3]

A

Odontogenic cysts:
developmental (dentigerous cyst, eruption cyst, lateral periodontal cyst, odontogenic keratocyst, calcifying odontogenic cyst)
Inflammatory (radicular cyst apical or lateral, residual cyst, paradental/collateral cyst)
Non-odontogenic cysts:
nasopalatine duct cyst

nasolabial cyst (non-odontogenic)
Glandular odontogenic cyst
Gingival cyst (developmental, infants and adults)
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5
Q

How do cysts grow and proliferate

[7]

A

Breakdown in the centre of the cyst. This brings water into the cyst via osmosis which increases the hydrostatic pressure and makes the cyst grow + proliferation of the epithelium. Process continues.
Interleukin, cytokines drive this and activate Oc and cause bone resorption.

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6
Q

Radicular cyst epithelium source

A

Hertwigs root sheath/epithelial rests of Malassez in the PDL.

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7
Q

Stimulus for the formation of a radicular cyst

[3]

A

Chronic periapical inflammation/periapical periodontitis is replaced with granulation tissue to make a periapical granuloma.

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8
Q

location of radicular cyst

[2]

A

always associated w a non-vital tooth. Can be apical or lateral (lateral canals) or residual.

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9
Q

radiographic appearance of radicular cyst

[5]

A

well defined, +/- corticated, large (15mm) radiolucency, continuous with the PDL

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10
Q

histological appearance of radicular cyst

[3]

A

non-keratinised epithelial lining, lots of chronic inflammatory cells
Arcaded pattern

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11
Q

how is a collateral/paradental cyst formed

[4]

A

stimulus is periodontal pocket inflammation and the cyst forms on the lateral aspect of the tooth.
Epithelium arises from the pocket epithelium.
Tooth needs to be at least partially erupted

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12
Q

histology of paradental cyst

[2]

A

attached at the ACJ and looks like a radicular cyst.

Inflammatory cells, non-keratinised SSE, arcaded pattern

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13
Q

follicular/dentigerous cyst formation

[4]

A

cyst surrounding the crown of an unerupted tooth.
A developmental cyst
arises from the reduced enamel epithelium.
Normal radiolucency around a developing tooth crown is 3mm (between the crown and the follicle)

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14
Q

dentigerous cysts + radiographic and histological features
[3]
[3]

A

Impacted tooth still in bone.
Well-defined, corticated radiolucency surrounding the crown and attaching at the ACJ.
Histologically = minimal inflammation, thin and regular non-keratinised epithelium

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15
Q

eruption cyst

[5]

A

a cyst surrounding the crown of an erupting tooth that is not in the bone.
Can impede the eruption of the tooth
Histologically same as dentigerous cyst but very close to the gingival epithelium
Epithelium from the reduced enamel epithelium
Erupts by itself usually

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16
Q

how is an odontogenic keratocyst formed

[3]

A

arises from the dental lamina remnants/rests of serres.
Can be associated with an unerupted tooth, and in the 3rd molar region, a lot of the time bc that’s where you find remnants of dental lamina.

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17
Q

odontogenic keratocyst clinical/histological/ radiographic appearance
[2]
[5]
[2]

A

Clinically - not destructive and little expansion.
Histology = Fragile lining (thin parakeratinised, with the basal layer nuclei all standing in a line (nuclear palisading)). Fragile lining means bits get broken off when removal is attempted so has a high recurrence rate.
Can get daughter cysts which bud off and are easy to leave behind.
Cyst can be solid (filled w keratin if small).
radiographic = multi or unilocular, w smooth or irregular outlines and not much bucco-lingal expansion even if very large. well defined +/- corticated, doesn’t push things out of the way.

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18
Q

Odontogenic keratocyst associated syndrome

A

basal cell naevus/Gorlin-Goltz syndrome

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19
Q

what is gorlin-goltz syndrome

[6]

A

multiple, recurrent odontogenic keratocysts
multiple and recurrent basal cell carcinomas of skin not exposed to sun.
frontal bossing/wide forehead
calcified falx cerebri (midline in skull so transmits electrical signals more so more likely to get epilepsy)
wide set eyes
bifurcation in ribs

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20
Q

lateral periodontal cyst formation

[3]

A

developmental.
Forms on the lateral aspect between vital teeth.
Epithelium arises from rests of Serres.

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21
Q

radiographic appearance of a lateral periodontal cyst

[4]

A

multilocular, well defined, corticated radiolucency.

Has localized thickenings of the lining (called plaques/Botroid)

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22
Q

gingival cysts

[4]

A

can be in adults and in children.

In children:

  • parakeratinised epithelium
  • arises from dental lamina rests in the alveolar mucosa
  • located under the alveolar mucosa

In adults:

  • non-keratinised epithelium
  • arises from dental lamina rests in the attached gingiva
  • form in the attached gingivae
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23
Q

glandular odontogenic cysts

[6]

A

have cuboidal or columnar epithelium w mucus production, duct-like/glandular structures.
High recurrence rate
Not in bone
Developmental

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24
Q

calcifying odontogenic cyst [2]
rad and histology
[4]
[3]

A

in young children. Developmental
radiolucency w calcification’s - well defined and displaces teeth.
lined with ameloblastoma-like epithelium and has ghost cells and dentine.

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25
Q

non-odontogenic cysts

A

nasopalatine cyst and nasolabial cysts

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26
Q

nasopalatine cyst formation

[2]

A

midline of anterior part of palate.

from nasopalatine duct epithelial residues as the processes fuse in utero.

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27
Q

nasopalatine cyst histological /clinical/radiographic appearance
[4]
[1]
[4]

A

lined by respiratory or mucosal epithelium or both.
can have nerve bundles or vascular signs in the lumen.
seen as a swelling in the hard palate.
radiographically - well-defined radiolucency overlying the upper central incisors roots but is separate to them (can trace the PDL around them) i.e. doesn’t interfere or resorb them - need to vitality test them

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28
Q

nasolabial cysts location

[3]

A

soft tissues of face - next to the nose, base of nostril or nasolabial fold

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29
Q

nasolabial cyst epithelium

[2]

A

remnants of nasolacrimal duct = pseudo-stratified columnar epithelium

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30
Q

what is an odontogenic tumour

[2]

A

tumour that arises from dental epithelium or mesenchyme. Radiolucent lesion, sometimes with calcifications.

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31
Q

different types/classification of odontogenic tumours

[5]

A 
Benign:
- odontogenic epithelium only
- odontogenic epithelium and mesenchyme (+/- dental hard tissues)
- odontogenic mesenchyme only
Malignant:
sarcoma (mesenchyme)
carcinoma (epithelium)
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32
Q

types of odontogenic epithelium sources

[5]

A

oral epithelium, dental lamina/rests of Serres, rest of Mallassez/Hertwig’s root sheath, enamel organ, reduced enamel epithelium

33
Q

sources of odontogenic mesenchyme

[3]

A

dental papilla, PDL, dental follicle

34
Q

What is an odontome

[3]

A

a lesion that develops during patient’s growth phase and stops growing when the normal growth of the patient stops.
AKA hamartoma.
Not a true neoplasm

35
Q

types of epithelium only odontogenic tumours

[4]

A

ameloblastoma
adenomatoid odontogenic tumour
calcifying epithelial odontogenic tumour
squamous odontogenic tumour

36
Q 
ameloblastoma (benign)
[8]
Histology [4]
types [4]
management [2]
A

Young people, usually at angle of mandible.
Destructive e.g. root resorption, bucco-lingual expansion, into soft tissues. Uni or multilocular well defined radiolucency. Reoccurs

Histology = ameloblast cells (appear columnar) in islands filled with stellate reticulum, surrounded by fibrous stroma

Conventional type:
- follicular (ameloblast lined areas and stellate reticulum)
- plexiform (ameloblast lined strands and little stellate reticulum)
Can be cystic
- luminal/intraluminal true unicystic
- other cystic types need to be excised w margins e.g. multicystic or mural type.

Management = excise w margins. Can decompress cysts first (marsupialisation). True unicystic can be enucleated.

37
Q

adenomatoid odontogenic tumour [6] and histology 3

A

like a hamartoma
not destructive, doesn’t reoccur.
looks like a dentigerous cyst (well-defined radiolucency) but has calcifications, and can be associated w unerupted upper canines
Histology = duct-like structures, dentine-like matrix w calcifications

38
Q

calcifying epithelial odontogenic tumour [3] and histology 5

A

asymptomatic but destructive and expansive
well defined multi/unilocular radiolucency w opacities, like an ameloblastoma
can be associated w unerupted teeth
calcifies more as it ages.
Histology = pleomorphic epithelium, cuboidal cells w prickles, enamel-like matrix and calcifications

39
Q

types of odontomas (benign)

[5]

A

complex = fused mess of teeth parts, esp in posterior mandible
compound = upper anterior region. Small non-aggressive and tooth like structures.
Radiolucency w tooth structure inside it.

40
Q

complications with odontomas

[4]

A

infection
impede eruption
try to erupt
gingival inflammation

41
Q

types of mixed odontogenic tumours (benign)

[4]

A

ameloblastic fibroma
dentinogenic ghost tumour
odontoma
+/- dental hard tissues

42
Q

histology of odontogenic epithelium

[2]

A

collumnar ameloblast cells + stellate reticulum usually

43
Q

ameloblastic fibroma [2], rad [3] and histology 3

A

younger patient and in the mandible
Well defined radiolucency with calcifications
histology = odontogenic epithelium and early pulp material and can get some dental hard tissues

44
Q

dentinogenic ghost tumour (benign) [3] [2]

A

radiolucent w calcifications.
Similar to a calcifying odontogenic cyst
Histology shows ghost cells w no nuclei, and dentine.

45
Q

mesenchyme odontogenic tumours types (benign) [3]

A

odontogenic myxoma/myxo-fibroma
odontogenic fibroma
cementoblastoma

46
Q 
odontogenic myxoma/myxo-fibroma
(benign)
[1] clinical
[3] rad
[1] histology
A

aggressive and destructive
uni or multilocular radiolucency (small like soap bubbles)
histology = stretched bone and lots of loose connective tissue

47
Q 
odontogenic fibroma
(benign) [3]
A

mature fibrous tissues
unilocular radiolucency
central or peripheral types (bone or gingivae origins)

48
Q

cementoblastoma
(benign)
[2]
[3]

A

cementoblasts = a radiopaque lesion attached to the root of the tooth
especially in lower posterior teeth
histology = sheets of osteoid, cementum and plump cementoblasts.

49
Q

malignant odontogenic tumours

A

v v rare but destructive so need excision.

50
Q

types of fibro-osseous lesions [4]

A 
ossifying fibroma
fibrous dysplasia
cemento-osseous dysplasia
Paget' disease
= bone resorbed and replaced w fibrous tissue, which abnormal bone grows in to.
51
Q

ossifying fibroma
[4]
[2]
[3]

A

benign neoplasm, destructive but doesn’t recur, Usually in the mandible, in females.

well defined margins, can be more radiolucent or more radiopaque depending on age of lesion

Histologically looks like fibrous dysplasia but is surrounded by normal bone - a mix of new irregular bone and fibrous tissue in the middle.

52
Q

fibrous dysplasia

[8]

A

developmental (younger patients)
bone replaced with fibrous tissue which calcifies
orange peel granular appearance on radiograph, not well defined and with no margins.
monostatic (single lesion) or multistatic (multiple in H&N)
can reoccur esp during growth phase.
unilateral or bilateral
can be destructive and cause bony expansion and other problems.

53
Q

cemento-osseous dysplasia

A

reactive, in older patients.
multiple mixed radiolucent and radiopaque lesions
focal/single lesion or periapical or florid (multiple lesions in jaws, can be genetic)

54
Q

Paget’s disease
[5]
[3]
[2]

A

Idiopathic, increased bone turnover.
Bone becomes more vascular, more prone to infection and sclerotic, and enlarged.
Causes legs bowing and enlarged skull w lots of problems, increased bone malignancy.
irregular radiopaque and radiolucent lesions - cotton wool appearance

55
Q

dental complications of Paget’s

[5]

A 
bisphosphinates
hypercementosis
difficult extractions
gaps/ill fitting dentures as skull expands
infection
56
Q

fibro-osseous lesions radiographic/histological appearance

A

usually radiopaque/radiolucent mixed lesions depending on the age of the lesion.
histology = Irregular bony fragments w fibrous tissues, Oc

57
Q

giant cell lesions

A

bone resorbed and replaced w fibrous tissue and lots of mulitnucleated giant cells/Oc
Radiolucent

58
Q

management of giant cell lesions

A

blood biochemistry to rule out hyperparathyroidism/treat this if it is the cause
curettage, remove lesion, resection

59
Q

cherubism

[9]

A

developmental - a type of fibrous dysplasia in v young patients
bilateral well defined swellings in angle of the mandible
multilocular radiolucent lesions
benign but can be locally destructive
Look like central giant cell granulomas on rad and histology
don’t usually treat

60
Q

hyperparathyroidism
[5]
[4]

A

primary or secondary (more PTH activates more Oc = more bone resorption = calcium out of bones = kidney stones, weaker bones)
radiolucent lesions “brown tumours” that look like central giant cell granulomas
Brown bc more blood and more breakdown of blood products and more Oc

61
Q

central giant cell granuloma

A

well demarcated multilocular radiolucency
pre-molar/molar region
Histology = lots of giant cells

62
Q

dry socket

A

alveolar osteitis
loss of blood clot or reduced blood supply
not seen on xray
can develop into osteomyelitis

63
Q

sclerosing osteitis

A

in response to a low grade infection e.g. chronic PAP.
Uniform opacity at apex of the tooth + some peripheral radiolucency
can look like a cementoblastoma or hypercementosis or osteoma

64
Q

osteomyelitis

A

infection in bone marrow space
acute - bacteria like staphylococci from a periapical abscess get into the bone after a fracture or trauma. Neutrophils and Oc
chronic - less pain, swelling, lymphocytes and macrophages. Oc and Ob and on radiograph bone looks moth eaten bc irregular areas of bone resorption and deposition.
Manage = remove infected bone and source of infection. Ab

65
Q

MRONJ/osteoradionecrosis

A

exposed bone,non healing.
Radiotherapy = reduced vasculature
Other risk factors =Paget’s, smoking, poor OH.

66
Q

osteoma

A

Bony nodule, can be mistaken for tori.
benign slow growing
radiopaque lesion w a radiolucent border
made of cancellous/compact bone

67
Q

osteosarcoma

A

malignant and destructive and aggressive inc pain and nerve damage
Radiolucency w irregular bone deposition
loss of lamina dura around teeth and destruction of bone inc cortical bone, into oral cavity
Histology = abnormal unorganised bone and dark abnormal cells.

68
Q

differential diagnosis for a well defined radiolucency

[5]

A

cyst
benign neoplasm
giant cell lesion
apical granuloma or a radicular cyst

69
Q

differentials for a peri coronal radiolucency

[5]

A

follicular cyst (dentigerous or eruption)
can have 3mm of normal radiolucency around the crown of a developing tooth
keratocyst or ameloblastoma
+ calcifications = odontogenic tumour

70
Q

apical granuloma vs radicular cyst

[4]

A

smaller, not corticated, will heal on its own after source of infection removed.
granulation tissue

71
Q

differentials for radiopaque lesions

[7]

A

retained teeth or roots that have drifted
salivary stones/calcifications in tonsils
odontomes or supernumerary teeth
around apex of teeth = sclerosing osteitis (non-vital)
cemental lesions/hypercementosis
Odontogenic cyst
benign neoplasms - osteoblastoma, osteoma (well-defined), calcifying epithelial odontogenic tumour
ill-defined borders can be malignant osteosarcoma
Mucous retention cyst

72
Q

soft tissue opacities differentials

[4]

A

calcifications of ligaments or nodes/glands/tonsils.
Phleboliths
maxillary sinus polyps
arterial sclerosis

73
Q

Gardner’s syndrome

[5]

A

Multiple jaw osteomas, supernumerary teeth and odontomes. Polyps in bowel which can become malignant and need monitoring.
not to be mistaken w gorlin-gortz syndrome

74
Q

phleboliths

[3]

A

vascular lesions - multiple small opacities w concentric rings

75
Q

maxillary sinus polyps

[2]

A

well-defined, dome shaped opacities in antrum floor.

Usually due to allergy or URTI and are harmless

76
Q

Osteopetrosis
[3]
[3]

A

inherited so can be in children:

  • loss of bone marrow spaces = anaemia, heart failure, fatal
  • marble bone on xray, brittle and fragile

chronic version in adults:

  • increased radiopacity in bones
  • loss of teeth and normal structures like IAN canal
77
Q

hyperpituitarism

[3]

A

increased growth hormone (gigantism in kids, acromegaly in adults)
big hands, spaces, enlarged sinus, big jaw.

78
Q

sickle cell anaemia

[4]

A

abnormal RBC so body responds by hyperplasia of bone marrow.
= reduced cortical bone, bony expansion, less dense bone.
Areas of bone infarction and sclerosis = radiopacities.

Oral medicine (4 decks)

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