Ch 15 Odontogenic cysts and tumors Flashcards
which odontogenic tumor contains no calcified structures and therefore is always radiolucent
ameloblastoma
- develops from separation of follicle around a crown
- usually develop before 35
- well defined around the crown of impacted tooth
- usually asymptomatic/non-inflammatory
- histo: SSE without inflammation
dentigerous cyst
- txt: curettage of cyst with or without extraction of impacted tooth
- large DC may be txt by marsupialization (creating a window)/decompression
- soft tissue analogue of dentigerous cyst
- separation of the dental follicle around the crown of a developing tooth
- within the soft tissue overlying alveolar bone
- usually in children younger than 10
- can come from surface trauma (eruption hematoma)
eruption cyst
-txt may not be required due to spontaneous rupture, or simple excision of roof of cyst if does not erupt
- arises from rests of dental lamina
- affects males more than females
- grow within medullary bone without expansion
- 60-80% mandible
odontogenic keratocyst
-txt: enucleation and curettage, peripheral ostectomy, chemical cauterization after cyst removal, DECOMPRESSION
- multiple basal cell carcinomas
- odontogenic keratocysts
- rib and vertebral anomalies (bifid rib)
- intracranial calcifications
- palmar and plantar pits
basal cell carcinoma syndrome
- small superficial keratin-filled custs on alveolar mucosa of infants
- arise from remnants of dental lamina
- common in 1/2 of newborns and disappear spontaneously by rupture into oral cavity
- epstein pearls and Bohn’s nodules midline of palate or laterally on hard or soft palate
gingival cyst of the newborn
- soft tissue counterpart of Lateral Periodontal Cyst
- facial gingival
- bluish
- 75-80% mandible canine/premolar region
Gingival cyst
- derived from dental lamina (rests of Serres)
- Adults in 5-6th decades; rare before 30
- most cysts less than 1 cm
- histo shows little “pouches”
gingival cyst of the adult
-not really that dangerous, can be removed
- arise from rests of dental lamina or proliferation of REE along lateral root
- 2% of epithelial lined jaw cysts
- affects males >30
- mandibular canine/premolar region, less common maxillary but same location
- cuboidal epithelial cells with foci of glycogen rich cells
- thickening of epithelial lining
lateral periodontal cyst
-the histo also has the out “pouches” that the gingival cyst of the adult has
- gorlin cyst
- dentinogenic ghost cell tumor
- calcifying ghost cell odontogenic cyst
- considered a cyst by some feel neoplas
- predomintly intraosseous lesion but 13-30% extraosseous
- mand=maxilla
- 65% cases found in incisor canine region
- RL lesion associated with unerupted tooth, most often canine
- root resorption or divergence of adjacent teeth seen
- can resemble gingival fibromas, cysts…
calcfying odontogenic cyst
-txt: simple enucleation with few recurrences
- Inflammatory Odontogenic Cyst on the buccal aspect of the mandibular first permanent molar
- also called Paradental cyst
- typically occurs in children 5-11
- foul tasting dischard
- Xray show well-circuscribed unilocular RL involving buccal furcation and root area
Buccal bifurcation cyst
types of Odontogenic tumors
Ameloblastoma
- most common clinically significant odontogenic tumor
- origins: cell rests of dental lamina, developing enamel organ, lining of odontogenic cyst, basal cells of oral mucosa
- painless swelling or expansion of jaw
- pain and paresthesia uncommon even in large tumors
- ML RL lesions
- “soap bubble” when large and “honeycombed” when small
- buccal and lingual cortical expansion and resorption of roots common
- unerupted tooth (mand 3rd) commonly associated with RL defect
- a single layer of tall ameloblast-like cells surround central core with reverse polarity
ameloblastoma
-tumor islands are as much as 1 cm further than the radiographic features show
Histology:
- A single layer of tall ameloblast- like cells surround central core with reverse polarity
- Islands of epithelium resemble enamel organ, consisting of loosely arrnaged angular cells resembling stellate reticulum
- Plexiform pattern
- -Long anastomosing cords or larger sheets of odontogenic epithelium
ameloblastoma
-grows intramular, similarto ameloblastoma
unicystic ameloblastoma
-excise them
-ameloblastoma on posterior gingiva and aleolar mucosa
peripheral ameloblastoma
-surgical excision
- 3-7% odontogenic temors
- slow growth and circumscription of lesion
- from enamel organ or remnants of dental lamina
- epithelial tumor with inductive (calcification)effect on odontogenic ectomesenchyme
- younger patients (2/3 10-19)
- anterior portions of jaws; 2X maxilla
- FEMALE 2X males
- enucleation
- often contains “snowflake calcifications”
- involves crown of unerupted tooth, usually canine
- extends apically along root past CEJ (distinguis from dent cyst
adenomatoid odontogenic tumor
-txt is enucleation
- small foci of calcifications
- rosettelike structures about central space and may contain eosinophilic materia
- epithelial cells that form sheets, stands or whorled masses of cells in scant fibrous stroma
adenomatoid odontogenic tumor
- also known as Pindborg Tumor
- rare; 30-50; 2/3 mandible, most often posterior region
- painless slow growing swelling
- unilocular or multilocular RL defect which may contain calcified structures
- frequently associated with impacted mand 3rd molars
Calcifying epithelial odontogenic tumor
-txt local resection lesion of posterior maxilla txt more aggressively
- polyhedral epithelial cells in a fibrous stroma
- epithelial cells distinct with intercellular bridges notes
- nuclei show considerable variation and can be bizarre
- calcification distinctive feature develop within the amyloid-like material and form concentric rings (Liesegang ring calcifications)
Calcifying Epithelial Odontogenic Tumor
- True mixed tumor of epithelial and mesenchymal elements
- Younger patients with posterior mandible most common site (70% cases)
- Unilocular or multilocular RL lesion; xray margins well defined and may be sclerotic
- Unerupted tooth associated 75%
Ameloblastic Fibroma
-txt: conservative removal
- Ameloblastic Fibroma with enamel and dentin
- average age 10; rare in adults
- asymptomatic and discovered on xray that is taken for failure of tooth to erupt
ameloblastic fibro-odontoma
-txt: conservative curettage and lesion separates easily from bone
- most common odontogenic tumor (not a true tumor)
- M=F; Max>mand
- mean age 14 (detected in first 2 decades)
- compound=complex
- 48% associated with impacted tooth
- ALWAYS radio opaque foci density of enamel
- well defined
- appears as little tooth masses to globs
Odontoma
-txt: remove if blocking tooth eruption
- young adults 25-30 yr olds
- UL or ML RL that may displace or cause resorption of teeth
- margins of RL often irregular or scalloped
- may be “soap bubble”
- may contain thin wispy trabeculae of residual bone which are arranged at right angles to each other
Odontogenic Myxoma
- txt small myomas managed by curettage with recall of at least 5 yrs
- larger lesions, resection may be required
-neuroectoderm is induced by dental lamina to become specialized cells capable of being induced further into odontogenic cells which differentiate and produce calcified dental tissues
odontogenic Ectomesenchyme
***histology of odontogenic keratoocyst
1-uniformly thin (about 6 layers)
2- devoid of rete pegs
3-prominent basal cell layer
-it can be line with parakeratin (has nuclei) or orthokeratin (without nuclei)
***Histo: ghost cells which are altered epithelial cells characterized by loss of nuclei with perservation of cell outline
Calcifying Odontogenic Cyst
- **Histo:follicular pattern: single layer of tall ameloblast-like cells surround central core with reverse polarity
- and plexiform pattern
Ameloblastoma (it is trying to do what a tooth does)
if you see expansion…
probably ameloblastoma
which tumor has a stronger predillection for the maxilla?
Adenomatorid odontogenic tumor
- anterior maxilla, usually canine area,
- “snowflake calcifications”
- young females
- it’s benign,
- txt: surgical excision
Liesegang ring calcifications, polyhedral
Calcifying Epithelial Odontogenic Tumor
basal cell carcinoma syndrome
- multiple basal cell carcinomas
- odontogenic keratocysts
- rib and vertebral anomalies (bifid rib)
- intracranial calcifications
- palmar and plantar pits
bohns nodules and epstein pearls
-what does it come from?
gingival cyst of the newborn
-remnants of dental lamina
what is the soft tissue counterpart of the lateral periodontal cyst?
-and where does it occur most commonly?
gingival cyst
-75-80 Mandibular near PM/K area
what abnormalities develop from the dental lamina?
- OKC
- gingival cyst of newborn
- gingival cyst of adult
- lateral periodontal cyst (or REE)
- Ameloblastoma (one possible origin)
- Adenomatoid Odontogenic tumor (or from enamel organ)
lateral periodontal cyst with multiple compartments
Botryoid odontogenic cyst
Cuboidal epithelial cells with foci of glycogen rich cells
lateral periodontal cyst
gorlin cyst
calcifying odontogenic cyst
ghost cell tumor
calcifying odontogenic cyst
average age is 10, more rare in adults
-asymptomatic and discovered on wray that is taken for failure of a tooth to erupt
ameloblastic fibro-odontoma
most common odontogenic tumor (not a true tumor)
-has the density of enamel
odontoma
- txt remove if it is blocking eruption
- compound is multiple little teeth, complex is enamel, dentin and pulp tissue swirled together
- during surgical excision=gelatinous
- young adults 25-30
- mandible>maxilla
- may be “soup bubble”
odontogenic myxoma
