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Neville and Damm > Ch15-Odontogenic Cysts > Flashcards

Ch15-Odontogenic Cysts Flashcards

1
Q

Dentigerous cysts can occur at any age, but mostly in…Age? Gender? Ethnicity?

A

10-30 yrs, male, white

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2
Q

Can there be expansion with a dentigerous cyst?

A

usually not, but if it gets large enough, yes

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3
Q

Pathogenesis of a dentigerous cyst is accumulation of fluid between the tooth crown and the ________?

A

reduced enamel epithelium

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4
Q

What are the 9 developmental odontogenic cysts?

A
  1. dentigerous cyst 2. eruption cyst 3. odontogenic keratocyst (OKC) 4. Orthokeratinized odontogenic cyst 5. gingival (alveolar) cyst of the newborn 6. gingival cyst of the adult 7. lateral periodontal cyst 8. calcifying odontogenic cyst 9. glandular odontogenic cyst
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5
Q

What are the 3 inflammatory odontogenic cysts?

A
  1. periapical (radicular) cyst 2. residual periapical (radicular) cyst 3. buccal bifurcation cyst
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6
Q

Can a dentigerous cyst have odontogenic epithelial rests in the cyst wall?

A

yep, can fool some into thinking ameloblastoma

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7
Q

How many cell layers thick is a typical dentigerous cyst?

A

2-4 layers

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8
Q

What are three possible entities that a dentigerous cyst can transition into?

A

ameloblastoma, SCC, intraosseous mucoepidermoid ca (arising from mucous cells lining the cyst)

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9
Q

What is the soft tissue analogue of a dentigerous cyst? What is its lining?

A

eruption cyst..a thin layer of non-keratinizing epithelium

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10
Q

If an eruption cyst undergoes trauma, it can become blood filled and blue…what is it then often called?

A

eruption hematoma

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11
Q

What was the 1970’s term for an OKC?

A

Primordial cyst (developed from the dental primordium aka dental lamina)

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12
Q

The OKC arises from….

A

the cell rests of the dental lamina

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13
Q

OKC shows increased expression of _____ and ____ IHC in the suprabasilar layer

A

PCNA (proliferating cell nuclear antigen) and Ki-67

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14
Q

What is the genetic alteration in 30% of sporatic OKCs and 85% of OKCs found in nevoid basal cell carcinoma (Gorlin) syndrome?

A

PTCH1 (patch one)

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15
Q

About 60% of OKCs are diagnosed in age? gender? site?

A

10-40 years old, male, posterior mandible

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16
Q

Are OKCs associated with expansion??

A

no, typically develop in the medullary space of bone

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17
Q

If an OKC presents in the maxillary midline what is the differential and what age group is it compatible with?

A

nasopalatine duct cyst and aged 70

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18
Q

Rarely what can be seen in the wall of an OKC?

A

Cartilage!

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19
Q

The agreed upon recurrence rate for OKC? Where are they most likely to recur? When are they most likely to recur?

A

30%, posterior mandible / ramus, less than 5 years after surgery, but cases of 10 years documented too

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20
Q

What is the name of the chemical cautery agent sometimes used by surgeons to destroy OKCs?

A

Carnoy’s solution (banned in some hospitals)

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21
Q

OrthokeratinizED odontogenic cyst (OOC) age? gender? location?

A

young males posterior mandible

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22
Q

What are the 2 main distinguishing factors between an OKC and an OOC?

A

OOC has 1. keratohyaline granules and 2. NO basal palisading

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23
Q

Whats the recurrence rate for an OOC?

A

2%

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24
Q

Genes involved in NBCC (Gorlin) Syndrome? Which chromosome? Type of inheritance?

A

Patched (PTCH)..9q22.3-q31…Autosomal Dominant

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25
Q

What percent range of affected patients in NBCCS represent NEW mutations?

A

35-50%

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26
Q

When do BCCs start to show up in a pt with NBCCS? Where do they typically apppear (2 locations-1 is general, 1 specific)

A

Puberty or 2nd-3rd decades (CAN develop in children-holy shit)..areas NOT exposed to sunlight, also on midface area

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27
Q

In pt’s with NBCCS what is the typical age of the first RESECTION of an OKC?

A

19 years old, just an average

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28
Q

OKCs in pts with NBCCS typically express which two oncoproteins when compared to non-syndrome OKCs?

A

p53 and cyclin D1 (bcl-1)

29
Q

Children diagnosed with NBCCS should have MRIs done every 6 months until age 7 to rule out what type of tumor?

A

medulloblastoma

30
Q

Gingival cysts of newborn arise from? About what percentage of newborns develop these? Where do they more commonly occur?

A

remnants of the dental lamina…50%…maxillary alveolar ridge as opposed to mandibular

31
Q

What is the soft tissue counterpart to the lateral periodontal cyst?

A

ginigival cyst of the adult

32
Q

Gingival cyst of the adult is derived from?

A

dental lamina (rests of Serres)

33
Q

If a cyst develops in the site of a graph and appears like a gingival cyst of the adult, what is it more likely to be?

A

epithelial inclusion cyst

34
Q

Gingival cyst of the adult: location? age?

A

60-75% of cases in the mandibular canine/PM area.. 5-6th decades

35
Q

Gingival cyst of the adult / lateral periodontal cyst: thin, flattened epithelial lining with or without focal ______ that contain ______ cells

A

PLAQUES…clear (glycogen rich)

36
Q

Lateral periodontal cyst: age? location?

A

5-7th decades,75-80% occur in mandibular PM-canine-lateral incisor area

37
Q

Can you develop a lateral periodontal cyst in an edentulous site?

A

yep

38
Q

A botryoid odontogenic cyst is another name for a polycystic appearance of a _______ cyst

A

lateral periodontal

39
Q

Thickness of a lateral periodontal cyst lining? what shapes of epithelial cells?

A

1-3 cell layers thick, squamous or cuboidal

40
Q

Lateral periodontal cysts have focal ______ thickenings primarily comprised of ______ cells

A

nodular…clear cells

41
Q

What is the histological hallmark of a calcifying odontogenic cyst?

A

ghost cells in odontogenic epithelium

42
Q

WHO has categorized COCs as odontogenic tumors in what three names?

A
  1. Calcifying cystic odontogenic tumor 2.dentinogenic ghost cell tumor 3.Ghost cell odontogenic carcinoma
43
Q

What 3 odontogenic tumors have COCs been associated with?

A

1.odontomas (20% of the time) 2.AOTs 3.ameloblastoma

44
Q

COC: age? location?

A

20-40, 65% in incisor / canine area, equal max and mand

45
Q

COC histo: +/- capsule? lining thickness/type?

A

+ thin fibrous capsule, 4-10 cells thick of cuboidal to columnar (ameloblast-like)

46
Q

A variant of COC unifocal or mulifocal epithelial proliferation of the cyst lining into the lumen may resemble WHAT entity?

A

ameloblastoma

47
Q

COC can closely resemble ameloblastoma…what is the main difference?

A

GHOST CELLS

48
Q

This malignant form of a COC tends to recur and has unpredictable behavior…73% 5 year survival rate

A

Ghost cell odontogenic carcinoma (GCOC)

49
Q

Whats the multi-cystic name of an LPC?

A

Bytrioid odontogenic cyst

50
Q

What is the alternate name for a GOC?

A

Sialo-Odontogenic Cyst

51
Q

GOC: age, location?

A

46-51 yrs (RARE under 20), anterior mandible (CROSSES MIDLINE!)

52
Q

GOC: +/- expansion? +/- symptoms?

A

+ expansion / + pain (considered aggressive)

53
Q

GOC Radio: +/- unilocular?

A

+ unilocular / OR multilocular

54
Q

GOC histo: What are the 9 histological diagnostic criteria?

A
  1. Flat epithelial interface 2. focal luminal projections 3. hobnail cells 4.mucous/goblet cells 5. ducts 6. papillary projections 7. ciliated cells 8. multicystic / multiluminal 9. clear cells in basal layer
55
Q

GOCs can have histological overlap with what malignancy? What gene rearrangement can help distinguish?

A

intraosseus low-grade, cystic mucoepidermoid carcinoma (UF study set)….MAML2 (in muco ep, not in GOC)

56
Q

What is the recurrence rate for GOC?

A

30%

57
Q

What tooth is mostly associated with a buccal bifurcation cyst?

A

Mand 1st molar (can occur on second molar)

58
Q

What is the synonym for buccal bifurcation cysT?

A

paraDental cyst

59
Q

Buccal bifurcation cyst: age? histology characteristics? Do you extract the associated tooth?

A

5-13…nonspecific - nonkeratinizing strat squam epi and inflam in wall.. Extraction of tooth is usually UNNECESSARY

60
Q

Odontogenic Carcinomas can arise from already existing cysts/tumors, like a _____________ arising from the mucous cells of a dentigerous cyst

A

mucoepidermoid caricinoma

61
Q

About what % of odontogenic cysts have been found to progress to cancer? Age range? Gender?

A

1-2%….older pts mean 60 yrs… Male

62
Q

What can be a radiographic indicator of odontogenic carcinoma vs benign cyst?

A

ragged borders of lesion

63
Q

What is the most common type of cyst associated with carcinomatous transformation?

A

RESIDUAL PERIAPICAL CYST

64
Q

What are the 5 (possibly 6) cysts that have given rise to odontogenic carcinomas?

A
  1. residual periapical cyst 2. periapical cyst (residual and periapical are 60% of cases) 3.dentigerous cyst 4. LPC 5 OKC (but it was likely an 6. OOC)….also didn’t include COC which is associated with Ghost Cell Odon Carcinoma or Ameloblastic carcinoma (not considered a cyst)
65
Q

What are most odontogenic carcinomas histologically classified as?

A

well-or-mod-differentiated SCC

66
Q

What % of COCs are associated with ODONTOMAS?

A

20%

67
Q

What are the 5 MAJOR criteria for NBCCS (Gorlin)?

A
  1. 5 or more BCCs OR 1 BCC before the age of 30 2. OKC 3. Lamellar calcification of the falx cerebri 4. two or more Palmar or Plantar pits 5. 1st degree relative with NBCCS
68
Q

What are the 8 MINOR criteria for NBCCS (Gorlin)?

A
  1. Macrocephaly 2. Congenital malformation: Cleft lip or palate, frontal bossing, coarse facial features, and/or hypertelorism 3. Preaxial or postaxial polydactyly 4. Rib or vertebral abnormalities: bifid, splayed, or extra ribs;
    bifid vertebrae 5. Ovarian or cardiac fibromas 6. Medulloblastoma* 7. Ocular anomalies: Cataract, coloboma, and/or microphthalmia 8. Lymphomesenteric or pleural cysts
69
Q

What are the requirements to make a Gorlin Syn Dx?

A

2 major

OR

1 major AND 2 minor

OR

1 major AND genetic confirmation (1st deg relative or PTCH? I’m confused)

Neville and Damm (72 decks)

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