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Oral Pathology - My deck > Chapter 15 > Flashcards

Chapter 15 Flashcards

1
Q

What are the 9 odontogenic cysts?

A

Dentigerous, eruption, odontogenic keratocyst, orthokeratinized odontogenic, gingival cyst of the adult, lateral periodontal, calcifying odontogenic, glandular odontogenic, buccal bifurcation

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2
Q

What are the 5 odontogenic tumors of epithelial origin?

A

Ameloblastoma, ameloblastic carcinoma, adenomatoid odontogenic tumor, calcifying epithelial odontogenic tumor

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3
Q

What are the 5 mixed odontogenic tumors?

A

ameloblastic fibroma, ameloblastic fibro-odontoma, ameloblastic fibrosarcoma, odontoma, odontogenic tumors

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4
Q

What are the 4 odontogenic ectomesenchyme tumors?

A

Central odontogenic fibroma, peripheral odontogenic fibroma, odontogenic myxoma, cementoblastoma

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5
Q

What is the most common developmental cyst?

A

Dentigerous cyst

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6
Q

What does a dentigerous cyst originate from?

A

Originates by separation of the follicle from around the crown of an unerupted tooth (fluid accumulation between REE and crown)

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7
Q

Where is a dentigerous cyst attached to a tooth?

A

Encloses the crown of the unerupted tooth and is attached to the CEJ

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8
Q

What teeth are most commonly involved in a dentigerous cyst?

A

Mandibular 3rd molars

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9
Q

What is the clinical presentation of dentigerous cysts?

A

Asyptomatic, they are discovered on routine xray –> they can grow to considerable size and cause facial asymmetry but this is rare

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10
Q

What is radiographic presentation of dentigerous cysts?

A

Unilocular radiolucency associated with the crown of an unerupted tooth, with a well defined and usually sclerotic border

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11
Q

What is the treatment for a dentigerous cyst?

A

Enucleation of the cyst and unerupted tooth (and any other affected teeth)

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12
Q

What is the prognosis and recurrence rate of dentigerous cysts?

A

Prognosis is good and recurrence is rare

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13
Q

What term describes the soft tissue analogue of the dentigerous cyst?

A

Eruption cyst

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14
Q

What is the cause of an eruption cyst?

A

Develops as a result of separation of the dental follicle from around the crown of an erupting tooth

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15
Q

What is the clinical appearance of an eruption cyst?

A

Appears as a soft, translucent/blue to purple swelling in the gingival mucosa overlying the crown of an erupting tooth

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16
Q

In what population is an eruption cyst most common?

A

In children younger than 10

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17
Q

What is another name for eruption cyst?

A

Eruption hematoma

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18
Q

What is the treatment for an eruption hematoma?

A

Cyst usually ruptures spontaneously, but if this doesn’t occur, excision of the roof of the cysts permits eruption of the totoh

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19
Q

What term describes a cyst that arises from the dental lamina?

A

Odontogenic keratocyst

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20
Q

What are the 2 most important things about an odontogenic keratocyst?

A

30% recurrence rate and is it associated with Gorlin syndrome

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21
Q

What is another name for odontogenic keratocyst?

A

Keratocystic odontogenic tumor

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22
Q

When are most cases of odontogenic keratocysts diagnosed?

A

Between the ages of 10-40

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23
Q

What is the most common location of odontogenic keratocyss?

A

The posterior mandible

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24
Q

What is the clinical presentation of odontogenic keratocysts?

A

They tend to grow in an anterior-posterior direction, may cause bone expansion

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25
Q

What is the radiographic presentation of odontogenic keratocysts?

A

Small lesions are well defined, unilocular RL with corticated margins. Large lesions can be mulitlocular. An unerupted tooth is involved in 1/3 of cases

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26
Q

What is the histopathology of odontogenic keratocysts?

A

Thin, friable wall; epithelial lining is a uniform 6-8 layers thick with parakeratinization; basal cell layer shows palisading and is hyperchromatic; may have satellite/daughter cysts; filled with keratin debris

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27
Q

Why is the recurrence rate of odontogenic keratocysts 30%?

A

Complete removal is challenging due to the friable nature of the cyst wall! Reurrence may happen 10 are more years after surgery

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28
Q

When should a patient with an odontogenic keratocyst be evaluated for Gorlin’s syndrome?

A

If they are younger than 20

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29
Q

What is another name for Gorlin syndrome?

A

Nevoid Basal Cell Carcinoma Syndrome

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30
Q

What causes nevoid basal cell carcinoma syndrome?

A

Is it a autosomal dominant syndrome associated with the PTCH gene on chromosome 9

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31
Q

What is the prevalence of nevoid basal cell carcinoma syndrome?

A

1:60,000

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32
Q

What are the characteristics associated with nevoid basal cell carcinoma syndrome?

A

multiple basal cell carcinomas, odontogenic keratocysts, calcification of the falx cerebri, rib anomalies – these characteristics are not usually life threatening

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33
Q

When do basal cell carcinomas occur in nevoid basal cell carcinoma syndrome?

A

Appear around puberty and appear on skin not exposed to sunlight

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34
Q

What are one of the most constant features of nevoid basal cell carcinoma syndrome?

A

The odontogenic keratocysts – there are frequently multiple, but may result in jaw deformity from operations to remove them

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35
Q

What is the prognosis of nevoid basal cell carcinoma syndrome?

A

Depends on the behavior of the basal cell carcinomas

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36
Q

What term describes an odontogenic cyst with orthokeratinized linging and no basal palisading?

A

Orthokeratinized odontogenic cyst

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37
Q

In what population does orthokeratinized odontogenic cysts occur?

A

In young adults and more commonly in males

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38
Q

Where doe orthokeratinized odontogenic cysts usually occur?

A

In the posterior mandible, typically unilocular and appear identical to a dentigerous cyst around a 3rd molar

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39
Q

What is the recurrence of orthokeratinized odontogenic cysts?

A

Recurrence is rare

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40
Q

What term describes the soft tissue counterpart of the lateral periodontal cyst?

A

Gingival cyst of the adult

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41
Q

What are gingival cysts of the adult derived from?

A

Derived from rests of dental lamina (rests of serres)

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42
Q

Where do gingival cysts of the adult occur?

A

Striking predilection for the mandibular canine and premolar area, in the facial gingiva or alveolar mucosa

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43
Q

In what age population is a gingival cyst of the adult common?

A

ADULTS, but between 40-50

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44
Q

What is the clinical presentation of a gingival cyst of the adult?

A

painless, dome like swellings (fluid filled) which are less than 5 mm, and may be blue in color – looks like a mucocele but is on the gingiva!

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45
Q

What term describes a developmental odontogenic cyst which typically occurs along the lateral root surfaces?

A

Lateral Periodontal Cyst

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46
Q

What does a lateral periodontal cyst arise from?

A

Rests of the dental lamina

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47
Q

Lateral periodontal cysts are the intrabony counterpart to the ______ ______ ___ ___ _______/

A

Gingival cyst of the adult

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48
Q

In what age population do lateral periodontal cysts occur?

A

Between 40 - 60 (gingival cyst of the adult is 40-50)

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49
Q

Where do lateral peridontal cysts occur?

A

Striking predilection to occur in the mandibular premolar-canine-lateral-incisor area

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50
Q

Are teeth vital in lateral peridontal cysts?

A

Yes

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51
Q

What term describes multilocular/polycystic variant of lateral periodontal cysts?

A

Botryoid odontogenic cyst – occurs when multiple rests are stimulated

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52
Q

What are the other names for calcifying odontogenic cyst?

A

Calcifying cystic odontogenic tumor, or gorlin cyst

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53
Q

Where do most calfifying odontogenic cysts occur?

A

65% in the incisor canine area

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54
Q

In what age population do calcifying odontogenic cysts occur?

A

Average age is 35

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55
Q

What are 20% of calcifying odontogenic cysts associated with? And what are 1/3 associated with?

A

Odontomas, an unerupted tooth (usually canine)

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56
Q

What are some radiographic features of calcifying odontogenic cysts?

A

Unilocular, radioloucency with radio-opaques flecks

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57
Q

What are the histopathologic feature of calcifying odontogenic cysts?

A

Have ghost cells, which can calcify

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58
Q

What is the treatment and prognosis of calcifying odontogenic cysts?

A

Enucleation, rare recurrence, good prognosis

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59
Q

What term describes a developmental cyst with glandular and/or salivary gland features?

A

Glandular odontogenic cyst

60
Q

What is the average age of patients that develop glandular odontogenic cysts?

A

50

61
Q

Where do glandular odontogenic cysts occur?

A

75% of cases occur in the mandible, with a predilection for the anterior jaws

62
Q

What are some radiographic features of glandular odontogenic cysts?

A

Either unilocular or multilocular, with well defined margins and sclerotic rim

63
Q

What is the treatment for glandular odontogenic cysts?

A

Enucleation, or curettage, but multilocal lesions can recur so sometimes en bloc resection is used

64
Q

What term describes an inflammatory cyst with uncertain pathogenesis that usually develops in the bifurcation?

A

Buccal bifucration cyst

65
Q

Where do buccal bifurcation cysts commonly develop?

A

Buccal aspect of the mandibulat 1st permanent molar

66
Q

What is the average age of the patient with a buccal bifurcation cyst?

A

Average age is 10

67
Q

What are some clinical features of buccal bifurcation cysts?

A

May have tenderness, swelling, foul tasting discharge or usually have a pocket

68
Q

How many cases of buccal bifurcation cysts will have bilateral involvement?

A

1/3 have bilateral involvement

69
Q

What are some radiographic features of buccal bifurcation cysts?

A

well circumscribed, unilocular RL involving the buccal bifurcation and root, average size is 1.5 cm, and root apices are tipped to the lingual

70
Q

How are buccal bifurcation cysts treated?

A

Enucleation, no need to extract the tooth

71
Q

What is the pathogenesis of odonotgenic carcinomas?

A

The pathology is unknown; it has to do with something abnormal that has been left for decades, and then progressed into something else

72
Q

What are the 2 most common symptoms of odontogenic carcinomas?

A

Pain and swelling

73
Q

What are some radiographic features of odontogenic carcinomas?

A

The mimic odontogenic cysts, except the margins are irregular and ragged

74
Q

What does histology usually show in odontogenic carcinomas?

A

Well-differentiated SCCA

75
Q

What is the treatment for odontogenic carcinomas, and what is the prognosis?

A

Treatment varies based on the type, and spread. Approximately 50% survive after treatment

76
Q

What must be ruled out before calling an odontogenic carcinoma a true primary intraosseous carcinoma?

A

Must rule out metastatic spread – carcinoma arising within bone is rare and essentially limited to the jaws

77
Q

What is the most common clinically significant odontogenic tumor?

A

Ameloblastoma

78
Q

What does an ameloblastoma arise from?

A

It is a tumor of odontogenic epithelial origin

79
Q

What are the 3 different types of ameloblastoma?

A

Conventional solid or multicystic (85%), unicystic (15%), peripheral (1%)

80
Q

At what age do ameloblastomas usually occur?

A

Between the 3rd and 7th decade

81
Q

Is there a sex predilection associated with ameloblastomas?

A

No sex predilection

82
Q

Where do ameloblastomas occur?

A

85% occur in the mandible, usually in the molar-ascending ramus area

83
Q

What is the clinical presentation of an ameloblastoma?

A

They are asymptomatic, only a painless swelling. Because of this they can go untreated and grow to grotesque portions

84
Q

What are the radiographic features of an ameloblastoma?

A

Multilocular radiolucency
- either “soap bubble” if RL’s are large, or “honeycombed” if they are small;
Buccal and lingual cortical expansion is frequently present; resorption of roots is common; unerupted tooth may be associated with the defect

85
Q

What form does not share features of the other forms?

A

Desmoplastic ameloblastoma

86
Q

What is desmoplastic ameloblastoma?

A

Predilection for the anterior maxilla, may be mixed RL/RO due to osseous metaplaisa

87
Q

What are the histopathological features of ameloblastomas?

A

Palisading, hyperchromatic basal layer; reverse polarity; apical vacuolization

88
Q

What is the treatment for an ameloblastoma? What is the most widely used treatment?

A

Variety of treatments from simple enucleation and curettage to en bloc resection. Marginal resection is the most widely used treatment (1.5 cm margins)

89
Q

What type of bone do ameloblastomas infiltrate?

A

Infiltrate between cancellous bone, at lesion periphery

90
Q

Can ameloblastomas recur?

A

Yes, curettage has recurrence rates anywhere from 50-90%, but recurrence takes years

91
Q

What is the recurrence rate of marginal resection of ameloblastomas?

A

Recurrence rate is 15%

92
Q

What are peripheral ameloblastomas?

A

Painless, non-ulcerated, sessile gingival ameloblastomas (LOOKS LIKE A BUMP ON THE GUMS)

93
Q

What is the average age of patients with peripheral ameloblastomas?

A

Average age is 50

94
Q

Where are peripheral ameloblastomas most commonly found?

A

On the posterior gingival mucosa, usually in the mandible

95
Q

How is the treatment for a peripheral ameloblastoma different than other types of ameloblastomas?

A

The peripheral variant is innocuous (not harmful), and only 15% recur

96
Q

What term describes an ameloblastoma that has histologic features of conventional ameloblastoma, but show metastatic deposits?

A

Malignant Ameloblastoma

97
Q

What is the most common site of malignant ameloblastoma?

A

The lung

98
Q

What term describes an ameloblast variant that has cytologic malignant featuers and follows an aggressive course?

A

Ameloblastic carcinoma

99
Q

When does ameloblastic carcinoma usually develop?

A

Later in life than conventional ameloblastomas

100
Q

What are the radiographic features of ameloblastic carcinoma?

A

Ill defined margins and cortical destruction

101
Q

What term describes an odontogenic tumor than is almost identical to a dentigerous cyst, but the lesion may contain fine, snowflake calcifications on radiographs?

A

Adenomatod odontogenic tumor

102
Q

In what age population do adenomatoid odontogenic tumors usually occur?

A

In young patients, ages 10-20, and more often females (2:1)

103
Q

Where doe adenomatoid odontogenic tumors usually occur?

A

Have a striking tendency for the anterior jaws, in the maxilla

104
Q

Why is it easy to mistake an adenomatoid odontogenic tumor for a dentigerous cyst?

A

In 75% of cases, the tumor is circumscribed, unilocular RL involving the crown of an unerupted tooth – most often a canine

105
Q

What can help differentiate an adenomatoid odontogenic tumor from a dentigerous cyst?

A

The lesion may extend apically past the CEJ and may contain snowflake calcifications

106
Q

What is the treatment, recurrence and prognosis for an adenomatoid odontogenic cyst?

A

Enucleation – the tumor has a thick, fibrous capsule that makes enucleation easy; recurrence doesn;t occur, and prognosis is good

107
Q

What term describes a RL with calcifications around the crown in a “drive snow” pattern?

A

Calcifying Epithelial Odontogenic Tumor

108
Q

What is another name for a calcifying epithelial odontogenic tumor?

A

Pindborg tumor

109
Q

What is the average age of patients with calcifying epithelial odontogenic tumors?

A

Around 40

110
Q

Where do calcifying epithelial odontogenic tumors occur?

A

Usually in the posterior mandible

111
Q

What is the most common presenting sign of calcifying epithelial odontogenic tumor?

A

Painless, Slow growing swelling

112
Q

What are some radiographic features of calcifying epithelial odontogenic tumors

A

Margins can be scalloped/well defined or ill defined, frequently associated with an impacted tooth (mandibular molar), and has a snow driven pattern around the crown

113
Q

What are the histopathologic features of calcifying epithelial odontogenic tumors?

A

Nuclear pleomorphism and atypia, amyloid like extracellular material (+ congo red –> apple green birefringence under polarized light); calcifications with concentric rings form in the amyloid like areas (Liesegang rings)

114
Q

What is the treatment of choice for calcifying epithelial odontogenic tumors? What is the recurrence and prognosis?

A

conservative local resection; recurrence is 15% (highest with curettage); prognosis is typically good but some lesions can be malignant or aggressive

115
Q

What term describes a true mixed tumor of both epithelial and mesenchymal tissues?

A

Ameloblastic fibroma

116
Q

When do ameloblastic fibromas usually occur?

A

In younger patients, before age 20

117
Q

Where do ameloblastic fibromas usually occur?

A

70% occur in the posterior mandible

118
Q

How many cases of ameloblastic fibromas are associated with an unerupted tooth?

A

75% are associated with an unerupted tooth

119
Q

What is the treatment for ameloblastic fibromas?

A

Conservative initial therapy but 50% of ameloblastic fibrosarcomas develop in recurrent ameloblastic fibromas so recurrences require mroe aggressive surgery

120
Q

How is an ameloblastic fibro-odontoma different from an ameloblastic fibroma?

A

It also has enamel and dentin

121
Q

What is the average age of patients with ameloblastic fibro-odontomas?

A

Average age is 10

122
Q

Where do ameloblastic fibro-odontomas usually occur?

A

In the posterior jaws

123
Q

What are the radigraphic features of ameloblastic fibro-odontomas?

A

Contains varying amounts of calcified amterial, typically associated with an unerupted tooth, a unilocular RL

124
Q

What is the treatment and recurrence for ameloblastic fibro-odontoma?

A

Conservative curettage with rare recurrences

125
Q

What term describes the malignant counterpart of the ameloblastic fibroma?

A

Ameloblastic fibrosarcoma

126
Q

On what portion do ameloblastic fibrosarcomas shows features of malignancy?

A

Typically on the mesenchymal portion of the elsion

127
Q

In what population does ameloblastic fibrosarcoma usually occur?

A

Average age is 25-30, and in males more than females

128
Q

Where do ameloblastic fibrosarcomas usually occur?

A

80% occur in the mandible

129
Q

What is different about the clinical presenation of ameloblastic fibrosarcoma?

A

Patients complain of pain and swelling

130
Q

What are the radiographic featuers of an ameloblastic fibrosarcoma?

A

Ill-defined, destructive RL lesion

131
Q

What is the treatment and prognosis of ameloblastic fibrosarcomas?

A

radical surgical excision, and 20% will succumb to the disease usually due to uncontrolled local growth

132
Q

What is the most common odontogenic tumor?

A

Odontoma

133
Q

What are odontomas considered to be rather than true neoplasms?

A

Considered to be developmental anomlaies (hamartomas)

134
Q

What are the 2 types of odontomas?

A

Compound and complex

135
Q

What are the characteristics of compound odontomas?

A

They are composed of multiple, small, toothlike structures surrounded by a narrow RL and occur in the anterior maxilla

136
Q

What are the characteristics of complex odontomas?

A

They are a conglomerate mass of enamel and dentin and occur in the molar region

137
Q

What is the average age of patients with odontomas?

A

Average age is 15

138
Q

What is the clinical presentation of odontomas?

A

They are asymptomatic

139
Q

What are some radiographic featuers of odontomas?

A

They have narrow RL rims, and are usually asssociated with and unerupted tooth.

140
Q

What is the treatment for odontomas?

A

Simple local excision

141
Q

What term describes a RL that may displace or cause resorption of teeth and may with thin wispy trabecular?

A

Odontogenic myxoma

142
Q

Where do myxomas occur?

A

Only in the jaws

143
Q

What is the treatment for odonogenic myxomas?

A

Small = curettage, and large need more extensive resection since myxomas tend to infiltrate the surround bone

144
Q

In what age population do odontogenic myxomas occur?

A

ages 25-30

145
Q

Where do odontogenic myxomas usually occur?

A

In the mandible

Oral Pathology - My deck (22 decks)

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