Chapter 15: Odontogenic Cysts and Tumors Flashcards
dentigerous cyst
what is the radiographic presentation of dentigerous cysts?
- unilocular radiolucency associated with the crown of unerupted tooth
- well-defined and usually sclerotic border
describe the basal cell carcinomas that characterize nevoid basal cell carcinoma syndrome
- appear around puberty
- on skin not exposed to sunlight
what is the recurrence of odontogenic keratocysts?
30%, which may happen 10+ years after surgery (long-term follow up is required)
calcifying epithelial odontogenic tumor is also called ___
pindborg tumor
odontogenic keratocysts are a type of ___ cyst
odontogenic
dentigerous cyst
gingival cysts of the adult are derived from ___
rests of the dental lamina (rests of serres)
___ is involved in 1/3 of odontogenic keratocyst cases
an unerupted tooth
patients with nevoid basal cell carcinoma syndrome usually do not have ___
life threatening anomolies
eruption cysts are a type of ___ cyst
odontogenic
what is the most common location of odontogenic keratocysts? what direction do they tend to grow?
posterior mandible, in an anterior-posterior direction
WHO has reclassified odontogenic keratocysts as ___
keratocystic odontogenic tumors
most clinicians still refer to it as odontogenic keratocysts
odontogenic tumors are tumors of ___ origin
odontogenic epithelial
dentigerous cyst
is a biopsy required for the diagnosis of odontogenic keratocysts?
yes
dentigerous cyst
nevoid basal cell carcinoma syndrome is a system complex characterized by what 4 things?
- multiple basal cell carcinomas
- odontogenic keratocysts
- calcification of the falx cerebri
- rib anomolies (splayed or bifid ribs)
- many others
describe the chromosome and gene involved in nevoid basal cell carcinoma syndrome
- chromosome 9
- PTCH gene
- this gene abnormality has been detected in odontogenic keratocysts, which is why WHO wanted to change the name to represent a cystic neoplasm rather than a cyst
dentigerous cysts are most frequently found in patients of what age?
10-30
what location are orthokeratinized odontogenic cysts more common?
posterior mandible
Orthokeratinized Odontogenic Cyst
The basal epithelial layer does not demonstrate palisading. Keratohyaline granules are present, and a thick layer of orthokeratin is seen on the luminal surface.
what are the 4 types of odontogenic ectomesenchyme tumors?
- central odontogenic fibroma
- peripheral odontogenic fibroma
- odontogenic myxoma
- cementoblastoma
gingival cysts of the adult have a striking predilection to occur in what location?
mandibular canine/premolar area
located on the facial gingiva or alveolar mucosa
what age patient is often affected by orthokeratinized odontogenic cysts? male to female ratio?
- young adults
- M:F 2:1
what are orthokeratinized odontogenic cysts?
odontogenic cysts with orthokeratinized lining and NO basal palisading
*remember* odontogenic keratocysts have parakeratin and a palisaded basal layer
what is the clinical presentation of gingival cysts of the adult?
painless, dome-like swellings which are less than 5mm
may be blue in color
Orthokeratinized Odontogenic Cyst
A large cyst involving a horizontally impacted lower third molar
dentigerous cyst
what are the 5 types of odontogenic tumors?
- ameloblastoma
- ameloblastic carcinoma
- malignant ameloblastoma
- adenomatoid odontogenic tumor
- calcifying epithelial odontogenic tumor
what is an eruption hematoma?
occurs when an eruption cyst is subjected to surface trauma, resulting in the blood to accumulate in the cystic fluid, which imparts a blue or purple color
do odontogenic keratocysts cause bone expansion?
no
what are the two most important things to remember about odontogenic keratocysts?
- 30% recurrence rate
- associated with a syndrome
eruption cyst
why do dentigerous cysts need to be removed?
- they can grown to considerable size, expand bone, and cause facial asymmetry, but they usually do not
- also to rule out other cysts
calcifying odontogenic cysts are a type of ___ cyst
odontogenic
nevoid basal cell carcinoma syndrome
characterized by:
- multiple basal cell carcinomas (top)
- bifid ribs (LL)
- calcification of falx cerebri (LR)
___ is the soft tissue analogue of the dentigerous cyst
eruption cyst
___ is the most common developmental cyst
dentigerous cyst
what is the treatment and recurrence of orthokeratinized odontogenic cysts?
rarely recur after enucleation with currettage (around 2% recur)
do odontogenic keratocysts resorb roots of adjacent teeth?
no
eruption cyst
odontogenic keratocyst
(this radiograph cannot be distinguished from lateral periodontal cyst)
what is the histopathology of odontogenic keratocysts?
- thin, friable wall (makes complete removal difficult)
- epithelial lining is a uniform 6-8 layers thick
- basal cell layer shows palisading and is hyperchromatic
- epithelium is surfaced by wavy or “corrugated” parakeratin
- may have small satellite cysts away from the primary lesion - “daughter cysts”
___ appears as a soft, translucent swelling in the gingival mucosa overlying the crown of an erupting tooth
eruption cyst
what is the treatment for dentigerous cysts? what about for larger cysts?
- enucleation of the cyst together with the unerupted tooth
- larger ones may be treated by marsupialization
what is the radiographic presentation of orthokeratinized odontogenic cysts?
- typically unilocular
- usually appear as a dentigerous cyst around a 3rd molar
what is the treatment of gingival cysts of the adult?
surgical excision is sufficient
what is the inheritance of nevoid basal cell carcinoma syndrome?
autosomal dominant
odontogenic keratocysts arise from ___
cell rests of the dental lamina
how are most odontogenic keratocyst lesions treated?
enucleation and currettage
lateral periodontal cysts are a type of ___ cyst
odontogenic
are dentigerous cysts symptomatic or asymptomatic?
asymptomatic and discovered on routine xray
eruption cysts develop as the result of a separation of the ___ from ___, and occurs within the soft tissues of the overlying alveolar bone
dental follicle from around the crown of an erupting tooth
what is the treatment of an eruption cyst?
- may not be required
- cyst usually ruptures spontaneously
- if this doesn’t occur, excision of the roof of the cyst permits eruption of the tooth
in patients with nevoid basal cell carcinoma syndrome, varying degrees of ___ may result from operations for multiple odontogenic keratocysts
jaw deformity
what is the prognosis of someone with nevoid basal cell carcinoma syndrome?
depends on the behavior of the skin tumors
glandular odontogenic cysts are a type of ___ cyst
odontogenic
gingival cysts of the adult are a type of ___ cyst
odontogenic
odontogenic keratocyst
notice it’s a larger, multilocular lesion
orthokeratinized odontogenic cysts are a type of ___ cyst
odontogenic
gingival cyst of the adult
notice it is (kind of) in the mandibular canine/premolar area
___ develops by accumulation of fluid between the reduced enamel epithelium and the tooth crown
dentigerous cyst
buccal bifurcation cysts are a type of ___ cyst
odontogenic
what is the prevalence of nevoid basal cell carcinoma syndrome?
1:60,000
dentigerous cysts are a type of ___ cyst
odontogenic
dentigerous cyst
describe the odontogenic keratocysts that are characteristic of nevoid basal cell carcinoma syndrome
- one of the most constant features of the syndrome
- frequently multiple
odontogenic keratocyst (cannot be differentiated from a dentigerous cyst in this radiograph)
Orthokeratinized Odontogenic Cyst
Small unilocular radiolucency associated with the impacted mandibular left third molar
what are the 5 types of mixed odontogenic tumors?
- ameloblastic fibroma
- ameloblastic fibro-odontoma
- ameloblastic fibrosarcoma
- odontoma
- odontogenic tumors
___ is a cyst that originates by separation of the follicle around the crown of an unerupted tooth
dentigerous cyst
Odontogenic Keratocyst
The epithelial lining is 6 to 8 cells thick, with a hyperchromatic and palisaded basal cell layer. Note the corrugated parakeratotic surface.
dentierous cysts enclose the ___ of the unerupted tooth and is attached at the ___
- crown
- CEJ
dentigerous cysts most often involve what teeth? which teeth do they rarely involve?
- mandibular 3rd molars
- rarely involve unerupted deciduous teeth
what is the prognosis and recurrence of dentigerous cysts?
prognosis is excellent and recurrence is rare
gingival cysts of the adult are most commonly found in what age patient?
40-50 years old
what is the radiographic presentation of odontogenic keratocysts (large vs small)?
- smaller lesions: well-defined, unilocular RL with corticated margins
- larger lesions: multilocular
___ represents the soft tissue counterpart of the lateral periodontal cyst
gingival cyst of the adult
if a patient <20 years old has an odontogenic keratocyst, they should be further evaluated to rule out ___
gorlin syndrome
nevoid basal cell carcinoma syndrome is also called ___
gorlin syndrome
most odontogenic keratocyst cases are diagnosed between what ages?
10-40 years old
what age patient are eruption cysts usually seen in?
children <10 years old
