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oral path > chpt 15- odontogenic cysts and tumors ppt > Flashcards

chpt 15- odontogenic cysts and tumors ppt Flashcards

1
Q

develops from separation of follicle around a crown

A

dentigerous cyst

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2
Q

Most common type of developmental odontogenic cyst

A

dentigerous cyst

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3
Q

character of dentigerous cyst

A

encloses crown of an unerupted tooth and is attached to the tooth at the CEJ

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4
Q

How will the dentigerous cyst appear radiographically

A

Well defined radiolucency around the crown of an impacted or unerupted tooth; > 3.0mm from crown to edge of RL

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5
Q

Dentigerous cyst demographics

A

M > F, 10-30 years, Whites > Blacks

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6
Q

Can dentigerous cyst cause resorption of adjacent tooth

A

yes

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7
Q

clinical features of dentigerous cyst

A
  • usually asymptomatic
  • found on routine examination
  • RARELY CAUSES EXPANSION
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8
Q

are DCs UL or ML?

A
  • Large DC may give the impression of a multilocular process due to persistence of bone trabeculae within the radiolucency
  • DC are grossly and histopathologically unilocular processes
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9
Q

Treatment for DC

A
  • Curettage of cyst with or without extraction of impacted tooth
  • No recurrence expected
  • Large DC may be treated by marsupialization which permits decompression of the cyst, with a resulting reduction in size of the bone defect
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10
Q

most common location for DC

A

Mandibular 3rd molar
Maxillary canines
Maxillary 3rd molars
Mandibular 2nd premolars

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11
Q

histology for DC

A

SSE with cyst wall devoid of inflam-mation

IROE

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12
Q

Soft tissue analogue of DC

A

eruption cyst

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13
Q

Separation of the dental follicle around the crown of a developing tooth within the soft tissue overlying alveolar bone

A

eruption cyst

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14
Q

Soft, translucent swelling in gingival mucosa overlying the crown of tooth in kids < 10

A

eruption cyst

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15
Q

Surface trauma may result in considerable blood (eruption hematoma)

A

eruption cyst

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16
Q

treatment for eruption cyst

A
  • may not be required due to spontaneous rupture, allowing tooth to erupt
  • simple excision of roof of cyst if it doesn’t erupt
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17
Q

Grow antero-posterior direction within medullary bone without expansion

A

OKC

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18
Q

most common location for OKC, where it is found 60-80% of the time

A

-mandible- body and ascending ramus

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19
Q

demographics

A
  • males > females

- 60% bwn 10-40

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20
Q

Histology for OKC

A

1) uniformly thin 6-8 cell layers of epithelium
2) no rete pegs
3) prominent basal cell layer
- can be parakeratin or orthokeratin
- high recurrence rate

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21
Q

treatment for OKC

A
  • Enucleation & curettage
  • Peripheral ostectomy
  • Chemical cauterization after cyst removal
  • Decompression
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22
Q 
Multiple BCCa
Odontogenic keratocysts
Rib and vertebral anomalies
Intracranial calcifications
Palmar & plantar pits
A

Basal cell carcinoma syndrome

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23
Q

Small superficial keratin-filled cysts on alveolar mucosa of infants

A

gingival cyst of the newborn

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24
Q

Common in ½ of newborns and disappear spontaneously by rupture into oral cavity

A

gingival cyst of the newborn

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25
Q

Gingival cyst name if they are found on midline of palate

A

Epstein pearl

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26
Q

Gingival cysts if they are scattered on hard or soft palate

A

Bohn’s nodules

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27
Q

where are gingival cysts more commonly found- max or manx?

A

maxilla

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28
Q

Treatment for Gingival cysts, Epstein pearls, or Bohn’s nodules

A

none; self rupture; rarely seen after 3 mo

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29
Q

Soft tissue counterpart of LPC located on the facial gingiva

A

gingival cyst of the adult

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30
Q

what color is gingival cyst of adult

A

bluish

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31
Q

most common location for gingival cyst of the adult

A

75-80% on mand canine/premolar

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32
Q

Derived from dental lamina (rests of Serres)
Adults in 5-6th decades; rare before 30
Most cyst less than 1 cm

A

gingival cyst of the adult

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33
Q

Arise from rests of dental lamina or proliferation of REE along lateral root

A

lateral periodontal cyst

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34
Q

demographics and location of LPC

A

Males > 30
Mandibular canine/premolar region
Less common maxillary lesions seen in same location

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35
Q

polycystic appearance; may have multilocular appearance

Grossly and microscopically, they show a grapelike cluster of small individual cysts

A

Botryoid odontogenic cyst - subtype of LPC; associated w/higher recurrence rate

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36
Q

Cuboidal epithelial cells with foci of glycogen rich cells

Thickening of epithelial lining

A

LPC histology

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37
Q

other names for calcifying odontogenic cyst

A

Gorlin cyst
Dentinogenic ghost cell tumor
Calcifying ghost cell odontogenic cyst

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38
Q

age and location of COC

A
  • mand = max
  • 65% found in incisor canine region
  • avg age 33 and most dx’d in 2-3 decades
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39
Q

what age is associated w/COC assoc w/odontomas found in

A

17 yrs

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40
Q

radiographic appearance of COC

A
  • usually well defined UL RL, occasionally ML; associated w/unerupted tooth (usually canine)
  • RL lesion w/calcified structures
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41
Q

size of COC

A

2-4cm

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42
Q

Is root resorption seen with COC?

A

Yes, also see divergence of adjacent teeth

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43
Q

what else can COC be mistaken for clinically?

A

gingival fibromas, gingival cysts, or peripheral gingival lesions

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44
Q

histology of COC

A
  • well defined cystic lesion w/fibrous capsule and 4-10 cell layers thick of odontogenic epithelial lining
  • ameloblast like epithelial cells w/cuboidal or columnar basal layer
  • GHOST cells: altered epithelial cells characterized by loss of nuclei w/preservation of cell outline (large eiosinophilic)
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45
Q

are COCs associated w/odontomas

A

Yes, 20% of COC are assoc w/odontomas

46
Q

treatment and recurrence of COC

A

simple enucleation w/few recurrences

47
Q

inflammatory odontogenic cyst on the B aspect of mandibular 1st permanent molar

A

Buccal Bifurcation Cyst

48
Q

well circumscribed UL RL involving B furcation and root area; associated w/swelling and foul tasting discharge; seen in kids 5-11

A

Buccal bifurcation cyst

49
Q

6 criteria used to diagnose odontogenic tumors

A

1) Radiogrpahic characteristics
2) Age
3) Association w/unerupted teeth
4) Induction vs no induction
5) Location: max vs mand
6) Sex predilection

50
Q

most common clinically significant odontogenic tumor

A

ameloblastoma

51
Q

tumor islands extend as much as 1cm beyond radiographic features indicate

A

ameloblastoma

52
Q

painless swelling or expansion of the jaw, 3rd-7th decades

A

ameloblastoma

53
Q

ML RL lesion, soap bubble (large), honeycombed (small), B and L expansion w/resorption of roots, unerupted tooth is often associated w/RL defect (manx 3rd)

A

ameloblastoma

54
Q

which histological pattern is associated with: single layer of tall ameloblast-like cells surrounding a centre core w/reverse polarity

A

follicular pattern of ameloblastoma

55
Q

which histologic pattern is associated with: long anastomosing cords or larger sheets of odontogenic epithelium; cyst formation is uncommon

A

plexiform pattern of ameloblastoma

56
Q

other histologic patterns of ameloblastoma (4)

A

Acanthomatous
Basal cell
Desmoplastic
granular cell

57
Q

most common location of ameloblastoma

A

posterior mandible

maxillary lesions are assoc w/molars and or antrum

58
Q

form of ameloblastoma in the posterior mandible that appears as a circumscribed RL surrounding the crown of unerupted 3rd molar

A

unicystic ameloblastoma

59
Q

form of ameloblastoma located in posterior gingiva and alveolar mucosa (manx > max)

A

peripheral ameloblastoma

60
Q

epithelial tumor with inductive effect on odontogenic ectomesenchyme

A

adenomatoid odontogenic tumor

61
Q

younger females (10-19), anterior maxilla

A

adenomatoid odontogenic tumor

62
Q

size and treatment for adenomatoid odontogenic tumor

A

usually small, rarely > 3cm

enucleation

63
Q

cricumscribed UL RL involving the crown of an unerupted tooth, usually CANINE and extends apically along the root past the CEJ (vs DC)

A

adenomatoid odontogenic tumor

64
Q

often contains snowflake calcifications

A

adenomatoid odontogenic tumor

65
Q

histology of adenomatoid odontogenic tumor

A
  • fibrous capsule, epithelial cells that form sheets, strands, or whorled masses of cells in scant fibrous storms, ROSETTElike structures about a central space that may contain eosinophilic material
  • small foci of calcifications
66
Q

also known as Pindborg tumor

A

calcifying epithelial odontogenic tumor

67
Q

posterior mandible, EL or ML RL defect that may contain calcified structures

A

calcifying epithelial odontogenic tumor

68
Q

polyhedral epithelial cells in fibrous stroma, epithelial cells have intercellular bridges, eosinophilic, hyalinized (amyloid like) extracellular material

A

calcifying epithelial odontogenic tumor

69
Q

calcification is a distinctive feature; develops w/in the amyloid like material and form concentric rings (Liesegang ring calcifications)

A

calcifying epithelial odontogenic tumor

70
Q

Liesegang ring calcifications

A

calcifying epithelial odontogenic tumor

71
Q

often associated w/impacted manx 3rd molar; less aggressive than ameloblastoma

A

calcifying epithelial odontogenic tumor

72
Q

treatment and recurrence of calcifying epithelial odontogenic tumor

A
  • conservative local resection w/narrow rim of surrounding bone
  • treat lesion in posterior maxilla more aggressively
  • 15% recurrence rate, spec if treated by curettage
73
Q

posterior mandible, kids <10, found on X-ray taken for failure of tooth to erupt

A

ameloblastic fibro-odontoma

74
Q

AF w/enamel and dentin

A

ameloblastic fibro-odontoma

75
Q

circumscribed UL RL w/variable amount of calcified material w/the radio density of a tooth structure; unerupted tooth is present at the margin or crown of the unerupted tooth found in the defect

A

ameloblastic fibro-odontoma

76
Q

treatment and prognosis for ameloblastic fibro-odontoma

A

conservative curettage and lesion easily separates from bone

excellent prognosis

77
Q

most common odontogenic tumor (not a true tumor)

A

odontoma

78
Q

max > mand, avg age 14, male = female, 50% associated w/impacted tooth, usually not expansile, compound = complex

A

odontoma

79
Q

ALWAYS a RO foci density of enamel; well defined

A

odontoma

80
Q

treatment for odontoma

A

remove if blocking eruption

81
Q

from the odontogenic ectomesenchyme, adults 25-30, found in any area of jaws but mand > max

A

odontogenic myxoma

82
Q

3 lesions w/soap bubble appearance

A

1) OKC
2) Ameloblastoma
3) Odontogenic myxoma

83
Q

UL or ML RL that can displace or cause resorption of teeth; margins are irregular/scalloped, can be soap bubble and contain thin wispy trabecular of residual bone arranged @ right angles to each other

A

odontogenic myxoma

84
Q

what does histochemical staining show

A

ground substance composed of GAGs, hyaluronic acid and chondroitin sulfate

85
Q

what does Immunohistochemistry show

A

Abs against VIMENTIN and focal reactivity for muscle specific actin

86
Q

treatment and recurrence of odontogenic myxoma

A

-small: curettage w/recall every 5 yrs
-large: resection may be required due to lack of capsulation and infiltrate into surrounding bone
-25% recurrence
prognosis = good

87
Q

Will and ameloblastoma, while causing buccal and lingual cortical expansion, perforate the inferior border of the mandible

A

no

88
Q

What tooth does the Adenomatoid Odontogenic tumor usually affect

A

crown of canine

89
Q

Appears radiographically as a collection of tooothlike structures of varying size and shape surrounded by a narrow radiolucent ring

A

compound odontoma

90
Q

Appears as a calcified mass with the radiodensity of tooth structure, which is surrounded by a narrow radiolucent ring

A

complex odontoma

91
Q

What germ layer does the dental lamina induce to become specialized cells (ectomesenchyme) capable of being induced further into odontogenic cells which differentiate and produce calcified dental tissues

A

neuroectoderm

92
Q

ameloblasts make

A

enamel

93
Q

odontoblasts make

A

dentin

94
Q

cementoblasts make

A

cementum

95
Q

what induces the formation of pre-secretory odontoblasts

A

formation of pre-ameloblasts

96
Q

What induce odontoblasts to secrete the dentin matrix

A

maturing ameloblasts

97
Q

what induces ameloblasts to secrete enamel matrix

A

odontoblasts secreting dentin

98
Q

3 things from which an Ameloblastoma can form

A

Basal cells or oral mucosa
Developing enamel organ (pre-induction
epithelium)
Cell rests of enamel organ

99
Q

2 most common forms of Ameloblastoma

A

plexiform and follicular

100
Q

which of the two most common forms of amelobalstoma is associated with cyst formation

A

follicular

101
Q

This ameloblastoma variant has highly eosinophilic cells with granules that look lysosomal

A

Granular Cell Ameloblastoma

102
Q

Acanthomatous variant Ameloblastoma forms what

A

keratin

103
Q

What can the Acanthomatous variant Ameloblastoma be confused with

A

SCC

104
Q

Tumors of odontogenic Epithelium are composed of what and is there ectomesenchyme participation

A

composed only of odontogenic epithelium without any ectomesenchyme participation

105
Q

3 tumors of Odontogenic Epithelium

A

Ameloblastoma
Adenomatoid Odontogenic tumor
Calcifying Epithelial Odontogenic tumor/ Pindborg tumor

106
Q

3 mixed odontogenic tumors

A

Ameloblastic fibroma Ameloblastic fibro-odontoma

Odontoma

107
Q

4 tumors of odontogenic ectomesenchyme

A

Central odontogenic fibroma Peripheral odontogenic fibroma Odontogenic myxoma Cementoblastoma

108
Q

true mixed tumor of epithelial and mesenchymal elements

A

ameloblastic fibroma

109
Q

young pts in posterior mandible, 75% associated w/unerupted tooth

A

ameloblastic fibroma

110
Q

UL or ML RL lesion; well defined margins which may be sclerotic; may or may not have a capsule

A

amelobalstic fibroma

111
Q

does NOT demonstrate micro cyst formation and has cell rich mesenchymal tissues that resemble primitive dental papilla mixed w/proliferating odontogenic epithelium

A

ameloblastic fibroma

112
Q

treatment for ameloblastic fibroma

A

conservative removal, usually don’t recur

oral path (13 decks)

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