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Pathology 2 > Cysts and Odontogenic Tumors > Flashcards

Cysts and Odontogenic Tumors Flashcards

1
Q

CYST DEFINITION

A

Epithelial lined pathologic cavity

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2
Q

DEVELOPMENTAL
NON-ODONTOGENIC CYSTS
(2)

A

Nasopalatine Duct Cyst
Median Palatine Cyst

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3
Q

Nasopalatine Duct Cyst
(5)

A
  • Incisive Canal Cyst
  • Most common non-
    odontogenic cyst of oral
    cavity
  • A developmental cyst that
    arises from epithelial
    remnants of nasopalatine
    duct
  • Vital teeth
  • Adults - 4th to 6th Decades
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4
Q

Symptoms associated with
Nasopalatine Duct Cyst
(3)

A
  • Radiolucency - 0.6 cm is the upper limit of normal for the incisive foramen
  • Swelling of anterior palate
  • Drainage and pain, if inflamed
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5
Q

Median Palatine Cyst
(4)

A
  • Well-circumscribed palatal lucency
  • Epithelium entrapped during fusion of palatal shelves
  • Stratified squamous or pseudostratified columnar
  • May be difficult to distinguish from Nasopalatine Duct Cyst
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6
Q

ODONTOGENIC CYSTS
(2)

A

INFLAMMATORY CYSTS AND DEVELOPMENTAL CYSTS

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7
Q

INFLAMMATORY ODONTOGENIC CYSTS
(3)

A

Periapical Cyst
Residual Cyst
Buccal Bifurcation Cyst

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8
Q

Periapical Cyst (Radicular Cyst)
(2)

A
  • Apex of non-vital tooth
  • Arises from rests of Malassez
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9
Q

Buccal Bifurcation Cyst
(2)

A
  • Paradental cyst
  • Buccal bifurcation of vital mandiblar molar teeth with
    cervical enamel projection
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10
Q

DEVELOPMENTAL ODONTOGENIC CYSTS
(6)

A

Dentigerous Cyst
Eruption Cyst
Dental Lamina Cyst
Odontokeratocyst
Calcifying Odontogenic Cyst
Glandular Odontogenic Cyst

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11
Q

Dentigerous Cyst
(3)

A
  • Most common type of developmental odontogenic cyst
  • Arises from dental follicle - attached to the cervix, enclosing
    the crown of an unerupted tooth
  • Enlarged follicular space > 4 mm
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12
Q

“Globulomaxillary Cyst”
(3)

A
  • The globulomaxillary position is located at the junction of
    maxilla with premaxilla, between maxillary lateral incisor
    and canine
  • No developmental fissural cyst in this position
  • A developmental “globulomaxillary cyst” does not exist
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13
Q

Globulomaxillary Lesions
* Periapical cyst –%
* Periapical granuloma –%
* Lateral periodontal cyst –%
* Odontogenic keratocyst –%
* Giant cell tumor –%
* Other lesions –%

A

50
15
10
10
7
3

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14
Q
  • Other lesions 3%
    (5)
A
  • Gorlin cyst
  • Odontogenic myxoma
  • Adenomatoid odontogenic tumor
  • Neurofibroma
  • Hemangioma
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15
Q

DENTAL LAMINA CYSTS
(4)

A

Lateral Periodontal Cyst
Botryoid Odontogenic Cyst
Gingiva Cyst of Adult
Dental Lamina Cyst of Newborn

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16
Q

Lateral Periodontal Cyst
(4)

A
  • A developmental cyst that arises from dental lamina rests
    (rests of Serres)
  • Vital teeth of adult males (3:1)
  • Mandibular premolar area
  • Maxillary incisor-canine area
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17
Q

Botryoid Odontogenic Cyst
(2)

A
  • Polycystic variant of the lateral periodontal cyst
  • A developmental odontogenic cyst that presents as a
    multilocular lucency associated with the vital mandibular
    premolars of adults
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18
Q

Gingival Cyst of the Adult
(4)

A
  • Soft tissue counterpart of the lateral periodontal cyst
  • A developmental cyst that arises from dental lamina rests
    (rests of Serres)
  • Vital teeth of adult males (3:1)
  • Mandibular premolar area and maxillary incisor-canine area
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19
Q

PALATAL CYST OF NEWBORN
(2)

A

Epstein’s Pearls
Bohn’s Nodule

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20
Q

Dental lamina cysts -

A

epithelial remnants of dental lamina
from odontogenesis
* Odontogenic cysts

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21
Q

Epstein’s pearls -

A

epithelial remnants from palatal shelf
fusion
* Non-odontogenic cysts

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22
Q

Bohn’s nodules -

A

epithelial remnants from minor salivary
gland formation
* Non-odontogenic cysts

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23
Q

Primordial Cyst
(2)

A
  • Radiographic term for a cyst that develops in place of a tooth
  • Likely to be an Odontogenic Keratocyst (OKC)
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24
Q

Odontogenic Keratocyst
(OKC)
(4)

A
  • World Health Organization (WHO)
  • 2005 Classification of Odontogenic Tumors
  • Keratinizing Cystic Odontogenic Tumor (KCOT)
  • Posterior jaws of teenagers, young adults
  • Aggressive growth with 30% recurrence
  • A unilocular or multilocular radiolucency; imitates other
    lucencies
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25
Q

Radiographic Presentations
OKC
* Primordial cysts –%
* Lateral periodontal –%
* Dentigerous –%
* Globulomaxillary –%

A

50
25
10
10

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26
Q

Odontogenic Keratocyst
Histology
(3)

A
  • Compact epithelium, no rete ridges, 8 to 10 cell layers thick
  • Corrugated surface parakeratin
  • Prominent, palisaded, hyperchromatic basal layer
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27
Q

Significance of the
Odontogenic Keratocyst
(3)

A
  • Aggressive behavior
  • Recurrence - 30%
  • Nevoid Basal Cell Carcinoma Syndrome
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28
Q

Clinical Settings
Odontogenic Keratocyst
* Non-syndrome-associated OKC -
* Syndrome-associated OKC –

A

idiopathic
multiple OKCs common in the nevoid basal cell carcinoma syndrome

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29
Q

NEVOID BASAL CELL
CARCINOMA SYNDROME
aka

A

Gorlin Syndrome

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30
Q

Nevoid Basal Cell
Carcinoma Syndrome
(5)

A
  • Basal cell nevus syndrome
  • Gorlin-Goltz syndrome
  • Gorlin syndrome
  • Autosomal dominant - highly penetrant and variably
    expressive
  • Mutation in PTCH (PATCHED) tumor supressor gene at
    9q22.3
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31
Q

Nevoid Basal Cell
Carcinoma Syndrome
symptoms (4)

A
  • Skeletal anomalies: Bifid ribs
  • Jaw cyst: Multiple OKCs
  • Skin tumors: Multiple, early onset basal cell carcinomas
  • Neoplasms: CNS –Medulloblastoma
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32
Q

Nevoid Basal Cell
Carcinoma Syndrome

A
  • Multiple basal cell carcinomas that occur early in life
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33
Q

Early Recognition and
Diagnosis of Nevoid Basal Cell
Carcinoma Syndrome
(3)

A
  • OKCs present early
  • Prevent disfiguring basal cell carcinomas
  • Evaluate for medulloblastoma
34
Q

Orthokeratinizing
Odontogenic Cyst
(3)

A
  • A developmental odontogenic cyst with an orthokeratin
    lining, NOT parakeratin
  • Originally described as the “orthokeratinized variant of the
    odontogenic keratocyst”
  • Does not behave as an odontogenic keratocyst
  • no recurrence
35
Q

Calcifying Odontogenic Cyst
(Gorlin Cyst)
* WHO: Calcifying Cystic Odontogenic Tumor
(5)

A
  • Gorlin cyst, calcifying and keratinizing odontogenic cyst
  • Anterior jaws of adults
  • Radiolucent to mixed
  • Ghost cells
  • Sometimes associated with odontomas
36
Q

Glandular Odontogenic Cyst
(4)

A
  • Sialodontogenic cyst –an odontogenic cyst with glandular
    (salivary) features
  • Anterior jaws of middle-aged adults, mandible > maxilla
  • Commonly multilocular, crosses midline
  • Aggressive behavior - 30% recurrence
37
Q

SOFT TISSUE CYSTS
(4)

A

Nasolabial Cyst
Lymphoepithelial Cyst
Cervical Lymphoepithelial Cyst
Thyroglossal Duct Cyst

38
Q

Nasolabial Cyst
(4)

A
  • Nasoalveolar cyst, Klestadt cyst
  • Soft tissue cyst of upper lip lateral to midline
  • Developmental cyst, remnants of nasolacrimal duct
  • Adult females (3:1)
39
Q

Oral Lymphoepithelial Cyst
(6)

A
  • Cystic change of crypt epithelium of lymphoid aggregate
  • Young adults
  • Waldeyer’sring
  • Tonsillar pillar
  • Floor of mouth
  • Ventral tongue
40
Q

Cervical Lymphoepithelial Cyst
(3)

A
  • Branchial Cleft Cyst
  • Cystic change of branchial epithelium
  • Upper lateral neck anterior to border of sternocleidomastoid
    muscle in young adults
41
Q

Cervical Lymphoepithelial Cyst
Histology

A
  • Stratified squamous epithelial lining exhibiting lymphoid
    tissue with or without germinal centers in wall
42
Q

Thyroglossal Duct Cyst
(2)

A
  • Cystic change of thyroglossal tract epithelium
  • Midline of neck in young people
43
Q

PSUEDOCYSTS
(3)

A

Traumatic Bone Cyst
Aneurysmal Bone Cyst
Static Bone Cyst

44
Q

Traumatic Bone Cyst
(5)

A
  • Idiopathic bone cavity
  • Solitary bone cyst
  • Hemorrhagic bone cyst
  • Simple bone cyst
  • Unicameral bone cyst
45
Q

Traumatic Bone Cyst
* Empty cavity -
* Theory of origin-

A

not a true cyst
Trauma-hemorrhage theory of origin

46
Q

Traumatic Bone Cyst
* Gender?
* Age?
* Where?
* XR?
* Border?
* Symptoms?
* Expansion?
* Vitality?
* What initiates healing?

A
  • Male (2:1)
  • Teenagers –young adults
  • Mandible
  • Lucency
  • Scalloped border frequent
  • Asymptomatic
  • Expansion rare (20%)
  • Vital teeth
  • Biopsy initiates healing
47
Q

Aneurysmal Bone Cyst
(4)

A
  • Young individuals < 20 years
  • Rapidly growing, may blow out the cortex, painful
  • Mandible most commonly
  • Lucency, frequently multilocular
48
Q

Surgical Findings
Aneurysmal Bone Cyst
(4)

A
  • Ballooning dilation of bone
  • Blood welling up from within the cavity, like a blood-soaked
    sponge
  • Fleshy aggregates of tumor surrounding cystic spaces filled
    with blood
  • Hemosiderin pigmentation
49
Q

Aneurysmal Bone Cyst
(3)

A
  • Not a true cyst
  • Cyst-like cavities, filled with blood
  • Multinucleated giant cells
50
Q

Static Bone Cyst
(Stafne Defect)
(3)

A
  • Asymptomatic
  • Radiolucency below inferior alveolar nerve canal
  • Submandibular gland
51
Q

ODONTOGENIC TUMORS
(3)

A

Epithelial
Mesenchymal
Mixed

52
Q

Epithelial
(3)

A
  • Ameloblastoma
  • Adenomatoid Odontogenic Tumor
  • Calcifying Epithelial Odontogenic Tumor
53
Q

Mesenchymal
(3)

A
  • Odontogenic myxoma
  • Odontogenic fibroma
  • Cementoblastoma
54
Q

Mixed
(3)

A
  • Odontoma
  • Ameloblastic Fibroma
  • Ameloblastic Fibro-odontoma
55
Q

Ameloblastoma

A

-Least differentiated
-Most aggressive

56
Q

Odontoma

A

-Most differentiated
- Least aggressive

57
Q

Ameloblastoma
(5)

A
  • Conventional ameloblastoma
  • An expansile, slow-growing, locally invasive lesion, typically
    of posterior mandible of adults (mean = 35 y)
  • Recurrence is common, but does not metastasize *
  • The histopathology of ameloblastoma recapitulates the
    enamel organ
  • Ameloblastoma does not form and hard tissue
58
Q

Histologic Types
Ameloblastoma
* Solid
(4)
* Unicystic

A
  • Follicular
  • Plexiform
  • Desmoplastic
  • Many more………
59
Q

Ameloblastoma
* The histopathology of ameloblastoma recapitulates the

A

enamel organ
* Ameloblastoma does not form and hard tissue

60
Q

Desmoplastic Ameloblastoma
(3)

A
  • Anterior jaws, equally distributed between mandible and
    maxilla
  • Mottled mixed density with diffuse margins
  • Solid tumor with dense, collagenous stroma
61
Q

Unicystic Ameloblastoma
(4)

A
  • Cystogenic ameloblastoma
  • Unilocular radiolucency, usually of posterior mandible –
    mimics a dentigerous cyst radiographically
  • 2nd to 3rd decades (Mean age = 18 y)
  • Recurrence uncommon
62
Q

Unicystic Ameloblastoma
(Vickers-Gorlin Change)
Histology
(4)

A
  • Nuclear hyperchromatism
  • Nuclear palasading
  • Reverse polarity of basal cell nuclei
  • Subnuclear vacuolation
63
Q

Adenomatoid Odontogenic
Tumor
* Mixed density
* Teenagers - –%
* Female -
* Maxilla -
* Anterior - –%

A

75
2:1
2:1
75

64
Q

Calcifying Epithelial
Odontogenic Tumor
(3)

A
  • Adults (Mean = 40 y)
  • Posterior mandible - molar-ramus region
  • Recurrence, but less aggressive than ameloblastoma
65
Q

Calcifying Epithelial
Odontogenic Tumor
Histology
(4)

A
  • A solid epithelial tumor (not cystic)
  • Pink polygonal polyhedral epithelial cells
  • Contains amyloid
  • Concentric Liesegang ring calcifications
66
Q

Odontogenic Myxoma
* Orgin
* Age
* Where
* XR
* Lesion is..

A
  • Ectomesenchymal odontogenic neoplasm
  • Young adults (Mean = 30 y)
  • The mandible more commonly involved than the maxilla
  • A radiolucency, often multiolcular, may cross midline
  • An unencapsulated lesion - recurrence is common
67
Q

Odontogenic Myxoma
* Resembles
* Termed myxofibroma if there is increased
*— variable

A

dental papilla, with stellate and spindled cells in a
myxoid extracellular matrix
collagen
Odontogenic rests

68
Q

Odontogenic Fibroma
(2)

A
  • Central Odontogenic Fibroma
  • Peripheral Odontogenic Fibroma
69
Q
  • Central Odontogenic Fibroma
    (2)
A
  • Simple type
  • World Health Organization (WHO) type
70
Q

Odontogenic Fibroma
* Most common in
* XR
* +/-
* One-third of cases are associated with
* Treatment by

A

adult females (2 : 1) (mean age = 40 y)
* Well-circumscribed unilocular or multilocular lucency of
anterior maxilla and posterior mandible
radiopaque flecks
unerupted tooth
enucleation and vigorous curettage

71
Q

Odontogenic Fibroma
* Mature, fibrous stroma with varying amounts of inactive
odontogenic epithelium
* Epithelium-poor type -
* Epithelium-rich type -

A

simple type
complex type (WHO-type)

72
Q

Cementoblastoma
(5)

A
  • Neoplasm
  • Young adults < 25 years
  • Mandibular first molar
  • Pain, expansion, root destruction
  • Does not recur after complete removal
73
Q

Ameloblastic Fibroma
(4)

A
  • “Kiddie” tumor (Mean = 14.8 y)
  • A painless swelling of posterior mandible
  • Well-circumscribed lucency, frequently associated with the
    crowns of impacted teeth
  • Treatment by enucleation and curettage. May recur
74
Q

Ameloblastic Fibroma
* — resembling dental papilla
* Epithelial strands and cords resembling

A

Ectomesenchyme
dental lamina and
enamel organ

75
Q

Ameloblastic Fibro-
Odontoma
(5)

A
  • A “kiddie” tumor (mean age = 8 to 12y)
  • Most frequent in posterior mandible
  • A unilocular or multilocular mixed density lesion, often associated with the crown of an unerupted tooth
  • Less common than ameloblastic fibroma
  • Treatment by enucleation. Recurrence is rare
76
Q

Ameloblastic Fibro-Odontoma
* Histologic features of

A

ameloblastic fibroma, with the
presence of dentin and enamel

77
Q

Odontoma
Age?
Viewed as
Description?
Tx?
Recurrence?

A
  • Teenagers
  • Viewed an a hamartoma
  • Well-circumscribed
  • Treated by enucleation
  • No recurrence expected
78
Q

Odontoma
* Compound -
* Complex -

A

anterior maxilla
posterior mandible

79
Q

Odontoma
* —% of Gorlin Cysts are associated with odontomas

80
Q

Ameloblastic
Fibroma
Mimics

A

early stage of odontogenesis

81
Q

Ameloblastic
Fibro-Odontoma
mimics

A

intermediate stage of odontogenesis

82
Q

Odontoma
mimics

A

end stage of odontogenesis

Pathology 2 (12 decks)

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