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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
Radiographic Presentations OKC * Primordial cysts --% * Lateral periodontal --% * Dentigerous --% * Globulomaxillary --%
50 25 10 10
26
Odontogenic Keratocyst Histology (3)
* Compact epithelium, no rete ridges, 8 to 10 cell layers thick * Corrugated surface parakeratin * Prominent, palisaded, hyperchromatic basal layer
27
Significance of the Odontogenic Keratocyst (3)
* Aggressive behavior * Recurrence - 30% * Nevoid Basal Cell Carcinoma Syndrome
28
Clinical Settings Odontogenic Keratocyst * Non-syndrome-associated OKC - * Syndrome-associated OKC –
idiopathic multiple OKCs common in the nevoid basal cell carcinoma syndrome
29
NEVOID BASAL CELL CARCINOMA SYNDROME aka
Gorlin Syndrome
30
Nevoid Basal Cell Carcinoma Syndrome (5)
* 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
31
Nevoid Basal Cell Carcinoma Syndrome symptoms (4)
* Skeletal anomalies: Bifid ribs * Jaw cyst: Multiple OKCs * Skin tumors: Multiple, early onset basal cell carcinomas * Neoplasms: CNS –Medulloblastoma
32
Nevoid Basal Cell Carcinoma Syndrome
* Multiple basal cell carcinomas that occur early in life
33
Early Recognition and Diagnosis of Nevoid Basal Cell Carcinoma Syndrome (3)
* OKCs present early * Prevent disfiguring basal cell carcinomas * Evaluate for medulloblastoma
34
Orthokeratinizing Odontogenic Cyst (3)
* 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
Calcifying Odontogenic Cyst (Gorlin Cyst) * WHO: Calcifying Cystic Odontogenic Tumor (5)
* Gorlin cyst, calcifying and keratinizing odontogenic cyst * Anterior jaws of adults * Radiolucent to mixed * Ghost cells * Sometimes associated with odontomas
36
Glandular Odontogenic Cyst (4)
* 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
SOFT TISSUE CYSTS (4)
Nasolabial Cyst Lymphoepithelial Cyst Cervical Lymphoepithelial Cyst Thyroglossal Duct Cyst
38
Nasolabial Cyst (4)
* Nasoalveolar cyst, Klestadt cyst * Soft tissue cyst of upper lip lateral to midline * Developmental cyst, remnants of nasolacrimal duct * Adult females (3:1)
39
Oral Lymphoepithelial Cyst (6)
* Cystic change of crypt epithelium of lymphoid aggregate * Young adults * Waldeyer’sring * Tonsillar pillar * Floor of mouth * Ventral tongue
40
Cervical Lymphoepithelial Cyst (3)
* Branchial Cleft Cyst * Cystic change of branchial epithelium * Upper lateral neck anterior to border of sternocleidomastoid muscle in young adults
41
Cervical Lymphoepithelial Cyst Histology
* Stratified squamous epithelial lining exhibiting lymphoid tissue with or without germinal centers in wall
42
Thyroglossal Duct Cyst (2)
* Cystic change of thyroglossal tract epithelium * Midline of neck in young people
43
PSUEDOCYSTS (3)
Traumatic Bone Cyst Aneurysmal Bone Cyst Static Bone Cyst
44
Traumatic Bone Cyst (5)
* Idiopathic bone cavity * Solitary bone cyst * Hemorrhagic bone cyst * Simple bone cyst * Unicameral bone cyst
45
Traumatic Bone Cyst * Empty cavity - * Theory of origin-
not a true cyst Trauma-hemorrhage theory of origin
46
Traumatic Bone Cyst * Gender? * Age? * Where? * XR? * Border? * Symptoms? * Expansion? * Vitality? * What initiates healing?
* Male (2:1) * Teenagers –young adults * Mandible * Lucency * Scalloped border frequent * Asymptomatic * Expansion rare (20%) * Vital teeth * Biopsy initiates healing
47
Aneurysmal Bone Cyst (4)
* Young individuals < 20 years * Rapidly growing, may blow out the cortex, painful * Mandible most commonly * Lucency, frequently multilocular
48
Surgical Findings Aneurysmal Bone Cyst (4)
* 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
Aneurysmal Bone Cyst (3)
* Not a true cyst * Cyst-like cavities, filled with blood * Multinucleated giant cells
50
Static Bone Cyst (Stafne Defect) (3)
* Asymptomatic * Radiolucency below inferior alveolar nerve canal * Submandibular gland
51
ODONTOGENIC TUMORS (3)
Epithelial Mesenchymal Mixed
52
Epithelial (3)
* Ameloblastoma * Adenomatoid Odontogenic Tumor * Calcifying Epithelial Odontogenic Tumor
53
Mesenchymal (3)
* Odontogenic myxoma * Odontogenic fibroma * Cementoblastoma
54
Mixed (3)
* Odontoma * Ameloblastic Fibroma * Ameloblastic Fibro-odontoma
55
Ameloblastoma
-Least differentiated -Most aggressive
56
Odontoma
-Most differentiated - Least aggressive
57
Ameloblastoma (5)
* 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
Histologic Types Ameloblastoma * Solid (4) * Unicystic
* Follicular * Plexiform * Desmoplastic * Many more.........
59
Ameloblastoma * The histopathology of ameloblastoma recapitulates the
enamel organ * Ameloblastoma does not form and hard tissue
60
Desmoplastic Ameloblastoma (3)
* Anterior jaws, equally distributed between mandible and maxilla * Mottled mixed density with diffuse margins * Solid tumor with dense, collagenous stroma
61
Unicystic Ameloblastoma (4)
* Cystogenic ameloblastoma * Unilocular radiolucency, usually of posterior mandible – mimics a dentigerous cyst radiographically * 2nd to 3rd decades (Mean age = 18 y) * Recurrence uncommon
62
Unicystic Ameloblastoma (Vickers-Gorlin Change) Histology (4)
* Nuclear hyperchromatism * Nuclear palasading * Reverse polarity of basal cell nuclei * Subnuclear vacuolation
63
Adenomatoid Odontogenic Tumor * Mixed density * Teenagers - --% * Female - * Maxilla - * Anterior - --%
75 2:1 2:1 75
64
Calcifying Epithelial Odontogenic Tumor (3)
* Adults (Mean = 40 y) * Posterior mandible - molar-ramus region * Recurrence, but less aggressive than ameloblastoma
65
Calcifying Epithelial Odontogenic Tumor Histology (4)
* A solid epithelial tumor (not cystic) * Pink polygonal polyhedral epithelial cells * Contains amyloid * Concentric Liesegang ring calcifications
66
Odontogenic Myxoma * Orgin * Age * Where * XR * Lesion is..
* 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
Odontogenic Myxoma * Resembles * Termed myxofibroma if there is increased *--- variable
dental papilla, with stellate and spindled cells in a myxoid extracellular matrix collagen Odontogenic rests
68
Odontogenic Fibroma (2)
* Central Odontogenic Fibroma * Peripheral Odontogenic Fibroma
69
* Central Odontogenic Fibroma (2)
* Simple type * World Health Organization (WHO) type
70
Odontogenic Fibroma * Most common in * XR * +/- * One-third of cases are associated with * Treatment by
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
Odontogenic Fibroma * Mature, fibrous stroma with varying amounts of inactive odontogenic epithelium * Epithelium-poor type - * Epithelium-rich type -
simple type complex type (WHO-type)
72
Cementoblastoma (5)
* Neoplasm * Young adults < 25 years * Mandibular first molar * Pain, expansion, root destruction * Does not recur after complete removal
73
Ameloblastic Fibroma (4)
* “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
Ameloblastic Fibroma * --- resembling dental papilla * Epithelial strands and cords resembling
Ectomesenchyme dental lamina and enamel organ
75
Ameloblastic Fibro- Odontoma (5)
* 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
Ameloblastic Fibro-Odontoma * Histologic features of
ameloblastic fibroma, with the presence of dentin and enamel
77
Odontoma Age? Viewed as Description? Tx? Recurrence?
* Teenagers * Viewed an a hamartoma * Well-circumscribed * Treated by enucleation * No recurrence expected
78
Odontoma * Compound - * Complex -
anterior maxilla posterior mandible
79
Odontoma * ---% of Gorlin Cysts are associated with odontomas
20
80
Ameloblastic Fibroma Mimics
early stage of odontogenesis
81
Ameloblastic Fibro-Odontoma mimics
intermediate stage of odontogenesis
82
Odontoma mimics
end stage of odontogenesis

Pathology 2 (12 decks)

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