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Oral Pathology > Cysts of the Oral Region > Flashcards

Cysts of the Oral Region Flashcards

1
Q

Define a Cyst

A

Pathologic cavity lined with epithelium. May contain fluid, semisolid material or nothing. Become clinically evident by the epithelium expanding into surrounding tissues. Radiographically they are black and round.

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2
Q

In general, jaw cysts:

A

Remain small.
Unless large, rarely loosen nearby teeth.
Unless infected, do not cause pain or devitalize nearby teeth.

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3
Q

Histology of a cyst wall

A

Epithelium lining the central cavity. CT supporting layer.

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4
Q

What info is needed to differentiate a cyst.

A

Microscopic, clinical and radiographic features. Tooth vitality tests. Patient history.

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5
Q

What are the 3 main classifications of oral cysts?

A

Odontogenic cysts, fissural cysts and pseudocysts

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6
Q

Odontogenic cysts basic summary

A

comming from the tooth germ apparatus, the germ gets left behind. Comes from the epithelial component, not the CT.

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7
Q

Fissural cysts basic summary

A

remenents of the epithelium from the bone structures of the face.

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8
Q

Pseudocysts basic summary

A

Clinically look just like a cyst, but when you look at them under the microscope, they aren’t lined with epithelium.

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9
Q

What are the epithelial components of the tooth germ?

A

The enamel organ is composed of the outer enamel epithelium, inner enamel epithelium, stellate reticulum and stratum intermedium. These cells give rise to ameloblasts, which produce enamel and become a part of the reduced enamel epithelium (REE) after maturation of the enamel. The location where the outer enamel epithelium and inner enamel epithelium join is called the cervical loop. The growth of cervical loop cells into the deeper tissues forms Hertwig Epithelial Root Sheath, which determines the root shape of the tooth.

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10
Q

What can odontogenic cysts arise from?

A

Tooth development remnants:

  1. Hertwig’s epithelial root sheath (rests of malassez)
  2. Covering of crown after enamel formation (reduced enamel epithelium.
  3. Remnants of the dental lamina
    - Rests of Serres
    - Originate from oral epithelium and remain after tooth formation.
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11
Q

What are the most agressive origins for an odontogenic cyst?

A

Dental Lamina. They have the proteins that drives the tooth bud into the bone and they have biologic memory built into them. Can do the most damage.

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12
Q

Other names for the Periapical Cyst

A

Radicular cyst. Apical periodontal cyst.

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13
Q

Where does the periapical cyst arise from?

A

Rests of Malassez. Odontoginic cyst of inflammatory region. Chronic inflammation stimulate rests of malassez from hertwigs root sheath to form a cyst lining. May be asymptomatic.

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14
Q

Where are periapical cysts found and what do they look like on the radiograph?

A

Arise at the apex of a nonvital tooth. Well circumscriped periapical radiolucency less than a cm in diameter

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15
Q

Periapical cyst histology

A

Central cavity lined with epithelium. CT wall with chronic inflammation. Central cavity filled with proteinaceous debris and necrotic material.

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16
Q

Periapical cyst treatment and prognosis

A

Endo therapy or extraction of associated tooth. Very little potential for malignant transformation.

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17
Q

What are the two common cysts formed from the REE.

A

REE covers the crown after enamel formation. It is derived from the epithelial component of the tooth germ. The two common cysts are the dentigerous cyst and eruption cyst.

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18
Q

What is another name for the dentigerous cyst?

A

Follicular cyst.

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19
Q

How do dentigerous/follicular cysts form?

A

Arises around the tooth crown. Fluid accumulation between the REE and the enamel surface produce the cyst. Etiology is unknown.

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20
Q

What are the 2 most common cysts found in the oral cavity?

A
  1. Periapical cyst

2. Dnetigerous cyst

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21
Q

Dentigerous cyst clinically

A

Presents as an asymptomatic radiolucency around the crown of an unerupted tooth in most instances. Mostly 3rd molars.

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22
Q

Dentigerous cyst histology

A

Lined with stratified squamous non keratinizing epithelium. CT wall may contain chronic inflammation. The cyst wall may contain scattered hyaline bodies called rushton bodies.

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23
Q

Dentigerous cyst treatment and prognosis

A

Malignancy is an uncommon occurrence but enough to be statistically significant. Comes from the epithelial lining, squamous cell carcinoma. Pain, bone destruction, cortical plate penetration, drainage, paresthesia may signal malignant transformation. Enucleation of the cyst and the associated tooth usually curative.

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24
Q

Eruption cyst

A

A dentigerous cyst overlying the crown of an erupting tooth arising from the REE. Can be a variant of a dentigerous cyst, mostly in young kids, not in adults.

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25
Q

Eruption cyst treatment and prognosis.

A

Often resolve spontaneously, but exposure of the crown and removal of the cyst may be required. Never remove the tooth.

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26
Q

Another name for the odontogenic keratocyst

A

Keratocystic odontogenic tumor.

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27
Q

General features of the Odontogenic Keratocyst

A

Aggressive behavior and distinctive histology. Can occur anywhere in the jaws, but most occur in the posterior mandible at any age.

28
Q

Odontogenic Keratocyst Radiographic features

A

Appear as unilocular or multilocular radiolucencies. Can achieve large size, erode bone and move teeth. Can be associated with impacted teeth.

29
Q

Nevoid Basal Carcinoma Syndrome (Basal Cell Nevus Syndrome)

A

Consists of bifid ribs, basal cell carcinomas of skin, falx cerebri calcifications, epidermoid cysts and frontal cysts. Have several OKC that can be in any quadrant and are associated with pain, paresthesia, drainage and swelling.

BCC and OKC are most important signs.

30
Q

Odontogenic Keratocyst Histopathology

A

Cavity lined with stratified squamous epithelium. Thin layer 6-10 cells thick. There is also a prominent basal layer that stands out and stains very basophilic. No rete ridges, flat epithelial-CT interface. Corrugated surface with a thin layer of keratin that is usually parakeratinized. Daughter cysts and cul-de-sacs may be present in the cyst wall making it difficult to remove.

31
Q

Odontogenic Keratocyst Treatment and prognosis

A

Surgical enucleation with eburnation of the bone. Marsupialization. Resection. Recurrence is common. 25-60% generally within 5 years. You need to follow up. Orthokeratinized linings may have less aggressive behavior than parakeratinized lining of cysts. Malignant transformation to SCC is rare, but does occur.

32
Q

Lateral Periodontal Cyst General features

A

Slow growing odontogenic cyst that can occasionally be quite destructive. Occur mostly in the anterior mandible but can occur in the maxilla. Occurs at mean age of 50.

33
Q

Lateral Periodontal Cyst Radiographic Features

A

Well defined less than 1 cm radiolucency lateral to the teeth.

34
Q

Lateral Periodontal Cyst Histopathologic features

A

Lined with stratified squamous nonkeratinizing epithelium. Lining is very thin, 1-2 cells thick with nodular invaginations into the cyst lumen.

35
Q

How do you determine between a lateral periodontal cyst and a periapical cyst?

A

No peri-apical inflammation or infection of the teeth. The teeth are vital. In lateral periodontal cyst.

36
Q

Botryoid Odontogenic Cyst

A

Variant of the lateral periodontal cyst. It is often multilocular radiographically and is more aggressive.

37
Q

Lateral Periodontal and botryoid odontogenic cyst treatment and prognosis

A

Enucleation. Recurrences are rare for LPC and botryoid odontogenic cysts have 15-20% recurrence rates.

38
Q

Gingival Cyst of the Adult

A

Small, dental lamina derived cyst in soft tissue.Cyst is fluid-filled compressible and less than 1 cm in diameter.

39
Q

Gingival Cyst of the Adult Histology

A

Lined with epithelium similar to lateral periodontal cyst.

40
Q

Gingival Cyst Treatment and prognosis

A

Surgical enucleation cures, recurrences are rare.

41
Q

Dental Lamina Cyst of the Newborn

A

Very uncommon. Occurs on the alveolar ridge. Dramatic appearance clinically that scares kids. Develop and disappear spontaneously. Benign and most likely disappear without treatment, can excise if they don’t.

42
Q

Another name for Glandular Odontogenic Cyst

A

Sialo-odontogenic cyst

43
Q

Glandular Odontogenic Cyst General features

A

Thought to be a variant of the botryoid odontogenic cyst. Appears as a unilocular or multilocular radiolucency.

44
Q

Glandular Odontogenic Cyst Histology

A

Epithelial lining has mucous secreting cells, unlike the botryoid cyst.

45
Q

Glandular and Odontogenic Cyst Treatment and Prognosis

A

Treatment is surgical enucleation and curettage. May transition to mucoepidermoid carcinoma, a malignant salivary gland tumor. 15-20% recurrence rate.

46
Q

Paradental Cyst

A

Arises from the distal or buccal aspect of a vital 3rd molar. Thought to be unusual dentigerous cysts.

47
Q

Developmental Cysts, another name.

A

Fissural cysts. Used to be thought to arise from epithelium entrapped in developmental suture line.s

48
Q

Developmental Cysts

A

Now thought to arise from epithelial remnants of ducts and other embryonic epithelial remnants. DON’T have to be associated with suture line entrapment.

49
Q

Cysts of Vestigial Ducts

A

Ducts that are developed embryologically have epithelium left behind.

50
Q

Nasopalatine Cyst general features

A

Intraosseus cyst located in the anterior palatal midline. Arises from remnants of the nasopalatine duct.

51
Q

Nasopalatine Duct Cyst Radiographic Features

A

Appears as a well-circumscribed oval or heart-shaped radiolucency. Lucency located in anterior palat just mesial to the central incisors. Usually see a soft tissue swelling.

52
Q

Nasopalatine Duct Cyst Histopathologic Features

A

Lined with stratified squamous or respiratory epithelium. CT wall may show chronic inflammation. Not very distinguishing. Need the xray to diagnose.

53
Q

Cyst of the Incisive Papilla

A

Epithelial remnants of the nasopalatine duct will give rise to a wholly soft tissue cyst with out bony involvement. Variant of the nasopalatine ducts cysts. No radiographic findings. Soft and spongy upon palpation.

54
Q

Nasopalatine Duct cyst treatment and prognosis

A

Surgical enucleation is curative for both the hard and soft tissue variants. Recurrences are rare. Malignant transformations have not been reported.

55
Q

Nasolabial Cyst Origin and Clinical Features

A

Soft tissue cyst of a vestigial duct. Located in the anterior mucobuccal fold beneath the nose ala. Arises from the remnants of the nasolacrimal duct. Appears as a soft tissue facial swelling in upper lip/lateral nose region. Females.

56
Q

Nasolabial Cyst Histology

A

Characterized by cystic cavity lined wit hcolumnar epithelium with goblet cells.

57
Q

Nasolabial Cyst Treatment and Prognosis

A

Surgical excision is curative. Recurrences are very rare

58
Q

Lymphoepithelial Cysts Info and Histology

A

Very rare. Appear on the floor of the mouth or in the neck. Oral or cervical. Same histologic features, but different location. Central cavity lined with stratified squamous epithelium and cyst wall filled with lymphoid follicles.

59
Q

Oral lymphoepithelial cyst

A

Arises from epithelial invagination into regional lymphoid tissue. Appears as a yellow to tan nodular less than 1 cm surface lesion. Surgical excision cures. Almost looks like an abcess but with no puss.

60
Q

Cervical Lymphoepithelial cyst

A

Similar to the oral kind. Anterior to SCM. Arise from trapped lymphoid tissue in second branchial cleft or pouch. Appears as a painless swelling. Kids or young adults. Surgical excision. Has malignant potential. Feels like dough.

61
Q

Thyroglossal Duct Cyst General features

A

Occurs as a cyst above the thyroid gland and the base of the tongue. May arise from the remnants of the thryoglossal duct. May occur in the tongue above the hyoid bone.

62
Q

Thyroglossal Duct Cyst Histology

A

Thin cyst lined with epithelium and with thyroid tissue in its wall. Thyroid carcinomas rarely arise in these lesions. Low malignant potential.

63
Q

Dermoid cyst

A

Occurs in the midline of the upper neck or anterior floor of the mouth. Looks like a frog belly. Occurs below the mylohyoid muscle. Young patients. Embryonic skin remnants. Teratomatous lesion, coming rom multiple germ layers.

64
Q

Dermoid cyst histology and treatment

A

Cyst walls often contain skin appendages such as hair follicles, sebaceous glands and sweat glands. Surgical excision is curative rarely come back.

65
Q

Epidermoid Cyst

A

Skin cyst. Lesion has a central keratin filled cavity lined with stratified squamous keratinizing epithelium. Wall contains skin appendages such as hair follicles, sweat glands, etc. Surgical excision is curative. No malignant potential.

66
Q

Surgical Ciliated Cyst of the Maxilla

A

Iatrogenic. Complication of the Caldwell-Luc operation. Maxillary sinus epithelium is surgically implanted in maxillary bone. Seen in adults who have undergone sinus surgery. Surgical excision is curative. Respiratory to more primitive epithelium. Hard for patients to breath.

Oral Pathology (3 decks)

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