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Oral Path I > Cysts of the Oral Region > Flashcards

Cysts of the Oral Region Flashcards

1
Q

pathologic cavity lined by epithelium

A

cysts

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2
Q

general features of cysts

A
  • remain small
  • rarely loosen teeth
  • unless infected, don’t cause pain
  • unless infected, do not devitalize nearby teeth
  • usually require much information for differentiation (i.e. radiographic/microscopic/clinical features, pt hist., tooth vitality test)
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3
Q

general histologic features of cysts

A
  • epithelium lines central cavity

- connective tissue is the supporting layer

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4
Q

general categories for classification

A
  • odontogenic cysts (OC)
  • developmental (fissural) cysts
  • pseudocysts
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5
Q

odontogenic cyst that arise from REST OF MALASSE (remnants of Hertzwig’s root sheath)

A

periapical cysts/radicular cysts

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6
Q

odontogenic cysts that arise from REDUCED ENAMEL EPITHELIUM (covering of crown after enamel formation)

A
  • dentigerous cysts

- eruption cysts

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7
Q

odontogenic cysts that arise from DENTAL LAMINA (rests of serres, originate from oral epithelium and remain after tooth formation)

A
  • odontogenic keratocysts (OKC)/keratocystic odontogenic tumor
  • lateral periodontal cysts
  • botryoid odontogenic cysts
  • gingival cyst of adults
  • dental lamina cysts of newborns/Epstein’s pearls
  • glandular odontogenic cysts/Sialo-Odontogenic Cyst (intraosseous)
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8
Q

unclassified odontogenic cyst

A

paradental cyst

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9
Q

MOST COMMON odontogenic cyst

A

periapical cysts/radicular cysts

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10
Q

2nd MOST COMMON odontogenic cyst

A

dentigerous cyst

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11
Q

MOST COMMON odontogenic cysts in POSTERIOR MANDIBLE

A
  • odontogenic keratocysts (OKC)/keratocystic odontogenic tumor (can be found anywhere, if in MX usually in canine area, most are intraosseous)
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12
Q

odontogenic cysts that arise from what tissue have a more AGGRESSIVE behavior?

A

odontogenic cysts that arise from the DENTAL LAMINA

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13
Q

relatively uncommon odontogenic cyst, occur most commonly in ANTERIOR MANDIBLE (premolars)

A

lateral periodontal cysts

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14
Q

odontogenic cyst of inflammatory origin

A

periapical/radicular cysts

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15
Q

key features of periapical (radicular) cysts

A
  • MOST COMMON odontogenic cyst
  • arise from RESTS OF MALASSEZ
  • will test NONVITAL (key for diagnosis)
  • well circumscribed apical radiolucency
  • may be ASYMPTOMATIC
  • histology: proteinaceous debris and necrotic material, may see hyaline (Rushton) bodies
  • TX: RCT or extraction
  • very little potential for malignant transformation
  • incomplete extraction may result in residual cyst
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16
Q

key features of dentigerous (follicular) cysts

A
  • 2nd MOST COMMON odontogenic cyst
  • derived from REE
  • surrounds the CROWN of UNERUPTED tooth
  • in bone (intraosseous) MN 3rd molars > MX canines > MX 3d molars
  • histology: cyst wall may have RUSHTON BODIES
  • malignant transformation is rare (indication of malignancy = pain, bone destruction, drainage, paresthesia)
  • TX: ENUCLEATION and extraction of associated tooth
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17
Q

what odontogenic cyst do some argue is merely an uncommon dentigerous cyst?

A

paradental cysts

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18
Q

what is enucleation?

A

removal/shelling-out of a cyst without rupture

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19
Q

what is paresthesia?

A

altered sensation, non-painful

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20
Q

what is dysesthesia?

A

altered sensation that the patient finds uncomfortable

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21
Q

what cyst is the soft tissue counterpart of a dentigerous cyst?

A

eruption cyst

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22
Q

key features of eruption cysts

A
  • arise from REE
  • may form an ERUPTION HEMOTOMA
  • bone is not affected (extraosseous)
  • no malignant potential
  • unroof the cyst and allow the tooth to fully erupt, may spontaneously resolve
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23
Q

key features of odontogenic keratocysts (OKCs)

A
  • arise from the dental lamina (rests of serres)
  • AGGRESSIVE behavior and distinctive HISTOLOGY
  • can occur at any age
  • can occur anywhere in the jaw, but most occur in POSTERIOR MN (intraosseous)
  • usually unilocular, can be multilocular
  • malignant transformation (SCC) is rare but can occur
  • can become very large, erode bone and move teeth
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24
Q

what is another name for odontogenic keratocysts (OKCs)?

A
  • keratocystic odontogenic tumor
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25
Q

what is the distinctive histology of OKCs?

A

Commonly the cysts separate the epithelium from the CT, you usually don’t see anything in the space - lack of inflammatory response in capsule. Capsule wall often contains daughter cysts and cul-de-sacs.
4 main characteristics:
1) THIN, uniform, PARAKERATINIZED squamous epithelium 6-10 LAYERS THICK (required for dx)
2) prominent layer of cuboidal/columnar basal cells (basal cell layer very dark) - lined up like a picket fence (palisade/polarized)
3) rippled/corrugated layer of parakeratin (PRODUCE KERATIN) on luminal surface - parakeratinized, keratin can be seen in the lumen (not required for dx)
4) LACK OF RETE RIDGES, flat epithelial-CT interface

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26
Q

what is marsupialization?

A

removal of the contents of a cyst with the cyst lining remaining in place

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27
Q

what is eburnation?

A

smoothing of the bone to an ivory like surface

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28
Q

how do you treat OKCs?

A
  • usual treatment is enucleation w/ eburnation
  • marsupialization
  • when extensive resection may be necessary
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29
Q

60% recurrence rate

A

OKCs

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30
Q

is recurrence of OKCs common or uncommon?

A

COMMON (25-60%), you cannot leave anything behind during removal, recurrence generally occur within 5 years

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31
Q

multiple OKCs are consistent with what syndrome?

A

nevoid basal cell carcinoma syndrome

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32
Q

what is another name for nevoid basal cell carcinoma syndrome?

A

Gorlin-Goltz syndrome

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33
Q

if a patient has multiple OKCs why should you refer them to their physician?

A

to rule out the AUTOSOMAL DOMINANT syndrome, nevoid basal cell carcinoma syndrome

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34
Q

in addition to multiple OKCs, what are the other predominant features of nevoid basal cell carcinoma syndrome?

A
  • bifid ribs
  • basal cell carcinoma of the skin
  • calcification of the falx cerebri
  • palmar pits
  • epidermoid cysts
  • frontal bossing
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35
Q

what is more aggressive, and orthokeratinized or parakatinized OKC lining?

A

parakeratinized

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36
Q

are lateral periodontal cysts common or uncommon?

A

relatively uncommon (only ~1% of OCs)

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37
Q

lateral periodontal cysts are very similar to what other cyst?

A

gingival cyst of the adult

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38
Q

key features of lateral periodontal cysts

A
  • slow growing, well-circumscribed, nonexpansile (<1cm)
  • arise from dental lamina (rest of Serres)
  • have a thin lining 1-3 cuboidal cells with distinctive focal thickenings (plaques)
  • usually occur in ANTERIOR MN (can occur in the MX), between VITAL teeth
  • average age of occurence is 50 y/o
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39
Q

what are the key histological features of lateral periodontal cysts?

A
  • nonkeratinized, stratified squamous epithelium

- thin lining of cuboidal cells, with focal areas of nodular invaginations into cyst lumen

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40
Q

where are lateral periodotnal cysts most commonly found?

A
  • between MN two premolars > anterior MX between the canine and lateral incisor
  • can occur between any anterior teeth
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41
Q

how do you treat lateral periodontal cysts and botryoid cysts?

A

enucleation

42
Q

recurrence of lateral periodontal cysts is common or rare?

A

rare

43
Q

what is the rare, MULTILOCULAR variant of lateral periodontal cyst called?

A

botryoid odontogenic cyst

44
Q

which are more aggressive, lateral periodontal cysts or botryoid odontogenic cysts?

A

botryoid odontogenic cysts

45
Q

which have a better chance of recurring, lateral periodontal cysts or botryoid cysts?

A

botryoid cysts (15-20%)

46
Q

what are some key features of botryoid odontogenic cysts?

A
  • arise from dental lamina (rests of Serres)
  • MULTILOCULAR variant of lateral periodontal cysts
  • look like a cluster of grapes
  • expand bone
  • smilar histology to lateral periodontal cysts
  • TX w/ enucleation
  • similar to to glandular odontogenic cyst but DOSE NOT SECRETE MUCOUS
47
Q

what odontogenic cyst is thought to be a variant of botryoid cysts?

A

glandular odontogenic cysts (sialo-odontogenic cyst)

48
Q

what is the difference between botryoid cysts and glandular odontogenic cysts?

A

glandular odontogenic cysts SECRETE MUCOUS and have GREATER GROWTH POTENTIAL

49
Q

what cysts can cross the midline?

A

glandular odontogenic cysts (this is rare for cysts)

50
Q

key features of glandular odontogenic cysts

A
  • arise from dental lamina (rests of Serres)
  • MUCOUS secreting variant of botryoid cysts
  • may be unilocular or multilocular
  • primarily occur in the MN
  • smilar histology to lateral periodontal cysts
  • TX: enucleation and curettage
  • may transition to mucoepidermoid carcinoma (a salivary gland tumor)
51
Q

what does curettage mean?

A

removal of tissue with a curette from the wall or cavity from another surface

52
Q

where do glandular odontogenic cysts primarily occur?

A

the MN

53
Q

what is the rare, soft tissue variant of lateral periodontal cysts?

A

gingival cysts of the adult

54
Q

key features of gingival cysts of the adult

A
  • arise from dental lamina (rests of Serres)
  • soft tissue (extraosseous) counterpart of lateral periodontal cysts
  • primarily occur in the MN of adults (can occur in MX)
  • histologically similar to lateral periodontal cysts, also found in premolar, cuspid, and incisor region
  • clinical presentation: small (<1cm), firm but compressible, fulid-filled swelling
  • TX: enucleation
55
Q

what cysts occur in newborns?

A

dental lamina cysts of newborns

56
Q

what is another name for dental lamina cysts of newborns?

A

Epstein Pearls

57
Q

key features of dental lamina cysts of newborns

A
  • small, sometime multiple, raised cystic nodules found on ALVEOLAR RIDGE
  • arise from dental lamina (rests of Serres)
  • consist of keratin filled cystic cavity
  • very uncommon, scare parents
  • often spontaneously develop and disappear
  • benign and generally disappear without treatment
58
Q

key features of paradental cyst

A
  • unclassified odontogenic cyst
  • para means that it is found on the side of the crown
  • often arise on the distal or buccal aspect of VITAL 3RD MOLARS
  • some maintain they are just UNUSUAL DENTIGEROUS CYSTS
  • usually contains inflammatory cells in the cyst capsule
59
Q

what are developmental (fissural) cysts?

A

cysts that arise from epithelial remnants of ducts and other embryonic epithelial remnants

60
Q

what are the 5 main categories of developmental cysts?

A
  • cysts of vestigial ducts
  • lymphoepithelial cysts
  • cysts of vestigial tracts
  • cysts of embryonic skin
  • cysts of mucosal epithelium
61
Q

what cysts arise from vestigial ducts?

A
  • cysts of the incisive papilla
  • nasopalatine duct cyst (incisive canal cyst)
  • nasolabial cyst (nasoalveolar cyst)
62
Q

key feature of cysts of the incisive papilla

A
  • developmental cysts that arises from vestigial ducts
  • occur entirely within the palatal soft tissue (extraosseous)
  • not evident radiographically
  • TX: enucleation
63
Q

key features of nasopalatine duct cysts

A
  • developmental cyst that arises from vestigial ducts (remnants of nasoplatine duct)
  • occur between VITAL MX central incisors at MIDLINE of palate, ANTERIOR MX (intraosseous)
  • HEART SHAPED RADIOLUCENCY
  • recurrence is rare
  • malignant transformation not reported
64
Q

what cyst presents with a heart shaped radiolucency?

A

nasopalatine duct cysts

65
Q

what cyst presents between the MX central incisors

A

nasopalatine duct cysts

66
Q

how do you treat nasopalatine duct cysts?

A

enucleation

67
Q

what are histological features of nasopalatine duct cysts?

A
  • lined with squamous or RESPIRATORY epithelium

- CT shows chronic inflammation

68
Q

key features of nasolabial cysts

A
  • DEVELOPMENTAL cyst of the vestigial ducts (likely from remnants of nasolacrimal duct)
  • VERY COMMON IN FEMALES (3x, 40-60 y/o) and blacks
  • SOFT TISSUE cyst (extraosseous), does NOT involve bone
  • appears in UPPER LIP/side of nose (anterior mucobuccal fold below the ala of the nose)
  • most often UNILATERAL (rarely bilateral)
  • histology: cystic cavity lined with columnar epithelium with GOBLET CELLS
  • TX: excision
  • recurrence is rare
69
Q

what is another name for a nasolabial cyst?

A

nasoalveolar cyst

70
Q

what is unique about lymphoepithelial cysts?

A

they are developmental cysts that have all the usual components of a cyst, PLUS a wall filled with LYMPHOID FOLLICLES

71
Q

what are the two lymphoepithelial cysts we must know?

A
  • oral lymphoepithelial cysts

- cervical lymphoepithelial cyst

72
Q

histologically do oral and cervical lymphoepithelial cysts look the same of different?

A

same

73
Q

where are oral lymphoepithelial cysts found?

A

in the FLOOR OF THE MOUTH and POSTERIOR LATERAL BORDERS of TONGUE (can occur other places)

74
Q

are lymphoepithelial cysts common or uncommon?

A

uncommon

75
Q

where are cervical lymphoepithelial cysts found?

A

in the lateral aspect of the NECK (anterior to the SCM)

76
Q

how do you treat both types of lymphoepithelial cysts?

A

excision

77
Q

what do oral lymphoepithelial cysts look like clinically?

A
  • asymptomatic, painless
  • YELLOW or TAN
  • superficial, submucosal (extraosseous) mass, <1cm
78
Q

do cervical lymphepithelial cysts cross the midline?

A

NO, NEVER!!

79
Q

what is another name for the cervical lymphoepithelial cyst?

A

brachial cleft cyst

80
Q

do cervical lymphoepithelial cysts have malignant potential?

A

YES, it has been reported (remember these are rare lesions)

81
Q

where do lymphoepithelial cysts arise from?

A

lymphoid tissue trapped in the 2nd brachial cleft/pouch

82
Q

what unique age group do cervical lymphoepithelial cysts affect?

A

LATE CHILDHOOD or EARLY ADULTHOOD

83
Q

are cervical lymphoepithelial cysts painful?

A

no, usually asymptomatic, PAINLESS masses/swelling

84
Q

what developmental cysts arise from vestigial TRACTS?

A

thyroglossal duct cysts (remnants of thyroglossal duct)

85
Q

where do thyroglossal duct cysts occur?

A

above the THYROID GLAND and below the BASE of the TONGUE

86
Q

what is histologically significant about thyroglossal duct cysts?

A

thin cyst lining with THYROID tissue (thyroid follicles) in the wall

87
Q

what do we know about the recurrence and malignant potential of thyroglossal duct cysts

A
  • recurrence is a distinct possibility

- although rare, these have the ability to malignantly transform to thyroid carcinoma

88
Q

what developmental cysts arise from embryonic skin?

A
  • dermoid cysts

- embryonic cysts

89
Q

what developmental, cyst of embryonic skin, is known to affect YOUNG patients (i.e. TEENS)?

A

dermoid cysts

90
Q

where do dermoid cysts occur?

A
  • in the MIDLINE of the UPPER NECK or ANTERIOR FLOOR of MOUTH (below the MYLOHYOID muscles)
91
Q

what is histologically unique about dermoid cysts?

A

the cyst walls contain one or more skin appendages such as hair, sweat, or sebaceous glands

92
Q

how do you treat dermoid cysts

A

excision

93
Q

how do you treat epidermoid cysts

A

excision

94
Q

how do you treat developmental, cysts of embryonic skin

A

excision

95
Q

where do epidermoid cysts occur?

A

primarily on the SKIN

96
Q

what is unique about histology of epidermoid cysts?

A

epidermoid cysts have a lumen lined by KERATINIZING stratified squamous epithelium, usually filled with KERATIN

97
Q

what developmental cysts arise from mucosal epithelium?

A

surgical ciliated cysts of the maxilla

98
Q

what cysts are known to be iatrogenic?

A

surgical ciliated cysts of the maxilla

99
Q

what procedure is generally results in surgical ciliated cysts of the maxilla?

A

Caldwell-Luc operation (surgical procedure to clear a BLOCKED MX SINUS by entering through the oral cavity)

100
Q

how do surgical ciliated cysts of the maxilla form?

A

epithelium from the MX sinus is surgically implanted in MX bone

101
Q

how do you treat surgical ciliated cysts of the MX?

A

excision

Oral Path I (5 decks)

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