Cysts SCR Flashcards
Radicular cysts
Give the associated names
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Diagnostic tests
Associated problems
Management
Radicular cysts - apical, lateral or residual
Aetiology
- Inflammatory odontogenic cyst
- Non vital tooth
- Rests of Malassez (Hertwigs epithelial root sheath)
- Max anterior
Pathogenesis
- Stimulated proliferation of epithelium within chronic periapical granulomas
- Pulp necrosis leads to periapical periodontitis leads to periapical granuloma - radicular cyst
Radiographic signs
- Round or ovoid well defined radiolucency
- Unilocular
- Corticated margins continuous with the lamina dura of a non vital tooth
- Bony expansion and cortical thinning (egg shell crackling)
Histopathology
- Non keratinised stratified squamous epithelium
- Epithelium supported by thick, inflamed fibrous capsule
- Rushton bodies
- Cholesterol clefts
Diagnostic tests
- Aspiration biopsy
- Excisional biopsy
- Serum protein test
- Assume cyst >15mm
Watery straw coloured or semi-brownish material
Associated problems
- Displacement of anatomy
- Thinning of cortical bone and external root resorption (large cysts)
Management
- Lab tests
- Definitive diagnosis
- RCT/XLA
- Enucleation
- Monitor
Dentigerous cyst
Associated names
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Diagnostic tests
Associated problems
Management
Eruption cyst from the dental lamina extra-alveolar bone
Aetiology
- Odontogenic development
- Reduced enamel epithelium remnants of enamel organ
- Most common M3M, U3, U8
Pathogenesis
- Cysts cavity develops between impacted or unerupted tooth and dental follicle
Radiographic signs
- Round or ovoid well defined radiolucency
- Unilocular with corticated margins continuous with the CEJ of unerupted crown
- Bony expansion and tooth displacement
Histopathology
- Non keratinsed thin stratified sqaumous epithelium
- Capsule resembles dental follicle
- Loose myxoid areas and odontogenic rests
- Lined by REE
- Squamous metaplasia
Diagnostic tests
- Aspiration biopsy
- Excisional biopsy
- Serum protein test
- Assume cyst and not enlarged follicle >10mm
- Proteinaceous yellow fluid
Ass problems
- Dispalcemnt of anatomy
- Thinning of cortical bone
Management
- Lab test
- Definitive diagnosis
- Marsupialisation
- Enucleation
- Monitor
Odontogenic keratocyst
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Diagnostic tests
Associated problems
Management
Aetiology
- Odontogenic development
- Derived from Rests of serres remnants of the dental lamina
- Mandible
- M3M and ramus area
Pathogenesis
- Destructive pattern on growth in Antero-posterior direction through cancellous bone
- Higher rate of mitotic activity and cellular activity in connective tissue capsule
Radiographic
- Well defined radiolucency
- Unilocular (small) , multilocular with scalloped margins
- AP growth
- Displacing adjacent structures
- Often large without bony expansion
Histopathology
- Thin keratinised statified squamous epithelium with parakeratosis (nucleated keratinocytes - retention of nuclei in stratum corneum)
- Daughter cysts (satellite cysts)
- Palisading basal cells
Diagnostic tests
- Aspiration biopsy (thick creamy white)
- Incisional or excsional biopsy
- Serum protein test (low protein content)
Associated problems
- Displacement of anatomy
- Highly recurrent due to thin friable lining, daughter cysts and nature of infiltrative growth
- Basal Cell Naevus syndrome - inherited autosomal dominant trait , mutation in PTCH1 - sonic hedgehob signalling pathway (multiple OKC, abnormal of Ca and Phoshpate levels, basal cell carcinomas of skin, calciication of falx cerebri)
Management
- Lab test
- Definitive diagnosis
- Marsupialisation
- Enucleation
- Monitor
What are the inflammatory collaterol cysts?
Paradental cyst
- Ass with M3M that have pericoronitis
Buccal bifurcation
- Buccal aspect of mandibular first permanent molar of children
Ameloblastoma
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Diagnostic tests
Associated problems
Management
Aetiology
- Epithelial odontogenic tumour
- RoS / RoM / REE
- Benign slow growing tumour
- Unicystic or multicystic
- Follicular or Plexiform
- Most common OT
Pathogenesis
- Locally invasive with tumour islands throughout cancellous bone
Radiographic
- Primarily radiolucent with radiopacities
- Well defined
- Corticated
- Expands equally
- Thinning of cortical bone
- Knife edge root resoprtion
- Multicystic - soap bubble appearance
Histopathology
Follicular type
- Fibrous tissue
- Surrounding ameloblast like cells (secrete enamel proteins enamelin and emelogenin)
- Stellate reticulum like cells within
- Cystic changes
Plexiform type
- Fibrous tissue surrounding ameloblast like cells
- stellate reticulum like cells within
Diagnostic test
- Incisional or excisional biopsy
Associated problems
- Displacement of anatomy
- Progressive hard swelling
- Thinnin of cortical bone
- Hard removal as no fibrous tissue capsule and
- Multicystic so highly recurrent
- rarely malignant <1%
Management
- Surgical resection +1cm
- Ilia bone graft to replace
- Monitor
-
Adenomatoid Odontogenic tumour
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Diagnostic tests
Associated problems
Management
Aetiology
- Epithelial odontogenic tumour
- Benign, slow growth
- 75% unerupted tooth U3
Radiographic signs
- Radiolucent with internal radiopacities
- Well definied , unilocular
- Corticated
- Bony expansion with displacement
- Attached more apical to CEJ than dentigerous cyst
Histopathology
- Epihtelium surrounding duct like structures
- Calcification
- fibrous tissue capsule
Diagnostis test
- Incisional biopsy
Associated features
-Displacement of anatomy
- failure of eruption
- progressive hard swelling
Management
- Enucleation
- Monitor
Calcifying epithelial odontogenic tumour
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Diagnostic tests
Associated problems
Management
Aetiology
- Epithelial benign slow growing tumour
- 50% unerupted tooth
Pathogenesis
- Amyloid material which undergoes progressive calcification
Radiographic signs
- Mixed radiolucent
- Unilocular / multilocular
- Well or poorly defined
- Possible internal septa
Histopathology (congo red stain)
- Pleomorphic epithelial cells with dark nuclei
- Pink staining amyloid
- No cystic change
Diagnostic test
- Incisional biopsy
Associated features
- Highly recureent 20%
- Rarely malignant
Management
- Surgical resection +1cm
- Ilia bone graft to rpelace
- Monitor
Odontogenic myxoma
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Diagnostic tests
Associated problems
Management
Aetiology
- Mesenchymal odontogenic tumour
- Benign slow growing
- 2nd most common OT
Radiographic
- Mixed radiolucent
- Uni/multilocular (soap bubble)
- Well or poorly defined
- Scallops between teeth
- Poss thinning of cortex
- rarely root resoprtion
Histo
- Loose myxoid connective tissue
- Nests of odontogenic epithelium
- no fibrous tissue capsule meaning locally invasive and harder removal
Diagnostic test
- Incisional biopsy
Ass features
- Highly recurrent 25%
Management
- Small = curettage
- Large = resection
- Monitor
Describe each of the management techniques
Aspiration = wide bore needle to extarct cyst fluid
Curettage = Tumour gently scraped away to minismise damage to surrounding tissues
Enucleation = Removal of whole cysts and lining , allows pathological examination whole cyst and little aftercare. Risk fracture of mandible if large or damage to anatomy or recurrence if any remains
Marsupialisation = Creation of surgical window to allow decompression of cysts, often followed by enucleation. Suture the cyst wall to surrounding epithelium. Simple and preserves anatomy. But needs very good oral hygiene or infection. Complete lining not ava for histo. premature closure risks cysts reformation
Fibrous dysplasia
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Differential diagnosis
Management
Aetiology
- Gene defect
- Maxilla > mandible
- Albrights syndrome
Pathogenesis
- Slow growing
- Asymptomatic bony swelling
- Stops after active growth period
Signs
- Asymmetry
- Radiolucency becomes more opaque over time
- poorly defined margins blend into adjacent bone (orange peel)
Histo
- Fibro-osseous
- Fibrous replacement of bone
- Cellular fibrous tissue
- Woven bone remodels, increasing density
Differential diagnosis
- Cemento-osseous dysplasia
- Paget disease
Management
- In severe cases where function is threatened - Bisphosphonates may be needed
- Monitor
Osteitis Fibrosa cystica (Brown tumour)
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Differential diagnosis
Management
Aetiology
- Hyperparathyroidism (XS parathyroid hormone , high levels of calcium in blood, loss of bone density- joint pain, muscle aches , fatigue)
- Noonans syndrome
Pathogenesis
- Reduced serum calcium levels causes increased PTH secretion
- Results in rapid osteoclastic turnover of bone to maintain calcium
Signs
- Generalised osteoporosis
- Giant cell epulis
- Brown tumours
- Radiolucent bony expansion, displacement of adjacent teeth
Histo
- Multinucleated giant cells
- Extravasated erythrocytes which forms the brown pigment tumour
Differential diagnosis
- Peripheral giant cell granuloma
- Central giant cell granuloma (same signs but unrelated to hyperparathyroidism)
Management
- Blood tests for calcium / paratghyroid hormone
- Treat for parathryodism
Cherubism
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Differential diagnosis
Management
Aetiology
- Gene defect
- Detected early age
Patho
- Gene mutation
- Family history
Signs
- Symmetrical fullness of the cheeks and submandibular space and jaws = chubby
- Multiple radiolucencies , multilocular, expansion and thinning of cortex
Histo
- Multinucleated giant cells
- Extravasated erythrocytes (leakage of red blood cells )
- As activity of lesion decreases there is progressively more fibrous and metaplastic bone
Differential diagnosis
- Fibrous dysplasia
Management
- Monitor
- mostly reduces in size after puberty
Pagets disease
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Differential diagnosis
Management
Aetiology
- Unknown
- Poss due to osteoclast dysfunction
- >40yrs
Patho
- Disorganised formation and remodelling of bone
Signs
- Bone swelling
- Pain , nerve compression
- Facial derformity
- Complete denture problems
- Poorly defined irregular radiopacities in cotton wool bone , loss of lamina dura, hypercementosis and ankylosis
Histo
- Increased bone turnover
- OC and OB activity
- Mosaic appearance
Differential diagnosis
- Fibrous dysplasia
Management
- Bisphosphonates
- Analgesics
Ossifying fibroma
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Differential diagnosis
Management
Aetiology
- Benign bone tumour
- Mandible premolar/molar region
- <10years old
Signs
- Slowly enlarging progressive swelling
- Well definined radiolucency , demarcated transitions to surrounding bone
Histo
- Cellular fibrous tissue conating islands of woven boone
Differential
- Fibrous dysplasia (FD has smooth trasnition to surroudning bone)
Management
- Surgical resection
Cementoblastoma
Give the aetiology
Give the pathogenesis
Radiographic signs
Histology
Differential diagnosis
Management
Aetiology
- Benign cementum tumour
- FPM
- 20yr
Signs
- Painful swelling buccal and lingual aspect of vital tooth
- Radiopaque well defined consistent with cementum , surrounded by radiolucent zone , poss loss of PDL
Histo
- Dense masses of acellular cementum like material
- Multinucleated cells
- Cementoblasts
Differential
- may resemble some cysts
Management
- Surgical resection (recurrent if not compleetly removed)
