Exam 1 - RL Flashcards
PA cyst or granuloma:
w/ out epithelial lining just granulation tissue
PA granuloma
PA cyst or granuloma:
variably thick, non-keratinized strat squam epi lining
PA cyst
What is the difference in histology of Dentigerous cyst and Hyperplastic Dental Follicle?
Dentigerous cyst virtually identical to a hyperplastic dental follicle but hyperplastic dental follicle lacks a true epi lining
Typically parulis forms at facial gingiva/ alveolar (thin) mucosa apical or near tooth of origin. What are the two exceptions?
Palatal bone for max lat incisors. Lingual Plate for mandib 2nd and 3rd molars.
Name the term: Enlargement comes from fluid accumulation inside abnormal sac or cavity lined by epithelium which is enclosed in CT.
Cyst
What are the two cyst classification?
- Developmental (odontogenic/non-odontogenic)
- Inflammatory (PA cyst, lat radicular cyst, residual cyst)
What three tissues do odontogenic cyst/tumors come from?
- Dental Lamina Rests
- Rest of Malassez
- Reduced Enamel Epithelium
What are the 3 Intraosseous developmental odontogenic cyst we talked about.
Dentigerous cyst, OKC, and Lateral periodontal cyst
What are the two extraosseous developmental odontogenic cyst we talked about.
Eruption cyst and gingival cyst of the adult.
What is the one Intraosseous nonodontogenic developmental cyst we talked about?
Nasopalatine duct cyst
What arises from reduced enamel epi (REE)?
Dentigerous Cyst
When is a lesion less likely to be a dentigerous cyst?
Impacted tooth other than 3rd molar or canine. Larger lesions.
Dentigerous Cyst Differentials (4 of them)
Odontogenic keratocyst (MOST common)
Unicystic ameloblastoma (infrequent)
Odontogenic myxoma (uncommon)
Central giant cell granuloma - anterior of the first molar (dont expect in posterior md/ramus)
What is derived from dental lamina rest?
Lateral Periodontal Cyst
OKC (possibly)
What can mimic a mucocele but there are no salivary glands on the gingiva so it would be a __________
Gingival cyst of the adult
What is the histology of OKC?
Makes luminal _________ production. Uniform _____ stratified squamous epi lining.
_______ (picket fence) appearance of basal cell nuclei. ________ ________ formation may be seen predisposing pt to recurrence of OKC.
Makes luminal parakeratin production. Uniform thin stratified squamous epi lining
Palisaded (picket fence) appearance of basal cell nuclei. Satellite cyst formation may be seen predisposing pt to recurrence of OKC.
How to tx large OKC?
Resection, Marsupialization (procedure to shrink), followed by surgical excision of residual cystic epithelium
If occurence is early in life (first decade) or notice multiple OKCs be sure to rule out ____________.
Nevoid Basal Cell Carcinoma (Gorlin Syndrome).
What is another name for nasopalatine duct cyst?
Incisive canal cyst
When does a nasopalatine duct cyst indicate disease?
Lesion greater than 6 mm
T/F You just leave a nasopalatine duct cyst no surgical intervention is necessary.
False
What are the cutaneous features of gorlin syndrome?
Basal cell carcinoma, early onset
Palmar/plantar pitting
What are the skeletal features of nevoid basal cell carcinoma?
Calcified falx cerebri
Increased cranial circumference
Bifid ribs
T/F You are likely to see expansion with a simple cyst.
False (75% with NO expansion) - usually painless
What lesions often scallops between roots of teeth?
Simple bone cyst usually lamina dura lost and sometimes PDL.
How do you treat a simple bone cyst
Scrape curettage inside of bony cavity to prompt bleeding and regeneration of the bone .
Follow up with radiographs to confirm bone fill.
Wait 3-6 months to take another radiograph to see if tx worked.
What’s another name for simple bone cyst?
Traumatic bone cyst even though usally trauma is NOT present.
What often has a soap bubble or honeycomb appearance and cortical expansion with thinning?
Ameloblastoma
T/F: Ameloblastoma can be associated with an impacted tooth.
T
What is the histology of ameloblastoma?
Variety of patterns of _________ ________ like odontogenic epithelium, ______ formation common.
Peripheral cells usually resemble _______ (columnar shape with palisaded nuclei away from basement membrane, “________ ________ _________” or “reverse polarization”).
Central cells often more spindled, (resemble ________ ___________).
Variety of patterns of enamel organ like odontogenic epithelium, cystic formation common
Peripheral cells usually resemble ameloblasts (columnar shape with palisaded nuclei away from basement membrane, “reverse nuclear polarity” or “reverse polarization”)
Central cells often more spindled, (resemble stellate reticulum).
T/F Recurrence is not common with ameloblastomas.
False
Tumor often extends beyond radiographic margin so that recurrence is common (50-90% when treated with curettage, particularly for larger lesions.
Smaller lesions - aggressive curettage and peripheral ostectomy (use a bone bur)
Larger lesion - marginal (leave a portion) or segmental resection (key is to go 1.0-2.0 cm beyond radiographic border take it ALL)
T/F There is no solid component in a unicystic ameloblastoma.
True - unilocular lesion is entirely cystic
What is the recurrence rate of unicystic ameloblastoma compared to ameloblastoma?
50-90% recurrence of ameloblastoma
10-20% recurrence of unicystic ameloblastoma
Name the lesion: Painless nodule of alveolar or gingival mucosa. It is rare, any odontogenic cyst or tumor can do this (peripheral odontogenic cystic tumor).
Peripheral ameloblastoma
How do you tx peripheral ameloblastoma?
Excision with limited recurrence so tx is similar to POF, PG.
How do you tx a gingival cyst of the adult?
Excision is curative
Ameloblastic fibroma and Odontogenic Fibroma are what type of lesions?
Benign RL odontogenic tumors
Name that lesion
RL in posterior jaw
Typically unilocular Associated with impacted tooth
<20 yrs
Tx is Excision
Ameloblastic fibroma
Name that lesion
RL usually in both jaws
Wide age range
Tx is Excision
Odontogenic Fibroma
Name the lesion and fill in the blank
Intrabony lesion of an ________ cause can be painless or cause pain. Usually happen before 30 yrs of age (60%) in the anterior mandible often cross midline. Do not expect it to be pericoronal.
Central Giant Cell Granuloma
Unknown cause
What should you rule out before diagnosing central giant cell granuloma?
Brown tumor of hyperparathyroidism which usually tends to occur >60 yrs.
What is a brown tumor of hyperparathyroidism primarily and secondarliy due to?
Primary - parathyroid neoplasia
Secondary - due to kidney disease
How would you treat central cell granuloma? What is the recurrence?
If isolated aggressive curettage.
Recurrence 15-20%
Name the lesion:
A developmental depression in the bone due to normal salivary gland tissue (pseudocyst).
Erosion of the lingual cortex, making the bone thin on buccal plate, and sometimes erosion of the inferior cortex.
Stafne Defect
T/F Stafne defect is symptomatic.
False
Where is the location of stafne defect?
Posterior mandible below the IAN occasionally anterior teeth
T/F A Schwannoma/Neurofibroma in bone can become multilocular.
True
How do you tx a stafne defect?
NO tx
How do you tx a Schwannoma/Neurofibroma? Whats the recurrence?
Excision
Little recurrence
What is a typical appearance of an AV malformation?
Multilocular, trabeculation runnin through it sometimes, sunburst or sunray appearance sometimes
Name the lesion: One lesion - area of bone that is less dense (bone) and it’s a defect at in old EXT site, doesn’t make good trabeculae during the healing process. No Tx necessary.
Focal Osteoporotic Marrow Defect
T/F: Focal Osteoporotic Marrow Defect is usually asymptomatic and 75% of time in females.
True
Name the lesion: Fatty and hematopoietic marrow seen microscopically.
Focal Osteoporotic Marrow Defect
RL Malignancies involving bone:
Name the three he listed with children.
- Leukemia/Lymphoma
- Rhabdomyosarcoma
- Ewing Sarcoma
RL Malignancies involving bone:
Name the three he listed with adults.
- Metastatic carcinoma (most often in mandible)
- Lymphoma
3.Multiple myeloma
T/F Multiple Myeloma has bone resorption and pathologic fractures (punched out RL), but is not usually painful.
False - chronic pain
Description of Multiple Myeloma
- ___________ causes confusion, weakness, and lethargy
- Recurrent _________
- Renal insufficiency (renal failure can occur in up to 50% of patients)
- Multiple areas of lytic destruction
- Hypercalcemia causes confusion, weakness, and lethargy
- Recurrent bacterial infections
- Renal insufficiency (renal failure can occur in up to 50% of patients)
- Multiple areas of lytic destruction
Description of Multiple Myeloma
- Hypercalcemia causes confusion, weakness, and lethargy
- Recurrent bacterial infections
- ______ insufficiency (_______ failure can occur in up to ____ of patients)
- Multiple areas of lytic destruction
- Hypercalcemia causes confusion, weakness, and lethargy
- Recurrent bacterial infections
- Renal insufficiency (renal failure can occur in up to 50% of patients)
- Multiple areas of lytic destruction
What is the median age for multiple myeloma?
70 yrs old
What is the type of multiple myeloma that may be asymptomatic for many years?
smoldering myeloma
What age range are you most likely to find lateral periodontal cyst?
middle age adults
What age range are you most likely to find Gorlin syndrome/ nevoid basal cell carcinoma?
Early age usually
What age range are you most likely to find simple bone cyst?
you pt 10-20s
What age range are you most likely to find ameloblastic fibroma?
<20 yrs
What age range are you most likely to find Central cell granuloma?
60% before 30 years
What age range and gender are you most likely to find stafne defect?
Middle age although developmental in males
What gender are you most likely to find Focal Osteoporotic Marrow Defect?
75% in females
What age range are you most likely to find multiple myeloma?
Median age around 70 years
What regions would you most likely find dentigerous cyst, lat periodontal cyst, and OKC?
Dentigerous cyst - 3rd molars or canines
Lat periodontal cyst - canine premolar region, mandible, superior portion of the root
OKC - most commonly seen in posterior mandible but can find anywhere
T/F Simple bone cyst are only found in the mandible.
True
What region is a unicystic ameloblastoma often found?
often pericoronal to unerupted third molar
Where is an ameloblastic fibroma usually found (region)?
Posterior jaw with an impacted tooth
Name the lesion:
often mandibular anterior lesion and can cross the midline - don’t expect to be pericoronal usually periapical
Central cell granuloma
Name the lesion: often located in the posterior mandible within the mandibular canal
Schwannoma/Neurofibroma in bone
What are the 4 RL that are likely to be associated with pain?
Neoplastic Central cell granuloma
Schwannoma/Neurofibroma in bony lesions (not usually soft tissue)
Non-hodgkin lymphoma
Multiple Myeloma
What is the percent of recurrence for a large OKC?
33%
large lesions more likely and satellite cyst formation can predispose pt
What is the percent of recurrence for an ameloblastoma compared to unicystic ameloblastoma?
Ameloblastoma - 50-90% recur when treat with curretage because tumor often extends beyond radiographic margin (rare malignant transformation) - larger lesions usually
Unicystic Ameloblastoma - 10-20% with enucleation and curettage so less aggressive than typical ameloblastoma like OKCS they may have satellite components in the wall of the cyst - increasing likelihood for recurrence
T/F A peripheral ameloblastoma has a high recurrence rate.
False
What is the recurrence rate for a central cell granuloma with aggressive curretage?
15-20%
T/F: Tx of a schwannoma/neurofibroma with a conservative excision there is little tendency to recur.
True
What two RL would you use radiographic follow up for rather than tx?
Stafne defect and Focal osteoporotic marrow defect
What age does a brown tumor usually occur?
> 60 yrs
Name the two other benign RL odontogenic tumors briefly talked about.
Ameloblastic fibroma
Odontogenic Fibroma
T/F: Asymptomatic PA granuloma/cyst are often patent and pus can be expressed from the center of the lesion.
True
T/F In a PA cyst/granuloma there is NO granulomatous inflammation.
True
What is identical to lat periodontal cyst but occurs within gingival soft tissue?
gingival cyst of the adult
T/F PA granulomas have granulomatous inflammation.
False
What is granulomatous inflammation?
Macrophages fuse together to make multinucleated giant cells + lymphocytes
What conditions have granulomatous inflammation?
Deep fungal infections (histoplasmosis), TB, Sarcodosis, Crohns disease
What is granulation tissue?
Little capillaries and immature fibroblasts
