multilocular lucencies Flashcards
potential multilocular lucencies
- Ameloblastoma
- Odontogenic Keratocyst
- Central Giant Cell Granuloma
- Odontogenic Myxoma
- Vascular Lesions - Hemangioma
. A-V aneurysm - Familial Fibrous Dysplasia
Ameloblastoma defined/aggression
Benign odontogenic neoplasm; one of very few true odontogenic neoplasms
Capable of uncontrolled, unlimited growth potential
classifications of ameloblastomas
- Conventional (Multicystic) Ameloblastoma
- Unicystic Ameloblastoma
Conventional (Multicystic)
Ameloblastoma
Account for % of all ameloblastomas?
* sub-types?
Account for 85 – 90% of all ameloblastomas
* Five histologic sub-types;
- follicular - most common
- also have plexiform, acanthomatous,
granular, desmoplastic and basaloid
Ameloblastoma Conventional
* symptoms
* Small lesions only detected how?
* Larger lesions detected how?
- Usually slow painless swellings
- Small lesions only detected by radiographs
- Larger lesions detected clinically
Ameloblastoma
Conventional radio app
small/large lesions
effect on teeth?
- Small lesions are unilocular with corticated borders
- Large, aggressive lesions develop multilocular patterns
- Displace and resorb teeth
can ameloblastomas expand?
yes, can displace teeth/ anatomical strucutres
ameloblastoma conventional age
- Mainly adults – equal prevalence in 3’rd to 7’th decade
- Uncommon in 2’nd decade
- Rare in 1’st decade
ameloblastoma conventional location
prefers mandible (85%)
ameloblastoma conventional genders
no preference
what could this be in 45 y/o male?
conventional ameloblastoma
ameloblastoma managment
Large lesions are aggressive requiring bone resection due to lesion being non-encapsulated
ameloblastoma recurrence
higher likelihood for recurrence, about 15% with proper resection
ameloblastoma resection
Block or marginal resection; ie resect >1.0cm
past radiographic limits of tumor
ameloblastoma recurrence without proper resection (% chance)
50-90%
are ameloblastomas malignant?
RARE, but possible
can ameloblastomas app unilocular
yes, in early stages or as unicystic variant
when planning resection of ameloblastomas what imaging modality can be used?
CBCT
Unicystic Ameloblastoma
aggression/recurrence?
- arise within a cyst lining; either luminal, intraluminal or mural
- less aggressive form of ameloblastoma
- Recurrence rates of 10-20%
dif dx
ameloblastoma
OKC
dentigerous cyst
Ameloblastoma unicystic
Age
Site
Age: Mean age 23 years
Site: Mandible (90%), Maxilla (10%)
from 23 y/o male dif dx
OKC
unicystic ameloblastoma
dentigerous cyst
Odontogenic Keratocyst
Pathophysiology
* commonality?
* aggression?
* arise from?
- 10-12% of all odontogenic cysts; 3’rd highest oral cyst frequency
- aggressive cysts; behave more like benign neoplasms
- thought to arise from cell rests of dental lamina
most common and second most common cysts
1: PA
2: dentigerous
histo of what lesion
OKC
Odontogenic Keratocyst clinical
* symptoms
* With increasing size what can occur
- Normally asymptomatic
- With increasing size, pain, swelling and exudate may oocur
OKC radio
* borders
* cortical plates
* teeth
- Well-defined, smooth, corticated borders
- Thinning and mild expansion with occasional perforation of cortical plates
- Displacement of teeth
OKC root resorb
- *only occasional root resorption
(< dentigerous and < radicular cysts)
OKC expansion directions
*mild B-Li expansion; but extensive antero-posterior extension
dif dx
ameloblastoma
OKC
dif dx
ameloblastoma
OKC
odontogenic myxoma
sign of OKC with cortical plates
emphysema, can be pushed in
OKC
age
site
gender
Age: Majority (i.e., 60%) in 2nd and 4th decade
Site: Majority (60-80%) affect mandible posterior to the
canines
Gender: Male predilection
management OKC
Enucleation with curettage and toxic agent carnatene in some cases
OKC recurrence
- High recurrence rate; some rates reported @ 47 and 62% (probably parakeratinized variants)
- When multiple OKCs are found they
may constitute part of?
- When multiple OKCs are found they
may constitute part of the basal cell
nevus syndrome (a.k.a. nevoid basal
cell carcinoma syndrome)
Nevoid basal cell carcinoma syndrome signs:
* skin
* Palmar
* jaws
* ribs
* spine
* Skull anomalies:
- multiple basal CA’s of skin
- Palmar and plantar pitting (60%)
- > 1 OKC (KOT) of jaws (75%)
- Bifid or splayed ribs (60-75%)
- Kyphoscoliosis (50%)
- Skull anomalies:
- frontal and parietal bossing
- hypertelorism
- intracranial calcifications; majority are of falx cerebri
Nevoid basal cell carcinoma syndrome
inheritance
Autosomal dominant inheritance
pt also presents with calcified falx cerebri, dx?
nevoid basal cell carcinoma syndrome
when enucleating OKC of NBCCa syndrome what can be done to prevent recurrence
Gauze+ caratene
Central Giant Cell Granuloma
Clinical
* symptoms
* aggression
- Asymptomatic swelling
- Can be aggressive
CGCG histology
solid tumor of granuloma tissue: collagen and giant cells
Central Giant Cell Granuloma
Radiographic app
* borders?
* locular?
* cortical plates?
* Displacement?
- Well-defined borders
- Can be multilocular
- Thinning and expansion of cortical plates
- Displacement of teeth and occasional root resorption
what could this be
OKC
ameloblastoma
Central giant cell granuloma
when imaging lesions how far should you go?
until border of lesion captured
Central Giant Cell Granuloma
age, site, gender
Age: Usually < 30 years (60%)
Site: mandible (70%) & frequently between the molars
Gender: Female > male (2:1)
Central Giant Cell Granuloma
Management
Enucleation with aggressive curretage
CGCG is histologically similar to what lesion
Lesion is histologically similar to the Brown
tumor of primary hyperparathyroidism
pts presenting with CGCG should be tested to rule out what?
hyperparathyroidism
* Screening test in the appropriate blood studies:
– serum calcium
– alkaline phosphatase
– serum phosphorus
Odontogenic Myxoma Clinical
* Primarily a lesion of?
* Basically a?
- Primarily a lesion of alveolar bone
- Basically a fibrous lesion
odontogenic myxoma radio
Scalloped and
multilocular
which multilocular luceny presents like this
myxoma
odontogenic myxoma
Odontogenic Myxoma
age and site
Age: Young to adults (25 – 30 years)
Site: Greater prevalence in mandible
Odontogenic Myxoma
Management
Excision
odontogenic myxoma recurrence
Recurrence up to 25% because the lesions are not encapsulated.
VASCULAR LESIONS
Central Hemangioma
Aneurysmal Bone Cyst
A-V Malformation
Central Hemangioma
Clinical
* common sites?
* expansion?
* mucosal app?
* gingival sign?
* possible detections
* Many require what to assist diagnosis
- Jaws are next most common site after skull and
vertebrae - Firm, slow-growing asymmetric expansion
- Overlying mucosa is more erythematous and warm to
touch - Spontaneous gingival bleeding
- Bruit on diascopy and pulsatile sensation may be
detected - Many require needle aspiration to assist diagnosis
Central Hemangioma
Radiographic
- Variable pattern ranging from cyst-like radiolucencies
- May have multilocular “soap-bubble” or spoke-like appearance
diagnosis of central hermangiomas
usually superficial so tell signs such as redness and heat are present
may use aspiration to help diagnose, NO BIOPSY
superficial erythmatous lesion:
central hermangioma, very superficial
Central Hemangioma
age, site, gender?
Age: Teens and young adults
Site: Posterior mandible
Sex: Female:male 2:1
lesion from 14 y/o female
central hermangioma
Central Hemangioma
Management
- Sclerosing agents, radiation, enucleation
- Embolization of major arteries necessary prior to surgery as hemorrhage is a significant and life threatening complication
potential etiologies of central hermangiomas
Etiology is either traumatic/developmental
or benign neoplasm
Cherubism (familial fibrous dysplasia)
Clinical
* face?
* symptoms?
* Bone lesions are more active when?
- Cherubic looking face by 5 years of age due to bilateral bony expansion
- Asymptomatic
- Bone lesions are more active in younger patients. After age 12, activity usually diminishes and finally lesions become inactive with residual deformity by age 30
likely dx?
cherubism
Cherubism Radiographic app
- Bilateral multilocular cyst-like, expansile lesion, usually
affecting the mandible and sometimes the maxilla - Pathologic fracture is not a feature
Cherubism
age, site, gender
Age: Usually detected by age 5
Site: Bilateral mandible, may affect maxilla
Sex: Male:female 2:1
Cherubism Management
- Cosmetic osseous contouring at age 12 and later
- Benign self-limiting condition
