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*AU15 - Oral Pathology Exam 3 > Odontogenic Cysts > Flashcards

Odontogenic Cysts Flashcards

1
Q

What is the most common cyst of the jaws?

A

periapical cyst

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2
Q

What is the only odontogenic cyst that is inflammatory in origin?

A

periapical cyst

all the rest are developmental in origin

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3
Q

A periapical cyst develops due to inflammatory stimulation of __.

A

epithelial rests of Malassez

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4
Q

What are the signs and symptoms of a periapical cyst?

A
  • asymptomatic
  • associated with a non-vital tooth
  • round/ovoid radiolucency at the apex
  • inflammation through lateral canals may lead to lateral radicular cyst
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5
Q

Describe the histology of a periapical cyst.

A

inflamed granulation tissue or fibrous connective tissue lined by non-keratinized stratified squamous epithelium

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6
Q

What is the treatment for a periapical cyst?

A

endodontic therapy +/- apicoectomy or extraction with curettage

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7
Q

What is the prognosis of a periapical cyst?

A
  • excellent

- routine follow-up is warranted (if tooth is removed, lesion may occasionally persist to form residual periapical cyst)

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8
Q

What is the most common developmental odontogenic cyst?

A

dentigerous cyst

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9
Q

How does a dentigerous cyst form?

A

fluid accumulates between the crown of the tooth and the reduced enamel epithelium (increased osmotic pressure) leading to gradual enlargement of the cyst

*note: subsequent infection and inflammation can occur

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10
Q

What are the signs and symptoms of a dentigerous cyst?

A
  • by definition, associated with the crown of an unerupted tooth
  • > 3-4 mm lucent space around crown to be considered dentigerous cyst
  • symptoms usually absent, unless secondarily infected
  • may produce swelling or resorption of the adjacent tooth roots

*note: radiographic findings are mimics by many odontogenic cysts and tumors

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11
Q

What is the most common site for dentigerous cyst? Age?

A
  • mandibular 3rd molars, maxillary canines, maxillary 3rd molars
  • 2nd or 3rd decades
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12
Q

Describe the histology of dentigerous cysts.

A
  • uninflamed connective tissue lined by a thin non-keratinized stratified squamous epithelium
  • some will have a few scattered mucous cells in the lining
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13
Q

What is the recommended treatment for a dentigerous cyst? Prognosis?

A
  • removal of tooth and enucleation of the cyst; decompression of large cysts
  • microscopic exam of lesional tissue to rule out OKC, ameloblastoma, other odontogenic cysts/tumors, or (rarely) central mucoepidermoid carcinoma
  • excellent prognosis
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14
Q

What is an eruption cyst?

A

dentigerous cyst that forms in the soft tissue overlying the crown of an erupting tooth

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15
Q

What are the signs and symptoms of an eruption cyst? Who is most susceptible?

A
  • bluish swelling common (thus the term “eruption hematoma”

- children

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16
Q

What is the treatment for an eruption cyst?

A
  • take a radiograph to ensure tooth is erupting properly

- can lance cyst and drain it to allow the tooth to erupt more quickly

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17
Q

How common is a primordial cyst?

A

rare

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18
Q

How does a primordial cyst form?

A
  • degenerating tooth bud epithelium

- forms in place of a tooth, before any mineralized material is deposited

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19
Q

What are the signs and symptoms of a primordial cyst?

A
  • clinical and radiographic diagnosis based on no history of extraction or surgery in the area
  • may arise from any tooth in the dentition
  • usually detected as a unilocular radiolucency in the area of a missing tooth, usually a 3rd molar
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20
Q

Describe the histology of a primordial cyst.

A

same as odontogenic keratocysts

3 criteria:

  • uniformly thin epithlial lining (stratified squamous, 6-8 cells thick)
  • corrugated surface layer of parakeratin
  • palisaded dark basal cell layer
  • connective tissue wall is usually uninflamed (if inflammation present, histology of lining epithelium is markedly altered)
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21
Q

What is the treatment for a primordial cyst? Prognosis?

A
  • TREATMENT: enucleation

- PROGNOSIS: good; with histo diagnosis of OKC, periodic radiograph follow-up for local recurrence is warranted

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22
Q

How common is an odontogenic keratocyst? Aggressive or non-aggressive?

A
  • relatively common

- aggressive

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23
Q

With what syndrome is odontogenic keratocysts associated?

A

nevoid basal cell carcinoma syndrome

*note: suspected in patients

24
Q

What is the most common age for odontogenic keratocysts?

A

3rd decade (but age ranges 6-80)

25
Q

Which is more common (maxilla or mandible) for odontogenic keratocysts? What areas of each?

A
  • mandible (2:1)
  • posterior quadrants or ramus of the mandible
  • anterior maxilla after age 60
26
Q

What cysts resemble odontogenic keratocyst?

A

dentigerous cyst, residual cyst, lateral periodontal cyst

27
Q

What are the signs and symptoms of an odontogenic keratocyst?

A
  • asymptomatic, but may produce swelling/discomfort with enlargement
  • 80% present as unilocular radiolucencies with well-demarcated margins and thin sclerotic border (larger lesions are multilocular)
28
Q

Describe the histology of an odontogenic keratocyst.

A

3 criteria:

  • uniformly thin epithlial lining (stratified squamous, 6-8 cells thick)
  • corrugated surface layer of parakeratin
  • palisaded dark basal cell layer (feature that we rely on most!)
  • connective tissue wall is usually uninflamed (if inflammation present, histology of lining epithelium is markedly altered)
29
Q

What is the treatment for an odontogenic keratocyst?

A
  • SMALL LESION: careful enucleation as single piece

- LARGE LESION: decompression followed by enucleation

30
Q

What is the prognosis for an odontogenic keratocyst?

A
  • guarded
  • recurrence rates range 3-62% (recent reports 40-50% in 5-years)
  • patient follow-up for 7 years to detect recurrence
31
Q

How is nevoid basal cell carcinoma syndrome acquired?

A
  • PTCH gene, chromosome 9
  • autosomal dominant, variable expressivity
  • 40% new mutations
32
Q

What are the signs and symptoms of nevoid basal cell carcinoma?

A
  • enlarged occipitofrontal cranial circumference (60 cm or more in adults)
  • heavy brow ridges
  • broad nasal root
  • mild ocular hypertelorism
  • basal cell carcinomas that are multiple, in unexposed areas, develop at earlier age, have melanin pigment, and are usually quiescent
  • shallow pits in the palms and/or soles (65%)
  • milia and mutliple epideroid cysts (50%)
  • lamellar calcification of the falx cerebri (85%)
  • bifid, fused, or hypoplastic ribs (60%)
  • odontogenic keratocysts (85%) at ages 7-10, probably multiple
33
Q

What is the treatment for nevoid basal cell carcinoma syndrome?

A
  • genetic counseling
  • remove odontogenic keratocysts as needed
  • remove basal cell carcinoma as needed
  • use sunscreen and reduce sun exposure to decrease risk of basal cell carcinoma
34
Q

What is the prognosis for nevoid basal cell carcinoma syndrome?

A
  • guarded
  • usually basal cell carcinomas are relatively small and indolent, but this can be variable
  • periodic radiographic follow-up for odontogenic keratocysts
35
Q

A gingival cyst of the newborn is a cyst of the ___.

A

dental lamina

36
Q

Describe the appearance of a gingival cyst of the newborn.

A
  • 1-2 mm yellow-white papules

- usually in the maxillary

37
Q

Describe the histology of gingival cyst of the newborn.

A
  • thin uniform stratified squamous epithelial lining

- cyst lumen is packed with keratin debris

38
Q

What is the treatment for gingival cyst of the newborn?

A

none!

self-marsupialization and spontaneous involution

39
Q

What are Epstein pearls? What are they related to?

A
  • along the median palatal raphe; arise from epithelium entrapped along the line of fusion
  • gingival cyst of the newborn
40
Q

What are Bohn nodules? What are they related to?

A
  • scattered over the hard palate, often near the soft palate junction; derived from minor salivary glands
  • gingival cyst of the newborn
41
Q

What cyst is related to the lateral periodontal cyst?

A

gingival cyst of the adult

42
Q

How does the gingival cyst of the adult form?

A

arises from dental lamina rests (rests of Serres) in the gingival connective tissue

43
Q

What age is most common for the gingival cyst of the adult? Gender? Location in oral cavity?

A
  • adult over age 40
  • no gender preference
  • anterior segments of jaw (canine/premolar)
44
Q

What are the signs and symptoms of the gingival cyst of the adult?

A
  • smooth-surfaced dome-shaped elevation of the attached gingiva
  • usually less than 1 cm in diameter
  • tense on palpation, otherwise asymptomatic
  • translucent or bluish
  • minimal, if any, findings on radiograph

*note: may mimic mucocele but it is on attached gingiva and there are no salivary glands on attached gingiva

45
Q

Describe the histology of the gingival cyst of the adult.

A

cystic cavity lined by thin uniform layer of cuboidal or attenuated non-keratinized stratified squamous epithelium

46
Q

What is the treatment for the gingival cyst of the adult? Prognosis?

A
  • TREATMENT: conservative excision

- PROGNOSIS: excellent

47
Q

How does a lateral periodontal cyst occur?

A

occurs adjacent or lateral to the root of a tooth, arising from the intrabony rests of the dental lamina

48
Q

What oral region is most common for a lateral periodontal cyst? What age range?

A
  • mandibular premolar or maxillary lateral incisor

- 5th or 6th decades

49
Q

True or false: The adjacent teeth to a lateral periodontal cyst are non-vital.

A

FALSE. They are vital!

50
Q

What are the signs and symptoms of a lateral periodontal cyst?

A
  • asymptomatic unilocular radiolucency lateral to vital tooth
  • typically less than 1 cm in diameter
51
Q

Describe the histology of a lateral periodontal cyst.

A

thin non-keratinized stratified squamous epithelium lining, uninflamed fibrous connective tissue

52
Q

What is the recommended treatment of a lateral periodontal cyst? Prognosis?

A
  • curettage

- excellent

53
Q

What condition is also known as a Gorlin cyst?

A

calcifying odontogenic cyst

54
Q

What are the signs and symptoms of a calcifying odontogenic cyst?

A
  • well-defined unilocular radiolucency with scattered radiopacities in 50% of cases
  • 5-17% reported in gingival soft tissues
  • resorption of adjacent tooth roots common (80%)
55
Q

With what are calcifying odontogenic cysts sometimes associated?

A
  • impacted tooth (30%)

- odontoma (20%)

56
Q

Describe the histology of calcifying odontogenic cysts.

A
  • cystic with proliferation of odontogenic epithelial cells that (at the periphery) show cuboidal or columnar appearance of basal cells
  • solid variants recognized
  • as cells approach lumen, undergo process termed “ghost cell” change
  • cells are pale and eosinophilic, with swollen cytoplasms and loss of the nucleus that exhibits a faint nuclear membrane outline
  • traditionally described as aberrant keratinization, but some think its a form of coagulation necrosis

*note: cuboidal/columnar basal cell appearance similar to ameloblastoma

57
Q

What is the treatment for calcifying odontogenic cysts? Prognosis?

A
  • TREATMENT: enucleation with curettage

- PROGNOSIS: recurrence not common, but does occur so need follow-up

*AU15 - Oral Pathology Exam 3 (3 decks)

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