Odontogenic Cysts and tumors- Dr. Flores Flashcards
1
Q
Ectomesenchyme
A
- derived from Neural Crest cells
- Dentin, Cementum, and Pulp
2
Q
Epithelium-Ectomesenchyme interaction in tooth development
A
- Ectomesenchyme is derived from neural crest cells
- Oral ectoderm & ectomesenchyme interact to start Tooth development
- epithelium and ectomesenchyme interact to form tooth
3
Q
Epithelium
A
Enamel
4
Q
What are the 2 prominent structures of odontogenic epithelium
A
Rests of Serres
Rests of Malassez
5
Q
Characterize the rests of serres
A
- rests of dental lamina found in gingival soft tissues
- round to ovoid aggregates of epithelial cells
- clear cytoplasm (Glycogen rich)
- result from early breakup of dental lamina during bell stage
6
Q
Characterize the rests of malassez
A
- result from breakup of Hertwig’s root sheath during root formation
7
Q
What is a cyst
A
- pathologic cavity
- lined by epithelium
- filled with fluid or keratin
8
Q
What do cysts and tumors share in common
A
- occupy space and may displace or replace normal tissues
- Resorb adjacent teeth or push teeth out of their normal alignment
- Cause expansion of the bone, usually painless
- compress nerves and cause numbness
-
tooth vitality unaffected
- cysts do not interrupt blood supply to teeth
- most tumors
- some cysts and tumors are radiographically similar
9
Q
what are the differences between tumors and cysts
A
- cysts
- central lumen
- Tumors
- solid growth
10
Q
characterize the etiology/development of cysts
A
- inflammatory:
- Periapical (radicular) cyst
- Residual periapical (radicular) cyst
- Buccal bifurcation cyst
- paradental cyst
- Developmental
- Dentigerous cyst
- Primordial cyst
- Odontogenic Keratocst (keratocystic odontogenic tumor)
- Orthokeratinized odontogenic cyst
- Gingival (alveolar) cyst of the newborn
- Gingival cyst of the adult
- lateral periodontal cyst
- Glandular odontogenic cyst
11
Q
Characterize the etiology/development of tumors
A
-
Tumors of odontogenic epithelium
- Ameloblastoma
- malignant amelobalstoma
- ameloblastic carcinoma
- Clear cell odontogenic carcinoma
- Adenomatoid odontogenic tumor
- Calcifying epithelial odontogenic tumor
- Squamous odontogenic tumor
- Ameloblastoma
-
Mixed Odontogenic tumors
- Ameloblastic fibroma
- Ameloblastic fibrosarcoma
- Ameloblastic fibro-odontoma
- Odontoameloblastoma
- Compound odontoma
- Complex odontoma
- Calcifying cystic odontogenic tumor/dentinogenic ghost cell tumor
- Ghost cell odontogenic carcinoma
-
Tumors of odontogenic ectomesenchyme
- Odonotogenic fibroma
- Central granular cell odontogenic tumor
- Odontogenic myxoma
12
Q
What tumors and cysts arise from Rests of Malassez:
A
- Origin: Hertwig’s Root sheath
- Radicular cyst
- Ameloblastoma
- Squamous Odontogenic Tumor
13
Q
What tumors and cysts arise from Reduced Enamel Epithelium:
A
- Paradental Cyst
- Calcifying Odontogenic Cyst
- Dentigerous Cyst
- Eruption Cyst
- Ameloblastoma
14
Q
What tumors and cysts arise from Rest of Serres
A
- Origin: Dental lamina in gingiva
- Odontogenic Keratocyst
- Lateral periodontal Cyst
- Gingival Cyst
- Glandular Odontogenic cyst
- Ameloblastoma
- Squamous odontogenic Tumor
- Calcifying Epithelial Odontogenic tumor
- Adenomatoid Odontogenic Tumor
15
Q
What is the etiology of Odontogenic Cysts
A
inflammatory
Development
16
Q
Periapical Cyst (Radicular Cyst)
A
- from Rests of Malassez
- Related to inflammation
- Empty cyst cavity w/epithelial lining
17
Q
Residual Cyst
A
- appears after tooth extraction
18
Q
Buccal Bifurcation Cyst
A
- Develops on buccal aspect of mandibular 1st perm molar
- occurs in 5-13 y.o.
- Clinical swelling and foul-tasting discharge
- Radigraphically
- root apices of molar tipped toward lingual mandibular cortex
- associated with proliferative periostitis
19
Q
Paradental Cyst
A
- Distal or buccal of partially erupted tooth w/history of pericoronitis
- confused w/lateral dentigerous cyst
20
Q
Dentigerous Cysts
A
- Aka Follicular Cyst
- radiolucency surrounding the crown of an impacted tooth, attached to tooth at CEJ
- Mandibular & Maxillary 3rd molars
-
Histology
- mucous, ciliated, and sebaceous elements
- Tx:
- enucleation
- marxupialization
21
Q
What are the 3 things you can get in a Dentigerous cell wall?
A
- Squamous Cell Carcinoma
- Intraosseous Mucoepidermoid carcinoma
- Ameloblastoma
22
Q
Eruption Cyst
A
- Aka Eruption Hematoma
- soft tissue analog of dentigerous cyst (follicular Cyst)
- Develops as a result from:
- separation of dental follicle from crown of erupting tooth
- within soft tissue
- overlyalveolar bone
- separation of dental follicle from crown of erupting tooth
- Appears as soft translucent swelling in gingival mucosa over crown of erupting tooth
23
Q
Odontogenic Keratocyst
A
- Aka Keratocystic Odontogenic Tumor
- Common Developmental Odontogenic cysts
- Locally aggressive potential
- high recurrence rate
- PTCH gene mutation
- associated with:
- NBCCS or Gorlin syndrome
- sporadic OKCs
- associated with:
- ⅔ of cases occur in mandible
- molar/ramus region
23
Q
Odontogenic Keratocyst: histology
A
- Uniform layer of stratified squamous epithelium
- 6-8 layers thick
- Basal Epithelial layer composed of:
- cuboidal to columnar cells
- palisaded and hyperchromatic
- cuboidal to columnar cells
- Corrugated (wavy) layer of parakeratin
24
Odontogenic Keratocyst: Treatment
* Surgical Enucleation
* Peripheral osteotomy w/bone bur to reduce chance of recurrence
* Use Carnoy's solution
* Good Prognosis
* 25%-305 Recur
25
Nevoid Basal Cell Carcinoma
* aka Gorlin Syndrome
* Autosomal Dominant
* PTCH Gene mutation
* Clinical:
* multiple OKCs (Odontogenic Keratocysts)
* Multi basal cell carcinomas
* Bifid ribs
* calcified fall cerebri
* Palmar pits
* Epidermal cysts on skin
* Hypertolerism
* Spina Bifida
26
What is a Primordial Cyst
* odontogenic cyst that appears to grow
* no associated with impacted teeth
27
Orthokeratinized Odontogenic Cyst
* 66%-90% occur in mandible
* lesion shows predilection for posterior of both jaws
* 2:1 males
* ⅔ of cases w/impacted teeth
* resemble dentigerous cyst radiographically
* 2% recur
28
Gingival Cyst of Newborn
* Bohn's Nodules
* Epstein Pearls
29
Lateral Periodontal Cyst
* Can occur partially within bone and partially in soft tissue
* in bone b/w roots of teeth
* ⅔ cases- canine/premolar of mandible
* same for maxillary
* Painless expansion of alveolar bone
* if polycystic=Botryoid odontogenic cyst
30
Gingival cyst of adult
* same as lateral periodontal cyst
* occur within gingival soft tissues
* occur in mandibular canine and premolar area
* maxillary-incisor, canine, and premolar
* facial gingiva or alveolar mucosa
* most common-50-60's
* painless dome-like swelling
* causes superficial “cupping out” of alveolar bone
* _Not detected on radiograph_
31
Glandular Odontogenic Cyst
* rare
* glandular or salivary differentiation
* 70% in mandible
* most common site-anterior mandible
* 30% recur
* Tx:
* aggressive curettage or en bloc resection
32
Glandular Odontogenic Cyst
32
Calcifying Odontogenic Cyst
* solid lesion w/little attempt at cyst formation
* occurs anywhere in the jaw
* most common-Anterior Maxilla
* 5-30% in gingival soft tissues
* Most develop within bone
* 20s-40s y.o.
* occurs in association with other odotonogenic tumor
* especially odontoma
33
Dentinogenic Ghost Cell Tumor
* 5-14% of odontogenic ghost cell lesions
* intraosseous DGCTs-more potential for more significant growth and destruction
* pheripheral DGCTs- gingival soft tissue=less aggressive
34
Ameloblastoma
* most encountered odontogenic neoplasms
* locally aggressive
* originate from:
* dental lamina rests
* developing enamel organ
* epithelial lining of odontogenic cyst
* basilar epithelial cells of gingival surface epithelium
* Tumor cells mimic inner enamel epithelium and central stellate reticulum of enamel organ
35
what are the two types of clfinicopathologic variants of Ameloblastomas?
* Conventional solid or multicystic
* Unicystic
36
Conventional solid or multi cystic Ameloblastoma
* adults-broad age range
* no strong gender or ethnic predilection
* 85% in mandible-molar/ascending ramus
* maxillary=posterior region
* Present with bony hard, painless swelling
* Painful occasionally
37
Botryoid Odontogenic Cyst
* High recurrence rate
* bc of multiple chambers/lobes
* painless expansion of bone
* harder to remove completely
38
Gingival Cyst of Adult
* Same as lateral periodontal cyst
* occur in gingival soft tissues
* mandibular canine/premolar
* Painless, domelike swelling
* causes superficial “cupping out” of alveolar bone
* not detected on radiographs
39
Glandular Odontogenic Cyst
* Characterized by glandular or salivary differentiation
* Found in mandible-70%
* anterior mandible=most common
* Recurrence rate=30%
* Tx:
* aggressive curettage Or
* en bloc resection
40
What are the types of Calcifying Odontogenic Cyst? Other names?
* Calcifying Cystic Odontogenic Tumor
* Keratinizing and Calcifying Odontogenic Cyst
* Gorlin Cyst
* Dentinogenic Ghost Cell Tumor
* Epithelial Odontogenic Ghost cell tumor
41
In general, what are calcifying odontogenic cyst?
* occurs as solid lesion w/little attempt at cyst formation
* anywhere in jaws
* most common-anterior maxilla
* Most develop within bone
* 20-40 y.o.
* associated with Odontoma
42
What is 1 referring to in the picture?
Dentigerous Cyst
* impacted tooth
43
What is 2 referring to?
Periapical Cyst (radicular cyst)
* periapex of tooth
44
What is 3 referring to?
Residual Cyst
* Reminent of periodical cyst
45
What is 4 referring to?
Paradental Cyst
46
What is 5 referring to?
Primordial Cyst
