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week 63 > Odontogenic Cysts and tumors- Dr. Flores > Flashcards

Odontogenic Cysts and tumors- Dr. Flores Flashcards

1
Q

Ectomesenchyme

A
  • derived from Neural Crest cells
  • Dentin, Cementum, and Pulp
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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
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3
Q

Epithelium

A

Enamel

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4
Q

What are the 2 prominent structures of odontogenic epithelium

A

Rests of Serres

Rests of Malassez

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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
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6
Q

Characterize the rests of malassez

A
  • result from breakup of Hertwig’s root sheath during root formation
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7
Q

What is a cyst

A
  • pathologic cavity
  • lined by epithelium
  • filled with fluid or keratin
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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
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9
Q

what are the differences between tumors and cysts

A
  • cysts
    • central lumen
  • Tumors
    • solid growth
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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
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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
  • 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
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12
Q

What tumors and cysts arise from Rests of Malassez:

A
  • Origin: Hertwig’s Root sheath
  • Radicular cyst
  • Ameloblastoma
  • Squamous Odontogenic Tumor
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13
Q

What tumors and cysts arise from Reduced Enamel Epithelium:

A
  • Paradental Cyst
  • Calcifying Odontogenic Cyst
  • Dentigerous Cyst
  • Eruption Cyst
  • Ameloblastoma
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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
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15
Q

What is the etiology of Odontogenic Cysts

A

inflammatory

Development

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16
Q

Periapical Cyst (Radicular Cyst)

A
  • from Rests of Malassez
  • Related to inflammation
  • Empty cyst cavity w/epithelial lining
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17
Q

Residual Cyst

A
  • appears after tooth extraction
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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
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19
Q

Paradental Cyst

A
  • Distal or buccal of partially erupted tooth w/history of pericoronitis
  • confused w/lateral dentigerous cyst
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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
  • 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
  • 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
  • Corrugated (wavy) layer of parakeratin
24
Q

Odontogenic Keratocyst: Treatment

A
  • Surgical Enucleation
    • Peripheral osteotomy w/bone bur to reduce chance of recurrence
    • Use Carnoy’s solution
  • Good Prognosis
    • 25%-305 Recur
25
Q

Nevoid Basal Cell Carcinoma

A
  • 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
Q

What is a Primordial Cyst

A
  • odontogenic cyst that appears to grow
  • no associated with impacted teeth
27
Q

Orthokeratinized Odontogenic Cyst

A
  • 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
Q

Gingival Cyst of Newborn

A
  • Bohn’s Nodules
  • Epstein Pearls
29
Q

Lateral Periodontal Cyst

A
  • 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
Q

Gingival cyst of adult

A
  • 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
Q

Glandular Odontogenic Cyst

A
  • rare
  • glandular or salivary differentiation
  • 70% in mandible
    • most common site-anterior mandible
  • 30% recur
  • Tx:
    • aggressive curettage or en bloc resection
32
Q

Glandular Odontogenic Cyst

A
32
Q

Calcifying Odontogenic Cyst

A
  • 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
Q

Dentinogenic Ghost Cell Tumor

A
  • 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
Q

Ameloblastoma

A
  • 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
Q

what are the two types of clfinicopathologic variants of Ameloblastomas?

A
  • Conventional solid or multicystic
  • Unicystic
36
Q

Conventional solid or multi cystic Ameloblastoma

A
  • 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
Q

Botryoid Odontogenic Cyst

A
  • High recurrence rate
    • bc of multiple chambers/lobes
  • painless expansion of bone
  • harder to remove completely
38
Q

Gingival Cyst of Adult

A
  • 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
Q

Glandular Odontogenic Cyst

A
  • 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
Q

What are the types of Calcifying Odontogenic Cyst? Other names?

A
  • Calcifying Cystic Odontogenic Tumor
  • Keratinizing and Calcifying Odontogenic Cyst
  • Gorlin Cyst
  • Dentinogenic Ghost Cell Tumor
  • Epithelial Odontogenic Ghost cell tumor
41
Q

In general, what are calcifying odontogenic cyst?

A
  • 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
Q

What is 1 referring to in the picture?

A

Dentigerous Cyst

  • impacted tooth
43
Q

What is 2 referring to?

A

Periapical Cyst (radicular cyst)

  • periapex of tooth
44
Q

What is 3 referring to?

A

Residual Cyst

  • Reminent of periodical cyst
45
Q

What is 4 referring to?

A

Paradental Cyst

46
Q

What is 5 referring to?

A

Primordial Cyst

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