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Oral Pathology > Odontogenic Cysts & Tumors > Flashcards

Odontogenic Cysts & Tumors Flashcards

1
Q

What are two odontogenic cysts of inflammatory etiology?

A

Radicular Cyst and Buccal Bifurcation Cyst

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2
Q

Periapical Radicular Cyst: What causes this cyst?

A

Inflammatory cyst caused by tooth infection

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3
Q

Periapical Radicular Cyst: What are two variants of this cyst?

A

Lateral Radicular Cyst
Residual Periapical Cyst

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4
Q

Periapical Radicular Cyst: Where does the lateral radicular cyst appear?

A

Along the lateral aspect of the root

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5
Q

Periapical Radicular Cyst: Why do residual perapical cysts form?

A

Form if periapical inflammatory tissue is not curetted during tooth removal.

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6
Q

Periapical Radicular Cyst: How is this cyst distinguished from periapical granuloma?

A

Presence of epithelial cyst lining on microscopy

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7
Q

Periapical Radicular Cyst: Periapical granuloma histology

A

Inflamed connective tissue

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8
Q

Periapical Radicular Cyst: Periapical cyst histology

A

True epithelial lined cyst structure present

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9
Q

Periapical Radicular Cyst: Radiology

A

Well circumscribed unilocular radiolucency closely associated with a non-vital tooth
Should see loss of lamina dura
Root resorption is common

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10
Q

Periapical Radicular Cyst: Treatment

A

-Endodontic treatment of the casual tooth
-periapical surgery (usually on lesions more than 2 cm)-> strong suggest submitting of apicoectomies for microscopic evaluation
-Extraction of involved tooth and curettage of the lesion from the base of the socket (send for evaluation with significant amount of tissue or a well-defined cystic lesion is present)

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11
Q

Periapical Radicular Cyst: Residual periapical cysts require what treatment

A

Simple excision/enucleation and curettage and always must be submitted for microscopic diagnosis

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12
Q

Buccal Bifurcation Cyst: Describe lesion and where it occurs

A

Inflammatory cyst thought to occur more frequently in teeth that have buccal enamel extensions in the bifurcation area -> buccal pocket formation

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13
Q

Buccal Bifurcation Cyst: Population affected

A

5-13 years old

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14
Q

Buccal Bifurcation Cyst: Characteristic site

A

Buccal aspect of the first permanent molar

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15
Q

Buccal Bifurcation Cyst: how is the molar affected

A

The crown of the tooth tips bucally and the root apices tip lingually.

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16
Q

Buccal Bifurcation Cyst: Does this lesion produce symptoms?

A

Slight to moderate tenderness at the site.
Patients may complain of swelling/foul taste
Periodontal pocketing at the site
Bilateral in 1/3 of patients

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17
Q

Buccal Bifurcation Cyst: Radiology

A

-Well circumscribed, unilocular radiolucency
-Involves buccal bifurcation and root area of affected tooth
-Root apices of molar are tipped towards the lingual

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18
Q

Buccal Bifurcation Cyst: What is associated with this lesion?

A

-Many associated with reactive periostitis (reactive bone formation)

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19
Q

Buccal Bifurcation Cyst: Treatment

A

-Enucleate cyst
-Removal of tooth is not necessary
-Some resolve on their own or with irrigation of the pocket daily with saline and hydrogen peroxide
-Pocket resolves after cyst removal in about 1 year

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20
Q

Name the Radiolucent developmental odontogenic cysts

A

Dentigerous Cyst
Eruption Cyst
Odonotogenic Keratocyst
Orthokeratinized odontogenic cyst
Lateral Periodontal Cyst
Gingival Cyst of the adult
Glandular Odontogenic Cyst

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21
Q

Name one mixed RO/RL developmental odontogenic cyst

A

Calcifying odontogenic cyst

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22
Q

What is the most common devlopmental odontogenic cyst

A

Dentigerous (Follicular) Cyst

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23
Q

Dentigerous (Follicular) Cyst: Describe major characteristic

A

Surrounds the crown of an unerupted tooth and attaches at the CEJ

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24
Q

Dentigerous (Follicular) Cyst: What causes an increase in size?

A

Increased osmotic pressure within the cyst

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25
Q

Dentigerous (Follicular) Cyst: What teeth are most often involved?

A

Mandibular third molars

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26
Q

Dentigerous (Follicular) Cyst: What other teeth are involved?

A

Maxillary canines, maxillary 3rd molars, mandibular second premolars

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27
Q

Dentigerous (Follicular) Cyst: Population affected

A

10-30 years old

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28
Q

Dentigerous (Follicular) Cyst: Radiographic Features

A

-Unilocular, well-defined, radiolucency associated with the crown of an unerupted tooth
-Well demarcated frequently corticated border

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29
Q

Dentigerous (Follicular) Cyst: What can these affected teeth cause in the surrounding area?

A

May displace the involved tooth and may cause resorption of the nearby tooth roots

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30
Q

Dentigerous (Follicular) Cyst: How is this cyst distinguished between an enlarged follicle?

A

If >3-4 mm considered dentigerous cyst

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31
Q

Dentigerous (Follicular) Cyst: Treatment

A

-Enucleation with affected tooth (or without if tooth can be salvaged)
-Masrsupialization followed by enculeation: create a surgical window from the cyst to the oral cavity to allow the cyst to drain/shrink in size before excision

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32
Q

Dentigerous (Follicular) Cyst: Prognosis

A

-Recurrence after removal is rare
-Malignant transformation to squamous cell carcinoma or mucoepidermoid carcinoma can rarely occur.

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33
Q

Eruption Cyst: Define

A

Soft Tissue analogue of the dentigerous cyst

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34
Q

Eruption Cyst: Population affected

A

Most common in children under 10

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35
Q

Eruption Cyst: Teeth affected

A

Can be on primary or permanent teeth
Most frequently affected primary mandibular central incisors, primary maxillary incisors and first permanent molars

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36
Q

Eruption Cyst: Clinical Features

A

Soft gingival swelling frequently with blue-ish hue. Occurs over an erupting tooth.

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37
Q

Eruption Cyst: Treatment

A

Usually nothing
Could remove the roof of the cyst to aid in eruption of affected tooth

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38
Q

Odontogenic Keratocyst (OKC): Define

A

OKC’s arise from the cell rests of the dental lamina

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39
Q

Odontogenic Keratocyst: What is growth related to?

A

Genetic factors

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40
Q

Odontogenic Keratocyst: Important Statistics

A

-Greater growth potential than most other odontogenic cysts
-Higher recurrence rate
-Possible association with Gorlin Syndrome

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41
Q

Odontogenic Keratocyst: Population affected

A

Slight male predilection
Age: 10-40 most commonly

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42
Q

Odontogenic Keratocyst: Areas affected

A

Mandible (60-80%) of cases)
Favors posterior/ramus
Involves an unerupted tooth in 25-40% of lesions

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43
Q

Odontogenic Keratocyst: Radiology

A

-Unilocular or multilocular radiolucency
-Well-defined often corticated borders
-DO NOT resorb surrounding roots as frequently as radicular or dentigerous cysts

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44
Q

Odontogenic Keratocyst: Pattern of growth

A

Grow in the anterior-posterior direction through the marrow spaces without causing expansion

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45
Q

Odontogenic Keratocyst: When OKC’s grow outside of bone, what are they referred to?

A

Peripheral OKCs

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46
Q

Odontogenic Keratocyst: Microscopic Features

A

-Cyst lumen may contain clear fluid or keratin debris (often identifiable during surgical excision as a cheesy material.)

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47
Q

Odontogenic Keratocyst: Describe epithelial lining

A

6-8 cells thick, predominantly parakeratinized with a wavy corrugated surface; basal call layer has palisading hyperchromiatic

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48
Q

Odontogenic Keratocyst: Relevance to Clinicians

A

Inflammation may cause loss of characteristic epithelial features making this diagnosis difficult to render in some cases

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49
Q

Odontogenic Keratocyst: Treatment

A

Enucleation and curettage

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50
Q

Odontogenic Keratocyst: Possible Treatment

A

+/- peripheral ostectomy of the bone cavity with a bur to reduce recurrence
+/- chemical cauterization (Carnoy’s solution, though this has fallen out of favor with some surgeons) after cyst removal.

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51
Q

Odontogenic Keratocyst: What is done before enucleation procedure?

A

Decompression before enucleation: results in thickening of the cyst lining allowing easier removal later.

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52
Q

Odontogenic Keratocyst: Recurrence

A

More frequent in mandibular OKCs
Up to 30% of cases overall.
Usually within 5 years but some as many as 10 years later

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53
Q

Odontogenic Keratocyst: What is done if there are multiple recurrences?

A

Require local resection and bone grafting may be necessary

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54
Q

Other name for Gorlin Syndrome

A

Nevoid Basal Cell Carcinoma Syndrome

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55
Q

Gorlin Syndrome: Cause

A

-Autosomal dominant inherited condition with high penetrance and variable expressivity
-Genetic Mutation: PTCH

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56
Q

Gorlin Syndrome: (Basal Cell Carcinomas) When do basal cell carcinomas appear?

A

Begin at puberty or second and third decades of life

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57
Q

Gorlin Syndrome: Describe some manifestations/ clinical features that can appear and who they affect/percentage

A

Palmar and Plantar Cysts (65-85%)
Ovarian Cysts and fibromas in 25-50% of women

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58
Q

Gorlin Syndrome: What are some less frequent manifestations

A

Cardiac fibromas, meningioma, fetal rhabdomyoma, medulloblastoma, ocular anomalies

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59
Q

Gorlin Syndrome: What are some skeletal anomalies

A

Bifid or splayed ribs
Kyphoscholiosis
Calcified falx cerebri in most patients

60
Q

Gorlin Syndrome: What is a lesion that occurs 90% of the time and is typically the first lesion that needs treatment by age 19

A

OKCs

61
Q

Gorlin Syndrome: What are some clinical manifestations that occur in 60% or more of patients

A

-Multiple BCCs
-OKCs
-Epidermal cyst of the skin
-Palmar/plantar pitting
-Calcified falx cerebri
-Enlarged head circumference
-Rib anomalies
-Mild ocular hypertelorism
-Spina bifida occulta of cervical or thoracic vertebrae

62
Q

Gorlin Syndrome: Treatment

A

Close follow-up
Excisions of BCCs and enucleation/excision of OKCs

63
Q

Gorlin Syndrome: Possible Treatment Options

A

-Trials are on-going investigating use of chemo for treatment of patients with a large BCC burden
-Possible MRI studies in kids to screen for medulloblastoma (every 6 months until age 7)

64
Q

What is the most common type of cancerous brain tumor in children?

A

Medulloblastoma

65
Q

What is the difference between OKC and OOC?

A

OOC has low rate of recurrence

66
Q

Orthokeratinized Odontogenic Cyst (OOC): Population affected

A

Young adults; 2:1 male to female ratio

67
Q

Orthokeratinized Odontogenic Cyst (OOC): Areas affected

A

3:1 mandible: maxilla (posterior)

68
Q

Orthokeratinized Odontogenic Cyst (OOC): Radiographic Features

A

Well demarcated uni or multilocular radiolucency
2/3 involve an unerupted mandibular 3rd molar, resembling a dentigerous cyst

69
Q

Orthokeratinized Odontogenic Cyst (OOC): Microscopic features

A

Cyst lining has only orthokeratin and lacks basal palisading seen in OKC

70
Q

Orthokeratinized Odontogenic Cyst (OOC): Treatment

A

Enucleation and curettage only

71
Q

Orthokeratinized Odontogenic Cyst (OOC): Prognosis

A

Rarely may show malignant transformation

72
Q

Lateral Periodontal Cyst: Etiology

A

Cyst arising from rests in the dental lamina

73
Q

Lateral Periodontal Cyst: Age Predominance

A

5th-7th decades

74
Q

Lateral Periodontal Cyst: Radiographic apperance

A

Well circumscribed radiolucency located lateral to the toots of vital teeth

75
Q

Lateral Periodontal Cyst: Area affected

A

75-80% in the mandibular premolar canine lateral incisor area

76
Q

Lateral Periodontal Cyst: What is the variant

A

Botryoid odontogenic cyst

77
Q

Lateral Periodontal Cyst: Define botryoid odonotogenic cyst

A

Polycystic appearing lateral periodontal cyst; grape-like cluster of individual cysts. May be multilocular radiographically

78
Q

Lateral Periodontal Cyst: Histology

A

Characteristic focal nodular thickening of the epithelial cyst lining with clear cells.

79
Q

Lateral Periodontal Cyst: Treatment

A

Enculeation

80
Q

Lateral Periodontal Cyst: Recurrence Rate

A

Recurrence is rare though slightly more frequent in botryoid variant

81
Q

Lateral Periodontal Cyst: Transformation rate to SCC

A

Rare transformation

82
Q

Gingival Cyst of the Adult: Define

A

Soft tissue counterpart of lateral periodontal cyst

83
Q

Gingival Cyst of the Adult: Area affected

A

Strong predilection from the mandibular canine and premolar area

84
Q

Gingival Cyst of the Adult: Patients affected

A

5th-6th decade

85
Q

Gingival Cyst of the Adult: Clinical Description

A

Painless, dome-like swelling, blusih to grey-blue in color

86
Q

Gingival Cyst of the Adult: Radiographic apperance

A

Some cysts may cause superficial cupping of the underlying bone

87
Q

Gingival Cyst of the Adult: Histology

A

Identical to LPC

88
Q

Glandular Odontogenic Cyst (GOC): Describe

A

Rare, can be aggressive odontogenic cyst

89
Q

Glandular Odontogenic Cyst (GOC): Origin

A

Odontogenic origin but can have salivary and glandular components

90
Q

Glandular Odontogenic Cyst (GOC): Population affected

A

Middle aged adults

91
Q

Glandular Odontogenic Cyst (GOC): Areas affected

A

75% of cases occur in the mandible
Anterior mandible most common site
Frequently crosses the midline

92
Q

Glandular Odontogenic Cyst (GOC): What can large cysts cause?

A

Clinical expansion

93
Q

Glandular Odontogenic Cyst (GOC): Radiology

A

Uni or multilocular, well-defined, radiolucency
Corticated rim

94
Q

Glandular Odontogenic Cyst (GOC): Histology

A

Histopathologic overlap between intraosseous mucoepidermoid carcinoma and GOC
May require molecular testing to distinguish

95
Q

Glandular Odontogenic Cyst (GOC): Treatment

A

Enucleation and currettage
May require en bloc resection with recurrence

96
Q

Glandular Odontogenic Cyst (GOC): Recurrence rate

A

30% after enucleation/currettage
Multilocular lesions recur more frequently

97
Q

Calcifying Odontogenic Cyst (COC): Describe variations

A

Exists on a spectrum from a cystic lesion to a solid tumor-like growth

98
Q

Calcifying Odontogenic Cyst (COC): What is the name of the cystic lesion?

A

Calcifying Odontogenic Cyst (COC)

99
Q

Calcifying Odontogenic Cyst (COC): What is the name of the solid lesion?

A

Dentinogenic ghost cell tumor

100
Q

Calcifying Odontogenic Cyst (COC): Area affected

A

Maxilla is equal to mandible in frequency
65% occur in incisor/canine region

101
Q

Calcifying Odontogenic Cyst (COC): Population affected

A

2nd-4th decades, avg age 30

102
Q

Calcifying Odontogenic Cyst (COC): Radiology

A

Unilocular (usually), well-defined mixed radiolucent/ radiopaque lesion

103
Q

Calcifying Odontogenic Cyst (COC): What can this lesion cause to neighboring teeth?

A

Can cause adjacent root resorption or displacement

104
Q

Calcifying Odontogenic Cyst (COC): What lesions can this be accompanied by?

A

-Odontoma
-Adenomatoid odontogenic tumor
-Ameloblastoma

105
Q

Calcifying Odontogenic Cyst (COC): What is the clinical variant

A

Peripheral COC

106
Q

Calcifying Odontogenic Cyst (COC): Describe characteristics of Peripheral COC

A

Presents as an indistinct gingival mass; less aggressive

107
Q

Calcifying Odontogenic Cyst (COC): Population affected by Peripheral COC

A

60-80 years of age

108
Q

Calcifying Odontogenic Cyst (COC): Buzz Histology

A

Presence of ghost cells

109
Q

Calcifying Odontogenic Cyst (COC): Define ghost cells

A

Epithelial cells that have lost nuclei

110
Q

Calcifying Odontogenic Cyst (COC): Recurrence

A

Recurrence for cystic and solid benign lesions is rare

111
Q

Calcifying Odontogenic Cyst (COC): Treatment for malignant transformation turning into ghost cell odonotogenic carcinoma

A

-Complete surgical excision

112
Q

Carcinoma arising in odontogenic cysts: What is the most common odontogenic cyst that arises as oral cavity carcinoma?

A

Residual periapical cyst

113
Q

Carcinoma arising in odontogenic cysts: Population affected

A

Middle age 60, male predilection: 2:1

114
Q

Carcinoma arising in odontogenic cysts: Symptoms

A

Pain and swelling are common complaints but can be symptomatic

115
Q

Carcinoma arising in odontogenic cysts: Histology

A

Most common malignant transformation is to squamous cell carcinoma
Some cases can transform into mucoepidermoid carcinoma

116
Q

Carcinoma arising in odontogenic cysts: Treatment

A

Local block or radical resection

117
Q

Carcinoma arising in odontogenic cysts: Survival rate

A

2 year survival 62%, 5 year 38%

118
Q

What are four radiolucent odontogenic tumors

A

-Ameloblastoma
-Ameloblastic fibroma
-Squamous odontogenic tumor
-Odontogenic myxoma

119
Q

What are three mixed radiolucent/radiopaque odontogenic tumors

A

-Odontoma
-Adenomatoid odontogenic tumor
-Calcifying epithelial odontogenic tumor

120
Q

What is the most common clinically significant odontogenic tumor

A

Ameloblastoma

121
Q

Ameloblastoma: Prevalence

A

As frequent as all odontogenic tumors combined with exception of odontomas

122
Q

Ameloblastoma: What are three different clinicoradiographic presentations

A
  1. Conventional solid/multicystic (Most common)
  2. Unicystic
  3. Peripheral
123
Q

Ameloblastoma: Describe population affected

A

3rd-7th decades equal prevalence, rare under 20
No sex predilection

124
Q

Ameloblastoma: Site affected

A

Mandible, molar ascending ramus

125
Q

Ameloblastoma: Symptoms

A

Asymptomatic swelling; buccal-lingual cortical expansion

126
Q

Ameloblastoma: Radiology

A

Soap bumble or honeycomb (mulilocular radiolucency)
Resorption of adjacent tooth roots common
Margins have irregular scalloping

127
Q

Ameloblastoma: Treatment

A

Typically always require marginal resection
Tumor tends to infiltrate between intact cancellous bone -> actual margin of tumor often extends beyond what is seen radiographically

128
Q

Ameloblastoma: Recurrence rates

A

Enucleation/curettage: 50-90%
Margin resection: 15%

129
Q

Ameloblastoma: Three variations

A
  1. Peripheral ameloblastoma
  2. Desmoplastic ameloblastoma
  3. Unicystic ameloblastoma
130
Q

Peripheral Ameloblastoma: Describe

A

Usually painless, non-ulcerated nodule of the gingiva or alveolar mucosa

131
Q

Peripheral Ameloblastoma: Site

A

Mandible> maxilla
Posterior> anterior

132
Q

Peripheral Ameloblastoma: Population

A

Middle age

133
Q

Peripheral Ameloblastoma: Recurrence

A

Less aggressive than intraosseous counterpart, but may have a local recurrence in 15-20 percent of cases

134
Q

Desmoplastic Ameloblastoma: Areas affected

A

Predilection for the anterior regions of the jaws
Mandible=maxilla

135
Q

Desmoplastic Ameloblastoma: Radiology

A

Mixed radiolucent radiopaque lesion that resembles BFOL

136
Q

Desmoplastic Ameloblastoma: Why does this resemble BFOL?

A

Due to osseous metaplasia within dense fibrous septa of the lesion

137
Q

Unicystic Ameloblastoma: Population affected

A

Second decade

138
Q

Unicystic Ameloblastoma: Areas affected

A

> 90% in the mandible

139
Q

Unicystic Ameloblastoma: Radiology

A

Frequently presents as a unilocular radiolucency surrounding crown of an unerupted mandibular third molar

140
Q

Unicystic Ameloblastoma: What are three histologic types?

A

Luminal unicystic, intraluminal unicystic, ameloblastoma, mural unicystic ameloblastoma

141
Q

Unicystic Ameloblastoma: Treatment

A

Can be treated with enucleation and curettage

142
Q

Unicystic Ameloblastoma: Treatment if mural type

A

Surgeons go back and perform prophylactic en-bloc resection

143
Q

Unicystic Ameloblastoma: After treatment protocol

A

Follow-up after excision

144
Q

Malignant Ameloblastoma: Define

A

Patient has a primary jaw tumor diagnosed as ameloblastoma and this lesion metastasizes to another site in the body

145
Q

Malignant Ameloblastoma: Histology

A

Same as the benign lesion

146
Q

Malignant Ameloblastoma: Population affected

A

No sex predilection mean age of 30

147
Q

Malignant Ameloblastoma:

A

Oral Pathology (7 decks)

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