Odontogenic Cysts & Tumors Flashcards
1
Q
What are two odontogenic cysts of inflammatory etiology?
A
Radicular Cyst and Buccal Bifurcation Cyst
2
Q
Periapical Radicular Cyst: What causes this cyst?
A
Inflammatory cyst caused by tooth infection
3
Q
Periapical Radicular Cyst: What are two variants of this cyst?
A
Lateral Radicular Cyst
Residual Periapical Cyst
4
Q
Periapical Radicular Cyst: Where does the lateral radicular cyst appear?
A
Along the lateral aspect of the root
5
Q
Periapical Radicular Cyst: Why do residual perapical cysts form?
A
Form if periapical inflammatory tissue is not curetted during tooth removal.
6
Q
Periapical Radicular Cyst: How is this cyst distinguished from periapical granuloma?
A
Presence of epithelial cyst lining on microscopy
7
Q
Periapical Radicular Cyst: Periapical granuloma histology
A
Inflamed connective tissue
8
Q
Periapical Radicular Cyst: Periapical cyst histology
A
True epithelial lined cyst structure present
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
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)
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
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
13
Q
Buccal Bifurcation Cyst: Population affected
A
5-13 years old
14
Q
Buccal Bifurcation Cyst: Characteristic site
A
Buccal aspect of the first permanent molar
15
Q
Buccal Bifurcation Cyst: how is the molar affected
A
The crown of the tooth tips bucally and the root apices tip lingually.
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
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
18
Q
Buccal Bifurcation Cyst: What is associated with this lesion?
A
-Many associated with reactive periostitis (reactive bone formation)
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
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
21
Q
Name one mixed RO/RL developmental odontogenic cyst
A
Calcifying odontogenic cyst
22
Q
What is the most common devlopmental odontogenic cyst
A
Dentigerous (Follicular) Cyst
23
Q
Dentigerous (Follicular) Cyst: Describe major characteristic
A
Surrounds the crown of an unerupted tooth and attaches at the CEJ
24
Q
Dentigerous (Follicular) Cyst: What causes an increase in size?
A
Increased osmotic pressure within the cyst
25
Dentigerous (Follicular) Cyst: What teeth are most often involved?
Mandibular third molars
26
Dentigerous (Follicular) Cyst: What other teeth are involved?
Maxillary canines, maxillary 3rd molars, mandibular second premolars
27
Dentigerous (Follicular) Cyst: Population affected
10-30 years old
28
Dentigerous (Follicular) Cyst: Radiographic Features
-Unilocular, well-defined, radiolucency associated with the crown of an unerupted tooth
-Well demarcated frequently corticated border
29
Dentigerous (Follicular) Cyst: What can these affected teeth cause in the surrounding area?
May displace the involved tooth and may cause resorption of the nearby tooth roots
30
Dentigerous (Follicular) Cyst: How is this cyst distinguished between an enlarged follicle?
If >3-4 mm considered dentigerous cyst
31
Dentigerous (Follicular) Cyst: Treatment
-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
32
Dentigerous (Follicular) Cyst: Prognosis
-Recurrence after removal is rare
-Malignant transformation to squamous cell carcinoma or mucoepidermoid carcinoma can rarely occur.
33
Eruption Cyst: Define
Soft Tissue analogue of the dentigerous cyst
34
Eruption Cyst: Population affected
Most common in children under 10
35
Eruption Cyst: Teeth affected
Can be on primary or permanent teeth
Most frequently affected primary mandibular central incisors, primary maxillary incisors and first permanent molars
36
Eruption Cyst: Clinical Features
Soft gingival swelling frequently with blue-ish hue. Occurs over an erupting tooth.
37
Eruption Cyst: Treatment
Usually nothing
Could remove the roof of the cyst to aid in eruption of affected tooth
38
Odontogenic Keratocyst (OKC): Define
OKC's arise from the cell rests of the dental lamina
39
Odontogenic Keratocyst: What is growth related to?
Genetic factors
40
Odontogenic Keratocyst: Important Statistics
-Greater growth potential than most other odontogenic cysts
-Higher recurrence rate
-Possible association with Gorlin Syndrome
41
Odontogenic Keratocyst: Population affected
Slight male predilection
Age: 10-40 most commonly
42
Odontogenic Keratocyst: Areas affected
Mandible (60-80%) of cases)
Favors posterior/ramus
Involves an unerupted tooth in 25-40% of lesions
43
Odontogenic Keratocyst: Radiology
-Unilocular or multilocular radiolucency
-Well-defined often corticated borders
-DO NOT resorb surrounding roots as frequently as radicular or dentigerous cysts
44
Odontogenic Keratocyst: Pattern of growth
Grow in the anterior-posterior direction through the marrow spaces without causing expansion
45
Odontogenic Keratocyst: When OKC's grow outside of bone, what are they referred to?
Peripheral OKCs
46
Odontogenic Keratocyst: Microscopic Features
-Cyst lumen may contain clear fluid or keratin debris (often identifiable during surgical excision as a cheesy material.)
47
Odontogenic Keratocyst: Describe epithelial lining
6-8 cells thick, predominantly parakeratinized with a wavy corrugated surface; basal call layer has palisading hyperchromiatic
48
Odontogenic Keratocyst: Relevance to Clinicians
Inflammation may cause loss of characteristic epithelial features making this diagnosis difficult to render in some cases
49
Odontogenic Keratocyst: Treatment
Enucleation and curettage
50
Odontogenic Keratocyst: Possible Treatment
+/- 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.
51
Odontogenic Keratocyst: What is done before enucleation procedure?
Decompression before enucleation: results in thickening of the cyst lining allowing easier removal later.
52
Odontogenic Keratocyst: Recurrence
More frequent in mandibular OKCs
Up to 30% of cases overall.
Usually within 5 years but some as many as 10 years later
53
Odontogenic Keratocyst: What is done if there are multiple recurrences?
Require local resection and bone grafting may be necessary
54
Other name for Gorlin Syndrome
Nevoid Basal Cell Carcinoma Syndrome
55
Gorlin Syndrome: Cause
-Autosomal dominant inherited condition with high penetrance and variable expressivity
-Genetic Mutation: PTCH
56
Gorlin Syndrome: (Basal Cell Carcinomas) When do basal cell carcinomas appear?
Begin at puberty or second and third decades of life
57
Gorlin Syndrome: Describe some manifestations/ clinical features that can appear and who they affect/percentage
Palmar and Plantar Cysts (65-85%)
Ovarian Cysts and fibromas in 25-50% of women
58
Gorlin Syndrome: What are some less frequent manifestations
Cardiac fibromas, meningioma, fetal rhabdomyoma, medulloblastoma, ocular anomalies
59
Gorlin Syndrome: What are some skeletal anomalies
Bifid or splayed ribs
Kyphoscholiosis
Calcified falx cerebri in most patients
60
Gorlin Syndrome: What is a lesion that occurs 90% of the time and is typically the first lesion that needs treatment by age 19
OKCs
61
Gorlin Syndrome: What are some clinical manifestations that occur in 60% or more of patients
-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
Gorlin Syndrome: Treatment
Close follow-up
Excisions of BCCs and enucleation/excision of OKCs
63
Gorlin Syndrome: Possible Treatment Options
-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
What is the most common type of cancerous brain tumor in children?
Medulloblastoma
65
What is the difference between OKC and OOC?
OOC has low rate of recurrence
66
Orthokeratinized Odontogenic Cyst (OOC): Population affected
Young adults; 2:1 male to female ratio
67
Orthokeratinized Odontogenic Cyst (OOC): Areas affected
3:1 mandible: maxilla (posterior)
68
Orthokeratinized Odontogenic Cyst (OOC): Radiographic Features
Well demarcated uni or multilocular radiolucency
2/3 involve an unerupted mandibular 3rd molar, resembling a dentigerous cyst
69
Orthokeratinized Odontogenic Cyst (OOC): Microscopic features
Cyst lining has only orthokeratin and lacks basal palisading seen in OKC
70
Orthokeratinized Odontogenic Cyst (OOC): Treatment
Enucleation and curettage only
71
Orthokeratinized Odontogenic Cyst (OOC): Prognosis
Rarely may show malignant transformation
72
Lateral Periodontal Cyst: Etiology
Cyst arising from rests in the dental lamina
73
Lateral Periodontal Cyst: Age Predominance
5th-7th decades
74
Lateral Periodontal Cyst: Radiographic apperance
Well circumscribed radiolucency located lateral to the toots of vital teeth
75
Lateral Periodontal Cyst: Area affected
75-80% in the mandibular premolar canine lateral incisor area
76
Lateral Periodontal Cyst: What is the variant
Botryoid odontogenic cyst
77
Lateral Periodontal Cyst: Define botryoid odonotogenic cyst
Polycystic appearing lateral periodontal cyst; grape-like cluster of individual cysts. May be multilocular radiographically
78
Lateral Periodontal Cyst: Histology
Characteristic focal nodular thickening of the epithelial cyst lining with clear cells.
79
Lateral Periodontal Cyst: Treatment
Enculeation
80
Lateral Periodontal Cyst: Recurrence Rate
Recurrence is rare though slightly more frequent in botryoid variant
81
Lateral Periodontal Cyst: Transformation rate to SCC
Rare transformation
82
Gingival Cyst of the Adult: Define
Soft tissue counterpart of lateral periodontal cyst
83
Gingival Cyst of the Adult: Area affected
Strong predilection from the mandibular canine and premolar area
84
Gingival Cyst of the Adult: Patients affected
5th-6th decade
85
Gingival Cyst of the Adult: Clinical Description
Painless, dome-like swelling, blusih to grey-blue in color
86
Gingival Cyst of the Adult: Radiographic apperance
Some cysts may cause superficial cupping of the underlying bone
87
Gingival Cyst of the Adult: Histology
Identical to LPC
88
Glandular Odontogenic Cyst (GOC): Describe
Rare, can be aggressive odontogenic cyst
89
Glandular Odontogenic Cyst (GOC): Origin
Odontogenic origin but can have salivary and glandular components
90
Glandular Odontogenic Cyst (GOC): Population affected
Middle aged adults
91
Glandular Odontogenic Cyst (GOC): Areas affected
75% of cases occur in the mandible
Anterior mandible most common site
Frequently crosses the midline
92
Glandular Odontogenic Cyst (GOC): What can large cysts cause?
Clinical expansion
93
Glandular Odontogenic Cyst (GOC): Radiology
Uni or multilocular, well-defined, radiolucency
Corticated rim
94
Glandular Odontogenic Cyst (GOC): Histology
Histopathologic overlap between intraosseous mucoepidermoid carcinoma and GOC
May require molecular testing to distinguish
95
Glandular Odontogenic Cyst (GOC): Treatment
Enucleation and currettage
May require en bloc resection with recurrence
96
Glandular Odontogenic Cyst (GOC): Recurrence rate
30% after enucleation/currettage
Multilocular lesions recur more frequently
97
Calcifying Odontogenic Cyst (COC): Describe variations
Exists on a spectrum from a cystic lesion to a solid tumor-like growth
98
Calcifying Odontogenic Cyst (COC): What is the name of the cystic lesion?
Calcifying Odontogenic Cyst (COC)
99
Calcifying Odontogenic Cyst (COC): What is the name of the solid lesion?
Dentinogenic ghost cell tumor
100
Calcifying Odontogenic Cyst (COC): Area affected
Maxilla is equal to mandible in frequency
65% occur in incisor/canine region
101
Calcifying Odontogenic Cyst (COC): Population affected
2nd-4th decades, avg age 30
102
Calcifying Odontogenic Cyst (COC): Radiology
Unilocular (usually), well-defined mixed radiolucent/ radiopaque lesion
103
Calcifying Odontogenic Cyst (COC): What can this lesion cause to neighboring teeth?
Can cause adjacent root resorption or displacement
104
Calcifying Odontogenic Cyst (COC): What lesions can this be accompanied by?
-Odontoma
-Adenomatoid odontogenic tumor
-Ameloblastoma
105
Calcifying Odontogenic Cyst (COC): What is the clinical variant
Peripheral COC
106
Calcifying Odontogenic Cyst (COC): Describe characteristics of Peripheral COC
Presents as an indistinct gingival mass; less aggressive
107
Calcifying Odontogenic Cyst (COC): Population affected by Peripheral COC
60-80 years of age
108
Calcifying Odontogenic Cyst (COC): Buzz Histology
Presence of ghost cells
109
Calcifying Odontogenic Cyst (COC): Define ghost cells
Epithelial cells that have lost nuclei
110
Calcifying Odontogenic Cyst (COC): Recurrence
Recurrence for cystic and solid benign lesions is rare
111
Calcifying Odontogenic Cyst (COC): Treatment for malignant transformation turning into ghost cell odonotogenic carcinoma
-Complete surgical excision
112
Carcinoma arising in odontogenic cysts: What is the most common odontogenic cyst that arises as oral cavity carcinoma?
Residual periapical cyst
113
Carcinoma arising in odontogenic cysts: Population affected
Middle age 60, male predilection: 2:1
114
Carcinoma arising in odontogenic cysts: Symptoms
Pain and swelling are common complaints but can be symptomatic
115
Carcinoma arising in odontogenic cysts: Histology
Most common malignant transformation is to squamous cell carcinoma
Some cases can transform into mucoepidermoid carcinoma
116
Carcinoma arising in odontogenic cysts: Treatment
Local block or radical resection
117
Carcinoma arising in odontogenic cysts: Survival rate
2 year survival 62%, 5 year 38%
118
What are four radiolucent odontogenic tumors
-Ameloblastoma
-Ameloblastic fibroma
-Squamous odontogenic tumor
-Odontogenic myxoma
119
What are three mixed radiolucent/radiopaque odontogenic tumors
-Odontoma
-Adenomatoid odontogenic tumor
-Calcifying epithelial odontogenic tumor
120
What is the most common clinically significant odontogenic tumor
Ameloblastoma
121
Ameloblastoma: Prevalence
As frequent as all odontogenic tumors combined with exception of odontomas
122
Ameloblastoma: What are three different clinicoradiographic presentations
1. Conventional solid/multicystic (Most common)
2. Unicystic
3. Peripheral
123
Ameloblastoma: Describe population affected
3rd-7th decades equal prevalence, rare under 20
No sex predilection
124
Ameloblastoma: Site affected
Mandible, molar ascending ramus
125
Ameloblastoma: Symptoms
Asymptomatic swelling; buccal-lingual cortical expansion
126
Ameloblastoma: Radiology
Soap bumble or honeycomb (mulilocular radiolucency)
Resorption of adjacent tooth roots common
Margins have irregular scalloping
127
Ameloblastoma: Treatment
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
Ameloblastoma: Recurrence rates
Enucleation/curettage: 50-90%
Margin resection: 15%
129
Ameloblastoma: Three variations
1. Peripheral ameloblastoma
2. Desmoplastic ameloblastoma
3. Unicystic ameloblastoma
130
Peripheral Ameloblastoma: Describe
Usually painless, non-ulcerated nodule of the gingiva or alveolar mucosa
131
Peripheral Ameloblastoma: Site
Mandible> maxilla
Posterior> anterior
132
Peripheral Ameloblastoma: Population
Middle age
133
Peripheral Ameloblastoma: Recurrence
Less aggressive than intraosseous counterpart, but may have a local recurrence in 15-20 percent of cases
134
Desmoplastic Ameloblastoma: Areas affected
Predilection for the anterior regions of the jaws
Mandible=maxilla
135
Desmoplastic Ameloblastoma: Radiology
Mixed radiolucent radiopaque lesion that resembles BFOL
136
Desmoplastic Ameloblastoma: Why does this resemble BFOL?
Due to osseous metaplasia within dense fibrous septa of the lesion
137
Unicystic Ameloblastoma: Population affected
Second decade
138
Unicystic Ameloblastoma: Areas affected
>90% in the mandible
139
Unicystic Ameloblastoma: Radiology
Frequently presents as a unilocular radiolucency surrounding crown of an unerupted mandibular third molar
140
Unicystic Ameloblastoma: What are three histologic types?
Luminal unicystic, intraluminal unicystic, ameloblastoma, mural unicystic ameloblastoma
141
Unicystic Ameloblastoma: Treatment
Can be treated with enucleation and curettage
142
Unicystic Ameloblastoma: Treatment if mural type
Surgeons go back and perform prophylactic en-bloc resection
143
Unicystic Ameloblastoma: After treatment protocol
Follow-up after excision
144
Malignant Ameloblastoma: Define
Patient has a primary jaw tumor diagnosed as ameloblastoma and this lesion metastasizes to another site in the body
145
Malignant Ameloblastoma: Histology
Same as the benign lesion
146
Malignant Ameloblastoma: Population affected
No sex predilection mean age of 30
147
Malignant Ameloblastoma:
