ORAL DIAGNOSIS Pathology and Diagnosis pt 2 Flashcards
___ is a group of neoplasms of bone marrow. what are the precursors?
- leukemias
- lymphocyte or myeloid precursors
in leukemias, malignant cells occupy and replace normal marrow cells, including ___. the malignant cells are also released into the ___
- megakaryocytes (platelet forming cells)
- peripheral blood
what are the causes of leukemias?
- genetic factors, such as chromosome translocations
- environmental agents (benzene, radiation)
- viruses (human T-lymphotropic virus 1)
classification of leukemia is based on ___ and ___
cell lineage and whether the disease is acute or chronic
what are the clinical features of leukemia?
- bleeding (owing to reduced platelets), fatigue (owing to anemia), and infection (owing to agranulocytosis) are important clinical signs of leukemias
- infiltration of gingival tissues by leukemic cells is common in chronic monocytic leukemia; gingiva is red, boggy, and hemorrhagic
what is the treatment for leukemias?
chemotherapy is quite successful for acute leukemias, but is less so for chronic leukemias
odontogenic cysts are derived from cells that are associated with ___
tooth formation
in odontogenic cysts, the stimulus for cystic change is unknown in all cysts except for ___ and ___
periapical cysts and some odontogenic keratocysts (keratocystic odontogenic tumors)
what is the most common odontogenic cyst? what is it always associated with?
- periapical (radicular) cyst
- always associated with a nonvital tooth
how do periapical cysts form?
- necrotic pulp causes periapical inflammation (can be acute or chronic)
- rests of malassez within a dental granuloma epithelialize the lesion, resulting in the formation of a cyst
describe the difference in acute and chronic periapical cysts
- if acute, a periapical abscess forms after periapical inflammation
- if chronic, a dental granuloma (granulation tissue and chronic inflammatory cells) forms after periapical inflammation
how is a periapical cyst treated?
RCT, apicoectomy, or tooth extraction with apical curettage
how does a dentigerous cyst manifest radiographically?
a radiolucency around the crown of an impacted tooth
which teeth are most commonly affected by dentigerous cysts?
third molars and canines
an eruption cyst is a ___ cyst that occurs over a tooth that has erupted into the submucosa
dentigerous cyst
in dentigerous cysts, the epithelial lining from reduced enamel epithelium has the potential to transform into ___
ameloblastoma
a ___ is a unilocular or multilocular lucency in the lateral periodontal membrane of adults
lateral periodontal cyst
where are most lateral periodontal cysts located?
most are found in the mandibular premolar region and are associated with a vital tooth
___ is the soft tissue counterpart of a lateral periodontal cyst
gingival cyst of the adult
gingival cysts of a newborn present as ___ resulting from ___
multiple small gingival nodules resulting from cystification of rests of the dental lamina
gingival cysts of the newborn are also called ___. what are inclusion cysts in the palates of infants called?
- bohn’s nodules
- epstein’s pearls
what is the treatment for gingival cysts of the newborn?
none
odontogenic keratocysts (keratocystic odontogenic tumors) are lesions that may be clinically aggressive, recurrent, or associated with which syndrome?
nevoid basal cell carcinoma (gorlin) syndrome
what characterizes nevoid basal cell carcinoma (gorlin) syndrome?
- multiple odontogenic keratocysts
- numerous cutaneous basal cell carcinomas
- skeletal abnormalities
- calcified falx
- other stigmata
mutation of which gene is evident in syndrome-related odontogenic keratocysts and probably in many solitary cysts
PTCH tumor suppressor gene
why are odontogenic keratocysts now termed keratocystic odontogenic tumors?
the new terminology reflects the concept that the lesion is a neoplasm with cystic architecture rather than a developmental cyst
the lining epithelium of odontogenic keratocysts is ___ and ___
thin and parakeratinized
how do orthokeratinized odontogenic cysts compare to odontogenic keratocysts?
orthokeratinized odontogenic cysts are less common and have much lower recurrence rate and is not syndrome-associated
calcifying odontogenic cysts are rare odontogenic cysts of unpredictable behavior. what is their recurrence?
has potential, especially for the solid variant
what characterizes calcifying odontogenic cysts microscopically?
- ghost cell keratinization
- ghost cells may undergo calcification that may be detected radiographically (lucency with opaque foci)
what is the cutaneous counterpart of calcifying odontogenic cysts?
malherbe calcifying epithelioma or pilomatricoma
are glandular odontogenic cysts common? what is another name for them?
- rare
- sialo-odontogenic cysts
are glandular odontogenic cysts (sialo-odontogenic cysts) aggressive?
may be locally aggressive and exhibit recurrence potential
the glandular odontogenic cyst (sialo-odontogenic cyst) name is derived from ___
glandlike spaces and mucous cells in epithelial lining
odontogenic tumors are bone tumors that are unique to the jaws, and the lesions are derived from ___ cells involved in the formation of teeth
epithelial or mesenchymal cells
are odontogenic tumors typically malignant?
- no, they are almost always benign
- some may exhibit aggressive behavior and may have significant recurrence potential
ameloblastoma is a benign but aggressive odontogenic tumor with significant recurrence potential, especially if treated ___
conservatively
which variant of ameloblastoma is less aggressive and less likely to recur?
cystic variant (cystic ameloblastoma)
___ or ___ ameloblastomas exhibit banal behavior
peripheral or gingival
very rare malignant ameloblastomas are known as ___ and ___
malignant ameloblastoma and ameloblastic carcinoma
there are several microscopic subtypes of ameloblastomas, all of which mimic to some degree the ___
- enamel organ
- no difference in behavior
what is the treatment for ameloblastoma?
ranges from wide excision to resection (want to avoid conservative treatment)
calcifying epithelial odontogenic tumor is also called ___
pindborg tumor
calcifying epithelial odontogenic tumors (pindborg tumors) are rare odontogenic tumors with unusual microscopy. describe their microscopy
sheets of large epithelioid cells with areas of amyloid, some of which may become calcified
how do calcifying epithelial odontogenic (pindborg) tumors compare to ameloblastomas?
similar age distribution and location but less aggressive than ameloblastomas
___ is an uncommon to rare odontogenic hamartoma that contains epithelial duct-like spaces and calcified enameloid material
adenomatoid odontogenic tumor
where do adenomatoid odontogenic tumors occur? do they recur?
- 2/3 in the maxilla, 2/3 in females, 2/3 in the anterior jaws, and 2/3 over the crown of an impacted tooth
- does not recur after conservative treatment
___ is an uncommon to rare tumor of myxomatous connective tissue (primitive-appearing connective tissue containing little collagen similar to dental pulp)
odontogenic myxoma (fibromyxoma)
which jaw do odontogenic myxomas (fibromyxomas) affect?
either jaw
how do odontogenic myxomas (fibromyxomas) present radiographically?
radiolucency often with small loculations (honeycomb pattern)
how are odontogenic myxomas (fibromyxomas) treated?
- surgical excision
- moderate recurrence potential owing to lack of encapsulation and tumor consistency
central odontogenic fibroma is a rare tumor of dense ___ with strands of ___
dense collagen with strands of epithelium
how do central odontogenic fibromas present radiographically?
well-defined radiolucency in either jaw; often multilocular
how are central odontogenic fibromas treated?
surgical excision with few recurrences
cementifying fibroma can be considered similar or identical to ___
ossifying fibroma
radiographically, how does a cementifying fibroma present?
- well-circumscribed lucency
- some lesions are lucent with opaque foci
what population and location is cementifying fibroma common in?
- adults and young adults
- typically in the body of the mandible
how is cementifying fibroma treated?
curettage or excision, rare recurrence
___ is a well-circumscribed radiopaque mass of cementum and cementoblasts replacing the root of a tooth
cementoblastoma
how are cementoblastomas treated?
- lesion is excised and the associated tooth is removed with the lesion because of intimate association
- no recurrence after excision
what are the clinical features of periapical cemento-osseous dysplasia?
- cause unknown, no treatment requried
- commonly seen at the apices of one or more mandibular anterior teeth
- no symptoms; vital teeth
- most frequently seen in middle aged women
- starts as circumscribed lucency, which gradually becomes opaque
- if entire jaw is involved, termed florid osseous dysplasia
what is the difference between an ameloblastic fibroma and an ameloblastic fibro-odontoma?
- the latter lesion has an odontoma
- otherwise, they are the same lesion
which population is most affected by ameloblastic fibromas and ameloblastic fibro-odontomas? which location most common?
- children and teens
- typically seen in mandibular molar regions
how do ameloblastic fibromas and ameloblastic fibro-odontomas present radiographically?
- unilocular or multilocular radiolucency
- ameloblastic fibro-odontomas will present as a radiolucency with an opacity (odontoma)
what are the microscopic characteristics of ameloblastic fibromas and ameloblastic fibro-odontomas?
encapsulated myxomatous connective tissue lesion containing strands of epithelium
how are ameloblastic fibromas and ameloblastic fibro-odontomas treated?
enucleation or excision; rarely recurs
___ is an opaque lesion composed of dental hard tissues
odontoma
what are the two types of odontomas?
- compound type contains miniature teeth
- complex type compose of a conglomerate mass
how are odontomas treated?
curettage, no recurrence
___ is a common fibro-osseous lesion that can be considered similar or identical to cementifying fibroma, although some may reach considerable size
ossifying fibroma
what are the clinical features of ossifying fibromas?
- radiographically appears as either well-circumscribed lucency or a lucency with opaque foci
- seen in adults and young adults, typically in the body of the mandible
- a variant known as juvenile ossifying fibroma occurs in younger patients and may exhibit aggressive behavior
what are the microscopic characteristics of ossifying fibromas?
fibroblastic stroma in which new bony islands or trabeculae are formed
what is the treatment for ossifying fibromas?
curettage or excision, rare recurrence
fibrous dysplasia is an uncommon to rare unencapsulated fibro-osseous lesion assiciated with mutations of the ___ gene, affecting proliferation and function of ___ cells
- GNAS1 gene
- fibroblasts and osteoblasts
what are the clinical features of fibrous dysplasia?
- involves the entire half jaw, more common in maxilla
- affects children and typically stops growing after puberty
- radiographic pattern is diffuse opacity (ground glass)
describe the mccune albright syndrome associated with fibrous dysplasia
- polyostotic (more than one bone) fibrous dysplasia
- cutaneous cafe au lait macules
- endocrine abnormalities (precocious puberty)