Oral Path: Odontogenic Cysts & Tumors

Question 1

Cysts

Answer 1

Cavities lined by epithelium

Question 2

Odontogenic Cysts

Answer 2

derived from cells associated w/tooth formation

Question 3

Radicular Cyst

Answer 3

Aka Periapical Cyst
Most common odontogenic cyst

Radiolucency at apex
* Always Nonvital tooth

Necrotic pulp –> periapical inflammation
* Acute=Abscess
* Chronic=Granuloma

Epithelial Rests of Malassez (ERM)
* from Hertwig’s Epithelial Root Sheath (HERS)
* encapsulate lesion=forms cyst

Tx: RCT, apicoectomy, or EXt w/curretage

Question 4

Dentigerous Cyst

Answer 4

Aka Eruption Cyst

Accumulation of fluid b/w crown & Reduced Enamel Epithelium

Radiolucency attached to CEJ of impacted teeth

Most common: K9s & 3rd molars

Tx: Excision, but might be source of future odontogenic tumor

Question 5

Lateral Periodontal Cyst

Answer 5

Most common=mandibular premolar region
* Always vital tooth
* not centered around apex

Question 6

Gingival Cyst of Adult

Answer 6

Soft tissue part of Lateral Periodontal Cyst

NO Radiolucency bc not in bone

Question 7

Gingival cyst of Newborn

Answer 7

Rests of dental lamina epithelialize the small lesions

Bohn’s Nodules=Lateral Palate
Epstein’s Pearls=midline palate

Tx: None,
* will go away as children get older

Question 8

Primordial Cyst

Answer 8

Develops where a tooth would have formed, but didn’t

Most common area=Mandibular 3rd molar

Tx: Complete removal

Question 9

Keratocystic Odontogenic Tumor (KCOT)

Answer 9

Aggressive & recurrent

Posterior Ascending Ramus of Mandible:
* Fusiform, M-D expansion (Not B-L)
* minimal displacement of teeth or resorption

Tx: Aggressive enucleation

Question 10

Gorlin Syndrome

Answer 10

=Multiple KCOTs (Keratocystic odontogenic tumor)

+ Multiple BCCs (Basal Cell Carcinomas)

+ Calcified Falx Cerebri

+ Fatal Disease

Aka Nevoid Basal Cell Carcinoma

Question 11

Calcifying Odontogenic Cyst

Answer 11

aka Gorlin Cyst

Rare & Unpredictable

Involves: Ghost Cells
* empty space and filled w/keratin–> Calcify
* Little radiodencities on x-ray

Question 12

Ameloblastoma

Answer 12

Benign BUT very AGGRESSIVE

Posterior Mandible
* Multilocular expansive lesion (Beach Ball B-L Expansion) w/erosion and displacement of roots & cortical bone

Tx: Wide excision or resection
* if too conservative=high recurrence

Question 13

Classic Differential Diagnosis for Multilocular Radiolucency in posterior mandible?

Answer 13

Ameloblastoma

KCOT (Keratocystic Odontogenic Tumor)

CGCG (Central Giant Cell Granuloma)

COF (Central Odontogenic Fibroma)

Question 14

Calcifying epithelial Odontogenic Tumor (CEOT)

Answer 14

Aka Pindborg Tumor

Radiolucency with driven snow calcifications (White flecks)

Liesegang rings: amorphous pink amyloid w/concentric calcifications

Tx: Surgical Excision, good prognosis

Question 15

Adenomatoid Odontogenic Tumor (AOT)

Answer 15

anterior maxilla over impacted canine (most common)

Contains:
* epithelial duct-like spaces
* enameloid material

Question 16

Odontogenic Myxoma

Answer 16

aka Myxofibroma

Myxomatous CT=Slimy stroma
* Pulp-like material w/minimal collagen

Messy radiolucency with:
* unclear borders
* honeycomb/tennis racket pattern

Tx: Surgical Excision, moderate recurrence

Question 17

Central Odontogenic Fibroma (COF)

Answer 17

Dense collagen w/strands of epithelium woven w/in it

Types:

Central:
* Bone
* well defined multilocular radiolucency

Peripheral:
* Gingiva
* No RL (not seen on x-ray)

Question 18

Cementoblastoma

Answer 18

Well-circumscribed radiopaque mass
* ball of cementum + cementoblasts= replace root of tooth

Connected to the root (Surrounded by a PDL Space)

tx: Surgical excision and extraction

Question 19

Ameloblastic Fibroma

Answer 19

Children & Teens

Posterior mandible
* contain: Myxomatous CT

Tx: Surgical Excision

Question 20

Odontoma

Answer 20

Opaque lesion
* composed of dental hard tissues
* block eruption of teeth

2 types:
Compound:
* anterior
* “bag of teeth”

Complex:
* posteiror
* conglomerate mass of dental tissue

Question 21

Gardner Syndrome

Answer 21

=Multiple Odontomas
+ Intestinal Polyps

Question 22

Hodgkin’s Lymphoma

Answer 22

Oral cavity=rare

Reed-Sternberg cells= Malignant B cells

Tx: Chemo +/- radiation

Question 23

Non-Hodgkin’s Lymphoma

Answer 23

Neoplasm of B or T cells

Burkett’s Lymphoma= Type of B cell NHL
Involves:
* bone marrow
* swelling
* pain
* tooth mobility
* Lip paresthesia (Pins & needs)
* Halted tooth development

Tx: Chemo +/- chemo

Question 24

Multiple Myeloma

Answer 24

Aka Plasma Cell Myeloma

Neoplasm of Plasma Cells
* Antibody-secreting B cells

multiple punched out radiolucencies in skull

Amyloidosis
* Accumulation of amyloid proteins-from antibody light chains

Tx: Chemotherapy- Poor prognosis

Question 25

Leukemia

Answer 25

Neoplasm of Bone Marrow cells:
* Lymphocytes
* NK Cells
* Granulocytes
* Megakaryocytes

Classification based on cell lineage (Myeloid or lymphoid) & Acute vs chronic:
* ALL -> CML -> AML -> CLL (Youngest to oldest)
* ALL Children Are Chill

Clinical Signs:
* Bleeding (Platelets)
* Fatigue (RBC)
* Infection (WBC)

Even though we are seeing increased production of bone marrow cells, they are immature & have less fxn