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Module 7 > Oral pathology - Common Findings > Flashcards

Oral pathology - Common Findings Flashcards

Common findings that may be examinable - radicular cyst, odontogenic keratocyst, ameloblastoma, lichenoid reaction, pleomorphic adenoma, adenoid cystic carcinoma, oral scc,

1
Q

What are the 2 types of inflammatory odontogenic cyst?

A
  1. Radicular cyst
  2. Inflammatory Collateral cysts
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2
Q

What are the 3 types of radicular cyst?

A

Apical
Lateral
Residual

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3
Q

Where does a lateral radicular cyst arise from?

A

A lateral root canal branch of a non-vital tooth

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4
Q

Where does a residual radicular cyst arise from?

A

Persists after an extraction of the associated non-vital tooth

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5
Q

Name the most common type of jaw cyst?

A

Radicular cyst

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6
Q

What % of odontogenic cysts are radicular cysts?

A

55%

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7
Q

What do radicular cysts arise from?

A

Epithelial proliferation and cystic formation within some periapical granuloma

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8
Q

Where are radicular cysts most commonly found?

A

Anterior maxilla

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9
Q

Are radicular cysts rapid or slow growing swellings?

A

Slow growing swelling

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10
Q

Would you expect symptoms with a radicular cyst?

A

Often no symptoms, unless very large

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11
Q

What are radicular cysts associated with?

A

Non-vital tooth - usually at the apex, although can be on lateral aspect of root if associated with lateral canal.

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12
Q

How would you describe the radiographic appearance of a radicular cyst?

A

Typically well-circumscribed unilocular radiolucent lesion seen at the apex.
(although can be on the lateral aspect of the root if associated with a lateral canal)

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13
Q

What is the pathogenesis associated with radicular cysts?

A

The proliferation of epithelium (Cell Rests of Malassez) in response to inflammation
Cyst enlarges due to osmotic pressure
Local bone resorption

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14
Q

What does the presence of hyaline/rushton bodies in the histopathological study of a cystic lesion indicate?

A

That the cystic lesion is of odontogenic origin

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15
Q

What are hyaline/rushton bodies secreted by?

A

The cyst lining

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16
Q

What is the treatment for radicular cysts?

A

Small cysts may resolve after RCT/extraction/periradicular surgery
Larger lesions may require enucleation (entire removal of the lesion)
Very large lesions may require marsupilisation (decompression) before enucleation

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17
Q

What causes the formation of inflammatory collateral cysts?

A

Inflammation associated with pericoronitis.
Proliferation of sulcular or junctional epithelium derived from reduced enamel epithelium.

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18
Q

What are the 2 types of inflammatory collateral cyst?

A

Paradental cyst
Mandibular buccal bifurcation cyst

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19
Q

Which teeth are paradental cysts commonly associated with?

A

Lower 3rd molars

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20
Q

What % of inflammatory collateral cysts are paradental cysts?

A

> 60%

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21
Q

Are paradental cysts associated with a vital or non-vital tooth?

A

A vital tooth - they are associated with chronic pericoronitis

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22
Q

How do inflammatory odontogenic cysts (paradental cyst and mandibular buccal bifurcation cyst) appear radiographically?

A

Well demarcated radiolucency

(Mandibular bifurcation cyst is seen buccally)

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23
Q

Which teeth are mandibular buccal bifurcation cysts commonly associated with?

A

Lower 1st and 2nd molars - associated tooth usually tilted buccally with deep perio pocket

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24
Q

Would you expect symptoms associated with a mandibular buccal bifurcation cyst?

A

No - often painless swelling

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25
Q

How are inflammatory odontogenic cysts treated?

A

Mandibular buccal bifurcation cysts - enucleation
Paradental cysts - removal of 8s and paradental cyst

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26
Q

Name 7 developmental odontogenic cysts:

A
  1. Odontogenic Keratocyst
  2. Dentigerous cyst/Eruption cyst
  3. Lateral periodontal cyst and Botryoid odontogenic cyst
  4. Glandular odontogenic cyst
  5. Gingival cysts
  6. Calcifying odontogenic cyst
  7. Orthokeratinised odontogenic cyst
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27
Q

Where does an OKC arise from?

A

Glands of Serres

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28
Q

What % of OKCs arise in the mandible?

A

80% - especially posteriorly

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29
Q

Would you expect symptoms associated with an OKC?

A

Symptomless unless infected or when cortical bony expansion is evident

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30
Q

Which direction does cortical bony expansion occur in OKCs?

A

In an anterior-posterior direction

31
Q

How do OKCs appear radiographically?

A

Well-defined radiolucent uni- or multi-locular lesion

32
Q

OKCs are associated with the mutation or inactivation of which gene?

A

PTCH1 gene (found in chromosome 9)

33
Q

Which syndrome can be associated with OKCs?

A

Naevoid Basal Cell Carcinoma Syndrome (Gorlin Syndrome)

34
Q

How do OKCs present in patients with Naevoid Basal Cell Carcinoma Syndrome?

A

Multiple (recurring) Odontogenic Keratocysts

35
Q

What happens to the characteristic histopathological features of OKCs if secondary infection is present?

A

The histopathological features are lost

36
Q

Why do OKCs have a high recurrence rate on removal?

A

Due to thin capsule/daughter cysts

37
Q

Which ways might OKCs be treated?

A

Marsupilisation
Enucleation
Marsupilisation and Enucleation
Enucleation and Carnoy’s
Enucleation and Cryotherapy
Resection

38
Q

Which solution can be used to aid elimination of remaining daughter cysts following enucleation of OKC?

A

Carnoys solution

39
Q

What is the % recurrence rate following the removal of an OKC using enucleation and Carnoys solution?

A

<10% recurrence rate

40
Q

What is a dentigerous cyst?

A

2nd most common odontogenic cyst

An accumulation of fluid between the reduced enamel epithelium of the dental follicle and the crown of an un-erupted tooth.

41
Q

Which teeth are associated with dentigerous cysts?

A

Impacted teeth or late to erupt (3s, 5s, 8s)

42
Q

Are dentigerous cysts most commonly seen in the mandible or the maxilla?

43
Q

Would you expect symptoms associated with a dentigerous cyst?

A

No unless significant swelling present or infected

44
Q

How might a dentigerous cyst appear radiographically?

A

Well-circumscribed unilocular radiolucency associated with the crown of un-erupted tooth

45
Q

What type of expansion is associated with a dentigerous cyst?

A

Ballooning expansion

46
Q

Where are dentigerous cysts clinically attached to on the UE tooth?

47
Q

How would you treat a dentigerous cyst?

A

Enucleation with exposure/transplantation/extraction of associated tooth

48
Q

Which type of dentigerous cyst arises in an extra-alveolar location?

A

Eruption cyst

49
Q

How does an eruption cyst present clinically?

A

Bluish swelling in primary and permanent molars

50
Q

How are eruption cysts treated?

A

Nothing - should erupt naturally
Exposure of erupting tooth

51
Q

Name the 2 most common odontogenic tumours:

A
  1. Odontoma
  2. Ameloblastoma
52
Q

What are odontomas?

A

Developmental malformations (hamartomas) of dental tissues

53
Q

What are the 2 different types of Odontomas?

A

Compound type (most common)
Complex type

54
Q

Where are compound-type Odontomas frequently found?

A

In the anterior maxilla

55
Q

What do compound type odontomas look like?

A

A bag of teeth

56
Q

Where are complex-type Odontomas frequently found?

A

Posterior mandible

57
Q

What do complex type odontomas look like?

A

Irregular mass of hard and soft dental tissues, haphazard arrangement with no resemblance to a tooth and often forming a cauliflower-like mass

58
Q

How do you treat odontomas?

A

Enucleation

59
Q

Where are conventional ameloblastomas frequently found?

A

Posterior mandible

60
Q

Name 2 features of ameloblastoma?

A

Slow growing
Locally aggressive

61
Q

What are the 2 patterns of ameloblastoma in fibrous tissue stroma?

A
  1. Follicular pattern - islands of epithelial cells
  2. Plexiform pattern - long strands of epithelial cells
62
Q

What is important to note about maxillary located ameloblastomas?

A

They are rare however, they are readily spread through thin bones of the base of the skull, are difficult to completely excise and are potentially LETHAL.

63
Q

Which drugs commonly result in lichenoid reactions?

A

Antihypertensives - ACE inhibitors, beta-blockers, calcium channel blockers, methyldopa, thiazide, diuretics, loop diuretics (e.g. frusemide)

Oral hypoglycaemics - Tolbutamide, Chlorpropamide (sulphonylureas)

NSAIDS - ibuprofen, naproxen, phenylbutazone

64
Q

What histopathological features can be seen in lichenoid inflammation?

A

Hyperorthokeratosis and hyperparakeratosis of the epithelium - may be acanthotic
Saw tooth rete ridges
Lymphocytic exocytosis
Civatte bodies (basal cells undergoing apoptosis)
Breakdown of basal cell layer

65
Q

If symptomatic, how might you treat lichenoid inflammation?

A

Steroid treatment

66
Q

What % of parotid tumours are pleomorphic adenoma?

67
Q

What are pleomorphic adenomas?

A

Most common type of salivary gland tumour.
Benign, typically but not always painless, slow growing, rubbery lump.

68
Q

Are pleomorphic adenomas solitary or multifocal?

A

Usually solitary, however recurrences may be multifocal

69
Q

Most pleomorphic adenomas are associated with gene rearrangements in ….

A

PLAG1 or HMGA2

70
Q

What histopathological features can be seen in pleomorphic adenoma

A

Well circumscribed tumour
Incomplete fibrous capsule
May be cystic
Complex intermingling of epithelial and myoepithelial components

71
Q

What is the treatment for pleomorphic adenoma?

A

Complete excision
High recurrence rate if incompletely excised
Malignant transformation can occur - usually in long standing lesions

72
Q

What are malignantly transformed pleomorphic adenomas known as?

A

Carcinoma ex pleomorphic adenoma

73
Q

What is the prognosis of carcinoma ex pleomorphic adenoma?

A

Typically high grade malignancies with poor prognosis

Module 7 (14 decks)

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