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ABOMS Oral Boards > Pathology > Flashcards

Pathology Flashcards

1
Q

Squamous Odontogenic Tumor

A
  • 20-40 yo, posterior jaws
  • Man=Max
  • Rests of Malassez
  • Expansile with swelling
  • Imaging: triangular/semicircular defect around tooth roots
  • Histo: bland islands of squamous epithelium w/ fibrous stroma
  • DDx: desmoplastic AB and SCCa
  • Tx: enucleation and curettage
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2
Q

Calcifying Epithelial Odontogenic Tumor (CEOT, Pindborg)

A
  • 2:1 Man:Max
  • 75% posterior
  • Imaging: variable. uni or multilocular lucency. mixed density. associated with impacted tooth
  • Histo: irregular sheets of pleomorphic amyloid congo red, liesegang rings
  • Tx: enucleation and curettage vs en bloc resection, recurrence ~ 20%
  • if clear cells present it is mor eggressive
    DDx: metastatic RCCa, ACCa, mucoepidermoid carcinoma, AOT
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3
Q

Adenomatoid Odontogenic Tumor (AOT)

A
  • Teenage girls
  • 2/3 maxilla, 80% anterior
  • Imaging: unilocular flecks, 75% associated with impacted teeth. Often will strip down to root past CEJ + adenomatiod structures
  • Tx: Enucleation and curettage, no recurrenc
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4
Q

Carcinoma vs Sarcoma

A

Carcinoma - epithelial origin
Sarcoma- mesenchymal origin

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5
Q

Ameloblastic Fibroma

A
  • Benign mixed odontogenic tunmor
  • 10s-20s
  • 75% posterior mandible
  • Expansile
  • Histo: starry sky, thin stands and cords, club shapes, cords of epithelium
  • Imaging: well demarcated but sclerotic uni or multilocular. unerupted tooth
  • Tx: complete excision/en bloc resection.
  • 15-20% recurrence
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6
Q

Odontoma

A
  • mean age 15
  • M=F
  • Anterior maxilla and posterior mandible

Imaging:
- compound - multiple tooth like structures surrounded by halo of follicle
- complex - amorphous mass surrounded by follicle

  • Tx: enucleation and curettage
  • low recurrecne
  • Variants: Ameloblastic fibro-odontoma, Ameloblastic fibrodentinoma
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7
Q

Dentinogenic Ghost Cell Tumor

A
  • wide age range 20-70
  • non healing ext site, possible ulceration
  • irregular, destructive, mixed lesion. may cross midline and invade sinonasal structures
  • variant of COC
  • Tx: wide surgical resection, may metastatisize
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8
Q

Odontogenic FIbroma

A
  • F>M
  • 60% anterior maxilla
  • Imaging: well demarcated radiolucency, usually associated with the root of a tooth
  • Tx: conservation excision or curettage
  • DDx: hyperplastic dental follicle, desmoplastic fibroma, infantile myofibromatosis
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9
Q

Odontogenic Myxoma

A
  • Wide age range
  • F=M
  • posterior mandible slightly more common
  • Imaging: multilocular, well demarcated but can be lytic. fine loculations (tennis racquet)
  • Histo: myxoid connective tissue, spindle cells
  • Tx: resection with 1-1.5cm margins and one anatomic barrier
  • Recurrence 25%
  • ameloblastoma, desmoplastic fibroma, myxomatous degeneration of neurofibroma or wilms tumor
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10
Q

Cementoblastoma

A
  • wide age. mean 20-30
  • F>M
  • benign odontogenic neoplasm of cementoblasts adherent to root
  • Imaging: well defined radiopaque mass adhered to root without PDL space separating
  • Tx: removal of tooth or hemisection with lesion removal
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11
Q

Ameloblastic Carcinoma

A
  • malignant neoplasm of odontogenic epithelium
  • Average age 30
  • Lung most common site for mets
  • Imaging: aggressive ill defined lucency
  • Tx: staged and treated like carcinoma
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12
Q

Carcinomas of Jaws

A
  • Ameloblastic
  • Primary intraosseous carcinoma; Tx - same as carcinoma
  • Sclerosing odontogenic carcinoma; Tx enucleation and curettage
  • Clear cell odontogenic carcinoma;
  • Ghost cell odontogenic carcinoma
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13
Q

Odontogenic Keratocyst (OKC)

A
  • 10-30s
  • posterior mandible most common
  • Imaging: 75% unilocular - 25% multilocular. may see tooth displacement/resorption and cortical destruction
  • Histo: parakeratinized, corrugated, startified squamous 6-8 cells thick
  • Tx: enucleation and curettage with peripheral ostectomy and adjuvant therapy (cryo, modified carnoys, 5-FU). Marsupialization vs resection for large and refractory lesions
  • 33% recurrence
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14
Q

Gorlins Sydrome

A
  • AD disease
  • BCC of skin, multiple OKC, palmar and plantar pits, bifid ribs, calcified cerebral falx, hypertelorism
  • 9,22 gene
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15
Q

Lateral Periodontal Cyst

A
  • 50s
  • 2/3 mandibular premolar
  • Imaging: mid root, lateral well circumscribed lucency
  • Tx: enucleation and curettage
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16
Q

Botryoid Odontogenic Cyst

A
  • variant of lateral periodontal cyst
  • 50s
    -Imaging- multilocular grape like clusters
  • Tx: enucleation and curettage
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17
Q

Glandular Odontogenic Cyst

A

Tx: wide local excision / resection due to possible recurrence

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18
Q

Calcifying Odontogenic Cyst (Gorlin Cyst)

A
  • M=F, max=man
  • Imaging: radiolucency w/ opacities 2/2 ghost cells
    Tx: wide local excision
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19
Q

Epithelial Odontogenic Lesions Features
1. Ameloblastoma
2. OKC
3. AOT
4. CEOT
5. SOT
6. COC

  1. Mean Age
  2. Location
  3. Imaging
A
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20
Q

Mixed Odontogenic Lesions Features
1. AF
2. AFO
3. Odontoma
4. DGCT

  1. Mean Age
  2. Location
  3. Imaging
A
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21
Q

Mesenchymal Odontogenic Lesions Features
1. Myxoma
2. Odontogenic Fibroma

  1. Mean Age
  2. Location
  3. Imaging
22
Q

Circumscribed Unilocular Radiolucency DDx

A
  1. Odontogenic cyst
  2. OKC
  3. Ameloblastoma
  4. AOT
  5. COC
  6. CEOT
  7. TBC
  8. OF
23
Q

Pericoronal Unilocular Radiolucency DDx

A
  1. Dentigerous Cyst
  2. OKC
  3. Ameloblastoma
  4. AOT
  5. COC
  6. CEOT
24
Q

Periradicular Circumscribed Radiolucency DDx

A
  1. Paradental cyst
  2. SOT
  3. Odontogenic Fibroma
  4. Periodontitis
  5. Langerans Histiocytosis
25
Q

Multilocular Radiolucency DDx

A
  1. OKC
  2. Ameloblastoma
  3. CGCG
  4. AF
  5. Myxoma
  6. BOC
  7. Cherubism
  8. GOC
26
Q

Radiopacity with Radiolucent Rim DDx

A
  1. Odontomas
  2. Ossifying fibroma
  3. Osseous dysplasias
  4. Cementoblastoma
27
Q

Mixed Density Lesion DDx

A
  1. Odontoma
  2. AFO
  3. AOT
  4. COC
  5. CEOT
  6. DGCT
  7. Ossifying fibroma
  8. Osseous dysplasia
  9. Primary bone tumor
28
Q

Poorly Defined Radiolucency DDx

A
  1. Myxoma
  2. Metastasis
  3. Vascular lesion
  4. Malignant odontogenic neoplasms
  5. Primary malignant bone tumor
29
Q

Dentigerous Cyst

A
  • most common odontogenic cyst
  • M>F, teens - 20s
  • Always associated with crown of impacted tooth
  • Imaging: well defined pericoronal, unilocular radiolucency
  • Typically gives rise to brown-clear cholesterol aspirate
  • Tx: enucleation and curettage
  • Has possibility to recur
30
Q

Chondrosarcoma

A
  • 30-40s
  • sinonasal tract most common
  • ant max/post mand
  • painless mass, nasal obstruction, loose teeth, epistaxis, proptosis
  • Imaging: moth eaten, uni or multilocular lucency
  • Grade 1,2,3 based on nuclear size and mitotic activity
  • Tx: resection w/ neg margins
  • 20% 5 year survival
31
Q

Osteosarcoma

A

-30s - 40s, long bones, posterior mandible
- Risks: radiation, fibrous dysplasia, pagets disease
- Rapid growth w/wo pain, expands/crowds teeth
- Histo spindle cells in osteoid
- Imaging: sunburst pattern
- Tx: 3cm margins and uninvolved anatomic barrier, chemo for high grade
- 5 year survival 50%

32
Q

Fibrous Dysplasia

A
  • Monostotic mosaic
  • max > zygomatic arch > mand
  • polyostotic - jaffe-lichtenstein, mccune albright
  • Imaging: ground glass, ill defined border, displaced teeth
  • Tx: recontouring
33
Q

Cemento Osseous Dysplasia

A
  • middle age black females
  • possible reactive hyperdensity of bone
  • secondary infections/osteomyelitis due to poor vascularity
  • periapical -> focal -> florid
  • Tx: surveillance. biopsy has risk of osteomyelitis
34
Q

Cemento-Ossifying Fibroma

A
  • F>M, mandible 75%
  • Imagin: well demarcated, mixed
  • Fibro, osteoid, cementum
  • Tx: shells out on enucleation
35
Q

Central Giant Cell Granuloma

A
  • reparative granuloma, painless expansion
  • F>M; mand>max
  • whorls of CD68+cells, fibroblasts in a fibroid stroma
  • aggressive = >5cm, rapid growth, tooth displacement, recurrence

Non surg tx:
- kenalog 1mg per ml of lesion
- calcitonin
- inteferon alpha

Tx: enucleation and curettage vs resection

36
Q

Cherubism

A
  • bilateral symmetrical mandibular expansion
  • loose teeth, displacement
  • limits by 30 yo -> recontouring
37
Q

Hodgkin Lymphoma

A
  • lymph node swelling
  • <40 yo
  • Reed sternberg cells, +/- EBV

Staging:
1. 1 lymphatic site
2. 2 or more sites same side of diaphragm
3. both sides of diaphragm
4. diffuse

Tx: XRT +/- chemo

38
Q

Non Hodgkins Lymphoma

A
  • systemic, >40 yo
  • CD20 cells - 85% B cells
  • Diffuse large B cell most common
  • chemo is tx
39
Q

Histiocytosis X

A

-increase in dendritic cells
-more common in children
- BRAF mutation
- pain, exopthalmos, ulcers
- unifocal single system - histio x
- multifocal/single system - hand-schuller-christian
- acute disseminated-letterer-siwe

40
Q

Epithelial Dysplastic Changes

A
  • loss of basal polarity
  • increased nucleus/cytoplasm ratio
  • hyperchromasia
  • increase mitoses
  • loss of cohesion
  • increased keratinization
41
Q

Proliferative Veruccous Leukoplakia

A
  • verrucous leukoplakia
  • increase rate of recurrence and can transform to SCCa
42
Q

HPV neg Tumor Criteria

43
Q

HPV neg Node Criteria

44
Q

HPV neg Met Criteria

45
Q

HPV neg TNM Staging

46
Q

HPV + TNM Staging

47
Q

Supraomohyoid Neck Dissection Indication

A

> 4mm depth of invasion
histologically high grade tumor
perineural invasion

48
Q

Indications for Post Op Radiation

A
  • positive or near margin
  • perivascular or neural invasion
  • bone involvement
  • multiple nodal involvement
  • extracapsular spread
  • stage III/IV
49
Q

Levels of the Neck

A
  1. submental A/submandibular B
  2. upper jugular-skull to hyoid
  3. middle jugular along SCM
  4. lower jugular - posterior SCM
  5. posterior trinagle
  6. pretracheal/laryngeal/paratracheal
  7. upper mediastinum
50
Q

Verrucous Carcinoma

A
  • M>F
  • chewing tobacco
  • 5 year survival 85%
  • Tx: resection 0.5-1 cm margin
51
Q

Ameloblastoma

A
  • slow growing expansile odontogenic epithelium neoplasm
  • 50% 20-40 yo
  • posterior mandible most common

Types:
- solid/conventional
- unicystic- lining, intraluminal, transmural, intramural
- peripheral / extraosseous

Imaging: multilocular radiolucency but can be unilocular

Histo: vickers gorlin criteria - peripheral palisading, reverse polarity in fibrous stroma

Tx: resection with 1-1.5 cm margins and one uninvolved anatomic barrier
Enucleation for ameloblastoma in situ only

ABOMS Oral Boards (4 decks)

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