Pathology3 Flashcards
A dental granuloma and a radicular cyst can be differentiated: • based on symptoms • radiographically • histologically • by an electric pulp tester
histologically and only histologically!
This inflammatory cyst derives its epithelial lining from ? within the periodontal ligament
proliferation of small odontogenic epithelial residues (rest of Malassez)
A 37-year-old patient comes into your office with the complaint of a slowly growing, painless swelling of his lower left jaw. A panoramic shows a multilocular radiolucency with well-defined and sclerotic margins along the left mandibular molar-ramus area. All teeth test as vital. A biopsy is conducted and shows odontogenic epithelium. What is the most likely diagnosis for the most aggressive type of this tumor?
• solid (multicystic or polycystic)
• unicystic
• extraosseous (peripheral)
solid (multicystic or polycystic)
ameloblastoma is the most common epithelial odontogenic tumor
Malignant behavior by ameloblastoma is ? encountered. These lesions occur in a younger age group (30s) and appear in the ? more frequently. Malignant lesions have been divided into two subtypes?
- rarely
- mandible
- the malignant ameloblastoma and ameloblastic carcinoma
A 30-year-old patient comes into your office complaining of a painless swelling of his lower left jaw. A panoramic radiograph shows a well-circumscribed multilocular radiolucency with a “honeycomb” pattern at the location of the lower left molars. The teeth have been displaced. The pathology report calls this an odontogenic myxoma. This tumor:
• is composed of large polyhedral, neoplastic, epithelial cells
• is composed of neoplastic epithelium and mesenchyme
• arises from follicular connective tissue resembling pulp tissue
• is composed of spindle-shaped mesenchymal cells and aggregates of multinucleated giant cells
arises from follicular connective tissue resembling pulp tissue
for odontogenic myxoma ? are the rule
- cortical expansion (rather than perforation)
* root displacement (rather than resorption)
The calcifying epithelial odontogenic (Pindborg) tumor is composed of ?
large polyhedral, neoplastic, epithelial cells
The ameloblastic fibro-odontoma and ameloblastic fibroma are composed of ?
neoplastic epithelium and mesenchyme
The central giant cell granuloma is composed of a proliferation of spindled fibroblasts in a stroma containing variable amounts of collagen. ? cells are present throughout the connective tissue stroma
Multinucleated giant cells
The cementoblastoma is more often seen:
• in the mandible than in the maxilla, and more often in the posterior than in the anterior regions
• in the mandible than in the maxilla, and more often in the anterior than in the posterior regions
• in the maxilla than in the mandible, and more often in the posterior than in the anterior regions
• in the maxilla than in the mandible, and more often in the anterior than in the posterior regions
in the mandible than in the maxilla, and more often in the posterior than in the anterior regions (also known as the true cementoma)
To distinguish cementoblastoma from condensing osteitis ?
in condensing osteitis you can distinguish the root outline
Periapical cemental dysplasia has:
• a predilection for persons younger than 20 years old
• a predilection for middle-aged caucasian men
• a predilection for middle-aged black women
• no age, racial, or sex predilection
a predilection for middle-aged black women
The most common location for a Pindborg tumor (calcifying epithelial odontogenic tumor (CEOT) is the: • tuberosity area • maxillary anterior area • mandibular premolar area • molar— ramus area
molar— ramus area
The ameloblastic fibroma and ameloblastic fibro-odontoma appear to be variations of the same process. These neoplasms occur predominantly in: • adults with a mean age of 40 • elderly people with a mean age of 75 • young adults with a mean age of 25 • children and young adults
children and young adults (Except for the presence of an odontoma, the two lesions are the same, Radiographically, are well circumscribed and are usually surrounded by a sclerotic margin and may be associated with the crown of an impacted tooth)
An ? appears within the ameloblastic fibro-odontoma owing to the presence of an odontoma. This lesion, therefore, presents as a combined lucent-opaque lesion; the ameloblastic fibroma is ?
- opaque focus
* completely lucent
- a compound odontoma looks ?
* a complex odontoma ?
- like a tooth
* does not look (it is a disorganized arrangement of tubular dentin, enamel, and thin layers of cementum)
A 45-year-old African-American female presents to your office for a routine exam. Periapicals of the mandibular incisors show multiple radioopacities with radiolucent rims. Teeth #23 through #26 test as vital. There is no pain on percussion or palpation. Treatment for these lesions should be:
• do nothing (observe)
• RCT treatment for teeth #23 through #26
• surgical excision of lesions
• none of the above
do nothing (observe) (Periapical cemental dysplasia formerly known as cementoma) The term “cementoma” is a misnomer as the opacities are not cementum but bone
Three stages of periapical cemental dysplasia :
- Osteolytic stage: radiolucency appears on radiograph.
- Osteoblastic stage: beginning of calcification in the radiolucent area (mixed radiolucent and radiopaque appearance).
- Mature (Sclerotic) stage: radiopacity appears on radiograph with a thin radiolucent line around the area
A 5-year-old boy presents with his mother for his first dental exam. Your exam reveals a normally developing dentition, but you notice multiple "freckles" on his lower lip and on the buccal mucosa. What condition should you be concerned about? • gorlin-goltz syndrome • gardner syndrome • peutz-jeghers syndrome • cleidocranial dysplasia
peutz-jeghers syndrome (refer for intestinal polyposis, signs and symptoms of abdominal pain, rectal bleeding, and diarrhea)
There is a strong tendency for these multiple polyps of the colon to undergo malignant change
? is the most common oral pigmented lesion. The tattoo has been mistaken for ?
- An amalgam tattoo
* a melanin-pigmented lesion
Attempt to locate amalgam on x-ray if tattoo is suspected; if you can not locate any amalgam, ? may be needed to rule out a melanocytic neoplasm
a biopsy
Focal (frictional) keratosis: common white lesion caused by chronic friction on the mucosa. Important: Differentiated from ? because cause is known
idiopathic leukoplakia
Linea alba: a type of ? that appears as a linear white line in buccal mucosa
frictional keratosis
The most common location for an intraoral congenital nevi (moles) (birthmark) is the: • buccal mucosa • tongue • hard palate • alveolar mucosa
hard palate (greater than 10 cm) have a higher incidence of malignant transformation (as opposed to acquired nevi)
? are much more common than congenital nevi both intraorally and extraorally.
Acquired nevi
? are both characterized by having numerous large, pigmented atypical nevi that have a high risk for developing malignant melanoma
- The B-K mole syndrome
* the dysplastic nevus syndrome
Which of the following conditions demonstrate pigmentation of the intraoral mucous membranes. Select all that apply. • addison disease • albright syndrome • cushing syndrome • peutz-jeghers syndrome
- addison disease
- albright syndrome
- peutz-jeghers syndrome
Addison disease results from ?. It is characterized by ?. Oral signs consist of ?. Although cutaneous pigmentation will most likely disappear following therapy, pigmentation of the oral tissues tends to persist
- hypofunction of the adrenal cortex
- bronzing of the entire skin
- diffuse pigmentation of the gingiva, tongue, hard palate, and buccal mucosa
There is an increased incidence of ? seen with polyostotic fibrous dysplasia.
osteosarcoma
Peutz-Jeghers syndrome is characterized by having ?
multiple intestinal polyps and intraoral melanin pigmentations
A 40-year-old patient presents to his physician with complaints of muscle weakness and loss of appetite. He has noticed a loss of weight and also that his skin has started to "bronze". His labs show lowered blood glucose and sodium and increased potassium. One condition likely to be causing this is: • peutz--jeghers syndrome • cushing syndrome • addison disease • albright syndrome
addison disease (Clinical features do not begin to appear until at least 90% of glandular tissue has been destroyed)
The main concern when performing dental procedures on a patient with Addison disease is that the adrenal cortex has ? to stress
no capacity to put out extra cortisol as a response
Focal melanosis is a common circumstance in which brownish areas of pigmentation occur in the oral cavity. Once properly diagnosed: • surgical excision is required • radiation is required • no treatment is necessary • antibiotics are required
no treatment is necessary (its etiology is developmental)
The intraoral nevus is usually a/an: • intradermal nevus • compound nevus • junctional nevus • blue nevus • intramucosal nevus
intramucosal nevus (rare in the oral cavity. When found intraorally they most frequently occur on the hard palate)
If a pigmented lesion shows ?, a biopsy should be performed—this may indicate transformation into a malignant melanoma.
ulceration, an increase in size, darkening in color, etc.
Radiographically, traumatic bone cysts present as a:
•well-defined unilocular or multilocular radiolucency with scalloping around the roots
• poorly circumscribed radiopaque lesion which may have a “ground-glass” appearance
• saucer-shaped radiopaque lesion
• poorly defined multilocular radiolucency with a “pear-shaped” appearance between the maxillary central incisors
well-defined unilocular or multilocular radiolucency with scalloping around the roots (are non-cysts (referred to as pseudocysts))
Which of the following statements are true concerning the aneurysmal bone cyst. Select all that apply.
• it is an uncommon expansile osteolytic lesion of bone consisting of a proliferation of vascular tissue that forms a lining around blood-filled cystic lesions
• most aneurysmal bone cysts occur in patients under 20 years of age, and it is uncommon after the age of 30
• it commonly involves the jaws
• the lesions are usually tender or painful, particularly upon motion of the bone affected
• upon entering the lesion surgically, excessive bleeding is encountered
• it is an uncommon expansile osteolytic lesion of bone consisting of a proliferation of vascular tissue that forms a lining around blood-filled cystic lesions
• most aneurysmal bone cysts occur in patients under 20 years of age, and it is uncommon after the age of 30
• the lesions are usually tender or painful, particularly upon motion of the bone affected
• upon entering the lesion surgically, excessive bleeding is encountered
(The aneurysmal bone cyst commonly involves the proximal humerus, femur, tibia, and pelvis. It is not as common in the jaws, but it does appear here as well)
