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Oral Path 100 > Pseudocysts > Flashcards

Pseudocysts Flashcards

1
Q

What are pesudocysts?

A
  • They have no epithelial lining.
  • They’re called cysts by convention just because that’s what everybody is used to
  • They’re not true cysts.
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2
Q

pesudocysts

List

(5)

A
  • Aneurysmal Bone Cyst
  • Antral Pseudocyst
  • Simple Bone Cyst
  • Osteoporotic Bone Marrow Defect
  • Stafne Bone Cyst
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3
Q

Aneurysmal Bone Cyst

Demographics

A

■ Most common site in the body is long bones or vertebrae
_■ In the jaw_s, most frequently seen in the 1st and 2nd decade
■ MD > MX

it’s a pesudocyst

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4
Q

Aneurysmal Bone Cyst

Clinically

A
  • swelling, frequently a rather rapid swelling
  • often with pain and/or paresthesia (signs which can be suggestive of the presence of a malignant or aggressive lesion)
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5
Q

Aneurysmal Bone Cyst

Etiology

A
  • Etiology is unclear, may result from trauma or a vascular malformation
  • most agree that it is a reactive and *not* a neoplastic lesion
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6
Q

Aneurysmal Bone Cyst

Radiographically

A

■ a radiolucency which can be either unilocular or multilocular in appearance

■ Borders are variable, often irregular in shape and may be ill-defined (again, giving the suggestion of malignancy)

■ Teeth may be displaced

■ we may see cortical expansion and thinning ~ the cortex itself can become quite thin

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7
Q

What does this person have?

A
  • you might think that he has an odontogenic infection but he didn’t. You can see that there’s
    a pretty significant swelling on the left side of his face

This is a Aneurysmal Bone Cysts

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8
Q
A

Aneurysmal Bone Cyst

you can see that there is kind of a
multilocular radiolucency in this particular area

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9
Q
A

Aneurysmal Bone Cyst

✎ There’s a radiolucency involving the second molar
that’s going as far anterior as the first molar and back
to the third molar
✎ There is a little bit of spiking root resorption and
that’s one of the signs that we associate with
malignancy
✎ It’s a little bit ill-defined ~ hard to say exactly
where it begins and ends

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10
Q

Aneurysmal Bone Cyst

Histology

A

■ An intraosseous accumulation of variously sized blood filled sinusoidal spaces (not lined by endothelium)
surrounded by cellular fibroblastic tissue
■ Woven (reactive, immature) bone may be seen in the FCT
■ Gross appearance of a “blood soaked sponge”
■ The connective tissue can contain multinucleated giant cells and extravasated red blood cells

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11
Q
A

Aneurysmal Bone Cyst

✎ It looks like a blood soaked sponge

✎ There’s these open sinusoidal spaces and then fibrous connective tissue surrounding them.

✎The sinusoidal spaces can vary in size; some of them are fairly small and others are large

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12
Q

Wall of the aneurysmal bone cyst can have a histology similar to the following

A

✎ Central giant cell granuloma

✎ Cherubism

✎ Brown tumor of hyperparathyroidism

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13
Q
A

Aneurysmal Bone Cyst
Histology

Left Image: you can see some of them are fairly small, little spaces within the connective tissue and others are large
✎ at the edges, you do not see endothelia lining, so
these are not vessels neither veins or arteries because they’re not endothelia lined
✎They are just these spaces within this fibrous connective tissue, referred to as sinusoids. You can see that there’s bone trabeculae down here on the left

Middle: On high power, there’s multinucleated giant cells (red) within the fibrous connective tissue and then there’s extravasated red blood cells within the connective
tissue

Right: On higher power; (red) would be the lumen of those sinusoidal spaces. Below that is the connective tissue and you can see there’s no endothelia lining, there’s just fibrous connective tissue and then some
multinucleated giant cells

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14
Q

Aneurysmal Bone Cyst

Treatment

A

■ Treatment is surgical enucleation and curettage

■ lesions can recur ~ Usually the recurrence is because
you didn’t get the entire thing out the first time around

■ Some surgeons follow enucleation with cryotherapy

■ Irradiation is contraindicated

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15
Q

Is bleeding a concern during surgical removal of Aneurysmal Bone Cyst?

A

■ No, vascularity is predominantly “low flow”, therefore not as much concern for bleeding upon surgical removal

■ As compared with central hemangioma where there is a concen for bleeding

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16
Q

Antral Pseudocyst

A

They are different than surgical ciliated cyst

in their lining, etiology, location and appearance!

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17
Q

As opposed of surgical ciliated cysts, Antral psuedocysts are not —-

( in term of their lining)

A

Not epithelial lined spaces

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18
Q

As opposed of surgical ciliated cysts, Antral psuedocysts are not —-

( in term of location)

A

Not within the bone but are in the sinus

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19
Q

As opposed of surgical ciliated cysts, Antral psuedocysts Develop as —-

( in term of etiology)

A

develop as an accumulation of an inflammatory exudate (often serum) between the sinus epithelial lining and the bone

-It develops because of an inflammatory event in the jaw, usually the maxilla, often from the roots of the maxillary teeth that cause inflammation

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20
Q

As opposed of surgical ciliated cysts, Antral psuedocysts appear as —-

( in term of Radiology)

A

Appears as a dome shaped elevation of the floor of the sinus

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21
Q
A

Antral Pseudocyst

  • a Dome-shape swelling on the floor of the sinus.
  • They can sometimes be fairly subtle

Antral Pseduocyst are NOT Mucoceles

Mucoceles would have more of meniscus-like
appearancewhere it would come up tothe edge of
the sinus

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22
Q
A

Aneurysmal Bone Cyst

✎ A dome shape swelling on the floor of the sinus that’s associated with some _sort of inflammation of tooth of t_he premolar caused inflammation underneath the apex of the bone (right) and then that leads to accumulation of fluid which causes the sinus lining to elevate off the bone and fill with fluid
✎ After root canal therapy and once the infection gets under control, these will typically resolve on their own

23
Q

Simple Bone Cyst

also known as

A

aka traumatic bone cyst

24
Q

Simple Bone Cyst

Charcterstics

A
  • A benign, empty or fluid filled, cavity in bone which is devoid of an epithelial lining – a pseudocyst
  • Thought to be reactive, NOT neoplastic
25
Q

Simple Bone Cyst

Etiology

A

Etiology ununcertain, theories include:

  • trauma
  • ischemic necrosis of medullary space
  • cystic degeneration of a primary bone lesion
26
Q

Simple Bone Cyst

Demographics

A
  • In jaws, most likely in the 2nd decade
  • Almost exclusively the mandible
  • Twice as common in males
27
Q

Simple Bone Cyst

Radiographically

A
  • a well-circumscribed radiolucency with an irregular outline
  • Tendency to “scallop” around and between roots (highly suggestive, but not diagnostic of this lesion)
28
Q

Simple Bone Cyst

Histology

A
  • We see only scant delicate vascularized FCT
29
Q

Simple Bone Cyst

Treatment

A
  • exploration and curettage of space to create bleeding. Clot will organize and allow bone repair
  • Recurrence is rare
30
Q
A

Simple Bone Cyst

✎A well-circumscribed with cortication in the body of the
mandible, affecting the posterior aspect (premolars and the molars )

✎Note the scalloping that happens up between the roots. It
doesn’t cause root resorption and actually the lesion will grow up between the roots of the teeth

31
Q
A

Simple Bone Cyst

  • A well-circumscribedshowing the scalloping up between the roots of the teeth radiolucency
32
Q
A

Simple Bone Cyst

✎Big lesion example: It’s going back to the molar area here.

✎You can see that the lesion extends over to the canine on the other side

✎Most lesions are usually in the anterior mandible

33
Q
A

Simple Bone Cyst
Histology

✎This is an example of a curetting from the socket and you can see there’s some bone trabeculae on the bottom
of the image
✎There really isn’t any epithelial lining because it’s a pseudocyst. It’s really just vessels and in fibrous connective
tissue

34
Q

Osteoporotic Bone Marrow Defect

Charcteristics

A
  • it’s a pesydocyst
  • a radiolucency in an area typically
    where tooth has been removed. Instead of filling in with bone, it fills in with marrow.
  • When we biopsy it, you’re seeing the hematopoietic elements. (fat, early stages of (the -blasts of) red cells,
    white cells.
  • We see basic bone forming marrow content
35
Q

Osteoporotic Bone Marrow Defect

Demographic

A

■ Uncommon finding

■ > 75% of cases are in females

■ ~ 70% occur in the posterior MD, often in an edentulous area

it’s a pesydocyst

36
Q

Osteoporotic Bone Marrow Defect

Etiology

A
  • Etiology unclear
  • may be hyperplasia of marrow due to need for RBCs or
  • abnormal regeneration of bone after an extraction or persistence of fetal marrow
37
Q

Osteoporotic Bone Marrow Defect

A

Hematopoietic bone marrow defect

38
Q

Osteoporotic Bone Marrow Defect

Clincalally

A

■ Typically asymptomatic and found on routine radiographic exam

39
Q

Osteoporotic Bone Marrow Defect

Radiographically

A
  • Irregularly shaped radiolucency with either a well-defined or ill-defined border (It can be in the differential diagnosis with malignancy)
40
Q

Osteoporotic Bone Marrow Defect

Histologically

A

■ a cellular hematopoietic marrow is seen with fewer than the normal numbers of fat cells

■ Must biopsy to make a definitive diagnosis

41
Q

Osteoporotic Bone Marrow Defect

Treatment

A

■ Must biopsy to make a definitive diagnosis
■ No further treatment is then necessary

~ You don’t have to remove it; you can just leave it as it is

42
Q
A
  • You can see there’s a little bit of radiolucency.
  • There happened to actually still be teeth in the area, but
  • when it was biopsied it showed that it was a
  • hematopoietic or osteopoietic bone marrow defect
43
Q
A

Osteoporotic Bone Marrow Defect

histology

On biopsy : there’s basically just
blood-forming elements and fat, which is pretty
much all that there is in that lesion

44
Q

Stafne Bone Cyst

also known as

A

static bone cyst, Stafne defect

45
Q

Stafne Bone Cyst

Charcterstics

A

■ An asymptomatic focal concavity of the cortical bone on the lingual aspect of the MD

■ A pseudocyst, not a true cyst

46
Q

Stafne Bone Cyst

Demographics and Location

A
  • Most commonly found near the angle of the mandible below the inferior alveolar nerve (but also seen in the anterior MD)
  • > 80% in Males
  • usually noted only in adults
47
Q

Stafne Bone Cyst

Radiographically

A

Oval round well-circumcribed radilucency

Below the Inferior Alveolar Nerve

48
Q

Stafne Bone Cyst

Etiology

A
  • Believed to be developmental in origin, but usually noted only in _adults_
49
Q

Stafne Bone Cyst

Treatment

A
  • lesions in the posterior MD are usually pathognomonic
  • no further treatment is necessary
50
Q
A

Stafne Bone Cyst

This is the classic look.

  • a well-circumscribed corticated radiolucency
  • below the inferior alveolar nerve, away from the teeth.
  • They can be either oval, like this, or round in appearance
51
Q
A

Stafne Bone Cyst

Less common location

Check if the teeth were vital with vitality test

Get a CBCT in that area
to see what was going on first and then once you saw
the CBCT you’d be able to make the diagnosis.

52
Q

Stafne Bone Cyst
Histology

A

When biopsied, usually get normal salivary gland tissue, but most likely because gland has expanded into the defect

53
Q
A

Stafne Bone Cyst

What we see on biopsy:

✎It’s just salivary gland tissue b_ecause the salivary glands grow into that space_
✎ It’s an empty space that they can grow into and that’s what they do; they just expand into that location. It’s not that the salivary gland is causing it

Oral Path 100 (23 decks)

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