Simplified Block 5: histology Flashcards
1
Q
developmental cysts- ~12
A
DC. EC/EH. PC. OKC. NBCCS (Gorlin Syndrome). OKOC. LPC. GCA. COC (Gorlin Cyst or Dentinogenic ghost cell tumor). GOD (dialo-odontogenic cyst). Carcinoma arising in odontogenic cysts.
1
Q
histology
developmental cysts- ~12
A
Dentigerous cyst. Eruption cyst. Paradental cyst. Odontogenic keratocyst. Nevoid basal cell carcinoma sydrome “Gorlin syndrome.” ortokeratinized dentinoGENIC cyst. Lateral periodontal cyst. Gingival cyst of a newborn. Gingival cyst of the adult. califying odontogenic cyst. glandular odontogenic cyst. [carcinoma arising in odontogenic cysts]
2
Q
dentigerous cyst (DC)
A
Thin, non-keratinized epithelial lining, multipotential (may have mucous or other cells present), Inflamed cyst=APC histo
2
Q
histology
dentigerous cyst (DC)
A
WD, CB, UL, RL around crown of an unerupted tooth, attached to the CEJ
3
Q
eruption cyst (eruption hematoma)
A
Thin layer of keratinized squamous epithelium, may contain blood
3
Q
histology
eruption cyst (eruption hematoma)
A
Soft, translucent swelling in gingival mucosa overlying the crown of an erupting tooth (most commonly 1st perm molars)
4
Q
Paradental cyst
A
“inflamed dentigerous cyst”, Hx of pericoronitis
4
Q
histology
Paradental cyst
A
Cyst on distal or buccal of partially erupted 3rd molar
5
Q
odontogenic keratocyst (OKC)
A
Small satellite cysts in fibrous wall, uniformly thin epithelium, corrugated parakeratin, palisaded basal layer with hyperchromatic nuclei
5
Q
histology
odontogenic keratocyst (OKC)
A
WD, smooth and CB, UL, RL between teeth. Smetimes ML. resemnbles other cytsts, Rx descriotion not diagnostic
6
Q
nevoid basal cell carcinoma syndrome “Gorlin syndrome”
A
Multiple basal cell ca’s, multiple OKCs, palmar/plantar pits, calcified cerebri, enlarged head circumference, Rib anomalies, ocular hypertelorism, spina bifida occulta
6
Q
histology
nevoid basal cell carcinoma syndrome “Gorlin syndrome”
A
Jaw cysts present in 75% of patients
7
Q
orthokeratinized odontogenic cyst
A
Orthokeratin WITHOUT nuclei, prominent granular cell layer, basal cell layer NOT PALISADED and less hyperchromatic
7
Q
histology
orthokeratinized odontogenic cyst
A
Posterior mandible, unerupted 3rd molars, UL, RL. Resembles DC
8
Q
lateral periodontal cyst
A
Focal nodular thickenings (epithelial plaques), lined by uniformly flattened squamous cells, swirl appearance
8
Q
histology
lateral periodontal cyst
A
WD, CB, RL lateral to the roots of VITAL teeth
9
Q
gingival cyst of the newborn
A
Multiple whitish papules on mucosa overlying alveolar process on a newborn (<3mos). Derived from rests of dental lamina, Keratin-filled cysts lined by parakeratotic stratified squamous epithelium.
9
Q
histology
gingival cyst of the newborn
A
N/A
10
Q
gingival cyst of the adult
A
Fluid-filled swelling of the facial gingiva or alveolar mucosa, blue/gray tint, md premolar/anteriors. Derived from rests of dental lamina, soft tissue counterpart of lateral periodontal cyst, focal nodular thickenings
10
Q
histology
gingival cyst of the adult
A
Usually not seen on radiograph due to soft-tissue nature
11
Q
calcifying odontogenic cyst (Gorlin cyst or dentinoGENIC ghost cell tumor)
A
Ghost cells (outline, but no nuclei), dystrophic calcification of ghost cells (RO’s), ghost cell keratinization, epithelium similar to enamel organ and ameloblastoma, loose stellate/spindle cells, columnar cells
11
Q
histology
calcifying odontogenic cyst (Gorlin cyst or dentinoGENIC ghost cell tumor)
A
WD, UL, RL with or without RO’s or Cal’s.
12
Q
Glandular odontogenic cyst (sialo-odontogenic cyst)
A
Derived from rests of dental lamina, lined by stratified squamous epithelium with cililated columnar shape, small microcysts and clusters of mucous cells in cystic lining
12
Q
histology
Glandular odontogenic cyst (sialo-odontogenic cyst)
A
WD, SB, UL or ML, RL. Anterior mandible
13
Carcinoma Arising in odontogenic cysts
Well-differentiated SCC
13
# histology
Carcinoma Arising in odontogenic cysts
Irregular and ragged margins of a RL defect
14
inflammatory cysts - 3
APC (periapical cyst or radicular cyst). RC. BBC.
14
# histology
inflammatory cysts - 3
Apical periodontal cyst. Residual cyst. Buccal bifurcation cyst.
15
Apical periodontal cyst (periapical cyst or radicular cyst)
NON-VITAL TOOTH. Derived from rests of Malassez, SSEpi exhibiting exocytosis and spongious, may have cholesterol clefts, dystrophic calcifications
15
# histology
Apical periodontal cyst (periapical cyst or radicular cyst)
WD, CB, UL, RL in periapical area (classical) or interproximal area. May be along lateral aspect of the root
16
residual cyst
Persistent APC after infected tooth has been extracted. Same histo as APC
16
# histology
residual cyst
WD, CB, RL at extraction site
17
buccal bifurcation cyst
Buccal of mandibular 1st molars, buccal enamel extension leads to pocket, “Site Specific” paradental cyst
17
# histology
buccal bifurcation cyst
WD, UL, RL at buccal bifurcation
18
Non-odontogenic cysts
ABC. FOBMD. STBC. ScC. Idiopathic osteosclerosis. CGCG.osteoma. Chondroma.
18
# histology
Non-odontogenic cysts
aneurysmal bone cyst. Focal osteoporotic bone marrow defect. Simple traumatic bone cyst. Surgical ciliated cyst. Idiopathic osteosclerosis. Central Giant cell Ganuloma. Osteoma. Chrodroma.
19
aneurysmal bone cyst
Blood-filled spaces lined by connective tissue septa, multinucleated giant cells
19
# histology
aneurysmal bone cyst
UL or ML, RL with cortical expansion and thinning
20
focal osteoporotic bone marrow defect
Normal bone marrow, hematopoietic progenitor cells, fat cells. Stimulates an intraosseous neoplasm in an extraction socket
20
# histology
focal osteoporotic bone marrow defect
RL with fine trabeculations, circumscribed with ill-defined borders
21
simple traumatic bone cyst
Thin connective tissue with reactive bone, NO epithelium (NOT a true cyst)
21
# histology
simple traumatic bone cyst
WD, RL, irregular borders, UL, maybe ML, no tooth displacement or root resorption
22
surgical ciliated cyst
Lined by respiratory epithelium, intrabony cyst caused by implantation of sinus epithelium
22
# histology
surgical ciliated cyst
WD, RL in close proximity, but separate from the maxillary sinus
23
idopathic osteosclerosis
Area of hematopoietic marrow, dense lamellar bone with scant fibro-fatty marrow, NOT pathological
23
# histology
idopathic osteosclerosis
RL area with fine trabeculations
24
central giant cell granuloma
Multinuclated giant cells with plump proliferating mesenchymal cells, RBC extravasation
24
# histology
central giant cell granuloma
WD, but NOT corticated, UL or ML, RL defect, anterior mandible
25
osteoma
Associated with Gardner Syndrome, progressive shift in patient occlusion and deviation of midline. Mature compact or cancellous bone
25
# histology
osteoma
Slowly growing masses on surface of mandible/maxilla
26
chrondroma
Composed of mature hyaline cartilage, located on short trabecular bones of the hands and feet
26
# histology
chrondroma
N/A
27
epithelial odontogenic tumors - 8
Ameloblastoma, conventional solid or multicystic ameloblastoma, unicystic ameloblastoma, peripheral ameloblastoma(extraosseaous), malignant ameloblastoma, ameloblastic carinoma, calcifying epithelial odontogenic tumor (pindborg tumor)
27
# histology
epithelial odontogenic tumors - 8
ameloblastoma. Conventional solid or multicystic ameloblastoma. Unicystic ameloblastoma. Peripheral ameloblastoma (extraosseous). Malignant ameloblastoma. Ameloblastic carcinoma. Adenoatoid odontogenic tumor. Calcifying epithelial odontogenic tumor (pindborg).
28
ameloblastoma
Most common clinically significant odontogenic tumor. Slow growing, locally invasive, usually benign , painless swelling covered by oral mucosa
28
# histology
ameloblastoma
RL, UL early, ML later, expansion, tooth displacement, might resorb roots
29
conventional solid or multicystic ameloblastoma
86% of Ameloblastomas. Islands of odontogenic epithelium, core resembles stellage reticulum of enamel organ, peripheral columnar cells with REVERSE POLARITY of nuclei
29
# histology
conventional solid or multicystic ameloblastoma
ML, RL lesion with “soap bubble” or honeycomb appearance, B/L cortical expansion, root resorption of teeth adjacent to the tumor.
30
unicystic ameloblastoma
13% of Ameloblastomas: Luminal: basal layer columnar/cuboidal cells with hyperchromatic nuclei, reverse polarity, basilar cytoplsmic vacuolization. Intraluminal/Plexiform: one or more nodules of ameloblastomas project from cystic lining into lumen. Mural: fibrous wall of the cyst infiltrated by typical follicular or plexiform ameloblastoma
30
# histology
unicystic ameloblastoma
circumscribed RL, may/may not be around the crown. Can resemble DC.
31
peripheral ameloblastoma- extraosseous
1% of Ameloblastomas
31
# histology
peripheral ameloblastoma- extraosseous
na
32
ameloblastic carcinoma
Ameloblastoma in primary tumor and metastatic deposits
32
# histology
ameloblastic carcinoma
na
33
malignant ameloblastoma
Ameloblastoma that has cytologic features of malignancy in the primary tumor, in a recurrence, or in any metastatic deposit
33
# histology
malignant ameloblastoma
na
34
adenomatoid odontogenic tumor
Thick fibrous capsule, duct-like epi structures lined by cuboidal columnar cells, nuclei polarized AWAY from central spaces, all cells are epithelial
34
# histology
adenomatoid odontogenic tumor
WD, CB, UL, RL invoving crown of unerupted tooth (below CEJ), tooth displacement, snowflake cal’s
35
califying epithelial odontogenic tumor (pindborg)
Large cells with nuclei (different from COC), expansile, painless swelling. Congo Red test + for Amyloid proteins . Concentric Liesegang Ring Calcifications
35
# histology
califying epithelial odontogenic tumor (pindborg)
WD or Ill-defined, UL or ML RL with flecks of RO’s, strong tooth displacement, honeycomb appearance
36
ectomesenchyme odontogenic tumors
Central odontogenic fibroma. Peripheral odontogenic fibroma. Odontogenic myxoma. Cementoblastoma.
36
# histology
ectomesenchyme odontogenic tumors
central odontogenic fibroma. Peripheral odontogenic fibroma. Odontogenic myoma. Cementoblastoma.
37
Central odontogenic fibroma
Hyperplastic dental follicle
37
# histology
Central odontogenic fibroma
WD, UL (early)/ML (late), RL associated with periradicular areas of erupted teeth, root resorption
38
peripheral odontogenic fibroma
Soft tissue counterpart of central odontogenic fibroma.Slow-growing, sessile mass covered by normal mucosa
38
# histology
peripheral odontogenic fibroma
Similar to peripherial ossifying fibroma
39
odontogenic myxoma
Haphazardly arranged stellate, spindle-shaped and round cells, glycosaminoglycans, no capsule, jelly-like. Locally aggressive, jaw lesion only with painless swelling
39
# histology
odontogenic myxoma
UL or ML, Irregular/scalloped margins, thin, wispy trabeculae of residual bone, “step ladder” pattern, rare root resorption, soap bubble appearance
40
cementoblastoma
Slow-growing, dentin-resorbing (not hypercementosis), strongly active osteoblastic activities
40
# histology
comentoblastoma
WD, RO (density of cementum), RL halo, attached to root of affected tooth, resorbed root
41
Mixed odontogenic tumors (odontogenic epithelium and ecomesenchymal elements)
ameloblastic fibroma. Ameloblastic fibrosarcoma. Ameloblastic fibro-odontoma. Compound odontoma. Complex odontoma.
41
# histology
Mixed odontogenic tumors (odontogenic epithelium and ecomesenchymal elements)
ameloblastic fibroma. Ameloblastic fibrosarcoma. Ameloblastic fibro-odontoma. Compound odontoma. Complex odontoma
42
ameloblastic fibroma
Narrow cords of odontogenic epithelium anastomosing, peripheral nuclear palisading columnar cells
42
# histology
ameloblastic fibroma
WD, UL or ML, RL extending from superior part of the tooth follicle (NOT CEJ) of an unerupted tooth
43
ameloblastic fibrosarcoma
Malignant counterpart of ameloblastic fibroma
44
ameloblastic fibro-odontoma
Disorganized tooth structure, same histo as ameloblastic fibroma,
44
# histology
ameloblastic fibro-odontoma
WD, CB, RL defect with variable amt of calcified material with the radiodensity of tooth structure
45
compound odontoma
Multiple tooth-like structures, anterior maxilla
45
# histology
compound odontoma
Collection of ROs (tooth-like structures) surrounded by a narrow RL zone
46
complex odontoma
Conglomerate mass of enamel and dentin, NO resemblance to a tooth, may cause impaction
46
# histology
complex odontoma
Calcified mass with radiodensity of tooth structure surrounded by RL halo
47
# histology
Three categories of fibro-osseous lesions in the jaw (normal bone replaced with excessive proliferation of fcellular fibrous CT)
fibrous dysplasia. Reactive/dysplastic lesions in alveolous (tooth bearing areas of the jaw) or? Cemento-osseous dysplasia. Fibro-osseous neoplasms.
48
name 7 fibro-osseous lesions of the jaw
Monostotic fibrous dysplasia of the jaw. Polyostotic dysplasia of the jaw. Focal-cemento-osseous dysplasia. Periapical cemento-posseous dysplasia. Florid cemento-osseous dysplasia. Ossifying/cementifying fibroma. Osteoblastoma (and osteoid osteoma)
48
# histology
name 7 fibro-osseous lesions of the jaw
FIBROUS DYSPLASIA: monostatic fibrous dysplasia of the jaws. Polyostotic fibrous dysplasia of the jaws. REACTIVE/DYSPLASTIC LESION OF THE ALVEOLOUS AND CEMENTO-OSSEOUS DYSPLASIA: Focal cemento-osseous dysplasia (FCOD). Periapical cemento-osseous dysplasia (PCOD). Florid cemento-osseous dysplasia (FOD, FLCOD). FIBRO-OSSEOUS NEOPLASMS (2): Ossifying/cementifying fibroma. osteoblastoma and osteoid osteoma.
49
FD: monostotic fibrous dysplasia of the jaw
single bone, max\>mandib, young F, poorly calcified bone trabeculae arranged in a disorganized pattern
49
# histology
FD: monostotic fibrous dysplasia of the jaw
Fine “ground glass” opacification, not well-demarcated
50
FD: polyostotic fibrous displasia of the jaw
two or more bones, café au lait spots, jaffe-lichtenstein syndrome, McCume-albright syndrome (sexual precosity)
50
# histology
FD: polyostotic fibrous displasia of the jaw
Early: RL, WD, UL. Late: ROs take on numerous shapes and sizes, borders blend with bone. Bone exp, tooth displacement, root resorption, obliteration of max sinus.
51
R/DL, COD: focal cemento-osseous dysplasia (FCOD)
anywhere in jaw, singl-site involved, asymptomatic, small
51
# histology
R/DL, COD: focal cemento-osseous dysplasia (FCOD)
Mixed RL/RO, thin RL rim
52
R/DL, COD: periapical cemento-osseous dysplasia (PCOD)
VITAL TEETH, asymptomatic pt, scpecules of bone and some cementum-like hard tissues
52
# histology
R/DL, COD: periapical cemento-osseous dysplasia (PCOD)
Uncircumscribed zones of RL involving periapical region of anterior mandible.
53
R/DL, COD: florid cemento-osseous dysplsia (PLCOD, FOD)
VITAL TEETH, multifocal involvement, not limited to anterior mandible, bilateral symmetry involvement, simple bone cyst may be present, osteomyolitis due to reduced valscularity
53
# histology
R/DL, COD: florid cemento-osseous dysplsia (PLCOD, FOD)
Multiple, WD, lobular, \<3m, RL with some ROs, bilateral and symmetric, no tooth resorption, hypercementosis, increased bone density
54
FON: ossifying/cementifying fibroma
painless swelling with obvious facial asmmatry, jaw expansion, tooth displacement, asymmtomatic
54
# histology
FON: ossifying/cementifying fibroma
WD, UL w/varying levels of RO (RL, Mixed or RO), CB (diff from later stage fibrous dysplasia), root resorption
55
FON: obsteoblastoma and osteoid osteoma
benign bone tumors occasionally seen in the haw, histo identical to OSTEOBLASTOMA
55
# histology
FON: obsteoblastoma and osteoid osteoma
N/A
56
Malignant bone tumors- 3
Osteosarcoma. Chondrosarcoma. Metatstatic tumors of the jaw.
56
# histology
Malignant bone tumors- 3
osteosarcoma. Chondrosarcoma. Metastatic tumors of the jaws.
57
clinical findings of bone malignancies (2)
redness and bleeding of gingiva. Persistent, non-healing ulcers
57
# histology
clinical findings of bone malignancies (2)
clinical findings of bone malignancies: 1. redness and bleeding of gingiva. 2. persistent, non-healing ulcer.
58
general RG findings of bone malignancies (8)
superficial horizontal resorption. Erosion of bony SF. RL with ill-defined bornders and ragged Ros. Pathologival fractures. Opacification of sinus. Destruction of sinus walls. Floating teeth. Root resorption.
58
# histology
general RG findings of bone malignancies (8)
general RG findings of bone malignancies: 1. superficial horizontal resorption. 2. erosion of bony SF. 3. RL with ill-defined borders and ragged Ros. 4. pathological fractures. 5. opacification of the sinus. 6. destruction of the sinus walls/floor. 7. floating teeth. 8. root resorption.
59
other malignancies of the jaws and O.C. (3)
leukemia. Burkitt's lymphoma. Multiple myeloma.
59
# histology
other malignancies of the jaws and O.C. (3)
leukemia. Burkitt's lymphoma. Multiple myeloma.
60
osteosarcoma
malignancy of mesenchymal cells, central lesion. "bad cells, bad bone" malignant cartilage and bone
60
# histology
osteosarcoma
Ill-defined and indistinct peripheral border, classic sunburst appearance (periosteal reaction), widening of PDL, elevation of bone height ABOVE CEJ, perforation, exp of cortical margins
61
chomdrosarcoma
maignancy Chx by formation of cartilage and no bone
61
# histology
chomdrosarcoma
RL process with poorly defined borders
62
metastatic tumors of the jaws
MOST COMMON malignancy of the jaw, from BREAST, PROSTATE, LUNG, KIDNEY carcinomas
62
# histology
metastatic tumors of the jaws
Ill-defined, “moth eaten”, destructive margins, irregular shape, destruction of lamina dura, tooth mobility, “floating teeth,” RL defects
63
leukemia
acute (50-60yo), gingival infiltration, swelling, perio disease
63
# histology
leukemia
Destruction of alveolar bone, loss of lamina dura, loosening of teeth, ill-defined RLs
64
burkitt's lymphoma
african form has jaw involvement, 5-12yo, loosening, displacement, premature eruption
64
# histology
burkitt's lymphoma
Jaw expansion, single or multiple RL foci in molar region, ill-defined borders, perforation, destruction, displacement of B/L corticies
65
multiple myeloma
weakness and pain, pathologic fractures, multiple bone involved (%14 JAWS), mobility and migration of teeth, bence-jones protein urine
65
# histology
multiple myeloma
Multiple, small, WD, non-corticated RLs, uni- or bilateral, skull often involved, “punched-out”
66
benign odontogenic tumors of the jaw
Fibroma: Ossifying fibroma, Fibromyxoma
Osteoma: Osteoid osteoma, Osteoblastoma
Chondroma: Chondroblastoma, Chondromyxoid fibroma, Osteochondroma
Hemangioma
Giant cell tumor: Giant cell reparative granuloma, Brown tumor of hyperparathyroidism, Cherubism
Histiocytosis: Benign fibrous histiocytoma
Neuroma: Neurofibroma, Schwannoma
Lymphangioma
67
odontogenic jaw tumors
Ameloblastoma
* Ameloblastic fibroma
* Ameloblastic myxoma
* Ameloblastic odontoma
Calcifying epithelial odontogenic tumor (Pindborg)
Ameloblastic adenomatoid tumor
Myxoma
Odontoma
Cementoma
68
tumor-like diseases of the jaw
* Fibrous dysplasia
* Paget’s disease of bone
* Florid osseous dysplasia
* Osteopetrosis
69
