chpt 15- odontogenic cysts and tumors ppt Flashcards Preview

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1

develops from separation of follicle around a crown

dentigerous cyst

2

Most common type of developmental odontogenic cyst

dentigerous cyst

3

character of dentigerous cyst

encloses crown of an unerupted tooth and is attached to the tooth at the CEJ

4

How will the dentigerous cyst appear radiographically

Well defined radiolucency around the crown of an impacted or unerupted tooth; > 3.0mm from crown to edge of RL

5

Dentigerous cyst demographics

M > F, 10-30 years, Whites > Blacks

6

Can dentigerous cyst cause resorption of adjacent tooth

yes

7

clinical features of dentigerous cyst

-usually asymptomatic
-found on routine examination
-RARELY CAUSES EXPANSION

8

are DCs UL or ML?

-Large DC may give the impression of a multilocular process due to persistence of bone trabeculae within the radiolucency
-DC are grossly and histopathologically unilocular processes

9

Treatment for DC

-Curettage of cyst with or without extraction of impacted tooth
-No recurrence expected
-Large DC may be treated by marsupialization which permits decompression of the cyst, with a resulting reduction in size of the bone defect

10

most common location for DC

Mandibular 3rd molar
Maxillary canines
Maxillary 3rd molars
Mandibular 2nd premolars

11

histology for DC

SSE with cyst wall devoid of inflam-mation
IROE

12

Soft tissue analogue of DC

eruption cyst

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Separation of the dental follicle around the crown of a developing tooth within the soft tissue overlying alveolar bone

eruption cyst

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Soft, translucent swelling in gingival mucosa overlying the crown of tooth in kids < 10

eruption cyst

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Surface trauma may result in considerable blood (eruption hematoma)

eruption cyst

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treatment for eruption cyst

-may not be required due to spontaneous rupture, allowing tooth to erupt
-simple excision of roof of cyst if it doesn't erupt

17

Grow antero-posterior direction within medullary bone without expansion

OKC

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most common location for OKC, where it is found 60-80% of the time

-mandible- body and ascending ramus

19

demographics

-males > females
-60% bwn 10-40

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Histology for OKC

1)uniformly thin 6-8 cell layers of epithelium
2)no rete pegs
3)prominent basal cell layer
-can be parakeratin or orthokeratin
-high recurrence rate

21

treatment for OKC

-Enucleation & curettage
-Peripheral ostectomy
-Chemical cauterization after cyst removal
-Decompression

22

Multiple BCCa
Odontogenic keratocysts
Rib and vertebral anomalies
Intracranial calcifications
Palmar & plantar pits

Basal cell carcinoma syndrome

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Small superficial keratin-filled cysts on alveolar mucosa of infants

gingival cyst of the newborn

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Common in ½ of newborns and disappear spontaneously by rupture into oral cavity

gingival cyst of the newborn

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Gingival cyst name if they are found on midline of palate

Epstein pearl

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Gingival cysts if they are scattered on hard or soft palate

Bohn's nodules

27

where are gingival cysts more commonly found- max or manx?

maxilla

28

Treatment for Gingival cysts, Epstein pearls, or Bohn’s nodules

none; self rupture; rarely seen after 3 mo

29

Soft tissue counterpart of LPC located on the facial gingiva

gingival cyst of the adult

30

what color is gingival cyst of adult

bluish

31

most common location for gingival cyst of the adult

75-80% on mand canine/premolar

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Derived from dental lamina (rests of Serres)
Adults in 5-6th decades; rare before 30
Most cyst less than 1 cm

gingival cyst of the adult

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Arise from rests of dental lamina or proliferation of REE along lateral root

lateral periodontal cyst

34

demographics and location of LPC

Males > 30
Mandibular canine/premolar region
Less common maxillary lesions seen in same location

35

polycystic appearance; may have multilocular appearance
Grossly and microscopically, they show a grapelike cluster of small individual cysts

Botryoid odontogenic cyst - subtype of LPC; associated w/higher recurrence rate

36

Cuboidal epithelial cells with foci of glycogen rich cells
Thickening of epithelial lining

LPC histology

37

other names for calcifying odontogenic cyst

Gorlin cyst
Dentinogenic ghost cell tumor
Calcifying ghost cell odontogenic cyst

38

age and location of COC

-mand = max
-65% found in incisor canine region
-avg age 33 and most dx'd in 2-3 decades

39

what age is associated w/COC assoc w/odontomas found in

17 yrs

40

radiographic appearance of COC

-usually well defined UL RL, occasionally ML; associated w/unerupted tooth (usually canine)
-RL lesion w/calcified structures

41

size of COC

2-4cm

42

Is root resorption seen with COC?

Yes, also see divergence of adjacent teeth

43

what else can COC be mistaken for clinically?

gingival fibromas, gingival cysts, or peripheral gingival lesions

44

histology of COC

-well defined cystic lesion w/fibrous capsule and 4-10 cell layers thick of odontogenic epithelial lining
-ameloblast like epithelial cells w/cuboidal or columnar basal layer
-GHOST cells: altered epithelial cells characterized by loss of nuclei w/preservation of cell outline (large eiosinophilic)

45

are COCs associated w/odontomas

Yes, 20% of COC are assoc w/odontomas

46

treatment and recurrence of COC

simple enucleation w/few recurrences

47

inflammatory odontogenic cyst on the B aspect of mandibular 1st permanent molar

Buccal Bifurcation Cyst

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well circumscribed UL RL involving B furcation and root area; associated w/swelling and foul tasting discharge; seen in kids 5-11

Buccal bifurcation cyst

49

6 criteria used to diagnose odontogenic tumors

1)Radiogrpahic characteristics
2)Age
3)Association w/unerupted teeth
4)Induction vs no induction
5)Location: max vs mand
6)Sex predilection

50

most common clinically significant odontogenic tumor

ameloblastoma

51

tumor islands extend as much as 1cm beyond radiographic features indicate

ameloblastoma

52

painless swelling or expansion of the jaw, 3rd-7th decades

ameloblastoma

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ML RL lesion, soap bubble (large), honeycombed (small), B and L expansion w/resorption of roots, unerupted tooth is often associated w/RL defect (manx 3rd)

ameloblastoma

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which histological pattern is associated with: single layer of tall ameloblast-like cells surrounding a centre core w/reverse polarity

follicular pattern of ameloblastoma

55

which histologic pattern is associated with: long anastomosing cords or larger sheets of odontogenic epithelium; cyst formation is uncommon

plexiform pattern of ameloblastoma

56

other histologic patterns of ameloblastoma (4)

Acanthomatous
Basal cell
Desmoplastic
granular cell

57

most common location of ameloblastoma

posterior mandible
maxillary lesions are assoc w/molars and or antrum

58

form of ameloblastoma in the posterior mandible that appears as a circumscribed RL surrounding the crown of unerupted 3rd molar

unicystic ameloblastoma

59

form of ameloblastoma located in posterior gingiva and alveolar mucosa (manx > max)

peripheral ameloblastoma

60

epithelial tumor with inductive effect on odontogenic ectomesenchyme

adenomatoid odontogenic tumor

61

younger females (10-19), anterior maxilla

adenomatoid odontogenic tumor

62

size and treatment for adenomatoid odontogenic tumor

usually small, rarely > 3cm
enucleation

63

cricumscribed UL RL involving the crown of an unerupted tooth, usually CANINE and extends apically along the root past the CEJ (vs DC)

adenomatoid odontogenic tumor

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often contains snowflake calcifications

adenomatoid odontogenic tumor

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histology of adenomatoid odontogenic tumor

-fibrous capsule, epithelial cells that form sheets, strands, or whorled masses of cells in scant fibrous storms, ROSETTElike structures about a central space that may contain eosinophilic material
-small foci of calcifications

66

also known as Pindborg tumor

calcifying epithelial odontogenic tumor

67

posterior mandible, EL or ML RL defect that may contain calcified structures

calcifying epithelial odontogenic tumor

68

polyhedral epithelial cells in fibrous stroma, epithelial cells have intercellular bridges, eosinophilic, hyalinized (amyloid like) extracellular material

calcifying epithelial odontogenic tumor

69

calcification is a distinctive feature; develops w/in the amyloid like material and form concentric rings (Liesegang ring calcifications)

calcifying epithelial odontogenic tumor

70

Liesegang ring calcifications

calcifying epithelial odontogenic tumor

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often associated w/impacted manx 3rd molar; less aggressive than ameloblastoma

calcifying epithelial odontogenic tumor

72

treatment and recurrence of calcifying epithelial odontogenic tumor

-conservative local resection w/narrow rim of surrounding bone
-treat lesion in posterior maxilla more aggressively
-15% recurrence rate, spec if treated by curettage

73

posterior mandible, kids <10, found on X-ray taken for failure of tooth to erupt

ameloblastic fibro-odontoma

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AF w/enamel and dentin

ameloblastic fibro-odontoma

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circumscribed UL RL w/variable amount of calcified material w/the radio density of a tooth structure; unerupted tooth is present at the margin or crown of the unerupted tooth found in the defect

ameloblastic fibro-odontoma

76

treatment and prognosis for ameloblastic fibro-odontoma

conservative curettage and lesion easily separates from bone
excellent prognosis

77

most common odontogenic tumor (not a true tumor)

odontoma

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max > mand, avg age 14, male = female, 50% associated w/impacted tooth, usually not expansile, compound = complex

odontoma

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ALWAYS a RO foci density of enamel; well defined

odontoma

80

treatment for odontoma

remove if blocking eruption

81

from the odontogenic ectomesenchyme, adults 25-30, found in any area of jaws but mand > max

odontogenic myxoma

82

3 lesions w/soap bubble appearance

1)OKC
2)Ameloblastoma
3)Odontogenic myxoma

83

UL or ML RL that can displace or cause resorption of teeth; margins are irregular/scalloped, can be soap bubble and contain thin wispy trabecular of residual bone arranged @ right angles to each other

odontogenic myxoma

84

what does histochemical staining show

ground substance composed of GAGs, hyaluronic acid and chondroitin sulfate

85

what does Immunohistochemistry show

Abs against VIMENTIN and focal reactivity for muscle specific actin

86

treatment and recurrence of odontogenic myxoma

-small: curettage w/recall every 5 yrs
-large: resection may be required due to lack of capsulation and infiltrate into surrounding bone
-25% recurrence
prognosis = good

87

Will and ameloblastoma, while causing buccal and lingual cortical expansion, perforate the inferior border of the mandible

no

88

What tooth does the Adenomatoid Odontogenic tumor usually affect

crown of canine

89

Appears radiographically as a collection of tooothlike structures of varying size and shape surrounded by a narrow radiolucent ring

compound odontoma

90

Appears as a calcified mass with the radiodensity of tooth structure, which is surrounded by a narrow radiolucent ring

complex odontoma

91

What germ layer does the dental lamina induce to become specialized cells (ectomesenchyme) capable of being induced further into odontogenic cells which differentiate and produce calcified dental tissues

neuroectoderm

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ameloblasts make

enamel

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odontoblasts make

dentin

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cementoblasts make

cementum

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what induces the formation of pre-secretory odontoblasts

formation of pre-ameloblasts

96

What induce odontoblasts to secrete the dentin matrix

maturing ameloblasts

97

what induces ameloblasts to secrete enamel matrix

odontoblasts secreting dentin

98

3 things from which an Ameloblastoma can form

Basal cells or oral mucosa
Developing enamel organ (pre-induction
epithelium)
Cell rests of enamel organ

99

2 most common forms of Ameloblastoma

plexiform and follicular

100

which of the two most common forms of amelobalstoma is associated with cyst formation

follicular

101

This ameloblastoma variant has highly eosinophilic cells with granules that look lysosomal

Granular Cell Ameloblastoma

102

Acanthomatous variant Ameloblastoma forms what

keratin

103

What can the Acanthomatous variant Ameloblastoma be confused with

SCC

104

Tumors of odontogenic Epithelium are composed of what and is there ectomesenchyme participation

composed only of odontogenic epithelium without any ectomesenchyme participation

105

3 tumors of Odontogenic Epithelium

Ameloblastoma
Adenomatoid Odontogenic tumor
Calcifying Epithelial Odontogenic tumor/ Pindborg tumor

106

3 mixed odontogenic tumors

Ameloblastic fibroma Ameloblastic fibro-odontoma
Odontoma

107

4 tumors of odontogenic ectomesenchyme

Central odontogenic fibroma Peripheral odontogenic fibroma Odontogenic myxoma Cementoblastoma

108

true mixed tumor of epithelial and mesenchymal elements

ameloblastic fibroma

109

young pts in posterior mandible, 75% associated w/unerupted tooth

ameloblastic fibroma

110

UL or ML RL lesion; well defined margins which may be sclerotic; may or may not have a capsule

amelobalstic fibroma

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does NOT demonstrate micro cyst formation and has cell rich mesenchymal tissues that resemble primitive dental papilla mixed w/proliferating odontogenic epithelium

ameloblastic fibroma

112

treatment for ameloblastic fibroma

conservative removal, usually don't recur