chpt 15- odontogenic cysts and tumors ppt Flashcards
(112 cards)
1
Q
develops from separation of follicle around a crown
A
dentigerous cyst
2
Q
Most common type of developmental odontogenic cyst
A
dentigerous cyst
3
Q
character of dentigerous cyst
A
encloses crown of an unerupted tooth and is attached to the tooth at the CEJ
4
Q
How will the dentigerous cyst appear radiographically
A
Well defined radiolucency around the crown of an impacted or unerupted tooth; > 3.0mm from crown to edge of RL
5
Q
Dentigerous cyst demographics
A
M > F, 10-30 years, Whites > Blacks
6
Q
Can dentigerous cyst cause resorption of adjacent tooth
A
yes
7
Q
clinical features of dentigerous cyst
A
- usually asymptomatic
- found on routine examination
- RARELY CAUSES EXPANSION
8
Q
are DCs UL or ML?
A
- 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
Q
Treatment for DC
A
- 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
Q
most common location for DC
A
Mandibular 3rd molar
Maxillary canines
Maxillary 3rd molars
Mandibular 2nd premolars
11
Q
histology for DC
A
SSE with cyst wall devoid of inflam-mation
IROE
12
Q
Soft tissue analogue of DC
A
eruption cyst
13
Q
Separation of the dental follicle around the crown of a developing tooth within the soft tissue overlying alveolar bone
A
eruption cyst
14
Q
Soft, translucent swelling in gingival mucosa overlying the crown of tooth in kids < 10
A
eruption cyst
15
Q
Surface trauma may result in considerable blood (eruption hematoma)
A
eruption cyst
16
Q
treatment for eruption cyst
A
- may not be required due to spontaneous rupture, allowing tooth to erupt
- simple excision of roof of cyst if it doesn’t erupt
17
Q
Grow antero-posterior direction within medullary bone without expansion
A
OKC
18
Q
most common location for OKC, where it is found 60-80% of the time
A
-mandible- body and ascending ramus
19
Q
demographics
A
- males > females
- 60% bwn 10-40
20
Q
Histology for OKC
A
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
Q
treatment for OKC
A
- Enucleation & curettage
- Peripheral ostectomy
- Chemical cauterization after cyst removal
- Decompression
22
Q
Multiple BCCa Odontogenic keratocysts Rib and vertebral anomalies Intracranial calcifications Palmar & plantar pits
A
Basal cell carcinoma syndrome
23
Q
Small superficial keratin-filled cysts on alveolar mucosa of infants
A
gingival cyst of the newborn
24
Q
Common in ½ of newborns and disappear spontaneously by rupture into oral cavity
A
gingival cyst of the newborn
25
Gingival cyst name if they are found on midline of palate
Epstein pearl
26
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
32
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
33
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
48
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
53
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
54
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
64
often contains snowflake calcifications
adenomatoid odontogenic tumor
65
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
71
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
74
AF w/enamel and dentin
ameloblastic fibro-odontoma
75
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
78
max > mand, avg age 14, male = female, 50% associated w/impacted tooth, usually not expansile, compound = complex
odontoma
79
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
92
ameloblasts make
enamel
93
odontoblasts make
dentin
94
cementoblasts make
cementum
95
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
111
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
