Cysts and Odontogenic Tumors Part 2

Question 1

where is the globulomaxillary position

Answer 1

at the junction of the maxilla with premaxilla, between maxillary lateral incisor and canine

Question 2

is there a developmental fissural cyst in the globulomaxillary position

Answer 2

no

Question 3

a developmental “globulomaxillary cyst”:

Answer 3

does not exist

Question 4

what cysts are found in the globulomaxillary position and what is the prevalence of each

Answer 4

• PA cyst: 50%
• PA granuloma: 15%
• lateral periodontal cyst: 10%
• odontogenic keratocyst: 10%
• giant cell tumor: 7%
• other lesions: 3% such as gorlin cyst, odontogenic myxoma, adenomatoid odontogenic tumor, neurofibroma, hemangioma

Question 5

what are the dental lamina cysts

Answer 5

• lateral periodontal cysts
• botryoid odontogenic cyst
• gingiva cyst of adult
• dental lamina cyst of newborn

Question 6

describe the lateral periodontal cyst and its prevalance

Answer 6

• a developmental cyst that arises from dental lamina rests (rests of Serres)
• vital teeth of adult males (3:1)
• mandibular premolar area
• maxillary incisor-canine area
• unilocular

Question 7

what is the DDX for lateral periodontal cyst

Answer 7

PA cyst

Question 8

what is the tx for lateral periodontal cyst

Answer 8

surgery

Question 9

what is the histological presentation for lateral periodontal cyst

Answer 9

• epithelium, lumen, wall
• epithelium alternates thick and thin areas

Question 10

describe the botyroid odontogenic cyst

Answer 10

• polycystic variant of the lateral periodontal cyst
• a developmental odontogenic cyst that presents as a multilocular lucency associated with the vital mandibular premolars of adults

Question 11

describe the gingival cyst of the adult and the prevalance

Answer 11

• soft tissue counterpart of the lateral periodontal cyst
• no radiographic presenation
• a developmental cyst that arises from dental lamina rests (rests of Serres)
• vital teeth of adult males (3:1)
• mandibular premolar area and. maxillary incisor-canine area

Question 12

what is the histological presentation of gingival cyst of the adult

Answer 12

alternating thick and thin epithelium

Question 13

what is the tx for the dental lamina cyst of the newborn

Answer 13

will usually resolve on their own

Question 14

what is the histological presentation of the dental lamina cyst of the newborn

Answer 14

mutliple cystic areas filled with keratin

Question 15

what are the other names for the palatal cyst of the newborn

Answer 15

• epstein’s pearls
• Bohn’s nodule

Question 16

describe dental lamina cysts

Answer 16

• epithelial remnants of dental lamina from odontogenesis
• odontogenic cysts

Question 17

describe epstein’s pearls

Answer 17

• epithelial remnants from palatal shelf fusion
• non-odontogenic cysts

Question 18

describe Bohn’s nodules

Answer 18

• epithelial remnants from minor salivary gland formation
• non-odontogenic cysts

Question 19

describe primordial cysts

Answer 19

• radiographic dx only
• radiographic term for a cyst that develops in place of a tooth
• likely to be an OKC
• found in an area of a congenitally missing tooth

Question 20

what is the DDX for primordial cyst

Answer 20

residual cyst

Question 21

describe OKCs

Answer 21

• posterior jaws of teenagers, young adults
• aggressive growth with 30% recurrence
• a unilocular or multilocular radiolucency; imitates other lucencies

Question 22

what are the radiographic presentations of OKCs and the prevelance of each

Answer 22

• primordial cysts: 50%
• lateral periodontal: 25%
• dentigerous: 10%
• globulomaxillary:10%

Question 23

what is the histology for an odontogenic keratocyst

Answer 23

• compact epithelium, no rete ridges, 8 to 10 cell layers thick
• corrugated surface parakeratin
• prominent, palisaded, hyperchromatic basal layer

Question 24

what is the histologic presentation of an OKC

Answer 24

• epithelium is thin
• basal cell layer is really dark
• keratin is wavy

Question 25

what is the significance of the odontogenic keratocyst

Answer 25

- aggressive behavior - recurrence- 30% - nevoid basal cell carcinoma syndrome

Question 26

what is the cause of non-syndrome associated OKC

Answer 26

idiopathic

Question 27

what is the cause of syndrome associated OKC

Answer 27

multiple OKCs common in the nevoid basal cell carcinoma syndrome

Question 28

what is the other name for nevoid basal cell carcinoma syndrome

Answer 28

gorlin syndrome

Question 29

describe nevoid basal cell carcinoma syndrome

Answer 29

- basal cell nevus syndrome - gorling-goltz syndrome - gorlin syndrome - autosomal dominant- highly penetrant and variably expressive - mutation in PTCH tumor suppressor gene at 9q22.3

Question 30

what are the features of the nevoid basal cell carcinoma syndrome

Answer 30

- skeletal anomalies: bifid ribs - jaw cysts: multiple OKCs - skin tumors: multiple, early onset, basal cell carcinomas - neoplasms- CNS- medulloblastoma

Question 31

when do multiple basal cell carcinomas in nevoid basal cell carcinoma syndrome occur

Answer 31

early in life

Question 32

what should you do in early recognition and dx of nevoid basal cell carcinoma syndrome

Answer 32

- OKCs present early - prevent disfiguring basal cell carcinomas - evaluate for medulloblastoma

Question 33

describe the orthokeratinizing odontogenic cyst

Answer 33

- a developmental odontogenic cyst with an orthokeratin lining, NOT parakeratin - originally described as the "orthokeratinized variant of the odontogenic keratocyst" - does not behave as an odontogenic keratocyst- no recurrence

Question 34

what is the difference between histology of OKC and OOC

Answer 34

- OKC is wavy and palisading - OOC is not wavy and not palisading

Question 35

describe the calcifying odontogenic cyst (Gorlin cyst)

Answer 35

- gorlin cyst, calcifying and keratinizing odontogenic cyst - anterior jaws of adults - radiolucent to mixed - ghost cells - sometimes associated with odontomas

Question 36

describe the glandular odontogenic cyst

Answer 36

-sialodontogenic cyst- an odontogenic cyst with glandular (salivary) features - anterior jaws of middle aged adults, mandible > maxilla - commonly multilocular, crosses midline - aggressive behavior - 30% recurrence