Cysts and Odontogenic Tumors Part 3

Question 1

what are the soft tissue cysts

Answer 1

• nasolabial cysts
• lymphoepithelial cyst
• cervical lymphopithelial cyst
• thyroglossal duct cyst

Question 2

what is another name for the naslabial cyst

Answer 2

• nasoalveolar cyst
• klestadt cyst

Question 3

describe the nasolabial cyst, the location and predeliction

Answer 3

• soft tissue cyst of the upper lip lateral to midline
• developmental cyst, remants of nasolacrimal duct
• adult females 3:1

Question 4

describe the histology of the nasolabial cyst

Answer 4

• goblet cells
• cilia
• respiratory like epithelium

Question 5

how do you tell the difference between the nasolabial cyst and the glandular odontogenic cyst

Answer 5

there will be radiographic presentation with glandular odontogenic cyst

Question 6

describe the oral lymphoepithelial cyst

Answer 6

• cystic change of crypt epithelium of lymphoid aggregate

Question 7

who is the oral lymphoepithelial cyst common in and where is it found

Answer 7

• young adults
• waldeyer’s ring
• tonsillar pillar
• FOM
• ventral tongue

Question 8

describe the histology for the oral lymphoepithelial cyst

Answer 8

• lymphoid tissue with germinal centers

Question 9

what is another name for the cervical lymphoepithelial cyst

Answer 9

branchial cleft cyst

Question 10

describe the cervical lymphoepithelial cyst and the location

Answer 10

• cystic change of branchial epithelium
• upper lateral neck anterior to border of sternocleidomastoid muscle in young adults

Question 11

describe the cervical lymphoepithelial cyst histology

Answer 11

• stratified squamous epithelial lining exhibiting lymphoid tissue with or without germinal centersin the wall

Question 12

describe the thyroglossal duct cyst and the predilection

Answer 12

• cystic change of thyroglossal tract epithelium
• midline of neck in young people

Question 13

describe the histology of the thyroglossal duct cyst

Answer 13

• thyroid follicles

Question 14

what are the pseudocysts

Answer 14

• traumatic bone cysts
• aneurysmal bone cyst
• static bone cyst

Question 15

what makes pseudocysts not real cysts

Answer 15

missing the epithelium

Question 16

what are the other names for the traumatic bone cyst

Answer 16

• idiopathic bone cavity
• solitary bone cyst
• hemorrhagic bone cyst
• simple bone cyst
• unicameral bone cyst

Question 17

describe the traumatic bone cyst and the theory of origin

Answer 17

• empty cavity- not a true cyst
• trauma- hemorrhage theory of origin

Question 18

describe the traumatic bone cyst incluing the predeliction

Answer 18

• male (2:1)
• teenagers- young adults
• mandible
• lucency
• scalloped border frequent
• asymptomatic
• expansion rare (20%)
• vital teeth
• biopsy initiates healing

Question 19

if you decide to put traumatic bone cyst in the DDX make sure:

Answer 19

there is no root resorption

Question 20

describe the aneurysmal bone cyst and the predilection

Answer 20

• young individuals less than 20 years old
• rapidly growing, may blow out the cortex, painful
• mandible most common
• lucency, frequently multilocular

Question 21

what are the surgical findings of the aneurysmal bone cyst

Answer 21

• ballooning dilation of bone
• blood welling up from within the cavity, like a blood-soaked sponge
• fleshy aggregates of tumor surrounding cystic spaces filled with blood
• hemosiderin pigmentation

Question 22

what is seen in the anuerysmal bone cyst

Answer 22

• not a true cyst
• cyst like cavities, filled with blood
• multinucleated giant cells

Question 23

describe the stafne bone cyst

Answer 23

• asymptomatic
• radiolucency below inferior alveolar nerve canal
• submandibular gland

Question 24

what are the classes of odontogenic tumors

Answer 24

• epithelial
• mesenchymal
• mixed

Question 25

what are the epithelial odontogenic tumors

Answer 25

- ameloblastoma - adenomatoid odontogenic tumor - calcifying epithelial odontogenic tumor

Question 26

what are the mesenchymal odontogenic tumors

Answer 26

- odontogenic myxoma - odontogenic fibrome - cementoblastoma

Question 27

what are the mixed odontogenic tumors

Answer 27

- odontoma - ameloblastic fibroma - ameloblastic fibro odontoma

Question 28

ameloblastoma is the ___ differentiated and ____ aggressive

Answer 28

least; most

Question 29

odontoma is the -_______ differentiated and the ___ aggresive

Answer 29

most; least

Question 30

describe an ameloblastoma

Answer 30

- conventional ameloblastoma - an expansile, slow growing, locally invasive lesion, typically of posterior mandible of adults - mean = 35years - recurrence is common but does not metastasize - the histopathology of ameloblastoma recapitulates the enamel organ - ameloblastoma does not form hard tissue!! - radiolucent!!

Question 31

what percentage of ameloblastomas occur in the anterior maxilla

Answer 31

6%

Question 32

what are the clinicpathologic forms of ameloblastomas

Answer 32

- multilocular radiolucency - expanding from bone- desmoplastic - pericoronal radiolucency - unicystic - bump on gums: extra/osseous/peripheral ameloblastoma

Question 33

what are the histologic types of ameloblastomas

Answer 33

- solid: follicular, plexiform, desmoplastic - unicystic

Question 34

describe the histology of an ameloblastoma

Answer 34

- the histopathology of ameloblastoma recapitulates the enamel organ - ameloblastoma does not form hard tissue - large ameloblastic island - loose epithelium called stellate reticulum - at the periphery there a clear area called cytoplasmic vacuolization because of reverse polarity

Question 35

what is the difference in histology between the follicular ameloblastoma and the plexiform ameloblastoma

Answer 35

- the plexiform tends to connect where the islands come together

Question 36

describe the desmoplastic ameloblastoma and its predilection

Answer 36

- anterior jaws, equally distributed between mandible and maxilla - mottled mixed density with diffuse margins - solid tumor with dense collagenous stroma - can cause root divergence

Question 37

why does the desmoplastic ameloblastoma appear radiopaque

Answer 37

because it has very dense fibrous CT stroma

Question 38

what is the histologic presentation of desmoplastic ameloblastoma

Answer 38

- does not have mineralization - can see ameloblastic islands - cannot see stellate reticulum or cytoplasmic vacuolization here because it is squished

Question 39

what is a peripheral ameloblastoma

Answer 39

if it appears on the bump on the gums with no radiographic presentation and feels firm

Question 40

what is a central ameloblastoma

Answer 40

means it is inside the bone

Question 41

describe the unicystic ameloblastoma and the prediclection

Answer 41

- cytogenic ameloblastoma - unilocular radiolucency usually of posterior mandible - 2nd to 3rd decade of life, mean age = 18 years - recurrence uncommon

Question 42

what does a unicystic ameloblastoma mimic radiographically

Answer 42

a dentigerous cyst

Question 43

what is the vicker's gorlin change in unicystic ameloblastomas

Answer 43

- nuclear hyperchromatism - nuclear palasading - reverse polarity of basal cell nuclei - subnuclear vacuolation

Question 44

what is the predilection for adenomatoid odontogenic tumors

Answer 44

- mixed density - teenagers: 75% - female: 2:1 - maxilla 2:1 - anterior 75%

Question 45

what is the histologic presentation of the adenomatoid odontogenic tumor

Answer 45

- rolling pattern : Zell ballin - calcifications - pseudo ducts

Question 46

what is the only tumor that has pseudo ducts

Answer 46

adenomatoid odontogenic tumor