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multilocular lucencies Flashcards

1
Q

potential multilocular lucencies

A
  • Ameloblastoma
  • Odontogenic Keratocyst
  • Central Giant Cell Granuloma
  • Odontogenic Myxoma
  • Vascular Lesions - Hemangioma
    . A-V aneurysm
  • Familial Fibrous Dysplasia
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2
Q

Ameloblastoma defined/aggression

A

Benign odontogenic neoplasm; one of very few true odontogenic neoplasms
Capable of uncontrolled, unlimited growth potential

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3
Q

classifications of ameloblastomas

A
  1. Conventional (Multicystic) Ameloblastoma
  2. Unicystic Ameloblastoma
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4
Q

Conventional (Multicystic)
Ameloblastoma
Account for % of all ameloblastomas?
* sub-types?

A

Account for 85 – 90% of all ameloblastomas
* Five histologic sub-types;
- follicular - most common
- also have plexiform, acanthomatous,
granular, desmoplastic and basaloid

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5
Q

Ameloblastoma Conventional
* symptoms
* Small lesions only detected how?
* Larger lesions detected how?

A
  • Usually slow painless swellings
  • Small lesions only detected by radiographs
  • Larger lesions detected clinically
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6
Q

Ameloblastoma
Conventional radio app

small/large lesions
effect on teeth?

A
  • Small lesions are unilocular with corticated borders
  • Large, aggressive lesions develop multilocular patterns
  • Displace and resorb teeth
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7
Q

can ameloblastomas expand?

A

yes, can displace teeth/ anatomical strucutres

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8
Q

ameloblastoma conventional age

A
  • Mainly adults – equal prevalence in 3’rd to 7’th decade
  • Uncommon in 2’nd decade
  • Rare in 1’st decade
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9
Q

ameloblastoma conventional location

A

prefers mandible (85%)

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10
Q

ameloblastoma conventional genders

A

no preference

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11
Q

what could this be in 45 y/o male?

A

conventional ameloblastoma

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12
Q

ameloblastoma managment

A

Large lesions are aggressive requiring bone resection due to lesion being non-encapsulated

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13
Q

ameloblastoma recurrence

A

higher likelihood for recurrence, about 15% with proper resection

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14
Q

ameloblastoma resection

A

Block or marginal resection; ie resect >1.0cm
past radiographic limits of tumor

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15
Q

ameloblastoma recurrence without proper resection (% chance)

A

50-90%

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16
Q

are ameloblastomas malignant?

A

RARE, but possible

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17
Q

can ameloblastomas app unilocular

A

yes, in early stages or as unicystic variant

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18
Q

when planning resection of ameloblastomas what imaging modality can be used?

A

CBCT

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19
Q

Unicystic Ameloblastoma
aggression/recurrence?

A
  • arise within a cyst lining; either luminal, intraluminal or mural
  • less aggressive form of ameloblastoma
  • Recurrence rates of 10-20%
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20
Q

dif dx

A

ameloblastoma
OKC
dentigerous cyst

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21
Q

Ameloblastoma unicystic
Age
Site

A

Age: Mean age 23 years
Site: Mandible (90%), Maxilla (10%)

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22
Q

from 23 y/o male dif dx

A

OKC
unicystic ameloblastoma
dentigerous cyst

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23
Q

Odontogenic Keratocyst
Pathophysiology
* commonality?
* aggression?
* arise from?

A
  • 10-12% of all odontogenic cysts; 3’rd highest oral cyst frequency
  • aggressive cysts; behave more like benign neoplasms
  • thought to arise from cell rests of dental lamina
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24
Q

most common and second most common cysts

A

1: PA
2: dentigerous

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25
histo of what lesion
OKC
26
Odontogenic Keratocyst clinical * symptoms * With increasing size what can occur
* Normally asymptomatic * With increasing size, pain, swelling and exudate may oocur
27
OKC radio * borders * cortical plates * teeth
* Well-defined, smooth, corticated borders * Thinning and mild expansion with occasional perforation of cortical plates * Displacement of teeth
28
OKC root resorb
* *only occasional root resorption (< dentigerous and < radicular cysts)
29
OKC expansion directions
*mild B-Li expansion; but extensive antero-posterior extension
30
dif dx
ameloblastoma OKC
31
dif dx
ameloblastoma OKC odontogenic myxoma
32
sign of OKC with cortical plates
emphysema, can be pushed in
33
OKC age site gender
Age: Majority (i.e., 60%) in 2nd and 4th decade Site: Majority (60-80%) affect mandible posterior to the canines Gender: Male predilection
34
management OKC
Enucleation with curettage and toxic agent carnatene in some cases
35
OKC recurrence
* High recurrence rate; some rates reported @ 47 and 62% (probably parakeratinized variants)
36
* When multiple OKCs are found they may constitute part of?
* When multiple OKCs are found they may constitute part of the basal cell nevus syndrome (a.k.a. nevoid basal cell carcinoma syndrome)
37
Nevoid basal cell carcinoma syndrome signs: * skin * Palmar * jaws * ribs * spine * Skull anomalies:
* multiple basal CA’s of skin * Palmar and plantar pitting (60%) * > 1 OKC (KOT) of jaws (75%) * Bifid or splayed ribs (60-75%) * Kyphoscoliosis (50%) * Skull anomalies: - frontal and parietal bossing - hypertelorism - intracranial calcifications; majority are of falx cerebri
38
Nevoid basal cell carcinoma syndrome inheritance
Autosomal dominant inheritance
39
pt also presents with calcified falx cerebri, dx?
nevoid basal cell carcinoma syndrome
40
when enucleating OKC of NBCCa syndrome what can be done to prevent recurrence
Gauze+ caratene
41
Central Giant Cell Granuloma Clinical * symptoms * aggression
* Asymptomatic swelling * Can be aggressive
42
CGCG histology
solid tumor of granuloma tissue: collagen and giant cells
43
Central Giant Cell Granuloma Radiographic app * borders? * locular? * cortical plates? * Displacement?
* Well-defined borders * Can be multilocular * Thinning and expansion of cortical plates * Displacement of teeth and occasional root resorption
44
what could this be
OKC ameloblastoma Central giant cell granuloma
45
when imaging lesions how far should you go?
until border of lesion captured
46
Central Giant Cell Granuloma age, site, gender
Age: Usually < 30 years (60%) Site: mandible (70%) & frequently between the molars Gender: Female > male (2:1)
47
Central Giant Cell Granuloma Management
Enucleation with aggressive curretage
48
CGCG is histologically similar to what lesion
Lesion is histologically similar to the Brown tumor of primary hyperparathyroidism
49
pts presenting with CGCG should be tested to rule out what?
hyperparathyroidism * Screening test in the appropriate blood studies: – serum calcium – alkaline phosphatase – serum phosphorus
50
Odontogenic Myxoma Clinical * Primarily a lesion of? * Basically a?
* Primarily a lesion of alveolar bone * Basically a fibrous lesion
51
odontogenic myxoma radio
Scalloped and multilocular
52
which multilocular luceny presents like this
myxoma
53
odontogenic myxoma
54
Odontogenic Myxoma age and site
Age: Young to adults (25 – 30 years) Site: Greater prevalence in mandible
55
Odontogenic Myxoma Management
Excision
56
odontogenic myxoma recurrence
Recurrence up to 25% because the lesions are not encapsulated.
57
VASCULAR LESIONS
Central Hemangioma Aneurysmal Bone Cyst A-V Malformation
58
Central Hemangioma Clinical * common sites? * expansion? * mucosal app? * gingival sign? * possible detections * Many require what to assist diagnosis
* Jaws are next most common site after skull and vertebrae * Firm, slow-growing asymmetric expansion * Overlying mucosa is more erythematous and warm to touch * Spontaneous gingival bleeding * Bruit on diascopy and pulsatile sensation may be detected * Many require needle aspiration to assist diagnosis
59
Central Hemangioma Radiographic
* Variable pattern ranging from cyst-like radiolucencies * May have multilocular “soap-bubble” or spoke-like appearance
60
diagnosis of central hermangiomas
usually superficial so tell signs such as redness and heat are present may use aspiration to help diagnose, NO BIOPSY
61
superficial erythmatous lesion:
central hermangioma, very superficial
62
Central Hemangioma age, site, gender?
Age: Teens and young adults Site: Posterior mandible Sex: Female:male 2:1
63
lesion from 14 y/o female
central hermangioma
64
Central Hemangioma Management
* Sclerosing agents, radiation, enucleation * Embolization of major arteries necessary prior to surgery as hemorrhage is a significant and life threatening complication
65
potential etiologies of central hermangiomas
Etiology is either traumatic/developmental or benign neoplasm
66
Cherubism (familial fibrous dysplasia) Clinical * face? * symptoms? * Bone lesions are more active when?
* Cherubic looking face by 5 years of age due to bilateral bony expansion * Asymptomatic * Bone lesions are more active in younger patients. After age 12, activity usually diminishes and finally lesions become inactive with residual deformity by age 30
67
likely dx?
cherubism
68
Cherubism Radiographic app
* Bilateral multilocular cyst-like, expansile lesion, usually affecting the mandible and sometimes the maxilla * **Pathologic fracture is not a feature**
69
Cherubism age, site, gender
Age: Usually detected by age 5 Site: Bilateral mandible, may affect maxilla Sex: Male:female 2:1
70
Cherubism Management
* Cosmetic osseous contouring at age 12 and later * Benign self-limiting condition

RADIO INTERPRETATION (18 decks)

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