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Oral Path > odontogenic cysts > Flashcards

odontogenic cysts Flashcards

1
Q

what are characteristics of periapical cyst?

A

most common cyst of the jaw
develops due to inflammatory stimulation of epithelial rests of malassez
asymptomatic, associated with a non-vital tooth

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2
Q

what are the radiographic characteristics of periapical cyst?

A

round- ovoid radiolucency at apex

inflammation through lateral canals may lead to lateral radicular cyst

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3
Q

what does periapical cyst look like microscopically?

A

inflammed granulation tissue or fibrous connecive tissue lined by non- keratinized stratified squamous epithelium

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4
Q

what is the treatment and prognosis of periapical cyst?

A

endodontic therapy +/- apicoectomy or extraction with curettage
prognosis- excellent but routine followup is warranted

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5
Q

what is a residual periapical cyst

A

if tooth is removed, lesion may occasionally persist

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6
Q

what is dentigerous cyst

A

most common developmental odontogenic cyst, second overall only to periapical (inflammatory)
fluid accumulates between the crown of the tooth and reduced enamel epithelium (increased osmotic pressure), leading to gradual enlargement of the cyst
subsequent infection/inflammation may occur
by definition, associated with the crown of an unerupted tooth
when lucent space around the crown is > and = 3-4 mm, considerd consistent with dentigerous cyst
radiographic findings, however, are mimicked by many odontogenic cysts and tumors

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7
Q

what are the characteristics of dentigerous cyst

A

most common site: mand 3rd molar region, followed by max. canines max 3rd molars
most present in 2nd and 3rd decades
symptoms are usually absent, unless secondarily infected
may produce swelling or resorption of adjacent tooth roots

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8
Q

what does dentigerous cyst look like microscopically?

A

uninflamed fibrous connective tissue lined by a thin non-keratinized stratified squamous epithelium
some cysts will have a few scattered mucous cells in their lining

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9
Q

what is the treatment and prognosis of dentigerous cyst?

A

tx- removal of the tooth and enucleation of the cyst, decompression of large cysts
microscopic exam of lesional tissue to rule out OKC, ameloblastoma, other odontogenic cysts/tumors or (rarely) central mucoepidermoid carcinoma
prognosis- excellent

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10
Q

what is an eruption cyst?

A

a dentigerous cyst that forms in the soft tissue overlying the crown of an erupting tooth
bluish swelling common (bleeding) thus the term eruption hematoma
children generally affected

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11
Q

what is a primordial cyst?

A

rare lesion- thought to be derived from degenerating tooth bud epithelium
develops in place of a tooth, before any mineralized material is deposited
clinical/radiographic diagnosis based on no history of extraction or surgery in the area

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12
Q

characteristic of primordial cyst?

A

may arise from any tooth in the dentition

usually detected as a unilocular radiolucency in the area of a missing tooth usually 3rd molar

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13
Q

what is the microscopic look of primordial cyst

A

majority of primordial cyst have microscopic features of odontogenic keratocyst (OKC)

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14
Q

what are the treatment and diagnosis of primordial cyst?

A

tx- enucleation

prognosis- good. with histologic diagnosis of OKC, periodic radiographic follow-up for local recurrence is warranted

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15
Q

what is odontogenic keratocysts?

A

relatively common but locally aggressive cyst (keratocystic odontogenic tumor)
associated with nevoid basal cell carcinoma syndrome (suspected in pts

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16
Q

what are the characteristics of odontogenic keratocysts?

A

peak incidence- 3rd decade
mandible:maxilla- 2:1 ratio
mandibular lesions usually develop in posterior quadrant or the ramus
anterior maxilla favored after 60 years of age
may mimic a dentigerous cyst, residual cyst or lateral periodontal cyst
usually aymptomatic, may produce swelling/discomfort with enlargement

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17
Q

what does odontogenic keratocyst look like radiographically?

A

majority (up to 80%) present as unilocular radiolucencies with well- demarcated margins and a thin sclerotic border
only 20% exhibit the classic multilocular expansile radiolucent appearance, which is probably related to the size of the lesion

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18
Q

what are the 3 criterias of odontogenic keratocyst histopathologically?

A
  1. uniformly thin epithelial lining- stratified squamous- 6-8 cells thick
  2. corrugated surface layer of parakeratin
  3. palisaded dark basal cell layer

the connective tissue wall is usually uninflamed
when inflammation is present, the histology of the lining epithelium is markedly altered

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19
Q

what is the treatment of odontogenic keratocyst?

A

treatment is controversial and depends on size of lesion
with smaller lesion,careful enucleation as a single piece is ideal
with larger lesion, decompression followed by enucleation

20
Q

what is the prognosis of odontogenic keratocyst?

A

prognosis- guarded. recurrence rates range from 3-62%
2 recent reports with 5 year minimum follow up indicated a 40-50% recurrence rate
patients should be followed annually for at least 7 years post-surgery to detect recurrence

21
Q

what is nevoid basal cell carcinoma syndrome

A

a complex syndrome of malformations and neoplasms exhibiting over 100 different features related to skin, CNS and skeleton
PTCH gene, chromosome 9 (9q22-31)
autosomal dominant, extremely variable expressivity, 40% are new mutations

22
Q

what are the craniofacial features of nevoid basal cell carcinoma syndrome?

A

enlarged occipitofrontal cranial circumference (60 cm or more in adults)
heavy brow ridges
broad nasal root
mild ocular hypertelorism

23
Q

what are the skin features of nevoid basal cell carcinoma syndrome?

A

basal cell carcinomas that -

  1. are multiple
  2. occur in unexposed as well as exposed skin
  3. develop at an earlier age (puberty- 35 years)
  4. often show melanin pigmentation
  5. are usually quiescent with few being aggressive

1-2 mm shallow pits of the palms and/or soles (65%)
milia and multiple epidermoid cysts (50%)

24
Q

what are the radiographic findings of nevoid basal cell carcinoma syndrome?

A

lamellar calcification of the falx cerebri (85%)

bifid, fused, or hypoplastic ribs (60%)

25
Q

what problems could happen with nevoid basal cell carcinoma syndrome?

A

odontogenic keratocysts of the jaws (85%) may develop during 1st decade but after 7 years
may be single or multiple- patient is more likely to have syndrome if multiple

26
Q

what are the treatment of nevoid basal cell carinoma syndrome?

A
  1. genetic counseling
  2. remove OKCs as needed
  3. remove BCCs as neede
  4. patient should use sunscreen and reduce sun exposure to decrease risk of basal cell ca
27
Q

what is the prognosis of nevoid basal cell carcinoma syndrome?

A

guarded
usually the basal cell carcinomas are relatively small and indolent, but this can be variable
periodic radiographic follow-up for OKCs

28
Q

what is gingival cyst of the newborn

A

biopsy of normal newborn alveolar ridge can show numerous microcystic structures, probably from dental lamina
the gingival cyst of the newborn (also known as dental lamina cyst) appears to represent an enlarged version of these structures

29
Q

what are the characteristics of gingival cyst of the newborn?

A

present as 1-2 mm yellow white papules, often multiple on alveolar ridge of newborn infant
usually maxillary

30
Q

what does gingival cyst of the new born look like microscopically?

A

thin, uniform stratified squamous epithelial lining

cyst lumen is packed with keratin debris

31
Q

what are the treatments of gingival cyst of the newborn?

A

none

these lesions will either self-marsupialize or involute/degenerate spontaneously

32
Q

epstein’s pearls

A

occur along the median palatal raphe and arise from epithelium entrapped along the line of fusion

33
Q

bohn’s nodules

A

scattered over the hard palate often near the soft palate junction, believed to be derived from the minor salivary glands

34
Q

what is gingival cyst of the adult

A

related to lateral periodontal cyst
arises from dental lamina rests in the gingival connective tissue (rests of serres)
adult, over 40 years of age, anterior segments of the jaws (canine/premolar)
no apparent sex predilection

35
Q

characteristics of gingival cysts of the adult

A

smooth-surfaced, dome shaped elevation of the attached gingiva
usually less than 1 cm in diameter
tense on palpation
otherwise asymptomatic
translucent or bluish appearance is often noted
may mimic mucocele, but on attached gingiva
minimal if any findings on radiograph

36
Q

histology of gingival cysts of the adult?

A

a cystic cavity lined by a thin, uniform layer of cubiodal or attenuated non-keratinized stratified squamous epithelium

37
Q

what is the treatment and prognosis of gingival cyst of the adult?

A

tx- conservative excision

prognosis- excellent

38
Q

what is a lateral periodontal cyst?

A

developmental cyst occurring adjacent or lateral to the root of a tooth, probably arising from intrabony rests of dental lamina
adjacent teeth typically vital

39
Q

what are the characteristics of lateral periodontal cyst?

A

mandibular premolar area, maxillary lateral incisor region
peak incidence in the 5th and 6th decades
asymptomatic unilocular radiolucency lateral root surface of vital tooth
typically less than 1 cm in diameter

40
Q

what is the histology of lateral periodontal cyst?

A

thin non-keratinized stratified squamous epithelium lining, uninflamed fibrous connective tissue
often identical to gingival cyst of the adult

41
Q

what is the treatment and prognosis of lateral periodontal cyst?

A

tx- curettage

prognosis- excellent

42
Q

what is calcifying odontogenic cyst?

A

also known as gorlin cyst
equal distribution between maxilla and mandible, anterior>posterior jaws
may occur at any age, with peak occurrence in second and third decade (mean age-33 years)

43
Q

what are the characteristics of calcifying odontogenic cyst?

A

usually a well-defined unilocular radiolucency
from 5-17% reported in the gingival soft tissues
scattered radiopacities in about 50% of cases
30% of COC’s are associated with an impacted tooth, 20% with odontoma, resoprtion of adjacent tooth roots common (around 80% of cases)

44
Q

what is the histology of calcifying odontogenic cyst?

A

most (86-98%) are cystic, with proliferation of odontogenic epithelial cells which at their periphery show a cubiodal or columnar appearance of the basal cells, similar to ameloblastoma
solid variants are recognized
as these cells approach the lumen they undergo a process termed a ghost cell change
cells are pale and eosinophilic with swollen cytoplasm and loss of nucleus that exhibits a faint nuclear membrane outline
traditionally described as aberrant keratinization but some investigators feel that this represents a form of coagulation necrosis

45
Q

what is the treatment and recurrence of calcifying odontogenic cyst?

A

treatment- enucleation with curettage

recurrence- not common but does occur so follow up is recommended

Oral Path (3 decks)

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