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OP16 Odontogenic cysts Flashcards

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1
Q

What is a cyst?

A

A pathological cavity lined by epithelium having fluid or semi-fluid contents, but not created by accumulation of pus.

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2
Q

What is an odontogenic cyst?

A

A cyst with epithelial lining derived from the epithelial residues of the tooth-forming organ.

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3
Q

What epithelial residues of the tooth forming organ are there?

A

Glands of Serres (ex dental lamina)
Reduced enamel epithelium (ex enamel organ)
Rest of Malassez (ex root sheath of Hertwig)

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4
Q

SEE THE WHO CLASSIFICATION OF CYSTS!!!

A
  • EPITHELIAL CYSTS -
    o Developmental
     Odontogenic
  • 1.”Gingival cysts” of infants (Epstein pearls)
  • 2.Odontogenic keratocyst (primordial cyst)
  • 3.Dentigerous (follicular) cyst
  • 4.Eruption cyst
  • 5.Lateral periodontal cyst
  • 6.Gingival cyst of adults
  • 7.Glandular odontogenic cyst; sialo-odontogenic cyst
     Non-odontogenic
  • 1.Nasopalatine duct (incisive canal) cyst
  • 2.Nasolabial (nasoalveolar) cyst
     Inflammatory
  • 1.Radicular cyst
    o 1.Apical and lateral
    o 2.Residual
  • 2.Paradental ( inflammatory collateral, mandibular infected buccal ) cyst
  • NON-EPITHELIAL PRIMARY BONE CYSTS —
    o 1.Solitary bone cyst
    o 2.Aneurysmal bone cyst
    o 3.Stafne’s idiopathic bone cavity
  • SOFT TISSUES CYSTS —
    o 1.Salivary mucoceles
     1.Mucous extravasation cyst
     2.Mucous retention cyst
    o 2.Dermoid and epidermoid cysts
    o 3.Lymphoepithelial cysts
    o 4.Thyroglossal cyst
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5
Q

What are all of the odontogenic cysts?

A
  • 1.”Gingival cysts” of infants (Epstein pearls)
  • 2.Odontogenic keratocyst (primordial cyst)
  • 3.Dentigerous (follicular) cyst
  • 4.Eruption cyst
  • 5.Lateral periodontal cyst
  • 6.Gingival cyst of adults
  • 7.Glandular odontogenic cyst; sialo-odontogenic cyst
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6
Q

What is the most common odontogenic cyst?

A

Radicular followed by dentigerous, keratocyst

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7
Q

What are the 3 types of radicular inflammatory cysts?

A

Apical, lateral, residual

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8
Q

What are radicular cysts associated with?

A

A non-vital tooth or canal
(mostly permanent dentition)

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9
Q

What is a residual cyst?

A

Historic radicular cyst - eg if cyst is present pre-extraction and remains there continuing to grow without a root

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10
Q

What are the symptoms of radicular cyst?

A

Frequently none

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11
Q

What is shown on a radiograph for a radicular cyst?

A

Radiolucent area, might have a radiopaque margin (not diagnostic)

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12
Q

How might radicular cyst affect the bone?

A

Might cause bone expansion

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13
Q

How does a radicular cyst form?

A

Proliferation of rests of Malassez within a periapical granuloma
Necrotic pulp induces periapical inflammation
Cytokine and growth factors stimulate epithelial rests to proliferate

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14
Q

How does a radicular cyst grow?

A

Limited growth due to no blood supply
Epithelial mass reaches a critical size, leading to degeneration and necrosis of the centre
Cyst enlarges: increased hydrostatic pressure from the hypertonic contents and semi-permeable lining induce further enlargement (attracts water)

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15
Q

What are the 3 theories of (radicular) cyst formation and which is most likely?

A
  1. Degeneration and death of central cells in the epithelial mass (most likely)
  2. Degeneration and liquefaction necrosis of granulation tissue
  3. Due to epithelialisation of a periapical abscess
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16
Q

What is the relationship between radicular cysts and periapical granulomas?

A

All radicular cysts are preceded by a periapical granuloma but not all periapical granulomas progress to cysts

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17
Q

What happens to surrounding bone during enlargement of a radicular cyst?

A

Osteoclastic activity
Proteolytic enzymes (capsule fibroblasts)
Increased hydrostatic pressure from hypertonic contents and semi-permeable lining
Silent phase followed by bony expansion followed by egg-shell cracking bone

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18
Q

What is the histopathology of the lining of a radicular cyst?

A

Fully or partially lining by non-keratinised stratified squamous epithelium, 40% show mucous cell metaplasia (goblet cells), 10% Rushton bodies

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19
Q

What is the histopathology of the capsule of a radicular cyst?

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A

Chronically inflamed fibrous tissue, variable vascularity, cholesterol crystals with foreign body giant cells, haemosiderin deposits (early sign of haemorrhage)

20
Q

What is the histopathology of the contents of a radicular cyst?

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A

Hypertonic, water to semi-solid:
Breakdown products, serum proteins, water and electrolytes, cholesterol crystals

21
Q

What are dentigerous/follicular cysts associated with?

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A

An unerupted tooth (deciduous or permanent) - impacted, delayed etc

22
Q

What teeth are dentigerous cysts most likely associated with from most to least likely?

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A

Lower 8’s, upper 3’s, upper 8, lower 4 and 5

23
Q

What are the radiographic findings of dentigerous cysts?

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A

A well defined, unilocular radiolucent area. Associated with the tooth crown.

24
Q

What are the 3 types of dentigerous cyst?

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A

Central, lateral, circumferential

25
What is a dentigerous cyst called if the tooth partially erupts?
If the tooth partially erupts, the cyst is still attached to the tooth and becomes infected, called a paradental cyst
26
How do dentigerous cysts form?
Cystic formation between crown and reduced enamel epithelium (or within the epithelium) Unclear formation mechanism
27
Where are dentigerous cysts more likely found?
In males in the mandible
28
What is the histopathology of the the lining of a dentigerous cyst?
Thin, regular, non-keratinised squamous or flattened epithelium, mucous metaplasia. If epithelium proliferates into lumen forming ameloblastoma-like plexus: uncystic ameloblastoma
29
What is the histopathology of the the capsule of a dentigerous cyst?
Fibrous tissue, free from inflammation (unless secondary), cholesterol crystals, epithelial rests
30
What is the histopathology of the the contents of a dentigerous cyst?
Hypertonic, yellowish, proteinaceous, cholesterol crystals
31
What are the clinical features of an odontogenic keratocyst or primordial cyst?
Few symptoms Can grow very large (antero-posterior direction) Can recur (friable capsule, satellite cysts, mitotic activity) Most common in males, mandible
32
What syndrome are multiple odontgenic keratocytes associated with?
Gorlin-Goltz (basal cell naevus) syndrome
33
What is the pathogenesis of odontogenic keratocyst formation and growth? (what remnants derived from too?)
Derived from the remnants of the dental lamina Hydrostatic forces Active epithelial growth (mitotic activity) Production of bone resorbing factors Localised areas of squame deposition, increasing pressure
34
What is the histopathology of the the lining of a odontogenic keratocyst?
Thin, regular, keratinised epithelium (usually para-k, if ortho-k then called an OOC): - Basal cells: palisading, columnar appearance - Suprabasal cells: abrupt transition to keratin forming cells - Lumen surface with 'wavy' appearance - Mitotic activity - If inflammation is present, characteristics revert to those of radicular cyst lining
35
What is the histopathology of the the capsule of a odontogenic keratocyst?
Thin, free from inflammation (unless secondary), epithelial rests and satellite cysts
36
What are satellite cysts?
Smaller cysts inside the capsule
37
What is the histopathology of the the contents of a odontogenic keratocyst?
Thick, white-grey cheesy material (keratin debris)
38
What is basal cell naevus syndrome caused by?
Mutation in the PTCH gene, chromosome 9
39
What is basal cell naevus syndrome characterised by?
Multiple odontogenic keratocysts (throughout life) Multiple (hundreds) of basal cell nevi/carcinomas of the skin Skeletal abnormalities (esp ribs and vertabrae) Calcium and phosphate metabolic abnormalities (calcification of falx cerebri) Other anomalies: palmar pits, ovarian fibromas, medulloblastoma
40
What is a gingival cyst?
Remnants of dental lamina proliferate to form small keratinising cysts Rare in adults, little clinical significance
41
What are lateral periodontal cysts?
Thin non-keratinising lining with epithelial plaques (thickenings) associated with a vital tooth (canine of premolar) Disputed origin, perhaps dentigerous cyst displaced during eruption
42
What are differential diagnoses for lateral periodontal cysts?
Lateral radicular cysts Odontogenic keratocysts
43
What are botryoid odontogenic cysts?
Thin non-keratinising lining with epithelial plaques, associated with a vital tooth (canine or premolar). Perhaps related to the lateral periodontal cyst Can recur
44
What is a glandular (sial0-) odontogenic cyst?
Mainly found in anterior mandible, multilocular. Histologically: columnar/cuboidal epithelium, occasional mucous cells, crypts/cyst-like spaces. Locally invasive
45
Summary of the cysts
Refer to image in lec 16! Look at images throughout please :)

Oral pathology (27 decks)

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