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ABOMS Oral Boards > Pathology > Flashcards

Pathology Flashcards

(51 cards)

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1
Q

Squamous Odontogenic Tumor

A
  • 20-40 yo, posterior jaws
  • Man=Max
  • Rests of Malassez
  • Expansile with swelling
  • Imaging: triangular/semicircular defect around tooth roots
  • Histo: bland islands of squamous epithelium w/ fibrous stroma
  • DDx: desmoplastic AB and SCCa
  • Tx: enucleation and curettage
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2
Q

Calcifying Epithelial Odontogenic Tumor (CEOT, Pindborg)

A
  • 2:1 Man:Max
  • 75% posterior
  • Imaging: variable. uni or multilocular lucency. mixed density. associated with impacted tooth
  • Histo: irregular sheets of pleomorphic amyloid congo red, liesegang rings
  • Tx: enucleation and curettage vs en bloc resection, recurrence ~ 20%
  • if clear cells present it is mor eggressive
    DDx: metastatic RCCa, ACCa, mucoepidermoid carcinoma, AOT
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3
Q

Adenomatoid Odontogenic Tumor (AOT)

A
  • Teenage girls
  • 2/3 maxilla, 80% anterior
  • Imaging: unilocular flecks, 75% associated with impacted teeth. Often will strip down to root past CEJ + adenomatiod structures
  • Tx: Enucleation and curettage, no recurrenc
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4
Q

Carcinoma vs Sarcoma

A

Carcinoma - epithelial origin
Sarcoma- mesenchymal origin

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5
Q

Ameloblastic Fibroma

A
  • Benign mixed odontogenic tunmor
  • 10s-20s
  • 75% posterior mandible
  • Expansile
  • Histo: starry sky, thin stands and cords, club shapes, cords of epithelium
  • Imaging: well demarcated but sclerotic uni or multilocular. unerupted tooth
  • Tx: complete excision/en bloc resection.
  • 15-20% recurrence
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6
Q

Odontoma

A
  • mean age 15
  • M=F
  • Anterior maxilla and posterior mandible

Imaging:
- compound - multiple tooth like structures surrounded by halo of follicle
- complex - amorphous mass surrounded by follicle

  • Tx: enucleation and curettage
  • low recurrecne
  • Variants: Ameloblastic fibro-odontoma, Ameloblastic fibrodentinoma
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7
Q

Dentinogenic Ghost Cell Tumor

A
  • wide age range 20-70
  • non healing ext site, possible ulceration
  • irregular, destructive, mixed lesion. may cross midline and invade sinonasal structures
  • variant of COC
  • Tx: wide surgical resection, may metastatisize
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8
Q

Odontogenic FIbroma

A
  • F>M
  • 60% anterior maxilla
  • Imaging: well demarcated radiolucency, usually associated with the root of a tooth
  • Tx: conservation excision or curettage
  • DDx: hyperplastic dental follicle, desmoplastic fibroma, infantile myofibromatosis
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9
Q

Odontogenic Myxoma

A
  • Wide age range
  • F=M
  • posterior mandible slightly more common
  • Imaging: multilocular, well demarcated but can be lytic. fine loculations (tennis racquet)
  • Histo: myxoid connective tissue, spindle cells
  • Tx: resection with 1-1.5cm margins and one anatomic barrier
  • Recurrence 25%
  • ameloblastoma, desmoplastic fibroma, myxomatous degeneration of neurofibroma or wilms tumor
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10
Q

Cementoblastoma

A
  • wide age. mean 20-30
  • F>M
  • benign odontogenic neoplasm of cementoblasts adherent to root
  • Imaging: well defined radiopaque mass adhered to root without PDL space separating
  • Tx: removal of tooth or hemisection with lesion removal
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11
Q

Ameloblastic Carcinoma

A
  • malignant neoplasm of odontogenic epithelium
  • Average age 30
  • Lung most common site for mets
  • Imaging: aggressive ill defined lucency
  • Tx: staged and treated like carcinoma
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12
Q

Carcinomas of Jaws

A
  • Ameloblastic
  • Primary intraosseous carcinoma; Tx - same as carcinoma
  • Sclerosing odontogenic carcinoma; Tx enucleation and curettage
  • Clear cell odontogenic carcinoma;
  • Ghost cell odontogenic carcinoma
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13
Q

Odontogenic Keratocyst (OKC)

A
  • 10-30s
  • posterior mandible most common
  • Imaging: 75% unilocular - 25% multilocular. may see tooth displacement/resorption and cortical destruction
  • Histo: parakeratinized, corrugated, startified squamous 6-8 cells thick
  • Tx: enucleation and curettage with peripheral ostectomy and adjuvant therapy (cryo, modified carnoys, 5-FU). Marsupialization vs resection for large and refractory lesions
  • 33% recurrence
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14
Q

Gorlins Sydrome

A
  • AD disease
  • BCC of skin, multiple OKC, palmar and plantar pits, bifid ribs, calcified cerebral falx, hypertelorism
  • 9,22 gene
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15
Q

Lateral Periodontal Cyst

A
  • 50s
  • 2/3 mandibular premolar
  • Imaging: mid root, lateral well circumscribed lucency
  • Tx: enucleation and curettage
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16
Q

Botryoid Odontogenic Cyst

A
  • variant of lateral periodontal cyst
  • 50s
    -Imaging- multilocular grape like clusters
  • Tx: enucleation and curettage
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17
Q

Glandular Odontogenic Cyst

A

Tx: wide local excision / resection due to possible recurrence

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18
Q

Calcifying Odontogenic Cyst (Gorlin Cyst)

A
  • M=F, max=man
  • Imaging: radiolucency w/ opacities 2/2 ghost cells
    Tx: wide local excision
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19
Q

Epithelial Odontogenic Lesions Features
1. Ameloblastoma
2. OKC
3. AOT
4. CEOT
5. SOT
6. COC

  1. Mean Age
  2. Location
  3. Imaging
A
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20
Q

Mixed Odontogenic Lesions Features
1. AF
2. AFO
3. Odontoma
4. DGCT

  1. Mean Age
  2. Location
  3. Imaging
A
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21
Q

Mesenchymal Odontogenic Lesions Features
1. Myxoma
2. Odontogenic Fibroma

  1. Mean Age
  2. Location
  3. Imaging
22
Q

Circumscribed Unilocular Radiolucency DDx

Study These Flashcards
A
  1. Odontogenic cyst
  2. OKC
  3. Ameloblastoma
  4. AOT
  5. COC
  6. CEOT
  7. TBC
  8. OF
23
Q

Pericoronal Unilocular Radiolucency DDx

Study These Flashcards
A
  1. Dentigerous Cyst
  2. OKC
  3. Ameloblastoma
  4. AOT
  5. COC
  6. CEOT
24
Q

Periradicular Circumscribed Radiolucency DDx

Study These Flashcards
A
  1. Paradental cyst
  2. SOT
  3. Odontogenic Fibroma
  4. Periodontitis
  5. Langerans Histiocytosis
25
Multilocular Radiolucency DDx
1. OKC 2. Ameloblastoma 3. CGCG 4. AF 5. Myxoma 6. BOC 7. Cherubism 8. GOC
26
Radiopacity with Radiolucent Rim DDx
1. Odontomas 2. Ossifying fibroma 3. Osseous dysplasias 4. Cementoblastoma
27
Mixed Density Lesion DDx
1. Odontoma 2. AFO 3. AOT 4. COC 5. CEOT 6. DGCT 7. Ossifying fibroma 8. Osseous dysplasia 9. Primary bone tumor
28
Poorly Defined Radiolucency DDx
1. Myxoma 2. Metastasis 3. Vascular lesion 4. Malignant odontogenic neoplasms 5. Primary malignant bone tumor
29
Dentigerous Cyst
- most common odontogenic cyst - M>F, teens - 20s - Always associated with crown of impacted tooth - Imaging: well defined pericoronal, unilocular radiolucency - Typically gives rise to brown-clear cholesterol aspirate - Tx: enucleation and curettage - Has possibility to recur
30
Chondrosarcoma
- 30-40s - sinonasal tract most common - ant max/post mand - painless mass, nasal obstruction, loose teeth, epistaxis, proptosis - Imaging: moth eaten, uni or multilocular lucency - Grade 1,2,3 based on nuclear size and mitotic activity - Tx: resection w/ neg margins - 20% 5 year survival
31
Osteosarcoma
-30s - 40s, long bones, posterior mandible - Risks: radiation, fibrous dysplasia, pagets disease - Rapid growth w/wo pain, expands/crowds teeth - Histo spindle cells in osteoid - Imaging: sunburst pattern - Tx: 3cm margins and uninvolved anatomic barrier, chemo for high grade - 5 year survival 50%
32
Fibrous Dysplasia
- Monostotic mosaic - max > zygomatic arch > mand - polyostotic - jaffe-lichtenstein, mccune albright - Imaging: ground glass, ill defined border, displaced teeth - Tx: recontouring
33
Cemento Osseous Dysplasia
- middle age black females - possible reactive hyperdensity of bone - secondary infections/osteomyelitis due to poor vascularity - periapical -> focal -> florid - Tx: surveillance. biopsy has risk of osteomyelitis
34
Cemento-Ossifying Fibroma
- F>M, mandible 75% - Imagin: well demarcated, mixed - Fibro, osteoid, cementum - Tx: shells out on enucleation
35
Central Giant Cell Granuloma
- reparative granuloma, painless expansion - F>M; mand>max - whorls of CD68+cells, fibroblasts in a fibroid stroma - aggressive = >5cm, rapid growth, tooth displacement, recurrence Non surg tx: - kenalog 1mg per ml of lesion - calcitonin - inteferon alpha Tx: enucleation and curettage vs resection
36
Cherubism
- bilateral symmetrical mandibular expansion - loose teeth, displacement - limits by 30 yo -> recontouring
37
Hodgkin Lymphoma
- lymph node swelling - <40 yo - Reed sternberg cells, +/- EBV Staging: 1. 1 lymphatic site 2. 2 or more sites same side of diaphragm 3. both sides of diaphragm 4. diffuse Tx: XRT +/- chemo
38
Non Hodgkins Lymphoma
- systemic, >40 yo - CD20 cells - 85% B cells - Diffuse large B cell most common - chemo is tx
39
Histiocytosis X
-increase in dendritic cells -more common in children - BRAF mutation - pain, exopthalmos, ulcers - unifocal single system - histio x - multifocal/single system - hand-schuller-christian - acute disseminated-letterer-siwe
40
Epithelial Dysplastic Changes
- loss of basal polarity - increased nucleus/cytoplasm ratio - hyperchromasia - increase mitoses - loss of cohesion - increased keratinization
41
Proliferative Veruccous Leukoplakia
- verrucous leukoplakia - increase rate of recurrence and can transform to SCCa
42
HPV neg Tumor Criteria
43
HPV neg Node Criteria
44
HPV neg Met Criteria
45
HPV neg TNM Staging
46
HPV + TNM Staging
47
Supraomohyoid Neck Dissection Indication
>4mm depth of invasion histologically high grade tumor perineural invasion
48
Indications for Post Op Radiation
- positive or near margin - perivascular or neural invasion - bone involvement - multiple nodal involvement - extracapsular spread - stage III/IV
49
Levels of the Neck
1. submental A/submandibular B 2. upper jugular-skull to hyoid 3. middle jugular along SCM 4. lower jugular - posterior SCM 5. posterior trinagle 6. pretracheal/laryngeal/paratracheal 7. upper mediastinum
50
Verrucous Carcinoma
- M>F - chewing tobacco - 5 year survival 85% - Tx: resection 0.5-1 cm margin
51
Ameloblastoma
- slow growing expansile odontogenic epithelium neoplasm - 50% 20-40 yo - posterior mandible most common Types: - solid/conventional - unicystic- lining, intraluminal, transmural, intramural - peripheral / extraosseous Imaging: multilocular radiolucency but can be unilocular Histo: vickers gorlin criteria - peripheral palisading, reverse polarity in fibrous stroma Tx: resection with 1-1.5 cm margins and one uninvolved anatomic barrier Enucleation for ameloblastoma in situ only

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