Pseudocysts COPY

Question 1

What are pesudocysts?

Answer 1

• They have no epithelial lining.
• They’re called cysts by convention just because that’s what everybody is used to
• They’re not true cysts.

Question 2

pesudocysts

List

(5)

Answer 2

• Aneurysmal Bone Cyst
• Antral Pseudocyst
• Simple Bone Cyst
• Osteoporotic Bone Marrow Defect
• Stafne Bone Cyst

Question 3

Aneurysmal Bone Cyst

Demographics

Answer 3

■ Most common site in the body is long bones or vertebrae
_■ In the jaw_s, most frequently seen in the 1st and 2nd decade
■ MD > MX

it’s a pesudocyst

Question 4

Aneurysmal Bone Cyst

Clinically

Answer 4

• swelling, frequently a rather rapid swelling
• often with pain and/or paresthesia (signs which can be suggestive of the presence of a malignant or aggressive lesion)

Question 5

Aneurysmal Bone Cyst

Etiology

Answer 5

• Etiology is unclear, may result from trauma or a vascular malformation
• most agree that it is a reactive and *not* a neoplastic lesion

Question 6

Aneurysmal Bone Cyst

Radiographically

Answer 6

■ a radiolucency which can be either unilocular or multilocular in appearance

■ Borders are variable, often irregular in shape and may be ill-defined (again, giving the suggestion of malignancy)

■ Teeth may be displaced

■ we may see cortical expansion and thinning ~ the cortex itself can become quite thin

Question 7

What does this person have?

Answer 7

• you might think that he has an odontogenic infection but he didn’t. You can see that there’s
  a pretty significant swelling on the left side of his face

This is a Aneurysmal Bone Cysts

Question 8

What is this radiographic finding?

Answer 8

Aneurysmal Bone Cyst

you can see that there is kind of a
multilocular radiolucency in this particular area

Question 9

What is this radiographic finding?

Answer 9

Aneurysmal Bone Cyst

✎ There’s a radiolucency involving the second molar
that’s going as far anterior as the first molar and back
to the third molar
✎ There is a little bit of spiking root resorption and
that’s one of the signs that we associate with
malignancy
✎ It’s a little bit ill-defined ~ hard to say exactly
where it begins and ends

Question 10

What is this gross finding?

Answer 10

Aneurysmal Bone Cyst

✎ It looks like a blood soaked sponge

✎ There’s these open sinusoidal spaces and then fibrous connective tissue surrounding them.

✎The sinusoidal spaces can vary in size; some of them are fairly small and others are large

Question 11

Aneurysmal Bone Cyst

Treatment

Answer 11

■ Treatment is surgical enucleation and curettage

■ lesions can recur ~ Usually the recurrence is because
you didn’t get the entire thing out the first time around

■ Some surgeons follow enucleation with cryotherapy

■ Irradiation is contraindicated

Question 12

Is bleeding a concern during surgical removal of Aneurysmal Bone Cyst?

Answer 12

■ No, vascularity is predominantly “low flow”, therefore not as much concern for bleeding upon surgical removal

■ As compared with central hemangioma where there is a concen for bleeding

Question 13

Antral Pseudocyst

Answer 13

They are different than surgical ciliated cyst

in their lining, etiology, location and appearance!

Question 14

As opposed of surgical ciliated cysts, Antral psuedocysts are not —-

( in term of their lining)

Answer 14

Not epithelial lined spaces

Question 15

As opposed of surgical ciliated cysts, Antral psuedocysts are not —-

( in term of location)

Answer 15

Not within the bone but are in the sinus

Question 16

As opposed of surgical ciliated cysts, Antral psuedocysts Develop as —-

( in term of etiology)

Answer 16

develop as an accumulation of an inflammatory exudate (often serum) between the sinus epithelial lining and the bone

-It develops because of an inflammatory event in the jaw, usually the maxilla, often from the roots of the maxillary teeth that cause inflammation

Question 17

As opposed of surgical ciliated cysts, Antral psuedocysts appear as —-

( in term of Radiology)

Answer 17

Appears as a dome shaped elevation of the floor of the sinus

Question 18

What is this radiographic finding?

Answer 18

Antral Pseudocyst

• a Dome-shape swelling on the floor of the sinus.
• They can sometimes be fairly subtle

Antral Pseduocyst are NOT Mucoceles

Mucoceles would have more of meniscus-like
appearancewhere it would come up tothe edge of
the sinus

Question 19

What are these radiographic findings?

Answer 19

Aneurysmal Bone Cyst

✎ A dome shape swelling on the floor of the sinus that’s associated with some _sort of inflammation of tooth of t_he premolar caused inflammation underneath the apex of the bone (right) and then that leads to accumulation of fluid which causes the sinus lining to elevate off the bone and fill with fluid
✎ After root canal therapy and once the infection gets under control, these will typically resolve on their own

Question 20

Simple Bone Cyst

also known as

Answer 20

aka traumatic bone cyst

Question 21

Simple Bone Cyst

Charcterstics

Answer 21

• A benign, empty or fluid filled, cavity in bone which is devoid of an epithelial lining – a pseudocyst
• Thought to be reactive, NOT neoplastic

Question 22

Simple Bone Cyst

Etiology

Answer 22

Etiology ununcertain, theories include:

• trauma
• ischemic necrosis of medullary space
• cystic degeneration of a primary bone lesion

Question 23

Simple Bone Cyst

Demographics

Answer 23

• In jaws, most likely in the 2nd decade
• Almost exclusively the mandible
• Twice as common in males

Question 24

Simple Bone Cyst

Radiographically

Answer 24

• a well-circumscribed radiolucency with an irregular outline
• Tendency to “scallop” around and between roots (highly suggestive, but not diagnostic of this lesion)

Question 25

**Simple Bone Cyst** _Treatment_

Answer 25

* **exploration** and **curettage** of space to create bleeding. Clot will organize and allow bone repair * **Recurrence** is **_rare_**

Question 26

What is this radiographic finding?

Answer 26

**Simple Bone Cyst** ## Footnote ✎**A well-circumscribed with cortication** in the **body of the mandible**, affecting _the posterior aspect (premolars and the molars )_ ✎Note the **scalloping** that happens up **between the roots**. It doesn't cause root resorption and actually the lesion will grow up between the roots of the teeth

Question 27

What is this radiographic finding?

Answer 27

**Simple Bone Cyst** * **A well-circumscribed**showing **the scalloping up between the roots of the teeth radiolucency**

Question 28

What is this radiographic finding?

Answer 28

**Simple Bone Cyst** ## Footnote ✎Big lesion example: It’s going back to the molar area here. ✎You can see that the lesion extends _over to the canine on the other side_ ✎Most lesions are usually **in the anterior mandible**

Question 29

**Osteoporotic Bone Marrow Defect** _Charcteristics_

Answer 29

* it's a pesydocyst * a **radiolucency** in an area typically where tooth has been removed. Instead of filling in with bone, it fills in with marrow. * When we biopsy it, you’re seeing the hematopoietic elements. (fat, early stages of (the -blasts of) red cells, white cells. * We see basic **bone forming marrow** **content**

Question 30

**Osteoporotic Bone Marrow Defect** _Demographic_

Answer 30

■ _Uncommon finding_ ■ \> 75% of cases are in **females** ■ ~ 70% occur in the **posterior MD**, often in _an edentulous area_ it's a *pesydocyst*

Question 31

**Osteoporotic Bone Marrow Defect** _Etiology_

Answer 31

* **Etiology unclear** * may be **hyperplasia of marrow** due to need for RBCs or * **abnormal regeneration of bone** after **an extraction or persistence of fetal marrow**

Question 32

Osteoporotic Bone Marrow Defect

Answer 32

**Hematopoietic bone marrow defect**

Question 33

**Osteoporotic Bone Marrow Defect** _Clincalally_

Answer 33

■ Typically **asymptomatic** and found on _routine_ radiographic exam

Question 34

**Osteoporotic Bone Marrow Defect** _Radiographically_

Answer 34

* **Irregularly shaped radiolucency** with _either_ **a well-defined or ill-defined border** (It can be in the _differential diagnosis with malignancy_)

Question 35

**Osteoporotic Bone Marrow Defect** _Treatment_

Answer 35

■ **Must biopsy** to make a definitive diagnosis ■ **No further treatment is then necessary** ~ You don't have to remove it; you can just leave it as it is

Question 36

What is this radiographic finding?

Answer 36

* You can see there's a little bit of radiolucency. * There happened to actually still be teeth in the area, but * when it was _biopsied_ it showed that it was a * **hematopoietic** or **osteopoietic bone marrow defect**

Question 37

**Stafne Bone Cyst** also known as

Answer 37

**static bone cyst, Stafne defect**

Question 38

**Stafne Bone Cyst** _Charcterstics_

Answer 38

■ An **asymptomatic** focal _concavity_ of the cortical bone on the _lingual aspect of the MD_ ■ A *pseudocyst*, not a true cyst

Question 39

**Stafne Bone Cyst** _Demographics and Location_

Answer 39

* Most commonly found near **the angle of the mandible** **below the inferior alveolar nerve** (but also _seen in the anterior MD)_ * **\> 80% in Males** * usually noted **only in adults**

Question 40

**Stafne Bone Cyst** _Radiographically_

Answer 40

Oval round well-circumcribed radilucency Below the Inferior Alveolar Nerve

Question 41

**Stafne Bone Cyst** _Etiology_

Answer 41

* Believed to be **developmental** in origin, *but usually noted only in **_adults_***

Question 42

**Stafne Bone Cyst** _Treatment_

Answer 42

* lesions in the posterior MD are usually pathognomonic * **no further treatment is necessary**

Question 43

What is this radiographic finding?

Answer 43

**Stafne Bone Cyst** _This is the classic look._ - a **well-circumscribed corticated radiolucency** - **below the inferior alveolar nerve**, away from the teeth. - They can be either **oval**, like this, or **round** in appearance

Question 44

What is this radiographic finding?

Answer 44

**Stafne Bone Cyst** Less common location Check if the teeth were vital with vitality test Get a CBCT in that area to see what was going on first and then once you saw the CBCT you'd be able to make the diagnosis.