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Dentistry in a Nutshell > scr - os & histopathology - cysts > Flashcards

scr - os & histopathology - cysts Flashcards

(54 cards)

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1
Q

what is a cyst

A

pathological cavity containing fluid / semi fluid / gaseous contents - NOT created by accumulation of pus

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2
Q

WHO 2017 classification of cysts

A

epithelial / non epithelial
epithelial becomes odontogenic & non odontogenic
odontogenic becomes inflammatory & developmental

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3
Q

epithelial odontogenic inflammatory cysts (4)

A
  1. radicular cyst
  2. residual cyst
  3. paradental cyst
  4. mandibular bifurcation cyst
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4
Q

clinical criteria of radicular cyst

A

4th-5th decades
60% maxilla
lateral incisor region
NON VITAL TEETH
often asymptomatic
can produce alveolar bone expansion +/- discharge

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5
Q

radiographic criteria of radicular cyst

A

round / ovoid radiolucency at root apex
unilocular / well defined
uniform radiolucency
corticated margin continuous with lamina dura key

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6
Q

histopathologic criteria of radicular cyst

A

regular lining of non keratinised squamous epithelium that is often incomplete
deposits of cholesterol
vascular capsule
inflammatory infiltrate in capsule
CT capsule

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7
Q

fibroblasts in radicular cyst

A

spindle shaped cells found with fibrous connective tissue

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8
Q

neutrophils in radicular cyst

A

round cells with nuclei that are segmented into lobes of condensed chromatin connected by filaments

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9
Q

plasma cells in radicular cyst

A

ovoid cells with eccentric nucleus with chromatin clumps arranged like a cartwheel

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10
Q

cholesterol clefts

A

derived from breakdown of RBCs as a result of haemorrhage
may be few in no or form large mural nodules
usually associated with epithelial discontinuities & project into cyst lumen
cholesterol crystals found in cyst fluid
cholesterol dissolves out during prep of section leaving clefts (looks like wavy white lines on stain)

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11
Q

hyaline / rushton bodies

A

translucent & pink staining lamellar bodies which are formed by cyst lining epithelium
eosinophilic bodies of varying size and shape of unknown origin that may represent some type of epithelial product
look like big pale splodges with dark outer staining

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12
Q

cyst content from radicular cyst

A

watery straw coloured fluid

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13
Q

aetiology of radicular cyst

A

inflammation from apical periodontitis following from pulp necrosis leading to proliferation of epithelium via rests of malassez (which are originally from hertwig’s epithelial root sheath in dental follicle) if these are not activated it will remain granuloma
cysts form by:
1. proliferating epithelium with central necrosis
OR
2. epithelium grows to surround an area of fluid

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14
Q

to differentiate between granuloma & cyst

A

> 1cm diameter = cyst
<1cm diameter = granuloma
but can only diagnose following being sent to lab

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15
Q

how does cyst expand

A

increase in osmotic pressure due to activation & proliferation of epithelial rests of malassez
& by cytokine mediated growth
often asymptomatic & slow growing with limited expansion

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16
Q

tx options for radicular cysts

A

non surgical endo; RCT
surgical endo; periradicular surgery
apicectomy
XLA
last 3 are if it remains symptomatic

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17
Q

paradental cyst

A

usually on lateral aspect of partially erupted vital teeth i.e. M3M where pericoronitis is inflammatory stimulus
related to neck or coronal 1/3 of tooth
tx =
SPM = enucleation
TPM = XLA

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18
Q

mandibular buccal bifurcation cysts

A

in children
usually buccal aspect of erupting FPM

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19
Q

developmental odontogenic cysts

A
  1. dentigerous cyst
  2. OKC
  3. lateral periodontal cyst
  4. gingival cysts
  5. calcifying odontogenic cyst
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20
Q

dentigerous cyst

A

associated with crown of u/e usually impacted tooth
commonly M3M
occurs when fluid accumulated between crown & reduced enamel epithelium (from enamel organ) dilating tooth follicle & preventing eruption
cyst attached to ACJ of u/e tooth

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21
Q

clinical criteria of dentigerous cyst

A

M>F
2nd-3rd decade
asymptomatic
often incidental finding
tooth missing from arch

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22
Q

radiographic criteria of dentigerous cyst

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A

round / ovoid
well defined unilocular / uniform radiolucency
corticated margins
attached at ADJ of tooth
larger cysts may envelope root of tooth
expand symmetrically initially but larger may expand unilaterally

23
Q

histopathological criteria

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A

thin non keratinised
stratified squamous epithelium
no significant inflammation

24
Q

why is dentigerous cyst commonly lower 8s and upper 3s

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A

they have the highest rate of impaction

25
follicular size v dentigerous cyst
<2.5mm = follicle >4.2mm = probable cyst >10mm = definite cyst asymmetrical radiolucency = cyst
26
tx of dentigerous cyst
1. XLA of u/e tooth 2. enucleation 3. marsupialisation
27
variation of dentigerous cyst
eruption cyst soft tissue variation caused by lack of separation of follicle & enlargement around tooth commonly primary incisors / FPMs in children
28
OKC
3rd most common after radicular & dentigerous originates from tooth structure but no specific relationship to teeth arises from cell rests of serres which originates from remnants of dental lamina
29
clinical criteria of OKC
M>F wide age range 70-80% mandible usually asymptomatic unless infected if infected white line of corticated margin is lost
30
radiographic criteria of OKC
oval well defined uniform radiolucency uni or multilocular
31
histopathological criteria of OKC
thin CT wall uninflamed thin parakeratinised stratified squamous epithelium ***no RETE PEGS with epithelium & CT*** pallisading of basal cell nuclei presence of daughter / satellite cells due epithelium being able to separate from wall following surgery leads to high recurrence rate - look like big pink / purple dots
32
to diagnose OKC
aspiration biopsy thick grey / white cheesy material with keratinous debris should contain squames & low soluble protein content (<4g/dl) squame = superficial keratinised squamous cell generally anucleated & increased no indicates abnormal keratinisation
33
tx of OKC
1. enucleation 2. marsupialisation
34
if multiple OKCs
associated with basal cell naevus syndrome which inc: - basal cell carcinoma - skeletal abnormalities - skin pigmentation aka gorlin goltz syndrome
35
lateral periodontal cyst
rare associated with lateral surface of tooth root commonly canine / premolar region vital tooth asymptomatic / incidental finding
36
clinical criteria of lateral periodontal cyst
middle aged may present with expansion vital mandible > maxilla
37
radiographic criteria of lateral periodontal cyst
well demarcated radiolucency attached to side of root
38
histopathological criteria of lateral periodontal cyst
thin stratified squamous epithelium similar to gingival cysts
39
gingival cysts
derived from remnants of dental lamina i.e. rests of serres in gingival / alveolar soft tissues in adults = <1cm pink / blue sessile swellings in children = bohn's nodules (similar to epstein pearls which are on palate but aren't odontogenic) naturally degenerate
40
calcifying odontogenic cyst clinical criteria
usually <40yrs 75% intraosseous mainly anterior to FPM small usually 1-3cm diameter shape variable monolocular adjacent teeth usually displaced +/- resorbed bony expansion
41
calcifying odontogenic cyst radiographic criteria
initially radiolucent uni or mulitlocular in more advanced stage contains variable calcified radiopaque material rarely recur - benign course
42
non odontogenic epithelial cysts
nasopalatine duct cyst
43
NPD cyst clinical criteria
M>F 5th-6th decades often asymptomatic may have salty taste & vital teeth i.e. no infection slowly enlarging swelling anterior midline of palate always involves midline but not always symmetrical larger cysts can displace teeth
44
NPD cyst radiographic criteria
well defined & corticated margin round / ovoid / heart shaped (due to superimposition of anterior nasal spine) radiolucency over roots of central incisors sclerotic margin
45
NPD cyst histopathological criteria
non keratinised stratified squamous with modified respiratory epithelium
46
cyst v incisive fossa
<6mm = incisive fossa 6-10mm = monitor >10mm = suspect cyst
47
non epithelial jaw cysts
solitary bone cyst - asymptomatic, incidental, aetiology unknown aneurysmal bone cyst - blood aspirated into this during biopsy stafne's idiopathic bone cavity - not a cyst just a depression / concavity in bone, only occurs in mandible
48
mx of cysts
referral initial consultation radiographs biopsy diagnosis txp & consent
49
what can you not enucleate
ameloblastoma
50
cyst enucleation
removal of entire cyst lining & contents useful for radicular / residual / dentigerous / OKC
51
complications of enucleation (4)
- damage to IAN - communication with maxillary sinus - pathological # of mandible - risk of recurrence
52
marsupialisation
creation of surgical window in wall of cyst to remove contents & suture surrounding epithelium encourages cyst to decrease in size for later enucleation (can take 1yr) tube / grommit insertion useful for large cyst
53
+/- of marsupialisation
+ simple + may spare vital structures + later enucleation - opening may close - long tx prior to completion - complete lining unavailable for histopathology - difficult to keep clean & a lot of aftercare required - chance of reinfection - uncomfortable
54
segmental resection
removal of cyst with margin of normal bone mainly for ameloblastoma / sarcoma normally require 2ndary procedure for reconstruction of defect

Dentistry in a Nutshell (30 decks)

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