Cysts and Tumors

7/29/2019 Cysts and Tumors

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Cystic lesion of the Mandible

Michael Chao, MD

Thursday March 11, 2004


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History

26 yo male w/ 6-8 month history of leftmandibular swelling

Fluctuating at first, now growing for 1 month

Loose molars (teeth 17-18)Intermittent bleeding, now purulent drainage from

loose teeth

Pain left mandible, no decreased sensation.

+trismus x 2 weeks, no dysphagia/odynophagia

No weight loss.


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Physical Exam

Left facial swelling over mandible andbuccal region

TTP along swelling

Teeth 17-18 loose

Mandible widened along body

No sensory deficits


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Panorex


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CT Face


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Differential Diagnosis

Odontogenic cysts

Nonodontogenic cysts

Odontogenic tumors


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Odontogenic Cysts

Periapical Cyst

Dentigerous Cyst

Odontogenic keratocyst

Basal cell neval syndrome

Primordial cyst

Lateral periodontal cyst

Gingival cyst of newborn/adult


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Periapical cysts

Most common odontogenic cyst (65%)

Secondary to infected tooth

Periapical bone resorbs and granulation

tissue replaces

Epithelial lining forms

Cyst forms when epithelium necrosis


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Dentigerous cyst

2nd most common odontogenic cyst (24%)

Most commonly found in 2nd-4th decades

Forms around unerupted teeth

Usually incidental finding on x-ray

Unilocular pericoronal radiolucent on x-ray


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Odontogenic keratocyst

3rd most common odontogenic cyst 5-8%

Aggressive lesion, rapid growth w/ frequent

recurrence

Capable of local bony destruction

Swelling, drainage, pain, infection frequent

complaints

Can mimic any cystic lesion of mandible

Recurrence 25-40% lesions


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Basal cell nevus syndrome

Associated with multiple OKCs

Autosomal dominant, high penetrance

Early development of multiple basal cell

carcinomas

5% pts w/ OKC have basal cell nevus

syndrome


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Other odontogenic cysts

Primordial cystdevelops instead of tooth

Rarest odontogenic cyst

Lateral periodontal cystoccur along root of vital tooth

Gingival cyst of newborn/adult

Remnants of dental laminaIn newborns-multiple nodules, found in bone

In adults-tense vesicles, found in soft tissue


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Nonodontogenic cysts

Stafne bone cyst

Traumatic bone cyst

Aneurysmal bone cyst


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Stafne bone cyst

Aberrant salivary tissue in or adjacent tomandible

Generally occur below inferior alveolar

canal


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Traumatic bone cyst

Despite name only ~50% have history oftrauma

No epithelial lining

Appears as radiolucency scalloped betweentooth roots

Does not erode cortex or teeth

Found above inferior alveolar canal


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Aneurysmal bone cyst

Can occur in any bone in body, most oftenspine or long bones

Not a true cystno epithelial lining

Displaces teeth

Often presents as painful localized lesion


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Odotogenic tumors

AmeloblastomaAdenomatoid odontogenic tumor

Keratinizing and clacifying odontogenic cyst

Odontogenic myxmoma

Ameloblastic fibroma

Ameloblastic fibro-odontoma

Complex odontoma

Compound odontomaCementoblastoma


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Ameloblastoma

Most common odontogenic tumor 13.5%

Slow persistent growth

locally aggressive

Large lesions cause thinning of cortex, pathologic

fractures

Radiographically uni-/multilocular, resorb teeth


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Ameloblastoma


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Calcifying epithelial odontogenic tumor

Benign infiltrative odontogenic tumorMost commonly in the mandibular

molar/premolar region

Associated with an unerupted/impacted toothLocally destructive and expanding

Slower growth, less aggressive than

Ameloblastoma

Radiographically snow-driven appearance


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Calcifying epithelial odontogenic tumor


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Keratinizing/calcifying odontogenic cyst

Tumor with cystic tendenciesVery rare lesion

Usually incidental finding on dental x-ray

Arise from a more mature enamel epithelium

On x-ray nondescript radiolucencies withradioopaque patches

Histologically may appear similar to unicystic

ameloblastoma


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Keratinizing/calcifying odontogenic cyst


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Odontogenic myxoma

Benign infiltrative lesion

locally invasive and destructive

Radiographically multilocular cyst

Histologically distinct from ameloblastoma

stellate fibroblasts w/ copious hyaluronic acid,

scant collagen

no capsule


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Odontogenic myxoma

Alcian blue stain of

odotogenic myxoma

Radiolucent lesionw/ small

multiloculated cysts


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A mixed tumor arising from 2 embryonictissues

Realtively uncommon tumorsues.

Benign expansile lesionRadiograhically similar to ameloblastoma

Epithelial component and connective tissue

components


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well defined lesion associated

w/ unerupted tooth

displaces adjacent teeth, does

not destroy

islands of ameloblasticepithelium surrounding a

stellate-reticulum-like center


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Ameoblastic fibro-odontoma

Most often develops before 20yrs oldExtremely rare odontogenic lesion

Develops from dental hard tissues (eg, dentin,

enamel, cementum)Generally do not have much growth potentialRadiographically well demarcated lesion,

radiolucent w/ central opacity

Surgical excision is curative


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Ameloblastic fibro-odontoma

cystic lesion destroying

and displacing teeth

narrow cords and small

islands of epithelium


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Complex odontoma

One step more differentiated thanameloblastic fibro-odontoma

Common lesions that persist through life

Usually detected in adolescence

Radiographically "sunburst" radiopacities

w/ uniform rim


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Complex odontoma

large radioopaque lesionwell encapsulated w/

radioiolucent border


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Compound odontoma

Most common odontogenic tumorAppears as a cluster of multiple abortive teeth

Often prevents normal tooth eruption

Radiographically multiple tiny toothlike structuresare contained within a fine radiolucent rim

Do not recur after excision


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Compound odontoma

3 small radioopaque lesion

w/ radiolucent rim

well encapsulated lesionsappear similar to normal teeth


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Cementoblastoma

Benign neoplasm of cementumRare and usually diagnosed by early 20's

50% lesions associated w/ apical 1st mandiblualr

molarMost commonly asymptomatic

Radiographically "suburst" mass attached to apex

Treatment consists of surgical extraction of tooth

and lesion

Recurrence is rare


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Cementoblastoma

sunburst lesion at apical root

radiolucent rim

acellular sheets of cemetumattached to root

Cysts and Tumors

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