Oral and Maxillofacial Pathology , Radiology
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Transcript of Oral and Maxillofacial Pathology , Radiology
BouquotBouquot’’s Desks DeskCirca 1971Circa 1971
The BouquotsThe Bouquots19811981
Oral & Maxillofacial Pathology IIOral & Maxillofacial Pathology IIDB 3702DB 3702
Thursdays, 10:00 – 11:50 amRoom DB 132
Course Director: Dr. J. E. BouquotCourse Director: Dr. J. E. BouquotRoom 3.094b; 713Room 3.094b; [email protected]@uth.tmc.edu
Topic: Odontogenic Tumors and CystsTopic: Odontogenic Tumors and Cysts
Cells & TissuesCells & Tissuesof Originof Origin
Ameloblasts v. PreameloblastsAmeloblasts v. Preameloblasts
PreameloblastsPreameloblasts EnamelEnamel
AmeloblastsAmeloblasts
OdontoblastsOdontoblasts
Stellate ReticulumStellate Reticulum
Dental PapillaDental Papilla
Classification of Classification of Odontogenic TumorsOdontogenic Tumors
Odontogenic TumorsOdontogenic TumorsEpithelial TypesEpithelial Types
Ameloblastoma-- Conventional ameloblastoma-- Unicystic ameloblastoma-- Peripheral ameloblastomaMalignant ameloblastomaAmeloblastic carcinomaClear cell odontogenic carcinomaAdenomatoid odontogenic tumorCalcifying epithelial odontogenictumorSquamous odontogenic tumor
AmeloblastomaAmeloblastoma
AmeloblastomaAmeloblastoma
Odontogenic TumorsOdontogenic TumorsMixed Epithelial/Mesenchymal TypesMixed Epithelial/Mesenchymal Types
Ameloblastic fibromaAmeloblastic fibro-odontomaAmeloblastic fibrosarcomaOdontoameloblastomaOdontoma
Ameloblastic FibromaAmeloblastic Fibroma
Ameloblastic FibromaAmeloblastic Fibroma
Compound OdontomaCompound Odontoma
Odontogenic TumorsOdontogenic TumorsEctomesenchymal TypesEctomesenchymal Types
Central Odontogenic FibromaPeripheral OdontogenicFibromaGranular Cell OdontogenicTumorOdontogenic MyxomaCementoblastoma
CementoblastomaCementoblastoma
Odontogenic MyxomaOdontogenic Myxoma
AmeloblastomaAmeloblastoma
AmeloblastomaAmeloblastoma
Benign neoplasm of preameloblasts-- Epithelial rests of dental lamina-- Basal cells of alveolar mucosa-- Cyst lining epithelium
GALP: -- None-- Any age, usually 30-50 years-- Posterior mandible-- Most common of “aggressive”
odontogenic tumors
PreameloblastsPreameloblasts
AmeloblastomaAmeloblastomaRadiographic/Clinical FeaturesRadiographic/Clinical Features
Multilocular (soap bubble) radiolucency-- May be unilocularWell demarcated bordersExpands, thins cortexAsymptomatic
AmeloblastomaAmeloblastomaRadiographic FeaturesRadiographic Features
May extend far into ramusMay fill maxillary sinusMay be huge
AmeloblastomaAmeloblastoma
AmeloblastomaAmeloblastomaRadiographic FeaturesRadiographic Features
Often associated with crown of unerupted tooth Often resorbs adjacent rootsMay push roots asideMay push whole tooth
AmeloblastomaAmeloblastomaHistopathologyHistopathology
Islands of odontogenic epitheliumPeripheral palisading cells-- Vacuoles toward basement membrane--PreameloblastsCenter: stellate reticulumMature fibrous stromaOften cystic degeneration
AmeloblastomaAmeloblastomaHistopathologic SubtypesHistopathologic Subtypes
Follicular type-- Most common type-- Islands resemble tooth budsPlexiform type-- Intertwining strands of epithelial cells
AmeloblastomaAmeloblastomaHistopathologic SubtypesHistopathologic Subtypes
Acanthomatous type-- Squamous epithelium in center
Granular cell type-- Histiocyte-like cells -- Granular cytoplasm
Basal cell type-- Like basal cell carcinoma
AmeloblastomaAmeloblastomaTreatment & PrognosisTreatment & Prognosis
Enucleation: >50% recurrence rateEn bloc resection: <15% recurrence rate↑ Cystic > ↑ prognosisMain problem: local destruction-- May invade through base of skull-- May wrap around neck structuresRarely: piece breaks off @ surgery: aspirated-- Ameloblastoma grows in bronchial tree
AmeloblastomaAmeloblastomaVariantsVariants
Unicystic ameloblastoma-- Intraluminal ameloblastoma-- Mural ameloblastoma
Peripheral ameloblastoma-- Extraosseous ameloblastoma
Desmoplastic ameloblastoma
Ameloblastic carcinoma
Malignant ameloblastoma
AmeloblastomaAmeloblastomaVariantsVariants
Unicystic ameloblastoma-- Intraluminal ameloblastoma-- Mural ameloblastoma
Peripheral ameloblastoma-- Extraosseous ameloblastoma
Desmoplastic ameloblastoma
Ameloblastic carcinoma
Malignant ameloblastoma
Unicystic AmeloblastomaUnicystic Ameloblastoma
15% of all ameloblastomasDegenerated “ basket weave” cyst liningUnilocular radiolucency onlyResembles dentigerous cystYounger persons-- Avg. age = 23 yearsMuch less aggressivethan regular ameloblastoma
Peripheral AmeloblastomaPeripheral AmeloblastomaExtraosseous AmeloblastomaExtraosseous Ameloblastoma
1% of all ameloblastomasSame histology as internal ameloblastomaMass on gingiva-- Sessile-- AsymptomaticMinimal growth potential-- < 1 cm. diameterMay cup out underlying cortex-- Saucerization
Conservative surgical removalAlmost no recurrence rate
Desmoplastic Desmoplastic AmeloblastomaAmeloblastoma
Dense fibrous stroma-- Transforming growth factor ß“Squished” epithelial islandsMixed radiolucent/radiopaque-- From bone stimulationMoth-eaten radiolucencyUsually not multilocularMaybe less aggressivethan regular ameloblastoma
AmeloblastomaAmeloblastomaMalignant VariantsMalignant Variants
Ameloblastic Ameloblastic CarcinomaCarcinoma
Cells are dysplasticMetastizesMay look like salivaryadenocarcinoma
Malignant AmeloblastomaMalignant Ameloblastoma
Cells look benignMetastasizesCaution: this is not same as aspiration ofameloblastoma cells!
Ameloblastic Ameloblastic FibromaFibroma
Ameloblastic FibromaAmeloblastic FibromaJuvenile AmeloblastomaJuvenile Ameloblastoma
Benign neoplasm-- Epithelial & mesenchymal
originGAL:-- None-- First two decades of life-- Posterior mandible
Ameloblastic FibromaAmeloblastic FibromaAsymptomaticUsually multilocular radiolucency-- No calcifications centrallyWell demarcated-- Often: thin sclerotic rimUsually associated withcrown of unerupted toothMay expand cortexCan move teeth
Ameloblastic FibromaAmeloblastic Fibroma
Primitive mesenchymaltissues-- Immature stroma-- Large, stellate, spindled
nuclei-- Mild/Moderate cellularityDouble-layered strands of cuboidal odontogenic epitheliumAmeloblastoma-like islands
Ameloblastic FibromaAmeloblastic FibromaWith AmeloblastomaWith Ameloblastoma--Like IslandsLike Islands
Hyaline InductionHyaline Induction
Ameloblastic FibromaAmeloblastic FibromaTreatment & PrognosisTreatment & Prognosis
May become very largeConservative surgical removal or curettage40% risk of recurrence
Ameloblastic Ameloblastic FibrosarcomaFibrosarcoma
Ameloblastic Ameloblastic FibrosarcomaFibrosarcoma
Stroma shows malignancyEpithelial islands OKBehaves like fibrosarcoma
Ameloblastic Ameloblastic FibroFibro--OdontomaOdontoma
Enamel and dentin structuresMay be early stage of odontomaMay become very largeRadiolucent backgroundGlobular opacities centrallyPerhaps: tooth-like shapes
Ameloblastic FibroAmeloblastic Fibro--OdontomaOdontoma
Ameloblastic FibroAmeloblastic Fibro--OdontomaOdontoma
©Photo: WESTOP, Dr. Beatriz Aldape, National University of Mexico, Mexico City, Mexico
Ameloblastic Ameloblastic FibroFibro--OdontomaOdontoma
©Photo: WESTOP, Dr. Beatriz Aldape, National University of Mexico, Mexico City, Mexico
Adenomatoid Adenomatoid Odontogenic TumorOdontogenic Tumor
Adenomatoid Adenomatoid Odontogenic TumorOdontogenic TumorAOT; AdenoameloblastomaAOT; Adenoameloblastoma
Benign neoplasm-- Reduced enamel epithelium-- Maybe it’s a hamartoma
GAL:-- Female-- Second decade-- Anterior maxilla-- 5% of all
odontogenictumors
Reduced enamel Reduced enamel epitheliumepithelium
Adenomatoid Odontogenic TumorAdenomatoid Odontogenic TumorAOT; AdenoameloblastomaAOT; Adenoameloblastoma
Unilocular radiolucencyOften: thin sclerotic rimWell-demarcated peripheryMay expand cortexEventually globular radiopacities-- Or small “snowflake” opacities Asymptomatic Around crown ofimpacted toothInterferes witheruption1-2 cm. in size
Adenomatoid Odontogenic TumorAdenomatoid Odontogenic Tumor
Adenomatoid Odontogenic Adenomatoid Odontogenic TumorTumor
HistopathologyHistopathology
Spindle-shaped epithelial cells-- Form sheets and strandsWhorled masses and rosette structuresDuctal structures -- Peripheral palisading-- Polarization of nuclei
toward the basementmembrane
Adenomatoid Odontogenic Adenomatoid Odontogenic TumorTumor
HistopathologyHistopathology
Dystrophic calcificationAmyloidThin fibrous capsule
Adenomatoid Odontogenic TumorAdenomatoid Odontogenic TumorTreatment & Special VariantsTreatment & Special Variants
Treat: Surgical curettageAlmost no recurrence risk
Variant:Peripheral AOT-- Very mild behavior-- Like fibroma-- On gingiva-- No recurrence
Calcifying Epithelial Calcifying Epithelial Odontogenic TumorOdontogenic Tumor
Calcifying Epithelial Calcifying Epithelial Odontogenic TumorOdontogenic Tumor
CEOT; Pindborg TumorCEOT; Pindborg Tumor
Benign, aggressive neoplasmTooth bud cells-- Probably stellate reticulum
GALP:-- None-- 30-50 years-- Posterior mandible-- < 1% of all
odontogenic tumors
Calcifying Epithelial Odontogenic TumorCalcifying Epithelial Odontogenic TumorCEOT; Pindborg TumorCEOT; Pindborg Tumor
Well-demarcated radiolucency-- Unilocular or multilocularOften: globular calcified opacitiesFrequently associated with crownof impacted toothAsymptomaticExpands cortex
Calcifying Epithelial Calcifying Epithelial Odontogenic TumorOdontogenic Tumor
HistopathologyHistopathology
Islands, clusters, strands ofpolyhedral epithelial cellsOften: intercellular bridgesOften: large and dysplastic-looking cells-- Not true dysplasia-- No mitotic activityBackground fibrous stromaGlobular calcifications withLiesegang rings(onion skinning)
Calcifying Epithelial Calcifying Epithelial Odontogenic TumorOdontogenic Tumor
HistopathologyHistopathology
Masses of hyalinized material-- Amyloid-- Congo red-- Thioflavin T immunostaining
Calcifying Epithelial Calcifying Epithelial Odontogenic TumorOdontogenic Tumor
TreatmentTreatment
Less aggressive than ameloblastoma--But may be aggressive locallyConservative local resection-- Narrow rim of normal bone15% recurrence rate
Peripheral Pindborg TumorPeripheral CEOT
Attached gingivaAnterior regionMay erode bone-- SaucerizationLow biological behaviorTumor may be attached to surfaceepithelium
OdontomaOdontoma
OdontomaOdontomaComplex Odontoma; Compound OdontomaComplex Odontoma; Compound Odontoma
Developmental hamartoma-- Maybe benign neoplasmGALP:-- None-- First two decades of life-- Compound variant = anterior maxilla-- Complex variant = molar regions
(both jaws)-- Most common odontogenic tumor
OdontomaOdontomaComplex Odontoma; Complex Odontoma;
Compound OdontomaCompound Odontoma
Well-demarcated radiolucency-- With irregular or tooth-like opacities Thin sclerotic rimmingAsymptomaticUsually associated with crownof unerupted toothPrevents eruption
OdontomaOdontomaComplex Odontoma; Compound OdontomaComplex Odontoma; Compound Odontoma
Complex odontoma-- Unorganized calcified tooth-related tissuesCompound odontoma-- Tooth-like structures are presentCombined odontoma-- Mixture of complex and compoundCystic odontoma-- In wall of dentigerous cyst
Compound OdontomaCompound Odontoma
Compound OdontomaCompound Odontoma
Cystic OdontomaCystic Odontoma
Complex OdontomaComplex OdontomaMay interfere with eruptionMay interfere with eruption
OdontomaOdontomaHistopathologyHistopathology
Mature fibrous stomaContaining irregular masses ofdentin with areas of enamel matrix Cementum and pulp tissueMasses may be tooth-likeEncapsulated
OdontomaOdontomaTreatmentTreatment
Usually “burn out”May become hugeEnucleation/curettageNo recurrence
A Kick in the OlA Kick in the Ol’’ OdontomaOdontomaIs this a good way to treat an odontoma?!!Is this a good way to treat an odontoma?!!
OdontoOdonto--AmeloblastomaAmeloblastoma
OdontoameloblastomaOdontoameloblastomaCollision Tumor: Ameloblastoma & OdontomaCollision Tumor: Ameloblastoma & Odontoma
Odontogenic Odontogenic MyxomaMyxoma
Odontogenic MyxomaOdontogenic Myxoma
Benign neoplasm-- Of odontogenic ectomesenchymeGAL:-- None-- Second - fourth decades-- RareExclusively in the jaws-- There are soft tissue myxomas
(e.g. cardiac myxoma)
Odontogenic MyxomaOdontogenic Myxoma
Multilocular radiolucency-- Occasionally unilocular
(Especially odontogenic fibromyxoma)Poorly or well-demarcated peripheryAsymptomaticExpands and thins cortexMaybe: push teethMaybe: resorb rootsOften associated withcrown of impacted tooth
Odontogenic Odontogenic MyxomaMyxoma
Odontogenic MyxomaOdontogenic MyxomaHistopathologyHistopathology
Background fibromyxoid stromaRather acellular, with few stellateor bipolar mesenchymal cells-- Similar to primitive pulpNot encapsulatedIf stroma is dysplastic:-- Odontogenic myxosarcoma
Odontogenic Odontogenic MyxofibromaMyxofibroma
TeenagersAround crown of impacted toothMuch less aggressive than routine myxoma
Odontogenic MyxomaOdontogenic MyxomaTreatment & PrognosisTreatment & Prognosis
May be locally aggressive-- Does not metastasize Small lesions: curettageOdontogenic myxofibroma: curettageLarge lesions: resection with 0.5 cm. margins
Odontogenic fibromyxosarcoma-- Radical surgery
Odontogenic Odontogenic FibromaFibroma
Odontogenic FibromaOdontogenic Fibroma
Benign neoplasm -- Odontogenic mesenchymal cells
GALP:-- Females-- Second - fourth decades of life-- Anterior maxilla and posterior mandible-- Rare
Odontogenic FibromaOdontogenic Fibroma
Well-demarcated radiolucencyUsually unilocular-- Larger: often multilocularOften surrounding crown ofimpacted toothAsymptomaticMay resorb rootsMay expand cortexMay move teethCaution!Must distinguish fromhyperplastic dentalfollicle
Odontogenic FibromaOdontogenic FibromaHistopathologyHistopathology
Background stroma:-- Mature fibrous tissueStellate and spindled fibroblastsOften with whorled pattern Stroma may be quite loose-- Like odontogenic myxomaOdontogenic epithelial restsDystrophic calcifications -- Or cementum-like globules -- Or dentin-like globulesEncapsulated
Odontogenic FibromaOdontogenic FibromaTreatment and Special VariantsTreatment and Special Variants
Enucleation or curettageRecurrence is rareSimple odontogenic fibroma-- Almost all fibrous-- Small epithelial islands-- Small dystrophic calcificationWHO type of odontogenic fibroma-- Many epithelial islands-- Calcified globulesPeripheral odontogenic fibroma-- Innocuous gingiva mass
CementoblastomaCementoblastoma
CementoblastomaCementoblastomaBenign CementoblastomaBenign Cementoblastoma
Benign neoplasm of cementumAttached to toothBone counterpart:-- Osteoblastoma
GALP:-- Female-- Second-fourth decades-- Mandibular molar-- Rare
CementoblastomaCementoblastomaBenign CementoblastomaBenign Cementoblastoma
Enlargement of root apexRounded or irregular radiopacity-- May be some radiolucency Well-demarcatedThin capsule, may be irregular-- Continuous with PDLOften: tender/painfulMay expand cortex
CementoblastomaCementoblastomaHistopathologyHistopathology
Cementoid or osseous calcified massesBackground stroma of fibrous tissueCementoblasts/cementoclastsEncapsulated (PLD?)
CementoblastomaCementoblastomaTreatment; PathophysiologyTreatment; Pathophysiology
May become 7 cm acrossDestroys root; tooth remains viableMaybe: pressure resorption of adjacent rootExtractionRecurrences are rare
Central Cementifying Central Cementifying FibromaFibroma
Central Cementifying FibromaCentral Cementifying Fibroma
Odontogenic or bone tumor?Benign tumor of alveolusTeens to 35 years of ageAsymptomaticRadiolucent background, globular radiopacities in centerGets more opaque over timeCapsule around itUsually <3 cm. in sizeMay expand cortexHistopathology:--Like cementoblastoma
Central Central Cementifying FibromaCementifying Fibroma
Early lesionEarly lesion
Late lesionLate lesion
Classification of Classification of Odontogenic CystsOdontogenic Cysts
Odontogenic Cysts Odontogenic Cysts
Dentigerous Cyst-- Eruption CystPrimordial CystLateral Periodontal CystBuccal Bifurcation CystOdontogenic Keratocyst-- Gorlin SyndromeOrthokeratinized Odontogenic CystGingival Cyst of the NewbornGingival Cyst of the AdultCalcifying Odontogenic CystGlandular Odontogenic Cyst
Odontogenic KeratocystOdontogenic Keratocyst
Dentigerous CystDentigerous Cyst
With rare exceptions, epithelium-lined cysts in bone
are seen only in the jaws
Dentigerous CystDentigerous Cyst
Dentigerous CystDentigerous Cyst
Usually developmentalMaybe: from inflammationCleft in reduced enamel epitheliumSeparation from crownDegenerated stellate reticulum
GAL:-- None-- 10-30 years of age-- Third molar areas-- Especially mandible
Dentigerous CystDentigerous CystClinical FeaturesClinical Features
Well-demarcated radiolucencyUsually: unilocularOften: thin sclerotic rimmingAround crown, by definitionTeeth can be pushedMay: resorb rootsOften: prevents eruptionThree types-- Central-- Lateral-- Circumferential
Dentigerous Cyst or Not?Dentigerous Cyst or Not?The 1.5 mm. ruleThe 1.5 mm. rule
Dentigerous CystDentigerous CystOnce Called Cystic CarcinomaOnce Called Cystic Carcinoma
Multiple Dentigerous CystsMultiple Dentigerous CystsWorry About Gorlin SyndromeWorry About Gorlin Syndrome
Dentigerous CystDentigerous CystHistopathologyHistopathology
Atrophic stratified squamous epithelial lining-- Usually parakeratin-- Maybe: mucus metaplasiaFibrous/fibromyxomatous stroma-- Often hyperplastic-- Maybe inflamedAttached at cervical regionMaybe: ulcerated epithelial lining
Dentigerous CystDentigerous CystHistopathologyHistopathology
Cholesterol granuloma:-- Cholesterol clefts-- Foreign body reaction-- Multinucleated giant cellsWaldron type dentigerous cyst-- If reduced enamel epithelium-- If no epitheliumOrthokeratinized odontogenic cyst
Dentigerous CystDentigerous CystTreatment; PathophysiologyTreatment; Pathophysiology
Enucleation-- Maybe: extraction-- Maybe: orthodontic guidanceMarsupialized (large lesions)Special Problems:-- Odontogenic keratocyst-- Carcinoma in epithelial lining-- Eruption cyst
Orthokeratinizing Orthokeratinizing Odontogenic CystOdontogenic Cyst
Orthokeratinizing Orthokeratinizing Odontogenic CystOdontogenic Cyst
Parakeratinizing OdontogenicParakeratinizing OdontogenicKeratocystKeratocyst
Usually dentigerous cystOnce thought to be a variant of odontogenic keratocyst-- But histology is different!Same biological behavior asdentigerous cyst
Eruption CystEruption Cyst
Eruption CystEruption CystEruption Hematoma; Dentigerous CystEruption Hematoma; Dentigerous Cyst
Dentigerous cyst of erupting toothBlue or bluish-red colorCortex completely missing Fibrous stroma between epitheliaNo treatment needed-- Unless infected-- Tooth erupts normallyMay erupt into pericoronitis:-- Paradental cyst
Eruption CystEruption CystEruption Hematoma; Dentigerous CystEruption Hematoma; Dentigerous Cyst
Cortex completely missing -- Fibrous stroma between epitheliaBlue or bluish-red color-- Maybe: clear fluid inside
Eruption CystEruption CystDentigerous CystDentigerous Cyst
Odontogenic Odontogenic KeratocystKeratocyst
Odontogenic KeratocystOdontogenic Keratocyst
Developmental cystic degeneration-- Of odontogenic epithelial rests-- Sometimes triggered by
inflammation?
GAL:-- None-- 10-40 years-- Posterior mandible-- Ramus
Odontogenic KeratocystOdontogenic KeratocystClinical FeaturesClinical Features
Well-demarcated radiolucencyMultilocular or unilocularAsymptomaticOften associated with crown of impacted toothSeldom expands cortex, may thin it--Except: superior-inferiorMay become very largeMay push teethMay resorb roots, perforate cortex
Odontogenic KeratocystOdontogenic Keratocyst
Odontogenic KeratocystOdontogenic KeratocystMay be hazy opacity if in sinus; May become inflamedMay be hazy opacity if in sinus; May become inflamed
Odontogenic KeratocystOdontogenic KeratocystClinical SubtypesClinical Subtypes
Dentigerous cyst typePrimordial cyst typeLateral periodontal cyst typePeriapical cyst type
Odontogenic KeratocystOdontogenic KeratocystHistopathologyHistopathology
Uniform 4-7 cell thicknessLoss of rete ridges/processesThin corrugated parakeratin layerPolarized basal cell nucleiHyperchromatic basal cell nucleiPulling away frombasement membrane
Orthokeratizing odontogenic cyst looks different!
Odontogenic KeratocystOdontogenic KeratocystHistopathology
Fibrous/fibromyxomatous stromaOften: islands of benignodontogenic epitheliumMaybe: daughter cysts
Odontogenic KeratocystOdontogenic KeratocystLoss of Classical Microscopic Features in Inflamed Area
Odontogenic KeratocystOdontogenic KeratocystTreatment; Special ProblemsTreatment; Special Problems
Enucleation and curettage-- Up to 62% recurrence-- Usually within 5 yearsOstectomy/En bloc resectionHemimandibulectomy Chemical cauterization-- Carnoy’s solution
Marsupialization (large lesions)Rare: carcinoma developsProblem: Gorlin syndrome
Gorlin SyndromeGorlin Syndrome
Gorlin SyndromeGorlin SyndromeNevoid Basal Cell Carcinoma SyndromeNevoid Basal Cell Carcinoma Syndrome
Mutation of PATCH (PTCH, patched)-- Tumor suppressor gene-- Chromosome 9q22.3-q31Multiple keratocysts-- Often dentigerous cyst type-- May be hugeMultiple basal cell carcinomas and nevi
Gorlin SyndromeGorlin SyndromeNevoid Basal Cell Carcinoma SyndromeNevoid Basal Cell Carcinoma Syndrome
Frontal bossingPalmar/plantar pitsBifid ribsSplayed ribsFused ribsMissing ribsCalcified falx cerebriSpina bifida occulta
Gorlin CystGorlin Cyst
Calcifying Odontogenic CystGorlin Cyst; COC
Cross between:-- Developmental cyst-- Benign neoplasm
GAL:-- None-- Anterior maxilla/mandible
(65% of cases)
Calcifying Odontogenic Cyst Clinical Features
Unilocular radiolucency-- May be multilocular Well-demarcated borders-- Often: thin sclerotic rimmingEventually: irregular radiopacities-- Or tooth-like structuresAround crown of tooth-- 1/3 of casesUsually 2-4 cm.-- Maybe: much larger
The Original Gorlin CystThe Original Gorlin CystCalcifying Odontogenic CystCalcifying Odontogenic Cyst
©Photos: Dr. R. J. Gorlin, University of Minnesota, Minneapolis, Minnesota
Calcifying Odontogenic Cyst
Histopathology
Stratified squamous epitheliumliningFibrous stromaAbundant keratin production-- Eosinophilic ghost cells--Dystrophic calcificationBasal cells might be cuboidal-- Look like preameloblastsEpithelium may proliferate-- Into lumen-- Into fibrous stroma
Calcifying Odontogenic CystSpecial Cases
Peripheral Gorlin cyst-- Attached gingiva-- Not aggressive-- May represent 30% of total
Epithelial odontogenic ghost cell tumor-- No cyst formation; solid tumor-- 2-14% of all “Gorlin cysts”-- More aggressive
Gorlin cyst phenomenon
Odontogenic ghost cell carcinoma-- Very rare-- 73% 5-year survival
Calcifying Odontogenic Cyst
Treatment & PrognosisTreatment & Prognosis
Enucleation for smaller lesionsSome recurrencesMore solid = more aggressiveLarge/aggressive lesion:-- Resection
Gingival Cyst of Gingival Cyst of NewbornNewborn
Gingival Cyst of NewbornGingival Cyst of NewbornEpstein Pearls; Bohn NodulesEpstein Pearls; Bohn Nodules
Developmental cyst-- Remnants of dental lamina100+ tooth buds to create 32 teethPrevalence: up to 50% of newborns
GAL:-- None -- Congenital-- Alveolus-- Palate
Gingival Cyst of Gingival Cyst of NewbornNewborn
Clinical FeaturesClinical Features
Small, superficial whitish blebsSingle or maybe dozensOn posterior hard/soft palate:-- Epstein pearls-- Bohn nodules
Gingival Cyst of NewbornGingival Cyst of NewbornHistopathology and TreatmentHistopathology and Treatment
Cyst lining of stratified squamous epitheliumLumen filled with sloughed keratin
No treatment required-- Cysts rupture spontaneously within days-- May last until teeth erupt-- Cysts do not interfere with eruption
Gingival Cyst of AdultGingival Cyst of Adult
Gingival Cyst of AdultGingival Cyst of Adult
Developmental, degenerative cyst-- Rests of Serres in gingival stroma
GAL:-- None-- 40-60 years-- Attached gingiva (facial)-- Mandibular cuspid/premolar area
(70% of cases)
Gingival Cyst of AdultGingival Cyst of AdultClinical FeaturesClinical Features
Painless mass of attached gingivaDome-shaped (sessile)Fluctuant
<.5 cm diameterMaybe: blue colorMaybe: saucerizationRound radiolucency-- Well demarcated
Gingival Cyst of AdultGingival Cyst of AdultHistopathology; TreatmentHistopathology; Treatment
Stratified squamous epithelial cyst liningDense fibrous stromaLumen: filled with fluid or keratinEnucleation-- No recurrence
Lateral Periodontal Lateral Periodontal CystCyst
Lateral Periodontal CystLateral Periodontal Cyst
Developmental-- Cystic degeneration of
odontogenic epithelial rests
GALP:-- None-- 40-70 years-- Mandibular premolar area
(80% of all cases)-- <2% of all odontogenic cysts
Lateral Periodontal CystLateral Periodontal CystClinical FeaturesClinical Features
AsymptomaticTeeth are viableCenter: inter-radicular bone-- Not periodontal ligament-- Midpoint halfway between premolarsWell-demarcated radiolucency-- UnilocularUsually < 5 mm. diameter May push roots out of wayDoes not resorb roots
Lateral Periodontal CystLateral Periodontal CystHistopathologyHistopathology
Cyst with clear fluid in lumen-- Lumen is empty on H&E slide Thin stratified squamous epitheliumFocal epithelial nodules (unique!)-- Extend into lumenSeldom inflamed
Lateral Periodontal CystLateral Periodontal CystTreatmentTreatment
EnucleationSmall recurrence rateCaution! Make sure it’s notmental foramen!Caution! Must send for biopsy diagnosis-- Odontogenic keratocyst
can have similar x-ray presentation
Botryoid Lateral Periodontal CystBotryoid Lateral Periodontal CystClinical FeaturesClinical Features
Multilocular radiolucency-- Like a grape cluster (”botryoid”) May be very large May be more aggressiveHigher recurrence rateMay require block resection
Buccal Bifurcation Buccal Bifurcation CystCyst
Buccal Bifurcation CystBuccal Bifurcation Cyst
Inflammatory stimulation of epithelial restsAlways: in furcation region of mandibular molar
GALP:-- None-- Middle-aged-- First mandibular molar area-- Rare
Buccal Bifurcation CystBuccal Bifurcation Cyst
Asymptomatic or tenderPoorly demarcated furcation radiolucencyWithout periodontal pocketTooth is viableSessile, moderately firm gingival mass-- Facing toward the facial-- < 8 mm. diameter
Buccal Bifurcation CystBuccal Bifurcation Cyst
Degenerated stratified squam. epitheliumFocally edematous fibrous stroma Numerous chronic inflammatory cellsPMNs in and beneath epitheliumTreat: Enucleation-- May have to extract toothCaution! Check vitality of the toothCaution Probe for periodontal pockets