Pseudotumors and cysts

Jan Laco, M.D., Ph.D.

Causes of swellings of jaws

• Cysts– odontogenic x non-odontogenic

• Odontogenic tumors• Giant cell lesions• Fibro-osseous lesions• Non-odontogenic tumors of bone• Metastatic tumors• Chronic osteomyelitis

Cysts of jaws

• = pathological cavity lined by epithelium• RTG: sharply-defined lucencies• ? fluid• slowly growth teeth displacement• asymptomatic x infection painfull• rarely: pathological fracture

Cysts of jaws

• Odontogenic– developmental

• dentigerous• eruption• gingival• lateral periodontal• odontogenic keratocyst• calcifying odontogenic cyst

– inflammatory• radicular• paradental

Cysts of jaws

• Non-odontogenic– nasopalatine duct – nasolabial

• Pseudocysts– solitary bone cyst– aneurysmal bone cyst

Cysts of jaws – frequency (%)

• 1. radicular 65-70• 2. dentigerous 15-50• 3. keratocyst 3-5• 4. nasopalatine 5-10

Odontogenic cysts – radicular cyst

common swelling of jaws and cyst males (M : F … 3 : 2)• 20 - 60 years• maxilla : mandible … 3 : 1• painless sweeling• enucleation

Odontogenic cysts – radicular cyst

• relationship to root of dead tooth• pulpitis periapical granuloma proliferation of

Malassez rests• Mi: hyperplastic squamous epithelium (net-like)

+ hyaline (Rushton) bodieswall: granulation tissue + fibrous tissue mixed inflammation hemosiderin, cholesterol clefts

Odontogenic cysts – residual cyst

= radicular cyst persisting after extraction- spontaneous regress

• lateral radicular cyst– at side of nonvital tooth– lateral branch of root canal– enucleation

Odontogenic cysts – paradental cyst

• inflammation around partially erupted tooth• lower 3. M males, 20 - 25 years• vital tooth with pericoronitis• Mi: ~ radicular cyst• enucleation

Odontogenic cysts – dentigerous cyst

• cystic change of enamel organ after complete enamel formation

• surrounds crown + attached to tooth neck at amelo-cemental junction crown inside (RTG)

• M : F … 2 : 1• 20 - 50 years• 3. M, C prevents eruption• Mi: thin squamous epithelium fibrous wall with scanty inflammation

Odontogenic cysts – eruption cyst

• in soft tissue over tooth about to erupt• from enamel organ (superficial dent. cyst)• children• teeth with no predecessors• soft bluish swelling in gingiva• spontaneously disappear

Odontogenic cysts – gingival cysts

• newborn (Bohn´s nodules) • > 80%• gingiva - proliferation of Serres nests• midline of palate (Epstein pearls)• spontaneously resolve

• adults - rare

Odontogenic cysts – lateral periodontal cyst

• uncommon cyst beside vital tooth• botryoid odontogenic cyst

– lower P and C– > 50 years– Mi: multilocular cyst with fibrous septa squamous epithelium + clear cells (glycogen)– recurrency

• glandular odontogenic cyst– Mi: mucous cells– recurrency

Odontogenic cysts

• odontogenic keratocyst keratocystic odontogenic tumor

• calcifying odontogenic cyst calcifying cystic odontogenic tumor

Odontogenic cysts – odontogenic keratocyst

• uncommon• from enamel organ before tooth formation• (20 – 30) + (50 – 70) years• mandible angle extending in finger-like

fashion in bone marrow spaces• asymptomatic• RTG: multilocular

Odontogenic cysts – odontogenic keratocyst

• Mi: squamous epithelium - basal layer (mitoses) - thin wavy para-

keratotic layer - folded cyst lining

wall - scanty inflammation• complete enucleation - difficult• 60% recurrency in first 5 years !!!

Odontogenic cysts – odontogenic keratocyst

• Gorlin-Goltz syndrome= multiple keratocysts + multiple naevoid

basal cell carcinomas of skin

Odontogenic cysts – calcifying odontogenic cyst

• Gorlin´s• anterior parts of jaws• RTG: cystic cavity + calcifications• Mi: ameloblastoma-like epithelium

ghost cells – large, pale, outlines of nucleus calcification+ odontomas (10% cases)

• enucleation• recurrency

Odontogenic cysts

• wall thickening– cholesterol clefts– carcinoma– ameloblastoma

Odontogenic cysts

• biopsy practice• nonspecific findings – inflammation

• X odontogenic keratocyst• X calcifying odontogenic cyst• X unicystic ameloblastoma

Non-odontogenic cysts – nasopalatine duct cyst

• uncommon• from nasopalatine duct epithelium • midline of palate• position variants (to incisive canal)

– nasopalatine– palatine papilla– median alveolar

• Mi: squamous + respiratory epitheliumwall: mucous glands + neurovascular bundle

• enucleation

Non-odontogenic cysts – nasolabial cyst

• = Klestadt´s, nasoalveolar• very uncommon• from remnants of nasolacrimal duct• in soft tissue deep in nasolabial fold• excision

Cysts of soft tissues

• thyroglossal duct cyst

• lymphoepithelial cyst

• lingual dermoid

• mucocele

Cysts of soft tissues- thyroglossal duct cyst

• uncommom• from remnants of any part of thyroglossal duct• early age• swelling in midline of mouth or neck• Mi: squamous + respiratory epithelium

wall: thyroid tissue, chronic inflammation• removal + part of hyoid bone

Cysts of soft tissues- lymphoepithelial cyst

• branchiogenic cyst ???• cystic change of epithelium entrapped in LN• early age• lateral part of neck + mandible angle + parotid• soft swelling• fistula to skin / oral cavity / pharynx• Mi: squamous + respiratory epithelium

wall: dense lymphoid tissue + germ centres• enucleation

Cysts of soft tissues- sublingual dermoid

• developmental anomaly of branchial arches or pharyngeal pouches

• between hyoid and jaws or beneath tongue• no symptoms• Mi: epidermoid cyst

dermoid cyst – dermal appendages• dissection

Cysts of soft tissues- mucoceles

minor salivary glands lower lip• superficial, 1 cm swellings• extravasation type – damage of duct

– saliva leak inflammation + mucophages – NO epithelium mucofagic granuloma

• retention type – obstruction of duct– epithelium of dilated duct

Cysts of soft tissues- mucoceles

• ranula= mucocele of submandibular or sublingual gland

• unilateral painless swelling, 2-3 cm• floor of mouth