oral & maxillofacial pathology - odontogenic tumors
TRANSCRIPT
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BouquotBouquot’’s Desks DeskCirca 1971Circa 1971
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The BouquotsThe Bouquots19811981
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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
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Cells & TissuesCells & Tissuesof Originof Origin
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Ameloblasts v. PreameloblastsAmeloblasts v. Preameloblasts
PreameloblastsPreameloblasts EnamelEnamel
AmeloblastsAmeloblasts
OdontoblastsOdontoblasts
Stellate ReticulumStellate Reticulum
Dental PapillaDental Papilla
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Classification of Classification of Odontogenic TumorsOdontogenic Tumors
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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
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Odontogenic TumorsOdontogenic TumorsMixed Epithelial/Mesenchymal TypesMixed Epithelial/Mesenchymal Types
Ameloblastic fibromaAmeloblastic fibro-odontomaAmeloblastic fibrosarcomaOdontoameloblastomaOdontoma
Ameloblastic FibromaAmeloblastic Fibroma
Ameloblastic FibromaAmeloblastic Fibroma
Compound OdontomaCompound Odontoma
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Odontogenic TumorsOdontogenic TumorsEctomesenchymal TypesEctomesenchymal Types
Central Odontogenic FibromaPeripheral OdontogenicFibromaGranular Cell OdontogenicTumorOdontogenic MyxomaCementoblastoma
CementoblastomaCementoblastoma
Odontogenic MyxomaOdontogenic Myxoma
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AmeloblastomaAmeloblastoma
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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
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AmeloblastomaAmeloblastomaRadiographic/Clinical FeaturesRadiographic/Clinical Features
Multilocular (soap bubble) radiolucency-- May be unilocularWell demarcated bordersExpands, thins cortexAsymptomatic
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AmeloblastomaAmeloblastomaRadiographic FeaturesRadiographic Features
May extend far into ramusMay fill maxillary sinusMay be huge
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AmeloblastomaAmeloblastoma
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AmeloblastomaAmeloblastomaRadiographic FeaturesRadiographic Features
Often associated with crown of unerupted tooth Often resorbs adjacent rootsMay push roots asideMay push whole tooth
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AmeloblastomaAmeloblastomaHistopathologyHistopathology
Islands of odontogenic epitheliumPeripheral palisading cells-- Vacuoles toward basement membrane--PreameloblastsCenter: stellate reticulumMature fibrous stromaOften cystic degeneration
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AmeloblastomaAmeloblastomaHistopathologic SubtypesHistopathologic Subtypes
Follicular type-- Most common type-- Islands resemble tooth budsPlexiform type-- Intertwining strands of epithelial cells
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AmeloblastomaAmeloblastomaHistopathologic SubtypesHistopathologic Subtypes
Acanthomatous type-- Squamous epithelium in center
Granular cell type-- Histiocyte-like cells -- Granular cytoplasm
Basal cell type-- Like basal cell carcinoma
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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
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AmeloblastomaAmeloblastomaVariantsVariants
Unicystic ameloblastoma-- Intraluminal ameloblastoma-- Mural ameloblastoma
Peripheral ameloblastoma-- Extraosseous ameloblastoma
Desmoplastic ameloblastoma
Ameloblastic carcinoma
Malignant ameloblastoma
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AmeloblastomaAmeloblastomaVariantsVariants
Unicystic ameloblastoma-- Intraluminal ameloblastoma-- Mural ameloblastoma
Peripheral ameloblastoma-- Extraosseous ameloblastoma
Desmoplastic ameloblastoma
Ameloblastic carcinoma
Malignant ameloblastoma
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Unicystic AmeloblastomaUnicystic Ameloblastoma
15% of all ameloblastomasDegenerated “ basket weave” cyst liningUnilocular radiolucency onlyResembles dentigerous cystYounger persons-- Avg. age = 23 yearsMuch less aggressivethan regular ameloblastoma
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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
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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
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AmeloblastomaAmeloblastomaMalignant VariantsMalignant Variants
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Ameloblastic Ameloblastic CarcinomaCarcinoma
Cells are dysplasticMetastizesMay look like salivaryadenocarcinoma
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Malignant AmeloblastomaMalignant Ameloblastoma
Cells look benignMetastasizesCaution: this is not same as aspiration ofameloblastoma cells!
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Ameloblastic Ameloblastic FibromaFibroma
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Ameloblastic FibromaAmeloblastic FibromaJuvenile AmeloblastomaJuvenile Ameloblastoma
Benign neoplasm-- Epithelial & mesenchymal
originGAL:-- None-- First two decades of life-- Posterior mandible
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Ameloblastic FibromaAmeloblastic FibromaAsymptomaticUsually multilocular radiolucency-- No calcifications centrallyWell demarcated-- Often: thin sclerotic rimUsually associated withcrown of unerupted toothMay expand cortexCan move teeth
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Ameloblastic FibromaAmeloblastic Fibroma
Primitive mesenchymaltissues-- Immature stroma-- Large, stellate, spindled
nuclei-- Mild/Moderate cellularityDouble-layered strands of cuboidal odontogenic epitheliumAmeloblastoma-like islands
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Ameloblastic FibromaAmeloblastic FibromaWith AmeloblastomaWith Ameloblastoma--Like IslandsLike Islands
Hyaline InductionHyaline Induction
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Ameloblastic FibromaAmeloblastic FibromaTreatment & PrognosisTreatment & Prognosis
May become very largeConservative surgical removal or curettage40% risk of recurrence
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Ameloblastic Ameloblastic FibrosarcomaFibrosarcoma
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Ameloblastic Ameloblastic FibrosarcomaFibrosarcoma
Stroma shows malignancyEpithelial islands OKBehaves like fibrosarcoma
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Ameloblastic Ameloblastic FibroFibro--OdontomaOdontoma
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Enamel and dentin structuresMay be early stage of odontomaMay become very largeRadiolucent backgroundGlobular opacities centrallyPerhaps: tooth-like shapes
Ameloblastic FibroAmeloblastic Fibro--OdontomaOdontoma
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Ameloblastic FibroAmeloblastic Fibro--OdontomaOdontoma
©Photo: WESTOP, Dr. Beatriz Aldape, National University of Mexico, Mexico City, Mexico
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Ameloblastic Ameloblastic FibroFibro--OdontomaOdontoma
©Photo: WESTOP, Dr. Beatriz Aldape, National University of Mexico, Mexico City, Mexico
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Adenomatoid Adenomatoid Odontogenic TumorOdontogenic Tumor
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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
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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
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Adenomatoid Odontogenic TumorAdenomatoid Odontogenic Tumor
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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
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Adenomatoid Odontogenic Adenomatoid Odontogenic TumorTumor
HistopathologyHistopathology
Dystrophic calcificationAmyloidThin fibrous capsule
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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
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Calcifying Epithelial Calcifying Epithelial Odontogenic TumorOdontogenic Tumor
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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
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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
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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)
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Calcifying Epithelial Calcifying Epithelial Odontogenic TumorOdontogenic Tumor
HistopathologyHistopathology
Masses of hyalinized material-- Amyloid-- Congo red-- Thioflavin T immunostaining
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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
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Peripheral Pindborg TumorPeripheral CEOT
Attached gingivaAnterior regionMay erode bone-- SaucerizationLow biological behaviorTumor may be attached to surfaceepithelium
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OdontomaOdontoma
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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
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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
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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
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Compound OdontomaCompound Odontoma
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Compound OdontomaCompound Odontoma
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Cystic OdontomaCystic Odontoma
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Complex OdontomaComplex OdontomaMay interfere with eruptionMay interfere with eruption
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OdontomaOdontomaHistopathologyHistopathology
Mature fibrous stomaContaining irregular masses ofdentin with areas of enamel matrix Cementum and pulp tissueMasses may be tooth-likeEncapsulated
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OdontomaOdontomaTreatmentTreatment
Usually “burn out”May become hugeEnucleation/curettageNo recurrence
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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?!!
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OdontoOdonto--AmeloblastomaAmeloblastoma
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OdontoameloblastomaOdontoameloblastomaCollision Tumor: Ameloblastoma & OdontomaCollision Tumor: Ameloblastoma & Odontoma
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Odontogenic Odontogenic MyxomaMyxoma
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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)
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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
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Odontogenic Odontogenic MyxomaMyxoma
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Odontogenic MyxomaOdontogenic MyxomaHistopathologyHistopathology
Background fibromyxoid stromaRather acellular, with few stellateor bipolar mesenchymal cells-- Similar to primitive pulpNot encapsulatedIf stroma is dysplastic:-- Odontogenic myxosarcoma
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Odontogenic Odontogenic MyxofibromaMyxofibroma
TeenagersAround crown of impacted toothMuch less aggressive than routine myxoma
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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
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Odontogenic Odontogenic FibromaFibroma
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Odontogenic FibromaOdontogenic Fibroma
Benign neoplasm -- Odontogenic mesenchymal cells
GALP:-- Females-- Second - fourth decades of life-- Anterior maxilla and posterior mandible-- Rare
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Odontogenic FibromaOdontogenic Fibroma
Well-demarcated radiolucencyUsually unilocular-- Larger: often multilocularOften surrounding crown ofimpacted toothAsymptomaticMay resorb rootsMay expand cortexMay move teethCaution!Must distinguish fromhyperplastic dentalfollicle
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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
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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
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CementoblastomaCementoblastoma
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CementoblastomaCementoblastomaBenign CementoblastomaBenign Cementoblastoma
Benign neoplasm of cementumAttached to toothBone counterpart:-- Osteoblastoma
GALP:-- Female-- Second-fourth decades-- Mandibular molar-- Rare
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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
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CementoblastomaCementoblastomaHistopathologyHistopathology
Cementoid or osseous calcified massesBackground stroma of fibrous tissueCementoblasts/cementoclastsEncapsulated (PLD?)
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CementoblastomaCementoblastomaTreatment; PathophysiologyTreatment; Pathophysiology
May become 7 cm acrossDestroys root; tooth remains viableMaybe: pressure resorption of adjacent rootExtractionRecurrences are rare
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Central Cementifying Central Cementifying FibromaFibroma
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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
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Central Central Cementifying FibromaCementifying Fibroma
Early lesionEarly lesion
Late lesionLate lesion
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Classification of Classification of Odontogenic CystsOdontogenic Cysts
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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
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Dentigerous CystDentigerous Cyst
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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
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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
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Dentigerous Cyst or Not?Dentigerous Cyst or Not?The 1.5 mm. ruleThe 1.5 mm. rule
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Dentigerous CystDentigerous CystOnce Called Cystic CarcinomaOnce Called Cystic Carcinoma
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Multiple Dentigerous CystsMultiple Dentigerous CystsWorry About Gorlin SyndromeWorry About Gorlin Syndrome
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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
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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
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Dentigerous CystDentigerous CystTreatment; PathophysiologyTreatment; Pathophysiology
Enucleation-- Maybe: extraction-- Maybe: orthodontic guidanceMarsupialized (large lesions)Special Problems:-- Odontogenic keratocyst-- Carcinoma in epithelial lining-- Eruption cyst
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Orthokeratinizing Orthokeratinizing Odontogenic CystOdontogenic Cyst
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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
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Eruption CystEruption Cyst
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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
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Eruption CystEruption CystEruption Hematoma; Dentigerous CystEruption Hematoma; Dentigerous Cyst
Cortex completely missing -- Fibrous stroma between epitheliaBlue or bluish-red color-- Maybe: clear fluid inside
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Eruption CystEruption CystDentigerous CystDentigerous Cyst
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Odontogenic Odontogenic KeratocystKeratocyst
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Odontogenic KeratocystOdontogenic Keratocyst
Developmental cystic degeneration-- Of odontogenic epithelial rests-- Sometimes triggered by
inflammation?
GAL:-- None-- 10-40 years-- Posterior mandible-- Ramus
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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
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Odontogenic KeratocystOdontogenic Keratocyst
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Odontogenic KeratocystOdontogenic KeratocystMay be hazy opacity if in sinus; May become inflamedMay be hazy opacity if in sinus; May become inflamed
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Odontogenic KeratocystOdontogenic KeratocystClinical SubtypesClinical Subtypes
Dentigerous cyst typePrimordial cyst typeLateral periodontal cyst typePeriapical cyst type
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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!
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Odontogenic KeratocystOdontogenic KeratocystHistopathology
Fibrous/fibromyxomatous stromaOften: islands of benignodontogenic epitheliumMaybe: daughter cysts
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Odontogenic KeratocystOdontogenic KeratocystLoss of Classical Microscopic Features in Inflamed Area
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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
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Gorlin SyndromeGorlin Syndrome
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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
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Gorlin SyndromeGorlin SyndromeNevoid Basal Cell Carcinoma SyndromeNevoid Basal Cell Carcinoma Syndrome
Frontal bossingPalmar/plantar pitsBifid ribsSplayed ribsFused ribsMissing ribsCalcified falx cerebriSpina bifida occulta
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Gorlin CystGorlin Cyst
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Calcifying Odontogenic CystGorlin Cyst; COC
Cross between:-- Developmental cyst-- Benign neoplasm
GAL:-- None-- Anterior maxilla/mandible
(65% of cases)
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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
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The Original Gorlin CystThe Original Gorlin CystCalcifying Odontogenic CystCalcifying Odontogenic Cyst
©Photos: Dr. R. J. Gorlin, University of Minnesota, Minneapolis, Minnesota
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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
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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
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Calcifying Odontogenic Cyst
Treatment & PrognosisTreatment & Prognosis
Enucleation for smaller lesionsSome recurrencesMore solid = more aggressiveLarge/aggressive lesion:-- Resection
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Gingival Cyst of Gingival Cyst of NewbornNewborn
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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
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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
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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
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Gingival Cyst of AdultGingival Cyst of Adult
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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)
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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
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Gingival Cyst of AdultGingival Cyst of AdultHistopathology; TreatmentHistopathology; Treatment
Stratified squamous epithelial cyst liningDense fibrous stromaLumen: filled with fluid or keratinEnucleation-- No recurrence
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Lateral Periodontal Lateral Periodontal CystCyst
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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
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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
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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
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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
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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
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Buccal Bifurcation Buccal Bifurcation CystCyst
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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
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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
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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
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