Upload
aliimadalkhasaki
View
2.266
Download
6
Embed Size (px)
DESCRIPTION
محاضرة الباثو د حلام
Citation preview
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 1/273
Odontogenic Cysts
And Tumors
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 2/273
Cyst: it’s a pathological cavity lined by epithelium & filledwith fluid or semi fluid material.
In the jaw bones & oral tissue there are remnant of epith.come mostly from odontogenic apparatus & most of theseremnants are embryonic in origin .for this reason the jaw
bone are affected by a large numbers of cysts incomparism to other bones in the body.
The epith. remnants that give rise to these cysts are:1- rest of malasses (e.g. P.A.C & residual cyst)2- reduced enamel epithelium (dentigerous cysts & eruption cyst)3- remnants of the dental lamina (rest of serres) (e.g.odontogenic keratocyst, lateral periodontal cyst, gingival
cyst & glandular odontogenic cyst).
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 3/273
What is a cyst?
An abnormal space withintissue lined by epithelium
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 4/273
Classification of the jaw cysts
I-Epithelial cysts A- odontogenic: 1- developmental cyst (odontogenic keratocyst, dentigerous cyst, eruption
cyst, lateral periodontal cyst, gingival cyst, glandular cyst) 2- inflammatory cyst (radicular cyst, paradental cyst)
B- non-odontogenic:
Nasopalatine duct cyst, nasolabial cyst
II-Non epith. (primary bone cysts) Solitary bone cyst (traumatic, simple), aneurysmal bone cyst, Stafine cyst
III-Soft tissue cysts: Salivary mucoceles (mucus extravasation, mucus retention) Dermoid & epidermoid cyst Lymphoepithelial cyst Thyroglossal tract cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 5/273
Odontogenic cysts
A cyst in which the lining of the lumen is derivedfrom epithelium produced during tooth development,these include:
1- cysts derived from rests of Malassez: Periapical
cyst (radicular)
2- cysts derived from reduced enamel epithelium: reduced enamel epithelium refers to the layer of epith. Thatremains around the tooth’s crown after enamel formation iscomplete. This layer of epith. Is derived from thespecialized epith. Components of the enamel organ (innerenamel epith., stratum intermedium, stellate reticulum, & outer enamel epith.)That were active during amelogenesis,& collapse into a thinned dormant membrane of two orthree cells in thickness.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 6/273
Odontogenic Cysts• Inflammatory – Periapical (radicular) cyst – Residual periapical (radicular)
cyst – Buccal bifurcation cyst (usually
firstmolars)• Paradental cysts (partially
eruptedthird molars
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 7/273
Radicular (Periapical) Cyst
!Most common (65%)
!Epithelial cell rests of Malassez
!Response to inflammation!Radiographic findings
!Pulpless, nonvital tooth
!Small well-defined periapical radiolucency!Histology
!Treatment - extraction, root canal
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 8/273
Radicular Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 9/273
Radicular Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 10/273
Periapical Cyst vs.Periapical Granuloma
• CANNOT TELL THE
DIFFERENCE BY
X-RAY• CAN ONLY TELL BY
HISTOLOGY
Periapical Granuloma
Granulation Tissue - Noepithelial lining
Periapical CystTrue cyst with centrallumen and epitheliallining
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 11/273
Why does a periapical cystform instead of just a
granuloma? Simply the chance of Rests
of Malassez being in thearea of inflammation
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 12/273
Periapical Inflammation
Odontogenic Epithelial Rest
1. Cells in the rest proliferate due to the inflammation
2. The ball of cells gets so big the center gets too far fromthe blood supply, the cells in the center die
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 13/273
3. The center of the ball of cells then has a higher proteinconcentration than the surrounding tissue
4. Fluid flows into the center by osmotic pressure, cyst
expands, more cells grow around the periphery, morecells in the center die, concentration increases again
5. Osmotic pressure can keep expanding the cystindependent of the inflammation
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 14/273
Result = Periapical Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 15/273
A radiolucency in the jaws must beinvestigatedIf the teeth in the area are
vital, you must biopsy theradiolucent area.If non-vital, obviously RCT
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 16/273
Vitality Test!Vitality Test!
Vitality Test!Vitality Test!
Vitality Test!
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 17/273
Residual Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 18/273
Paradental Cyst
! Associated with partially impacted 3rd
molars
!Result of inflammation of the gingivaover an erupting molar
!0.5 to 4% of cysts
!Radiology - radiolucency in apicalportion of the root
!Treatment - enucleation
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 19/273
Paradental Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 20/273
Odontogenic Cysts
! Inflammatory ! Developmental
! Radicular ! Dentigerous
! Paradental ! Developmental
lateral periodontal ! Odontogenic
keratocyst
! Glandular
odontogenic
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 21/273
Odontogenic Cysts• Developmental
– Dentigerous cyst – Odontogenic keratocyst – Orthokeratinized odontogenic cyst
– Gingival (alveolar) cyst of thenewborn
– Gingival cyst of the adult – Lateral periodontal cyst – Calcifying odontogenic (Gorlin) cyst – Glandular odontogenic cyst – Eruption cyst
Cyst Lumen
LiningEpithelium
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 22/273
A- Dentigerous cyst : an odontogenic cyst that surrounds the
crown of an impacted tooth,
caused by fluid accumulation
between the reduced enamel epith.& the enamel surface, resulting
in a cyst in which the crown is located
within the lumen & root outside.
The pathogenesis of this cyst is
uncertain but apparently it developsby accumulation of fluid between the
REE & the tooth crown. Progressivegrowth of the cyst leads to dilatationof the dental follicle.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 23/273
Clinically:
These cysts are commonly associated with unerupted mand. or max. thirdmolars or max. canine.
The cyst usually remains asymptomatic but may produce some swelling or pain, particularly if it is large or inflamed.
Radiographically:
Mostly diagnosed by their radiographic appearance. They present as wellcircumscribed radiolucency surrounding the crown of a tooth.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 24/273
Dentigerous Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 25/273
•Dentigerous – “tooth containing” cyst
•Origin – reduced enamel epithelium
(dentalfollicle)
If a radiolucency is
ASSOCIATEDwith an unerupted tooth
Dentigerous cyst should beyour FIRST differential
diagnosis
Differential Diagnosis• Dentigerous Cyst• Odontogenic Keratocyst• Ameloblastoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 26/273
•Like other cysts, uncomplicated DC(small DC) causes no symptoms untilswelling becomes noticeable & is
discovered on a routine radiographicexamination or when the cause issought for a missing tooth.•Large cyst may be associated with a
painless expansion of the bone in theinvolved area, infection of a DC causesthe usual symptoms of pain andaccelerated swelling, such infection mayarise in a DC that is associated with apartially erupted tooth or by extensionfrom a periapical or periodontal lesionthat affects an adjacent tooth.
Radiographically:
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 27/273
Radiographically:
It appears as well circumscribed radiolucuncies surroundingthe crown of an unerupted tooth which may displace fromits normal position.
If the width of RL around the crown is less than + 2mm, itis considered fitting a normal tooth follicle, and if the RLspace is of least 3 to 4 mm then a DC should beconsidered. The RL usually has well-defined and oftensclerotic borders.
A large DC may appear radiographically as a multilocularprocess because of the persistence of bone trabecularewithin the RL.
However, a keratocyst or ameloblastoma may occasionally
envelop the crown of the tooth and appear radiographicallysimilar to DC. The diagnosis ultimately therefore dependson histological examination that’s why radiographicalfindings are not diagnosis for a DC.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 28/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 29/273
Histopathology:
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 30/273
op o ogy
The gross examination of the wall of DC show nodular thickening,which must examined microscopically to role out early neoplasticchanges.
The lining of a non-inflammated DC composed of stratifiedsequamous epithelium, rarely showing keratinization.
Mucous - producing cells are sometime seen in the epithelium.
The wall consists of loose fibrous C.T. with inactive odontogenic
epithelial rests. Small nests of sebaceous cells rarely may benoticed with the fibrous cyst wall. These mucous and sebaceouselements are believed to represent the multipotentiality of theodontogenic epithelial lining in a DC. Therefore it's advisable toexamined DC microscopically and to role out the presenceof early neoplastic changes such as mucoepidermoid Ca,ameloblastoma and sequamous cell Ca.
In inflammed DC The fibrous wall is more collagenized with the chronic
inflammatory cells, and the lining show hyperplasia and developrete -ridges.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 31/273
Histopathology:
The epith. Lining is relatively uniform layer of non-keratinized, stratified, squamous epith., measuring 2-10 cellsin thickness.
This lining may alters by inflammation & may becomehyperplastic, atrophic, or ulcerated.
Variable numbers of mucus cells are occasionally seen in theepith. Lining .
Like the periapical cyst, crystalline cholesterol deposits,hemosiderin deposits, hyaline (Rushton ) bodies, & lipid ladenmacrophage are also seen in dentigerous cyst.
Long standing cyst will occasionally exhibit areas of keratinization or premalignant (dysplastic) changes of their epith. Lining.
Treatment: either by enucleation or marsupilization,recurrency is uncommon
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 32/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 33/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 34/273
Dentigerous Cyst
Treatment
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 35/273
Treatment
Surgical enucleation, with removal of
associated tooth. A large DC may betreated by marsupialization, which permitsdecompression of the cyst and reductionin the size of bone defect, especially incanines, and then we do alignment of thetooth properly by orthodontic appliance.Recurrences are very rare.
However, several potential complicationsmust be considered when recurrenceoccurs. In which it will need more
aggressive treatment.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 36/273
B- Eruption cyst: Is a variant of the dentigerous cyst that develops in
the alveolar soft tissue around the crown of an erupting tooth.
Clinically, appear as fluctuant swelling of the
alveolar ridge, the lesion may bleed during
mastication giving rise to the term “eruption
hematoma” Histologically, same as those of a dentigerous cyst.
Most of these cysts require no treatment because
rupture spontaneously during mastication. But
sometime surgical exposure of the crown of affected
tooth may be needed.
Eruption cyst: (eruption
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 37/273
Eruption cyst: (eruptionhematoma)
An eruption cyst occasionally formsover a tooth about to erupt. It’s asoft tissue analogue of the DC,
results from separation of the dentalfollicle from around the crown of eruption tooth.
Presumably, the cysts developedbecause of collagen deposition in thegingival C.T. that resulted in a
thicker per coronal roof.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 38/273
Clinical features
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 39/273
Clinical features
EC effect children and adult chiefly in thedeciduous teeth or permanent molars. Its
soft, fluctuant, translucent swelling in thegingival mucosa overlying the crown of unerupting tooth and rarely painful.
Surface trauma may result in aconsiderable amount of blood in the cysticfluid which gives its blue to purple-browncolor and that why some time referred aseruption hematomas.
No X-ray findings appear because itoccurs in soft tissue.
Histopathologically
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 40/273
Histopathologically
Surface oral epithelium covering theunderlying lamina propria withinflammatory cells, and the deep of the bottom is the roof of the cyst,
thin layer of non-keratinized sq.epithelium.
Treatment
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 41/273
Treatment
Treatment may not be neededbecause the cyst usually rupturesspontaneously permitting the toothto erupt.
Sometime simple excision of the roof of the cyst is needed to permits theeruption of tooth.
Developmental Lateral
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 42/273
Developmental LateralPeriodontal Cyst
!From epithelial rests in periodontal ligament
! Mandibular premolar
region ! Middle-aged men! Radiographic findings
! Interradicular radiolucency, well-defined margins
! Histology
! Nonkeratinizing stratified squamous or cuboidalepithelium
! Treatment - enucleation, curettage withpreservation of adjacent teeth
Lateral periodontal C
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 43/273
Lateral periodontal C
These are uncommon type of developmental OC that typicallyoccur along the root surface of atooth, it arise from rests of dental
lamina. Its asymptomatic lesion,mainly occur in mandibular canine-premolar region & less between
maxillary lateral and canine.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 44/273
Radio- graphically
Appear as a well-circumscribed RL area located
laterally to the root(s) of vital tooth.
Occasionally this cyst appears as multilocular(poly cystic) and termed: botryoid OC. Theradiographic picture of lateral periodontal cyst is
not diagnostic:
An odontogenic KC that develop between theroots of adjacent teeth may show identicalradiographic findings
An inflammatory RC that occurs laterally to aroot in relation to an accessory foramen
A cyst that arises from periodontal inflammation.
Developmental Lateral
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 45/273
Developmental LateralPeriodontal Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 46/273
Derived from remnantsof the dental lamina
Lateral Periodontal Cyst
Histopathology
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 47/273
p gy
The typical picture is thin lining of non-keratinized epith. Which only 1-2 cell layers thick,with foci of glycogen-rich clear cells, some cyst
exhibit focal epithelial thickening (plaque) of clearcells.
Clear cell epithelial rests sometimes are seenwithin the fibrous wall.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 48/273
Treatment
Conservative enuncleation, norecurrence and avoid damages toadjacent teeth.
3 cysts derived from dental lamina:
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 49/273
3- cysts derived from dental lamina:
A- Odontogenic Keratocyst ( okc): A cyst derived from remnants of the
dental lamina. It’s less common than the dentigerous cyst but more serous
because epith. Lining show high rate of growth.
Clinically:
Occurs in young patient, however, it can occur at any age.
The mand. Is affected more commonly than max. in the mand.,the cyst occur mostly in the 3rd molar area, while in the max.,
the 3rd molar & canine areas are usually affected. The cyst is slowly growing & asymptomatic, but later it may
cause bone expansion.
Although okc is usually present as a single lesion, it can
occasionally occur as multiple cysts that sometimes occupy allfour quadrants of the jaws as in nevoid basal cell carcinoma.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 50/273
Odontogenic Keratocyst
!11% of jaw cysts
!May mimic any of the other cysts!Most often in mandibular ramus and
angle!Radiographically
!Well-marginated, radiolucency
!Pericoronal, inter-radicular, or pericoronal!Multilocular
Odontogenic keratocyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 51/273
It has specific histopathological features andclinical behavior. It arises from cell rests of thedental lamina. It shows a different growthmechanisms and biological behavior from themore common dentigerous cyst and radicularcyst, which enlarged as a result of increasedosmatic pressure within the lumen of thecyst. While the growth of the keratocyst may be
related to unknown factors inherent in theepithelium itself or enzymatic activity in thefibrous wall. That’s why now day severalinvestigators suggested that OKC beregarded as benign cystic neoplasms ratherthan cysts, and the latest WHO classification of odontogenic tumors, these lesions have given thename (keratocystic odontogenic tumors).
It makes up 3% to 11% of all odontogeniccysts.
Clinical features
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 52/273
The peak incidence between ages 20 to 30 years, themandible is usually affected, usually in the region of the jaw angle and the ascending remaus. KC like other jawcyst, are symptom less until the bone is expanded or they
become infected.
It grows in anterioposterior direction within mandibularycavity of the bone without causing obvious bone expansion.This is useful to differentiate clinically and radiographicallybetween DC & RC which produce bone expansion.
Multiple OK is seen in Nevoid basal cell carcinoma (Gorlinsyndrome).
When multiple KC are found in the jaws, basal cell nervous
syndrome appear to be involved in about half of cases.
This syndrome is characterized by multiple KC, basal cellnevi of the skin and bifid ribs.
Radiographically
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 53/273
Well defined RL area will smooth corticatedmargin. Large lesion in posterior body and
ascending remaus of the mandible may appearmultilocular. An unerupted tooth is involved inthe lesion in 25% to 40% of cases.
Differential diagnosis.
DC (radiographic findings an highly suggestivebut not diagnostic)
Large RC & residual C which are near impacted
tooth. Lateral periodontal cyst or globulomaxillary cyst if
the KC is small and between teeth.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 54/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 55/273
Odontogenic Keratocyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 56/273
Odontogenic Keratocyst
Odontogenic 2005 Classification by the
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 57/273
OdontogenicKeratocystBecause of its behavior,many oral pathologistsnow consider the OKC
an odontogenic tumorthat has a cystic form
2005 Classification by theW.H.O.KeratinocysticOdontogenic Tumor
Odontogenic Keratocyst(Keratinocystic Odontogenic
Tumor)Three important thingsassociated withthis diagnosis:1. High recurrence rate (up to60%)
2. Highly aggressive (nowconsidered byW.H.O. to be an odontogenictumor)3. Relation to Gorlin syndrome
OdontogenicKeratocyst• Can be in the location of any odontogenic cyst• Can be isolated in the
jaws
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 58/273
Histopathology: the microscopic appearance of okc is
pathognomonic, characterized by:
Thin uniform lining of parakeratin sq. epith. 6-10 cellsthickness.
palisaded layer of columnar or cuboidal basal cells. Corrugated layer of parakeratin. Lack of rete ridges, and focal separation of epithelium C.T.
wall. The C.T wall is often loose and fibrillar and free of
inflammation. dental lamina rests and microcysts (daughter or satellite)
cyst may present in the capsule wall the capsule wall is folded
The lumen contains desquamated parakeratin.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 59/273
OdontogenicKeratocystDiagnosis entirely dependson the histology of thecyst lining
1. Uniform (5-8 cells) thickness
2. Hyperchromatic, cuboidal orcolumnar basal cell layer
3. Corrugated parakeratin layer
4. Virtually no inflammation in
cyst wall
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 60/273
Odontogenic Keratocyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 61/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 62/273
“Daughter” Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 63/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 64/273
Odontogenic Keratocyst
!Histology
!Thin epithelial lining with underlyingconnective tissue (collagen and epithelial
nests)!Secondary inflammation may mask features
!High frequency of recurrence (up to 62%)
!Complete removal difficult and satellitecysts can be left behind
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 65/273
Nevoid Basal CellC i
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 66/273
Carcinoma(Gorlin) Syndrome• Multiple basal cell carcinomas• Multiple jaw cysts (odontogenic keratocysts)
• Numerous bone abnormalities including bifidribs, intracranial calcification, vertebralanomalies• Mild ocular hypertelorism• Epidermal cysts of the skin• Etc. Gorlin (Nevoid Basal Cell Carcinoma) Syndrome
Basal cell carcinomas in non-sun exposed areas
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 67/273
Multiple OKCs
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 68/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 69/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 70/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 71/273
Treatment of OKC
! Depends on extent of lesion ! Small
- simple enucleation, complete removal
of cyst wall
! Larger - enucleation with/without peripheralostectomy
! promote complete resection with 1 cm bony
margins (if extension through cortex, overlyingsoft tissues excised) ! Long term follow-up
required (5-10 years)
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 72/273
The causes of recurrence are:
Loose attachment between the epith. & C.T.
Presence of daughter cysts
Orthokeratinized OC
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 73/273
It's an OC that shows microscopically anorthokeratinized epithelial lining. Althoughsuch lesion were originally called theorthokeratinized variant of OK . Itrepresents 7% to 17% of all keratinizing
jaw cyst. It appear clinically and radio
graphically like dentigerous cyst, theymostly involve unerupted mandibular 3rdmolar, occur predominantly in young adultand show 2:1 male to female ratio, morecommon in the mandible than the maxilla.
They have the same clinical andradiographical features of inflammatory ordevelopmental OC it appear as aunilocular RL but occasionally it mayappear as multilocular.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 74/273
Histopathology
The cyst lining is composed of st.sq.epith., whichshows an orthokeratotic surface of variousthicknesses. The epithelial lining may berelatively thin and the prominent palisaded basalcell layers of OKC are not present.
Treatment
Enucleation with curettage, no recurrence butmay be associated with greater risk of malignant
transformation.
Orthokeratinised keratocyst.P f ti f d th
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 75/273
Perforation of and pressure on thecyst roof has caused keratin toextrude and has helped to confirmthe diagnosis.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 76/273
B- glandular odontog enic cys t :
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 77/273
an unusual large unilocular or multilocular odontogenic cyst, first described in
1987.
it originated from epith. Of the dental lamina & it has greater growth potential
Radiographically:
Appear as well defined, unilocular, or multilocular radiolucencies, mostly in the mandible.
Histopathology:
It’s composed of a thin squamous epith. lining that may showareas of focal epith. thickening.
The epith. Contain glandular structures or microcysts lined bycolumnar or cuboidal cells.
Treatment:
By surgical enucleation.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 78/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 79/273
Glandular odontogenic cyst
It is a rare type of developmental OCthat show aggressive behavior, andit closely resemble polycystic variantof lateral periodontal cyst but has
much greater growth potential andtendency to recur.
Clinical feature
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 80/273
It occurs most commonly in middle agedadult, more in mandible and in anteriorregion of the jaws. Their size varies fromsmall lesion less than 1cm to largedestructive lesions that involve most of the jaw
Radiographically:
May appear as well defined unilocualr or
multilocuallr RL.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 81/273
Glandular Odontogenic Cyst
Histopathology
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 82/273
Lining by sq.epi of varying thickness.
The interface between the epith andthe fibrous C.T. wall in generally flat.
The fibrous wall is usually devoid of any inflammatory cell infiltrate.
Small glandular structures of microcysts within epith.
glandular structure lined by cuboidalcells, the lumen contain secretoryproducts
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 83/273
Glandular Odontogenic Cyst
! Histology
! Stratified epithelium
! Cuboidal, ciliated
surface lining cells !
Polycystic with
secretory and
epithelial elements
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 84/273
GlandularOdontogenic Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 85/273
Treatment of GOC
!Considerable recurrence potential !25%
after enucleation or curettage !Marginal
resection suggested for larger lesions or
involvement of posteriormaxilla ! close
follow-up
Gingival cyst of newborn (alveolar)
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 86/273
They are small, superficial, keratin-filled cyststhat are found on the alveolar mucosa of infants.These cysts are arises from remnants of thedental lamina.
It is appear as small, usually multiple whitishpapules on the mucosa overlying the alveolar
processes of neonates.
Histopathology: show thin, flattened epith,lining with parakeratin. The lumen containkeratinaeous debris.
Treatment: not indicated, lesion rupturespontaneously.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 87/273
2 Week femalebrought to pediatricdentistry clinic -parents were veryupset
Gingival cysts of the newborn
No treatmentneeded - they’llregress in a shorttime
Gingival cyst of the adult
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 88/273
It considered the extra osseous form of thelateral periodontal cyst. Its uncommon lesion, itoccurs mostly in mandibular canine and premolararea 60-75% and is most commonly found inpatients in the 5th and sixth decades of life.
They are almost located on the facial gingival or
alveolar mucosa. It appears as small painlessswelling bluish-gray in color.
Histopathologic: resemble lateral periodontalcyst.
Treatment: conservative surgical enucleation.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 89/273
Gingival Cyst of the Adult
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 90/273
Lining derivedfrom remnantsof the dentallamina
Gingival cyst
Malignant lymphoma
Calcifying OC: (calcifying chost cell OC)Gorlin cyst Its ncommon lesion that sho di e s
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 91/273
Its uncommon lesion, that show divershistopathological feature and variable clinicalbehavior. Although it is widely considered to
regards a cyst, some investigators prefer toclassify it as a neoplasm. Recent WHO classification of OT groups, consider
the calcifying OC with all its variants as an OTrather than an OC.
Clinical features COC Is predominantly an intraosscous and 13-
30% of cases reported as per- peripheral (extraosseous) lesion.
Usually occur in maxilla region, the mean age is33years. Those which associated with odontomatend to occur in younger patients.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 92/273
Radiographically: RL andmultilocualr RL
RO structures are present in about
one third to one half of cases.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 93/273
Calcifying
Odontogenic(Gorlin) Cyst
Histopathology
The cyst lining consist of epithelium often with palisading of
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 94/273
The cyst lining consist of epithelium often with palisading of the basal cells which may resemble ameloblasts , theoverlying layer of loosely arranged epithelium mayresemble stellate reticulum.
The most striking features is areas of abnormalkeratinization producing swollen cells whose outlines andnuclei become progressively polar (ghost cell)
The nature of the ghost cell is controversial, some believethat this change represent 1-coagulative necrosis oraccumulation of enamel protein.
It is a form of normal or aberrant keratinization of Oralepithelium.
Masses of ghost cells may fuss to form large sheets of amorphous a cellular materials.
Calcification within the ghost cells is common.
Treatment: surgical enucleation and prognosis good.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 95/273
“Ghost”
cellscalcify
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 96/273
Squamous cell carcinoma arising in theepithelial lining of a cyst
A rare, but definite possibility in any cyst
Odontogenic tumors: According to the origin of these tumors, they are classified
as follows:
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 97/273
Tumor of odontogenic epithelium (ectodermal origin).• Ameloblastoma
Malignant ameloblastoma
Ameloblastic carcinoma• Clear cell odontogenic carcinoma• Adenomatoid OT• Calcifying epithelial OT• Squamous OT
odontogenic ectomesenchymal with hard tooth (mixed OT)• Ameloblastic fibroma• Ameloblastic fibro-odontoma• Ameloblastic fibrosarcoma• Odonto ameloblastoma• Compound odontoma• Complex odontoma
tumors of odontogenic ectomesenchymal alone• Odontogenic fibroma• Myxoma• Cementoblastoma• Granular cell odontogenic fibroma
Biologic Classification of Odontogenic Tumors*
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 98/273
Odontogenic Tumors
BENIGN, NO RECURRENCE POTENTIAL Adenomatoid odontogenic tumor Squamous odontogenic tumor
Cementoblastoma Periapical cementoosseous dysplasia Odontoma
BENIGN, AGGRESSIVE Ameloblastoma Clear cell odontogenic tumor (some consider this a carcinoma) Odontogenic ghost cell tumor (COC, solid type) Odontogenic myxoma Odontoameloblastoma
MALIGNANT Malignant ameloblastoma Ameloblastic carcinoma Primary intraosseous carcinoma Odontogenic ghost cell carcinoma Ameloblastic fibrosarcoma
BENIGN, SOME RECURRENCE POTENTIAL
Cystic ameloblastoma (unicystic) Calcifying epithelial odontogenic tumor Central odontogenic fibroma Florid cementoosseous dysplasia Ameloblastic fibroma and fibroodontoma *From Regezi, et al.
A l bl t
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 99/273
Ameloblastoma
!Most common odontogenic tumor
!Benign, but locally invasive
!Clinically and histologically similar to BCCa
!4th and 5th decades
!Occasionally arise from dentigerous cysts
!Subtypes - multicystic (86%), unicystic(13%), and peripheral (extraosseous - 1%)
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 100/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 101/273
Are the most common neoplasms of the jaws.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 102/273
They may arise from
Rest of dental lamina
Developing enamel organ Epithelial lining of OC
The basal cell of the oral mucosa
ameloblastoma are slow-growing, locally
invasive, produce bone expansion and facialdeformity, had high recurrence rate, nometastasis, it present in 3 type.
(They occur in 3 different clinico-radiographicsituations which deserve separate consideration
because of different therapeutic considerationsand prognosis)
A l bl t
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 103/273
Ameloblastoma
!Radiographic findings
!Classic - multilocular radiolucency of posterior mandible
!Well-circumscribed, soap-bubble!Unilocular - often confused with
odontogenic cysts
!Root resorption - associated withmalignancy
A l bl t
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 104/273
Ameloblastoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 105/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 106/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 107/273
1-common polycystic ameloblastoma
(C ti l lid lti ti i t
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 108/273
(Conventional solid or multicystic interoasseousameloblastoma)
It's most common type, occur in patients over25y (20-40y) it is rare in children, there is no sexpredilection.
About 80%-85% of conventional ameloblastomaoccur in the mandible and ascending rams.
The tumor is often asymptomatic, a small lesionare detected during a radiographic examination.If untreated the lesion grow slowly to massiveproducing facial deformity when palpatedproduce easily bone cracks due to thin outer shellof expand bone (egg shell cracking, diagnosticsign).
Histopathology: several microscopic subtypes of conventi
onal ameloblastoma are recognized:
Th l i l f t i th l bl t lik ll hi h
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 109/273
The classical feature is the ameloblast- like cells which arepalisaded columnar basal cells, with reverse polarization(nucleous away from basement membrane). It may be
arranged in the following forms:
Follicular: It is the most common and resembles early stage of tooth
development. It consisted of island of odontogenicepithelium resemble enamel organ in a mature fibrous C.T.
stroma. These islauds consist of outer border of palisadedameloblast-like cell and a central loosely arranged angularcells resembling the stellate reticulum.
The central area may undergo degeneration and formmicrocystic changes or some tissue they transformed to
sq. cells and produce keratin and referred asAcanthomatous pattern. If these cells are swollen anddensely packed with eonsinophilic granules, it referred asgranular cell, variant.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 110/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 111/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 112/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 113/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 114/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 115/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 116/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 117/273
Large epithelial areas of loosely structured spindle epitheliumenclosing liquefacting stromal areas are typical of a plexiformameloblastoma. The epithelial cells facing the stroma showpalisading
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 118/273
p g
Ameloblastoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 119/273
Ameloblastoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 120/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 121/273
In cases of follicular ameloblastoma, the tumour consistsof epithelial islands with a loose oedematous centre and aperipheralrim of palisading cells Liquefaction of their centre results
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 122/273
rim of palisading cells. Liquefaction of their centre resultsin cyst formation
2- Plexiform pattern: It consist of anastomosing cords or large sheets of odontogenic
epithelium in a lossely arranged and vascular supportingstroma.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 123/273
3- Acanthamatous pattern 4- Granular cell pattern: Represent aging or degenerative change in long standing lesion
, seen in young patient and in clinically aggressive tumors. 5- Desmoplastic pattern Contain small islands and cord of odontogenic epithelium in a
densely collagenized stroma. IHC studies have shown increased production of the cytokeratin
which know as transforming growth factor-B (TGF-B) inassociation with this lesion which may be responsible fordesmoplasia.
6- Basal cell pattern It is the least common type , composed of nests of uniform
basaloid cells which histologically are very similar to basal cellcarcinoma of the skin , no stellate reticulum is present.
Desmoplastic ameloblastoma consists of denselypacked spindle cells lying in a fibrous stroma. Palisading of peripheralcells is not a conspicuous feature in this type of ameloblastoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 124/273
Treatment of Ameloblastoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 125/273
! According to growth characteristics and type! Unicystic! Complete removal
! Peripheral ostectomies if extension through cystwall
! Classic infiltrative (aggressive)
! Mandibular - adequate normal bone aroundmargins of resection
!
Maxillary - more aggressive surgery, 1.5 cmmargins
! Ameloblastic carcinoma
! Radical surgical resection (like SCCa)!
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 126/273
Treatment: It never depends on
histopathological pattern, all types
are locally invasive thereforeresistant.extensive surgical removal( block resection ) is recommended .
The lesion is radio resistant.
Unicystic amelblastoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 127/273
It is a new entity: it account for 10% to
46% of all intraosseous ameloblastoma .
It occurs at young patients 16-20 y as asymptomatic painless swelling of the jaw ,
more than 90% are found in the mandibleusually in the posterior regions .
X-Ray : typically appears as unilocularRL,well demarcated, associated withunerupted 3rd molar.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 128/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 129/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 130/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 131/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 132/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 133/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 134/273
Histopathology:
Three histopathological variant of unicystic ameloblastoma, have been described:
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 135/273
have been described:
Luminal unicystic ameloblastoma. The tumor is confined to the luminal surface of the cyst, it
consist of fibrous cyst wall with a lining that consist of ameloblastic epithelium, the over lying epithelial cell areloosely cohesive and resemble stellate reticulum.
Intra luminal unicystic Ameloblastoma. When one or more nodules of ameloblastoma projects from
the cystic lining in to the lumen of the cyst.
Mural unicystic ameloblastoma. There will be infiltration of the fibrous wall by typical
follicular or plexiform ameloblastoma.
unicystic ameloblastoma, the tumour consists of cyst-lining epithelium that still shows the typical features of ameloblastoma:loose epithelium and a rim of palisading cells facingthe stroma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 136/273
the stroma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 137/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 138/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 139/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 140/273
Treatment: enucleation forintraluminal plexiform patternhowever mural compound beneath
bone required marginal resection andperiodic follow up to ensureadequate removal.
Peripheral Ameloblastoma: Its uncommon, it accounts for about 1%-10% appear as
f
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 141/273
pppainless firm sessile, nodule on the gingiva which is small insize but continuously growing and has normal color. Most
lesions are clinically considered to represent a fibroma orpyogenic granuloma.
X-Ray: Seldom present, but occasionally superficial saucerization of
cortical plate. Sometimes tooth separation will show if located in the interdental papilla.
Histopathology: Resemble follicular pattern or plexiform pattern.
Treatment: Local surgical excision with small normal bone margin.
Malignant ameloblastoma and ameloblasticcarcinoma
It is a rare type account 1% of all ameloblastoma It
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 142/273
It is a rare type, account 1% of all ameloblastoma. Itproduce metastasis that not appear until 10y aftertreatment of primary tumor.
X-ray: it had ill defined margines with cortical bonedestruction due to aggressive behavior.
Histopathology:
The malignant ameloblastoma at primary and metastaticsite are similar to benign local course ameloblastoma, whileameloblastoma carcinoma has anaplasia and dysplasia of malignancy and necrosis.
Treatment: surgical removal , has poor prognosis.
Ameloblastic carcinoma combines the presence of epithelialnests with peripheral palisading and cytonuclear atypia
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 143/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 144/273
Calcifying odontogenic tumor(Pindborg tumour)
Its rare, account 1% of all odontogenictumor, its locally invasive, not capsulated
arise from remnants of dental lamina. Its most often present in patients between
30-50 years of age, there is no sexpredilection mostly occur in mandible in
posterior areas a painless, slow growingswelling is the most common presentingfeatures.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 145/273
X-Ray: unilocualr or multilocular RLwith ill defined borders.
The lesion usually contains calcified
structures of varying size and densityand frequently associated with animpacted tooth, (mandibular molar).
Calcifying EpithelialOdontogenic Tumor
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 146/273
g
Differential Diagnosis : DC,Adenomatoied OT amelofibro-
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 147/273
Adenomatoied OT, amelofibro-
odontoma,
a few cases of peripheral
(extraosseous) calcifying epithelialOT have been reported which appearas sessile gingival mass most oftenon the anterior gingiva and showsuperficial cortical erosionradiographically.
Calcifying EpithelialOdontogenic Tumor
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 148/273
g
Histopathology:
f h f l h d l ll h
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 149/273
It consists of sheets of polyhedral cell withprominent intracellular bridges, pleomorphism,multinucleated prominent nucleoli accosionallyhyperchromatism, rare mitosis.
There is a large areas of apple-green
birefringenic amorphous, eosinphilic hyalinized(amyloid-like) extracellular material scatteredthrough out the epithelium and C.T. calcificationwithin the amyloid-like material and formconcentric rings. (liesengang ring calcification).
The peripheral type has less tendency forcalcification and prominent clear cell cytoplasmvariant.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 150/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 151/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 152/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 153/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 154/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 155/273
Nuclear atypia, ample cytoplasm and pronounced intercellularbridging are typical of a calcifying epithelial odontogenic tumor
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 156/273
Extracellular material staining for amyloid with congored is another characteristic feature of a calcifyingepithelialodontogenic tumour
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 157/273
g
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 158/273
Treatment: It is less aggressive than
ameloblastoma so local resection
including soft tissue and normal bonesurrounding margins.
Adenomatoid OdontogenicTumor
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 159/273
! Associated with the crown of an impactedanterior tooth
! Painless expansion
!Radiographic findings
! Well-defined expansile radiolucency ! Root
divergence, calcified flecks (“target”) !
Histology
! Thick fibrous capsule, clusters of spindle cells,columnar cells (rosettes, ductal) throughout
! Treatment - enucleation, recurrence is rare
Adenomatoid OdontogenicTumor
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 160/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 161/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 162/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 163/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 164/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 165/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 166/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 167/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 168/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 169/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 170/273
Calcifying odontogenic cyst (COC)
It is uncommon lesion may appears as cyst, solid pattern andassociated with odontoma.
Clinical :
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 171/273
Occurs at any part of teeth bearing area, commonly in anterior
region to molars, at any age predilection 2nd decade , may beintraosseous causing generalized expantion of buccal and lingualcortices, or extra osseous appears as localized swelling. There isno pain.
X-ray:- Well circumscribed unilocular RL containing RO and tooth –like structure .
Differential diagnosis: odontoma, ameloblastic fibro-odontoma. Histopathology: It has varying pictures
Cystic and solid , containing epithelial cells like ameloblastoma ,outer layer of palisaded columnar basal cells an dinner layer likestellate reticulum , in between there is enlarged eosinophilicepithelial cells lack nuclei ( ghost cells) and calcification arescattered within the epithelial and C.T.
Treatment: enucleation , recurrence are uncommon.
Calcifying odontogenic cyst closely resemblesameloblastoma,but the presence of large intraepithelial aggregates of ghost cells rules out the latter diagnosis
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 172/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 173/273
Histopathology: It has varying pictures
Cystic and solid , containing epithelial cellslike ameloblastoma , outer layer of
palisaded columnar basal cells and innerlayer like stellate reticulum , in betweenthere is enlarged eosinophilic epithelialcells lack nuclei ( ghost cells) and
calcification are scattered within theepithelial and C.T.
Squamous OT
Its rare, benign tumor with aggressive potential.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 174/273
Its rare, benign tumor with aggressive potential.It arises from remnant of dental lamina, rest of malasses and overlying epithelium.
Clinical:
Sq. OT has been found in patient with averageage 38y. Occur in anterior region to molar, in
max and mandible, as painless gingival swellingassociated with mobility of teeth and its slowlygrowing.
X-Ray:
Unilocular RL lateral to roots which result in teethseparation but not root resorption.
Squamous Odontogenic Tumor
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 175/273
! Hamartomatous proliferation! Maxillary incisor-canine and mandibular
molar
! Tooth mobility common complaint !
Radiology - triangular, localized radiolucencybetween contiguous teeth
! Histology - oval nest of squamous epitheliumin mature collagen stroma
! Treatment - extraction of involved tooth andthorough curettage; maxillary - moreextensive resection; recurrences – treat withaggressive resection
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 176/273
Histopathology: Microscopically the tumor consist of
varying shaped (round and elongated)islands of stratified sq. epith. in mature
fibrous C.T. stroma, no polarization inepith.
Microcystic vaculation and individual cell
keratinized is common. Treatment: local excision or curettage.
Squamous OdontogenicTumor
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 177/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 178/273
Clear cell odontogenic tumor or carcinoma,
it is a rare jaw tumor that was first describedin 1985.
It is a malignant neoplasm, clear cytoplasm
indicate glycogen rich presecretory ameloblastcells. Clinically: It occurs in patient older than age 50y. 80%
develop in mandible as painful swelling or
sometime symptom free. Radiographically: uniloccular or multiloccular
RL with irregular margins.
Histopathology: Three patterns have been described:
The biphasic pattern appears as nests of varying size of clear cell or faint
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 179/273
varying size of clear cell or faint
eosinophilic cytoplasm admixed with moreeosinophilic polygonal epithelium cell.
monophasic type: characterized byappearance of cord or nests of clear cell in
a fibrous C.T. stroma. The third pattern has a resemblance to
amelobastoma in that the peripherial cellsof the clear cell islands may infrequently
demonstrate palisading and the lesionalcells don’t show nuclear or cytoplasmicpleomorphism, mitosis are rare andnecrosis is not a prominent feature.
Clear cell odontogenic carcinoma is characterised byclear cells forming epithelial nests
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 180/273
At higher magnification, clear cell odontogeniccarcinomais seen to contain clear cells as well as eosinophiliccells
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 181/273
Differential diagnosis• Intraosseous mucoepidemoid
carcinoma (+ve mucin stain) withi t l ll t
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 182/273
a prominent clear cell component.
•COT with clear cell (amyloid stain+ve in COT and –ve in Odontogeniccarcinoma)
•Metastatic clear cell neoplasm(renal cell carcinoma, clear cellbreast carcinoma).
Treatment: it has aggressive clinicalcourse need surgical radicalresection, metastasis to lung andL.N.
Mesenchymal OdontogenicTumors
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 183/273
!Odontogenic Myxoma!Cementoblastoma
Odontogenic Myxoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 184/273
!Originates from dental papilla or follicular mesenchyme
!Slow growing, aggressively invasive
!Multilocular, expansile; impactedteeth?!Radiology - radiolucency with septae
!Histology - spindle/stellate fibroblasts
with basophilic ground substance
!Treatment - en bloc resection, curettage
may be attempted if fibrotic
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 185/273
Odontogenic myxoma is composed of poorly cellularmyxoid material that surrounds pre-existing jaw bone
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 186/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 187/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 188/273
Cementoblastoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 189/273
! True neoplasm of cementoblasts! First mandibular molars
! Cortex expanded without pain ! Involved
tooth ankylosed, percussion ! Radiology -
apical mass; lucent or solid, radiolucent halowith dense lesions ! Histology - radiallyoriented trabeculaefrom cementum, rim of
osteoblasts
! Treatment - complete excision and toothsacrifice
Cementoblastoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 190/273
Mixed Odontogenic Tumors
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 191/273
! Ameloblastic fibroma, ameloblasticfibrodentinoma, ameloblastic fibro-odontoma, odontoma
!Both epithelial and mesenchymal cells!Mimic differentiation of developing tooth
!Treatment - enucleation, thorough
curettage with extraction of impacted tooth
!Ameloblastic fibrosarcomas - malignant,treat with aggressive en bloc resection
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 192/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 193/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 194/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 195/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 196/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 197/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 198/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 199/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 200/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 201/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 202/273
Ameloblastic Fibro-odontoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 203/273
This lesion is defined as a tumor withgeneral features of an ameloblasticfibroma but containing enamel and
dentin.
Some investigators believe that thisentity is but a stage in the
development of an odontoma;however, most agree that
progressive destructive tumors aretrue neoplasms.
Ameloblastic Fibro-odontoma:Clinical and Radiographic Features
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 204/273
Patient Age: Most common in the 5-12year age range with a mean of 10 years.
Gender Predilection: None.
Location: It is more common in the
premolar/molar regions of both jaws.Radiographic Features: Usually appears
as a well-defined unilocular or rarelymultilocular radiolucency with variable
amounts of calcified material which isradiopaque. Therefore, it may appear asa mixed, radiolucent-radiopaque lesion.
Ameloblastic Fibro-odontoma:Histologic Features
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 205/273
The soft tissue component isidentical to the ameloblastic fibroma.
The calcified portion consists of fociof enamel and dentin matrix
formation in close relationship to theepithelial structures.
Ameloblastic Fibro-odontoma:Treatment and Prognosis
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 206/273
The ameloblastic fibro-odontoma isusually treated by conservative
curettage with the lesion separatingeasily from the surrounding bone.
Prognosis is excellent and recurrenceis unusual.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 207/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 208/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 209/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 210/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 211/273
Ameloblastic Fibrosarcoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 212/273
This lesion is considered themalignant counterpart of the
ameloblastic fibroma in which themesenchymal portion shows features
of malignancy.
The ameloblastic fibrosarcoma mayarise de novo or there may be amalignant transformation of an
ameloblastic fibroma.
Ameloblastic Fibrosarcoma:Clinical and Radiographic Features
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 213/273
Patient Age: The mean age forpatients with ameloblasticfibrosarcoma is 26 years.
Gender Predilection: Males 2:1.Location: 75 % have occurred in the
mandible.
Radiographic Features: Appear asan ill-defined, destructive,
radiolucent lesion.
Ameloblastic Fibrosarcoma:Histologic Features
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 214/273
The epithelial component of thistumor appears histologically benign.
The mesenchymal portion is highly
cellular. The cells arehyperchromatic and quitepleomorphic. Mitoses are usually
prominent.
Ameloblastic Fibrosarcoma: Additional Features, Treatment &
Prognosis
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 215/273
Pain and swelling are typicallyassociated with this tumor. Rapidclinical growth is another common
feature.
Radical surgical excision is thetreatment of choice.
The long-term prognosis is difficult toascertain because of the smallnumber of reported cases.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 216/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 217/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 218/273
Odontoma
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 219/273
The odontoma is the most commonodontogenic tumor.
It is not a true neoplasm but rather isconsidered to be a developmental
anomaly (hamartoma).Two types of odontomas are recognized:
•Compound: this type of odontoma iscomposed of multiple small tooth-like
structures.
•Complex: this lesion is composed of aconglomerate mass of enamel and dentin,which bears no anatomic resemblance to a
Odontoma: Clinical Features
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 220/273
Patient Age: Most cases arerecognized during the second decadeof life with a mean of 14 years.
Gender Predilection: Approximately
equal.Location: Somewhat more common
in the maxilla. The compound type
is more often in the anterior maxillawhile the complex type occurs moreoften in the posterior regions of
either jaw.
Odontoma: Radiographic Features
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 221/273
Early lesions are radiolucent withsmooth, well-defined contours.
Later a well-defined radiopaque
appearance develops.The compound type shows apparent
tooth shapes while the complex typeappears as a uniform opaque mass
with no apparent tooth shapespresent.
Odontoma: Additional Features
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 222/273
Most odontomas are small and do notexceed the size of a normal tooth in theregion.
However, large ones do occur and these
may cause expansion of the jaw.Most odontomas are asymptomatic and as
a result are discovered upon routineradiographic examination.
Odontomas may block the eruption of apermanent tooth and in these cases are
often discovered when “searching for” the
“ ”
Odontoma: Histologic Features
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 223/273
The compound odontoma iscomposed of enamel, dentin andcementum arrange in recognizabletooth forms; some enamel matrix
may be retained in immature andhypomineralized specimens.
The complex odontoma is composedof enamel, dentin and cementum but
these tissues are arranged in arandom manner that bears no
morphological resemblance to a
Odontoma: Treatment andPrognosis
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 224/273
Odontomas are treated by simplelocal excision and the prognosis isexcellent.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 225/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 226/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 227/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 228/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 229/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 230/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 231/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 232/273
Tumors of Odontogenic
Ectomesenchyme
(Central) Odontogenic Fibroma:Clinical Features
Fewer than 70 cases have been reported
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 233/273
pin the English literature. (VS hyperplasticfollicle when associated with uneruptedtooth)
Patient Age: Patients have ranged in agefrom 9-80 years old with a mean of 40years.
Gender Predilection: Females, 7.4:1 inone study.
Location: Sixty percent occur in themaxilla where most are located anterior tothe first molar. When in the mandible,
Odontogenic Fibroma:Radiographic Appearance
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 234/273
The odontogenic fibroma usuallyappears as a well-defined, unilocularradiolucency. It is often associatedwith the apical area of an eruptedtooth.
Larger lesions are often multilocular.
Many odontogenic fibromas havesclerotic borders.
Root resorption is common.
Odontogenic Fibroma: AdditionalFeatures
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 235/273
Small odontogenic fibromas areusually asymptomatic.
The larger lesions may be associated
with localized bony expansion of the jaw or with the loosening of adjacentteeth.
Odontogenic Fibroma: HistologicFeatures
Some authors have described two
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 236/273
separate types of odontogenic fibromas.
The simple odontogenic fibroma iscomposed of stellate fibroblasts arranged
in a whorled pattern with fine collagenfibrils and a lot of ground substance.
Foci of odontogenic epithelium may ormay not be present.
Occasionally, foci of dystrophiccalcification may be present.
Odontogenic Fibroma: HistologicFeatures
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 237/273
WHO type odontogenicThe appears as a fairly cellularfibromafibrous connective tissue with
collagen fibers arranged ininterlacing bundles.
Odontogenic epithelium in the formof long strands or isolated nests is
present throughout the lesion.
Calcifications composed of cementoidand/or dentinoid may be present.
Odontogenic Fibroma: Treatmentand Prognosis
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 238/273
The odontogenic fibroma is usuallytreated by enucleation andcurettage.
There have been few recurrences,the prognosis is good.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 239/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 240/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 241/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 242/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 243/273
Developmental non-odontogenic cysts
The remaining 5% of cysts within the jaws are made up of non-odontogenic cysts.
Developmental non-odontogenic cysts within the jaws must arise from epithelium
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 244/273
not associated with tooth development.
In the past, several entities were described as fissural cysts because they were
suspected to have arisen from tissue entrapped during fusion across various
fissures during facial development.
It has now been clearly shown that the only true fissural cyst is the midpalatal cyst
of infants.Other so-called fissural cysts such as the globulomaxillary cyst, the median alveolar
cyst, and the median mandibular cyst are most likely to be developmental or
inflammatory odontogenic cysts.
The other two lesions within this category are the nasopalatine duct cyst,
which arises from the cystic degeneration of the vestigule bilateral oro-nasal ducts,and the nasolabial cyst, which is a soft-tissue cyst arising from dystopic rests of the
naso-lacrimal ducts.
Nonodontogenic Cysts
! C C
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 245/273
!Incisive Canal Cyst!Stafne Bone Cyst
!Traumatic Bone Cyst
!Surgical Ciliated Cyst (of Maxilla)
l i d
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 246/273
Nasopalatine duct cyst Midpalatal cyst of infants
Nasolabial cyst
Globulomaxillary cyst dermoid cyst
N i h li l
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 247/273
Nonepithelial. Idiopathic bone cavity (traumatic,
solitary, hemorrhagic bone cyst)
b. Aneurysmal bone cyst c. Stafne's mandibular lingual cortical
defect
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 248/273
Sublingual dermoid cyst. This is anunusually large specimenbut appears even larger because thepatient is raising and protruding hertongue. This cyst, unlike a ranula,can be seen to have a thick wallbecause it has arisen in the deepertissues of the floor of the mouth
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 249/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 250/273
Nasopalatine duct cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 251/273
The nasopalatine duct cyst, also known as
the incisive canal cyst is formedfrom cystic degeneration of the oronasal
ducts thatconnect the nasal cavity to the oral cavity
during development.
Incisive Canal Cyst
!D i d f ith li l t f th( )
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 252/273
Derived from epithelial remnants of thenasopalatine duct (incisive canal)
!4th to 6th decades
!Palatal swelling common, asymptomatic!Radiographic findings
!Well-delineated oval radiolucency betweenmaxillary incisors, root resorption occasional
!Histology!Cyst lined by stratified squamous or
respiratory epithelium or both
Incisive Canal Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 253/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 254/273
Nasopalatine cyst. The usualappearance is a rounded or pear-shapedarea of radiolucency, mainly in themidline.
Incisive Canal Cyst
!T t t i t f i l
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 255/273
!Treatment consists of surgicalenucleation or periodic radiographs
!Progressive enlargement requires
surgical intervention
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 256/273
Nasopalatine cyst. Typical presentation with adome-shapedbluish enlargement overlying the incisive canal
Nasopalatine cyst. The lining, in partat least, may consist of respiratory (ciliated columnar)epithelium,
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 257/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 258/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 259/273
“Globulomaxillary” Cyst
Cyst of theglobulomaxillary
area
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 260/273
Stafne Bone Cyst
!Submandibular salivary gland depression
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 261/273
!Submandibular salivary gland depression!Incidental finding, not a true cyst
!Radiographs - small, circular, corticated
radiolucency below mandibularcanal!Histology - normal salivary tissue
!Treatment - routine follow up
Stafne's mandibular lingual cortical defect
This entity is also known by several otherterms including lingual mandibula bonecavity, static bone cavity, and lingual
salivary gland defect. This is an
asymptomatic lesion
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 262/273
asymptomatic lesion.
It usually occurs in adults over the age of 25. Radiographically, the lesion is a solitaryradiolucency below the inferior alveolar
canal near the angle region of the mandible.The lesion is usually oval and exhibits nogrowth over long periods of time. Theperiphery is smooth and symmetric. Thelesion is benign, has not growth potential,and a classic radiographic appearance thatmakes diagnosis without biopsy possibleand observation without active interventionthe treatment of choice.
Stafne Bone Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 263/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 264/273
Traumatic Bone Cyst
!Empty or fluid filled cavity associatedwith jaw trauma (50%)
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 265/273
with jaw trauma (50%)
!Radiographic findings
!Radiolucency, most commonly in body or
anterior portion of mandible!Histology - thin membrane of fibrous
granulation
!Treatment - exploratory surgery mayexpedite healing
Traumatic Bone Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 266/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 267/273
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 268/273
Surgical Ciliated Cyst
!May occur following Caldwell Luc
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 269/273
!May occur following Caldwell-Luc!Trapped fragments of sinus epithelium
that undergo benign proliferation
!Radiographic findings!Unilocular radiolucency in maxilla
!Histology
!Lining of pseudostratified columnar ciliated!Treatment - enucleation
Surgical Ciliated Cyst
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 270/273
Aneurysmal Bone Cyst
!Large vascular sinusoids (no bruit)
!Not a true cyst; aggressive reactive!G i l f h d f i
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 271/273
!Not a true cyst; aggressive, reactive!Great potential for growth, deformity!Multilocular radiolucency with cortical expansion!Mandible body
!Simple enucleation, rare recurrence
Aneurysmal bone cyst
The aneurysmal bone cyst is not unique to the maxillofacialcomplex. It is a lesion that has a predilection for femalesand occurs most commonly in the vertebral column and thelong bones. In the craniofacial skeleton, the mandible isaffected most often. The patient often complains of
swelling over a localized area and pain. It is felt that thislesion may develop from some other primary lesion such as
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 272/273
g plesion may develop from some other primary lesion such asthe central giant-cell granuloma that undergoes alterationin local hemodynamics. Radiographically, the lesion is aradiolucency with a multilocular or honeycombedappearance. The sclerotic bone margins seen in most cystsmay be absent. Histologically, the lesion is made up of afibrous connective tissue stroma with multiple cavernousand sinusoidal spaces with multinucleated giant cellswithin the stroma.
Enucleation is the treatment of choice with hemorrhage
during the removal being risk because of the large numberof vascular spaces within the lesion. Hemorrhage is usuallycontrolled easily once the entire lesion is removed; whentreating these lesions, the goal should be rapid enucleationto prevent blood loss with control of bony bleeding withbone wax or packing. The lesion does not recur aftersimple enucleation.
7/16/2019 Odontogenic Cysts And Tumors (2).ppt
http://slidepdf.com/reader/full/odontogenic-cysts-and-tumors-2ppt 273/273