IN THE NAME OF GOD. Dr.kheirandish DDS,MSC Oral and maxillofacial pathology

Size: px

Start display at page:

Download "IN THE NAME OF GOD. Dr.kheirandish DDS,MSC Oral and maxillofacial pathology"

Lesley McCormick
5 years ago
Views:

1 IN THE NAME OF GOD Dr.kheirandish DDS,MSC Oral and maxillofacial pathology

2 ODONTOGENIC CYSTS AND TUMORS Chapter 15

3 I. DENTIGEROUS CYST II. III. IV. ERUPTION CYST ODONTOGENIC KERATOCYST Orthokeratinized Odontogenic Cyst V. Nevoid Basal Cell Carcinoma Syndrome VI. VII. VIII. IX. Gingival (Alveolar) Cyst of the Newborn Gingival Cyst of the Adult lateral Periodontal Cyst CALCIFYING ODONTOGENIC CYST X. GLANDULAR ODONTOGENIC CYST XI. XII. BUCCAL BIFURCATION CYST CARCINOMA ARISING IN ODONTOGENIC CYSTS

4 Odontogenic cysts Odontogenic tumors Epithelium-lined cysts in bone are seen only in the jaws Inclusion of epithelium along embryonic lines of Fusion Odontogenic epithelium odontogenic cysts Odontogenic cysts Developmental or Inflammatory

5 DENTIGEROUS CYST (FOLLICULAR CYST)

6 Separation of the follicle from around the crown of an unerupted tooth Most common type of developmental odontogenic cyst (20%) Unerupted tooth Cementoenamel junction Inflammatory pathogenesis

7 Mandibular third molars(65%) Maxillary canines / third molars / mandibular second premolars Deciduous teeth Vary size Unilocular radiolucent (welldefined / corticated border) Infected cyst (ill-defined borders)

8 Radiographic variations Central variety (most common) Lateral variety Circumferential variant Displace the involved tooth Root resorption 3 to 4 mm in diameter Not diagnostic

nonkeratinizing cells Interface (flat) Inflamed : Fibrous wall

9 Non inflamed : Fibrous connective Inactive-appearing odontogenic epithelial rests Epithelial lining (2-4) Flattened nonkeratinizing cells Interface (flat) Inflamed : Fibrous wall is more collagenized Inflammatory cells Epithelial lining Keratinized surface

10 Mucous cells Ciliated columnar cells Sebaceous cells Multipotentiality of the odontogenic epithelial lining

11 Enucleation Unerupted tooth Marsupialization o Neoplastic transformation Ameloblastoma Squamous cell carcinoma Intraosseous mucoepidermoid carcinomas

12 ERUPTION CYST (ERUPTION HEMATOMA)

13 Soft tissue analogue of the dentigerous cyst Erupting deciduous or permanent tooth Age 10 Deciduous mandibular central incisors, first permanent molars, deciduous maxillary incisors

14 Blue to purplebrown color Eruption hematomas Oral epithelium (superior aspect) Variable inflammatory cell Thin layer of nonkeratinizing squamous epithelium

15 ODONTOGENIC KERATOCYST

Specific histopathologic features and clinical behavior Cell rests of the dental lamina Different growth mechanism and biologic behavior

16 Specific histopathologic features and clinical behavior Cell rests of the dental lamina Different growth mechanism and biologic behavior Increased osmotic pressure within the lumen Genetic factors inherent in the epithelium itself or enzymatic activity in the Fibrous wall.

17 Benign cystic neoplasm Who Keratocystic odontogenic tumor (kcot). PCNA KI-67 PTCH1 Hedgehog signaling pathway Loss of heterozygosity (tumor suppressor genes) (P16, p53)

18 1. Greater growth potential than most other odontogenic Cysts 2. Higher recurrence rate 3. Possible association with the nevoid basal cell carcinoma Syndrome

19 3% to 11% Male Mandible Small Larger Anteroposterior Expansion

20 Multiple okcs Well-defined radiolucent Multilocular Unerupted tooth (25% to 40%) Root resorption Diagnosis Peripheral

21 Thin, friable wall Cystic lumen Epithelial lining Interface Detachment Parakeratotic epithelial cells Corrugated appearance Palisaded layer Satellite cysts, cords, or islands INFLAMMATION

22 o Recur (5% to 62%) Number of cases Length of follow-up Inclusion or exclusion of orthokeratinized cysts o 30% o Posterior body and ramus o Longterm clinical and radiographic follow-up

23 Bone bur Chemical cauterization (carnoy s solution) Polyethylene drainage tube o Malignant alteration

24 Orthokeratinized Odontogenic Cyst

25 Young adults 2:1 male-to-female Mandible : twice Posterior

26 Unilocular radiolucency ( multilocular) Two thirds involve an unerupted mandibular third Molar tooth (dentigerous cyst) Size :1-7 cm

28 Stratified squamous epithelium Orthokeratotic surface Keratohyaline granules Palisaded basal layer (not present)

30 o Enucleation with curettage o Recurrence (2%) o Malignant transformation o Nevoid basal cell carcinoma syndrome

31 Nevoid Basal Cell Carcinoma Syndrome

32 Gorlin Syndrome Autosomal dominant Mutations in patched(ptch) : a tumor Suppressor gene

33 Basal cell carcinomas Odontogenic keratocysts Intracranial calcification Rib and vertebral anomalies 1 in 60,000

34 Characteristic facies : o Frontal and temporoparietal bossing o Increased cranial circumference o Hypertelorism o Mandibular prognathism

35 Basal cell carcinomas o Major component o Non syndromic basal cell carcinoma o Less aggressive o Puberty or in the second and third decades o Fleshcolored papules to ulcerating plaques o Not exposed to sunlight o Midface o Number : vary o Blacks

37 Palmar and plantar pits 65% to 80% localized retardation of the maturation of basal epithelial cells

38 Jaw cysts 75% Odontogenic keratocysts Isolated keratocysts Multiple (ten) separate Younger Often associated unerupted teeth (Mimic dentigerous cysts)

40 More satellite cysts, solid islands of epithelial proliferation, and odontogenic epithelial rests

41 Skin tumors Jaw cysts

42 Gingival Cyst of the Newborn

43 Small Multiple Whitish papules Alveolar processes Maxilla 2 to 3 mm

44 keratin-filled Remnants of the dental lamina Common Disappear spontaneously Inclusion cysts (e.g., Epstein's pearls and Bohn's nodules) Thin, flattened epithelial lining with a parakeratotic luminal surface

45 Gingival Cyst of the Adult

46 o Uncommon lesion o Soft tissue counterpart of the LPC o Rests of the dental lamina (rests of Serres) o Epithelial inclusion cysts o Mandibular o Canine and premolar area (60% to 75%) o 5-6 decades

47 o Facial gingiva o Painless o Domelike swellings o Bluish or blue-gray o "cupping out"

48 Lateral periodontal cyst Thin, flattened epithelial lining With or without focal plaques Dilated blood vessel

49 lateral Periodontal Cyst

50 Uncommon Lateral root Rests of the dental lamina Intrabony counterpart of the gingival cyst of the adult

51 o Asymptomatic o Radiographic examination o 5-7 decades o Mandibular (premolar, canine, lateral incisor )

52 Well-circumscribed Laterally to the root Vital teeth

53 o Epithelial lining that is only one to three cells thick in most areas o Flattened squamous cells o Foci of glycogen-rich clear cells o Focal nodular thickenings

54 Botryoid odontogenic cysts : polycystic appearance( Grossly and microscopically) Grape like cluster of small individual cysts Multilocular

55 Enucleation Recurrence : botryoid variant

56 CALCIFYING ODONTOGENIC CYST (COC)

57 CALCIFYING CYSTIC ODONTOGENIC TUMOR GOLIN CRYST DENTINOGENIC GHOST CELL TUMOR GHOST CELL ODONTOGENIC CARCINOMA) Cystic Solid (tumorlike) WHO classification : 1. Calcifying cystic odontogenic tumor 2. Dentinogenic ghost cell tumor 3. Ghost cell odontogenic carcinoma

58 Intraosseous Cystic lesions Less than 5%... solid dentinogenic ghost cell tumors Peripheral One-third solid o Associated with other odontogenic tumors : Odontomas Adenomatoid odontogenic tumors Ameloblastomas

59 Intraosseous : Maxilla = mandible Incisor and canine areas 30 years Associated with odontomas (younger patients) Unilocular Well-defined 1/2-1/3 radiopaque structures 1/3 unerupted tooth (canine)

60 Vary size (12cm) Root resorption Divergence of adjacent teeth Extraosseous 5% to 17% Gingival Sixth to eighth decades

62 Ghost cells : Altered epithelial cells Loss of nuclei Basic cell outline 1. Coagulative necrosis 2. Accumulation of enamel protein 3. Normal or aberrant keratinization of odontogenic epithelium

64 o Cystic lesion o Fibrous capsule o Lining of odontogenic epithelium o Basal cells cuboidal or columnar (ameloblasts) o Overlying layer of loosely arranged epithelium (stellate reticulum) o Most characteristic : ghost cells Within the epithelial component Calcification within the ghost cells (basophilic granules) Dentinoid (eosinophilic)

70 Malignant epithelial odontogenic ghost cell tumors (ghost cell odontogenic carcinoma) o Cellular pleomorphism o Mitotic activity o Recurrence o Local disease or metastases o 5-year survival 73% Associated with odontogenic tumor Peripheral

71 GLANDULAR ODONTOGENIC CYST (SIALO-ODONTOGENIC CYST)

72 Rare Aggressive behavior Pluripotentiality Middle-aged Mandible Anterior

73 Vary size Large (expansion, pain or paresthesia) Unilocular or multilocular Corticated rim

75 Squamous epithelium of varying thickness Interface (flat) Superficial epithelial cells cuboidal to columnar Mucinproducing goblet cells Cilia Ductlike spaces within the epithelial lining (lined by cuboidal cells and often contain mucicarmine-positive fluid) Spherical nodules

76 Cystic mucoepidermoid carcinomas LPC Recurrence(multilocular) Enbloc resection

77 BUCCAL BIFURCATION CYST

78 Inflammatory odontogenic cyst Buccal aspect of the mandibular first permanent molar Buccal enamel extensions Tooth eruption

79 Children from Slight-to-moderate tenderness Swelling Foultasting discharge Bilateral 1/3 Unilocular radiolucency Occlusal radiograph Proliferative periostitis

80 Nonspecific Nonkeratinizing stratified squamous epithelium Chronic inflammatory cell Enucleation Tooth extraction unnecessary

81 CARCINOMA ARISING IN ODONTOGENIC CYSTS

82 Odontogenic tumors De novo Odontogenic cysts Intraosseous mucoepidermoid 1% to 2%

83 Wide age range Men Pain and swelling Margins of the radiolucent defect are usually irregular and ragged I. Residual II. Dentigerous cyst III. Okc IV. Lateral periodontal cyst

84 Well-differentiated or moderately well-differentiated squamous cell carcinomas Local block excision to radical resection Radiation or adjunctive chemotherapy Metastases

Origin of Odontogenic Cysts & Tumors

Origin of Odontogenic Cysts & Tumors Odontogenic Apparatus Origin of Odontogenic Cysts & Tumors Odontogenic Apparatus Remnants of dental lamina Reduced enamel epithelium Odontogenic rests Basal cell layer