Pseudo cyst

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Oral Pathology I
Third Year

Published in: Health & Medicine, Technology

Pseudo cyst

  1. 1. Pseudosoft tissue Cyst By Dr . Wael Mohamed Swelam Dr. Wael Swelam Monday, January 20, 2014
  2. 2. References Dr. Wael Swelam Monday, January 20, 2014
  3. 3. pseudo cyst ╳ true cyst Type Lining True cyst Pseudo cyst The wall of a true cyst consists of a The wall of a pseudocyst consists of clearly defined epithelial cell layer granulation and/or fibrous tissue (origin: odontogenic X non odontogenic) (which is present secondary to inflammation) Classification of Pseudo cysts Traumatic Aneurysmal Dr. Wael Swelam Traumatic Developmental Static bone cyst bone marrow defect Monday, January 20, 2014
  4. 4. 1. Aneurysmal bone cyst Etiology and pathogenesis: 1. Traumatic event result in an area of haemorrhage that maintain connection with the original with the disrupted feeding vessels. Subsequently giant cell granuloma-like can develop after loss of connection with the original vascular source 2. Frequently develops secondary within another lesion of bone as a result of disrupted vascular dynamics in pre-existing intrabony lesion ex. Central giant cell tumors Dr. Wael Swelam Monday, January 20, 2014
  5. 5. Aneurysmal bone cyst Age :  Young adults < 30 Years Location:  Shaft of long bones  Vertebral  2% column Jaw bone; posterior mandibular is more common Sex : No predilection Manifestations:  Rapidly  Painful Dr. Wael Swelam growing swelling frequently with parathesia Monday, January 20, 2014
  6. 6. Aneurysmal bone cyst  Radiographic features:     Malocclusion Mobility Migration Root resorption  Maxillary lesions:  Nasal manifestations     Bulging into adjacent sinus Nasal obstruction Nasal bleeding Optical manifestations   Proptosis Diplopia Dr. Wael Swelam Monday, January 20, 2014
  7. 7. Aneurysmal bone cyst  Surgical Histopathology:  At operation Intact periosteum B. Shell cortex often with perforation C. After removal of A & B dark venous blood wells up A.  Surgeon impression:  Blood soaked sponge Histopathological features:  Spaces of varying size  Filled with blood  Surrounded by cellular fibroblastic tissue  Wall contain multinucleated giant cells and osteoid tissue  Might be associated with other pathosis mostly fibrous dysplasia Dr. Wael Swelam Monday, January 20, 2014
  8. 8. Traumatic bone cyst Etiology and pathogenesis: 1. Trauma-hemorrhage theory: Traumatic event that is insufficient to cause bone fracture result in an intraosseous hematoma. If hematoma doesn’t undergo organization and repair the clot breaks down (liquefy) leaving an empty bony cavity. 2. Altered bone metabolism theory: Inability to of interstitial fluid to exit the bone because of * Inadequate venous drainage * Local disturbance of in bone growth * Ischemic marrow necrosis Result in Osteolysis Dr. Wael Swelam Monday, January 20, 2014
  9. 9. Traumatic bone cyst Age :  10-20 Years Location:  Essentially  More  Sex restricted to the mandible common in premolar – molar region : 60% ♂ Manifestations:  Asymptomatic  20% and usually discovered accidentally might have painless swelling  Associated with vital teeth  At operation the lesion appear as an empty cavity Dr. Wael Swelam Monday, January 20, 2014
  10. 10. Traumatic bone cyst Radiographic features :  Well delineated, radiolucent defect  Unilocular, or Multilocular  When several teeth are involved in the lesion, the defect shows domelike projections that scallop upward between the roots, NO root resorption of related teeth Location:  Essentially  More  Sex restricted to the mandible common in premolar – molar region : 60% ♂ Dr. Wael Swelam Monday, January 20, 2014
  11. 11. Traumatic bone cyst Histopathological features:     Empty spaces of varying size Surrounded by thin band of vascular fibrous connective tissue cellular fibroblastic tissue Wall occasionally contain multinucleated giant cells and osteoid tissue Might be associated with other pathosis mostly fibrous dysplasia Dr. Wael Swelam Monday, January 20, 2014
  12. 12. Static bone cyst Stafne’s bone defect Definition: Lingual mandibular Salivary Gland Depression: A developmental concavity of the lingual cortex of the mandible, usually in the third molar area, that forms around an accessory lateral lobe of submandibular gland and has the radiographic appearance of a well-circumscribed cystic lesion within the bone, usually below the inferior alveolar canal. canal Etiology and pathogenesis: The pathogenesis is unknown exactly 1. Entrapment of salivary gland tissue during the development of the mandible 2. Lingual cortical erosion from hyperplastic salivary gland tissue, both demographic and anatomic findings are consistent with this hypothesis Dr. Wael Swelam Monday, January 20, 2014
  13. 13. Stafne’s bone defect Age :  Adults Sex:  80-90% ♂  Clinical features:  Anterior defects are related to sublingual SG  Posterior defects are related to submandibular SG  Might interrupt the continuity of the inferior border of the mandible  Rarely; increase in size over time which indicate that these lesions are nor congenital Dr. Wael Swelam Monday, January 20, 2014
  14. 14. Osteoporotic bone marrow defect Etiology  Abnormal  Residual  Focus healing following tooth extraction remnants of fetal marrow of extramedullary haematopoiesis Sex  Female 70% Clinical features  Site: Angle/ posterior mandible Histopathological features:  Predominance of haematopoietic cells with fewer fat cells  Lymphoid aggregates within cellular marrow & megakaryocytes Dr. Wael Swelam Monday, January 20, 2014
  15. 15. Dr. Wael Swelam Monday, January 20, 2014
  16. 16. Embryological review Development of pharyngeal pouches Development of Tongue Dr. Wael Swelam Monday, January 20, 2014
  17. 17. Branchial cyst Cervical lymphoepithelial cyst Etiology and pathogenesis Fusional lesion hypothesis    Incomplete obliteration of the fetal branchial arches, i.e. the lack of degeneration of the cervical sinus created by the growth of the second arch over the third and fourth arches is the proposed cause. The third and fourth arches thus overlaid by the second arch persist as small pockets with their ectodermal epithelium. These pockets usually fill in during fetal development; however, when they do not, cysts, sinuses and fistulas. Dr. Wael Swelam Monday, January 20, 2014
  18. 18. Branchial cyst Cervical lymphoepithelial cyst Clinical features  Age 20:40 Y  Usually unilateral, rarely bilateral  Soft, fluctuant, asymptomatic, enlargement  Along anterior margin of sternomastoid  Some lesions appear as sinus or fistulae on the skin Histological features 90% are lined by stratified squamous epithelium may/may not be keratinized  Cyst wall typically contain lymphoid tissue with germinal centers  Dr. Wael Swelam Monday, January 20, 2014
  19. 19. Oral Lymphoepithelial cyst Cystic changes in entrapped lymph node epithelial islands Etiology:  Epithelial invagination into tonsillar tissue, result in blind pouches or tonsillar crypts Clinical features:  Small submucosal nodule covered by normal overlying mucosa. Microscopic features:  Epithelial lined space with lymphoid tissue in the surrounding c.t. wall. Dr. Wael Swelam Monday, January 20, 2014
  20. 20. Thyroid gland development Dr. Wael Swelam Monday, January 20, 2014
  21. 21. Thyroglossal tract cyst  Most common 75% of developmental cyst of the neck  As thyroid anlage grow downward from foramen caecum to its permanent location in the neck. Residual epithelial elements along this pathway may give rise to cysts Dr. Wael Swelam Monday, January 20, 2014
  22. 22. Thyroglossal tract cyst        Mostly occur in midline, Below the level of hyoid bone 2% occur within the tongue itself (lingual thyroid nodule) Sinus tract formation if secondary infected Rarely undergo malignant transformation 50% occur before 20 years No sex predilection Painless, fluctuant, movable swelling  Retract on swallowing if it maintain an attachment to hyoid  Retract on tongue movement if it maintain attachment with tongue Histopathological features: Cyst lining with ciliated or columnar epithelial lining Thyroid tissue might be seen within CT Dr. Wael Swelam Monday, January 20, 2014
  23. 23. Dermoid cyst  Developmental cystic malformation,  Due to entrapment of totipotent blastomeres, which can produce derivatives of all three germ layers  Oral lesions affect anterior portion of oral cavity,  Appear on midline  If develop above geniohyoid ms sublingual swelling will displace tongue = difficulty in eating, speaking, berating  If develop below geniohyoid ms will result in submental swelling ‘double chin appearance’ Teratoid cyst is a term used to describe a cystic form of teratoma that contain a variety of germ layer derivatives:  Skin appendages ex. Hair follicle, sebaceous gland, sweet gland  Connective tissue elements ex. Muscle, blood vessel, bone  Endodermal structures ex. GIT lining Dr. Wael Swelam Monday, January 20, 2014
  24. 24. Epidermoid cyst  Usually follow localized inflammation of the hair follicle and represent non neoplastic proliferation of epithelium resulting from healing process  Oral lesions are very rare, the lesion mainly affect skin Clinical features     Common in acne-prone areas of the head and neck, Unusual before puberty Usually associated with Gardner Syndrome Appear as nodular fluctuant subcutaneous lesion Histopathological features     Cavity lined by stratified squamous epithelium, Well developed granular cell layer Lumen filled with orthokeratin Prominent inflammatory reaction including multinucleated giant cells Dr. Wael Swelam Monday, January 20, 2014
  25. 25. Dr. Wael Swelam Monday, January 20, 2014

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