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Odontogenic Cysts and Tumors
Introduction
• A cyst is an epithelium lined sac containing
fluid or semifluid material
• The epithelial cells first proli...
Odontogenic cysts
• Originate from residues of the tooth-forming organ
• Derived from 3 origins:
- epithelial rests of Ser...
Radicular Cysts
•Subdivided into :
Apical
Lateral
Residual
•Causes:
Develops from a preexisting periapical granuloma,
Rela...
Clinical features
• High incidence in anterior maxillary teeth
• Usually symptomless
• When enlarged cause expansion of th...
Histopathology
• Lined by non-keratinized stratified squamous
epithelium
• Chronically inflamed fibrous tissue capsule
• N...
• The connective tissue capsule becomes more fibrous, less
vascular, and with less inflammatory cells
• Metaplasia of epit...
Radiographic features
• Round radiolucency at the root apex
• Well defined, surrounded by radiopaque
margin
• 40 % of apic...
Contents
• Hypertonic fluid containing:
-breakdown products of epithelial,
inflammatory, connective tissue elements
-serum...
Residual cyst
• It is a radicular cyst that is retained after the
extraction of the related tooth
• May continue growth ca...
Dentigerous cyst
• Encloses part or all of the
crown of an unerupted tooth
• Develops from proliferation
of the reduced en...
Radiographic examination
• Well-defined, unilocular, radiolucent, related
to the crown
• Associated with impacted or delay...
Clinical features
• Twice as common in males
• Twice as common in mandible
• Usually asymptomatic
• Large cysts tend to ex...
Histopathology
• Lining is a thin, regular, 2-5 cells thick, non-
keratinized, stratified squamous or cuboidal
• Fibrous C...
Odontogenic keratocyst
• uncommon
• 2nd
to 3rd
decades, or fifth decade
• More common in males
• Asymptomatic
• Multiple c...
Radiographic features
•3rd
molar and ramus of mandible area favored
•Well-defined radiolucency
•Can displace and resorb te...
Histopathology
• wall is thin, regular, 5-10 cells thick stratified
squamous epithelium
• Characteristic folded wall
• Bas...
Histopathology
• Thin fibrous capsule free from inflammatory
cells
• High recurrence due to rupture
• Cyst contains kerati...
Gorlin Syndrome
• Gorlin syndrome: autosomal dominant,
uncommon
• Manifestations:
Skin: multiple naevoid basal cell carcin...
Gingival cyst
• Common in neonates
• Also knows as Bohn’s nodules or Epstein pearls
• Disappear by 3 months of age
• Arise...
Developmental lateral periodontal cyst
• Uncommon
• Canine and premolar region of the mandible
• Derived from either reduc...
• Radiographically: well-defined radiolucency
• Large cysts can displace teeth and cause
expansion
• Histologically: Lined...
Paradental cyst
• Arises alongside an unerupted third molar
involved with pericoronitis
• Radiographically: well-defined r...
Glandular odontogenic cyst
• Rare
• occur in the anterior part of the mandible
• Slow growing, painless
• Histology: lined...
Odontogenic Tumors
Odontomes
• Definition: non-neoplastic developmental
anomaly or malformation that includes enamel
and dentine
• Types:
1.I...
Invaginated odontome
• Invagination of the enamel organ into the
dental papilla early in odontogenesis
• Permanent maxilla...
Histopathology
• Enamel and dentin lining the cavity are often
defective and poorly mineralized
• The cavity is occupied w...
Evaginated odontome
• Uncommon
• Extra cusp like tubercles
• Easily fractured, exposing the pulp
Complex odontome
• Disorderly arranged dental
tissues
• Limited growth potential
• 2nd
and 3rd
decades, in the
molar regio...
Radiographic examination
• well-defined radiolucent lesion, proceeds to
radiopaque
• When mature it is surrounded by a
tra...
Histopathology
• Developing lesions contain varying amounts of
soft tissue and show features of stages of
odontogenesis
Compound odontome
• Consists of numerous small denticles
• 1st
and 2nd
decades of life and in anterior maxilla
• Less grow...
Radiographic examination
• Mixed radiopaque/radiolucent bodies
Ameloblastoma
• Rare
• Benign, locally invasive
• Derived from odontogenic epithelium
• More common in africans
• Two vari...
Radiographic examination
• Multiloculated radiolucency, resorption of
roots around it
• May become associated with unerupt...
Histopathology
• 2 patterns:
• Follicular: epithelium arranged into discrete
follicles resembling tooth germ
• Plexiform t...
• The ameloblast-like cells express amelogenin,
however, enamel and dentine are not formed
• Behavior: locally invasive, i...
Unicystic ameloblastoma
• Occur at younger age than other variants
• Mainly in mandibular third molar region
• Histologica...
• Radiographically: unilocular radilucency, usually associated
with an unerupted tooth
• distinguishable from dentigerous ...
Squamous odontogenic tumor
• Rare
• Radiographically: well-circumscribed
radiolucency
• Sclerotic border associated with r...
Calcifying epithelial odontogenic
tumour
• Rare
• Benign
• Wide age range
• Mandible > maxilla
• Mostly seen in molar and ...
Radiographic features
• Irregular radiolucent area
• May or may not be clearly demarcated
• Contains radiopaque bodies due...
Histopathology
• Sheets and strands of polyhedral epithelial
cells
• Abundant eosinophilic cytoplasm
• Prominent intercell...
Adenomatoid odontogenic tumour
• Presents usually in 2nd
or 3rd
decades
• Majority in the anterior maxilla
• Slowly growin...
Radiographic features
• Well defined radiolucency
• Faint radiopacities due to calcifications
• May simulate a dentigerous...
Histopathology
• Well encapsulated lesion
• Maybe partly or wholly cystic
• Central spaces contain eosinophilic material
•...
Ameloblastic fibroma
• Rare
• Benign
• Neoplasm of epithelial and mesenchymal
elements
• Well circumscribed
Histopathology
• Proliferating strands of odontogenic
epithelium in highly cellular fibroblastic tissue
with peripheral la...
Calcifying cystic odontogenic tumour
• Grossly cystic
• Mostly intraosseous
• Radiographically: well-defined, uni or multi...
Histopathology
• Basal layer of ameloblast-like cells, masses of
swollen keratinized epithelial cells (ghost cells)
Odontogenic fibroma
• Derived from mesenchymal dental tissues
• 2 types:
• Central type: uncommon, well demarcated,
cement...
Odontogenic myxoma
• Locally invasive
• More common than odontogenic fibroma
• Radiographically:
Multilocular (soap-bubble...
Histopathology
• Non-encapsulated
Infiltrative growth pattern
Stellate cells with anastomosing processes
Cementoblastoma
• Mostly patients under 25 years of age
• Usually molar and premolar area of mandible
• Attached to the ro...
• Radiographically: well demarcated
mottled, radiopaque
radiolucent margin, root resorption
• Histologically: cementum-lik...
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
Odontogenic cysts and tumors (ppt)
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Odontogenic cysts and tumors (ppt)

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Odontogenic cysts and tumors (ppt)

  1. 1. Odontogenic Cysts and Tumors
  2. 2. Introduction • A cyst is an epithelium lined sac containing fluid or semifluid material • The epithelial cells first proliferate and later undergo degeneration and liquefaction • Grow by expansion, causing displacement of adjacent teeth
  3. 3. Odontogenic cysts • Originate from residues of the tooth-forming organ • Derived from 3 origins: - epithelial rests of Serres: odontogenic keratocyst, developmental lateral periodontal and gingival cysts - reduced enamel epithelium : dentigerous, eruption and paradental cyst - rests of Malassez : radicular cysts
  4. 4. Radicular Cysts •Subdivided into : Apical Lateral Residual •Causes: Develops from a preexisting periapical granuloma, Related to the apex of a nonvital tooth
  5. 5. Clinical features • High incidence in anterior maxillary teeth • Usually symptomless • When enlarged cause expansion of the alveolar arch and may discharge through a sinus • The rate of expansion 5mm/year in diameter
  6. 6. Histopathology • Lined by non-keratinized stratified squamous epithelium • Chronically inflamed fibrous tissue capsule • Newly formed cysts have irregular epithelial lining with variable thickness. Becomes regular and even in thickness
  7. 7. • The connective tissue capsule becomes more fibrous, less vascular, and with less inflammatory cells • Metaplasia of epithelial lining may give rise to mucous cells, and rarely ciliated respiratory epithelium • In some cases the lining contains hyaline eosinophilic bodies, Rushton bodies • Common cholesterol crystals deposits, which form clefts. • Cholesterol crystals result from hemorrhage and breakdown of RBCs
  8. 8. Radiographic features • Round radiolucency at the root apex • Well defined, surrounded by radiopaque margin • 40 % of apical radiolucencies are cystic
  9. 9. Contents • Hypertonic fluid containing: -breakdown products of epithelial, inflammatory, connective tissue elements -serum proteins (5-11 g/dl), Igs higher than serum -water and electrolytes -cholesterol crystals
  10. 10. Residual cyst • It is a radicular cyst that is retained after the extraction of the related tooth • May continue growth causing significant bone resorption
  11. 11. Dentigerous cyst • Encloses part or all of the crown of an unerupted tooth • Develops from proliferation of the reduced enamel epithelium • Eruption cyst arises in an extra-alveolar location
  12. 12. Radiographic examination • Well-defined, unilocular, radiolucent, related to the crown • Associated with impacted or delayed eruption (most commonly lower 8, upper 3)
  13. 13. Clinical features • Twice as common in males • Twice as common in mandible • Usually asymptomatic • Large cysts tend to expand the outer plate
  14. 14. Histopathology • Lining is a thin, regular, 2-5 cells thick, non- keratinized, stratified squamous or cuboidal • Fibrous CT capsule free from inflammatory cell infiltration • Occasional cholesterol clefts
  15. 15. Odontogenic keratocyst • uncommon • 2nd to 3rd decades, or fifth decade • More common in males • Asymptomatic • Multiple cysts are associated with naevoid basal cell carcinoma syndrome (Gorlin syndrome)
  16. 16. Radiographic features •3rd molar and ramus of mandible area favored •Well-defined radiolucency •Can displace and resorb teeth •Uni or multi locular
  17. 17. Histopathology • wall is thin, regular, 5-10 cells thick stratified squamous epithelium • Characteristic folded wall • Basal cell layer is well defined, contains columnar or cuboidal cells • Sudden transition between stratum spinosum and surface cells
  18. 18. Histopathology • Thin fibrous capsule free from inflammatory cells • High recurrence due to rupture • Cyst contains keratinous debris, white cheesy material, protein level 4 g/dl
  19. 19. Gorlin Syndrome • Gorlin syndrome: autosomal dominant, uncommon • Manifestations: Skin: multiple naevoid basal cell carcinomas Oral: multiple odontogenic keratocysts Skeletal: rib, vertebral anomalies. Polyductyly, cleft lip/palate CNS: calcified falx cerebri brain tumors
  20. 20. Gingival cyst • Common in neonates • Also knows as Bohn’s nodules or Epstein pearls • Disappear by 3 months of age • Arise from remnants of dental lamina, form keratinizing cysts
  21. 21. Developmental lateral periodontal cyst • Uncommon • Canine and premolar region of the mandible • Derived from either reduced enamel epithelium or rests of dental lamina • Occasionally multi locular
  22. 22. • Radiographically: well-defined radiolucency • Large cysts can displace teeth and cause expansion • Histologically: Lined by non-keratinized squamous or cuboidal epithelium
  23. 23. Paradental cyst • Arises alongside an unerupted third molar involved with pericoronitis • Radiographically: well-defined radiolucency related to the neck of the tooth • Inflammatory origin stimulating proliferation of reduced enamel epithelium
  24. 24. Glandular odontogenic cyst • Rare • occur in the anterior part of the mandible • Slow growing, painless • Histology: lined by varying thickness of epithelium • Potentially aggressive, locally invasive with tendency to recur
  25. 25. Odontogenic Tumors
  26. 26. Odontomes • Definition: non-neoplastic developmental anomaly or malformation that includes enamel and dentine • Types: 1.Invaginated 2.Evaginated 3.Enamel pearl (enameloma) 4.Double tooth 5.Complex odontome 6.Compound odontome
  27. 27. Invaginated odontome • Invagination of the enamel organ into the dental papilla early in odontogenesis • Permanent maxillary lateral incisor • Three main types: 1: confined to the crown 2: extends into the root 3: extends through the root apex
  28. 28. Histopathology • Enamel and dentin lining the cavity are often defective and poorly mineralized • The cavity is occupied with food debris and bacteria
  29. 29. Evaginated odontome • Uncommon • Extra cusp like tubercles • Easily fractured, exposing the pulp
  30. 30. Complex odontome • Disorderly arranged dental tissues • Limited growth potential • 2nd and 3rd decades, in the molar region of the mandible • Painless, slow-growing
  31. 31. Radiographic examination • well-defined radiolucent lesion, proceeds to radiopaque • When mature it is surrounded by a translucent zone
  32. 32. Histopathology • Developing lesions contain varying amounts of soft tissue and show features of stages of odontogenesis
  33. 33. Compound odontome • Consists of numerous small denticles • 1st and 2nd decades of life and in anterior maxilla • Less growth potential than the complex type
  34. 34. Radiographic examination • Mixed radiopaque/radiolucent bodies
  35. 35. Ameloblastoma • Rare • Benign, locally invasive • Derived from odontogenic epithelium • More common in africans • Two variants: unicystic peripheral • 80% occur in mandible
  36. 36. Radiographic examination • Multiloculated radiolucency, resorption of roots around it • May become associated with unerupted 3rd molars
  37. 37. Histopathology • 2 patterns: • Follicular: epithelium arranged into discrete follicles resembling tooth germ • Plexiform type: epithelium is arranged in tangled network and irregular masses
  38. 38. • The ameloblast-like cells express amelogenin, however, enamel and dentine are not formed • Behavior: locally invasive, infiltrate cancellous bone without bone destruction initially • High recurrence rate
  39. 39. Unicystic ameloblastoma • Occur at younger age than other variants • Mainly in mandibular third molar region • Histologically: ameloblastomatous lining with reversed polarity nuclei
  40. 40. • Radiographically: unilocular radilucency, usually associated with an unerupted tooth • distinguishable from dentigerous cyst on by histopathological examination
  41. 41. Squamous odontogenic tumor • Rare • Radiographically: well-circumscribed radiolucency • Sclerotic border associated with roots of teeth • Histologically: irregularly shaped islands of well-differentiated squamous epithelium in a stroma of mature fibrous tissue • Derived from epithelial cells of Malassez.
  42. 42. Calcifying epithelial odontogenic tumour • Rare • Benign • Wide age range • Mandible > maxilla • Mostly seen in molar and premolar region • 50% associated with an unerupted tooth • Some extraosseous case have been reported
  43. 43. Radiographic features • Irregular radiolucent area • May or may not be clearly demarcated • Contains radiopaque bodies due to calcification • Less aggressive than ameloblastoma
  44. 44. Histopathology • Sheets and strands of polyhedral epithelial cells • Abundant eosinophilic cytoplasm • Prominent intercellular bridges • Nuclear pleomorphism
  45. 45. Adenomatoid odontogenic tumour • Presents usually in 2nd or 3rd decades • Majority in the anterior maxilla • Slowly growing swelling
  46. 46. Radiographic features • Well defined radiolucency • Faint radiopacities due to calcifications • May simulate a dentigerous cyst _often associated with an unerupted tooth
  47. 47. Histopathology • Well encapsulated lesion • Maybe partly or wholly cystic • Central spaces contain eosinophilic material • Small foci of calcification
  48. 48. Ameloblastic fibroma • Rare • Benign • Neoplasm of epithelial and mesenchymal elements • Well circumscribed
  49. 49. Histopathology • Proliferating strands of odontogenic epithelium in highly cellular fibroblastic tissue with peripheral layer of columnar cells • Appearance similar to ameloblastoma
  50. 50. Calcifying cystic odontogenic tumour • Grossly cystic • Mostly intraosseous • Radiographically: well-defined, uni or multi locular, radiolucent, with radiopaque areas
  51. 51. Histopathology • Basal layer of ameloblast-like cells, masses of swollen keratinized epithelial cells (ghost cells)
  52. 52. Odontogenic fibroma • Derived from mesenchymal dental tissues • 2 types: • Central type: uncommon, well demarcated, cementum-like and dentine-like foci • Peripheral type: fibrous epulis, fibrous tissue with cementum or dentinoid material
  53. 53. Odontogenic myxoma • Locally invasive • More common than odontogenic fibroma • Radiographically: Multilocular (soap-bubble appearance) Well defined Roots show resorption
  54. 54. Histopathology • Non-encapsulated Infiltrative growth pattern Stellate cells with anastomosing processes
  55. 55. Cementoblastoma • Mostly patients under 25 years of age • Usually molar and premolar area of mandible • Attached to the root of the tooth - vital • Slowly enlarging, sometimes causing pain
  56. 56. • Radiographically: well demarcated mottled, radiopaque radiolucent margin, root resorption • Histologically: cementum-like tissue, surrounded by sheets of uncalcified matrix

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