lab 4 Cysts of Jaws &Oral Soft Tissues ( 2008 script )

8/3/2019 lab 4 Cysts of Jaws &Oral Soft Tissues ( 2008 script )

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Cysts of the Jaws & oral soft tissues LAB

The locations of different jaws cysts :

The ramus and body of the mandible : OKC(Odontogenic

Keratocyst)

In association with

unerupted tooth : D

(Dentigerous cyst)

Periapical location

and associated withcarious tooth : P

(Periapical Radicular

Cyst)

In the area of

extracted tooth : R ( Residual Radicular Cyst)

Between the roots of vital mandibular premolars :

L (Lateral Periodontal Cyst) >> could be OKC too.

Surrounding crown of tooth which is

erupting and still in

the alveolar mucosa as swelling : E (Eruption

Cyst)

In the gingiva of an adult person : G (Gingival Cyst)

The Components of

the cyst:

Lumen : which could

contain :-

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Degenerating epithelial & inflammatory cells

Serum proteins

Cholestrtol crystals

Wall : fibrous tissues

OKC : will increase the potential for recurrence

of the cysts

Inflammatory cysts : inflammatory infiltrate

Lining :

Epithelial tissue gives an indications about the

origins of the cyst (odontogenic , non-odontogenic )

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Dermoid cyst :

A mass in the midline

(rubbery and firm)

Present Intraoral or

Submental swellings

Histologically :

Regular

Orthokeratinized stratified

squamous epithelium

The wall contains

skin appendages such as

Sebaceous glands and hair

follicles

The lumen contains

keratinous debris

Sebaceous glands and hair follicles

Differential diagnosis : we said that the

mass is a rubbery & firm to differentiate it from

Extravsation Mucoceles which contains fluid fill

and occurs in association with glands (usually

sublingual gland )

Epidrmoid cysts :

No skin appendagesand they occurring

anywhere in the oral soft

tissues

Histologically :

Orthokeratin

Connective tissue

Prominent granular layer

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Arise as a result oftraumatic implantation

of the epithelium causing it to include into the

deeper tissues (epidermal

inclusion).

Extravasation Mucocele:

Soft swelling of the lower

lip , increasing and decreasing

in sizes , filling emptying then

refilling

Histologically :

Granular tissue

Mucous (mucin)

No lining : we

can't define a specific

layer

Salivary nodules

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The difference between Extravasation

Mucocele and Retention mucoceles is that

retention mucoceles the mucin retains insidethe duct and we don't have inflammatory

infiltrate in contrast to exteravasation

mucoceles , so we have here well

defined layers histologically.

Thyroglossal duct cyst:

Moving upward and downward

while swallowing

Colloid Homogenous Eosinophilic

material , similar to the material found

in thyroid follicles .

Lateral Periodontal Cyst :

Radiolucent lesion well defined

between mandibular premolars (in this

pic the tooth is not vital so we are not

sure if it's lateral periodontal or lateral

radicular cysts .. so we take a biopsy)

Histologically :

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thin non-keratinized

epithelium with Plaque-

like focal thickening( thin segment followed by

thick one )

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Here variant ofLateral

Periodontal Cystwhich is

called "Botryoid" , small

grapelike , multiple cystic

spaces lined withepithelium which shows

varying degrees of

thickening , this type

requires more aggressive

treatment to overcome recurrence potential

Gingival cyst of the

adult:

Similar to theLateral Periodontal

Cyst in its

histopathology on

contrast to Gingival

Cyst of the newborn

which shows features

similar to epidermoid

cyst(only epitheliumand Keratin)

Keratinized epithelium Two small cystic nodules on the palate

(Gingival Cyst of the newborn)

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Eruption cyst :

Fluctuant swellings

on the alveolar mucosa

and are often bluish incolor

Counterpart of Dentigerous cyst

Glandular odontogenic cyst:

Radiolucent lesion in the anterior region of

the mandible(a typical location)

Histologically :

Epithelium lining , cystic space , fibrous wall

Mucous

cells arranged

in a glandular

pattern

Aneurysmal bone cyst :

Multiloculated

radiolucent lesions in

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the body and angle of the mandible causing

bony expansion which is rapidly developing in

young adult

Histologically :

Multinucleated giant cells

Pools of blood

Surrounded by granulation tissue

Idiopathic bone cavity (traumatic bone cyst ):

Trauma-hemorrhage theorywhere the clot

disintegrate leaving an

empty cavity which is

considered aspseudocyst

Histologically : Normal

bone and fibrous tissue ,

absence of fibrous wall andepithelium lining

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Lymphoepithelial Cyst :

Cystic lesion anterior

to SternoCleidoMastoid

muscle

Unusual lesion in the

oral cavity

Histologically :

Dense well-

organized lymphoidtissue

Paradental cyst :

Partially erupted

third molar

Distally (the locationof the cyst )

Inflammatory

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Origin : Reduced Enamel Epithelium

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Ranula/plunging ranula :

Swelling in the floor of the

mouth

Bluish in color

Translucent

Histologically :

Mucous Extravasation Cysts

Nasopalatine duct

cyst :

Enlargement in the

palate

Differential

diagnosis :

OKC(appear in any location)

Periapical radicular cyst(non-vital tooth)

Histologically :

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Pseudostratified Ciliated Columnar

Epithelium

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OKC (Odontogenic

Keratocyst ) :

Radiolucent lesions

involving the body of themandible and surrounding

impacted third molar

(Differential diagnosis :Ameloblastoma, maybe

Dentigerous cystbut the cyst is growing in

anteroposterior directions with minimal bony

expansion so we

exclude

dentigerous cyst )

Histologically :

Epithelium

is sloughed from

the underlying

connective

tissues

Higher

magnification : some

areas shows

hyperchromatic

columnar cells , a lot ofkeratin in the lumen

Palisaded

columnar basal

layer

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Uniform thickness, Parakeratosis

What can I see

in the wall ?

daughter cysts

(Satellite Cysts )

Ki-67 is a marker

for proliferative activity

and it is highly expressed

in OKC reflecting the

biological behavior of thelining epithelium

Bcl-2 (anti-

apoptotic protein ) highly

expressed , and

apoptotic doesn't occur

normally here , and it is

more closed to be benign

tumor and is called

keratinizing odontogenic

tumor

Radiographic of OKC :

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o it can be associated with impacted

tooth

o It can be Lateral Periodontal

appearance

o glandular odontogenic cyst

appearance

o It can be Residual appearance

o It can be multiple .. then I should think

about which syndrome ? Neavoid basal cell

carcinoma (NBCCS)

OKC has typical

histological features

that must be present in

order to consider it as

OKC :

Uniform

thickness

Palisaded

columnar

Most frequently Parakeratinized

Even if I have orthokeratinized with the typical

features (uniform thickness , palisaded columnar ) I

can consider it OKC .

Typical features lost

because theinflammation is altered

the lining characteristic

so we start have

hyperplasia of

epithelium, Rete Ridges.

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Orthokeratinized

odontogenic cysts

different from OKC , we

don't have the typical

features although we

have cyst producing

keratin (could be

Radicularor Dentigerous

Cysts)

Gorlin-Goltz Syndrome ( Neavoid basal

cell carcinoma ):

Multiple naevoid basal cell carcinomaunlike basal cell carcinomas which occur on

sun-exposed skin, commonly appear around

the age of puberty

Multiple OKC

Rib anomalies (Bifid Rib)

Calcified flax cerebri

(Professor Gorlin)

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Dentigerous cyst

A coronal radiolucency

surounded impacted third molar

Histologically : the lining non-

specific non-keratinized , mucous

cell

The occurring ofmetaplasia in the lining

can form keratin, or Secondary Inflamedhappened so we will have Cholesterol Cleft

Radicular cyst :

Periapical radiolucent

Non-keratinizing squamous

lining

Hyperplasic epithelium

Cholesterol Cleft

Rushton bodies

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All these finding are non-specific, it

can be present in Dentigerous cyst

,

o Look at the inflammatory infiltration, it is

dense because the cyst is inflammatory in

origin.

o

R

es

idual Radicular Cyst

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Solitary bone

cyst (simple bone

cyst):

Premolar &

molars regions

Scalloping isprominent feature

around and

between the roots

Trauma-

hemorrhage

theory

Done by:

HeRoN

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lab 4 Cysts of Jaws &Oral Soft Tissues ( 2008 script )