Michelle Ng Wai Yan (00000021924)

DT116
AIR TOPIC: CYSTS AND TUMOURS

CYSTS

Lesion Demographic Clinical and other significant Radiographical Histological

features

KCOT  Grows If large:  Small, round/ovoid 2 variants

anteroposteriorly  Pain radiolucency 1. Parakeratinized
(keratocystic  Male  Swelling/discharge  Multilocular (mostly) or  Columnar basal cell
odontogenic  Mandible (mostly),  Tooth displacement unilocular  Stratum granulosum not present
maxilla (>50 years (not resorption)  Sclerotic borders  Reverse polarization
tumor) old)  Displacement & destruction of  Scalloped margins
orbit - indicating unequal growth 2. Orthokeratinized
 Proptosis  Cuboidal basal cell
 Gorlin-Goltz Syndrome 4 types  Stratum granulosum
 CNS deformities  More keratin
 Frontal bossing  Replacement
 Proptosis  Envelopmental Core features
 Hypertelorism  Extraneous  5-8 cell layers
 Naevous formations  Collateral  Corrugated lining epithelium
 Palmar and plantar  Prominent palisaded, polarized basal layer
calcifications Differential diagnosis:  Weak junction between epithelium and
 Sexual abnormalities  Radicular connective tissue
 Multiple basal cell  Dentigerous  Dirty white pus-like material in cyst cavity
epitheliomas  Lateral periodontal cyst  Stroma resembles mesenchymal
 Jaw cysts  Nasopalatine duct cyst connective tissue
 Bifid ribs  Satellite/daughter cysts in CT wall
 Intense inflammation can --> increased
epithelium thickness, rete peg formation,
loss of keratinized surface
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

Dentigerous  10-30 years  Missing tooth (usually)  Unilocular  2-4 cell layers
 Male  Teeth displacement  Crown of impacted tooth  Cuboidal epithelium
cyst  White > blacks  Root resorption  Well-defined sclerotic  REE-like lining epithelium
 Site: mandi 3rd molar  Facial asymmetry borders, unless  No rete peg formation unless secondarily
> max 3rd molar > secondarily infected infected
max canine  Root resorption of  Sometimes, Rushton bodies in lining
 Permanent tooth neighbouring teeth epithelium
 Large may appear  Loose fibrous connective tissue stroma making
multilocular even when up thickened connective tissue wall
unilocular histologically  Islands of
odontogenic epithelium

Radiographical types

 Central - envelops crown

of impacted tooth
symmetrically from all
sides
 Lateral - dilation of follicle
on one aspect of crown.
Partially erupted tooth
 Circumferential - cystic
cavity encloses entire
tooth.
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

Lateral  ~60 years old  Gingival swelling facially  Round/ovoid  Reduced enamel epithelium-like
 Male (only slightly  Pain, tender on palpation  Sclerotic borders  1-5 cell layers
periodontal more likely)  Egg shell crackling  <1 cm diameter  Thin, non-keratinized squamous/cuboidal
cyst  Mandibular premolar  Gelatinous  Between apex and cervical  Epithelial plaques (extending into cyst wall,
 Maxillary anterior  Associated w/ vital teeth margin mural bulges)
 Glycogen-rich clear cells
 Hyalinization of collagen
 No inflammation

Botryoid  More aggressively treated  Multilocular  Thin, 1-2 cell layers, non-keratinized
than LPC  Bigger than LPC  Plaque-like thickenings
cyst  More likely to recur than LPC  Clear cells UNUSUAL

CEOC  ~33 years old Intraosseous:  Unilocular (usually) or  Stratified squamous epithelium w/
 Males = females  Painless swelling w/ bone multilocular cuboidal/ameloblast-like cells
(Calcifying  Max = mandible expansion  Calcifications appear as  Areas resembling stellate reticulum
epithelial  Anterior region  Perforated sometimes radiopaque flecks  Calcified ghost cells (pale, swollen eosinophilic
 Associated w/ odontome  Tooth-like structures cells w/ FAINT nuclei)
odontogenic and ameloblastic fibro-  Root resorption  Ameloblastous proliferations
cyst) odontoma  Saucerization of bone  Presence of odontome
 2-4 cm or more typically (extraosseous)
 Malignant transformation

Extraosseous:
 Painless, smooth,
circumscribed swelling
 Sessile or pedunculated
gingival masses
 Bone thinning
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

 Most common  Slowly progressing painless  Unilocular  Stratified squamous non-keratinized

Radicular odontogenic cyst swelling unless secondarily  At apex  Variable epithelial thickness
 Always non vital infected  Lamina dura intact  Epithelial proliferation in ARCADING manner
 Males > females  Bone becomes thinner as  Granuloma (<1.6cm)  Rushton bodies seen in epithelial lining
 Range: 20-60 yrs swelling enlarges, despite sub smaller than cyst (>2cm)  Mature collagenous connective tissue wall
(mostly 20-30 y.o's) periosteal bone deposition >>  Chronic inflammatory cells seen in CT capsule
 Max anteriors egg shell crackling  Chief inflammatory cells = lymphocytes and
(mostly)  Sinus formation sometimes plasma cells
 Areas of hemorrhage
 Bone spicules
 Multinucleated giant cells
 Needle-shaped cholesterol clefts

Aneurysmal  Rare in jaw (more  Facial asymmetry, rapidly  Balloon-like radiolucency  Fibrous connective tissue stroma w/
often in long bones developing >> expanding cortica plates cavernous/sinusoidal blood filled spaces, lined
bone cyst and spine)  Pain  Honey comb/soap bubble by spindle-shaped cells
 Younger age group  Tender on motion  Cortical bone destruction  Young fibroblasts
(~30 years old)  Displacement of vital teeth and periosteal reaction  Patchy distribution of multinucleated giant
 Females > males  Egg shell crackling (maybe) cells
 Mandi > maxillary  Reactive bone formation
 Areas of hemorrhage in CT stroma
 Hemosiderin present (variable amounts) in CT
stroma

Mucocele  Young people Superficial -  Area of spilled mucin surrounded by

(children and young  Blu-ish granulation tissue
adults)  Raised, circumscribed  Spillage below mucosal epithelium
 Lower lip causes separation of epithelium from CT
 Lesion can be Deep  Granulation tissue prominent as
superficial or deep  MAY swell mucocele resolves
 No change in colour  Predominant cells = macrophages
because overlying  Salivary gland tissue containing dilated ducts
epithelium is thick and chronic inflammatory cell infiltrate
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

TUMOURS

Lesion Demographic Clinical and other Radiographical Histological

significant features

Ameloblastoma  Second most common  Swelling and facial  Honeycomb/soap CORE FEATURES
odontogenic tumour asymmetry bubble
 Large range (20 - 60  Painless (usually)  Small daughter cysts 1. Cells arranged in disconnected
years)  Egg shell crackling  Scalloped margins islands, strands and cords
 Males > Female  Displacement AND  Root resorption 2. Mature collagenous connective
 Mandible > maxilla resorption tissue stroma
 Molar area  Paresthesia 3. Colour gradation between
 Average size ~4.3cm  Failed eruption peripheral and central cells
 Association with a. Central: stellate reticulum-
impacted tooth like
b. Peripheral: columnar,
Types hyperchromatic nuclei,
Solid multicystic reverse polarity, same
ameloblastoma (SMA) location in cytoplasm >>
 Unicystic palisaded appearance
ameloblastoma
 Younger age group Classical features (Vickers, Gorlin)
(~22.1 years) 1. Peripheral columnar,
 Mandible, hyperchromatic cells
posterior region 2. Reverse polarity
 Mostly impacted 3. Subnuclear vacuole
teeth
Peripheral ameloblastoma
 Middle age (~52
years old)
 Male
 Mandible > maxilla
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

 3mm-2cm in size 6 histological types

 Desmoplastic 1. Follicular
ameloblastoma  Islands similar to enamel organ
 Central cells loosely arranged
stellate reticulum-like cells
Malignant ameloblastoma  Colour gradation (central pink,
 Wide age range 4-75 peripheral blue)
years
 Metastases 2. Acanthomatous
 Lung  Like follicular but instead of central
 Cervical lymph stellate reticulum-like cells,
nodes SQUAMOUS cells (d/t metaplasia)
 Vertebrae  Central typically Parakeratinized
 Bones
 Viscera 3. Plexiform
 Appears the same as  DISTINCT
benign (no o Not island, STRAND-like
pleomorphisms, no cell growth pattern imitating
division) dental lamina (bilayer of
cuboidal cells)
Ameloblastic carcinoma o Interconnection between
 May/may not strands
metastasize o Cell proliferation > expansion
 pleomorphisms of strands > stellate
reticulum-like
 Fibrous connective tissue stroma
sparse, loose and myxoid
4. Basal cell
 RAREST
 Extraosseous
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

 Like follicular but instead of central

stellate reticulum-like cells,
BASALOID appearing cells
o Colour gradation hard to see
5. Granular cell
 MOST AGGRESSIVE, RARE
 Like follicular, but instead of central
stellate reticulum-like cells,
GRANULAR CHANGE (which can
extend to peripheral cells)
6. Desmoplastic
 Variation of island; thin strands and
cords
 Dense collagenous stroma
(hyalinized and hypocellular)
 Peripheral cells flattened/cuboidal

Non-histological types

1. SMA (solid multicystic

ameloblastoma)
 Cystic degeneration

2. Unicystic
 Diff. diagnosis: SMA
 4 histopathological features
o Luminal: lining epithelium
follows Vickers-Gorlin criteria
o Intraluminal: Nodules from
cystic lining into lumen.
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

Nodules small or large, shows

edematous plexiform pattern
o Mural: fibrous cyst wall
infiltrated w/ ameloblastoma
maintaining connection w/
lining epithelium
3. Peripheral
o Islands of ameloblastic
epithelium under surface
epithelium
o Plexiform/follicular pattern
mostly
4. Desmoplastic

Ameloblastic carcinoma
 High nucleus/cytoplasm ratio
 Nuclear hyperchromatism
 Mitosis
 Tumour island necrosis
 Dystrophic calcification areas
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

Adenomatoid  Young (~20's)  Delayed eruption  Unilocular GROSS

 Female > male  Slow growing bony  Smooth  Well defined fibrous capsule
Odontogenic  Maxilla > mandible expansion corticated/sclerotic  Cut surface
Tumour  Aka 2/3 tumour!  Displacement of border  White to tan
 2/3 likelihood teeth  Calcification within  Solid to crumblt
female  RARE lumen  Cystic span varies in size
 2/3 likelihood  Tooth  Not attached at CEJ  Calcified masses
anterior mobility  Tooth embedded in solid tumour mass
 2/3 likelihood  Facial
young asymmetry
 2/3 likelihood  Mandibular MICROSCOPY
impacted fracture  Nodules, inside of which are spindle-
 1-3 cm in size  Nasal shaped cells with duct-like spaces
 Often occurs w/ CEOT obstruction containing eosinophilic droplets
(mostly), COC,  Calcifications (more basophilic)
dentigerous cyst and  Strands of epithelium
odontoma  Microcysts
 Lined by simple
cuboidal/columnar epithelium
 Homogenous eosinophilic material in
cysts
 Microcyst lumen lining = hyaline ring
(eosinophilic rim of varying thickness)
 Columnar cells form a rosette
appearance
 Double row = convoluted double
row
 Stellate reticulum-like spindle cells
between nodules and microcysts
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

Cystic AOT

 Basaloid cells lining cystic cavity buds

into stroma
 Rounded and irregular globules w/
varying calcifications within
parenchyma
 Dentinoid non-mineralized, fibrillar,
eosinophilic material
 Leiesegang rings

CEOT  <1% of odontogenic  Painless  Wind driven snow  Polyhedral epithelial cells packed in
tumours (VERY RARE)  Hard, bony swelling SHEETS
 30-50 years old  Tooth tipping,  Bland connective tissue stroma
 Mandible > maxilla rotation, migration,  Prominent intercellular bridges
 Posterior region mobility, root  Amyloid material
resorption  Calcifications
 Leisegang rings (hematoxyphilic,
concentrically lamellated masses) of
calcification
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

Ameloblastic  YOUNG (children and  Painless  Unilocular/multilocular  Scattered islands/strands/cords of

young adults)  Slow growing,  In connection w/ mal odontogenic epithelium
fibroma  20's expansile lesion positioned tooth  Stellate reticulum-like central cells (not
 Male (slightly more  1-8cm seen in strands)
common)  Smooth, well-defined  Cuboidal/columnar peripheral layer
 Mandible, posterior outline  VERY LITTLE COLLAGEN
 Mostly involves impacted  Sclerotic border  Ectomesenchyme = cell rich, mimicking
tooth  Diff. diagnosis: dental papilla
 Dentigerous cyst  Islands are mushroom-like
 Hyperplastic
dental follicle

Odontoma  Compound > complex  Painless  Dense RADIOPAQUE  Disorderly arrangement of normal
 Compound more  Hard, small masses mass enamel/enamel matrix, dentin, pulp
ordered than  Impacted  Unerupted/impacted and cementum (but they are all seen in
complex permanent/retained teeth normally most cases)
 Average age: 20's deciduous tooth involved  Ghost cells (common)
 Compound: maxilla,  Swelling  Cystic follicle  Connective tissue capsule resembles
anterior  Complex odontoma (radiolucent line) normal follicle
 Complex: mandible, >> facial asymmetry surrounds mass  Fully calcified enamel >> empty spaces
posterior w/ growth  Encased by sclerotic  Enamel matrix w/ prismatic structure
bone  Dentin forms bulk of tumour, usually
 Compound: collection well-formed w/ regular tubules
of tooth-like structures
of various sizes
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

Cementoblastoma  Young, 20-30 years  PAIN  Round  SHEETS of cementum-like tissue with a
 Female slightly more  Paraesthesia  RADIOOPAQUE lot of reversal lines, unmineralized at
common occasionally  Fuse with roots of periphery (or in more active growth
 Mandible, posterior  Slow growing, associated tooth >> area)
 Associated with tooth unilateral swelling obliterate radiopaque  Cemental trabeculae rimmed w/ active
root  Bone expansion details of roots cementoblasts
 Root resorption  Radiopacity  Fibrous tissue w/ dilated vessels and
 Invades root canals surrounded by thin, giant cells between calcified bands
 Toothache arising well-defined  Fibrous tissue is attached to root
in pulp radiolucent border
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

Diagrams

Odontogenic Radicular cyst –

keratocyst
Radicular cyst cholesterol clefts

Calcifying odontogenic Mucocele

Dentigerous cyst
cyst
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS

Ameloblastoma -
Adenomatoid odontogenic tumour
Plexiform

Ameloblastoma -
Ameloblastoma -
Calcifying epithelial odontogenic tumour
Acanthomatous
follicular
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS