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 with carious 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

:1

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 )

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

S ebaceous 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 appendages and they occurring anywhere in the oral soft tissues

Histologically :
Orthokeratin Connective tissue Prominent granular layer 3

Arise as a result of traumatic 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

The difference between Extravasation Mucocele and Retention mucoceles is that retention mucoceles the mucin retains inside the 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 :
5

 thin non-keratinized

epithelium with Plaquelike focal thickening

( thin segment followed by thick one )

 Here variant of Lateral

Periodontal Cyst which is called "Botryoid" , small grapelike , multiple cystic spaces lined with epithelium which shows varying degrees of thickening , this type requires more aggressive treatment to overcome recurrence potential

Gingival cyst of the adult:

Similar to the Lateral Periodontal Cyst in its histopathology on contrast to Gingival Cyst of the newborn which shows features similar to epidermoid cyst (only epithelium and Keratin)

Keratinized epithelium

Two small cystic nodules on the palate (Gingival Cyst of the newborn)

Eruption cyst : Fluctuant swellings on the alveolar mucosa and are often bluish in color

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

8

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 theory where the clot disintegrate leaving an empty cavity which is considered as pseudocyst

Histologically : Normal bone and fibrous tissue , absence of fibrous wall and epithelium lining

Lymphoepithelial Cyst :

Cystic lesion anterior to SternoCleidoMastoid muscle

Unusual lesion in the oral cavity Histologically :

Dense wellorganized lymphoid tissue

Paradental cyst : Partially erupted third molar

Distally (the location Inflammatory

of the cyst )

10

Origin : Reduced Enamel Epithelium

11

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 :

12

Pseudostratified Ciliated Columnar Epithelium

13

OKC (Odontogenic Keratocyst ) :

Radiolucent lesions involving the body of the mandible and surrounding impacted third molar (Differential diagnosis : Ameloblastoma , maybe Dentigerous cyst but 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 of keratin in the lumen

Palisaded columnar basal layer

14

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 the lining epithelium
Bcl-2 (antiapoptotic 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 :

15

it can be associated with impacted

tooth It can be Lateral Periodontal appearance

o

glandular odontogenic cyst appearance

o o o

It can be Residual appearance

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 the inflammation is altered the lining characteristic so we start have hyperplasia of epithelium, Rete Ridges.

16

Orthokeratinized odontogenic cysts different from OKC , we don't have the typical features although we have cyst producing keratin (could be Radicular or Dentigerous Cysts)

Gorlin -Goltz Syndrome ( Neavoid basal cell carcinoma ):

Multiple naevoid basal cell carcinoma unlike 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)

17

Dentigerous cyst A coronal radiolucency surounded impacted third molar

Histologically : the lining nonspecific non-keratinized , mucous cell The occurring of metaplasia in the lining can form keratin, or Secondary Inflamed happened so we will have Cholesterol Cleft

Radicular cyst :

Periapical radiolucent

Non-keratinizing squamous lining

Hyperplasic epithelium Cholesterol Cleft Rushton bodies

18

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.

R es idual Radicular Cyst

19

Solitary bone cyst (simple bone cyst):

Premolar & molars regions Scalloping is prominent feature around and between the roots Traumahemorrhage theory

Done by: HeRoN

20