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DT116
AIR TOPIC: CYSTS AND TUMOURS
CYSTS
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
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
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
TUMOURS
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
Non-histological types
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
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
Cystic AOT
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
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
Ameloblastoma -
Adenomatoid odontogenic tumour
Plexiform
Ameloblastoma -
Ameloblastoma -
Calcifying epithelial odontogenic tumour
Acanthomatous
follicular
Michelle Ng Wai Yan (00000021924)
DT116
AIR TOPIC: CYSTS AND TUMOURS