Difference between revisions of "Odontogenic tumours and cysts"

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This article covers '''odontogenic tumours and cysts''', which is a subset of oral pathology and can be grouped under the heading of ''head and neck pathology''.
This article covers '''odontogenic tumours and cysts''', which is a subset of [[oral pathology]] and can be grouped under the heading of ''head and neck pathology''.


The general topic of ''head and neck pathology'' is covered in the ''[[head and neck pathology]]'' and ''[[head and neck cytopathology]]'' articles.  
The general topic of ''head and neck pathology'' is covered in the ''[[head and neck pathology]]'' and ''[[head and neck cytopathology]]'' articles.  


==Tooth histiology 101==
The vast majority of oral malignancies are [[squamous cell carcinoma]].  Common odontogenic cysts are [[dentigerous cyst]]s, and [[radicular cyst]]s.<ref name=pmid20303056>{{Cite journal  | last1 = Eichhorn | first1 = W. | last2 = Wehrmann | first2 = M. | last3 = Blessmann | first3 = M. | last4 = Pohlenz | first4 = P. | last5 = Blake | first5 = F. | last6 = Schmelzle | first6 = R. | last7 = Heiland | first7 = M. | title = Metastases in odontogenic cysts: literature review and case presentation. | journal = Oral Surg Oral Med Oral Pathol Oral Radiol Endod | volume = 109 | issue = 4 | pages = 582-6 | month = Apr | year = 2010 | doi = 10.1016/j.tripleo.2009.11.013 | PMID = 20303056 }}</ref>
 
=Tooth histology 101=
Teeth develop from a combination of:
Teeth develop from a combination of:
#Epithelium (downward growth).
#Epithelium (downward growth).
#Mesenchyme.
#Mesenchyme.


===Identifying stuff===
==Identifying stuff==
Pulp:
Pulp:
*Paucicellular.
*Paucicellular.
Line 17: Line 19:
*"Fish scale" appearance.
*"Fish scale" appearance.


==Enamel 101==
Image:
<gallery>
Image:Tooth_in_teratoma_-_very_low_mag.jpg | Tooth. (WC)
</gallery>
 
===Enamel 101===
*Arises from ''reduced enamel epithelium''.
*Arises from ''reduced enamel epithelium''.


===Reduced enamel epithelium===
====Reduced enamel epithelium====
====Microscopic====
=====Microscopic=====
Features:
Features:
*Bilayered epithelium consisting of:
*Bilayered epithelium consisting of:
Line 31: Line 38:
*Transforms into squamous epithelium. (???)
*Transforms into squamous epithelium. (???)


==Compound odontome==
=Specific entities=
==Odontoma==
===General===
===General===
*Usually diagnosed clinically.
*Usually diagnosed clinically.
*Benign.
*Benign.
*Most common odontogenic tumour - considered to be a [[hamartoma]].<ref name=pmid20533004/>
*Etiology unknown.<ref name=pmid22629054>{{Cite journal  | last1 = Yadav | first1 = M. | last2 = Godge | first2 = P. | last3 = Meghana | first3 = SM. | last4 = Kulkarni | first4 = SR. | title = Compound odontoma. | journal = Contemp Clin Dent | volume = 3 | issue = Suppl 1 | pages = S13-5 | month = Apr | year = 2012 | doi = 10.4103/0976-237X.95095 | PMID = 22629054 }}</ref>
*Typically first two decades of life.
Classification:<ref name=pmid20533004/>
*''Compound odontoma'' - tooth-like structure.
*''Complex odontoma'' - disorganized mass of odontogenic tissues.


===Microscopic===
===Microscopic===
Features:
Features:<ref name=pmid20533004/>
* ???
* Dentin.
* Cementum.
* Pulpal tissue.
* Enamel - has a "fish-scale" appearance.
**Usually lost during decalcificiation.
 
Images:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996496/figure/Fig3/ Compound odontoma (nih.gov)].<ref name=pmid20533004>{{Cite journal  | last1 = Nelson | first1 = BL. | last2 = Thompson | first2 = LD. | title = Compound odontoma. | journal = Head Neck Pathol | volume = 4 | issue = 4 | pages = 290-1 | month = Dec | year = 2010 | doi = 10.1007/s12105-010-0186-2 | PMID = 20533004 }}</ref>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996496/figure/Fig3/ Enamel matrix (nih.gov)].


==Radicular cyst==
==Radicular cyst==
*[[AKA]] periapical cyst.
*[[AKA]] ''periapical cyst''.


===Clinical===
===Clinical===
Line 49: Line 72:
===Microscopic===
===Microscopic===
Features:
Features:
*Squamous epithelium - ''always'' non-keratinized.
*Squamous epithelium - non-keratinized - '''important'''.
*+/-Giant cells.
*+/-Giant cells.
*+/-Cholesterol clefts.
*+/-Cholesterol clefts.
*+/-Abundant [[plasma cell]]s.


DDx:
DDx:
*Dentigerous cyst (history is the '''key''' to differentiate).
*[[Dentigerous cyst]] - history is the '''key''' to differentiate.
 
*[[Keratocystic odontogenic tumour]] - keratinized epithelium.
Notes:
*[[Plasma cell neoplasm]]<ref name=pmid9495138>{{Cite journal  | last1 = Dhanrajani | first1 = PJ. | last2 = Abdulkarim | first2 = SA. | title = Multiple myeloma presenting as a periapical lesion in the mandible. | journal = Indian J Dent Res | volume = 8 | issue = 2 | pages = 58-61 | month =  | year =  | doi =  | PMID = 9495138 }}</ref> - should be considered if the lesion is ''not'' associated with a carious tooth.
*Keratinized epithelium: think keratocytic odontogenic tumour.


==Dentigerous cyst==
==Dentigerous cyst==
 
===General===
===Clinical===
*Unerupted tooth - usually wisdom teeth.
*Unerupted tooth - usually wisdom teeth.
**Young adults.
**Young adults.
Treatment:
*Complete removal - as may transform to [[squamous cell carcinoma]] or [[ameloblastoma]].<ref>{{Ref PBoD8|748}}</ref>


===Gross===
===Gross===
Line 70: Line 95:
===Microscopic===
===Microscopic===
Features:
Features:
*Squamous epithelium - ''always'' non-keratinized.
*Squamous epithelium.
**Classically described as non-keratinized - in which case the diagnosis is straight forward - '''important'''.
**Approximately half have keratin.<ref name=pmid9195629>{{Cite journal  | last1 = Yoshiura | first1 = K. | last2 = Higuchi | first2 = Y. | last3 = Araki | first3 = K. | last4 = Shinohara | first4 = M. | last5 = Kawazu | first5 = T. | last6 = Yuasa | first6 = K. | last7 = Tabata | first7 = O. | last8 = Kanda | first8 = S. | title = Morphologic analysis of odontogenic cysts with computed tomography. | journal = Oral Surg Oral Med Oral Pathol Oral Radiol Endod | volume = 83 | issue = 6 | pages = 712-8 | month = Jun | year = 1997 | doi =  | PMID = 9195629 }}</ref>
*+/-Giant cells.
*+/-Giant cells.
*+/-Cholesterol clefts.
*+/-Cholesterol clefts.


DDx:
DDx:
*Radicular cyst (history is the '''key''' to differentiate).
*[[Radicular cyst]] - history is the '''key''' to differentiate.
*[[Keratocystic odontogenic tumour]] - parakeratosis, ribbon like, (artefactual) clefting.
 
Images:
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802170149187 Dentigerous cyst (surgicalpathologyatlas.com)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180832/figure/F2/ Dentigerous cyst (nih.gov)].<ref name=pmid21957386>{{Cite journal  | last1 = Moosvi | first1 = Z. | last2 = Tayaar | first2 = SA. | last3 = Kumar | first3 = GS. | title = Neoplastic potential of odontogenic cysts. | journal = Contemp Clin Dent | volume = 2 | issue = 2 | pages = 106-9 | month = Apr | year = 2011 | doi = 10.4103/0976-237X.83073 | PMID = 21957386 | PMC = 3180832 }}</ref>


Notes:
===Sign out===
*Keratinized epithelium: think keratocytic odontogenic tumour.
====Keratinized====
<pre>
MAXILLARY SINUS CYST, LEFT, EXCISION:
- ACANTHOTIC STRATIFIED SQUAMOUS EPITHELIUM WITH INFLAMMATION, COMPACT
KERATIN AND FOCAL PARAKERATOSIS -- CONSISTENT WITH DENTIGEROUS CYST WITH KERATIN.
- BENIGN BONE.
- NEGATIVE FOR ODONTOGENIC KERATOCYSTIC TUMOUR (ODONTOGENIC KERATOCYST).
</pre>


==Keratocystic odontogenic tumour==
==Keratocystic odontogenic tumour==
===General===
{{Main|Keratocystic odontogenic tumour}}
*Used to be known as ''odontogenic keratocyst''.<ref name=pmid18353202>{{Cite journal  | last1 = Madras | first1 = J. | last2 = Lapointe | first2 = H. | title = Keratocystic odontogenic tumour: reclassification of the odontogenic keratocyst from cyst to tumour. | journal = J Can Dent Assoc | volume = 74 | issue = 2 | pages = 165-165h | month = Mar | year = 2008 | doi =  | PMID = 18353202 }}
</ref>
*May be associated with ''[[nevoid basal cell carcinoma syndrome]]''.
 
===Clinical===
Features:<ref name=pmid17928730>{{Cite journal  | last1 = Habibi | first1 = A. | last2 = Saghravanian | first2 = N. | last3 = Habibi | first3 = M. | last4 = Mellati | first4 = E. | last5 = Habibi | first5 = M. | title = Keratocystic odontogenic tumor: a 10-year retrospective study of 83 cases in an Iranian population. | journal = J Oral Sci | volume = 49 | issue = 3 | pages = 229-35 | month = Sep | year = 2007 | doi =  | PMID = 17928730 }}</ref>
*Most common presentation: swelling.
*Location: usually mandible.
*May mimic ameloblastoma radiologically.
 
===Microscopic===
Features: <ref>Thompson LDR. Head and neck pathology - (Foundations in diagnostic pathology). Goldblum JR, Ed.. Churchill Livingstone. 2006. ISBN 0-443-06960-3.</ref>
*Stratified epithelium resembling squamous epithelium - typically 8-10 cell layers thick - with relatively uniform thickness ("ribbon-like appearance").
*Artefactual separation of epithelium from the basement membrane.
*Parakeratosis (keratinized cells with nuclei) -- '''key feature'''.
*Palisaded basal cell layer.
*Lacks [[rete ridges]].
 
DDx:
*Odontogenic cyst.
**Orthokeratinized odontogenic cyst (has orthokeratosis instead of parakeratosis).
***Orthokeratosis = keratinized cells no nuclei; parakeratosis = keratinized cell with nuclei.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Keratocystic_odontogenic_tumour1.jpg KOT (WC)].
*[http://commons.wikimedia.org/wiki/File:Keratocystic_odontogenic_tumour2.jpg KOT - showing artefactual separation of epithelium (WC)].


==Ameloblastoma==
==Ameloblastoma==
===General===
{{Main|Ameloblastoma}}
*Osteous lesion.
 
===Classification===
Location:
#Intra-osseous.
#*Locally aggressive.
#Peripheral.
#*Benign.
 
====Subclassification of intra-osseous type====
Histology:
#Solid/multicystic.
#*More commonly reoccur.
#Unicystic.
#*Unlikely to reoccur.
#*Classically found in younger individuals.
 
===Microscopic===
Features:<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970616-7 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970616-7]. Accessed on: March 9, 2010.</ref>
*Stellate reticulum - star-shaped cells, found in a developing tooth.<ref>URL: [http://en.wikipedia.org/wiki/Stellate_reticulum http://en.wikipedia.org/wiki/Stellate_reticulum]. Accessed on: March 9, 2010.</ref>
*Tall columnar cells.
**Palisaded nuclei with reverse polarization.
***Reverse polarization of nuclei = nuclei distant from the basement membrane/nuclei at pole opposite of basement membrane.
***Palisaded nuclei = picket fence appearance; columnar-shaped nuclei with long axis aligned perpendicular to the basement membrane -- '''key feature'''.
**Subnuclear vacuolization.
*+/-Giant cells.
*+/-Subepithelial hyalinization (eosinophilic acellular amorphous material).
**Seen deep to the basement membrane.
*Variable morphology (see below - ''morphology'').
 
DDx (nuclear palisading):
*Adenomatoid odontogenic tumour.
*Ameloblastic fibroma.
 
Images:
*[http://www.estomatologia.com.br/diagnosticos_det2.asp?cod_diag=12 Ameloblastoma - several images (estomatologia.com.br)].
*[http://www.cytochemistry.net/microanatomy/digestive/devtooth9.jpg Stellate reticulum (cytochemistry.net)].
 
====Morphology===
*Not prognostic.
 
Morphologic variants:
*Follicular ameloblastoma  (classic appearance).
*Plexiform ameloblastoma (does not have prominent pallisading).
*Acanthomatous ameloblastoma.
*Desmoplastic ameloblastoma.
*Basaloid ameloblastoma.


==Adenomatoid odontogenic tumour==
==Adenomatoid odontogenic tumour==
===General===
{{Main|Adenomatoid odontogenic tumour}}
*Paedatric population.
 
===Microscopic===
Features:
*Palisaded nuclei.
*Whorled epithelium.
 
Notes:
*No stellate reticulum.
 
DDx: Ameloblastoma.


==Ameloblastic fibroma==
==Ameloblastic fibroma==
Line 185: Line 140:
*No stellate reticulum.
*No stellate reticulum.


DDx: Ameloblastoma.
DDx:  
*[[Ameloblastoma]].


==Odontogenic myxoma==
==Odontogenic myxoma==
Line 191: Line 147:
*Benign tumour of mesenchymal origin.
*Benign tumour of mesenchymal origin.
*Often reoccurs.
*Often reoccurs.
*Radiologic DDx includes ameloblastoma.
*Radiologic DDx includes [[ameloblastoma]].


===Gross===
===Gross===
Line 200: Line 156:
*Paucicellular lesion with pale staining.
*Paucicellular lesion with pale staining.


==See also==
==Squamous odontogenic tumour==
{{Main|Squamous odontogenic tumour}}
 
=See also=
*[[Bone tumours]].
*[[Head and neck pathology]].
*[[Head and neck pathology]].
*[[Head and neck cytopathology]].
*[[Head and neck cytopathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}
=External=
*[http://www.oralpath.org/gallery/cyst_diagrams.htm Oral cavity and jaw cysts - schematic representations (oralpath.org)].


[[Category:Head and neck pathology]]
[[Category:Head and neck pathology]]
[[Category:Odontogenic tumours and cysts|Odontogenic tumours and cysts]]

Latest revision as of 00:54, 24 March 2019

This article covers odontogenic tumours and cysts, which is a subset of oral pathology and can be grouped under the heading of head and neck pathology.

The general topic of head and neck pathology is covered in the head and neck pathology and head and neck cytopathology articles.

The vast majority of oral malignancies are squamous cell carcinoma. Common odontogenic cysts are dentigerous cysts, and radicular cysts.[1]

Tooth histology 101

Teeth develop from a combination of:

  1. Epithelium (downward growth).
  2. Mesenchyme.

Identifying stuff

Pulp:

  • Paucicellular.
  • Pale staining.

Enamel:

  • Hyperchromatic (dark purple).
  • "Fish scale" appearance.

Image:

  • Tooth. (WC)

Enamel 101

  • Arises from reduced enamel epithelium.

Reduced enamel epithelium

Microscopic

Features:

  • Bilayered epithelium consisting of:
    • Cuboidal/columnar cells with:
      • Moderate eosinophilic cytoplasm.
      • Round (slightly irregular) centrally place nuclei.

Notes:

  • Transforms into squamous epithelium. (???)

Specific entities

Odontoma

General

  • Usually diagnosed clinically.
  • Benign.
  • Most common odontogenic tumour - considered to be a hamartoma.[2]
  • Etiology unknown.[3]
  • Typically first two decades of life.

Classification:[2]

  • Compound odontoma - tooth-like structure.
  • Complex odontoma - disorganized mass of odontogenic tissues.

Microscopic

Features:[2]

  • Dentin.
  • Cementum.
  • Pulpal tissue.
  • Enamel - has a "fish-scale" appearance.
    • Usually lost during decalcificiation.

Images:

Radicular cyst

  • AKA periapical cyst.

Clinical

  • Non-vital tooth - key feature.
    • The tooth that has lost its nerve.

Microscopic

Features:

  • Squamous epithelium - non-keratinized - important.
  • +/-Giant cells.
  • +/-Cholesterol clefts.
  • +/-Abundant plasma cells.

DDx:

Dentigerous cyst

General

  • Unerupted tooth - usually wisdom teeth.
    • Young adults.

Treatment:

Gross

  • Lesion at crown of tooth.

Microscopic

Features:

  • Squamous epithelium.
    • Classically described as non-keratinized - in which case the diagnosis is straight forward - important.
    • Approximately half have keratin.[6]
  • +/-Giant cells.
  • +/-Cholesterol clefts.

DDx:

Images:

Sign out

Keratinized

MAXILLARY SINUS CYST, LEFT, EXCISION:
- ACANTHOTIC STRATIFIED SQUAMOUS EPITHELIUM WITH INFLAMMATION, COMPACT
KERATIN AND FOCAL PARAKERATOSIS -- CONSISTENT WITH DENTIGEROUS CYST WITH KERATIN.
- BENIGN BONE.
- NEGATIVE FOR ODONTOGENIC KERATOCYSTIC TUMOUR (ODONTOGENIC KERATOCYST).

Keratocystic odontogenic tumour

Main article: Keratocystic odontogenic tumour

Ameloblastoma

Main article: Ameloblastoma

Adenomatoid odontogenic tumour

Main article: Adenomatoid odontogenic tumour

Ameloblastic fibroma

General

  • Paedatric population.

Microscopic

Features:

  • Palisaded nuclei.
  • Fibrous stroma.

Notes:

  • No stellate reticulum.

DDx:

Odontogenic myxoma

General

  • Benign tumour of mesenchymal origin.
  • Often reoccurs.
  • Radiologic DDx includes ameloblastoma.

Gross

  • Gelatinous mass.

Microscopic

Features:

  • Paucicellular lesion with pale staining.

Squamous odontogenic tumour

Main article: Squamous odontogenic tumour

See also

References

  1. ↑ Eichhorn, W.; Wehrmann, M.; Blessmann, M.; Pohlenz, P.; Blake, F.; Schmelzle, R.; Heiland, M. (Apr 2010). "Metastases in odontogenic cysts: literature review and case presentation.". Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109 (4): 582-6. doi:10.1016/j.tripleo.2009.11.013. PMID 20303056.
  2. ↑ 2.0 2.1 2.2 2.3 Nelson, BL.; Thompson, LD. (Dec 2010). "Compound odontoma.". Head Neck Pathol 4 (4): 290-1. doi:10.1007/s12105-010-0186-2. PMID 20533004.
  3. ↑ Yadav, M.; Godge, P.; Meghana, SM.; Kulkarni, SR. (Apr 2012). "Compound odontoma.". Contemp Clin Dent 3 (Suppl 1): S13-5. doi:10.4103/0976-237X.95095. PMID 22629054.
  4. ↑ Dhanrajani, PJ.; Abdulkarim, SA.. "Multiple myeloma presenting as a periapical lesion in the mandible.". Indian J Dent Res 8 (2): 58-61. PMID 9495138.
  5. ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 748. ISBN 978-1416031215.
  6. ↑ Yoshiura, K.; Higuchi, Y.; Araki, K.; Shinohara, M.; Kawazu, T.; Yuasa, K.; Tabata, O.; Kanda, S. (Jun 1997). "Morphologic analysis of odontogenic cysts with computed tomography.". Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83 (6): 712-8. PMID 9195629.
  7. ↑ Moosvi, Z.; Tayaar, SA.; Kumar, GS. (Apr 2011). "Neoplastic potential of odontogenic cysts.". Contemp Clin Dent 2 (2): 106-9. doi:10.4103/0976-237X.83073. PMC 3180832. PMID 21957386. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180832/.

External

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