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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 | 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== | |||
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: | ||
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*Transforms into squamous epithelium. (???) | *Transforms into squamous epithelium. (???) | ||
== | =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=== | ||
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===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Squamous epithelium - '' | *Squamous epithelium - non-keratinized - '''important'''. | ||
*+/-Giant cells. | *+/-Giant cells. | ||
*+/-Cholesterol clefts. | *+/-Cholesterol clefts. | ||
*+/-Abundant [[plasma cell]]s. | |||
DDx: | DDx: | ||
*Dentigerous cyst | *[[Dentigerous cyst]] - history is the '''key''' to differentiate. | ||
*[[Keratocystic odontogenic tumour]] - keratinized epithelium. | |||
*[[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. | |||
==Dentigerous cyst== | |||
===General=== | |||
=== | |||
*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=== | ||
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===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Squamous epithelium - '' | *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 | *[[Radicular cyst]] - history is the '''key''' to differentiate. | ||
*[[Keratocystic odontogenic tumour]] - parakeratosis, ribbon like, (artefactual) clefting. | |||
Images: | |||
*Keratinized | *[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> | |||
===Sign out=== | |||
====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== | ||
{{Main|Keratocystic odontogenic tumour}} | |||
==Ameloblastoma== | ==Ameloblastoma== | ||
{{Main|Ameloblastoma}} | |||
==Adenomatoid odontogenic tumour== | ==Adenomatoid odontogenic tumour== | ||
{{Main|Adenomatoid odontogenic tumour}} | |||
==Ameloblastic fibroma== | ==Ameloblastic fibroma== | ||
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*No stellate reticulum. | *No stellate reticulum. | ||
DDx: Ameloblastoma. | DDx: | ||
*[[Ameloblastoma]]. | |||
==Odontogenic myxoma== | ==Odontogenic myxoma== | ||
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*Benign tumour of mesenchymal origin. | *Benign tumour of mesenchymal origin. | ||
*Often reoccurs. | *Often reoccurs. | ||
*Radiologic DDx includes ameloblastoma. | *Radiologic DDx includes [[ameloblastoma]]. | ||
===Gross=== | ===Gross=== | ||
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*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= | |||
{{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]] |
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