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Odontogenic tumours and cysts (view source)

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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.
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*"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. (???)


==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===
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===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===
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===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.


Notes:
Images:
*Keratinized epithelium: think keratocytic odontogenic tumour.
*[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==
*Abbreviated ''KOT''.
{{Main|Keratocystic odontogenic tumour}}
*Previously known as ''odontogenic keratocyst'', abbreviated ''OKC''.<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>
===General===
*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.
*Usually mandible.<ref>URL: [http://www.waent.org/archives/2010/Vol3-2/20100618-ameloblastoma/jaw-tumor.htm http://www.waent.org/archives/2010/Vol3-2/20100618-ameloblastoma/jaw-tumor.htm]. Accessed on: 30 November 2011.</ref>
**In a review of 3677 cases, the mandible-to-maxilla ratio was 5 to 1.<ref name=pmid7633291>{{Cite journal  | last1 = Reichart | first1 = PA. | last2 = Philipsen | first2 = HP. | last3 = Sonner | first3 = S. | title = Ameloblastoma: biological profile of 3677 cases. | journal = Eur J Cancer B Oral Oncol | volume = 31B | issue = 2 | pages = 86-99 | month = Mar | year = 1995 | doi =  | PMID = 7633291 }}</ref>
 
===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.
*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 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:
*www:
**[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)].
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Ameloblastoma_-_intermed_mag.jpg Ameloblastoma - intermed. mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Ameloblastoma_-_very_high_mag.jpg Ameloblastoma - very high mag.j (WC)].
 
====Morphology====
*Not prognostic.
 
Morphologic variants:
*Follicular ameloblastoma  (classic appearance).
*Plexiform ameloblastoma (does not have prominent palisading).
*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]].
 
Image:
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802170145276 AOT (surgical pathologyatlas.com)].


==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]].
*[[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]]
Michael
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