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.  


==Keratocystic odontogenic tumour==
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:
#Epithelium (downward growth).
#Mesenchyme.
 
==Identifying stuff==
Pulp:
*Paucicellular.
*Pale staining.
 
Enamel:
*Hyperchromatic (dark purple).
*"Fish scale" appearance.
 
Image:
<gallery>
Image:Tooth_in_teratoma_-_very_low_mag.jpg | Tooth. (WC)
</gallery>
 
===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===
===General===
*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 }}
*Usually diagnosed clinically.
</ref>
*Benign.
*May be associated with ''[[nevoid basal cell carcinoma syndrome]]''.
*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===
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==
*[[AKA]] ''periapical cyst''.


===Clinical===
===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>
*Non-vital tooth - '''key feature'''.
*Most common presentation: swelling.
**The tooth that has lost its nerve.
*Location: usually mandible.
*May mimic ameloblastoma radiologically.


===Microscopic===
===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>
Features:
* Stratified epithelium resembling squamous epithelium -- but:
*Squamous epithelium - non-keratinized - '''important'''.
** Lacks [[rete ridges]].
*+/-Giant cells.
** Artefactual separation of epithelium from the basement membrane.
*+/-Cholesterol clefts.
*+/-Abundant [[plasma cell]]s.


DDx:
DDx:
*Odontogenic 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.
**Young adults.
 
Treatment:
*Complete removal - as may transform to [[squamous cell carcinoma]] or [[ameloblastoma]].<ref>{{Ref PBoD8|748}}</ref>
 
===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.<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.
*+/-Cholesterol clefts.
 
DDx:
*[[Radicular cyst]] - history is the '''key''' to differentiate.
*[[Keratocystic odontogenic tumour]] - parakeratosis, ribbon like, (artefactual) clefting.


Images:
Images:
*[http://commons.wikimedia.org/wiki/File:Keratocystic_odontogenic_tumour1.jpg KOT (WC)].
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802170149187 Dentigerous cyst (surgicalpathologyatlas.com)].
*[http://commons.wikimedia.org/wiki/File:Keratocystic_odontogenic_tumour2.jpg KOT - showing artefactual separation of epithelium (WC)].
*[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==
{{Main|Keratocystic odontogenic tumour}}


==Ameloblastoma==
==Ameloblastoma==
{{Main|Ameloblastoma}}
==Adenomatoid odontogenic tumour==
{{Main|Adenomatoid odontogenic tumour}}
==Ameloblastic fibroma==
===General===
===General===
*Osteous lesion.
*Paedatric population.


===Microscopic===
===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>
Features:
*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>
*Palisaded nuclei.
*Tall columnar cells.
*Fibrous stroma.
**Nuclei distant from the basement membrane (reverse polarization of the nuclei).
 
*+/-Giant cells.
Notes:
*No stellate reticulum.
 
DDx:  
*[[Ameloblastoma]].
 
==Odontogenic myxoma==
===General===
*Benign tumour of mesenchymal origin.
*Often reoccurs.
*Radiologic DDx includes [[ameloblastoma]].
 
===Gross===
*Gelatinous mass.


Images:
===Microscopic===
*[http://www.estomatologia.com.br/diagnosticos_det2.asp?cod_diag=12 Ameloblastoma - several images (estomatologia.com.br)].
Features:
*[http://www.cytochemistry.net/microanatomy/digestive/devtooth9.jpg Stellate reticulum (cytochemistry.net)].
*Paucicellular lesion with pale staining.


==Squamous odontogenic tumour==
{{Main|Squamous odontogenic tumour}}


==See also==
=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

Retrieved from "https://librepathology.org/w/index.php?title=Odontogenic_tumours_and_cysts&oldid=49963"