differential diagnosis of radiolucent lesions of the jaws · 2019-11-22 · multilocular...
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![Page 1: Differential Diagnosis of Radiolucent Lesions of the Jaws · 2019-11-22 · Multilocular Radiolucencies • Odontogenic Keratocyst • Botryoid Odontogenic Cyst • Glandular odontogenic](https://reader030.vdocuments.site/reader030/viewer/2022040918/5e9469b70b2158680d7e3900/html5/thumbnails/1.jpg)
Differential Diagnosis of Radiolucent Lesions
of the Jaws
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Multilocular
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Multilocular Radiolucencies• Odontogenic Keratocyst• Botryoid Odontogenic Cyst• Glandular odontogenic Cyst• Invasive Ameloblastoma• Central Giant Cell Granuloma• Brown Tumor (Hyperparathyroidism)• Aneurysmal Bone Cyst• Odontogenic Myxoma• Central Arteriovenous Malformations• Fibromatosis/Myofibromatosis• Nerve Sheath Tumors• Thalassemia (Mediterranian Anemia)
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Odontogenic Keratocyst
• Mandible > Maxilla• Aggressive, expansile• May perforate cortex• <2cm – recurrence low (>20%)• >2cm – recurrence may reach 50%• Tx is Curettage, Marsupialization• Soft tissue invasion may require resection• Multiple OKCs – R/O Gorlin syndrome
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Odontogenic Keratocyst
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Odontogenic Keratocyst• Histopathology
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Botryoid Odontogenic Cyst
• Variant of the Lateral Periodontal Cyst• Mandible>Maxilla• Anterior to premolars• Nonaggressive Behavior, yet may
recur after curettage• Thin lining with focal clear cell
acanthomatous nodules
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Botryoid Odontogenic Cyst
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Glandular (Sialo-Odontogenic) Cyst
• Anterior Jaws• Pericoronal or Multilocular• Adults• Tendency for Recurrence after
curettage• Stratified Squamous lining with
mucous metaplasia, forming acinar-like clusters.
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Sialo-odontogenic Cyst
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Ameloblastoma (Invasive)
• Unicystic type may be scalloped• Invasive type “soap bubble”• Mandible > Maxilla (both posterior)• Adult Onset• Histologic Subtypes are not prognostic
– Follicular, acanthomatous, granular cell• Mandible -- curettage, resection• Maxilla -- resection
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Ameloblastoma
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Invasive Ameloblastoma
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Ameloblastoma Microscopic Patterns
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Ameloblastoma Multilocular Histology
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Desmoplastic Ameloblastoma
• Histologic Variant with unique clinical features.
• Multilocular with diffuse opacification (“fibro-osseous radiography”)
• Adult onset• Anterior Mandible• Resection is usually required
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Desmoplasic Ameloblastoma
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Central Giant Cell Granuloma• Anterior to First Molars• Mandible > Maxilla• Expansile• Teens, Adults• Periapical location, tooth bearing regions• Treatment
– Intralesional Steroids– Curettage
• Aggressive Variants recur• R/O Hyperparathyroidism
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Central Giant Cell Granuloma• Radiographic
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CGCG
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Central Giant Cell Granuloma
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Brown Tumor, Hyperparathyroidism
Gross Specimen Histopathology
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Aneurysmal Bone Cyst
• Expansile, Balloon-like appearance• May accompany other osteogenic
and fibro-osseous lesions• Teens, Adults• Sinusoidal spaces under low
pressure– Positive bloody aspirate– Angiography, low flow
• Giant cells are present• Curettage
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Aneurysmal Bone Cyst
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Aneurysmal Bone Cyst
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Central Arteriovenous Malformation• Expansile, Microloculations
– “worm-hole appearance”• Loosening of teeth, crevicular bleeds• Feeder vessels
– Bilateral carotids– Bilateral vertebrals
• Bloody Aspirate• Angiography, high flow• Embolization
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Arteriovenous Malformation
Radiograph and Angiogram
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Aspiration of AV Malformation
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Time Lapse AngiographyArterial Capillary Venous
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Central Hemagioma(low pressure)
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Odontogenic Myxoma
• Expansile• Loculations: fine mesh, “icicle-like”
septations• Adults• Mandibular body• Connective tissue consistency
– Mucoid – higher recurrence– Fibrous – lower recurrence
• Resection
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Odontogenic Myxoma
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Odontogenic Myxoma
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Odontogenic Myxoma
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Desmoplastic Fibroma
• “Fibromatosis”, “Myofibromatosis”• Early childhood• Posterior Inferior Mandible• Expansile, scalloped appearance• Fasiculated Fibroblastic
– IHC: smooth muscle actin
• Curettage vrs. Resection
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Myofibromatosis
Radiographic 3D CT Image
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MyofibromatosisHistopathology
Smooth Muscle Actin
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Familial Fibrous Dysplasia (Cherubism)
• Autosomal dominant• Childhood onset• Bilateral multilocular lucencies of body and
ramus of mandible, maxilla occasionally involved
• Multiple unerupted teeth• Treatment
– Mild cases: none, lesions fill with mature bone– Severe cases: cosmetic contouring– Orthodontic therapy
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Cherubism
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Central Neurogenous Tumors
• Most often Solitary• Rarely component of neurofibromatosis• Mandible, posterior body
– Emerging from canal
• Neurilemmoma vrs. Neurofibroma– IHC: S100 protein (cytoplasmic & nuclear)
• Curettage• PO hypoesthesia
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Nerve Sheath Neoplasms
Neurofibroma
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Nerve Sheath Neoplasms
Radiographic Neurilemmoma
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Thalassemia (Mediterranian Anemia)
• Genetically inherited defect with mutations in the α or β peptide chains of hemoglobin
• Slight clinical evidence of osseous expansion
• Radiolucencies in all four quadrants– Multiloculated– “icicle” septate trabeculae
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Thalassemia Jaw Changes