lab 4 cysts of jaws &oral soft tissues ( 2008 script )
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Cysts of the Jaws & oral soft tissues LAB
The locations of different jaws cysts :
The ramus and body of the mandible : OKC(Odontogenic
Keratocyst)
In association with
unerupted tooth : D
(Dentigerous cyst)
Periapical location
and associated withcarious tooth : P
(Periapical Radicular
Cyst)
In the area of
extracted tooth : R ( Residual Radicular Cyst)
Between the roots of vital mandibular premolars :
L (Lateral Periodontal Cyst) >> could be OKC too.
Surrounding crown of tooth which is
erupting and still in
the alveolar mucosa as swelling : E (Eruption
Cyst)
In the gingiva of an adult person : G (Gingival Cyst)
The Components of
the cyst:
Lumen : which could
contain :-
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Degenerating epithelial & inflammatory cells
Serum proteins
Cholestrtol crystals
Wall : fibrous tissues
OKC : will increase the potential for recurrence
of the cysts
Inflammatory cysts : inflammatory infiltrate
Lining :
Epithelial tissue gives an indications about the
origins of the cyst (odontogenic , non-odontogenic )
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Dermoid cyst :
A mass in the midline
(rubbery and firm)
Present Intraoral or
Submental swellings
Histologically :
Regular
Orthokeratinized stratified
squamous epithelium
The wall contains
skin appendages such as
Sebaceous glands and hair
follicles
The lumen contains
keratinous debris
Sebaceous glands and hair follicles
Differential diagnosis : we said that the
mass is a rubbery & firm to differentiate it from
Extravsation Mucoceles which contains fluid fill
and occurs in association with glands (usually
sublingual gland )
Epidrmoid cysts :
No skin appendagesand they occurring
anywhere in the oral soft
tissues
Histologically :
Orthokeratin
Connective tissue
Prominent granular layer
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Arise as a result oftraumatic implantation
of the epithelium causing it to include into the
deeper tissues (epidermal
inclusion).
Extravasation Mucocele:
Soft swelling of the lower
lip , increasing and decreasing
in sizes , filling emptying then
refilling
Histologically :
Granular tissue
Mucous (mucin)
No lining : we
can't define a specific
layer
Salivary nodules
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The difference between Extravasation
Mucocele and Retention mucoceles is that
retention mucoceles the mucin retains insidethe duct and we don't have inflammatory
infiltrate in contrast to exteravasation
mucoceles , so we have here well
defined layers histologically.
Thyroglossal duct cyst:
Moving upward and downward
while swallowing
Colloid Homogenous Eosinophilic
material , similar to the material found
in thyroid follicles .
Lateral Periodontal Cyst :
Radiolucent lesion well defined
between mandibular premolars (in this
pic the tooth is not vital so we are not
sure if it's lateral periodontal or lateral
radicular cysts .. so we take a biopsy)
Histologically :
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thin non-keratinized
epithelium with Plaque-
like focal thickening( thin segment followed by
thick one )
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Here variant ofLateral
Periodontal Cystwhich is
called "Botryoid" , small
grapelike , multiple cystic
spaces lined withepithelium which shows
varying degrees of
thickening , this type
requires more aggressive
treatment to overcome recurrence potential
Gingival cyst of the
adult:
Similar to theLateral Periodontal
Cyst in its
histopathology on
contrast to Gingival
Cyst of the newborn
which shows features
similar to epidermoid
cyst(only epitheliumand Keratin)
Keratinized epithelium Two small cystic nodules on the palate
(Gingival Cyst of the newborn)
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Eruption cyst :
Fluctuant swellings
on the alveolar mucosa
and are often bluish incolor
Counterpart of Dentigerous cyst
Glandular odontogenic cyst:
Radiolucent lesion in the anterior region of
the mandible(a typical location)
Histologically :
Epithelium lining , cystic space , fibrous wall
Mucous
cells arranged
in a glandular
pattern
Aneurysmal bone cyst :
Multiloculated
radiolucent lesions in
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the body and angle of the mandible causing
bony expansion which is rapidly developing in
young adult
Histologically :
Multinucleated giant cells
Pools of blood
Surrounded by granulation tissue
Idiopathic bone cavity (traumatic bone cyst ):
Trauma-hemorrhage theorywhere the clot
disintegrate leaving an
empty cavity which is
considered aspseudocyst
Histologically : Normal
bone and fibrous tissue ,
absence of fibrous wall andepithelium lining
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Lymphoepithelial Cyst :
Cystic lesion anterior
to SternoCleidoMastoid
muscle
Unusual lesion in the
oral cavity
Histologically :
Dense well-
organized lymphoidtissue
Paradental cyst :
Partially erupted
third molar
Distally (the locationof the cyst )
Inflammatory
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Origin : Reduced Enamel Epithelium
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Ranula/plunging ranula :
Swelling in the floor of the
mouth
Bluish in color
Translucent
Histologically :
Mucous Extravasation Cysts
Nasopalatine duct
cyst :
Enlargement in the
palate
Differential
diagnosis :
OKC(appear in any location)
Periapical radicular cyst(non-vital tooth)
Histologically :
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Pseudostratified Ciliated Columnar
Epithelium
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OKC (Odontogenic
Keratocyst ) :
Radiolucent lesions
involving the body of themandible and surrounding
impacted third molar
(Differential diagnosis :Ameloblastoma, maybe
Dentigerous cystbut the cyst is growing in
anteroposterior directions with minimal bony
expansion so we
exclude
dentigerous cyst )
Histologically :
Epithelium
is sloughed from
the underlying
connective
tissues
Higher
magnification : some
areas shows
hyperchromatic
columnar cells , a lot ofkeratin in the lumen
Palisaded
columnar basal
layer
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Uniform thickness, Parakeratosis
What can I see
in the wall ?
daughter cysts
(Satellite Cysts )
Ki-67 is a marker
for proliferative activity
and it is highly expressed
in OKC reflecting the
biological behavior of thelining epithelium
Bcl-2 (anti-
apoptotic protein ) highly
expressed , and
apoptotic doesn't occur
normally here , and it is
more closed to be benign
tumor and is called
keratinizing odontogenic
tumor
Radiographic of OKC :
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o it can be associated with impacted
tooth
o It can be Lateral Periodontal
appearance
o glandular odontogenic cyst
appearance
o It can be Residual appearance
o It can be multiple .. then I should think
about which syndrome ? Neavoid basal cell
carcinoma (NBCCS)
OKC has typical
histological features
that must be present in
order to consider it as
OKC :
Uniform
thickness
Palisaded
columnar
Most frequently Parakeratinized
Even if I have orthokeratinized with the typical
features (uniform thickness , palisaded columnar ) I
can consider it OKC .
Typical features lost
because theinflammation is altered
the lining characteristic
so we start have
hyperplasia of
epithelium, Rete Ridges.
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Orthokeratinized
odontogenic cysts
different from OKC , we
don't have the typical
features although we
have cyst producing
keratin (could be
Radicularor Dentigerous
Cysts)
Gorlin-Goltz Syndrome ( Neavoid basal
cell carcinoma ):
Multiple naevoid basal cell carcinomaunlike basal cell carcinomas which occur on
sun-exposed skin, commonly appear around
the age of puberty
Multiple OKC
Rib anomalies (Bifid Rib)
Calcified flax cerebri
(Professor Gorlin)
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Dentigerous cyst
A coronal radiolucency
surounded impacted third molar
Histologically : the lining non-
specific non-keratinized , mucous
cell
The occurring ofmetaplasia in the lining
can form keratin, or Secondary Inflamedhappened so we will have Cholesterol Cleft
Radicular cyst :
Periapical radiolucent
Non-keratinizing squamous
lining
Hyperplasic epithelium
Cholesterol Cleft
Rushton bodies
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All these finding are non-specific, it
can be present in Dentigerous cyst
,
o Look at the inflammatory infiltration, it is
dense because the cyst is inflammatory in
origin.
o
R
es
idual Radicular Cyst
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Solitary bone
cyst (simple bone
cyst):
Premolar &
molars regions
Scalloping isprominent feature
around and
between the roots
Trauma-
hemorrhage
theory
Done by:
HeRoN
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