Pseudotumors and cysts
Jan Laco, M.D., Ph.D.
Causes of swellings of jaws
• Cysts
– odontogenic x non-odontogenic
•
•
•
•
•
•
Odontogenic tumors
Giant cell lesions
Fibro-osseous lesions
Non-odontogenic tumors of bone
Metastatic tumors
Chronic osteomyelitis
Cysts of jaws
•
•
•
•
•
•
= pathological cavity lined by epithelium
RTG: sharply-defined lucencies
? fluid
slowly growth  teeth displacement
asymptomatic x infection  painfull
rarely: pathological fracture
Cysts of jaws
• Odontogenic
– developmental
•
•
•
•
•
•
dentigerous
eruption
gingival
lateral periodontal
odontogenic keratocyst
calcifying odontogenic cyst
– inflammatory
• radicular
• paradental
Cysts of jaws
• Non-odontogenic
– nasopalatine duct
– nasolabial
• Pseudocysts
– solitary bone cyst
– aneurysmal bone cyst
Cysts of jaws – frequency (%)
•
•
•
•
1. radicular
2. dentigerous
3. keratocyst
4. nasopalatine
65-70
15-50
3-5
5-10
Odontogenic cysts
– radicular cyst
•
•
•
•
•
•
 common swelling of jaws and cyst
 males (M : F … 3 : 2)
20 - 60 years
maxilla : mandible … 3 : 1
painless sweeling
enucleation
Odontogenic cysts
– radicular cyst
• relationship to root of dead tooth
• pulpitis  periapical granuloma  proliferation
of Malassez rests
• Mi: hyperplastic squamous epithelium (net-like)
+ hyaline (Rushton) bodies
wall: granulation tissue + fibrous tissue
mixed inflammation
hemosiderin, cholesterol clefts
Odontogenic cysts
– residual cyst
= radicular cyst persisting after extraction
- spontaneous regress
• lateral radicular cyst
– at side of nonvital tooth
– lateral branch of root canal
– enucleation
Odontogenic cysts
– paradental cyst
•
•
•
•
•
•
inflammation around partially erupted tooth
lower 3. M
 males, 20 - 25 years
vital tooth with pericoronitis
Mi: ~ radicular cyst
enucleation
Odontogenic cysts
– dentigerous cyst
• cystic change of enamel organ after complete
enamel formation
• surrounds crown + attached to tooth neck at
amelo-cemental junction  crown inside (RTG)
• M:F…2:1
• 20 - 50 years
• 3. M, C  prevents eruption
• Mi: thin squamous epithelium
fibrous wall with scanty inflammation
Odontogenic cysts
– eruption cyst
•
•
•
•
•
•
in soft tissue over tooth about to erupt
from enamel organ (superficial dent. cyst)
children
teeth with no predecessors
soft bluish swelling in gingiva
spontaneously disappear
Odontogenic cysts
– gingival cysts
•
•
•
•
•
newborn (Bohn´s nodules)
> 80%
gingiva - proliferation of Serres nests
midline of palate (Epstein pearls)
spontaneously resolve
• adults - rare
Odontogenic cysts
– lateral periodontal cyst
• uncommon cyst beside vital tooth
• botryoid odontogenic cyst
– lower P and C
– > 50 years
– Mi: multilocular cyst with fibrous septa
squamous epithelium + clear cells (glycogen)
– recurrency
• glandular odontogenic cyst
– Mi: mucous cells
– recurrency
Odontogenic cysts
• odontogenic keratocyst
•  keratocystic odontogenic tumor
• calcifying odontogenic cyst
•  calcifying cystic odontogenic tumor
Odontogenic cysts
– odontogenic keratocyst
•
•
•
•
uncommon
from enamel organ before tooth formation
(20 – 30) + (50 – 70) years
mandible angle  extending in finger-like
fashion in bone marrow spaces
• asymptomatic
• RTG: multilocular
Odontogenic cysts
– odontogenic keratocyst
• Mi: squamous epithelium - basal layer (mitoses)
- thin wavy parakeratotic layer
- folded cyst lining
wall - scanty inflammation
• complete enucleation - difficult
• 60% recurrency in first 5 years !!!
Odontogenic cysts
– odontogenic keratocyst
• Gorlin-Goltz syndrome
= multiple keratocysts + multiple naevoid
basal cell carcinomas of skin
Odontogenic cysts
– calcifying odontogenic cyst
•
•
•
•
Gorlin´s
anterior parts of jaws
RTG: cystic cavity + calcifications
Mi: ameloblastoma-like epithelium
ghost cells – large, pale, outlines of nucleus
 calcification
+ odontomas (10% cases)
• enucleation
• recurrency
Odontogenic cysts
• wall thickening
– cholesterol clefts
– carcinoma
– ameloblastoma
Odontogenic cysts
• biopsy practice
• nonspecific findings – inflammation
• X odontogenic keratocyst
• X calcifying odontogenic cyst
• X unicystic ameloblastoma
Non-odontogenic cysts
– nasopalatine duct cyst
•
•
•
•
uncommon
from nasopalatine duct epithelium
midline of palate
position variants (to incisive canal)
– nasopalatine
– palatine papilla
– median alveolar
• Mi: squamous + respiratory epithelium
wall: mucous glands + neurovascular bundle
• enucleation
Non-odontogenic cysts
– nasolabial cyst
•
•
•
•
•
= Klestadt´s, nasoalveolar
very uncommon
from remnants of nasolacrimal duct
in soft tissue deep in nasolabial fold
excision
Cysts of soft tissues
• thyroglossal duct cyst
• lymphoepithelial cyst
• lingual dermoid
• mucocele
Cysts of soft tissues
- thyroglossal duct cyst
•
•
•
•
•
uncommom
from remnants of any part of thyroglossal duct
early age
swelling in midline of mouth or neck
Mi: squamous + respiratory epithelium
wall: thyroid tissue, chronic inflammation
• removal + part of hyoid bone
Cysts of soft tissues
- lymphoepithelial cyst
•
•
•
•
•
•
•
branchiogenic cyst ???
cystic change of epithelium entrapped in LN
early age
lateral part of neck + mandible angle + parotid
soft swelling
fistula to skin / oral cavity / pharynx
Mi: squamous + respiratory epithelium
wall: dense lymphoid tissue + germ centres
• enucleation
Cysts of soft tissues
- sublingual dermoid
• developmental anomaly of branchial arches
or pharyngeal pouches
• between hyoid and jaws or beneath tongue
• no symptoms
• Mi: epidermoid cyst
dermoid cyst – dermal appendages
• dissection
Cysts of soft tissues
- mucoceles
•
•
•
•
 minor salivary glands
 lower lip
superficial, 1 cm swellings
extravasation type – damage of duct
– saliva leak  inflammation + mucophages
– NO epithelium  mucofagic granuloma
• retention type – obstruction of duct
– epithelium of dilated duct
Cysts of soft tissues
- mucoceles
• ranula
= mucocele of submandibular or sublingual
gland
• unilateral painless swelling, 2-3 cm
• floor of mouth