Benign Non-Odontogenic Tumors PDF

**BENIGN NON-ODONTOGENIC TUMOR** 1. **OSSIFYING FIBROMA** - [CLINICAL FEATURES] third & fourth decade of life slow growing, asymptomatic & expansile lesion most often in the mandibular premolar area **Juvenile (aggressive) ossifying fibroma** a. occurs in children & young adults...

**BENIGN NON-ODONTOGENIC TUMOR** 1. **OSSIFYING FIBROMA** - [CLINICAL FEATURES] third & fourth decade of life slow growing, asymptomatic & expansile lesion most often in the mandibular premolar area **Juvenile (aggressive) ossifying fibroma** a. occurs in children & young adults b. causes exophthalmos, proptosis,sinusitis & nasal symptoms [HISTOPATHOLOGIC FEATURE] composed of fibrous connective tissue with well differentiated spindled fibroblast collagen fibers [RADIOGRAPHIC FEATURES] well circumscribed , sharply defined border unilocular or multilocular radiolucencies  [DIFFERENTIAL DIAGNOSIS] fibrous dysplasia osteoblastoma focal cementoosseous dysplasia focal osteomyelitis [TREATMENT AND PROGNOSIS] :Curettage or enucleation : Recurrence is rare after removal 2. **FIBROUS DYSPLASIA** - - - [CLINICAL FEATURES] Slow progressive enlargement of the affected jaw usually painless & typically presents as a unilateral swelling facial asymmetry displacement of teeth bone doesn\'t develop; doesn\'t mature [HISTOPATHOLOGIC FEATURE] consist of a slight to moderate cellular fibrous connective tissue stroma that contains foci of irregularly shaped trabecule of immature bone fibroblast exhibit uniform spindle shaped nuclei  [RADIOGRAPHIC FEATURES] ranges from a radiolucent lesion to a uniformly radiopaque mass [DIFFERENTIAL DIAGNOSIS] ossifying fibroma chronic osteomyelitis [TREATMENT AND PROGNOSIS] Small lesion no treatment Large lesion surgical recontouring Malignant transformation radiation therapy 3. **OSTEOBLASTOMA** - -  [CLINICAL FEATURES] Lesion measuring 1.5 cm. in diameter usual sites is in the posterior tooth bearing regions of the maxilla de mandible occur during second decade before the age of 30 nocturnal pain is common likely the same to a periapical abscess [HISTOPATHOLOGIC FEATURE] Irregular trabeculae of osteoid and immature bone within a stroma containing a prominent vascular network [RADIOGRAPHIC FEATURES] Well circumscribed or spherical Thin radiolucency surrounding a variably calcified central tumor mass Periapical abscess having thin radiopaque ;ine, thin radiolucent line  [DIFFERENTIAL DIAGNOSIS] cementoblastoma ossifying fibroma fibrous dysplasia [TREATMENT AND PROGNOSIS] :Curettage local excision : Recurrence not common 4. **OSTEOID OSTEOMA** - represent a smaller version of osteoblastoma [CLINICAL FEATURES] lesion is lesser than 1.5 cm. in diameter occur during second decade of life pain is relieved by aspirin [HISTOPATHOLOGIC FEATURE] Basophilic bony trabeculae surrounded by plump hyperchromatic osteoblasts and some multinucleated giant cells [RADIOGRAPHIC FEATURES] Well circumscribed and has a mixed lucent-opaque pattern Most commonly seen in long bones  [DIFFERENTIAL DIAGNOSIS] cementoblastoma ossifying fibroma fibrous dysplasia osteosarcoma [TREATMENT AND PROGNOSIS] :Curettage local excision : Recurrence not common 5. **OSTEOMA** - - - associated with Gardner\'s syndrome\ (autosomal dominant disorder) - arise in the maxilla or mandible as well as an facial & skull bones & within paranasal sinuses - headaches, recurrent sinusitis & ophthalmologic complains (symptoms) [HISTOPATHOLOGIC FEATURE] Two variants:\ Composed of relatively dense, compact bone with sparse marrow tissue Consist of lamellar trabeculae of cancellous bone with abundant fibrofatty marrow  [RADIOGRAPHIC FEATURES] **Periosteal osteoma-** Well circumscribed radiopacities  [DIFFERENTIAL DIAGNOSIS] exostoses [TREATMENT AND PROGNOSIS] :Surgical excision :No recurrence 6. **DESMOPLASTIC FIBROMA** - - Can be malignant even if it is under benign [CLINICAL FEATURES] occur in patient under the age of 30 with a mean age of 14 years Body or ramus of the mandible is more affected than the maxilla swelling of the jaw with displacement of teeth  [HISTOPATHOLOGIC FEATURE] Lesion consists of interlacing bundles and whorled aggregates of densely collagenous tissue that contains uniform spindled & elongated fibroblast (rubbery to firm tissue consistency) [DIFFERENTIAL DIAGNOSIS] DIFFERENTIAL DIAGNOSES: \* odontogenic cyst odontogenic tumor odontogenic fibroma [TREATMENT AND PROGNOSIS] :Surgical resection & curettage :Curettage alone with significance recurrence 7. **CHONDROMA** - Cartilaginous tumor of unknown cause [CLINICAL FEATURES] present as a painless, slowly progressive swelling arise in the nasal septum &e ethmoid sinuses anterior at the maxilla are most often location mandible most often location is in the body & symphysis area appear before 50 years of age [HISTOPATHOLOGIC FEATURE] consist of well defined lobules of mature hyaline cartilage chondrocytes are small & contain single, regular nuclei  [DIFFERENTIAL DIAGNOSIS] Chondrosarcoma [TREATMENT AND PROGNOSIS] :Surgical excision :recurrence is unusual 8. **CENTRAL/ PERIPHERAL GIANT CELL GRANULOMA** - benign proliferation of fibroblast & multinucleated giant cells that occurs almost exclusively within the jaw [CLINICAL FEATURES] before 30 years of age females are more affected almost exclusively in the maxilla & mandible Iesion tend to involve the jaws anterior to the permanent teeth produces painless expansion or swelling [RADIOGRAPHIC FEATURES] consist of multilocular less commonly locular radiolucency of the bone present as scalloped bonder  [HISTOPATHOLOGIC FEATURE] hemosiderin-laden macrophages and extravasated erythrocytes are usually evident Multinucleated giant cells are present throughout connective tissue stroma [DIFFERENTIAL DIAGNOSIS] \* ameloblastoma odontogenic myxoma odontogenic keratocyst [TREATMENT AND PROGNOSIS] excision or curettage 9. **GIANT CELL TUMOR** [CLINICAL FEATURES] Commonly in long bones especially in the knee joint rare in the jaw seen in third & fourth decades of life exhibit slow growth & bone expansion or sometimes they produce rapid growth, pain or paresthesia  [RADIOGRAPHIC FEATURES] produces radiolucent image [HISTOPATHOLOGIC FEATURE] numerous multinucleated giant cells dispersed evenly among mononuclear fibroblast [DIFFERENTIAL DIAGNOSIS] [TREATMENT AND PROGNOSIS] surgical excision or curettage 30% recurrence noted after curettage 10. **HEMANGIOMA OF THE BONE** - Rare intraosseous vascular malformation that can mimic both odontogenic & nonodontogenic lesion [CLINICAL FEATURES] occur in the mandible especially in the posterior region second decade of life spontaneous bleeding around the teeth paresthesia or pain are evident bruits or pulsation of large lesion may be detected [HISTOPATHOLOGIC FEATURE] Represents proliferation of blood vessels [Two types: ] **a. Cavernous typ**e- large caliber vessels **b. Capillary typ**e- small caliber vessels Multinucleated giant cells are present throughout connective tissue stroma [RADIOGRAPHIC FEATURES] multilocular radiolucency that have a characteristics of soap bubble appearance large lesions can have the sun ray appearance of an osteosarcoma root resorption of adjacent teeth is common. Developing teeth may be larger and erupt earlier when the lesion involves the inferior dental canal, the canal can be enlarged  [DIFFERENTIAL DIAGNOSIS] \* ameloblastoma \* central giant cell granuloma \* aneurysmal bone cyst odontogenic myxoma odontogenic keratocyst **\*\*\*Aspiration of the lesion is an important diagnostic tool** [TREATMENT AND PROGNOSIS] surgery, radiation therapy, sclerosing agents, cryotherapy & presurgical embolization technique 11. **LANGERHANS CELL DISEASE** - Formerly known as histiocytosis X & idiopathic histiocytosis - Proliferation of cells exhibiting phenotype characteristics of langerhans cells - "Floating teeth" [CLINICAL FEATURES] inflammation of gingiva Multiple dental loss attachment loss spontaneous gingival bleeding deep periodontal pocket ranges from solitary or multiple bone lesion to disseminated visceral, skin, & bone lesion condition of children & young adult tenderness & pain swelling are common loosening of teeth on the affected area inflammation of gingival tissue, hyperplastic & ulcerated a. eosinophilic granuloma (chronic localized) b. hand-schuller- Christian syndrome (chronic disseminated) c. letterer - siwe disease (acute disseminated) [HISTOPATHOLOGIC FEATURE] tumor cells show unique rod shape cytoplasmic structure which are identical to birbeck granules oval to reniform nuclei [RADIOGRAPHIC FEATURES] exhibit solitary radiolucent lesion sharp circumscribed punched out appearance  [DIFFERENTIAL DIAGNOSIS] juvenile or diabetic periodontitis Agranulocytosis Hypophosphatasia Leukemia periapical,cyst or granuloma primary or metastatic malignant neoplasm cyclic neutropenia multiple myeloma [TREATMENT AND PROGNOSIS] Chemotherapeutic agents Surgical or low dose therapy Poor prognosis Patient survival is 10 to 15 years 12. **TORI** - a. **torus palatinus** - sessile, nodular mass of bone that presents along the midline of the hard palate b. **torus mandibularis** - bony exophytic growth that present along the lingual aspect of the mandible superior to the mylohyoid ridge [CLINICAL FEATURES] **Torus Palatinus:** occur in females twice as often in males appear during second or third decade of life exhibit slow growth generally asymptomatic formed various configuration nodular, spindled, lobular or flat **Torus Mandibularis:**\ present along the lingual aspect of the mandible superior to the mylohyoid ridge almost always bilateral occurring in premolar region a appear during the second or third decades of life [HISTOPATHOLOGIC FEATURE] composed of hyperplastic bone consisting of mature cortical and trabecular bone outer surface exhibits a smooth rounded contour (osteoblast and osteoclasts can only be seen [RADIOGRAPHIC FEATURES] Large tori may be evident as diffuse radiopaque lesion [TREATMENT AND PROGNOSIS] No treatment needed Surgical removal for prosthetic purposes No recurrence 13. **EXOSTOSES** - - [CLINICAL FEATURES] asymptomatic bony nodules present along the buccal aspect of the alveolar bone most often in the posterior portion of both the maxilla and the mandible reported as rare occurrence following skin graft vestibuloplasty, gingival grafts, as well as beneath the pontic of a fixed bridge [HISTOPATHOLOGIC FEATURE] composed of hyperplastic bone consisting of mature cortical and trabecular bone outer surface exhibits a smooth rounded contour (osteoblast and osteoclasts can only be seen [RADIOGRAPHIC FEATURES] - Well defined radiopacity that resembles periosteal osteoma [TREATMENT AND PROGNOSIS] Surgical removal for prosthetic purposes Rare recurrence after surgical excision 14. **CORONOID HYPERPLASIA** - - [CLINICAL FEATURES] painless not associated with facial asymmetry most often in young males age onset is around puberty [Two types:] ** unilateral** **bilateral** - results in limitation of mandibular movement which is progressive over time; common type [HISTOPATHOLOGIC FEATURE] Bilateral-consist of mature hyperplastic bone bone may be partially covered by cartilaginous & fibrous connective tissue [RADIOGRAPHIC FEATURES] - Unilateral type-results in misshapen or mushroom shaped coronoid process on radiographs [DIFFERENTIAL DIAGNOSIS] osseous & chondroid neoplasm [TREATMENT AND PROGNOSIS] Surgical excision Rare recurrence **MALIGNANT NON-ODONTOGENIC NEOPLASM OF THE JAWS** -Hard tissues and marrow cavity of mandible and maxilla [SUBTYPES:] - Osteosarcoma - Chondrosarcoma - Ewing's sarcoma - Burkitt's Lymphoma - Plasma cell neoplasm - Metastatic carcinoma 1. **OSTEOSARCOMA** - Second most common primary bone tumor **Site of origin:** [CLINICAL FEATURES] Swelling and localized pain Loosening and displacement of teeth Mandibular paresthesia -- impingement inferior alveolar nerve involved  Swelling and localized pain; maxillary paresthesia -- impingement of infraorbital nerve, epistaxis, nasal obstruction or eye problems [RADIOGRAPHIC FEATURES] - Variable on depending on degree of calcification radiopaque [HISTOPATHOLOGIC FEATURE] - Sarcomatous stroma directly producing tumor osteoid - Variable histologic patterns - More differentiated in jaw than those in the skeleton, better prognosis [DIFFERENTIAL DIAGNOSIS] - Scleroderma -- widening of periodontal ligament space - Chronic osteomyelitis, other malignancies, several benign neoplasms -- moth eaten radiographic appearance - Pindborg tumor and metastatic carcinomas -- sclerotic radiographic appearance - Chondrosarcoma, fibrosarcoma of bone, aneurysmal bone cyst or giant cell tumor [TREATMENT AND PROGNOSIS] Radical mandibulectomy or maxillectomy Radiotherapy and chemotherapy for recurrences, soft tissue extension, metastatic disease Presurgical insertion of radium needles for mandibular osteosarcoma -- 76% 5-year survival rate [PROGNOSIS] Overall, 5-year survival for 35 to 40% of jaw osteosarcoma Mandibular tumor better than maxillary tumors Rarely metastasize to lymph nodes Most common sites of metastasis -- lung and brain; 6 months' survival rate Local recurrences -- surgical excision and chemotherapy 2. **JUXTACORTICAL OSTEOSARCOMA** **A. Parosteal-** more common than periosteal **B. Periosteal** A. **Parosteal Osteosarcoma** [CLINICAL FEATURES] Female predominance Common on long bones Most commonly involves distal femoral metaphysis Slow-growing swelling or palpable, mass, dull acting sensation Periphery is ossified than the base, may have lobulated cartilaginous cap or may be irregular because extensions into soft tissues [RADIOGRAPHIC FEATURES] - Radiodense and attached the external surface of the bone by broad and sessile base [HISTOPATHOLOGIC FEATURE] - Well-differentiated has spindle stroma with minimal atypia and rare mitotic figures separating irregular trabeculae of woven bone having foci of osteoid and cartilage - Periphery is ossified than the base, may have lobulated cartilaginous cap or may be irregular because extensions into soft tissues [DIFFERENTIAL DIAGNOSIS] - Osteoma, osteochondroma, heterotopic ossification and myositis ossificans [TREATMENT AND PROGNOSIS] - En bloc resection - Significant local recurrence underlying cortical bone B. **Parosteal Osteosarcoma** [CLINICAL FEATURES] Occurs much less than parosteal sarcoma Common location -- upper tibial metaphysis Rarely seen in jaw [RADIOGRAPHIC FEATURES] - Cortex of involved bone radiographically intact and sometimes thickened, with no tumor involvement of the underlying marrow cavity [HISTOPATHOLOGIC FEATURE] - Lobules of poorly differentiated malignant cartilage with central ossification, minimal tumor infiltration into cortical bone without medullary involvement [DIFFERENTIAL DIAGNOSIS] - Chondroblastic intramedullary osteosarcoma 3. **CHONDROSARCOMA** [CLINICAL FEATURES] - Maxillofacial area (60%) -- lateral incisor and canine region and palate - Pain, visual disturbances, nasal signs and headache may result from extension of chondrosarcomas from jaw bones to contiguous structures - Mandibular area (40%) -- premolar, molar, symphysis, coronoid and condylar process - Adulthood and old age - Painless swelling and expansion of affected bones - Loosening of teeth or ill-fitting dentures - Maxillofacial area (60%) -- lateral incisor and canine region and palate [RADIOGRAPHIC FEATURES] - Variable - Moth -- eaten radiolucency or - Diffusely opaque unilocular or multilocular - May contain mottled densities -- areas of calcification [DIFFERENTIAL DIAGNOSIS] - Chondroblastic type of osteosarcoma - Cartilaginous tumors of bone - Synovial chondromatosis involving tmj [TREATMENT AND PROGNOSIS] - Wide local radical surgical excision - Death -- local recurrence and extension into adjacent vital structures - Metastasis -- lungs or bone 4. **EWING'S SARCOMA** - Highly lethal round cell sarcoma - Problem in chromosome translocation 11 & 22 [CLINICAL FEATURES] - Bones of lower extremity of pelvis - Ramus of mandible - Pain and swelling, mucosal ulcers - Facial deformity, destruction of alveolar bone with loosening of teeth [HISTOPATHOLOGIC FEATURE] - Proliferation of uniform, closely packed cells that may be compartmentalized by fibrous bands - Round to oval nuclei have finely dispersed chromatin inconspicuous nucleoli - Cytoplasm has glycogen -- stains with Schiff stain [RADIOGRAPHIC FEATURES] - Non-specific - May stimulate infectious process as well as malignant process - Moth eaten destructive radiolucency modular and erosion of cortex with expansion [DIFFERENTIAL DIAGNOSIS] - Lymphoma/leukemia - Metastatic carcinoma - Metastatic neuroblastoma - Mesenchymal chondrosarcoma - Small cell osteosarcoma [TREATMENT AND PROGNOSIS] - Multiple method protocols -- surgery and radiation for local control; chemotherapy for systematic micrometastases - Metastatic to lungs, other bones and lymph nodes - Poor prognosis for patient below 30 years old, metastasis, systematic symptoms, high erythrocyte sedimentation rate, elevated serum lactate dehydrogenase value and thrombocytosis *- (excessive \# of platelets in the blood)* *- High LDH indication of having liver disease, heart disease anemia or infections such as meninges, encephalitis and HIV* 5. **BURKITT'S LYMPHOMA** \- Translocation of the distal part of chromosome 8 to chromosome 14 \-\-- enhanced tumor cell proliferation of burkitt's lymphoma [CLINICAL FEATURES] - High grade non-Hodgkin\'s lymphoma endemic in Africa and sporadical in North America [HISTOPATHOLOGIC FEATURE] - Neoplastic B cell proliferation [RADIOGRAPHIC FEATURES] - Moth-eaten radiolucency [DIFFERENTIAL DIAGNOSIS] - Subtypes of non-Hodgkin\'s lymphoma, undifferentiated carcinoma and sarcoma, metastatic neuroblastoma, acute leukemia [TREATMENT AND PROGNOSIS] - Combination chemotherapy - Potentially curable 6. **PLASMA CELL NEOPLASMS** **2 types:** [ETIOLOGY] - Derived from bone marrow stem cell of B lymphocytes lineage, functionally differentiated in their ability to produce and secrete immunoglobulins - Tumor derived from a single neoplastic clone, associated with the production of monoclonal immunoglobulin components [CAUSE] - Multiple myeloma occurs spontaneously - Patients exposed to ionizing radiation and the pesticide dioxin may develop the disease - Infection with some viruses (HIV and human herpes 8) has also been associated with multiple myeloma - No known risk factors are inherited [SYMPTOMS] - Patients usually complain of bone pain ***Other symptoms include:*** - Fatigue, feeling ill, fever, night sweats - Weight loss is not common in the early stages - Physically, patients are pale with diffuse bone tenderness, especially around the sternum(breastbone) and pelvis (hips) - Pathologic fractures (fractures caused by tumors) occur frequently. Thirty percent of patients will have their multiple myeloma first discovered when they develop this kind of fracture - The spine is the most common location for pathological fracture. It can also happen in the ribs and pelvis - Compression of the spinal cord occurs in 10 % to 15% of patients. This causes pain in the back and legs and numbness and weakness in the legs - Patients who have high levels of calcium in the blood may experience nausea, fatigue, confusion, constipation and frequent urination - Patients with anemia may experience fatigue, weakness and shortness of breath with exercise - In advanced cases, patients typically have recurrent infections and can have kidney failure ***Patients may also have:*** - Anemia (low red blood cell count) - Leukopenia (low white blood cell count) - Thrombocytopenia (low platelet count) - Hypercalcemia (high calcium level in the blood [RADIOGRAPHIC FEATURES] - Multiple myeloma appears as decreased bone density with a lot of "punched out" holes in the bone. These destructive lesions are not surrounded by the white rim of bone seen in other types if destructive lesions - The diagnosis is made when large number of abnormal plasma cells are found in the patient's bone marrow. The doctor obtains this marrow through a bone biopsy - A blood test can confirm the diagnosis. The patient's blood is checked for abnormal antibodies produced by myeloma cells - Some forms of multiple myeloma produce proteins that can be detected with a urine analysis [TREATMENT] - Multiple myeloma is currently not curable, chemotherapy may prolong life expectancy and decrease symptoms [Chemotherapy] a. The standard treatment medications are melphalan and prednisone b. The median survival rate is 3 years with this treatment alone ***For patients in whom this therapy is ineffective, alternatives include:*** 1. VBMCP (vincristine, carmustine, melphalan, cyclophosphamide and prednisone) 2. VAD (vincristine, Adriamycin and dexamethasone) \*\*\*These treatments may cause severe muscle weakness. They may also increase the chance of infections 3. Thalidomide and interferon are also sometimes used ***This stem cell transplantation involves:*** \- Harvesting a patient's own blood cells \- Conditioning them with very high doses of melphalan \- Re-infusing the blood cells back into the patient [Radiation therapy] - is reserved for decreasing the size of symptomatic bone lesions [Surgical Treatment] - it will not cure multiple myeloma. - Surgery is used to treat fractures and impending fractures in the spine, pelvis, hip and shoulder. The goal of these surgeries is to decrease pain and maintain function. - Internal fixation augmented with cement is frequently recommended, as are joint replacements and vertebroplasties (for spinal fractures). Operative intervention does not alter the survival rate, but it does increase the quality of life [Supportive care] - Supportive care is critical. This includes comfort measures, pain control and interventions that maintain function. Supportive care includes managing the bone disease, anemia, infections, kidney failure and pain associated with multiple myeloma - Bisphosphonates (medication) can prevent destructive bone lesions and spine fractures - Erythropoietin or occasional blood transfusions can manage anemia - Antibody infusions and vaccinations can help patients with recurrent infections - Corticosteroids and hydration can be used to treat high blood calcium concentrations (from bone loss) and dehydration - Narcotics can address the pain associated with bone lesions - Operative intervention may be required to control the pain associated with bone fractures 7. **MULTIPLE MYELOMA** [CLINICAL FEATURES] - Rarely seen before fifth decade, male predominance - Asymptomatic or may have pain, swelling expansion, numbness, mobility of the teeth or pathologic fractures - Soft tissue mass - Weakness, weight loss, anemia and hyperviscosity - May develop systemic amyloidosis [RADIOGRAPHIC FEATURES] - Variable - Punch out appearance, but non-corticated radiolucent area of bone in jaws and many of hematopoietic marrow containing bones of the skeleton - May by expansile and osteosclerotic [HISTOPATHOLOGIC FEATURES] - Monotonous proliferation of pure plasma cells - Wide range of differentiation from mature to less differentiated forms [DIFFERENTIAL DIAGNOSIS] - Metastatic carcinoma - Lymphoma - Idiopathic histiocytosis (LCD) - Carcinoma - Neuroblastoma [TREATMENT AND PROGNOSIS] - Chemotherapy with local radiation - Death due to infection - Renal failure - Disseminated myeloma - Cardiac complication - Hemorrhage or thrombosis - Poor prognosis for patients with severe azotemia, hypercalcemia, anemia 8. **SOLITARY PLASMACYTOMA OF BONE** [CLINICAL FEATURES] - Disease of adulthood, male predominance - Rare in jaws; but occur in angle of mandible - Diagnosis: radiologic bone survey and random bone marrow aspirate and biopsy - Pain, swelling, pathologic fracture [HISTOPATHOLOGIC FEATURE] - Similar to multiple myeloma; monotonous proliferation of neoplastic plasma cells [RADIOGRAPHIC FEATURES] - Well defined lytic lesions - May be multilocular, resembling central giant cell granuloma - May destroy cortical bone and spread into adjacent soft tissue [DIFFERENTIAL DIAGNOSIS] - Multiple myeloma [TREATMENT AND PROGNOSIS] - Radiotherapy - *L*ocal recurrence in 10% of cases - May progress to multiple myeloma 9. **METASTATIC CARCINOMA** \- Most common malignancy affecting skeletal bones [PATHOGENESIS] \- From primary carcinomas of the breast, kidney, lung, colon, prostate, thyroid gland [CLINICAL FEATURES] - Older age group (50-70), average of 45 years' old - Common location -- angle and body of mandible - Bone pain, loosening of teeth, lip paresthesia, bone swelling, gingival mass and pathologic fracture [HISTOPATHOLOGIC FEATURES] - Extremely variable, depending on tumor type and grade of tumor differentiation [RADIOGRAPHIC FEATURES] - Poorly marginated, radiolucent, irregular, motheven, expansile defects - Even of moth-eaten radiolucency, rarely expands cortical bone [TREATMENT AND PROGNOSIS] - Surgical excision - chemoradiotherapy - dismal 10% 5 year survival, 2/3 dead with in a year [DIFFERENTIAL DIAGNOSIS] - anaplastic sarcoma - lymphoma - melanotic melanoma \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **CYSTS OF THE JAW AND NECK** - odontogenic, nonodontogenic, pseudocyst and soft tissue cyst of the neck - cyst: epithelium lined pathologic cavity that may contain fluid or cellular debris **[ODONTOGENIC CYST]** 1. **PERIAPICAL CYST** [CLINICAL FEATURES] - Etiology: periapical granuloma - Most common cyst in the oral and perioral region - Asymptomatic - Cause bone resorption - Associated with non-vital tooth - Occurs at any age peaks at 3rd decade of life - Commonly seen at anterior maxillary region and posterior mandibular region [RADIOGRAPHIC FEATURES] - VRound to ovoid radiolucency with narrow opaque margin that is continuous with lamina dura [HISTOPATHOLOGIC FEATURE] - Lined by stratified squamous epithelium polymorphonuclear leukocytes, few lymphocytes - Epithelial lining are residues from rest of malassez [DIFFERENTIAL DIAGNOSIS] - Anterior region - Posterior region [TREATMENT AND PROGNOSIS] - Extraction and curettage of the apical zone - RCT with apicoectomy - Extraction only w/o curettage will lead to the development of a residual cyst that can weaken the bone 2. **LATERAL PERIODONTAL CYST** [CLINICAL FEATURES] - Etiology: dental lamina remnants within bone - Adults older than 21 yrs; male predilection - Associated with vital teeth; nonmobile and may show root divergence - Bluish discoloration when large (seen in the soft tissue in bluish discoloration at a reflection of the fluid content) - Location: mandibular premolar and cuspid region - Small soft tissue swelling within or slightly inferior to the interdental papilla [RADIOGRAPHIC FEATURES] - Well-delineated, round or teardrop shaped unilocular radiolucency between teeth [HISTOPATHOLOGIC FEATURE] - Lined by nonkeratinized epithelium - With glycogen containing clear cells [DIFFERENTIAL DIAGNOSIS] - Botryoid odontogenic cyst - Odontogenic keratocyst - Squamous odontogenic tumor [TREATMENT AND PROGNOSIS] - Extraction and curettage of the apical zone - RCT with apicoectomy 3. **BOTRYOID ODONTOGENIC CYST** [RADIOGRAPHIC FEATURES] - Well-delineated, round or teardrop shaped unilocular radiolucency between teeth [HISTOPATHOLOGIC FEATURE] - Multilocular cyst lined by thin stratified squamous epithelium [TREATMENT AND PROGNOSIS] - Enucleation is curative - No recurrence potential - Bone regeneration is over 6 mos to 1 year - Root divergence normalizes even without orthodontic tooth movement 4. **GINGIVAL CYST** [CLINICAL FEATURES] - A soft tissue counter part of lateral periodontal cyst - Etiology: dental lamina remnants in soft tissue between oral epithelium and periosteum (rest of serres) - Location: mandibular premolar area and maxillary incisor and canine area - Small soft tissue swelling (1 cm or less) within the dental papilla or in midcrestal area in edentulous ridges [RADIOGRAPHIC FEATURES] - No radiographic evidence of bone resorption [HISTOPATHOLOGIC FEATURE] - Same as lateral periodontal cyst - Lined by a thin layer of keratinized squamous epithelium [DIFFERENTIAL DIAGNOSIS] - Gingival mucocele - Fordyce's granules - Peripheral odontogenic tumor [TREATMENT AND PROGNOSIS] - Local excision - Recurrence is not seen 5. **GINGIVAL CYST OF THE NEW BORN** [CLINICAL FEATURES] - Multiple nodules along the alveolar ridge in neonates - Location: alveolar ridge (Bohn's nodules), midline of the palate (Eptein's pearls or palatine cyst of the newborn) - Appear as a small nodule that are white in color due to the presence of keratin in the lumen [RADIOGRAPHIC FEATURES] - No radiographic evidence of bone resorption [HISTOPATHOLOGIC FEATURE] - Lined by keratinized stratified squamous epithelium with keratin in the lume [TREATMENT AND PROGNOSIS] - No treatment needed - Cysts rupture in the oral cavity before patient is 3 months of age 6. **DENTIGEROUS CYST** [CLINICAL FEATURES] - Location: 3rd molars and maxillary canine - Greater incidence in males - Occurs in the 2nd or 3rd decades of life - Asymptomatic - Late eruption or impaction of permanent tooth [RADIOGRAPHIC FEATURES] - presence of radiolucency associated with crown of impacted teeth [HISTOPATHOLOGIC FEATURE] - Lined by non-keratinized stratified squamous epithelium [DIFFERENTIAL DIAGNOSIS] - Odontogenic keratocyst - Ameloblastoma - Adenomatoid odontogenic cyst [TREATMENT AND PROGNOSIS] - Removal of the associated tooth and enucleation of the soft tissue component 7. **ERUPTION CYST** [CLINICAL FEATURES] - Etiology: reduced enamel epithelium - Bluish discoloration on gums - Eruption hematoma is also used when there is bleeding within the cyst due to surface trauma [RADIOGRAPHIC FEATURES] - presence of radiolucency associated with crown of impacted teeth [HISTOPATHOLOGIC FEATURE] - Fragments of thin epithelium can be seen lining the fibrous tissue, which has become compressed by the eruption cyst [DIFFERENTIAL DIAGNOSIS] - Dentigerous cyst [TREATMENT AND PROGNOSIS] - No treatment needed - Subsequent to eruption, the cyst disappears spontaneously without complications - If necessary, uncover the erupting tooth to marsupialize the cyst and to facilitate tooth eruption 8. **GLANDULAR ODONTOGENIC CYST** [CLINICAL FEATURES] - Adults - jaw expansion - Either jaw, anterior mandible favored crossing the midline [RADIOGRAPHIC FEATURES] - Multiloculated radiolucency - Margins may be well defined and sclerotic [HISTOPATHOLOGIC FEATURE] - The epithelium is often squamous, but a distinct layer of cuboidal to columnar cells with eosinophilic cytoplasm is seen. These are mucous producing and some may have cilia in the surface [DIFFERENTIAL DIAGNOSIS] - Mucoepidermoid carcinoma [TREATMENT AND PROGNOSIS] - Surgical management periapical curettage/marginal excision - Long term follow up - Aggressive with recurrence potential 9. **ODONTOGENIC KERATOCYST** [CLINICAL FEATURES] - Asymptomatic but can cause jaw expansion and tooth mobility if affected area - Occur at any age, peak 2nd and 3rd decades - Occurs in children as part of basal cell nevus syndrome - Commonly affected is the posterior portion of the body of the ramus of the mandible and maxillary canine and 3rd molar area - **Two basic types:** [RADIOGRAPHIC FEATURES] - Well circumscribed radiolucency with smooth radiopaque rim [HISTOPATHOLOGIC FEATURE] - Keratinizing odontogenic cyst showing orthokeratin, a granular cell layer, and flattered basal cell - Typical odontogenic keratocyst shows parakeratinized corrugated surface, hyperchromatic palisaded basal cells [DIFFERENTIAL DIAGNOSIS] - Dentigerous cyst - Adenomatoid odontogenic cyst - Ameloblastoma - Lateral periodontal cyst - Residual cyst [TREATMENT AND PROGNOSIS] - Marsupialization and an unerupted tooth that is associated with the cyst is guided into the arch - Enucleation and curettage for small cysts - Resection for large multilocular keratocyst - Resection if multiple recurrences occurs after - enucleation and curettage 10. **CALCIFYING ODONTOGENIC CYST** [CLINICAL FEATURES] - From odontogenic epithelial remnants within the gingival area of either jaw - Location: maxilla - Peak 2nd decade - Individuals younger than 40 - Predilection from females - Expansion of alveolar bone or soft tissues - Absence of tenderness [RADIOGRAPHIC FEATURES] - Unilocular or multilocular radiolucency - Opacies may produce a "salt and pepper" type of pattern [HISTOPATHOLOGIC FEATURE] - Ghost cell keratinization characteristic microscopic feature - Well delineated cystic proliferation with fibrous CT wall [DIFFERENTIAL DIAGNOSIS] - Calcifying epithelial odontogenic tumor - Peripheral ossifying fibroma - Adenomatoid odontogenic tumor [TREATMENT AND PROGNOSIS] - Enucleation and no recurrence potential ***[NONODONTOGENIC CYST]*** 1. **GLOBULOMAXILLARY CYST** [CLINICAL FEATURES] - Nonspecific designation for any lesion in the globulomaxillary area (between maxillary lateral incisor and canine) - Inverted pear shaped radiolucency - Asymptomatic; teeth vital; divergence of roots [TREATMENT AND PROGNOSIS] - Treatment is usually surgical enucleation 2. **NASOLABIAL CYST** [CLINICAL FEATURES] - Usually appears as a swelling of the upper lip lateral to the midline - Soft tissue cysts of the upper lip - Incidence noted in the 4th and 5th decade - Distinct in female 3:1 ratio - Common in canine region or the mucobuccal fold [RADIOGRAPHIC FEATURES] - Multiloculated radiolucency - Margins may be well defined and sclerotic [HISTOPATHOLOGIC FEATURE] - Epithelial lining is pseudo stratified columnar type with numerous goblet cells [DIFFERENTIAL DIAGNOSIS] - Canine space abscess - Benign salivary gland tumors [TREATMENT AND PROGNOSIS] - Complete surgical excision - Recurrence is rare 3. **MEDIAN MANDIBULAR CYST** [CLINICAL FEATURES] - Fissural origin was based in the no-longer-tenable theory of epithelial entrapment in the midline of the mandible during the fusion of each half of the mandibular arch [TREATMENT AND PROGNOSIS] - Treatment is usually surgical enucleation 4. **NASOPALATINE CANAL CYST** [CLINICAL FEATURES] - Developmental in origin - Arises from embryonic remnants of the nasopalatine duct - Intraosseous lesion usually present in the midline of the anterior maxilla near the incisive foramen - Many are inflamed; pain, pressure, drainage and swelling can occur [RADIOGRAPHIC FEATURES] - Well-circumscribed oval or heart-shaped radiolucency or the midline of the anterior maxilla superior to and between the roots of the central incisors smooth cortical border [HISTOPATHOLOGIC FEATURE] - Lined by: [DIFFERENTIAL DIAGNOSIS] - Periapical granuloma - Radicular cyst - Incisive canal cyst [TREATMENT AND PROGNOSIS] - Surgical enucleation **[PSEUDOCYST]** 1. **ANEURYSMAL BONE CYST** [CLINICAL FEATURES] - Etiology: unknown; maybe related to altered hemodynamic or abnormal healing of bone hemorrhage - Teenagers and young adults affected - Benign Tumors of Connective Tissue origin -- aneurysmal bone cyst - This lesion occurs in young patient usually below 20 years of age - The mandible appears to be more commonly affected than the maxilla - The posterior molar bearing segments of the maxilla and mandible seem to be more commonly affected region - Clinically, these lesions are characterized by a nonpulsatile swelling of variable duration [HISTOPATHOLOGIC FEATURE] - Blood filled spaces lined by connective tissue and multinucleated giant cells [DIFFERENTIAL DIAGNOSIS] - Central giant cell granuloma - Hyperparathyroidism - Cherubism [TREATMENT AND PROGNOSIS] - Excision 2. **TRAUMATIC BONE CYST** [CLINICAL FEATURES] - Etiology: Unknown; trauma sometime suggested - Maybe related to bleeding in the jaw with clot resorption - Teenagers most commonly affected - Age: 13-25 years - Location: mandible area - Male predilection - Manifestations: asymptomatic and painless swelling. - Associated with vital teeth [RADIOGRAPHIC FEATURES] - Lucency discovered on routine examination - Well demarcated unilocular or multilocular radiolucency with scalloping around roots commonly found in posterior mandible [DIFFERENTIAL DIAGNOSIS] - Aneurysmal bone cyst - Traumatic bone cyst - Lateral periodontal cyst - Odontogenic myxoma - Unicystic ameloblasmtoma [TREATMENT AND PROGNOSIS] - Surgical intervention and curettage 3. **STATIC STAFNE'S BONE CYST** [CLINICAL FEATURES] - Development defect - Located below mandibular canal in molar region 4. **FOCAL OSTEOPOROTIC BONE MARROW DEFECT** [CLINICAL FEATURES] - Uncommon lesion that typically present as asymptomatic [RADIOGRAPHIC FEATURES] - Focal radiolucency in areas where hematopoiesis is normally seen (angle of the mandible and maxillary tuberosity [HISTOPATHOLOGIC FEATURE] - Predominance of hematopoietic cells with relatively fewer flat cells - Small lymphoid aggregates maybe found [TREATMENT AND PROGNOSIS] - \- Incision biopsy is generally desirable ***[SOFT TISSUE CYSTS OF THE NECK]*** 1. **BRANCHIAL CYST/ CERVICAL LYMPHOEPITHELIAL CYST** [CLINICAL FEATURES] - Etiology: entrapped epithelium in cervical lymph nodes during embryogenesis - Location: Lateral portion of the neck; usually anterior to the sternocleidomastoid muscle - Most common site of these lesions is in the floor of the mouth followed by posterior lateral tongue [HISTOPATHOLOGIC FEATURE] - Branchial cyst is lined with stratified squamous epithelium, pseudostratified columnar epithelium or both [DIFFERENTIAL DIAGNOSIS] - Cervical lymphadenitis - Skin inclusion cyst - Lymphangioma - Tumor of the tail of the parotid [TREATMENT AND PROGNOSIS] - Surgical excision 2. **DERMOID CYST** [CLINICAL FEATURES] - Etiology: developmental entrapment of multi potential cells/possibly implantation of epithelium - Anterior portion of the floor of the mouth in the midline (oral cavity) - Painless and slow growing - No gender predilection - Soft and doughy because of keratin and sebum in the lumen [HISTOPATHOLOGIC FEATURE] - Lined by stratified squamous epithelium supported by a fibrous connective tissue wall - Numerous secondary skin structures [DIFFERENTIAL DIAGNOSIS] - Ranula - Sublingual space infection - Sublingual salivary gland tumor [TREATMENT AND PROGNOSIS] - Surgical excision 3. **THYROGLOSSAL TRACT CYST** [CLINICAL FEATURES] - Etiology: epithelial remnants of the thyroid gland as it grows downward from the foramen caecum area to its permanent location in the neck - Most common development cysts of the neck, accounting for nearly ¾ of small lesions - Asymptomatic and occurs in patient's older than 30 years of age [HISTOPATHOLOGIC FEATURE] - Stratified squamous epithelium at the level of the hyoid bone - Ciliated or columnar type of epithelium is usually found in cysts occurring below the hyoid bone [DIFFERENTIAL DIAGNOSIS] - Thyroid neoplasm - Branchial cyst - Sebaceous cyst [TREATMENT AND PROGNOSIS] - Surgical excision