OSD5 Simplified.txt

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  1. Dentigerous Cyst (DC)
    • Thin, non-keratinized epithelial lining, multipotential (may have mucous or other cells present),
    • Inflamed cyst=APC histo
    • WD, CB, UL, RL around crown of an unerupted tooth, attached to the CEJ
    • Tx: surgery
  2. Eruption Cyst (Eruption Hematoma)
    • Thin layer of keratinized squamous epithelium,
    • may contain blood
    • Soft, translucent swelling in gingival mucosa overlying the crown of an erupting tooth (most commonly 1st perm molars)
    • tx: self resolving
  3. Paradental Cyst
    • “inflamed dentigerous cyst”, Hx of pericoronitis
    • Cyst on distal or buccal of partially erupted 3rd molar
  4. Odontogenic Keratocyst (OKC)
    • Small satellite cysts in fibrous wall
    • uniformly thin epithelium
    • corrugated parakeratin
    • palisaded basal layer with hyperchromatic nuclei
    • WD, smooth and CB, UL, RL between teeth
    • Sometimes ML
    • Resembles other cysts, Rx description NOT diagnostic
    • Tx: surgical excision w curettage or osteoectomy
  5. Nevoid Basal Cell Carcinoma Syndrome
    • (Gorlin Syndrome)
    • Multiple basal cell ca’s
    • multiple OKCs
    • palmar/plantar pits
    • calcified cerebri
    • enlarged head circumference
    • Rib anomalies, ocular hypertelorism
    • spina bifida occulta
    • Jaw cysts present in 75% of patients
  6. Orthokeratinized Odontogenic Cyst
    • Orthokeratin WITHOUT nuclei, prominent granular cell layer, basal cell layer NOT PALISADED and less hyperchromatic
    • Posterior mandible, unerupted 3rd molars, UL, RL
    • Resembles DC
    • less aggressive: enucleation w/ curettage
  7. Lateral Periodontal Cyst
    • Focal nodular thickenings (epithelial plaques), lined by uniformly flattened squamous cells, swirl appearance
    • mandiblular anterior-premolar
    • WD, CB, RL lateral to the roots of VITAL teeth
    • Tx: enucleation
    • Botyroid: polycystic LPC
    • Gingival Cyst: soft tissue counterpart
  8. Gingival Cyst of the Newborn
    • Multiple whitish papules on mucosa overlying alveolar process on a newborn (<3mos)
    • Derived from rests of dental lamina, Keratin-filled cysts lined by parakeratotic stratified squamous epithelium N/A
  9. Gingival Cyst of the Adult
    • Fluid-filled swelling of the facial gingiva or alveolar mucosa, blue/gray tint, md premolar/anteriors
    • Derived from rests of dental lamina, soft tissue counterpart of lateral periodontal cyst, focal nodular thickenings
    • Usually not seen on radiograph due to soft-tissue nature
    • Lateral Periodontal Cyst: intrabony counterpart
  10. Calcifying Odontogenic Cyst
    • (Gorlin Cyst or Dentinogenic Ghost Cell Tumor)
    • Ghost cells (outline, but no nuclei), dystrophic calcification of ghost cells (RO’s), ghost cell keratinization, epithelium similar to enamel organ and ameloblastoma, loose stellate/spindle cells, columnar cells (ameloblast like)
    • WD, UL, RL with or without RO’s or Cal’s.
    • Tx: peripheral-conservative, intraosseous cyst-enucleation/curettage, neoplasm-bloc excision/segmental resection
    • follow up
  11. Odontogenic Glandular Cyst (Sialo-odontogenic Cyst)
    • Derived from rests of dental lamina, lined by stratified squamous epithelium with cililated columnar shape, small microcysts and clusters of mucous cells in cystic lining
    • WD, SB, UL or ML, RL
    • Anterior mandible
    • tx: enucleation/curettage (small), en block resection (large, multilocular)
  12. Carcinoma Arising in Odontogenic Cysts
    • Well-differentiated SCC
    • Irregular and ragged margins of a RL defect
  13. Apical Periodontal Cyst
    • (Periapical Cyst or Radicular Cyst)
    • Derived from rests of Malassez, SSEpi exhibiting exocytosis and spongious, may have cholesterol clefts, dystrophic calcifications
    • WD, CB, UL, RL in periapical area (classical) or interproximal area
    • May be along lateral aspect of the root
  14. Residual Cyst
    • Persistent APC after infected tooth has been extracted
    • Same histo as APC
    • WD, CB, RL at extraction site
  15. Buccal Bifurcation Cyst
    • Buccal of mandibular 1st molars, buccal enamel extension leads to pocket, “Site Specific” paradental cyst WD, UL, RL at buccal bifurcation
    • Tx: enucleation
  16. Aneurysmal Bone Cyst
    • Blood-filled spaces lined by connective tissue septa (no bruit)
    • multinucleated giant cells
    • usually in combo w/ fibro-osseous, giant cell granuloma
    • UL or ML, RL with cortical expansion and thinning
    • tx: curettage/enucleation (recurrence)
  17. Focal Osteoporotic Bone Marrow Defect
    • Normal bone marrow, hematopoietic progenitor cells, fat cells
    • Stimulates an intraosseous neoplasm in an extraction socket
    • RL with fine trabeculations, circumscribed with ill-defined borders
    • no tx:
  18. Benign vs Malignant
    benign: well-definied, shaped, displaces adj, expands and thins cortices, onion skin periosteum, displace & resorb

    malignant: ill-defined, irregular, invasive, destructive, perforation, sun-burst spicules, teeth in position
  19. Simple Traumatic Bone Cyst
    • Thin connective tissue with reactive bone,
    • NO epithelium (NOT a true cyst)
    • WD, RL, irregular borders, UL, maybe ML
    • no tooth displacement or root resorption
    • Domelike-projections w scalloping
    • tx: induce hemorrhage
  20. Surgical Ciliated Cyst
    • Lined by respiratory epithelium, intrabony cyst caused by implantation of sinus epithelium
    • WD, RL in close proximity, but separate from the maxillary sinus
    • tx: surgical
  21. Idiopathic Osteosclerosis
    • Area of hematopoietic marrow, dense lamellar bone with scant fibro-fatty marrow, NOT pathological
    • RL area with fine trabeculations
  22. Neurofibroma
    • CT and Nerve tissue
    • mandibular canal apongiosa
    • single or multiple WD RL
    • malignant potential
    • von REcklinghausen (neurofibromatosis)
  23. Neuroma
    • Traumatic
    • WD RL in alveolar canal
  24. Neurilemoma
    • Schwannoma
    • most common nerve tumor, encapsulated
    • Antoni A verocay, Antoni B, S100+
    • mandible
    • WD, round/ovoid RL, UL or ML
    • expands alveolar canal
  25. Central Giant Cell Granuloma
    • Multinuclated giant cells with plump proliferating mesenchymal cells, RBC extravasation
    • displaces, resorbs
    • WD, thin septa NOT corticated, UL or ML, RL defect,
    • anterior mandible
  26. Osteoma
    • Associated with Gardner Syndrome, progressive shift in patient occlusion and deviation of midline
    • Mature compact or cancellous bone
    • Slowly growing masses on surface of mandible/maxilla
    • WD opacity
  27. Chondroma
    • Composed of mature hyaline cartilage
    • located on short trabecular bones of the hands and feet
  28. Ameloblastoma
    • Most common clinically significant odontogenic tumor
    • Slow growing, locally invasive, usually benign , painless swelling covered by oral mucosa
    • RL, UL early, ML later, expansion, tooth displacement, might resorb roots
  29. Conventional Solid or Multicystic Ameloblastoma
    • 86% of Ameloblastomas
    • Islands of odontogenic epithelium, core resembles stellage reticulum of enamel organ, peripheral columnar cells with REVERSE POLARITY of nuclei ML, RL lesion with “soap bubble” or honeycomb appearance, B/L cortical expansion, root resorption of teeth adjacent to the tumor
  30. Unicystic Ameloblastoma
    • 13% of Ameloblastomas
    • Luminal: basal layer columnar/cuboidal cells with hyperchromatic nuclei, reverse polarity, basilar cytoplsmic vacuolization
    • Intraluminal/Plexiform: one or more nodules of ameloblastomas project from cystic lining into lumen
    • Mural: fibrous wall of the cyst infiltrated by typical follicular or plexiform ameloblastoma
    • Circumscribed RL, may or may not be around the crown
    • Can resemble DC
  31. Peripheral Aemloblastoma
    (Extraosseous) 1% of Ameloblastomas
  32. Malignant Aemloblastoma
    Ameloblastoma in primary tumor and metastatic deposits
  33. Ameloblastic Carcinoma
    Ameloblastoma that has cytologic features of malignancy in the primary tumor, in a recurrence, or in any metastatic deposit
  34. AV shunt
    • bone expansion, bruit
    • uni-multi lucent in mandibular canal
    • hemorrhagic, angiography
    • sclerose then surgery
  35. Central Hemangioma
    • hemmorhagic
    • F, mandible
    • slow growing, painless
    • aspiration->arteriial blood
    • maxilla present like enlarged trabeculae
    • linear strations
  36. Adenomatoid Odontogenic Tumor
    • Thick fibrous capsule,
    • duct-like epi structures lined by cuboidal columnar cells,
    • nuclei polarized AWAY from central spaces,
    • all cells are epithelial
    • WD, CB, UL, RL invoving crown of unerupted tooth (below CEJ),
    • tooth displacement, snowflake cal’s

    Conservative surgical excision.
  37. Osteoblastoma/Osteoid Osteoma
    • young
    • pain/swelling
    • variable radio
    • mixed density APC, cementoblastoma looking
    • osteoid rims, fat osteoblasts, cellular stroma
  38. Calcifying Epithelial Odontogenic Tumor
    • (Pindborg)
    • Large cells with nuclei (different from COC), expansile, painless swelling
    • Congo Red test + for Amyloid proteins
    • Concentric Liesegang Ring Calcifications
    • WD or Ill-defined, UL or ML RL with flecks of RO’s, strong tooth displacement, honeycomb appearance

    Agressive Treatment
  39. Central Odontogenic Fibroma
    • Hyperplastic dental follicle
    • WD, UL (early)/ML (late), RL associated with periradicular areas of erupted teeth, root resorption
    • Simple excision, low recurrence
  40. Peripheral Odontogenic Fibroma
    • Soft tissue counterpart of central odontogenic fibroma
    • Slow-growing, sessile mass covered by normal mucosa
    • Similar to peripherial ossifying fibroma
    • simple excision, low recurrence
  41. Odontogenic Myxoma
    • Haphazardly arranged stellate, spindle-shaped and round cells
    • glycosaminoglycans, no capsule, jelly-like
    • Locally aggressive, jaw lesion only with painless swelling
    • UL or ML, Irregular/scalloped margins, thin, wispy trabeculae of residual bone, “step ladder” pattern, rare root resorption, soap bubble appearance
    • Aggressive Treatment
  42. Cementoblastoma
    • Slow-growing, dentin-resorbing (not hypercementosis), strongly active osteoblastic activities WD, RO (density of cementum), RL halo, attached to root of affected tooth, resorbed root
    • Conservative treatment
  43. Ameloblastic Fibroma
    • young pts
    • arrested odontoma
    • anastomosing arrow cords of odontogenic epithelium
    •  peripheral nuclear palisading columnar cells
    • WD, UL or ML, RL extending from superior part of the tooth follicle (NOT CEJ) of an unerupted tooth
    • very benign, conservative excision
  44. Ameloblastic Fibrosarcoma
    Malignant counterpart of ameloblastic fibroma
  45. Ameloblastic Fibro-Odontoma
    • Disorganized tooth structure,
    • same histo as ameloblastic fibroma,
    • WD, CB, RL defect with variable amt of calcified material with the radiodensity of tooth structure
  46. Compound Odontoma
    • Multiple tooth-like structures, anterior maxilla
    • Collection of ROs (tooth-like structures) surrounded by a narrow RL zone
    • conservative tx.
  47. Complex Odontoma
    • Conglomerate mass of enamel and dentin, NO resemblance to a tooth, may cause impaction
    • Calcified mass with radiodensity of tooth structure surrounded by RL halo
  48. Monostotic Fibrous Dysplasia of the Jaws
    • Single bone,
    • max>mand,
    • young females
    • Poorly calcified bone trabeculae arranged in a disorganized pattern
    • Fine “ground glass” opacification,
    • not well-demarcated
  49. How does fibrous dysplasia present radiographically?
    • early: WD UL RL
    • RO foci-> coalesce -> smoky mottled, ground glass, orange peel, Pagetoid
    • Ill defined and blend with normal bone
    • expansion, displacement, resorption, obliteration of max sinuses
  50. What often accompanies SCC orally?
  51. Polyostotic Fibrous Dysplasia of the Jaws
    • Two or more bones
    • café au lait spots
    • Jaffe-Lichtenstein Syndrome
    • McCune-Albright Syndrome (sexual precosity), endocrinopaties
    • Early: RL, WD, UL
    • Late: ROs take on numerous shapes and sizes, borders blend with bone
    • Bone exp, tooth displacement, root resorption, obliteration of max sinus
  52. Focal Cemento-Ossseous Dysplasia (FCOD)
    • Anywhere in jaw, single-site involved, asymptomatic, small
    • Mixed RL/RO, thin RL rim
    • Reactive/Dysplastic Lesions in Alveolous (Tooth bearing areas of jaw)
    • no tx: watch to see development, increasing opacification
  53. Periapical Cemento-Osseous Dysplaisa (PCOD)
    • black women
    • VITAL TEETH, asymptomatic patient, specules of bone and some cementum-like hard tissue
    • Uncircumscribed zones of RL involving periapical region of anterior mandible.
    • Reactive/Dysplastic Lesions in Alveolous (Tooth bearing areas of jaw)
  54. Florid Cemento-Osseous Dysplasia (FOD, FLCOD)
    • Multifocal involvement,
    • NOT limited to anterior mandible,
    • bilateral and symmetric involvement,
    • simple bone cyst may be present
    • osteomyelitis due to reduced vascularity
    • Multiple, WD, lobular, <3m, RL with some ROs,
    • bilateral and symmetric,
    • no tooth resorption, hypercementosis, increased bone density
  55. Ossifying/ Cementifying Fibroma
    • Fibro-Osseous Neoplasm
    • Painless swelling with obvious facial asymmetry, jaw expansion, tooth displacement, asymmtomatic
    • WD, UL w/varying levels of RO (RL, Mixed or RO), CB (diff from later stage fibrous dysplasia),
    • root resorption, displacement, expansion
    • juvenile: very aggressive
  56. Osteoblastoma and Osteoid Osteoma
    • Fibro-Osseous Neoplasms
    • Benign bone tumors occasionally seen in the jaws, histo identical to osteoblastoma
  57. Osteosarcoma
    • Malignancy of mesenchymal cells,
    • central lesion, “bad cells, bad bone,”
    • malignant cartilage and bone
    • Ill-defined and indistinct peripheral border,
    • classic sunburst appearance (periosteal reaction),
    • widening of PDL,
    • elevation of bone height ABOVE CEJ, perforation,
    • exp of cortical margins
  58. Chondrosarcoma
    • Malignancy chx by formation of cartilage and no bone
    • RL process with poorly defined borders
  59. Metatstatic Tumors of the Jaws
    • MOST COMMON malignancy in the jaw, from breast, prostate, lung, kidney carcinomas
    • Ill-defined, “moth eaten”, destructive margins, irregular shape, destruction of lamina dura, tooth mobility, “floating teeth,” RL defects
  60. Clinical Findings of Bone Malignancies:
    • -Redness and bleeding of gingiva
    • -Persistent, non-healing ulcer
  61. General Radiographic Findings of Bone Malignancies:
    • -Superficial horizontal resorption
    • -Erosion of bony surface
    • -RL with ill-defined borders and ragged ROs
    • -Pathological fractures
    • -Opacification of the sinus
    • -Destruction of the sinus walls
    • -Floating teeth
    • -Root resorption
  62. Leukemia
    • Acute (<10yrs), Chronic (50-60yrs), gingival infiltration, swelling, perio disease
    • Destruction of alveolar bone, loss of lamina dura, loosening of teeth, ill-defined RLs
  63. Burkitt’s Lymphoma
    • African form has jaw involvement, 5-12yo, loosening, displacement, premature eruption
    • Jaw expansion,
    • single or multiple RL foci in molar region, ill-defined borders, perforation, destruction, displacement of B/L corticies
  64. Multiple Myeloma
    • Weakness and pain, pathologic fractures, multiple bones involved (14% jaws), mobility and migration of teeth,
    • Bence-Jones protein in urine
    • Multiple, small, WD, non-corticated RLs, uni- or bilateral, skull often involved, “punched-out”
  65. What cysts can be diagnosed clinically w/o biopsy?
    • ginival(newborn)
    • eruption
  66. which cysts need biopsy?
    • OKC
    • glandular odontogenic cyst
    • calcifying odontogenic
    • orthokeratinized odontogenic cyst
  67. which are diagnosed clinically/radiographically & histo?
    APC, residual, LPC, gingival (adult), DC, Paradental, Buccal bifurcation
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OSD5 Simplified.txt

Simplified OSD5 chart
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