Odontogenic cyst and tumors

Periapical granuloma

Chronic apical periodontitis, inflammatory, root of non-vital

Periapical cyst

Inflammatory, root of nonvital, rests of Malassez, most common jaw cyst, may swell, root absorption common, loss of PDL

Periapical scar

PA defect fills soft tissue instead of bone, commonly when B/L plates are lost

Lateral radicular cyst

Similar to PA cyst, inflammatory, nonvital, rests of Malassez, could indicate a missed lateral canal, pushing effect

Residual cyst

Persistent PA cyst at site of previously extracted tooth, inflammatory, highest likelihood of maligant transformation

Buccal bifurcation cyst

Buccal of man 1st molar, children, 1/3 bilaterial, vital tooth, best seen in occlusal films

Dentigerous cyst

Most common developmental, cyst lining from reduced enamel epith, MD 3rd molar, asym, associated with crown of unerupted tooth, attached to CEJ

Eruption cyst

Soft tissue counterpart of dentigerous cyst, common in kids, 1st molars and incisors, no radiographic presentation due to soft tissue

Primordial cyst

Controversial entitiy because it does not exist because almost some are OKC

Odontogenic keratocyst (OKC)

Rests of dental lamina, greater growth potential, grows ant-post direction, post MD, parakeratinized SSE, recurrence is common within 5yrs

Nevoid basal cell carcinoma syndrome

AD, PTCH1, OKCs at young age and multiple BCC, palmar/plantar pits, calcified falx cerebri, frontal bossing, rib anomalies, hypertelorism, spina bifida occulta

Orthokeratinized odontogenic cyst (OOC)

Orthokeratinized, posterior MD, young adults, involves 3rd unerupted molars, no assoication with NBCCs. no syndrome association

Gingival cyst of new born

Superficial, small papules, keratin filled (white), remnants of dental lamina, common on alveolar ridge, disappear spontaneously

Lateral periodontal cyst

Adjacent to tooth root, lateral-k9-pm area in MD, found incidentally, vital tooth, plaque-like thickenings, conservative enucleation

Gingival cyst of the adult

Arise from rests of Serres, MD k9-pm, soft tissue counterpart of lateral peridontal cyst, similar thickening like lateral peridontal cyst

Calcifying odontogenic cyst (COC)

Previously a tumor, “ghost cell”, anterior jaws, intraosseous or peripheral, can cause root resorption

Glandular odontogenic cyst

Glandular features, paresthesia, small (asym) or large (sym), MD anterior and can cross midline, aggressive, scalloped edges, duct-like structores/mucous cells

Carcinoma arising in odontogenic cysts

Rare, odontogenic caricinoma, most arise from odontogenic cysts, associated with residual cyst, males, radiation or chemo, metastasis can occur

Ameloblastoma

Often asym, slow growing, locally invasive, BRAF mutation, 2nd most common odontogenic tumor, posterior MD

Conventional ameloblastoma

Multilocular small or large, unilocular, B/L expension, may resorption, reverse polarization, look like enamel organ epith such as stellate reticulum, En bloc resection, increased recurrence with curettage

Unicystic ameloblastoma

2nd decarde, post MD, painless swelling, cystic, fibrous wall (reverse polarization), luminal vs intraluminal vs mural (infiltration), enucleation

Peripheral ameloblastoma

Rare, dental lamina beneath oral mucosa or basal epith, common on gingica, alveolar mucosa, painless, non-ulcerated sessile (4Ps), should NOT infiltrated the bone, same as conventional ameloblastoma (reverse polarization)

Malignant ameloblastoma

Histology of normal ameloblastoma, metastasizes (lungs, cervical, LN), avg 30yrs, super rare

Ameloblastic carcinoma

Cytologic features of malignancy in primary tumor, avg 6th decade, usually no metastasis, arise de novo or from ameloblastoma, poor prognosis, aggressive clinical course, usually with perforated cortical plates and extend to soft tissues

Adenomatoid odontogenic tumor (AOT)

Benign, 2/3 tumor: females, ant MX, unerupted k9, RO foci, 2nd decade of life, often discovered with tooth fails to erupt, mixed RO/RL, unilocular, beyond CEJ, “snow flakes”, fibrous capsule

Calcifying epithelial odontogenic tumor (CEOT)

Slow, painless swelling, 30-50 yrs, posterior MD, associated with impacted tooth, intraosseous or peripheral, super rare, mixed RO/RL, “drived snow”-amyloid, Liesegang ring with Congo red

Squamous odontogenic tumor (SOT)

Rare, benign, mostly intraossesous, from dental lamina or Malassez, no jaw predilection, super rare, trangular RL defect, most no recur

Clear cell odontogenic carcinoma

Rare malignant, common in MD, old, some paresthesia, EWSR1-AFT1 gene, clear cells, often invasive

Central odontogenic fibroma (COF)

Uncommon benign, common on ant MX, post MD, avg 40 yrs, 1/3 associated with CGCG (central giant cell granuloma), root resorption common, simple vs WHO

Odontogenic myxoma

Uncommon benign, dental papilla arise, MD, 25-30yrs, aggressive, rapid but painless expansion of bone, loose/gelatinous stroma, most likely to recur, radiographically similar to ameloblastoma

Cementoblastoma

Most common MD 1st molar, post MD, <25 yrs, pain and swelling, well-definied RO mass with RL rim, attached to root of tooth, trabeculae surrounded by cementoblast and MNGCs, surgical removal

Ameloblastic fibroma

Benign, 1-2nd decade, M>F, pos MD, associated with unerupted teeth, can become larger, push neighbor, primitive dental papilla (pulp), conservative initial tx with long-term f/u

Ameloblastic fibro-odontoma

Benign, children, same as AF, swelling in large case, mixed RL/RO, conjunction with complex odontoma

Odontomas

Most common odontogenic tumors, benign, young patients, asym, associated with missing teeth or unerupted, complex vs compounds, may need ortho for missing teeth