robbypowell's version from 2016-07-26 14:29

Multilocular Radiolucencies


-Analyze the radiographic features of multilocular lesions of odontogenic and non-odontogenic in origin
-Describe the histopathologic characteristics of each entity
-Develop a differential diagnosis
-Determine the prognosis and management of a disease based on clinical, radiographic and histopathologic features

Odontogenic or non-odontogenic?

Question Answer
Odontogenic Keratocyst (posterior regions, little to no expansion, pericoronal, periapical, botryoid OC-like, multiple → Gorlin – Goltz syndrome)Odontogenic
Botryoid odontogenic cyst (polycystic variant of LPC)Odontogenic
Ameloblastoma (most common multilocular radiolucency, expansile )Odontogenic
Odontogenic myxomaOdontogenic
Central giant cell granulomaNon-odontogenic
Aneurysmal bone cystNon-odontogenic
Central hemangiomaNon-odontogenic


Question Answer
T/F: Odontogenic Keratocysts have aggressive clinical behavior and high reoccurrence ratesTrue (now classified as neoplasm and called Keratocystic Odontogenic Tumor)
Odontogenic Keratocysts are found where in the mouth?Posterior regions, (but can be pericoronal, periodical or botryoid OC-like... great mimicker of other types of lucency)
How much expansion is associated with Odontogenic Keratocysts?Little to no expansion
Multiple Odontogenic Keratocysts is indicates what systemic condition that is identified in early childhood?Gorlin-Goltz syndrome (aka Basal Cell Nevus Syndrome)
How is an Odontogenic Keratocyst treated?Curettage and chemical cauterization (Carnoy's solution) depending on size, excision and occasionally resection
What does the inside of an Odontogenic keratocyst look like when opened?Thick yellow cheesy material
How does an Odontogenic Keratocyst appear radiographically?hazy
T/F: Odontogenic Keratocysts have a tendency to reoccur within 2-5 yearsTrue
What is the most commonly misdiagnosed multilocular radiolucency of the jaws?Odontogenic Keratocyst
what do the borders of Odontogenic keratocyst look like histologically?fibrous capsule with parakeratinized lining epithelium
What syndromic condition is associated with multiple Odontogenic Keratocysts (OKC's) ?Basal Cell Nevus Syndrome (aka Gorlin-Goltz syndrome)
Basal Cell Nuves syndrome is associated with mutation of the ______ genePTCH gene
what type of multilocular radiolucent lesion would you expect to find on a patient with Hypertelomerism, multiple epidermoid cysts of skin, shortened metacarpals and calcification of the fall cerebri?Odontogenic Keratocysts (multiple, syndrome is Basal Cell Nevus syndrome)
Daughter cysts in multilocular Odontogenic keratocysts are packed in _____ and are highly recurrent after treatmentkeratin
T/F: Ameloblastomas can come from left over epithelial rests of malasseiz, lining epithelium or gingival epitheliumTrue
T/F: Ameloblastomas are associated with much expansion and displacement of teethTrue
T/F: Ameloblastomas do not typically displace teeth and have minimal expansionFalse
T/F: Maxillary ameloblastomas have a tendency to infiltrate maxillary sinus, pteyrgomaxillary spaces, base of skull and brainTrue
What type of tissue is the origin of Odontogenic myxoma?Mesenchyme (dental papilla)
In what region are Central Giant Cell Granulomas (CGCG) commonly found?Anterior mandible near midline
Central Giant Cell Granulomas are treated through curettage/resection. Some cases respond to ____ or ____ injectionssteroid or Calcitonin injections
Small CGCG's (Central Giant Cell Granuloma) are commonly misaken for what (not OKC) in the anterior mandible?Radicular cyst
what is the suggested treatment for cherubism (autosomal dominant trait)wait it out, disease is self-limiting. (can do surgery for aesthetics)
benign, but locally aggressive giant cell lesion w/ large pools of blood with unclear pathogenesis, but believed to result from a hemorrhagic blowoutAneursymal Bone Cyst (ABC)
appears similar to CGCG, but contains pools of hemorrhagic bloodAneurysmal Bone Cyst
painful, benign but locally aggressive giant cell lesion that is more common in female childrenCentral Giant Cell Granuloma
arises De novo in 50% of cases, but other times is associated with other bone lesions like Ossifying Fibroma, Osteoblastoma, and OsteosarcomaAneurysmal Bone Cyst (ABC)
benign intra-osseous vascular neoplasm (from arterial origin)Central Hemangioma
lesion that feels warmer to the touchCentral Hemangioma
lesion that "has to be handled well" because of serious bleeding riskCentral Hemangioma (because of arterial origin)
finding of tooth may be “compressible” w/ blood oozing upon releasing pressure (exsanguination may result from removal of such a tooth) Central Hemangioma
can be detected by an angiogram after injection of contrastCentral Hemangioma (probably also AV node)
Central hemangiomas are more commonly found in the (maxilla/mandible) at a ratio of 2:1Maxilla
Which of these 4 non-odontogenic multilocular radiolucent lesions is NOT a giant cell lesion (CGCG, Cherubism, Aneurysmal Bone Cyst, Cental Hemangioma)Central Hemangioma (the rest are... and have giant cells in the lesion)
what is the treatment for central hemangioma?surgical ligation of arterial communications to the region
clinical presentation with swelling and large spider-like appearance that can be seen extra orally from proliferation of blood vesselsCentral Hemangioma

Which type of Multilocular radiolucent lesion...

Question Answer
was recently reclassified as a neoplasm... and so is now called Keratocystic odontogenic TUMOROdontogenic Keratocyt
Microscopically uniform keratinized lining epithelium with corrugated parakeratin & distinct basal cell layer exhibiting paisaded hyper chromatic nucleiOdontogenic Keratocyst
Is found in multiples in maxilla and mandible when a patient has Basal Cell Nevus Syndrome (aka Gorlin-Goltz syndrome)Odontogenic Keratocysts
has a tendency to reoccur within 2-5 yearsOdontogenic keratocyst
is considered a "great mimicker" because its position is variable relative to nearby teeth (peri-apical, peri-coronal, or botyroid OC like)Odontogenic Keratocysts
most commonly misdiagnosed multilocular radiolucencyOdontogenic Keratocyst (the great mimicker)
Polycystic variation of Lateral periodontal cystBotryoid Odontogenic cyst
this multilocular lesion is typically found in the mandibular premolars area & occasionally in the maxillary lateral inc./cuspid areaBotryoid odontogenic cyst
plaques that "slough off" is a common feature of this multilocular radiolucent lesionBotryoid Odontogenic cyst
radiographically has a "soap-bubble" or "honey-comb" appearance ... Microscopically, islands & strands of epithelium surrounded by ameloblastic cells exhibiting nuclear palisading & reverse polarizationAmeloblastoma
Most common multilocular radiolucency... expansileAmeloblastoma
locally aggressive, destructive tumor derived from odontogenic CT (mesenchyme) (dental papilla)Odontogenic myxoma
Microscopically, loose CT with fibroblast-like cells in ground substance... radiographically soap-bubble or honeycomb appearanceOdontogenic Myxoma
This lesion is characterized by abundant “mucoid” ground substance (this facilitates bone invasion)Odontogenic Myxoma
misplaces teeth and causes resorption... soap bubble appearance.. fibroblast cells in mucoid ground substance insideOdontogenic Myxoma
inside of lesion content mucoid substance that microscopically looks like "feathery cells"Odontogenic Myxoma
inside of lesion contents have yellow-cheesy like appearanceOdontogenic Keratocyst
benign, locally aggressive and painful lesion with expansion in a young female patient that has already tested negative for hyperparathyroidism (thus these are not brown tumors)Central Giant Cell Granuloma
microscopically Sheets of mononucleated (histiocyte-like) interspersed by multinucleated giant cells in a young female patient without hyperparathyroidismCentral Giant Cell Granuloma
are histologically indistinguishable from "brown tumors"Central Giant Cell Granuloma
brownish or bloody in their clinical appearanceCGCG (central giant cell granuloma) (this is assuming that it's not actually brown tumor induced by hyperparathyroidism)
commonly mistaken for radicular cyst in the anterior mandibleCGCG (central giant cell granuloma)
benign, genetically-based bone dysplasia w/ self-limiting process caused by autosomal dominant disorder that presents with asymptomatic bilateral lesions.Cherubism
radiographically, multilocular asymptomatic lesions bilaterally. microscopically, fibro-osseus lesion with giant cellscherubism
treatment by resection after injection with a sclerosing (thrombosing) solutionCentral Hemangioma
round lesions with radiating course, trabecular with a spoke-like (sometimes honey comb) patternCentral Hemangioma
there is a lot of blood in this lesion... under very high pressureCentral Hemangioma
treated by surgical ligation arterial communication to the regionCentral Hemangioma