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Chapter 15: Odontogenic Cysts and Tumors

front 1 What are the two classes of odontogenic cysts?	back 1 developmental inflammatory
front 2 What is the most common type of developmental odontogenic cyst?	back 2 dentigerous cyst
front 3 Clinical Features separation of follicle from crown of an unerupted tooth most often involve mandibular third molars (65%) most frequent in patients between 10 and 30 years slight male predilection, prevalence higher for whites asymptomatic (small) or painless bony expansion (large) may become infected and cause pain and swelling Radiographic Features unilocular radiolucent area associated with the crown of an unerupted tooth well-defined, often corticated border (unless infected) root resorption of adjacent erupted teeth can occur radiolucent space should be at least 3 to 4 mm in diameter Histopathologic Features loosely arranged fibrous connective tissue wall islands or cords of odontogenic epithelial rests two to four layers of flattened nonkeratinizing cells focal areas of mucous cells in epithelial lining	back 3 dentigerous cyst
front 4 Gross specimen of a cyst involving a maxillary canine tooth. The cyst has been cut open to show the cyst-to-crown relationship.	back 4 dentigerous cyst

front 5 A unilocular radiolucent cyst involving the crown of an unerupted tooth, with the crown projecting into the cystic cavity.	back 5 dentigerous cyst, central type
front 6 A unilocular radiolucent cyst along the mesial root of the unerupted molar. This cyst exhibited mucous cell prosoplasia.	back 6 dentigerous cyst, lateral type
front 7 A unilocular radiolucent cyst extending along the mesial and distal roots of the unerupted tooth.	back 7 dentigerous cyst, circumferential type
front 8 This noninflamed cyst shows a thin, nonkeratinized epithelial lining and a loosely arranged fibrous connective tissue wall.	back 8 dentigerous cyst, noninflamed

front 9 This inflamed cyst shows a thick epithelial lining with hyperplastic rete ridges and diffuse chronic inflammatory infiltrate.	back 9 dentigerous cyst, inflammed
front 10 This cyst shows scattered mucous cells within the thin epithelial nonkeratinized epithelial lining.	back 10 dentigerous cyst
front 11 What is the treatment and prognosis for dentigerous cyst?	back 11 enucleation plus removal of the unerupted tooth recurrence is rare malignant transformation is possible, but extremely rare
front 12 Clinical Features soft tissue analogue of the dentigerous cyst soft, translucent swelling in the gingival mucosa overlies the crown of an unerupted tooth most often seen in children younger than age 10 most commonly associated with: deciduous mandibular central incisors permanent first molars deciduous maxillary incisors Histopathologic Features surface oral epithelium on the superior aspect variable inflammatory cell infiltrate in lamina propria thin layer of nonkeratinizing squamous epithelium	back 12 eruption cyst

front 13 This soft gingival swelling contains considerable blood and can also be designated as an eruption hematoma.	back 13 eruption cyst
front 14 A cystic epithelial cavity can be seen below the mucosal surface with inflammatory cell infiltrate in lamina propria.	back 14 eruption cyst
front 15 What is the treatment and prognosis for eruption cyst?	back 15 ruptures spontaneously - treatment may not be required if necessary simple excision permits tooth eruption
front 16 A cyst is located in the third molar area in a patient with no history of third molar extraction. The cyst was excised, and histopathologic examination revealed an odontogenic keratocyst (OKC).	back 16 primordial cyst

front 17 There is debate over reclassification of the odontogenic keratocyst (OKC) as keratocystic odontogenic tumor (KCOT). What are three reasons why are these lesions particularly significant?	back 17 Because of their (1) growth potential, (2) recurrence rate, and (3) association with nevoid basal cell carcinoma syndrome.
front 18 Clinical Features arises from cell rests of the dental lamina most often diagnosed between 10 and 40 years (60%) slight male predilection most often occurs in the mandible (60% to 80%) asymptomatic (small) or pain, swelling, and drainage (large) Radiographic Features well-defined radiolucent area large lesions may appear multilocular smooth and often corticated margins growth in an anteroposterior direction may involve an unerupted tooth (25% to 40%) Histopathologic Features thin, friable wall, difficult to enucleate in one piece cystic lumen may contain either: clear liquid similar to a transudate of serum cheesy material consisting of keratinaceous debris epithelial lining of stratified squamous epithelium luminal surface of flattened parakeratotic epithelial cells basal layer composed of a palisaded epithelial cells	back 18 odontogenic keratocyst (OKC)
front 19 What possibility should always be considered in patients who present with multiple odontogenic keratocysts (OKC)?	back 19 nevoid basal cell carcinoma (Gorlin) syndrome
front 20 This large, multilocular cyst involves most of the ascending ramus and is growing in an anteroposterior direction.	back 20 odontogenic keratocyst (OKC)

front 21 This cyst involves the crown of an unerupted premolar, which appears similar to a dentigerous cyst.	back 21 odontogenic keratocyst (OKC)
front 22 Computed tomography (CT) scan showing a large cyst involving the crown of an unerupted maxillary third molar.	back 22 odontogenic keratocyst (OKC)
front 23 The epithelial lining is 6 to 8 cells thick, with a hyperchromatic and palisaded basal cell layer. Note the corrugated parakeratotic surface.	back 23 odontogenic keratocyst (OKC)
front 24 The characteristic palisaded basal layer of this cyst has been lost in the central area due to the chronic inflammatory cell infiltrate.	back 24 odontogenic keratocyst (OKC)

front 25 What is the tratment and prognosis for odontogenic keratocyst (OKC)?	back 25 enucleation and curettage often recur after treatment (5% to 62%) malignant tranformation is unlikely
front 26 Clinical Features lack distinct clinical or radiographic features occur predominantly in young adults more common in males than females (2 : 1) more common in mandible than maxilla (3 : 1) Radiographic Features unilocular radiolucency size from less than 1 cm to greater than 7 cm appear similar to dentigerous cysts often involve an unerupted mandibular third molar Histopathologic Features lining of orthokeratotic stratified squamous epithelium keratohyaline granules in the superficial epithelial layer	back 26 orthokeratinized odontogenic cyst
front 27 A small unilocular radiolucency associated with the impacted mandibular left third molar. Histopathologic examination shows a lining of orthokeratotic stratified squamous epithelium.	back 27 orthokeratinized odontogenic cyst
front 28 A large cyst involving a horizontally impacted lower third molar. Histopathologic examination shows a lining of orthokeratotic stratified squamous epithelium.	back 28 orthokeratinized odontogenic cyst

front 29 Microscopic features showing a thin epithelial lining. The basal epithelial layer does not demonstrate palisading. Keratohyaline granules are present, and a thick layer of orthokeratin is seen on the luminal surface.	back 29 orthokeratinized odontogenic cyst
front 30 What is the treatment and prognosis for orthokeratinized odontogenic cyst?	back 30 enucleation with curettage recurrence is rare (2%) possibly slightly greater risk for malignant transformation
front 31 Nevoid basal cell carcinoma syndrome (Gorlin syndrome) is an autosomal dominant inherited condition that exhibits high penetrance and variable expressivity. What mutation causes this disease?	back 31 The syndrome is caused by mutations in patched (PTCH), a tumor suppressor gene that has been mapped to chromosome 9q22.3-q31.
front 32 Clinical Features enlarged head circumference multiple basal cell carcinomas epidermal cysts of the skin palmar/plantar pits (65% to 85%) mild ocular hypertelorism spina bifida occulta Radiographic Features multiple odontogenic keratocysts (90%) frontal and temporal bossing calcified falx cerebri splayed, bifid, or fused ribs Histopathologic Features keratocysts with a fibrous capsule having more: satellite cysts islands of epithelial proliferation odontogenic epithelial rests foci of calcification also appear to be more common	back 32 nevoid basal cell carcinoma syndrome (Gorlin syndrome)

front 33 This 11-year-old girl shows hypertelorism and mandibular swelling.	back 33 nevoid basal cell carcinoma syndrome
front 34 An ulcerating basal cell carcinoma is present on the upper face.	back 34 nevoid basal cell carcinoma syndrome
front 35 Punctate lesions representing a localized impairment of the maturation of basal epithelial cells.	back 35 nevoid basal cell carcinoma syndrome
front 36 Chest film showing presence of bifid ribs.	back 36 nevoid basal cell carcinoma syndrome

front 37 Anteroposterior skull film showing calcification of the falx cerebri.	back 37 nevoid basal cell carcinoma syndrome
front 38 Large cysts present in the right and left mandibular molar regions, together with a smaller cyst involving the right maxillary canine.	back 38 nevoid basal cell carcinoma syndrome
front 39 A diagnosis of nevoid basal cell carcinoma syndrome can be made if a patient meets two major diagnostic criteria. What are the five major criteria for nevoid basal cell carcinoma syndrome?	back 39 five or more basal cell carcinomas (or one before 30 years old) odontogenic keratocyst (OKC) lamellar calcification of the falx cerebri two or more palmar or plantar pits first degree relative with nevoid basal cell carcinoma syndrome
front 40 A diagnosis of nevoid basal cell carcinoma syndrome can be made if a patient meets one major and two minor diagnostic criteria. What are the seven minor criteria for nevoid basal cell carcinoma syndrome?	back 40 macrocephaly congenital malformations polydactyly skeletal abnormalities ovarian or cardiac fibromas medulloblastoma* ocular anomalies lymphomesenteric or pleural cysts ^{*has been suggested as a major criterion}

front 41 Odontogenic keratocyst (OKC) showing numerous odontogenic epithelial rests in the cyst wall.	back 41 nevoid basal cell carcinoma syndrome
front 42 What is the treatment and prognosis for nevoid basal cell carcinoma syndrome?	back 42 prognosis depends on behavior of skin tumors patients should take precautions to avoid sunlight jaw cysts are treated the same as isolated OKCs genetic counseling is appropriate for affected individuals
front 43 This 52-year-old man had more than 100 basal cell carcinomas removed from his face over a 30-year period.	back 43 nevoid basal cell carcinoma syndrome
front 44 Facial deformity secondary to multiple surgical procedures to remove basal cell carcinomas.	back 44 nevoid basal cell carcinoma syndrome

front 45 Clinical Features multiple whitish papules on the mucosa overlie the alveolar processes of neonates usually no more than 2 to 3 mm maxillary alveolus is more commonly involved Histopathologic Features flattened epithelial lining parakeratotic luminal surface lumen contains keratinaceous debris	back 45 gingival cyst of the newborn
front 46 Multiple whitish papules on the alveolar ridge of a newborn infant.	back 46 gingival cyst of the newborn
front 47 What is the treatment and prognosis for gingival cyst of the newborn?	back 47 no treatment indicated (rupture spontaneously) rarely seen after 3 months of age
front 48 Clinical Features soft tissue counterpart of lateral periodontal cyst predilection for mandibular canine/premolar area found in patients in the fifth and sixth decades almost invariably on facial gingiva or alveolar mucosa painless, domelike swellings less than 0.5 cm often bluish or blue-gray Histopathologic Features thin, flattened epithelial lining focal plaques containing glycogen-rich clear cells	back 48 gingival cyst of the adult

front 49 Tense, fluid-filled swelling on the facial gingiva. Surgical excision revealed superficial “cupping out” of the alveolar bone.	back 49 gingival cyst of the adult
front 50 Low-power photomicrograph showing a thin-walled cyst in the gingival soft tissue, resembling lateral periodontal cyst.	back 50 gingival cyst of the adult
front 51 High-power photomicrograph showing a plaquelike thickening of the epithelial lining containing clear, glycogen-rich cells.	back 51 gingival cyst of the adult
front 52 What is the treatment and prognosis for gingival cyst of the adult?	back 52 simple surgical excision prognosis is excellent

front 53 Clinical Features intrabony counterpart of gingival cyst of the adult often asymptomatic occur in fifth to seventh decades of life mandibular premolar-canine-lateral incisor area may have a polycystic appearance ("botryoid") Radiographic Features well-circumscribed radiolucent area located laterally to roots of vital teeth less than 1.0 cm Histopathologic Features thin, generally noninflamed, fibrous wall epithelial lining only one to three cells thick interspersed foci of glycogen-rich clear cells focal nodular thickenings composed of clear cells	back 53 lateral periodontal cyst
front 54 Radiolucent lesion located lateral to the roots of a vital mandibular canine and first premolar.	back 54 lateral periodontal cyst
front 55 A larger lesion located lateral to the roots of two vital teeth, causing root divergence.	back 55 lateral periodontal cyst
front 56 Gross specimen of a botryoid variant. Microscopically, this grapelike cluster revealed three separate cavities.	back 56 lateral periodontal cyst

front 57 This photomicrograph shows a thin epithelial lining with focal nodular thickenings of clear cells. These thickenings often show a swirling appearance of the glycogen-rich clear cells.	back 57 lateral periodontal cyst
front 58 The calcifying odontogenic cyst is part of a spectrum of lesions characterized by odontogenic epithelium containing “ghost cells,” which then may undergo calcification. What are the three categories of calcifying odontogenic cysts?	back 58 calcifying cystic odontogenic tumor dentinogenic ghost cell tumor ghost cell odontogenic carcinoma
front 59 Clinical Features equal frequency in the maxilla and mandible most found in incisor/canine areas (65%) most diagnosed in second to fourth decades of life Radiographic Features unilocular, well-defined radiolucency radiopaque structures within the lesion most are between 2.0 and 4.0 cm Histopathologic Features well-defined cystic lesion with a fibrous capsule lining of odontogenic epithelium, four to ten cells thick “ghost cells” within the epithelium (loss of nuclei)	back 59 calcifying odontogenic cyst
front 60 A well-circumscribed mixed radiolucent/radiopaque lesion in the right body of the mandible. Note root resorption of adjacent teeth.	back 60 calcifying odontogenic cyst

front 61 Expansion of the posterior maxillary alveolus caused by a large pink lesion. Panoramic radiograph showing a large radiolucency with a small calcified structure is seen in the lower portion.	back 61 calcifying odontogenic cyst
front 62 A nodular mass of the mandibular facial gingiva. Radiography would reveal calcified structures within this lesion.	back 62 peripheral calcifying odontogenic cyst
front 63 The cyst lining shows ameloblastoma-like epithelial cells, with a columnar basal layer. Large eosinophilic ghost cells are present within the epithelial lining.	back 63 calcifying odontogenic cyst
front 64 Eosinophilic dentinoid material is present adjacent to a sheet of ghost cells.	back 64 calcifying odontogenic cyst

front 65 What is the treatment and prognosis for calcifying odontogenic cyst?	back 65 simple enucleation recurrence is rare
front 66 Clinical Features most common in middle-aged adults (46 to 51 years) most occur in the mandible (75%) strong predilection for the anterior region asymptomatic (small) or painful expansion (large) Radiographic Features unilocular or multilocular radiolucency well defined with a corticated rim Histopathologic Features lined by squamous epithelium of varying thickness uneven hobnail and sometimes papillary surface mucin-producing goblet cells in the surface layer glandular, ductlike spaces within the epithelial lining mucicarmine-positive fluid within spaces	back 66 glandular odontogenic cyst
front 67 Expansile lesion of the anterior mandible. Panoramic radiograph showing a large multilocular radiolucency.	back 67 glandular odontogenic cyst
front 68 The cyst is lined by stratified squamous epithelium that exhibits surface columnar cells with cilia. Numerous microcysts containing mucinous material are present.	back 68 glandular odontogenic cyst

front 69 What is the treatment and prognosis for glandular odontogenic cyst?	back 69 enucleation or curettage propensity for recurrence (30%) decompression may promote shrinkage before surgery
front 70 Clinical Features develops on buccal of mandibular first or second molar occurs in children from 5 to 13 years of age slight-to-moderate tenderness swelling and foul-tasting discharge pocket formation on the buccal aspect Radiographic Features well-circumscribed unilocular radiolucency involves buccal bifurcation and root area average size is 1.2 cm, but may be up to 2.5 cm root apices tipped toward lingual mandibular cortex Histopathologic Features microscopic features are nonspecific lined by nonkeratinizing stratified squamous epithelium prominent chronic inflammatory cell infiltrate	back 70 buccal bifurcation cyst
front 71 What term is given to bifurcation cysts that occur distal or buccal to partially erupted mandibular third molars with a history of pericoronitis?	back 71 paradental cyst
front 72 Well-circumscribed unilocular radiolucency superimposed on the roots of the mandibular first permanent molar. Periodontal probing revealed pocket formation on the buccal aspect.	back 72 buccal bifurcation cyst

front 73 Axial computed tomography (CT) image showing a circumscribed radiolucency buccal to the roots of the mandibular first molar, which are tipping toward the lingual mandibular cortex.	back 73 buccal bifurcation cyst
front 74 What is the treatment and prognosis for buccal bifurcation cyst?	back 74 enucleation (extraction is unnecessary) usually completely healed within 1 year some cases resolve without surgery
front 75 Clinical Features encountered most often in older patients (60 years) twice as common in men as in women pain and swelling are common complaints Radiographic Features may mimic those of any odontogenic cyst radiolucent defect with irregular, ragged margins Histopathologic Features well-differentiated or moderately well-differentiated transition from normal lining to squamous cell carcinoma	back 75 odontogenic carcinoma
front 76 Radiolucent lesion with irregular, ragged margins surrounding the crown of an impacted third molar in a 56-year-old woman. This was clinically considered to be a dentigerous cyst.	back 76 odontogenic carcinoma

front 77 Nineteen years previously, a large odontogenic keratocyst (OKC) with areas of epithelial dysplasia had been removed from the ascending ramus.	back 77 odontogenic carcinoma
front 78 High-power view of a dentigerous cyst from a 53-year-old man. The lining demonstrates full-thickness epithelial dysplasia.	back 78 odontogenic carcinoma
front 79 A dentigerous cyst from a 53-year-old man showing islands of invasive epithelial cells in the cyst wall.	back 79 odontogenic carcinoma
front 80 What is the treatment and prognosis for odontogenic carcinoma?	back 80 varies from local block excision to radical resection possible radiation or adjunctive chemotherapy 2-year survival rate of 62% 5-year survival rate of 38%

front 81 What are the three classes of odontogenic tumors?	back 81 tumors of odontogenic epithelium mixed odontogenic tumors tumors of odontogenic ectomesenchyme
front 82 What is the most common clinically significant odontogenic tumor?	back 82 ameloblastoma
front 83 What are the three different clinicoradiographic presentations of ameloblastoma?	back 83 conventional solid or multicystic (80%) unicystic (18%) peripheral or extraosseous (2%)
front 84 Clinical Features equal prevalence in third to seventh decades most often occur in the mandible (80% to 85%) asymptomatic (small) or painless expansion (large) Radiographic Features multilocular or unilocular radiolucent lesion “soap bubble” or “honeycombed” appearance resorption of the roots of adjacent teeth irregular, scalloped margins Histopathologic Features islands of epithelium in a fibrous connective tissue stroma with ameloblast-like cells with reversed polarity (follicular type) cords or sheets of odontogenic epithelium with a loose, vascular stroma and ameloblast-like cells (plexiform type) extensive squamous metaplasia with keratin formation within epithelial islands (acanthomatous type) epithelial cells with abundant cytoplasm and eosinophilic granules (granular cell type) epithelial cells in a densely collagenized stroma with increased production of TGF-β (desmoplastic type) islands of uniform, hyperchromatic basaloid cells with peripheral palisading (basal cell type)	back 84 ameloblastoma

front 85 Large, painless expansile mass of the anterior mandible.	back 85 ameloblastoma
front 86 Prominent expansion of the lingual alveolus caused by a large, painless expansile mass of the mandibular symphysis.	back 86 ameloblastoma
front 87 Massive tumor of the anterior mandible.	back 87 ameloblastoma
front 88 Large multilocular lesion with “soap bubble” appearance involving the mandibular angle and ascending ramus.	back 88 ameloblastoma

front 89 Periapical films of a smaller multilocular lesion, showing a “honeycombed” appearance.	back 89 ameloblastoma
front 90 Destructive radiolucent lesion with root resorption of the associated posterior teeth.	back 90 ameloblastoma
front 91 Large mixed radiolucent and radiopaque lesion of the anterior and right body of the mandible. This type has a predilection for anterior region, with equal distribution between mandible and maxilla.	back 91 desmoplastic ameloblastoma
front 92 Multiple islands of odontogenic epithelium demonstrating peripheral columnar differentiation with reverse polarization. The central zones resemble stellate reticulum and exhibit foci of cystic degeneration.	back 92 ameloblastoma, follicular pattern

front 93 This high-power photomicrograph highlights a single layer of tall columnar ameloblast-like cells exhibiting reverse polarization, surrounding a central core of loosely arranged angular cells resembling the stellate reticulum.	back 93 ameloblastoma, follicular pattern
front 94 Tumor demonstrating anastomosing cords of odontogenic epithelium.	back 94 ameloblastoma, plexiform pattern
front 95 Islands of ameloblastoma demonstrating central squamous differentiation.	back 95 ameloblastoma, acanthomatous pattern
front 96 Tumor island exhibiting central cells with prominent granular cytoplasm.	back 96 ameloblastoma, granular pattern

front 97 Thin cords of ameloblastic epithelium within a dense fibrous connective tissue stroma.	back 97 ameloblastoma, desmoplastic pattern
front 98 Islands of hyperchromatic basaloid tumor cells with peripheral palisading.	back 98 ameloblastoma, basal cell pattern
front 99 Gross photograph of a mandibular resection specimen. The radiograph of the specimen shows a large radiolucent defect associated with an inferiorly displaced third molar.	back 99 ameloblastoma
front 100 What is the treatment and prognosis for conventional solid or multicystic intraosseous ameloblastoma?	back 100 ranges from enucleation and curettage to en bloc resection recurrence rates of 50% to 90% have been reported marginal resection is the most widely used treatment,

front 101 Clinical Features most often in younger patients (second decade of life) most often in mandible (90%), especially posterior asymptomatic (small) or painless swelling (large) Radiographic Features circumscribed radiolucency surrounds crown of unerupted mandibular third molar Histopathologic Features fibrous cyst wall with lining of ameloblastic epithelium confined to the luminal surface (luminal type) one or more nodules project from the cystic lining into the lumen of the cyst (intraluminal type) fibrous wall of the cyst is infiltrated by follicular or plexiform ameloblastoma (mural type)	back 101 ameloblastoma, unicystic
front 102 A large radiolucency in the posterior mandible associated with the crown of the developing mandibular third molar.	back 102 unicystic ameloblastoma
front 103 Coronal computed tomography (CT) image that shows a large cystic lesion with an intraluminal mass arising from the cyst wall.	back 103 unicystic ameloblastoma
front 104 The cyst is lined by ameloblastic epithelium showing a hyperchromatic, polarized basal layer. The overlying epithelial cells are loosely cohesive and resemble stellate reticulum.	back 104 unicystic ameloblastoma, luminal type

front 105 Photomicrograph of an intraluminal mass arising from the ameloblastic epithelium of the cyst wall. The inset shows the intraluminal mass at higher magnification.	back 105 unicystic ameloblastoma, intraluminal type
front 106 The epithelial lining of the cystic component can be seen on the left edge of the photomicrograph. Islands of follicular ameloblastoma are infiltrating into the fibrous connective tissue wall on the right.	back 106 unicystic ameloblastoma, mural type
front 107 What is the treatment and prognosis for unicystic ameloblastoma?	back 107 enucleation and curettage recurrence rates of 10% to 20%
front 108 Clinical Features painless, nonulcerated sessile or pedunculated lesion common on posterior gingival or alveolar mucosa often smaller than 1.5 cm seen in middle-aged persons (52 years) Histopathologic Features islands of ameloblastic epithelium in lamina propria may merge with basal layer of surface epithelium	back 108 peripheral ameloblastoma

front 109 A painless, nonulcerated sessile mass arising from the alveolar mucosa which appears similar to a fibroma or pyogenic granuloma.	back 109 peripheral ameloblastoma
front 110 Interconnecting cords of ameloblastic epithelium filling the lamina propria.	back 110 peripheral ameloblastoma
front 111 What is the treatment and prognosis for peripheral ameloblastoma?	back 111 local surgical excision recurrence rate of 15% to 20% malignant change possible, but rare
front 112 Clinical Features tend to develop later in life (sixth decade) affects men twice as often as women aggressive clinical course Radiographic Features ill-defined margins rapid cortical destruction Histopathologic Features microscopic pattern similar to ameloblastoma increased nuclear-to-cytoplasmic ratio nuclear hyperchromatism presence of mitoses necrosis or dystrophic calcification may be present	back 112 ameloblastic carcinoma

front 113 Rapidly growing tumor showing prominent labial expansion of the mandible in the incisor and premolar area. The panoramic radiograph shows irregular destruction of the mandible.	back 113 ameloblastic carcinoma
front 114 Ameloblastic epithelium demonstrating hyperchromatism, pleomorphism, and numerous mitotic figures.	back 114 ameloblastic carcinoma
front 115 What is the treatment and prognosis for ameloblastic carcinoma?	back 115 poor prognosis uniformly aggressive clinical course 50% mortality with long-term follow-up
front 116 Clinical Features most often diagnosed in patients older than age 50 most often develops in the mandible (80%) patients complain of pain or lower lip paresthesia aggressive clinical course Radiographic Features unilocular or multilocular radiolucencies ill-defined or irregular margins Histopathologic Features nests of epithelial cells with clear cytoplasm amixed eosinophilic polygonal epithelial cells occasional palisading of peripheral clear cells	back 116 clear cell odontogenic carcinoma

front 117 A unilocular radiolucent defect at the apex of the mandibular first molar. This patient complained of pain and lower lip paresthesia.	back 117 clear cell odontogenic carcinoma
front 118 Hyperchromatic epithelial nests including clusters of cells with abundant clear cytoplasm.	back 118 clear cell odontogenic carcinoma
front 119 Tumor island demonstrating cells with a clear cytoplasm. Note the peripheral columnar differentiation.	back 119 clear cell odontogenic carcinoma
front 120 What is the treatment and prognosis for clear cell odontogenic carcinoma?	back 120 significant tendency to recur most require fairly radical surgery can metastasize to lymph nodes and lungs

front 121 Clinical Features largely limited to younger patients (10 to 19 years) striking predilection for anterior portions of the jaws found twice as often in the maxilla as in the mandible affect females about twice as often as males seldom exceed 3 cm and frequently asymptomatic Radiographic Features circumscribed, unilocular radiolucency involves crown of unerupted tooth (often canine) sometimes extends apically along the root can also be located between roots of erupted teeth often contains fine "snowflake" calcifications Histopathologic Features well-defined lesion surrounded by a thick, fibrous capsule spindle-shaped epithelial cells in sheets, strands, or whorls tubular or ductlike structures wihtout glandular elements occasional scattered foci of calcification	back 121 adenomatoid odontogenic tumor
front 122 Radiolucent lesion involving an unerupted mandibular first premolar. In contrast to the usual dentigerous cyst, the radiolucency extends almost to the apex of the tooth.	back 122 adenomatoid odontogenic tumor
front 123 A small radiolucency is present between the roots of the lateral incisor and canine. These lesions may occasionally contain fine "snowflake" calcifications.	back 123 adenomatoid odontogenic tumor
front 124 Well-defined pericoronal radiolucency enveloping the maxillary right lateral incisor in a 14-year-old male. Note the subtle snowflake-like calcifications within the lesion.	back 124 adenomatoid odontogenic tumor

front 125 A well-circumscribed cystlike mass can be seen enveloping the crown of a maxillary cuspid. Note the intraluminal vegetations, which represent nodular tumor growth.	back 125 adenomatoid odontogenic tumor
front 126 Low-power view demonstrating a thick capsule surrounding the tumor. Higher magnification showing the ductlike epithelial structures. The nuclei of the columnar cells are polarized away from the central spaces.	back 126 adenomatoid odontogenic tumor
front 127 What is the treatment and prognosis for adenomatoid odontogenic tumor?	back 127 enucleates easily from bone recurrence after enucleation seldom completely benign
front 128 Clinical Features encountered in patients between 30 and 50 years two-thirds are found in the mandible (posterior areas) painless, slow-growing swelling Radiographic Features unilocular or multilocular radiolucent defect scalloped, well-defined margins frequently associated with an impacted tooth traditionally described “driven-snow” calcifications Histopathologic Features polyhedral epithelial cells in a fibrous stroma distinct cellular outlines and intercellular bridges variable and occasionally giant nuclei hyalinized (amyloid-like) extracellular material concentric calcifications ("Liesegang rings") apple-green birefringence after Congo red staining	back 128 calcifying epithelial odontogenic tumor ("Pindborg tumor")

front 129 Honeycombed multilocular radiolucency containing fine calcifications.	back 129 calcifying epithelial odontogenic tumor
front 130 Prominent calcification around the crown of an impacted second molar that is involved in the tumor.	back 130 calcifying epithelial odontogenic tumor
front 131 Sheets of epithelial tumor cells that surround pools of amorphous, eosinophilic amyloid with focal calcification. Higher-power view showing polyhedral cells with eosinophilic cytoplasm and intercellular bridging. Adjacent amyloid deposits can be seen.	back 131 calcifying epithelial odontogenic tumor
front 132 Multiple concentric Liesegang ring calcifications.	back 132 calcifying epithelial odontogenic tumor

front 133 With Congo red staining, pools of amyloid exhibit an apple-green birefringence when viewed with polarized light.	back 133 calcifying epithelial odontogenic tumor
front 134 What is the treatment and prognosis for calcifying epithelial odontogenic tumor?	back 134 conservative local resection recurrence rate of 15% rare cases of malignancy
front 135 Clinical Features found in patients from 8 to 74 years (average, 38) painless or mildly painful gingival swelling mobility of associated teeth Radiographic Features triangular radiolucent defect lateral to roots of teeth ill defined or well-defined, corticated margin seldom exceed 1.5 cm Histopathologic Features islands of bland-appearing squamous epithelium mature fibrous connective tissue stroma vacuolization and individual cell keratinization small microcysts are sometimes observed	back 135 squamous odontogenic tumor
front 136 A triangular radiolucent defect extending along the roots of the lateral incisor and first premolar teeth.	back 136 squamous odontogenic tumor

front 137 Low-power photomicrograph showing islands of bland-appearing squamous epithelium in a fibrous stroma. Higher-power photomicrograph showing bland appearance of the epithelium with microcyst formation.	back 137 squamous odontogenic tumor
front 138 What is the treatment and prognosis for squamous odontogenic tumor?	back 138 conservative local excision or curettage recurrence rare after local excision maxillary tumors may be somewhat more aggressive malignant transformation is possible
front 139 Clinical Features occur in younger patients (first two decades) more common in males than in females asymptomatic (small) or swelling (large) posterior mandible is the most common site (70%) solid, soft tissue mass with a smooth outer surface Radiographic Features unilocular or multilocular radiolucent lesion margins tend to be well-defined and corticated often associated with an unerupted tooth (75%) Histopathologic Features cell-rich mesenchymal tissue long, narrow cords of odontogenic epithelium mesenchymal portion of plump stellate and ovoid cells	back 139 ameloblastic fibroma
front 140 Multilocular radiolucent defect with well defined, corticated margins associated with an unerupted second molar.	back 140 ameloblastic fibroma

front 141 Long, narrow cords of odontogenic epithelium supported by richly cellular, primitive connective tissue. Basophilic epithelial islands with peripheral nuclear palisading.	back 141 ameloblastic fibroma
front 142 What is the treatment and prognosis for ameloblastic fibroma?	back 142 conservative initial therapy high recurrance rate (up to 43.5%) aggressive surgical excision for recurrent lesions transformation accounts for 35% of ameloblastic fibrosarcoma
front 143 Clinical Features usually seen in children (average, 10 years) most frequent in the posterior mandible males affected more often than females (3 : 2) asymptomatic (small) or painless swelling (large) Radiographic Features well-circumscribed radiolucent defect unilocular or (infrequently) multilocular flecks or masses of calcified material often associated with an unerupted tooth Histopathologic Features microscopically identical to ameloblastic fibroma narrow cords and small islands of odontogenic epithelium loose connective tissue resembling the dental papilla calcified elements consisting of enamel and dentin matrix	back 143 ameloblastic fibro-odontoma
front 144 Radiolucent defect in the ramus containing small calcifications having the radiodensity of tooth structure.	back 144 ameloblastic fibro-odontoma

front 145 Unilocular radiolucent defect displacing the developing mandibular third molar posteriorly. Flecks of mineralized material are present in the radiolucent defect.	back 145 ameloblastic fibro-odontoma
front 146 The soft tissue component of the tumor is indistinguishable from an ameloblastic fibroma. Formation of disorganized tooth structure can be seen.	back 146 ameloblastic fibro-odontoma
front 147 What is the treatment and prognosis for ameloblastic fibro-odontoma?	back 147 conservative curettage prognosis is excellent low recurrence rate (7%)
front 148 Clinical Features rare malignant counterpart of ameloblastic fibroma occurs 1.5 times as often in males as in females tends to occur in younger patients (27.5 years) occurs most often in the mandible (80%) Radiographic Features ill-defined destructive radiolucent lesion locally aggressive and infiltrates adjacent bone Histopathologic Features benign-appearing epithelial component highly cellular mesenchymal portion hyperchromatic and bizarre pleomorphic cells mitoses are usually prominent	back 148 ameloblastic fibrosarcoma

front 149 A 21-year-old woman complained of facial asymmetry and recent increase in size of a mandibular mass that had been present for some years. Radiograph of the same patient. Note the lytic destruction of the posterior mandible.	back 149 ameloblastic fibrosarcoma
front 150 The cellular mesenchymal tissue shows hyperchromatism and atypical cells. A small island of benign-appearing ameloblastic epithelium is present.	back 150 ameloblastic fibrosarcoma
front 151 What is the treatment and prognosis for ameloblastic fibrosarcoma?	back 151 radical surgical excision estimated 20% of patients succumb to their tumor
front 152 Clinical Features occurs more often in younger patients pain, delayed eruption of teeth, expansion of bone tends to occur in younger patients (27.5 years) occurs most often in the mandible (80%) Radiographic Features radiolucent, destructive lesion contains calcified structures Histopathologic Features epithelial features of an ameloblastoma dental tissue with appearance of an odontoma	back 152 odontoameloblastoma

front 153 What is the most common type of odontogenic tumor?	back 153 odontoma
front 154 Clinical Features most detected during first two decades (14 years) completely asymptomatic and relatively small more frequent in the maxilla than the mandible Radiographic Features collection of toothlike structures (compound type) conglomerate mass of enamel and dentin (complex type) narrow radiolucent rim frequently associated with an unerupted tooth Histopathologic Features multiple structures resembling small, single-rooted teeth in a loose fibrous matrix (compound type) largely a mature tubular dentin enclosing clefts that contain mature enamel (complex type)	back 154 odontoma
front 155 A small cluster of toothlike structures is preventing the eruption of the maxillary canine.	back 155 compound odontoma
front 156 Multiple toothlets preventing the eruption of the mandibular cuspid.	back 156 compound odontoma

front 157 A calcified mass with the radiodensity of tooth structure, overlying the crown of the mandibular right second molar.	back 157 complex odontoma
front 158 Surgical specimen consisting of more than 20 malformed toothlike structures.	back 158 compound odontoma
front 159 This decalcified section shows a disorganized mass of dentin intermixed with small pools of enamel matrix.	back 159 complex odontoma
front 160 What is the treatment and prognosis for complex odontoma?	back 160 simple local excision prognosis is excellent

front 161 Clinical Features occur between 4 to 80 years (mean, 40 years) strong female predilection (almost 2 : 1) maxillary lesions located anterior to first molar mandibular lesions located posterior to first molar one-third associated with an unerupted tooth asymptomatic (small) or bony expansion (large) defect or groove in overlying palatal mucosa Radiographic Features unilocular or multilocular radiolucent lesions well-defined, corticated border associated with periradicular area of erupted teeth root resorption of associated teeth is common Histopathologic Features stellate fibroblasts in a whorled pattern fine collagen fibrils and abundant ground substance cellular fibrous connective tissue with collagen fibers odontogenic epithelium in long strands or isolated nests	back 161 odontogenic fibroma
front 162 Clinical image showing a groove or defect in the palatal mucosa, a feature described with maxillary lesions. Radiograph of this patient, depicting a multilocular radiolucency of the anterior maxilla.	back 162 odontogenic fibroma
front 163 Scattered stellate fibroblasts within a collagenous background. No epithelial rests were found on multiple sections from this tumor.	back 163 odontogenic fibroma, simple type
front 164 A cellular fibroblastic lesion containing narrow cords of odontogenic epithelium and collagen fibers arranged in interlacing bundles.	back 164 odontogenic fibroma, WHO type

front 165 Unilocular radiolucency between the left mandibular bicuspids. Microscopic examination reveals two distinct patterns. Cords of odontogenic epithelium within a fibrous background on the left, with features of giant cell granuloma on the right.	back 165 odontogenic fibroma associated with a giant cell granuloma
front 166 What is the treatment and prognosis for odontogenic fibroma?	back 166 enucleation and vigorous curettage recurrence is rare prognosis is very good
front 167 Clinical Features soft tissue counterpart of odontogenic fibroma firm, slow-growing, sessile gingival mass covered by normal-appearing mucosa most often on mandibular facial gingiva most are between 0.5 and 1.5 cm Radiographic Features demonstrate a soft tissue mass some show areas of calcification occasional “cupped out” appearance Histopathologic Features similar to central odontogenic fibroma (WHO type) interwoven fascicles of cellular fibrous connective tissue areas of less cellular, myxoid connective tissue scattered islands or strands of odontogenic epithelium	back 167 peripheral odontogenic fibroma
front 168 This sessile gingival mass cannot be clinically distinguished from the common peripheral ossifying fibroma.	back 168 peripheral odontogenic fibroma

front 169 What is the treatment and prognosis for peripheral odontogenic fibroma?	back 169 local surgical excision prognosis is good recurrence is possible
front 170 Clinical Features only ever diagnosed in adults (50% over 40 years) most cases have developed in women (70%) occurs in mandiblular premolar/molar region asymptomatic or painless expansion of bone Radiographic Features well-demarcated radiolucency unilocular or multilocular occasionally shows small calcifications Histopathologic Features large eosinophilic granular cells narrow cords or small islands of odontogenic epithelium cementum-like or dystrophic calcifications	back 170 granular cell odontogenic tumor
front 171 Well-demarcated unilocular radiolucent lesion involving the apical area of endodontically treated maxillary teeth. These lesions occasionally show small calcifications.	back 171 granular cell odontogenic tumor
front 172 Sheet of large granular mesenchymal cells with small nests of odontogenic epithelium.	back 172 granular cell odontogenic tumor

front 173 What is the treatment and prognosis for granular cell odontogenic tumor?	back 173 appears to be completely benign responds well to curettage one reported case of recurrence one reported case of malignancy
front 174 Clinical Features predominantly found in young adults (25 to 30 years) mandible is involved more commonly than maxilla rapid clinical growth in some cases Radiographic Features unilocular or multilocular radiolucency may displace or cause resorption of teeth irregular or scalloped margins may contain wispy trabeculae at right angles may show a “soap bubble” radiolucent pattern Histopathologic Features haphazard stellate, spindle-shaped, and round cells abundant, gelatinous, loose myxoid stroma ground substance composed of glycosaminoglycans	back 174 odontogenic myxoma
front 175 Unilocular radiolucency between the right mandibular lateral incisor and cuspid. These lesions may show wispy trabeculae of residual bone in a “stepladder” pattern.	back 175 odontogenic myxoma
front 176 Radiolucent lesion of anterior maxilla showing fine residual bone trabeculae arranged at right angles to one another (“stepladder” pattern).	back 176 odontogenic myxoma

front 177 Multilocular expansile radiolucency of the posterior mandible with wispy trabeculae of residual bone.	back 177 odontogenic myxoma
front 178 Gross specimen of a mandibular jaw lesion, demonstrating a white gelatinous mass.	back 178 odontogenic myxoma
front 179 A loose, myxomatous tumor can be seen filling the marrow spaces between the bony trabeculae. The inset shows stellate-shaped cells and fine collagen fibrils.	back 179 odontogenic myxoma
front 180 What is the treatment and prognosis for odontogenic myxoma?	back 180 curettage or more extensive resection careful periodic reevaluation for at least 5 years recurrence rate of 25%