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409 Cards in this Set

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Reactive lesion, or 'true' neoplasia? Overgrowth is in response to irritation
Reactive lesion
Reactive lesion, or 'true' neoplasia? Associated with a stimulus
Reactive lesion
Reactive lesion, or 'true' neoplasia? Usually inflammation a consistent finding
Reactive lesion
Reactive lesion, or 'true' neoplasia? Growth continues after stimulus is removed/no stimulus required
'true' neoplasia
Reactive lesion, or 'true' neoplasia? No regression with normal therapy
'true' neoplasia
Reactive lesion, or 'true' neoplasia? Unrestricted new growth
'true' neoplasia
What is the most common 'tumor'/lesion in the oral cavity?
Irritation fibroma
Where is the most common location to find an irritation fibroma?
Buccal mucosa, at the occlusal plane
What age group and gender is most often affected by irritation fibromas?
40-60 year old females
What two colors are irritation fibromas (usually)?
1 Pink (same shade as mucosa) 2 White from hyperkeratosis
Name 3 histological findings in irritation fibromas.
1 Dense CT 2 Inflammatory cells 3 Stratified squamous epithelium
What is the term used for an irritation fibroma caused by a denture?
Epulis Fissuratum
What characterizes Epulis Fissuratum?
Long folds of dense CT
Name 3 common causes for papillary hyperplasia.
1 Ill-fitting dentures 2 Dentures worn 24 hours/day 3 Poor denture hygiene
What clinical feature is pathognomonic for Papillary Hyperplasia?
Raspberry, bubbly, papillary look, usually on hard palate
What microorganism is often to blame for Papillary Hyperplasia?
Candida
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Usually on gingiva, but occur anywhere
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Bright red color
Pyogenic granuloma OR ulcerated peripheral fibroma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Bleeds easily
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Painless
Pyogenic granuloma and peripheral giant cell granuloma for sure
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Caused by irritation
All three
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Develops rapidly
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? More common in children and young adults
Pyogenic granuloma and peripheral fibroma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Found in pregnant women
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Female predilection
All three
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Histologically has endothelial lined vascular spaces
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Most common of the three
Pyogenic granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Bluish-purple in color
Peripheral Giant Cell Granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Pink color
peripheral fibroma OR Peripheral Giant Cell Granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Affects individuals around age 30
Peripheral Giant Cell Granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Can only occur on the gingiva
Peripheral Giant Cell Granuloma or Peripheral fibroma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Histologically has CT stroma, mesenchymal cells, and multinucleated giant cells
Peripheral Giant Cell Granuloma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Results from pyogenic granuloma developing over time
Peripheral fibroma
Pyogenic granuloma, peripheral giant cell granuloma, or peripheral fibroma (or more than one)? Histologically has dense CT with mineralization (calcified or ossified)
Peripheral (ossifying) fibroma
What term is used for red vascular tissue growing out of recent extraction site or socket?
Epulis Granulomatosa
Name the most common oral area to have a lipoma.
Buccal mucosa
What color is a lipoma?
Yellowish
What kind of cells are subject to neurolemoma?
Schwann cells (it's also called a schwannoma)
Are neurolemomas fast or slow-growing?
Slow-growing
Name the most common oral area to have a neurolemoma.
Tongue
What soft tissue lesion is associated with Antoni A and B tissue types?
Neurolemoma (Schwannoma)
What soft tissue lesion is associated with Verocay bodies?
Neurolemoma (Schwannoma)
Name the most common peripheral nerve neoplasm, which is rare but not uncommon.
Neurofibroma
What soft tissue lesion is associated with spindle cells, and Mast cells intermingled with neurites?
Neurofibroma
Name the hereditary/systemic form of neurofibromas.
Von Recklinghausen's Disease of the Skin
Name two clinical features of Von Recklinghausen's Disease of the Skin.
1 Multiple neurofibromas 2 Café au lait spots
What 'neoplasm' occurs when a damaged nerve attempts to repair itself?
Traumatic neuroma
Is a Traumatic neuroma painless or painful?
Painful
What lesion has the following histology: Neurofibrils and Schwann cells in CT?
Traumatic neuroma
What is the most common tumor of infancy?
Hemangioma
What causes a hemangioma?
Proliferation of blood vessels
What color is a hemangioma?
Deep blue (this helps diagnose)
If a hemangioma is present as a large, flat lesion of the skin, what term is used?
Birthmark
If a hemangioma is present as a large, unilateral lesion on the face following the division of the trigeminal nerve, what term is used?
Port-wine stain
What type of biopsy must be done on a hemangioma: Incisional or excisional?
Excisional, because it bleeds profusely with incisional
What is "diascopy"?
Blanching with pressure
A hemangioma (does/does not) blanch with pressure.
DOES
If a hemangioma is present due to small capillary proliferation, what disease is this?
Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu)
What disease features Port-wine stian, and maybe convulsive disorders and mental retardation due to calcifications in the brain?
Sturge-Weber Syndrome
What is more common, hemangioma or lymphangioma?
Hemangioma
How can you differentiate a lymphangioma from a hemangioma?
Lymphangiomas are pink, or colorless, not red.
If a lymphangioma is present in the tongue, what syndrome could occur secondarily?
Macroglossia
Name the most common oral area to have a granular cell tumor.
Tongue
What lesion has the following histology: Large, granular cells with eosinophils, keratin production, and pseudoepitheliomatous hyperplasia?
Granular cell tumor
What soft tissue lesion may be confused with carcinoma?
Granular cell tumor
What disease features fibroma-looking lesion at birth?
Congenital Granular Cell Epulis
Where is the most common location to find a Congenital Granular Cell Epulis?
Maxillary anterior gingiva
T/F: Congenital Granular Cell Epulis most commonly affects males.
False; the predilection is 90% female, suggesting a hormonal link
What disease features rapidly-growing dark, pigmented lesion at birth?
Melanotic Neuroectodermal Tumor of infancy
What disease is associated with high levels of vanilmadelic acid in the urine?
Melanotic Neuroectodermal Tumor of infancy
What lesion has the following histology: Mass of cells arranged in a pattern of alveolus-like spaces, lined by cuboidal cells, maybe containing melanin?
Melanotic Neuroectodermal Tumor of infancy
What is another name for physiologic (racial) pigmentation?
Melanoplakia
Name the most common location for physiologic (racial) pigmentation/melanoplakia.
Attached gingiva
What causes physiologic (racial) pigmentation/melanoplakia?
Increased ACTIVITY (not number) of melanocytes
Name two risk factors (besides smoking) for Smoker's Melanosis.
1 Female 2 Females on the Pill
Name the three most common areas to see Smoker's Melanosis.
1 Mandibular anterior (gingiva) 2 Buccal mucosa 3 Palate
Is Smoker's Melanosis premalignant?
No, not alone
Does Smoker's Melanosis go away after quitting smoking?
Yes, probably
T/F: Oral Melanotic Macules are due to sun-exposure.
False, freckles are
What disease histologically features an increase in melanin granules, which is confined to the basal cell layer?
Oral melanotic macule
What is the most common of all human 'tumors'?
Pigmented Cellular Nevus/ Acquired melanocytic nevus/Mole
Name 2 synonyms for a mole.
1 Pigmented Cellular Nevus 2 Acquired melanocytic nevus
What's the difference between a mole and a freckle (ephelis)?
A mole does NOT depend on sun exposure; freckles do.
What do nevus cells look like (4)?
1 Large 2 Oval 3 Epithelioid 4 Arranged in clumps
What type of mole do all moles start out as?
Junctional nevus
What variant of mole is the second most common intraoral nevus?
Blue
Malignant melanoma is the (#) most common skin cancer. ____% of skin melanomas occur in the head/neck area. (Chronic/acute) sun damage is more important when it comes to malignant melanoma. The lifetime risk for a __(ethnicity)__ to get malignant melanoma is 1 in _____.
3rd most common. 25% in head and neck. Acute is worse. Caucasians 1:100 will get them.
What is the most common type of Malignant melanoma?
Superficial spreading melanoma
What type of Malignant melanoma is multicolored and flat?
Superficial spreading melanoma
1/3 of this type of Malignant melanoma are in the head and neck area.
Nodular melanoma
What type of Malignant melanoma is elevated, and sometimes has no pigmentation?
Nodular melanoma
What type of Malignant melanoma is melanoma in situ?
Lentigo maligna melanoma
What is the most common type of oral Malignant melanoma?
Acral lentiginous melanoma
Name the two most common sites for oral Malignant melanoma.
1 Maxillary anterior mucosa 2 Hard palate
Most oral Malignant melanomas are (primary/metastatic) and have (good/bad) prognosis.
Metastatic, bad
How does Addison's disease manifest in the skin/mucous membranes?
Bronzing
What are two clinical features of Peutz-Jeghers Syndrome?
1 Oral freckles (melanotic macules) 2 Intestinal polyposis
What are the three structural parts of a cyst?
1 Central cavity (containing fluid, etc) 2 Lining (usually strat squa) 3 CT Capsule
How are cysts usually discovered?
Routine exam/xrays
Name the cyst characterized by a non-vital tooth, inflammation, radiolucent, derived from rest of Malassez, either asympomatic or acute pain.
Dental Granuloma
Name the cyst characterized by a non-vital tooth, cholesterol clefts, radiolucent, either asympomatic or acute pain.
Radicular/Periradicular/Periapical Cyst
Name the cyst that develops from fragments of an apical cyst after removal of a tooth.
Residual cyst
Name the cyst that is associated with the crown of a normal/supernumerary impacted tooth.
Dentigerous cyst
What is the origin of a dentigerous cyst?
Reduced enamel epithelium, after the crown has formed
Name the 2 most common sites for a dentigerous cyst.
1 3rd molars 2 Maxillary cuspids
Dentigerous cysts usually occur from age ____ to ____, and is lined by ______ _________ epithelium.
10-30, stratified squamous epi
Name 3 possible progressions of a dentigerous cyst.
1 Ameloblastoma 2 Squamous cell carcinoma 3 Mucoepidermoid carcinoma (salivary gland tumor)
If a radiolucency is less than 2.5 mm, it is probably not a dentigerous cyst, but is probably…
Perifollicular fibrosis
Can you see an eruption cyst on an xray?
NO
Name the cyst that is a soft-tissue counterpart of a dentigerous cyst.
Eruption cyst
Name the cyst that develops in place of a tooth (no history of extraction or existing tooth).
Primordial cyst
What is the origin of a primordial cyst?
Remnants/degeneration of the enamel organ
Where is the most common location to find a primordial cyst?
3rd molar area
T/F: Primordial cysts can be multilocular.
TRUE
Name the cyst that shows keratinization.
Odontogenic keratocyst
What is the origin of an Odontogenic keratocyst?
Dental lamina/cell rests
Odontogenic keratocysts are (rare/common) make up ___-____% of all odontogenic cysts. OKC affects ____-____ year olds. They are lined by (thin/thick) epithelium.
Common, 3-11% of all odontogenic cysts, 10-40 year olds. Thin
What is the most common location to find an Odontogenic keratocyst?
Mandibular molar area
T/F: Odontogenic keratocysts can be aggressive.
True, can cause tooth movement and resorption
Name the syndrome which features multiple Odontogenic keratocysts.
Jaw cyst-basal cell nevus-Bifid rib syndrome
T/F: Odontogenic keratocysts can be multilocular.
TRUE
On an xray, name two things that Odontogenic keratocysts may resemble (and cannot be differentiated from).
1 Dentigerous cyst 2 Lateral periodontal cyst
Name a unique histologic feature of Odontogenic keratocysts.
Satellite cysts
T/F: Recurrence rate is high for Odontogenic keratocysts.
True, due to satellite cysts and wavy epi lining
Name a variant of Odontogenic keratocysts. Is its recurrence rate higher or lower than Odontogenic keratocysts?
Orthokeratinized odontogenic cyst. Recurrence is much lower (2% instead of 30%)
T/F: Gingival cyst of the newborn is rare.
False, it is found in 50% of all newborns!
What is the origin of Gingival cyst of the newborn and adult?
Remnants of the dental lamina
T/F: Gingival cyst of the adult is rare.
TRUE
Where is the most common area to find a Gingival cyst of the adult?
Mandibular bicuspid/anterior area
Name the cyst that is the bony counterpart to a gingival cyst of the adult.
Lateral periodontal cyst
T/F: Lateral periodontal cysts can be multilocular.
True, it would be called a Botryoid odontogenic cyst
Where is the most common area to find a Lateral periodontal cyst?
Mandibular premolar/cuspid area
Name the multilocular variant of a Lateral periodontal cyst.
Botryoid odontogenic cyst (grape-like cluster)
T/F: Recurrence rate is high for Lateral periodontal cysts.
False, it is low
Name the cyst that is more like a neoplasm than a cyst.
Calcifying Odontogenic Cyst (Gorlin cyst)
Where is the most common area to find a Calcifying Odontogenic Cyst (Gorlin cyst)?
Trick question - it's found equally in maxilla and mandible, but tends to be in the anterior area
Name a unique histologic feature of a Calcifying Odontogenic Cyst (Gorlin cyst).
Ghost cells, usually with calcifications (diffuse or clumpy)
Name the cyst that has glandular differentiation.
Glandular Odontogenic Cyst
Where is the most common area to find a Glandular Odontogenic Cyst?
Mandibular anteriors
What is a (better) synonym for a paradental cyst?
Buccal bifurcation cyst
Name the cyst that usually occurs on mandibular molars that have a history of pericoronitis.
Paradental/Buccal bifurcation cyst
What is the cause of Paradental/Buccal bifurcation cysts?
Infection stimulates Inflammation, which stimulates rests of Malassez to make enamel
What is the age predilection for Paradental/Buccal bifurcation cysts?
20-30 years old
Name the most common site to find a Paradental/Buccal bifurcation cyst.
Mandibular second/third molars
Name the cyst that is small, white, and found on the palate of newborns. Name 2 synonyms.
Palatal cyst of the newborn. 1 Epstein Pearls 2 Bohn's Nodules
Name the cyst that is caused by ectoderm entrapped in median palatal fusion line and/or epithelial remnants of developing palatal salivary glands.
Palatal cyst of the newborn/ Epstein Pearls/Bohn's Nodules
What is one differential diagnosis for Palatal cyst of the newborn?
Gingival cyst of the newborn
Name the rare soft tissue cyst affecting the lower portion of the nasolacrimal duct.
Nasolabial or Nasoalveolar cysts
Nasolabial or Nasoalveolar cysts affect more (males/females).
Females
Name the characteristic histological feature of Nasolabial or Nasoalveolar cyst.
Psuedostratified columnar epithelium
Name the cyst that occurs between the roots of the maxillary lateral and canines.
Globulomaxillary cyst
What shape is a Globulomaxillary cyst, usually?
Pear-shaped
Name 3 differential diagnoses for Globulomaxillary cysts.
1 Periapical cysts 2 Odontogenic cysts 3 Lateral periodontal cysts
Name the cyst that occurs in the incisive canal.
Nasopalatine Duct/Incisive Canal cyst
What is the soft-tissue counterpart of the Nasopalatine Duct/Incisive Canal cyst?
Palatine papilla cyst
Does the Nasopalatine Duct/Incisive Canal cyst affect (non/vital) teeth?
Vital
Nasopalatine Duct/Incisive Canal cysts usually occur in (males/females) age ____-_____.
Males, 40-60
What is the rule of thumb for Nasopalatine Duct/Incisive Canal cysts?
If it is less than .6 mm, it is probably just an enlarged incisive canal
Where is the most common location for Nasopalatine Duct/Incisive Canal cysts?
Between the maxillary centrals
What shape is a Nasopalatine Duct/Incisive Canal cyst, usually?
Heart-shaped
Name the cyst that is located posterior to the incisive papilla in the midline of the hard palate.
Median palatal cyst
Name the cyst that is lined by keratinized stratified squamous epithelium and is often filled with keratin.
Epidermoid cyst
Name the cyst that is lined by keratinized stratified squamous epithelium and is often filled with sebaceous glands, hair follicles, bone, muscle, etc.
Dermoid cyst
What other neoplasm does a dermoid cyst resemble?
Teratoma
Where is the most common location for an epi/dermoid cyst?
Floor of the mouth
If the patient has a bulge in the floor of the mouth/has no neck, the epi/dermoid cyst is (above/below) the mylohyoid.
Above
If the patient has a double chin, the epi/dermoid cyst is (above/below) the mylohyoid.
Below
Name the cyst that occurs on the midline, between the foramen cecum of the tongue and the suprasternal notch.
Thyroglossal duct cysts
What causes a thyroglossal duct cyst?
Epithelial remnants of the thyroid migration turn into cysts
What is the treatment for a thyroglossal duct cyst, and why?
Remove, because it may turn malignant
What % of thyroglossal duct cysts occur below the hyoid?
70%
Name the cyst that comes from epithelium trapped in lymph nodes.
Cervical Lymphoepithelial cyst (Branchial Cleft Cyst)
Name the cyst that occurs in the lateral neck as an asymptomatic, slow-growing fluctuant mass.
Cervical Lymphoepithelial cyst (Branchial Cleft Cyst)
Name the cyst that occurs in oral lymphoid tissue, is yellow, and has no rete pegs.
Oral lymphoepithelial cyst
Where do 50% of oral lymphoepithelial cysts occur?
Floor of the mouth
Name the cyst that occurs in the maxilla, after a maxillary sinus surgery/extraction.
Surgical Ciliated Cyst of the maxilla
What type of lining does a Surgical Ciliated Cyst of the maxilla have?
Respiratory epi
What causes a surgical ciliated cyst of the maxilla?
Epi becomes implanted/trapped at the site of surgery and starts to proliferate and cavitate
Name the cyst that is similar to dermoid but has gastric/intestinal mucosa lining.
Heterotropic Oral Gastrointestinal Cyst/Anterior Median Lingual Cyst/Gastric Cystic Choristoma
What is the age and gender predilection for Heterotropic Oral Gastrointestinal Cysts?
Infants/young children, males
Where is the most common location for a Heterotropic Oral Gastrointestinal Cyst (2)?
1 Tongue 2 Floor of the mouth
Name the pseudocyst that should be completely obvious on a radiograph.
Simple bone cyst/Traumatic Bone cyst
Why is a Simple bone cyst not a cyst?
It has no epithelium, and the cavity is empty
What is a key characteristic on the radiographs for a Simple bone cyst?
Scalloped border
What is the age group for Simple bone cysts?
Young adults
Are simple bone cysts associated with (non/vital) teeth?
Vital
What is the treatment for a Simple bone cyst?
Curette to start bleeding, then it heals on its own
Name the pseudocyst that has salivary gland tissue in it.
Lingual Mandibular Salivary Gland Depression (Static bone cyst/Stafne bone cyst)
Name the pseudocyst that radiographically occurs as an ovoid lucency between the mandibular canal and inferior border, with a sclerotic border.
Lingual Mandibular Salivary Gland Depression (Static bone cyst/Stafne bone cyst)
Name the uncommon vascular lesion of jaws/bones that resembles a "blood-soaked sponge".
Aneurysmal Bone Cyst
Do Aneurysmal bone cysts occur mainly in the maxilla or mandible?
Mandible
What is a differential diagnosis for an Aneurysmal Bone Cyst?
OKC
Name three other lesions that may be associated with an Aneurysmal Bone Cyst.
1 Fibrous dysplasia 2 Hemangioma 3 Traumatic bone cyst
What is the most common type of oral change?
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Lowest recurrence rate of the three types.
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Childhood/Late teens - 20s
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Affects more females than males
All three
Minor, Herpetiform, or Major Aphthous: Affects 20% of the general population
Aphthous Minor
Minor, Herpetiform, or Major Aphthous: Affects non-smokers
Aphthous Minor and Major
Minor, Herpetiform, or Major Aphthous: Caused by - Inherited and immunodysregulation, mucosa decrease, and antigen increase
Aphthous Minor and Major
What is the most common clinically significant odontogenic tumor?
Ameloblastoma
Common, Unicystic, or Peripheral Ameloblastoma: Average age of occurrence is 30 years old.
Common
Common, Unicystic, or Peripheral Ameloblastoma: Benign aggressive
Common
Where do 85% of Common ameloblastomas occur?
Posterior mandible
Common, Unicystic, or Peripheral Ameloblastoma: Multilocular radiolucency with small compartments
Common
How do you differentate the multilocular radiolucency of a common ameloblastoma from a cyst?
Ameloblastoma has SMALL compartments, but cysts have BIG compartments
What disease features nests of odontogenic epithelium with stellate reticulum inside a rim of columnar ameloblasts?
Common Ameloblastoma
What disease features connective tissue stroma separating epithelial nests?
Common Ameloblastoma
Common, Unicystic, or Peripheral Ameloblastoma:Not encapsulated
Common
Common, Unicystic, or Peripheral Ameloblastoma: Resection is the typical treatment
Common
If a Common ameloblastoma is curetted, what is the recurrence rate (____-____%)?
50-90%
Name a differential diagnosis for Common ameloblastoma, and why it is similar.
Simple bone cyst - Scalloped border
Common, Unicystic, or Peripheral Ameloblastoma:Benign and not locally destructive
Unicystic
Common, Unicystic, or Peripheral Ameloblastoma:Average age of occurrence is 23 years old
Unicystic
Where do 90% of unicystic ameloblastomas occur?
Posterior mandible
Common, Unicystic, or Peripheral Ameloblastoma: Unilocular radiolucency, well-circumscribed
Unicystic
What disease features a cystic cavity, lined by ameloblasts, filled with stellate reticulum?
Unicystic Ameloblastoma
Common, Unicystic, or Peripheral Ameloblastoma: Capsulated
Unicystic
Name 3 differential diagnoses for Unicystic Ameloblastoma.
1 OKC 2 Dentigerous cysts 3 Simple bone cysts
How do you differentate Unicystic Ameloblastoma from Dentigerous cysts?
Unicystic Ameloblastomas are larger on radiographs
Name 3 differential diagnoses for Peripheral Ameloblastoma.
1 Pyogenic granuloma 2 Peripheral Giant Cell Granuloma 3 Peripheral Fibroma
Does peripheral Ameloblastoma look more like a well defined Common or Unicystic Ameloblastoma?
Common
What is the age and gender predilection for Adenomatoid odontogenic tumors?
10-19 years old, females
What is the MOST common site for an Adenomatoid odontogenic tumor?
Anterior maxilla, which is VERY unusual for an odontogenic tumor
T/F: Adenomatoid odontogenic tumors never occur around teeth.
False, 75% occur around unerupted teeth
How do you differentiate Adenomatoid odontogenic tumors from Dentigerous cysts?
Adenomatoid odontogenic tumors attach somewhere other than the CEJ, and occur in kids (not adults)
What disease histologically features columnar cells in duct-like arrangement, and polyhedral cells arranged in loose sheets?
Adenomatoid odontogenic tumors
Why are Adenomatoid odontogenic tumors so easy to remove, and have rare recurrence?
Because of their thick fibrous capsules, excision is curative
What is the age predilection for Calcifying Epithelial Odontogenic Tumors/Pindborg tumors?
Adults, 30-50 (a 40+ disease)
Name the tumor that most commonly presents as a painless, slow-growing swelling.
Calcifying Epithelial Odontogenic Tumors/Pindborg tumors
Calcifying Epithelial Odontogenic Tumors/Pindborg tumors can be (radiolucent/opaque/mixed/more than one)?
Pure radioluent or mixed
If Calcifying Epithelial Odontogenic Tumors/Pindborg tumors are mixed radiolucencies, what two patterns of radioopacity are often seen?
1 Ground glass 2 Cotton wool
What disease histologically features polyhedral epithelial cells, and amyloid or amyloid-like material?
Calcifying Epithelial Odontogenic Tumors/Pindborg tumors
Calcifying Epithelial Odontogenic Tumors/Pindborg tumors are classified as (innocuous, benign, benign aggressive, malignant).
Benign
Name the exceptionally rare tumor that appears to arise from neoplastic transformation of the rests of Malassez.
Squamous odontogenic tumor
What age range can squamous odontogenic tumor occur within?
8-74 years old
Name the disease that radiographically looks like a periodontal defect, destroyig crestal bone, and occurring as a triangular lucency lateral to tooth roots.
Squamous odontogenic tumor
What disease histologically features nests of bland stratified squamous epithelium?
Squamous odontogenic tumor
What uncommon tumor has both epithelial and mesenchymal tissue that are neoplastic?
Ameloblastic fibroma
What age group is most often affected by ameloblastic fibroma?
Teens, or younger
What is the site predilection for ameloblastic fibroma?
Posterior mandible
If any child presents with a radiolucent lesion in the posterior mandible, what disease is it until proven otherwise?
Ameloblastic fibroma
What disease histologically features islands of odontogenic epithelium, and developing tooth germ, with plump fibroblasts?
Ameloblastic fibroma
How does ameloblastic fibroma histologically differ from ameloblastoma?
Epithelial islands are small,and too skinny to be filled with stellate reticulum
What is the most common type of odontogenic tumor, exceeding the prevalence of all other odontogenic tumors combined?
Odontoma
What disease features multiple, small structures with recognizable tooth morphology?
Compound odontoma
What disease features masses/globs of tissue with no anatomic resemblance to a tooth?
Complex odontoma
During what age range are odontomas usually detected?
0-20
What is the site predilection for compound odontomas?
Anterior maxilla
What is the site predilection for complex odontomas?
Posterior mandible
If you cannot tell the type of odontoma by looking at the morphology,what is a reliable indicator of type?
Site of occurrence
If an odontoma is associated with a tooth, will it be around the crown or the root?
Crown
What is the age predilection for ameloblastic fibro-odontoma?
Children
What is the more common pattern of odontogenic fibroma; peripheral or central?
Peripheral
Name the tumor that most commonly presents as a painless, slow-growing gingival swelling, which occurs at any age.
Peripheral odontogenic fibroma
What disease histologically featues fibrous connectiv tissue and odontogenic epithelial nests?
Peripheral odontogenic fibroma
What is gender predilection for central odontogenic fibroma?
Females, 2.2:1
What are the two most common site predilections for odontogenic fibromas?
Anterior maxilla, or posterior mandible
What disease is often associated with a palatal mucosal groove when the lesions are in the maxilla?
Central odontogenic fibroma
What is the age predilection for odontogenic myxomas?
Young adults
Name the disease that radiographically has small honeycomb loculations, and often has a delicate, wispy appearance.
Odontogenic myxoma
Why is an odontogenic myxoma hard to remove?
It is soft, mushy, and gelatinous, like an umbilical cord, and clean margins are hard to get
What disease is histologically indistinguishable from osteoblastoma?
Cementoblastoma
What is the age predilection for cementoblastomas?
Young adults, under 25
What is the single-most common site for cementoblastomas to occur?
Mandibular first molars
With cementoblastomas, are the teeth (non/vital)?
Vital *KEY
What tumor should be easily identifiable only by radiographs?
Cementoblastoma
What does a cementoblastoma look like on radiographs?
Mixed, well-defined radiolucency/opacity, with a central opaque portion that obscures the root outline of the tooth
Why might cementoblastoma be mistaken for osteoblastoma/sarcoma?
Histologically indistinguishable
How is a cementoblastoma treated?
Remove, with the entire tooth, or do root canal and do partial amputation
Name the systemic disease defined as an absolute decrease in amount of bone due to bone resorption.
Osteoporosis
What is the age and gender predilection for osteoporosis?
50+ females
What is the generic term for increased amounts of calcified bone, and thus, increased density?
Osteosclerosis
Name 3 conditions that would produce osteosclerosis.
1 Metastatic tumors from prostate/breast 2 Lead poisoning 3 Hypothyroidism
Name two synonyms for Hyperparathyroidism.
1 Von Recklinghausen's 2 Osteitis fibrosa cystica
What generally characterizes hyperparathyroidism?
Generalized bone loss, replaced by fibrous tissue
What is the age and gender predilection for hyperparathyroidism?
Middle-aged females
What causes primary hyperparathyroidism?
Parathyroid adenoma
What causes secondary hyperparathyroidism?
Poor renal function, leading to decreased vitamin D, and decreased calcium
Name the two classic radiographic features of hyperparathyroidism.
1 Ground glass 2 Loss of lamina dura
Name 3 histological findings in hyperparathyroidism.
1 Cellular fibrous stoma 2 Vascular brown tumors 3 Giant cells
Name the disease that is characterized by abnormal/no bone resorption, so new bone is added on top of a crumbling foundation.
Osteopetrosis
Name the disease that features blue sclera.
Osteopetrosis
How is benign osteopetrosis transmitted?
Autosomal dominant
What is the age of onset for benign osteopetrosis?
Middle-to-older age
What disease has common manifestations of: Multiple pathologic fractures, pain, cranial nerve palsy, and osteomyelitis?
Benign osteopetrosis
How is malignant osteopetrosis transmitted?
Autosomal recessive
What is the age of onset for malignant osteopetrosis?
Birth; none survive to 20 years old
What disease has common manifestations of: Optic atrophy, hepatosplenomegaly, loss of hearing, pathological fractures, and osteomyelitis/secondary infections?
Malignant osteopetrosis
Name four dental findings in osteopetrosis.
1 Delayed eruption 2 Enamel hypoplasia 3 Osteomyelitis risk 4 Pathologic jaw fracture
What are the 2 radiographic features of osteopetrosis?
1 Milky, opaque changes 2 Increased cortical thickening
What disease classically features bilateral, symmetrical swelling of the mandible?
Cherubism
What is the 100% site predilection for cherubism?
Mandible
What is the age and gender predilection for cherubism?
Children, males
Why is the inheritance pattern for cherubism unique?
100% penetrance for males, 75% for females
What is the classic radiographic feature for cherubism?
Soap-bubble pattern radiolucencies
What disease is cherubism histologically similar to? How do you differentiate the two?
Hyperparathyroidism, but kids are too young to get it
What histologic feature is classic for cherubism?
Pink zone of eosinophilic cuffing
What is the most common bony lesion in the jaw?
Tori/exostoses
If a tori is located in the palate at the midline,what is it called? What about those that are anywhere other than midline palate?
Tori palatinus = Palate midline. Palatal tubercles/Buccal or palatal exostoses if anywhere else
Name the disease characterized by inflamed/necrosing bone that occurs in bone that was previously iradiated.
Osteoradionecrosis
What is the cause of osteoradionecrosis?
Compromised blood supply from radiation
What is the best treatment for osteoradionecrosis?
PREVENTION
What type of drugs can cause the same pattern as osteoradionecrosis?
Bisphosphonate drugs
Name the disease that is an inflammatory condition spreading in the medullary saces or cortical surface of bone.
Osteomyelitis
What causes most of the cases of osteomyelitis in the jaws?
Odontogenic infection
What radiographic features are seen in osteomyelitis after 1-2 weeks of acute onset?
Moth-eaten, skip radiolucencies
What is unique about the lacunae in osteomyelitis?
They are empty!
Name the disease that is a unique proliferative reaction in inflamed or irritated bone.
Osteomyelitis with proliferative periostitis
Name the age predilection for Osteomyelitis with proliferative periostitis.
Young people, way below 25 years old
What is the classic radiographic feature for Osteomyelitis with proliferative periostitis?
Onion-skin layering of new bone over the cortex
What is the treatment for Osteomyelitis with proliferative periostitis and osteomyelitis?
Remove the source of infection
Name the disease that is a localized area of osteosclerosis associated with the apex of a tooth with pulpal inflammation.
Condensing osteitis
What is the radiographic feature of condensing osteitis?
Radioopacity that blends with adjacent patterns
Name the disease that is radiographically indistinguishable from condensing osteitis. What is the difference? Which is more common?
Idiopathic osteosclerosis. Idiopathic has no obvious source of trauma/inflammation. Idiopathic is more common
Where do 90% of idiopathic osteosclerosis occur?
Mandible
Name the three types of Cemento-Osseous Dysplasias.
1 Periapical 2 Focal 3 Florid
What are the most common fibro-osseous lesions encountered in dentistry that we WILL see?
Cemento-Osseous Dysplasias
Cemento-osseous dysplasia is (almost always/very rarely) biopsied.
Very rarely
Name the three stages of Cemento-osseous dysplasia that are common to all three types.
1 Osteolytic 2 Blastic 3 Mature
What stage of Cemento-osseous dysplasia is always radiolucent, and features proliferating cellular fibroblastic tissue?
Osteolytic
What stage of Cemento-osseous dysplasia is mixed radiolucent/opaque, and features irregular immature bone/cementum within a fibrous stroma?
Blastic
What stage of Cemento-osseous dysplasia is mostly opaque, with a lucent rim, and features a central core of dense cementum/bone with fibrous tissue at the periphery?
Mature
What is the basis for determining the type of Cemento-osseous dysplasia?
Site of occurrence
What is the most common form of Cemento-osseous dysplasia?
Periapical
What is the age, gender, and ethnic predilection for Periapical Cemento-osseous dysplasia?
30-50 years old, Black, Women
What is the site predilection for Periapical Cemento-osseous dysplasia?
Anterior mandibular teeth ONLY
With Cemento-osseous dysplasia (all types), teeth are (non/vital).
Vital
What is the age, gender, and ethnic predilection for Focal Cemento-osseous dysplasia?
30-60 years old, White, Women
What is the site predilection for Focal Cemento-osseous dysplasia?
Trick question- It can occur anywhere, but is SOLITARY
What is the age, gender, and ethnic predilection for Florid Cemento-osseous dysplasia?
Middle-aged Black females
What classifies a Florid Cemento-osseous dysplasia?
At least one lesion in all four quadrants
What type of Cemento-osseous dysplasia may require attention because complications will require treatment?
Florid Cemento-osseous dysplasia
Name 5 complications of Florid Cemento-osseous dysplasia if teeth are not well-maintained.
1 Secondary infection 2 Poor healing after ext 3 Simple bone cysts 4 Resorption of ridges 5 OSTEOMYELITIS (yuck)
Name the disease that is classified as a developmental anomaly and features ground-glass radiographs, with no distinguished borders, and bone trabeculae that appear to arise directly from bone.
Fibrous dysplasia
What name is used for fibrous dysplasia that involves multiple bones, but not the entire skeleton, and features café-au-lait spots but no endocrine involvement?
Jaffe-Lictenstein Syndrome, a type of polyostotic fibrous dysplasia
What radiographic features are seen in Jaffe-Lictenstein syndrome that are not seen in other fibrous dysplasias?
Cotton-wool appearance, NOT ground glass
What is more important for diagnosing Jaffe-Lictenstein syndrome, radiographs or clinical findings?
Clinical findings
What name is used for fibrous dysplasia that involves multiple bones, features café-au-lait spots with endocrine involvement?
McCune-Albright syndrome
What is the most common type of fibrous dysplasia?
Monostotic
What is the classic radiographic appearance for fibrous dysplasia?
Finely stippled ground glass appearance, with ill-defined borders
If Richards shows an occlusal film with ground glass appearance, what is the most likely diagnosis?
Fibrous dysplasia
What is another name for Osteitis Deformans?
Paget Disease of Bone
Describe the etiologic development of Paget Disease of bone.
Osteoblasts exceed osteoclasts
What is the age predilection for Paget Disease of bone?
Adults over 40
What dental complaints will be seen with Paget Disease of bone?
"Occlusion is changing" "Denture doesn't fit anymore"
What is the classic radiographic presentation for Paget Disease of bone?
Cotton-wool appearance, loss of lamina dura, and hypercementosis
Besides biopsy, what can be used to diagnose Paget Disease of bone?
Serum alkaline phosphatase
What disease is associated with a 30X risk for developing osteosarcoma, and therefore patients should not be radiographed?
Paget Disease of Bone
What disease might come from fibroblasts, cementoblasts, or osteoblasts, but we're not sure?
Cemento-ossifying Fibroma
Where does cemento-ossifying fibroma occur more: Maxilla or mandible?
Mandible
What is the age predilection for Cemento-ossifying fibroma?
Young adults, rarely over 40
Cemento-ossifying fibroma should never be used on a differential diagnosis if the unknown lesion is (pure radiolucent/opaque/mixed).
Pure radiolucent - COF is usually mixed
What is the only bone disease (besides benign/malignant bone tumors) that must be excised? Why?
Cemento-ossifying Fibroma - It continues to grow
How can you differentiate a Cemento-ossifying fibroma from a Cemento-osseous dysplasia?
Osteoblastic/Cementoblastic rimming is common with COF
What shape are benign bone tumors, usually?
Round
What disease looks similar to tori/exostoses, and fibrous dysplasia? How do you tell the difference?
Osteoma - osteomas grow!
What systemic disease is associated with Osteomas?
Gardner's syndrome
Name 5 clinical features of Gardner's syndrome.
1 Multiple osteomas 2 Epidermoid cysts 3 Adenomatous polyps 4 Impacted/supernumerary teeth 5 Colon cancer risk
Name two closely related fibro-osseous neoplasms that are only distinguished on size.
Osteoid osteomas and osteoblastomas
What is the age predilection for osteoblastoma/osteoid osteoma?
Adolescents/young people
Name the clinical feature of osteoblastoma/osteoid osteoma.
Pain and swelling
What rare disease features knobby growths on cartilage?
Chondroma
Name the disease that is Richards' favorite, which is histologically indistinguishable from the brown tumor of hyperperathyroidism.
Central Giant Cell Granuloma
What is the age and gender predilection for central giant cell granulomas?
Children/young adult females
What is the site predilection for central giant cell granuloma?
Mandible
What is the usual clinical presentation for a central giant cell granuloma?
Bony swelling
What is the radiographic appearance of a central giant cell granuloma?
Pure radiolucency, NOT multilocular
What disease histologically features multinucleated giant cells resembling osteoclasts and resembles brown tumors of hyperparathyroidism?
central giant cell granuloma
Name 2 congenital anomalies that may occur centrally in the jaws.
Central Hemangioma and Vascular Malformations
What is the age and site predilection for Central Hemangioma and Vascular Malformations?
Adolescents, Mandible
List 4 clinical features of Central Hemangioma and Vascular Malformation.
1 Bony destruction 2 Expansion 3 Facial asymmetry 4 Purple gingiva
What is the most common primary malignancy of bone?
Osteosarcoma
List 3 contributing factors for osteosarcoma.
1 Paget Disease of Bone 2 Prior irradiation tx 3 Osteogenesis Imperfecta
What is the age and site predilection for Osteosarcoma?
Avg. age 33, Mand=Max
List 4 S/S of osteosarcoma.
1 Pain/swelling 2 Loose teeth 3 Toothache 4 Paresthesia
Describe the radiographic presentation of osteosarcoma.
Bony expansion, mixed opacity, Sunburst, widened PDLspace
Name a malignancy that closely resembles Odontogenic myxoma.
Chondrosarcoma
What is the age and site predilection for chondrosarcoma?
Peak incidence in 7th decade, Max:Mand 4:1
Describe the radiographic presentation of chondrosarcoma.
Expansile radiolucent mass, poorly defined margins, possibly speckled opacities
What is the most important histologic feature of chondrosarcoma?
Appearance/architecture of cells
What is the cell of origin of Ewing Sarcoma?
Neuroectoderm
What is the age, race and site predilection of Ewing Sarcoma?
2nd decade, strong white predominance, Mandible
What is the classic radiographic presentation of Ewing Sarcoma?
Onion-skin layering of new bone over the cortex
Describe the S/S of Ewing Sarcoma.
pain/swelling, paresthesia, loose teeth, fever, leukocytosis
What is the histologic presentation of Ewing Sarcoma?
Small dark round cells, scant cytoplasm, little stroma, cells contain glycogen
What is the most common malignancy in bone?
metastatic tumor
Name 3 tumors that tend to metastisize to bone.
Prostate, Breast, Lung
Name 3 tumors that tend to metastisize to jaws.
Breast (30%), Lung (20%), Kidney (15%)
Describe the radiographic presentation of Metastatic lesions.
Diffuse radiolucencies, poorly defined (but can be well circumscribed)
What are the two most common PRIMARY malignant bone tumors?
Osteosarcoma and Chondrosarcoma
Name the 5 most common MALIGNANT tumors occurring in bone.
1 Metastatic Tumor 2 Multiple Myeloma 3 Osteosarcoma 4 Chondrosarcoma 5 Ewing Sarcoma
Name 4 bone disorders that may be difinitively diagnosed by radiograph.
1- Cementoblastoma 2- Compound Odontoma 3- Peripheral Cemento- Osseous Dysplasia 4- Nasopalatine Duct Cyst
Name 2 bone disorders that have "ground glass" appearance.
1- Hyperparathyroidism 2- Fibrous Dysplasia
This is a condition that is associated with delayed eruption or unerupted tooth.
Adenomatoid Odontogenic Tumor
This bone disorder has diffuse borders and is associated with "tilted teeth."
Central Giant Cell Granuloma
The histology of this lesion displays eosinophilic cuffing.
Cherubism
My deaf cat Paget lost his dentures while playing with a cotton ball.
You have my permission to beat the crap out of me if I miss this one!!
This bone disorder has generalized milky opacity.
Osteopetrosis
The residual bone in this lesion is "delicate and wispy."
Odontogenic Myxoma
The onion-skin pattern of bone in this bone disorder best seen in an occlusal film.
Osteomyelitis with proliferative periostitis
These two bone disorders display brown tumors histologically.
1- Hyperparathyroidism 2- Central Giant Cell Granuloma
Name 4 bone disorders that exhibit giant cells histologically.
1- Central Giant Cell Granuloma 2- ABC 3- Cherubism 4- Peripheral Giant Cell Granuloma
These two bone diseases display "moth-eaten" pattern of loss.
1- Osteomyelitis 2- Malignancies
These 3 bone disorders are round radiographically.
1- Cementoblastoma 2- Osteoma 3- Osteoblastoma/Osteoid osteoma
This bone disorder has a palatal mucosal groove.
Central Odonogenic Fibroma
Amyloid or amyloid-like material is often present and may contain focal calcifications.
Calcifying Epithelial Odontogenic Tumors/Pindborg tumors
Avoid radiation Tx for these two disorders.
1- Paget Disease of Bone 2- Fibrous Dysplasia
This one is for me: Name the 3 P's!
1- Pyogenic Granuloma 2- Peripheral Giant Cell Granuloma 3- Peripheral Fibroma