Jaw cysts: Difference between revisions

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Cystic changes in the jaw bones or around teeth:


==Microscopic examination==
==Microscopic examination==
Attempt to characterize the lining of the cyst. Look for important signs:
===Signs===
<gallery mode=packed heights=200>
File:Histopathology of cholesterol clefts of a periapical cyst of the jaw.jpg|'''Cholesterol clefts''': Indicates of a periapical (radicular) cyst<ref name=PathologyOutlinesPeriapical/> or an inflamed dentigerous cyst<ref name=PathologyOutlinesDentigerous/>.
</gallery>
Any keratinization of the lining.
Any signs of malignancy. {{Further|Evaluation of suspected malignancies|linebreak=no}}
===Diagnoses===
[[File:Relative incidence of odontogenic cysts.jpg|thumb|Relative incidence of odontogenic cysts.<ref>{{cite journal|author=Leandro Bezerra Borges; Francisco Vagnaldo Fechine; Mário Rogério Lima Mota; Fabrício Bitu Sousa; Ana Paula Negreiros Nunes Alves|title=Odontogenic lesions of the jaw: a clinical-pathological study of 461 cases.|journal=Revista Gaúcha de Odontologia|year=2012|volume=60|issue=1|url=http://revodonto.bvsalud.org/scielo.php?script=sci_arttext&pid=S1981-86372012000100010&lng=pt&nrm=iso}}</ref>]]
[[File:Relative incidence of odontogenic cysts.jpg|thumb|Relative incidence of odontogenic cysts.<ref>{{cite journal|author=Leandro Bezerra Borges; Francisco Vagnaldo Fechine; Mário Rogério Lima Mota; Fabrício Bitu Sousa; Ana Paula Negreiros Nunes Alves|title=Odontogenic lesions of the jaw: a clinical-pathological study of 461 cases.|journal=Revista Gaúcha de Odontologia|year=2012|volume=60|issue=1|url=http://revodonto.bvsalud.org/scielo.php?script=sci_arttext&pid=S1981-86372012000100010&lng=pt&nrm=iso}}</ref>]]
By epidemiology, look for signs of being either a periapical cyst (also called radicular cyst), a dentigerous cyst or a residual cyst:
All the following are odontogenic cyst, and in case of inability to specify further, may be simply diagnosed as such:


{|class="wikitable"
{|class="wikitable"
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|-
|-
! Periapical (radicular) cyst
! Periapical (radicular) cyst
| Stratified squamous epithelium of variable thickness, except when originating in a maxillary sinus where there is respiratory epithelium (pseudostratified ciliated columnar epithelium).<ref name=PathologyOutlinesPeriapical/>
| '''Stratified squamous''' epithelium of variable thickness, except when originating in a maxillary sinus where there is respiratory epithelium (pseudostratified ciliated columnar epithelium).<ref name=PathologyOutlinesPeriapical/>
|
|
*A fibrous capsule of varying thickness, with chronic inflammatory cells, wherein a plasma cells may be abundant.<ref name=PathologyOutlinesPeriapical>{{cite web|url=https://www.pathologyoutlines.com/topic/mandiblemaxillaperiapicalcyst.html|title=Mandible & maxilla - Odontogenic cysts - Periapical (radicular) cyst|website=Pathology Outlines|author=Annie S. Morrison, Kelly Magliocca}} Topic Completed: 1 March 2014. Revised: 13 December 2019</ref>
*A fibrous capsule of varying thickness, with chronic inflammatory cells, wherein a plasma cells may be abundant.<ref name=PathologyOutlinesPeriapical>{{cite web|url=https://www.pathologyoutlines.com/topic/mandiblemaxillaperiapicalcyst.html|title=Mandible & maxilla - Odontogenic cysts - Periapical (radicular) cyst|website=Pathology Outlines|author=Annie S. Morrison, Kelly Magliocca}} Topic Completed: 1 March 2014. Revised: 13 December 2019</ref>
They sometimes have the following features:<ref name=PathologyOutlinesPeriapical/>
They sometimes have the following features:<ref name=PathologyOutlinesPeriapical/>
*Cholesterol clefts in the cyst lining.
*Cholesterol clefts in the cyst lining.
| [[File:Histopathology of a periapical cyst, with metaplastic changes of mucous secreting cells, and ciliated cells.jpg|thumb|Histopathology of a periapical cyst, with metaplastic changes of mucous secreting cells (B), and ciliated cells (C).<ref name=Tsesis2016>{{cite journal|last1=Tsesis|first1=I|last2=Rosen|first2=E|last3=Dubinsky|first3=L|last4=Buchner|first4=A|last5=Vered|first5=M|title=Metaplastic changes in the epithelium of radicular cysts: A series of 711 cases|journal=Journal of Clinical and Experimental Dentistry|year=2016|pages=0–0|issn=19895488|doi=10.4317/jced.52846}}<br>- "Fig 2- available via license: Creative Commons Attribution 2.5 Generic"</ref>]]
| [[File:Histopathology of a periapical cyst, with metaplastic changes of mucous secreting cells, and ciliated cells.jpg|thumb|220px|Histopathology of a periapical cyst, with metaplastic changes of mucous secreting cells (B), and ciliated cells (C).<ref name=Tsesis2016>{{cite journal|last1=Tsesis|first1=I|last2=Rosen|first2=E|last3=Dubinsky|first3=L|last4=Buchner|first4=A|last5=Vered|first5=M|title=Metaplastic changes in the epithelium of radicular cysts: A series of 711 cases|journal=Journal of Clinical and Experimental Dentistry|year=2016|pages=0–0|issn=19895488|doi=10.4317/jced.52846}}<br>- "Fig 2- available via license: Creative Commons Attribution 2.5 Generic"</ref>]]
|-
|-
! Non-inflamed dentigerous cyst
! Non-inflamed dentigerous cyst
Line 28: Line 41:
They occasionally have:
They occasionally have:
*Dystrophic calcifications
*Dystrophic calcifications
| [[File:Histopathology of dentigerous cyst.jpg|220px]]
|-
|-
! Inflamed dentigerous cyst
! Inflamed dentigerous cyst
| Hyperplastic non-keratinized epithelium<ref name=PathologyOutlinesDentigerous/
| Hyperplastic non-keratinized epithelium<ref name=PathologyOutlinesDentigerous/>
| Typically:<ref name=PathologyOutlinesDentigerous/>
| Typically:<ref name=PathologyOutlinesDentigerous/>
*Fibrous connective tissue
*Fibrous connective tissue
Line 39: Line 53:
They occasionally have:<ref name=PathologyOutlinesDentigerous/>
They occasionally have:<ref name=PathologyOutlinesDentigerous/>
*Dystrophic calcifications
*Dystrophic calcifications
|
|-
|-
! Residual cyst
! Residual cyst
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In early cysts, the epithelial lining tend to be proliferative and arcading, with an intense inflammation.
In early cysts, the epithelial lining tend to be proliferative and arcading, with an intense inflammation.
<br>Established cysts tend to rather have fairly regular lining with a higher degree of differentiation, resembling a simple stratified squamous epithelium
<br>Established cysts tend to rather have fairly regular lining with a higher degree of differentiation, resembling a simple stratified squamous epithelium
| Cyst lumen may demonstrate fluid and cellular debris.<ref name=PathologyOutlinesResidual/>
|
|}
|}


All types above can occasionally have scattered mucous or ciliated cells, as well as Rushton bodies, which are amorphic, eosinophilic, linear to crescent-shaped bodies in the cyst epithelium.<ref name=Tsesis2016/><ref name=PathologyOutlinesPeriapical/><ref name=PathologyOutlinesDentigerous/><ref name=PathologyOutlinesResidual/>
All types above can occasionally have scattered mucous or ciliated cells, as well as Rushton bodies, which are amorphic, eosinophilic, linear to crescent-shaped bodies in the cyst epithelium.<ref name=Tsesis2016/><ref name=PathologyOutlinesPeriapical/><ref name=PathologyOutlinesDentigerous/><ref name=PathologyOutlinesResidual/>
==Report==
*Type of lining
*Other visible features
*At least the most probable type of cyst.
*Even absence of signs of malignancy
Example:
{|class="wikitable"
| [[File:Histopathology of a periapical cyst, with metaplastic changes of mucous secreting cells, and ciliated cells.jpg|left|200px]] Parts of a cyst, lined by stratified squamous epithelium, with foci of mucous cells and ciliated cells. The underlying fibrous capsule contains cholesterol clefts and inflammation. No signs of malignancy.<br>- Benign odontogenic cyst of periapical type.
|}
{{Reporting}}
{{Bottom}}
{{Bottom}}

Latest revision as of 11:14, 4 March 2020

Author: Mikael Häggström [note 1]
Cystic changes in the jaw bones or around teeth:

Microscopic examination

Attempt to characterize the lining of the cyst. Look for important signs:

Signs

  • Cholesterol clefts: Indicates of a periapical (radicular) cyst[1] or an inflamed dentigerous cyst[2].
    Cholesterol clefts: Indicates of a periapical (radicular) cyst[1] or an inflamed dentigerous cyst[2].

Any keratinization of the lining.

Any signs of malignancy. Further information: Evaluation of suspected malignancies

Diagnoses

Relative incidence of odontogenic cysts.[3]

All the following are odontogenic cyst, and in case of inability to specify further, may be simply diagnosed as such:

Cyst type Lining epithelium Other characteristics Image
Periapical (radicular) cyst Stratified squamous epithelium of variable thickness, except when originating in a maxillary sinus where there is respiratory epithelium (pseudostratified ciliated columnar epithelium).[1]
  • A fibrous capsule of varying thickness, with chronic inflammatory cells, wherein a plasma cells may be abundant.[1]

They sometimes have the following features:[1]

  • Cholesterol clefts in the cyst lining.
Histopathology of a periapical cyst, with metaplastic changes of mucous secreting cells (B), and ciliated cells (C).[4]
Non-inflamed dentigerous cyst
  • 2 - 4 layers of cuboidal epithelium, devoid of superficial keratinization.[2]
  • Sometimes partially a thin, fragmented layer of eosinophilic columnar cells or low cuboidal epithelium[2]
 Typically:[2]
  • Fibrous to fibromyxoid connective tissue
  • No rete ridges, flat interface

They occasionally have:

  • Dystrophic calcifications
Inflamed dentigerous cyst Hyperplastic non-keratinized epithelium[2] Typically:[2]
  • Fibrous connective tissue
  • Chronic inflammatory cells

Sometimes:[2]

  • Elongated interconnecting rete ridges
  • Cholesterol clefts, possibly cholesterol granuloma

They occasionally have:[2]

  • Dystrophic calcifications
Residual cyst Stratified squamous epithelium:[5]
  • May demonstrate exocytosis, spongiosis, and/or hyperplasia
  • May be discontinuous in part and range in thickness from 1 to 50 cell layers, but usually 6 - 20 cell layers

In early cysts, the epithelial lining tend to be proliferative and arcading, with an intense inflammation.
Established cysts tend to rather have fairly regular lining with a higher degree of differentiation, resembling a simple stratified squamous epithelium

Cyst lumen may demonstrate fluid and cellular debris.[5]

All types above can occasionally have scattered mucous or ciliated cells, as well as Rushton bodies, which are amorphic, eosinophilic, linear to crescent-shaped bodies in the cyst epithelium.[4][1][2][5]

Report

  • Type of lining
  • Other visible features
  • At least the most probable type of cyst.
  • Even absence of signs of malignancy

Example:

Parts of a cyst, lined by stratified squamous epithelium, with foci of mucous cells and ciliated cells. The underlying fibrous capsule contains cholesterol clefts and inflammation. No signs of malignancy.
- Benign odontogenic cyst of periapical type.

  See also: General notes on reporting


Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Annie S. Morrison, Kelly Magliocca. Mandible & maxilla - Odontogenic cysts - Periapical (radicular) cyst. Pathology Outlines. Topic Completed: 1 March 2014. Revised: 13 December 2019
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Kelly Magliocca, Annie S. Morrison. Mandible & maxilla - Odontogenic cysts - Dentigerous. Pathology Outlines. Topic Completed: 1 October 2013. Revised: 2 December 2019
  3. ↑ Leandro Bezerra Borges; Francisco Vagnaldo Fechine; Mário Rogério Lima Mota; Fabrício Bitu Sousa; Ana Paula Negreiros Nunes Alves (2012). "Odontogenic lesions of the jaw: a clinical-pathological study of 461 cases. ". Revista Gaúcha de Odontologia 60 (1). Archived from the original. . 
  4. ↑ 4.0 4.1 Tsesis, I; Rosen, E; Dubinsky, L; Buchner, A; Vered, M (2016). "Metaplastic changes in the epithelium of radicular cysts: A series of 711 cases ". Journal of Clinical and Experimental Dentistry: 0–0. doi:10.4317/jced.52846. ISSN 19895488. 
    - "Fig 2- available via license: Creative Commons Attribution 2.5 Generic"
  5. ↑ 5.0 5.1 5.2 Annie S. Morrison, Kelly Magliocca. Mandible & maxilla - Odontogenic cysts - Residual cyst. Pathology Outlines. Topic Completed: 1 April 2014. Revised: 13 December 2019

Image sources


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