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>
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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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