Odontogenic cyst

Odontogenic cyst - Pathogenesis and Microscopy

1. Odontogenic cyst – Pathogenesis & Microscopy RameshKumar Prof. Dept. of Oral Pathology SRM Dental College

2. Components of cyst ( Kystis – Greek Word – Sac, bladder, pouch, bag)

3. Frequency of odontogenic cysts in Indian population RC 70% (67) DC 20% (18) OKC 08% (12) LPC 01% (0.7) GC(a) 01% (0.6) CEOC (0.3) GOC (0.2) Er.C (0.2) *According to the T.B. Cysts of oral & maxillofacial regions – Mervyn Shear 95.2% Odo . Cyst – OKC, RC, DC (Ref : Oncofetal transformation – D.K.Shruthi – JMOFP, Vol. 18, Sep-Dec 2014) Analysis of odontogenic cysts in South Indian population –Manickam selvamani , Brazillian oral research –Aug.2012(vol.26;no.4)

4. F Radicular cyst in relation to primary teeth 0.5% - 03% F PA lesions resolve after tooth removal F Left untreated – very less symptoms F Diagnostic errors – non referral for path. Exam. F Regresses after endo . treatment (Exact reason for less incidence is yet to be explained) Rad.cyst associated with deci.molars – Narasopur IJDR -2012 (vol.23)

5. Periapical Granuloma

6. Pathogenesis – Radicular Cyst

7. Pathogenesis

8. Histopathology

9. Dead RBC’s & lympocytes releases cholesterol from their cell membrane Plasma lipids also contribute cholesterol Histopathology

10. F Rushton bodies F Odontogenic epi. Origin - enamel cuticle / Keratin Epithelial Secretion – around cell debris or RBC or macrophages (type 1 & 2) Hematogenous origin Rushton bodies in RC – Sumitha Jacob, Indian jr. of path. & micro. 2010(vol.53)

11. True RC needs surg. Intervention, Dept. of oral biology – Uni. Of Zurich, Int. endo . Jr. (2002) Bay cyst mostly heals after RCT True RC needs surgical intervention

12. Dentigerous cyst - Intrafollicular

13. Dentigerous cyst - Extrafollicular

14. Dentigerous cyst

15. Dentigerous cyst – Radiographic variants

16. OKC - Pathogenesis

17. Histopathology

18. OKC

19. Follicular OKC

20. Radiograh - OKC

21. Gingival Cyst / Dental Lamina cyst of new born Keratinized epithilium Epstein’s Pearls Bohn’s nodules Non Odo . Cysts Cysts of new born

22. Lateral periodontal cyst Cell Of Origin REE Malassez Serres Jn. Epithilium Traumatic imp. Of Oral Epithilium Serres

23. Lateral periodontal & Gingival cyst

24. Botryoid odontogenic cyst

25. BOC - Piyush Arora : contemp.clin.dent 2012(July) One LPC - BOC Multiple LPC unites – BOC BOC – cannot be considered as LPC – extends well beyond lateral area of root – vander waal . BOC, a variant of LPC – shows aggressive behaviour and recurrence rate but with same histological features. Botryoid odontogenic cyst

26. GOC - Microscopic Criteria for diagnosis - Craig B. Fowle – Head & Neck Pathology [2011-(5)] * Surface hobnail cells Intra epi . micro cysts (duct like spaces lined by a layer of cuboidal cell) – opening in to lumen Apocrine snouting of hob nail cells – “Pinching off” Mucus cell / clear cells (glycogen rich) Variable thickness of cyst lining (non kesatinized ) Epithelial plaques Cilia Glandular odontogenic cyst

27. COC S.M. Balaji Ann. Maxillofacial surgery 2012 (Jan) Origin (REE, Odo . Epithilium ) Mutated presecretory ameloblast or post secretory ameloblast . - that has acquired its mesenchymal inducting potential. During its course may form Ghost cells – get calcified Ghost cells Enamel matrix Abnormal Keratin Type of Necrosis Calcifying odontogenic cyst

28. CCOT Cystic Lining ( Ameloblastomatous ) Solid islands in C.T. Dentin like / Odontome in C.T. Associated with other odontogenic tumuors Pretorius (2006) Simple cyst (CEOC) Cyst with Odo . Hamartomas / Tumuors (CCOT) Benign appearing solid islands similar to CEOC with dentinoid ( dentinogenic ghost cell tumuor ) Malignant - dentinogenic ghost cell Carcinoma Calcifying odontogenic cyst – old concept

29. Calcifying odontogenic cyst – Ghost cell

30. Unicystic ameloblastoma REE – associated with developing tooth undergoes ameloblastomatous transformation with subsequent cyst development Solid Ameloblastoma undergoes cystic degeneration in ameloblastomatous islands with subsequent fusion of multiple microcysts and develops into unicystic ameloblastoma ( Eversole )

31. Unicystic ameloblastoma

32. Mural Type Unicystic ameloblastoma

33. CD10 & Osteopontin expression in DC UCA & MCA, Shaimaa M-Diagnostic pathology 2011 CD10 & Osteopontin expression in DC, UCA & MCA ++ DC ++++ UCA ++++++ MCA Unicystic ameloblastoma

34. CD 10 – Normal – Haemopoitic and Lymphoid Cells - Homeostasis (Apoptosis & Proliferation) in Malig . Haemopoitic and Lymphoid Cells in Breast ca., OSCC, BCC - Poor Prognosis OPN (BSP) – Bonematrix - Normal Bone Cells, T-Lymphocytes, Macro Phages - Resorption , Cell Survival In tumors - Calcification, Resorption , Neovascularlization , Tumor Cell Migration - Poor Prognosis Role of CD10 and OPN

35. AOT & DC – Anshita agerwal , Case reports in pathology-2012 DC associated with AOT 9 Cases in lit. 05m - 0 4f 08 - 17y. 08max. - 01man. 08ant. - 01post. Odontogenic cyst or Hybrid tumor? Odontogenic cyst or Hybrid tumor?

36. AOT & DC

37. Bilateral or multiple dentigerous cysts- Avinash Tam Gadge – Jr. of Oral & Maxillofacial Pathology 2011 – [15(1)] Only 21 reported in literature, usually associated with Syndromes – cleidocranial dysplasia, maroteaux – Lamy Syndorme Bilateral or multiple dentigerous cysts

38. Cmyc oncogene exp. in seletected odo cyst & tumor an IHC study, K.Rekha , Jomfp – 2013 Vol. 17 80% - OKC, AM, AOT 50% - RC 20% - DC OKC Cmyc = AM & AOT Inherent proli . Capacity of OKC * Increased Cmyc in RC is due to IL-1 from inflam.cells * DC –cyst fluid plays major role in dev. & expansion than epi . Proliferation. Cmyc – Normally – Cell Poliferation , differentiation, arrest and death Early Tooth Development IHC study

39. Analysis of collagen fibers to detect role of CT stroma on bio logical behaviour of Odo.Cysts . Nat. jr . of Mac.Fa.Surg . 2012, vol.3 Young and inmature collagen fibers, loosely arranged in OKC. (Similar to the areas seen in tooth development) – aggressive behavior & epi . Lining also separates easily. Thick mature fibers seen in RC and DC. ( inflam.cells – cytokines– more fibroblasts—mature fibers) Analysis of collagen fibers

40. CK in cysts -Tsuji K – Me. Mol. Morphology 2013, October CK10 - + in surface & Spinous cell layer in OOC & DMC CK17 - + in surface & spinous cell layer in OKC (Para) CK13 & 19 - + in surface and spinous cell layer in OKC (Para) DC & RC OOC – arises from oral epitheluim rather than odo.epithelium . CK in cyst

41. Gorlin Goltz syndrome, Yamamoto : Asian Jr. of Oral & Maxillofacial Surgery, 2011. Basal cell carcinomas (BCC) & OKC : arises due to PTCH 1 gene alteration BCC originate from hair follicles OKC originate from odontogenic epi. remnants. Gorlin Goltz syndrome

42. PIOSCC in odontogenic cysts - JOPM : 2011(40) 60% Radicular / Residual cyst - PIOSCC 40% DC / OKC - PIOSCC H/P either WDSCC or MDSCC Age : 6-8 th decade M : F : 2:1 Mand . : Max : 3:1 PIOSCC

43. Long standing Chronic inflammation in odo . Cysts - Jain M. Mittal – Jr. of Oral & Maxillofacial Surgery 2013, Jan. – 71(1) Long standing chronic inflammation in a benign odontogenic cyst – malignant transformation (Carcinoma) PIOSCC

44. PIOSCC from odo.cyst - Sandhya Tamgadge : E cancer 2013 (316) Frequency is : 1-2/1000 OKC – lining has higher mitotic rate – more chances for mlignancy Long stading inflammation – Reactive oxygen metabolites - Damage to DNA, protein, cell membrances – proliferation of damaged (neoplastic) cells instead of apoptosis. PIOSCC

45. Fissural cyst ?

46. Cervical Spine, sacrum & Illeum - gas is nitrogen Traumatic bone cyst? Parasitic hydatid cyst in human?}--- may contain nitrogen Trematode cyst veternary ? Pneumato cysts

47. Metastasis in Odo . Cysts – Wolfgang Eichhorn, OOO 2010;109 3 Women (Breast Ca.) , 2 Men (Melanoma) Mandible – 4, Maxilla – 1 4 Radicular Cysts, 1 DC Reasons Red marrow of Mandible Chronic inflamation Increased Vascularity Metastasis in Odo . Cysts

48. PTCH Mutation In 85% of NBCC In 35% of Sporodic OKC Suprabasal Distribution of Proliferating Cells Basal Cells not Proliferating (transformed into Ameloblast like cells under the influence of connective tissue) OKC – A Cyst or a cystic neoplasm – T.J.Li – J.Dent.Res.90(2), 2011

49. CK 14 – Typical finding of Odo . Epithilium CK 18 – Fetal Skin (absent in Adult skin epithilium ) CK 18 – Expressed in epithilium after Oncogenic transformation CK 18 – in DC may lead to Ameloblastomatous change Oncofetal transformation – D.K.Shruthi – JMOFP, Vol. 18, Sep-Dec 2014

50. F DC – Less Desmosmes (REE compressed due to Cystic Fluid) OKC Increased Desmosmes Fragile & Damaged in many areas - Affecting structural integrity - Fragility of Epithilium - Recurrence Analysis of Desmosmes in OKC – Prathima Raju – JMOFP, Vol 18, Sep – Dec 2014

51. Thank you!!