studyguide.txt

A young boy enters your office with the chief complaint of a swelling of his right mandible. You order a Panorex to better visualize the lesion. It appears that the small, unilocular, radiolucency is around the crown of an unerupted tooth, attached to the CEJ. The borders are well-defined and sclerotic. Biopsy shows a thin, non-keratinized layer of epithelium.

What lesion is this?

What lesion is this?

During perio probing, you notice an unusally deep pocket on the buccal of #30. The patient complains of a foul-tasting discharge, swelling and tenderness in the area. An occlusal radiograph shows you that the lesion is in the buccal bifurcation and is a well-circumscribed, unilocular radiolucency invovling the buccal bifurcation and the root.

What lesion is this?

Routine radiographs were taken and a small unilocular radiolucency with a well-defined border in the periapical region was found. The tooth was found to be Non-Vital after endo testing. The patient had a history of a large carious lesion on the crown of the tooth. Biopsy shows a significant number of rests of Malassez, as well as exocytosis and spongiosis of the epithelium.

What lesion is this?

Your patient presents for their routine 6 mo check-up. You take annual radiographs and notice a well-defined, corticated radiolucency at an extraction site from 2 years ago. You ask the patient the purpose of the extraction and they said they had some kind of cyst at the root of the tooth. What is this lesion now?

A new patient comes into your office and you take radiographs. You notice a small well-defined RL with smooth and corticated borders. It is unilocular and between two teeth. The patient is asymptomatic and the teeth are vital. You take a biopsy and the results show small satellite cysts within the fibrous wall, uniformly thick epithelium and a palisaded basal cell layer with hyperchromatic nuclei. There is only one lesion present.

What lesion is this?

A patient presents with swelling in the posterior right mandible near the 3rd molars. A panorex shows a unilocular radiolucency that somewhat resembles a dentigerous cyst. A biopsy was taken and the results show orthokeratin without nuclei and an unpalasaded basal cell layer. There is also a prominent granular cell layer. Recurrance of this lesion is rare.

A small well-circumscribed RL lateral to the roots of #20 and #21 is visible on your 55yo patient’s radiograph. The patient is asymptomatic. Histology shows that the lesion is derived from rests of dental lamina and that the lesion is lined by thin uniform, flattened squamous epithelial cells. There are focal nodular thickenings or “epithelial plaques” that form a swirl appearance.

What lesion is this?

A 0.5cm nodule is visible on your patient’s gingiva near the root of #20. This fluid-filled swelling of the facial gingiva appears blue-gray. Histology shows that the lesion is derived from rests of dental lamina and that the lesion is lined by thin uniform, flattened squamous epithelial cells. There are focal nodular thickenings or “epithelial plaques” that form a swirl appearance.

As a pediatric dentist, you see a lot of babies with these lesions. They are small, superficial, keratin-filled cysts on the alveolar mucosa. They are derived from the rests of dental lamina. There are usually multiple whitish papules 2-3mm in size on mucosa overlying the alveolar processes. They will disappear spontaneously.

A unilocular, well-defined RLwith radiopacities or calcifications is visible on your patient’s radiograph. You take a biopsy of the area and the results are extremely characteristic: ghost cell keratinization and calcification, epithelium similar to enamel organ and ameloblastoma, loose stellate/spindle cells and columnar cells are all present.

What lesion is this?

This lesion is derived from rests of dental lamina and it is known to show aggressive behavior. It is usually found in the anterior mandible. Radiographic evidence shows a unilocular or multi-locular RL with well-defined and sclerotic borders. Histology presents with a lesion lined by stratified squamous epithelium exhibiting cilliated columnar cells. Small microcysts and clusters of mucous cells are present in the cystic lining.

A new patient presents to your office with a significant number of basal cell carcinomas on their skin. You take the typical panorex and notice several well-defined RL’s with smooth, corticated borders. You ask them if they have any other unique symptoms and they say that they know they have some rib malformations as well as palmer pits. What is your diagnosis?

Your patient complains of a painless swelling near the angle of the left mandible. You take a radiograph and see a “soap bubble” apearance of a large multilocular RL lesion. Adjacent roots have been somewhat resorbed. You take a biopsy of the lesion and the results show islands of odontogenic epithelium. There are peripheral columnar cells with reverse polarity of nuclei as well.

What lesion is this?

Your patient complains of a painless swelling near the angle of the left mandible. You take a radiograph and see a “soap bubble” apearance of a large multilocular RL lesion. Adjacent roots have been somewhat resorbed. You take a biopsy of the lesion and the results show islands of odontogenic epithelium. There are peripheral columnar cells with reverse polarity of nuclei as well.

What lesion is this?

What lesion is this?

A young 10yo boy presents to your office complaining of a swelling in the anterior maxilla. You take an occlusal radiograph and see a circumscribed, unilocular radiolucency that is involving the crown of the impacted canine. There is evidence of small “snowflake” calcifications, but to be sure you order a medical CT and take a biopsy. The histology shows a very thick fibrous capsule as well as nuceli of columnar cells polarized away from the central duct-like structures.

What lesion is this?

A male patient presents to your office with a swelling of the right mandible near the premolars. He claims it is painless. You take a panorex and see a radiolucency with flecks of opacities. There is strong tooth displacement and the lesion is ill-defined. You take a biopsy and results show concentric Liesegang Ring calcifications as well as giant multi-nucleated cells. A test with Congo Red proves positive for amyloid proteins.

What lesion is this?

Radiographic findings show a small well-defined RL associated with periradicular areas of erupted teeth. Larger lesions can be multi-locular and 12% show small internal radiopacities. Some root resorption is visible as well as significant tooth displacement. It’s soft tissue counterpart is very rare, but appears as a slow-growing, sessile mass covered by normal ginigva.

What lesion is this?

A locally aggressive mandibular lesion showing expansion of the bone as well as tooth displacement is visible on the radiograph of your patient. The borders are irregular and thin, wispy trabeculae of residual bone create a honeycomb appearance. There is no evidence of root resorption. The biopsy results show haphazardly arranged stellate, spindle-shaped and round cells as well as an abundance of glycoaminoglycans. There is no capsule and the lesion is jelly-like.

What lesion is this?

A young male patient presents with a some-what painful swelling near #29. He says that it has been slow-growing. You take a panorex and see a well-defined radiopacity surrounded by a RL halo. The lesion appears to be attached to the root of #29 of which is somewhat resorbed. Tooth #28 and #30 seem displaced. The biopsy results prove strongly active osteoblastic activity and dentin resorption. The patient has not had #4 or #5 extracted.

What lesion is this?

A patient presents with a tumor consisting of both epithelial and mesenchymal neoplastic tissue. There is an expansile, painless swelling with tooth displacement on his posterior manidble. The lesion is associated with the follicle of an unerupted tooth and appears to be extending from the follicle. It is a well-defined, unilocular lesion. Biopsy shows no calcifications and long narrow cords of odontogenic epithelium, anastamosing.

What lesion is this?

What lesion is this?

An ameloblastic fibroma that becomes malignant is called a______________________.

What lesion is this?

Your patient presents with the chief complaint of my molar didn’t erupt. You take a panorex and see a conglomerate of RO material blocking the eruption pathway for #3. The material appears to have the density of dental tissue surrounded by a narrow RL rim. The structure is not associated with any tooth or root directly and has not affected the tooth follicle.

Your teenage patient presents with facial swelling and pain in the posterior segment of the right mandible. You take a panorex and see a unilocular RL with cortical expansion and thinning. The teeth are somewhat displaced. You aspirate the lesion prior to biopsying and retract blood. The biopsy shows blood-filled spaces lined by fibroblastic CT. There are scattered multi-nucleated giant cells adjacent to the vascular space.

What lesion is this?

Your 45yo female patient presents for her routine 1yr check-up. There is an area of RL in her edentulous posterior right mandible. The RL contains fine trabeculation, is circumscribed, but has ill-defined borders. For precaution, you take a biopsy and the biopsy results return with hematopoetic progenitor cells and fat cells.

A 15yo patient presents for regular check-up and cleaning. You take a panorex and notice a well-defined, unilocular RL with irregular borders. The outline appears to be scalloping between the roots of teeth, but no displacement or root resorption is visible. The patient is asymmtomatic. You take a biopsy and the results show a thin connective tissue layer with reactive bone, but no epithelial lining.

What lesion is this?

A middle-aged African American woman comes into your office for a cleaning and radiographs. You notice a mixed density lesion about 1cm in diameter near #24. You do endo testing and determine that the tooth is vital. Because the patient is asymptomatic, you decide to wait until her next appointment in 3 months to do anything. You take another radiograph at her next visit and notice that the lesion is more RO than before. The tooth is still vital and the patient is still asymptomatic. You make the diagnosis without a biopsy.

A new patient comes into your office for radiographs and a cleaning. You take a panorex and notice multiple well-defined, lobular radiolucencies with evidence of radiopaque areas on both sides of the mandible near the molars. You take an occlusal radiograph and notice expansion and swelling of the right ramus. You test vitality of the teeth and all teeth are vital. There is no evidence of root resorption, however you believe there is some hypercementosis. The patient claims that they are asymptomatic and haven’t been to a dentist in over 20 years.

A new 45yo female patient comes into your office for routine radiographs. You notice a small region of mixed density in her edentulous posterior right mandible. She is completely asymptomatic and didn’t know that she had this kind of lesion there. You decide to take a biopsy and the results show specules of bone and some cementum-like hard tissue within moderately cellular fibrous tissue. Because you cannot make a definitive diagnosis, you consult an Oral Surgeon and they advise surgical investigation.

What lesion is this?
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What lesion is this?

What lesion is this?

A 35yo female comes into your office with the chief complaint of painless swelling in the posterior right manidble. You take a panorex and see a well-defined, unilocular lesion with mixed density. You notice that it has corticated borders and is separated from the normal bone by a thin RL line. You also notice that the teeth are significantly displaced. There is obvious facial asymmetry clinically.

A 9yo female comes into your office. You notice a “ground glass” opacification on her left posterior maxilla. There is no evidence of other lesions similar to this one in her jaws or rest of her skeleton. The borders are not well-demarcated and seem to be blending with the normal bone. You take a biopsy and the results show irregularly shaped trabeculae of immature bone in a cellular, loosely arranged, fibrous stroma. The trabeculae take on curvilinear shapes. From genetic testing, her mother tells you that her daughter has genetic mutation of the GNAS1 gene.

What lesion is this?

A 3yo girl presents with multiple café au lait spots on her trunk and thighs. She has sexual precocity and already menstrates in addition to developing breasts. There is evidence based on a panorex that areas of her mandible contain excessive proliferation of cellular fibrous connective tissue intermixed with irregular trabeculae. The lesion shows bone resorption, tooth displacement, root resorption and the borders are ill-defined and blend with the normal bone. This type of lesion has been found in her tibia and skull. What is her diagnosis?

This benign tumor is composed of compact or cancellous bone. It can arise on a surface of the bone as a polypoid or sessie mass. It is slow growing and is associated with Gardner Syndrome. It can cause a progressive shift in patient occlusion and deviation of the midline.

This RO mass is fused to one or more tooth roots. It is surrounded by a thin RL rim. Root resorption is clearly visible due to the fusion of root with tumor.

This benign tumor is composed of mature hyaline cartilage. It is commonly located on the short tubular bones of the hands and feet. When present in the jaws, if has been known to recur and act in a malignant manner.

What benign or malignant?

What benign or malignant?

What is this called and what is characteristic of?

Metastatic tumors of the jaw come from which four carcinomas primarily?

List 5 of the 9 radiographic appearances of malignant bone tumors.

Benign or Malignant?

Which malignant tumor of the oral cavity presents with uni- or multi-locular radiolucency with well-defined borders?

A 7 yo patient comes into your office with significant gingival infiltration and swelling. There is evidence of periodontal disease and destruction of the alveolar bone. Some teeth have significant mobility and radiographically have lost their lamina dura. There are some ill-defined RL’s near the mobile teeth as well as destruction of the corticies and periosteal reaction. What could this child have?

A 11yo male presents with loosening, displacement and early eruption of teeth. There is significant jaw expansion and he complains of paresthesia of the chin. You take a panorex and see multiple RL foci in the molar region of his right mandible. These lesions seem to have coalesced together and have irregular borders. There is clear erosion, peroforation, destruction and displacement of both the buccal and lingual cortices. What does this child have?

A 55yo male presents with the CC of weakness and pain in the lower jaw. You take a panorex and see a pathological fracture of the body of the right mandible. The radiograph shows multiple, small, well-defined non-corticated RL’s with a “punched-out” look. There is facial asymmetry clinically and evidence of mobile teeth in the affected area. Due to this presentation, you order a cephalograph and see that the skull is involved as well. What is your diagnosis?

Benign or Malignant?

Benign or malignant?

Benign or malignant?

The patient presents radiologically with multiple osteomas, supernumerary teeth, and sebacious hyperplasia. What condition do you suspect? Why is it important to investigate?

Radiographs shows a well-defined radiolucency of the posterior mandible and the clincian elects to biopsy the specimen. Upon aspiration, lots of blood is found. What pathology is now on your DDx?

What are the three stages common to fibro-osseus lesions and what is their radiologic manifestation?

A patient presents with a small, non-corticated periapical radiolucency associated with #25. Pulp testing showed the tooth to be vital. You decide to watch the lesion and see that a few months later, there are small opacifications present. What is your diagnosis?

A patient presents with a destructive, radiolucent lesion with sclerotic borders in the posterior mandible. It has caused tooth mobility but no displacement. What is the general class of the lesion? We later find out that the patient has been diagnosed with breast cancer. What is the diagnosis?

In an initial exam a dentist finds an incidental focal area of increased radiopacity in the area of #30 and 31. Pulp testing showed vital teeth. It is somewhat sclerotic. Biopsy shows dense lamellar bone with fibrofatty marrow. Follow-up shows that there is no cortical expansion and the lesion does not grow in size. What is the diagnosis?

An 11 year old patients presents with pain and facial swelling. Lesion presents as a rapidily growing, expansile radiolucency with thinning of the cortices. Histology is remarkable for blood-filled spaces lined by CT septa and multinucleated giant cells. No epithelial lining is found. What is the diagnosis and what should be kept in mind when treating?

Patient presents with a chief complaint of pain and tenderness of the midface. The history shows that he recently suffered a large fracture of the maxillary sinus 6 months ago. Radiographs are taken which show a well-defined radiolucency apical to the roots of 9 and 10 but not associated with the teeth. Biopsy shows ciliated epithelial cells as well as goblet cells. What is the diagnosis?

An 18 year old male presents with a “swollen jaw”. Radiographs show a unilocular, well-defined corticated radiolucency around an impacted #32. A closer look at the radiograph shows a cyst-like cavity originating at the CEJ and enveloping the tooth. Histology shows epithelial rests with myxoid connective tissue as will as thin, non-keratinized epithelial lining. What is at the top of your diagnosis?

A 7 year old girl present for a periodic exam when a swelling is noticed in the area of the left posterior mandible on the alveolar ridge. The swelling is soft and translucent. Bitewing radiographs show a developing #19 in the cystic area. The girl is very afraid of knives and needles but you assure her it wont be necessary. Why are you able to say that.

The histology of the lesion shows uniform flattened squamous epithelial cells with focal nodular thickening of the enamel epithelium. What is your DDx?Clinically, you see that the lesion if found as a well-circumscribed radiolucency adjacent to the MB root of #30. Pulp testing showed a vital tooth. What is your final diagnosis?

A 2 month old male baby presents with a multiple whitish papules on the left maxillary posterior alveolar mucosa. What diagnostic tests would be needed to confirm your suspicion and what would be your treatment?

A well-defined corticated unilocular radiolucency is found in the interproximal between teeth #30 and #31 along the lateral aspect of #31 mesial root. There is some discomfort in the area. Histology showed inflamed stratified squamous epithelium with exocytosis and spongiosis. Pulp testing revealed a non-vital tooth. What is the diagnosis?

Endo treatment of the lateral APC fails and the tooth is extracted. Months lateral, the well-defined corticated radiolucency remains. Histology comes back the same as before. What is the Dx:

A dental student in Puerto Rico takes an intial FMX and discovers a lesion in the jaw of the patient. The student is not instructed by Dr.Tetradis and thus described the unilocular well-defined corticated radiolucency spanning from the mid-ramus to the distal of #31 showing significant anterior-posterior expansion and limited bucco-lingual expansion instead as a “hole in the jaw”. A UCLA dental student and amateur pathologist on vacation was able to obtain a biopsy and study it on a makeshift microscope on the beach. The histology showed epithelium of uniform thickness with parakeratin corrugation and a palisaded, hyperchromatic basal layer. Due to rolling blackouts, the UCLA student was not able to view the digital radiographs, but still came up with the correct diagnosis, which is…

The panoramic radiograph shows a well-defined, yet amorphous radiopacity adjacent to the rooth of #27 with a small rim of radiolucency surrounding the lesion. It appears the root has not been affected. What type of lesion is this? Be specific. Had the root been incorporated into the lesion and resorbed, what would be your primary diagnosis?

Blood tests are typically not very helpful when diagnosing oral pathology. However, they have been show to be helpful in diagnosing Brown tumors and hyperparathyroidism. Are these statements T/F?

The patient presents with a unilocular, well-defined corticated radiolucency in the region of the posterior mandible. What is your diagnosis? Just kidding. CT imaging shows some very small opacities present within the lesion. However, Dr. Tetradis has ruled these radiographs unusable because they are “not of diagnostic quality”. Histology reveals that there are small cellular spaces without nuclei. A few of them have become calcified. There are also stellate/spindle cells and columnar cells present. Does the CT need to be retaken or is the histo enough?

A unilocular, well-defined radiolucency is found incidentally in the anterior mandible. Histology shows the presence of multinucleated giant cells. What are your top 2 DDx? Histo also showed some deposits of brownish-reddish pigment and CT showed significant cortical expansion and thinning. What is the final Dx?

You are an oral radiologist and are presented with a DDx of ameloblastoma, OKC and simple bone cyst based upon clinical findings and panoramic radiograph. The lesion is fairly large. What is your preferred imaging modality (and the best view) to further explore this lesion and why?

A student notices a radiolucent, moderately well-defined unilocular lesion surrounding the apices of the roots of 28-30. This forms a soemwhat scalloped outline, which is somewhat irregular. All the associated teeth test vital. A panoramic is taken, showing multiple small, well-defined lesions of mixed density found throughout the mandible. What is going on here.