1. Identify the key features of jaw cysts.

● Jaw cysts are pathological epithelial-lined cavities that fill with fluid or soft
material and usually grow from internal pressure generated by fluid being drawn
into the cavity from osmosis (hydrostatic pressure). The bones of the jaws, the
mandible and maxilla, have the highest prevalence of cysts in the human body
2. List the differential diagnosis of cyst-like areas of radiolucency in the jaws.
1. Radicular cyst
2. Residual cyst
3. Paradental cyst
4. Mandibular buccal bifurcation cyst
5. Dentigerous cyst
6. Eruption cyst
7. Odontogenic keratocyst
8. Orthokeratinised odontogenic cyst
9. Gingival cysts
10. Lateral periodontal cyst
11. Botryoid odontogenic cyst
12. Glandular odontogenic cyst
13. Calcifying odontogenic cyst
14. Naso-palatine duct cyst
15. Nonepithelial-lined:
16. Secondary aneurysmal bone cystic change
17. Solitary/Simple bone cyst
18. Stafne’s pseudo mandibular cyst
19. Focal osteoporotic bone marrow defect
3. Classify the cysts of the jaws into developmental cysts and inflammatory cysts.
● Radicular cyst Inflammatory
● Residual cyst Inflammatory
● Paradental cyst Inflammatory
● Mandibular buccal bifurcation cyst Developmental
● Dentigerous cyst Developmental
● Eruption cyst Developmental
● Odontogenic keratocyst Developmental
● Orthokeratinised odontogenic cyst Developmental
● Gingival cysts Developmental or Inflammatory
● Lateral periodontal cyst Developmental
● Botryoid odontogenic cyst Developmental
● Glandular odontogenic cyst Developmental
● Calcifying odontogenic cyst Developmental
● Naso-palatine duct cyst Developmental
● Secondary aneurysmal bone cystic change Developmental
● Solitary/Simple bone cyst Developmental
 ● Stafne’s pseudo mandibular cyst Developmental
● Focal osteoporotic bone marrow defect Developmental or Inflammatory
4. Name some cystic odontogenic tumors that can mimic cysts of the jaws.
● Calcifying cystic odontogenic tumor (previously called calcifying odontogenic
cyst)
● Unicystic ameloblastoma
● Keratocystic odontogenic tumor (previously called odontogenic keratocysts)
● Botryoid odontogenic cysts
● Glandular odontogenic cysts
5. List the relative frequency of the main jaw cysts.
● jaw cysts affect approximately 3.5% of the population [3]. The most common type
of jaw cyst is the radicular cyst, representing over 50% of jaw cysts in several
studies [2]. Dentigerous cysts are the second most common type of jaw cyst,
followed by residual cysts and odontogenic keratocysts [3].
6. Provide the differential diagnosis of a well-defined unilocular radiolucency in the
jaws.
● Radicular cysts are typically well-circumscribed periapical, unilocular
radiolucencies that may cause displacement of neighboring structures, and root
resorption may also be present. Dentigerous cysts, also known as odontogenic
developmental cysts, are commonly associated with impacted teeth and present
as well-defined unilocular radiolucencies with well-defined border
● Other possible differential diagnoses may include ameloblastoma, keratocystic
odontogenic tumors, and odontogenic myxomas, among others
7. Provide the differential diagnosis of a multilocular radiolucency at the angle of
mandible.
● A multilocular radiolucency at the angle of mandible requires further evaluation
and imaging to identify the underlying cause. A comprehensive differential
diagnosis should consider several potential etiologies, including ameloblastoma,
odontogenic keratocyst, giant cell granuloma, central giant cell lesion, cherubism,
and metastatic tumors
8. Identify which cysts have characteristically diagnostic histological features.
9. Describe the clinical and radiological features of the radicular cyst.
● Radicular cysts are the most common type of odontogenic cystic lesion of
inflammatory origin . These cysts typically arise as a result of pulpal necrosis or
inflammation following dental caries or trauma, and they are most commonly
found in the periapical region of the affected tooth.
● Clinically, radicular cysts are characterized by a small, round- or pear-shaped,
unilocular, lucent lesion that is usually less than 1 cm in diameter and is bordered
by a thin rim of cortical bone. The associated tooth typically has a deep
restoration or large carious lesion, with caries appearing as erosion of the
enamel/crown of the affected tooth.
● Radiographically, radicular cysts appear as well-defined radiolucencies in the
periapical region of the affected tooth, with a thin, often sclerotic margin. These
 cysts are usually centered on the root apex and can expand the surrounding
cortical bone
10. Explain the pathogenesis of the radicular cyst.
● The pathogenesis of the radicular cyst is associated with inflammation and
infection of the dental pulp, which progresses to the periapical region through the
apical foramen or lateral root canal [1]. The activation of epithelial remnants in
the periodontal ligament due to inflammation is also believed to be involved in the
pathogenesis of radicular cysts [3]. The inflammation and subsequent
proliferation of epithelial remnants lead to the formation of a pathologic cavity
lined by epithelium and often filled with fluid, which is characteristic of radicular
cysts [1][3]. If a tooth associated with a radicular cyst is extracted but the cyst is
not removed, it may persist and continue to expand, resulting in a residual cyst
11. Describe and identify the histological features of the radicular cyst in detail.
● Radicular cysts are inflammatory odontogenic cysts that develop in the periapical
region of non-vital teeth [2].
● The histological features of the radicular cyst include a hyperplastic
non-keratinized epithelial lining, intense mural inflammation, and abundant
cholesterol clefts [3]. The source of epithelium is cell rests of Malassez, and the
proliferation is stimulated by inflammation [2].
● The cyst lining is typically composed of stratified squamous epithelium with a
variable thickness that ranges from one to several cell layers, depending on the
cyst's age and degree of inflammation [3]. The epithelium may have varying
degrees of hyperplasia, ranging from mild to severe, and may be hyperkeratotic
[3].
● The connective tissue wall surrounding the cyst may have various degrees of
fibrosis and chronic inflammation, including plasma cells, lymphocytes, and
macrophages [2].
● In radiographic images, radicular cysts typically appear as round- or
pear-shaped, unilocular, lucent lesions in the periapical region, usually less than
1 cm in diameter and bordered by a thin rim of cortical bone.
● The associated tooth may have deep restoration or large carious lesions, which
will appear as erosion of the enamel/crown
12. Explain how may hyaline or Rushton bodies aid in cyst diagnosis.
● Hyaline or Rushton bodies are peculiar structures that can be found in the
epithelial lining of odontogenic cysts. These structures are eosinophilic, linear,
curved or straight, irregular or rounded, polycyclic, and glassy in nature, and their
presence in the cystic lining can aid in the diagnosis of a radicular cyst. The
presence of these structures depends on the sectioning plane of the tissue and
their frequency varies. In particular, Rushton bodies are more commonly
observed in radicular cysts compared to other odontogenic cysts, and their
presence can contribute to the diagnosis of radicular cysts [1][2]. Therefore, the
detection of hyaline or Rushton bodies in a cystic lining during microscopic
examination can help in the diagnosis of a radicular cyst.
 ● However, it should be noted that the presence of Rushton bodies is not
pathognomonic for radicular cysts, and their presence alone cannot confirm the
diagnosis of a radicular cyst. Other factors such as clinical history, radiographic
findings, and other histological features must also be considered to make a
definitive diagnosis
13. Explain the origins of the residual cyst and the lateral radicular cyst and describe
their features.
● Residual cysts are inflammatory odontogenic cysts that develop after a tooth has
been extracted, leaving behind a remnant of a radicular or periapical cyst in the
bone [1][2]. The residual cysts are more commonly seen in the maxilla, and they
appear as unilocular, radiolucent lesions on radiographic imaging [1]. These cysts
can cause bone resorption and expansion of the surrounding bone, leading to the
displacement of adjacent teeth [2].
● Lateral radicular cysts are also known as paradental cysts, and they arise from
the lateral aspect of the root of a tooth, most commonly mandibular third molars.
They can also develop from the periodontal ligament of partially erupted teeth [1].
Lateral radicular cysts present as a unilocular radiolucency with a well-defined
border, and the lesion is located lateral to the root of the affected tooth
14. Explain what radiological cortication is and what it does represent.
15. Explain the rationale for marsupialisation of large cystic lesions.
● The rationale for marsupialization of large cystic lesions of the jaw is to reduce
the size of the cyst and allow for natural healing of the surrounding tissues. This
is accomplished by making a small incision in the cyst and draining its contents.
The cyst wall is then sutured to the surrounding mucosa, creating a pouch that
remains open to the oral cavity or nasal cavity [3]. The purpose of this pouch is to
allow for the continuous drainage of any remaining fluid or debris, while also
facilitating the formation of new epithelial tissue. Over time, the size of the cyst
will decrease, and the surrounding tissues will heal, thus reducing the risk of
complications such as infection, pain, and nerve damage
16. Explain the possible origins of a paradental cyst and compare its histology to that
of the radicular cyst and an inflamed dentigerous cyst.
● Paradental cysts are inflammatory cysts that occur in the periodontal tissues
adjacent to the roots of partially erupted or impacted teeth. The origin of
paradental cysts is unclear, but it is believed to arise from the proliferation of the
reduced enamel epithelium, which gets trapped in the periodontal tissues during
tooth eruption [1].
● Histologically, a paradental cyst has a well-defined capsule that is lined by
stratified squamous epithelium with varying degrees of hyperplasia and
inflammation. The lumen of the cyst is filled with inflammatory exudates and
granulation tissue [3].
● A radicular cyst, on the other hand, is a type of periapical cyst that develops at
the apex of a non-vital tooth. The cyst forms as a result of an inflammatory
reaction to necrotic pulp tissue within the root canal system. The lining of the cyst
 is composed of epithelial cells, which undergo hyperplasia and form multiple
layers [4].
● An inflamed dentigerous cyst is a type of odontogenic cyst that arises from the
follicle surrounding an unerupted tooth. Inflammation in the follicular space
results in the formation of a cyst. Histologically, the lining of an inflamed
dentigerous cyst is composed of non-keratinizing stratified squamous epithelium
with varying degrees of inflammation and hyperplasia [2].
● In summary, a paradental cyst arises from the periodontal tissues adjacent to the
roots of partially erupted or impacted teeth, and its histology is characterized by a
well-defined capsule lined by stratified squamous epithelium with varying degrees
of hyperplasia and inflammation. This is different from the histology of a radicular
cyst, which has a lining composed of hyperplastic epithelial cells, and an inflamed
dentigerous cyst, which has a lining of non-keratinizing stratified squamous
epithelium with varying degrees of inflammation and hyperplasia.
17. Give the definition of a dentigerous cyst and list its key features.
● A dentigerous cyst is a common type of odontogenic cyst that forms over an
unerupted or partially erupted tooth, also known as an impacted tooth. It
develops when fluid accumulates between the crown of an unerupted tooth and
the surrounding dental follicle, which is a sac that encloses the developing tooth.
Dentigerous cysts are typically asymptomatic and are usually discovered during
routine dental X-rays.
● Some key features of a dentigerous cyst include:
○ The cyst is usually located at the crown of an unerupted tooth.
○ It is typically asymptomatic and is often discovered during routine dental
X-rays.
○ It may cause displacement of adjacent teeth or resorption of the roots of
adjacent teeth if it grows large enough.
○ The cyst is lined by epithelial cells, which are the same type of cells that
line the dental follicle. The lining may be either thin and translucent or
thick and opaque, depending on the age and size of the cyst.
○ The fluid inside the cyst is usually clear or yellow and may contain
cholesterol crystals or keratin debris.
18. Describe the radiological appearances of a dentigerous cyst with its variations
and list the differential diagnosis.
● Dentigerous cysts are classified into three types: central, lateral, and
circumferential. Central cysts surround the crown of an impacted tooth, while
lateral cysts are located adjacent to the tooth and are usually associated with the
crown of the tooth. Circumferential cysts involve the entire crown of an impacted
tooth and are often associated with a supernumerary tooth
● May displace the involved tooth for aconsiderable distance
● Root resorption of adjacent teeth may be seen
● Differential diagnoses for a dentigerous cyst include an odontogenic keratocyst,
ameloblastoma, and unicystic ameloblastoma
19. Explain the possible aetiologies and describe the pathogenesis of the dentigerous
cyst.
● According to [1], dentigerous cysts are a type of jaw cyst that can develop around
an impacted or partially erupted tooth. The exact cause of dentigerous cysts is
not fully understood, but it is believed to be related to the fluid accumulation
between the reduced enamel epithelium and the tooth crown of the unerupted
tooth [2]. This accumulation of fluid leads to the separation of the reduced
enamel epithelium from the tooth surface and its proliferation around the crown of
the unerupted tooth, eventually forming a cys
20. Describe in detail the histological features of the dentigerous cyst and recognise
these in images.
● Histologically, a dentigerous cyst has a fibrous wall that is lined with
non-keratinized stratified squamous epithelium [1]. The cyst wall may also
contain inflammatory infiltrate and cystic fluid [2]. The cyst lining may sometimes
show signs of epithelial proliferation, hyperplasia, or metaplasia [2]. It is also
important to note that dentigerous cysts may sometimes undergo malignant
transformation, resulting in a cystic ameloblastoma [1]. A definitive diagnosis of a
dentigerous cyst can be made through a histological examination of a biopsy
specimen
21. Define an eruption cyst and describe its clinical features; recognise the
histological features.
● An eruption cyst is a bluish swelling that occurs on the soft tissue over an
erupting tooth [1]. It is typically seen in children and forms when fluid
accumulates between the tooth that is emerging and the gum tissue surrounding
it. The cyst may be caused by trauma or pressure to the tooth, causing blood
vessels to rupture and blood to collect in the area [2].
● Clinically, eruption cysts are characterized by a blue or bluish-gray swelling on
the soft tissue overlying the tooth that is about to erupt. The cyst is usually
painless, but it can cause discomfort or bleeding if the overlying tissue is
traumatized. The cysts are typically diagnosed through clinical examination [1].
● Histologically, an eruption cyst is a soft tissue analogue of a dentigerous cyst. It
develops as a result of the separation of the dental follicle, which surrounds the
crown of an erupting tooth, from the soft tissue overlying the alveolar bone [3].
The cyst is lined by stratified squamous epithelium and contains clear or
hemorrhagic fluid
22. Define the nature of keratinising odontogenic cysts, list the key features and
distinguish between the two main (parakeratinized and other keratinising) types.
● Keratinising odontogenic cysts are a group of jaw cysts that contain keratin,
which is a protein found in skin, hair, and nails [1]. These cysts are also known as
keratocysts, and they are believed to arise from the cell rests of the dental lamina
or the basal cells of the oral epithelium [3].
● There are two types of keratinising odontogenic cysts: parakeratinized and
orthokeratinized.
 ○ Parakeratinized cysts have a thin epithelial lining that contains a
parakeratinized layer, which is a layer of keratin with retained nuclei.
These cysts are typically smaller and less aggressive than
orthokeratinized cysts [1].
○ Orthokeratinized cysts have a thick epithelial lining that contains an
orthokeratinized layer, which is a layer of keratin without retained nuclei.
These cysts are larger and more aggressive than parakeratinized cysts,
and they are more likely to recur after treatment
● The key features of keratinising odontogenic cysts on radiographic examination
include a well-defined unilocular or multilocular radiolucency, often with a
scalloped margin and internal septa. These cysts also have a tendency to grow
along the mandibular canal, and may cause displacement or resorption of
adjacent teeth [1]. Histologically, keratinising odontogenic cysts have a
characteristic thin, uniform lining composed of keratinizing stratified squamous
epithelium
23. Describe the typical clinical and radiological features of an odontogenic
keratocyst/keratinising cystic odontogenic tumor (OKC/KCOT).
● An odontogenic keratocyst (OKC), previously known as keratocystic odontogenic
tumor (KCOT), is a rare benign cystic lesion that typically involves the mandible
or maxilla and is believed to arise from dental lamina. Clinical features of OKC
are nonspecific, and these cysts are usually asymptomatic and discovered
incidentally on routine radiographs. However, large OKCs can cause swelling and
pain [2]. On radiographs, they appear as a solitary, radiolucent, unilocular,
expansile lesion with smooth, corticated borders, which are often scalloped
around the roots of teeth [1]. These radiological features can be confusing
because of their similarity with other intraosseous cysts. A definitive diagnosis of
OKC can be made by histopathologic examination of the biopsy or resected
specimen. OKCs are characterized histologically by a uniform, parakeratinized
stratified squamous epithelial lining, and they lack an inflammatory component
24. Summarize the etiology, the pathogenesis and growth pattern of the OKC/KCOT
and explain how these differ from the other jaw cysts.
● The exact etiology and pathogenesis of OKCs/KCOTs are still unclear, although
some studies suggest that they arise from the remnants of the dental lamina [2].
OKCs/KCOTs are unique from other jaw cysts due to their aggressive growth
pattern, high recurrence rates, and association with the nevoid basal cell
carcinoma syndrome (NBCCS) [2,3]. Additionally, OKCs/KCOTs have been found
to exhibit mutations in the PTCH1 gene, which is associated with the Hedgehog
signaling pathway [2]. This may explain the cysts' propensity for growth and
recurrence. OKCs/KCOTs are characterized by a thin, uniform lining of
parakeratinized or orthokeratinized stratified squamous epithelium, which may be
corrugated or exhibit an undulating pattern [3]. The cysts typically appear as a
solitary, radiolucent, unilocular, expansile lesion with smooth, corticated borders
on radiographs [2]. Overall, OKCs/KCOTs have unique features that distinguish
them from other jaw cysts, such as ameloblastomas and dentigerous cysts.
25. Describe in detail the histological features of the OKC/KCOT and identify these in
images.
● The cystic neoplasm shows a lack of rete ridges, resulting in a characteristic
separation of the epithelial lining from the underlying fibrous connective tissue [1].
The epithelial lining is uniformly thin and usually six to eight cells thick [1]. The
cysts are typically seen as solitary, radiolucent, unilocular, expansile lesions with
smooth, corticated borders, which are often scalloped around the roots of teeth
[2]. The OKCs show a tendency to infiltrate the adjacent tissue, which is one of
the factors responsible for their high recurrence rates [3]. Overall, the histological
features of OKCs/KCOTs are different from other jaw cysts, such as radicular
cysts, dentigerous cysts, and residual cysts, which have different origins and
growth patterns
26. Explain why odontogenic keratocysts may be possibly neoplastic.
● There are several features of OKCs that support the neoplastic theory, such as
their high recurrence rate and the ability to invade adjacent tissues [1].
● Additionally, OKCs have been shown to exhibit chromosomal abnormalities that
are similar to those observed in other neoplastic conditions
27. Explain the rationale for the aggressive treatment of the OKC/KCOT and list the
possible reasons for the recurrence of keratocysts.
● The rationale for aggressive treatment of OKCs/KCOTs is to prevent their
recurrence and minimize the potential for jawbone destruction. The traditional
method for treating most KCOTs is surgical enucleation, which involves removing
the cystic tissue and surrounding normal bone, followed by the application of a
chemical agent to reduce the risk of recurrence [3]. However, it should be noted
that this approach may not be effective in preventing the recurrence of
OKCs/KCOTs, particularly when dealing with large or aggressive lesions.
Therefore, other treatment options, such as marsupialization or resection, may be
considered, depending on the size and location of the lesion, as well as the
patient's age and overall health
● The possible reasons for the recurrence of keratocysts include incomplete
removal of the cystic tissue during surgery, the presence of satellite cysts, which
are smaller cysts that develop around the main lesion, and the ability of the cystic
lining to proliferate and form new cysts after surgery
● In addition, genetic factors may also play a role in the recurrence of
OKCs/KCOTs, particularly in cases of multiple cysts as a component of nevoid
basal cell carcinoma syndrome (NBCCS)
28. Describe the key features of the Gorlin-Goltz syndrome and the implications for
the multiple recurrences of the associated keratocysts.
● Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome
(NBCCS), is a rare genetic disorder caused by mutations in the patched-1
(PTCH1) gene [2]. This autosomal dominant disorder is characterized by a wide
range of developmental abnormalities that can affect any organ in the body,
including the skin, bones, and reproductive system [1]. Some of the most
common features of Gorlin syndrome include multiple basal cell carcinomas,
 benign cysts in the jaw, and pitted skin in the palms of the hands and soles of the
feet
● One of the implications of Gorlin-Goltz syndrome is the occurrence of multiple
recurrences of the associated keratocysts. These keratocysts, also known as
odontogenic keratocysts, are benign cystic lesions that involve the mandible or
maxilla and are believed to arise from dental lamina [2]. Patients with Gorlin
syndrome are at increased risk for these keratocysts, and they tend to recur even
after aggressive treatment, with reported recurrence rates ranging from 3% to
60% [2][3]. Therefore, it is important for individuals with Gorlin syndrome to
undergo regular dental and medical checkups to monitor for the presence of
these cysts and to treat them promptly
29. Describe the clinical features of the gingival cyst of the newborn and adults.
● Gingival cysts of the newborn are small, round or oval nodules, white to yellowish
in color, and measuring about 2-3 mm in size. They are located on the alveolar
ridge of the jawbones and usually disappear spontaneously after weeks to a few
months [3].
● On the other hand, gingival cysts in adults are smooth, asymptomatic, and
bluish-colored gingival swellings without osseous involvement. They are usually
larger than those in newborns and do not resolve spontaneously
30. Identify the key features of the lateral periodontal cyst and its variants.
● the lateral periodontal cyst (LPC) is a rare developmental odontogenic cyst that
is non-inflammatory and non-keratinized in nature, located adjacent or lateral to
the root of a vital tooth. LPCs are considered to have the same histopathological
characteristics as gingival cysts of adults (GCA) [3]. LPCs have the lowest
incidence when compared to other developmental cysts in the oral cavity [1].
LPCs are often diagnosed as a radiographic finding, presenting as a
well-circumscribed or a round or teardrop-shaped radiolucent area [2]. LPCs are
usually asymptomatic, but in some cases, they can cause swelling or pain [1].
LPCs can occur in all age groups, with a slight predilection for males [1]. LPCs
have three variants: the central LPC, the botryoid LPC, and the gingival cyst-like
LPC. The central LPC is located in the jawbone, while the botryoid LPC is
typically a multicystic lesion that appears as a cluster of grapes [1]. The gingival
cyst-like LPC variant is the most common and is histopathologically
indistinguishable from GCA [1]. It is important to note that LPCs can easily be
misdiagnosed as lesions of endodontic origin due to their location
31. Describe the main histological features of the lateral periodontal cyst
● Histologically, the LPC is lined with stratified squamous epithelium that is often
two to three cells thick, with a prominent layer of surface cuticle. The cyst wall
also contains a connective tissue layer, which can be thin or thick and fibrous.
The cyst lumen contains a clear or yellowish fluid with varying amounts of
proteinaceous material [1]. LPCs have the same histopathological characteristics
as gingival cysts of adults (GCA), which are also non-keratinized and
non-inflammatory developmental cysts. Both LPCs and GCAs are lined with
 stratified squamous epithelium, and the cyst wall contains a connective tissue
layer
32. List the key features of the calcifying odontogenic cyst.
● Age and gender: COC can occur at any age, but it is commonly seen in the
second and third decades of life. There is no gender predilection.
● Radiographic appearance: COC shows a variable radiographic appearance,
which may range from radiolucent to radiopaque or a combination of both. The
radiopaque areas correspond to the calcified material present in the cyst.
● Histological appearance: COC shows a characteristic histological appearance,
with a lining of odontogenic epithelium and the presence of ghost cells. Ghost
cells are cells that have undergone keratinization but have lost their nuclei, giving
them a characteristic "ghost-like" appearance.
● Variants: COC has two variants, the benign cystic variant, and the neoplastic
variant known as the odontogenic ghost cell tumor.
● Treatment: The treatment of COC involves surgical removal of the lesion. The
recurrence rate of COC is low, but long-term follow-up is recommended due to
the neoplastic potential of the odontogenic ghost cell tumor variant
33. Describe the main histological features of the calcifying odontogenic cyst
● Histologically, COCs can contain ghost cells, which are rounded or
irregularly-shaped cells with central basophilic staining and peripheral
eosinophilic cytoplasmic zones. They can also contain calcifications in various
forms, such as amorphous, globular, or nodular calcifications. Depending on the
subtype, COCs may have different histological features. For example, the
peripheral type COC may contain squamous cells with intercellular bridges, and
the central type COC may have more ghost cells and calcifications in a pattern
resembling a keratinized cyst [1]. The cytokeratin profile and bcl-2 and Mel-CAM
expression suggest that these proteins may be involved in the development of
COC, and COCs generally do not recur after surgery
34. List the key features of the glandular odontogenic cyst.
● The glandular odontogenic cyst (GOC) is a rare odontogenic cyst that exhibits
glandular and cystic properties. Its key features include a variable thickness of
the squamous epithelial lining with flat or cuboidal cells and stratified epithelium,
eosinophilic cuboidal or low columnar cells known as hobnail cells, intraepithelial
microcystic spaces, and luminal cell apocrine metaplasia [1]. GOCs have a slow
and aggressive development, and they tend to be large and multilocular, with a
0.2% diagnosis rate in jaw lesion cases [2]. Although generally accepted as
odontogenic in origin, GOCs demonstrate glandular features such as mucin
production and the presence of cuboidal/columnar cells, highlighting the
pluripotentiality of odontogenic epithelium
35. Describe the main histological features of the glandular odontogenic cyst
● the glandular odontogenic cyst (GOC) is a rare cystic lesion in the jaw bone that
has uncertain and aggressive behavior with high recurrence rate. GOC's
microscopic features have been well documented [1] and should show at least
seven of the following features [2]: a variable thickness of the squamous
 epithelial lining with flat or cuboidal cells and stratified epithelium, eosinophilic
cuboidal or low columnar cells (hobnail cells), intraepithelial microcystic spaces,
luminal cell apocrine metaplasia, and mucin production. It is worth noting that
GOC can be challenging to diagnose
36. List the key features of the nasopalatine duct cyst.
● The nasopalatine duct cyst (NPDC), also known as the incisive canal cyst, is a
common nonodontogenic cyst of the oral cavity that occurs in the midline of the
anterior maxilla near the incisive foramen [1]. It often appears between the roots
of the maxillary central incisors, and radiographically, it may appear as a
heart-shaped radiolucency [2]. The cyst is usually asymptomatic, but it may
sometimes produce an elevation in the anterior portion of the palate [2]. The cyst
is a developmental, non-neoplastic cyst arising from degeneration of
nasopalatine ducts that usually regress in fetal life [3]. On radiographs, the cyst is
seen as a solitary, well-defined, oval or round, unilocular radiolucency that
measures more than 6 mm in diameter
37. Describe the pathogenesis, clinical and radiological features of the nasopalatine
duct cyst.
● The pathogenesis of NPDCs involves the failure of the nasopalatine duct to fuse,
leading to the accumulation of epithelial remnants that may develop into a cyst
over time [2].
● Clinically, NPDCs are usually asymptomatic and can be detected incidentally on
radiographs. However, they may occasionally present with swelling or pain in the
anterior maxilla [2]. On radiographs, NPDCs appear as a solitary, well-defined,
oval or heart-shaped radiolucency, usually located in the midline of the anterior
maxilla, between the central incisors [3].
● In terms of management, asymptomatic NPDCs do not require treatment and can
be monitored with periodic radiographic follow-up. Symptomatic or enlarging
cysts may require surgical intervention, such as enucleation or marsupialization,
depending on their size and location
38. Recognise the histological characteristics of the nasopalatine duct cyst.
● NPDC is lined by stratified squamous epithelium with occasional areas of
pseudostratification. The epithelium may be hyperplastic, and keratinization may
occur. The cyst may also contain mucous or serous fluid, and occasionally blood
may be present due to rupture of blood vessels in the cyst wall. The cyst wall is
composed of fibrous connective tissue, which may contain chronic inflammatory
cells such as lymphocytes and plasma cells. The lining epithelium may also show
focal areas of inflammation or ulceration. These histological features are
consistent with a developmental cyst, which arises from remnants of embryonic
structures
39. Explain why the entity “globulomaxillary cyst” is not accepted anymore.
● the entity "globulomaxillary cyst" is no longer accepted due to a better
understanding of the embryological development of the maxillary process, which
suggests that entrapped epithelium is unlikely to cause cyst formation
40. Define and list the key features of the aneurysmal bone cyst.
● Aneurysmal bone cyst (ABC) is a benign, tumor-like lesion that can occur in any
bone of the body [1]. It is a rare condition and commonly affects children and
people under the age of 20, but can occur at any age [2]. ABCs are characterized
by an expanding osteolytic lesion consisting of blood-filled spaces surrounded by
connective tissue and woven bone [3]. The key features of ABC include:
○ Rapid growth: ABCs can grow rapidly and cause bone destruction,
leading to pain, swelling, and limited mobility [1].
○ Benign nature: ABCs are noncancerous, but can cause damage to the
surrounding areas of bone and tissue [2].
○ Blood-filled spaces: ABCs are characterized by aneurysmal dilation of
vascular channels filled with blood [3].
○ Multifocal lesions: In rare cases, ABCs can be multifocal and affect
multiple bones in the body [3].
○ Radiographic appearance: On imaging studies, ABCs may appear as an
eccentric, lytic lesion with a thin, expanded cortex, and may have internal
septations or fluid-fluid levels
41. Describe the clinical and radiological findings of the aneurysmal bone cyst.
● They are characterized by an expansile osteolytic lesion with a thin wall that
contains blood-filled cystic cavities, giving it its aneurysmal appearance [1, 3].
These cysts are typically found near the ends of the long bones of the arms and
legs and can grow rapidly, causing damage to the surrounding areas of bone and
tissue [1, 2]. Aneurysmal bone cysts are most commonly seen in children and
people under the age of 20, but they can occur at any age [2].
● Radiographically, the aneurysmal bone cyst appears as an expanding osteolytic
lesion with a thin wall, containing blood-filled cystic cavities [3]. Magnetic
resonance imaging (MRI) can be used to identify the typical fluid-fluid levels and
septations that separate the cysts [2]. Radiographs are usually adequate for
diagnosis and for characterizing typical lesions, but cross-sectional imaging may
be required when lesions are in unusual locations or have atypical features
42. Describe the histological features of the aneurysmal bone cyst and recognise
these on images
● the histological features of an aneurysmal bone cyst (ABC) are characterized by
blood-filled cystic spaces separated by septa containing woven bone, bland
fibroblasts, and multinucleated osteoclastic giant cells. The woven bone follows
the border of the fibrous septa, bordered by osteoblasts [3]. ABCs are benign,
non-neoplastic, reactive bone lesions that can occur in any bone but are most
commonly found near the ends of long bones in the arms and legs. They typically
present in patients less than 20 years of age with focal pain and swelling [2].
Despite their rapid growth, they do not spread to other locations in the body
43. List the key features of a simple / solitary bone “cyst”.
 ● A simple or solitary bone cyst is a type of benign bone tumor. The following are
the key features of a simple bone cyst:
○ Fluid-filled space: A simple bone cyst is a fluid-filled space inside the
bone, which can be a single chamber or septated. The word "unicameral"
means "one chamber" and describes the single fluid-filled chamber in
each cyst. [1]
○ Benign: Simple bone cysts are benign or noncancerous tumors. They are
not related to an infection or cancer. [1]
○ Age group: They occur most often in children and adolescents under 20
years of age. [1]
○ Common locations: The most common sites for simple bone cysts are the
proximal humerus and proximal femur. [2]
○ Diagnosis: In certain cases, a magnetic resonance imaging (MRI) scan or
computerized tomography (CT) scan may be ordered to provide more
detailed images of the cyst. An MRI scan of a simple bone cyst will show
a single cavity finding, as compared with multiple cavities filled with fluid
seen in an aneurysmal bone cyst
44. Describe the clinical and detailed radiological findings of the solitary bone cavity.
● The clinical and radiological findings may vary depending on the specific type of
lesion.
● Simple bone cysts, also known as unicameral bone cysts, are typically found in
children and adolescents under the age of 20 [1]. These cysts are fluid-filled
spaces inside a bone and are most commonly located in the proximal humerus
and femur [2]. Clinically, simple bone cysts are often asymptomatic and
discovered incidentally on imaging studies obtained for other reasons [2]. On
imaging, a simple bone cyst appears as a well-defined, cystic lesion with a thin,
sclerotic rim and an expansile appearance
● Traumatic bone cysts, also known as hemorrhagic bone cysts or idiopathic bone
cysts, are non-neoplastic, cystic lesions that occur most commonly in the
mandible, followed by the proximal humerus and femur [2]. These cysts are also
typically discovered incidentally on imaging studies [2]. Clinically, they may
present with pain, swelling, or pathologic fracture [2]. On imaging, a traumatic
bone cyst appears as a well-defined, unilocular or multilocular, cystic lesion with
a thin sclerotic rim and internal septations or fluid levels
45. Explain the pathological findings of a solitary bone cavity.
● Solitary bone cyst is a benign bone lesion that is characterized by a single cavity
in the bone that may be empty or filled with fluid, which is typically serous and
yellowish or may be tainted with blood. The cyst is lined by a membrane but does
not contain epithelium [1]. The etiology of solitary bone cysts is not completely
understood and is believed to be multifactorial, with proposed causes ranging
from developmental to traumatic factors. Solitary bone cysts can weaken the
bone and increase the risk of fractur
46. Explain the nature and radiographic appearances of Stafne’s Bone cyst
 ● Stafne’s Bone cyst, also known as Stafne defect or static bone cyst, is a benign
radiolucent defect of the jawbone. It is a rare and asymptomatic lesion that is
often discovered incidentally during routine dental radiographs. The cyst is
believed to be formed due to the remodelling of the bone by adjacent salivary
tissue, resulting in a hollowed-out depression in the cortical bone. [1]
● Stafne’s Bone cysts are usually found in the posterior aspect of the mandible,
below the mandibular canal and are often well-defined, round or oval-shaped,
with a uniform radiolucent appearance on dental radiographs. They can vary in
size and shape, and the cyst wall is usually corticated, which is the hallmark of
the lesion. Additionally, Stafne’s Bone cysts do not show any evidence of
expansion or bone destruction, which is useful in distinguishing them from other
jaw cysts or tumors. [2]
● Since Stafne’s Bone cysts are benign and asymptomatic, they do not require
treatment, and the management approach is usually conservative. However, in
some cases where the lesion is large, interferes with denture placement or if the
diagnosis is uncertain, further imaging or biopsy may be necessary
47. Define and describe the osteoporotic bone marrow defect
● According to a source, osteoporotic bone marrow defect is a condition that can
be detected in the body of the mandible during routine radiographs [3]. It usually
appears as a poorly defined radiolucency (dark area) that resembles metastatic
disease [3]. It is typically painless and is often found in an area where there was
a previous history of tooth extraction [3].
● However, it's worth noting that osteoporosis is a condition in which the creation of
new bone doesn't keep up with the loss of old bone, causing bones to become
weak and brittle [1]. On the other hand, myelodysplastic syndrome is a group of
disorders caused by blood cells that are poorly formed or don't work properly due
to a problem in the bone marrow [2]. These conditions are not related to
osteoporotic bone marrow defect, which is a radiographic finding