Jaw Lesions
Jaw Lesions
Jaw Lesions
Jaw Lesions
General
Diverse array of cysts, tumors, and reactive lesions can arise in the jaw—many of which are associated
with odontogenesis, which can involve both epithelial and mesenchymal elements.
Overall, odontogenic tumors are relatively rare, comprising <1% of all oral tumors.
Although most odontogenic tumors are benign, they can be locally aggressive and have a high rate of
recurrence.
Like with other bone tumors, radiographic and clinical correlations is essential to form a diagnosis.
Particularly for odontogenic tumors, it is essential to know the relationship of the lesion to nearby teeth
Complex
odontoma
Radicular cyst
Residual Cyst
Gingival Cyst
Odontogenic cysts in the alveolar mucosa just below oral mucosa surface.
Lined by a thin layer of squamous mucosa 1-2 cells thick with focal thickening. (Similar to lateral periodontal
cyst above)
Very common in infants (but often not biopsied as often spontaneously resolve).
Glandular Odontogenic Cyst
Cyst with epithelial features that simulate
salivary gland differentiation.
Variable epithelium from 2-3 cells to thicker
stratified squamous epithelium. Also can see
cuboidal cells, microcysts, apocrine metaplasia,
clear cells, tufting, mucous cells, and cilia
Rare. Often asymptomatic and mandibular.
Associated with roots of multiple teeth.
High rate of recurrence. Must exclude
mucoepidermoid carcinoma
Osteomyelitis
Acute Osteomyelitis: Neutrophilic inflammation with
bone destruction, edema, and fibrosis
Chronic Osteomyelitis: Plasma cells and lymphocyte-
rich inflammation with bone destruction, edema,
and fibrosis
Necrotic bone with empty osteocyte lacunae.
May see brisk osteoclast activity.
Bone often appears “moth eaten” (irregular erosions)
with lots of “rat bites.”
Often secondary to poor dentition or dental
extractions (direct inoculation). Can also result from
hematogenous spread.
Odontogenic Myxoma
Benign.
Stellate to spindled cells in abundant myxoid
matrix. May see rare odontogenic epithelium.
Good prognosis, but can recur if not completely
removed.
Cementoblastoma
Benign.
Cherubism
Autosomal Dominant inherited condition
Symmetrical expansion of the maxilla and mandible
→ give a “heavenly gaze” (big cheeks, upward gaze)
→ look like cherubs in Renaissance paintings→
Presents in childhood→ often regresses spontaneous by
adulthood. Mutations in SH3BP2.
Nonspecific histology (similar to above)
Aneurysmal Bone Cyst— Cystic/multicystic osteolytic neoplasm composed of blood-filled spaces lined by
fibrous septae with osteoclast-type giant cells. USP6 Translocations. Relatively rare in jaw. Usually
young.
Simple Bone Cyst— (aka unicameral bone cyst) Intraosseous cavity lined by fibrous tissue filled with
serous or bloody fluid. Usually long bones, rarely in mandible.
Hyperparathyroidism—Hyperparathyroidism (often due to adenoma) stimulates a proliferation of
osteoclasts with fibrous tissue and hemorrhage. Forms a mass lesion, often in Mandible and Maxilla.
Resembles many other giant cell-rich lesions, so knowing PTH is key. Treat with parathyroidectomy.
Giant Cell Tumor of Bone—Usually in long bones of adults (not in Jaw). Local proliferation of numerous
(reactive) large osteoclasts together with a mononuclear neoplastic component without atypia. IHC:
(+)H3.3 G34W, often p63,
Bone/Cartilage Tumors with a special predilection for the Jaw
Note: You can get pretty much any bone tumor in the jaw, so also look at the dedicated bone guide ;-)
Ossifying Fibroma A
Benign.
Usually in Jaw. Sometimes craniofacial.
Well-defined fibro-osseous lesions with
hypercellular fibroblastic stroma containing
variable amounts of osteoid or cementum-
like material. Osteoblastic rimming. B
Hyperchromatic nuclei, but no significant
pleomorphism or mitoses
3 subtypes
A) Juvenile psammomatoid OF
B) Juvenile trabecular OF
C) Cemento-ossifying fibroma
Desmoplastic Fibroma
aka “Desmoid tumor of bone”
Locally aggressive (myo)fibroblastic lesion of bone.
Often young patients, most often in mandible.
Infiltrative/permeative lesion composed of fascicles of
uniform myofibroblasts with slender tapering nuclei.
IHC: (+) SMA, Sometimes nuclear β-catenin.
Molecular: CTNNB1 hotspot mutations or APC mutations.
Recurrence may occur.
Osteoma
Benign. Usually on face or jaw bones (sites of
membranous ossification).
Often on the surface.
Composed of lamellar/cortical-type bone.
Osteoblasts are inconspicuous.
When develops in medullary cavity→ use the
term “Bone Island”
Multiple osteomas→ seen in Gardner’s
syndrome (subset of FAP)
Generally require no treatment unless
symptomatic
Torus/Exostosis
Benign. Thought to be reactive/developmental.
First appear when young adult and slowly grow.
Seem to grow in locations of mechanical stress.
Usually composed of dense, mature, lamellar bone
Minimal osteoblastic activity. Fatty marrow.
Frequently become ischemic→ loose osteocytes.
Don’t need to be treated unless troublesome to patient.
May be hard to differentiate from osteoma (above)
pathologically, so may have to rely on clinical
information to differentiate.
3 main locations: (Tori are usually bilateral and
multilobulated/bossellated)
Palatal torus→ midline of hard palate
Mandibular torus→ lingual surface of the mandible
Buccal exostosis→ facial surface of alveolar bone
Mesenchymal Chondrosarcoma
Biphasic tumor with 1)Islands of organized 1
hyaline cartilage in 2)an undifferentiated
component with high N:C ratios.
Frequent staghorn vessels (3).