NON ODONTOGENIC CYSTS

WHAT ARE NON ODONTOGENIC CYSTS
?
 According to Shafer's
Cysts in the orofacial region not essentially
derived or related to the odontogenic
apparatus are called non odontogenic
cysts.

Non odontogenic cysts are grouped into
DEVELOPMENTAL and INFLAMMATORY
CYSTS.
 All the developmental non odontogenic
cysts are true cysts (i.e. pathological cavity
lined by the epithelium, usually containing
fluid or semisolid material)
 All the inflammatory non odontogenic cysts
are pseudo cysts.

Classification of Non Odontogenic
cysts
 DEVELOPMENTAL
 INTRAOSSEOUS
Nasopalatine duct cyst
Median palatal cyst
Globulomaxillary cyst
Median mandibular cyst
 EXTRAOSSEOUS
Palatal cyst of newborn
(Epstein’s nodule)
Nasolabial cyst
Thyroglossal duct cyst
Oral lymphoepithelial cyst
Epidermoid cyst
Dermoid cyst
 INFLAMMATORY
 Traumatic
Salivary cyst
Antral cyst
Traumatic bone cyst
Aneurysmal bone cyst
 Infectious
Parasitic cyst

INTRAOSSEOUS
DEVELOPMENTAL
NON ODONTOGENIC
CYST

 OTHER NAMES :
o Median anterior cyst
o Midline maxillary cyst
o Anterior median palatine cyst
o Incisive canal cyst
o Incisor duct cyst
 Most common intraosseous, non-odontogenic
cyst of jaw (maxilla)
NASOPALATINE DUCT CYST

 Occurs in ~1% of population
 Represents 1.7-11.9% of all jaw cysts
 Usually adults, peak prevalence in fourth
and fifth decades
 More common in males (ranges in
literature from slightly more common to up
to 3x more common in males than females
EPIDIMIOLOGY :

SITE :
 Exclusively in maxilla, located in anterior midline of
hard palate
o Occasionally can produce a midline anterior
maxillary swelling if cyst erodes bone of anterior
maxilla
 Cysts can form within the incisive canal located in
palatine bone behind alveolar process of maxillary
central incisors
 Some doubt the existence of median palatine cyst as
a distinct entity and characterize all non-odontogenic
cysts of the midline maxilla regardless of anterior or
midline location, as nasopalatine duct cysts
 Rarely, may develop within incisive papilla, the anterior
soft tissue protuberance that overlies the incisive

ETIOLOGY :
 Two main theories: First: originates from
spontaneous proliferation of remnants of
nasopalatine duct within incisive canal
o Exact trigger that stimulates development is
unknown, but factors proposed include
trauma and infection
 Second: theory now out of favor; originates from
trapping of epithelial remnants during
embryologic fusion between nasal cavity and
anterior maxilla

 Usually asymptomatic, may
have swelling of palate in
relation to maxillary central
incisors
 Occasionally produces a
midline anterior maxillary
swelling if cyst erodes bone of
the anterior maxilla
 Can present with painful
swelling or drainage, or tooth
root displacement
 Salty taste in mouth and
CLINICAL FEATURES :

HISTOLOGY :
 Lined by stratified squamous
epithelium alone or with
pseudostratified columnar
epithelium (variable cilia and
goblet cells), simple columnar
epithelium or simple cuboidal
epithelium
 Cyst wall is composed of
fibrous tissue with nerves,
cartilaginous rests, arteries and
veins
 The nasopalatine duct contains
the nasopalatine nerve and the
terminal branch of the

RADIOLOGY
 well-circumscribed radiolucency
in or near midline of anterior
maxilla
 between apical to central incisor
 root resorption is rarely noted
 lesion most often is round or oval
with a sclerotic border
 some cases, a classic heart
shape as a result of superimposition
of nasal spine OR because they are
notched by nasal septum

 radiographic diameter
can range from small lesions, less than 6 mm
 to destructive lesions as large as 6 cm
 most cyst are in range 1.0- 2.5 cm, with average
diameter of 1.5-1.7 cm
 radiolucency that is 6 cm or smaller in this area is
usually considered a normal foramen unless other
clinical signs or symptoms are present

DIFFERENTIAL DIAGNOSIS
 Glandular odontogenic cyst:
o Intraosseous developmental odontogenic cyst, may
have ciliated or mucous cells within cystic lining
o Should NOT have contents of incisive foramen
(peripheral nerve, cartilaginous rests, muscular
vascular channels)
 Nasolabial (nasoalveolar) cyst:
o Soft tissue (non-intraosseous) cyst with histologic
features similar to nasopalatine cyst
o Occurs in soft tissues of upper lip lateral to midline
o Should not have contents of incisive foramen
(peripheral nerve, cartilaginous rests, muscular
vascular channels)

 Periapical (radicular) cyst:
o Most common inflammatory odontogenic cyst
o Lined by stratified squamous epithelium of
variable thickness, often with scattered ciliated
cells
o Derived from rests of Malassez
o In nasopalatine cysts, the lamina dura is intact
and the pulp is usually vital, but radicular cysts
are associated with a pulpless tooth and involve
a portion of the root, usually with loss of
continuity of the lamina dura
 Surgical ciliated cyst:
o Post-operative "complication" with cystic
expansion of respiratory epithelium within
maxilla, may have ciliated or mucous cells within
cystic lining

 Surgical enucleation
 Biopsy is recommended
• because lesion is not
diagnostic radiographically
• benign + malignant lesions
have been known to mimic
nasopalatine duct cyst
 Palatal flap reflected after
incision -made along lingual
gingival margin of anterior
maxillary teeth
 Recurrence is rare
TREATMENT

 rare fissural cyst
 develops from epithelium entrapped along embryonic
line of fusion of lateral palatal shelves of maxilla
 Also known as Median Palatine cyst
MEDIAN PALATAL CYST
EPIDIMIOLOGY
 Rare, only 21 cases have been reported in the
literature (4 after 1992)
 Although limited numbers, more common in males
(4:1)

SITE :
Midline of the hard palate between lateral palatal
processes
ETIOLOGY :
 Controversial, and the existence of the cyst itself has
been questioned
 Originally thought to arise from remnants of epithelium
entrapped during fusion of facial processes during
embryogenesis, specifically the lateral palatal shelves
 More recently, the 1992 WHO wrote "it is now felt that
those [cysts] in the maxilla represent a posterior
extension of the nasopalatine duct cyst in the case of a
median palatine cyst" (WHO: Histological Typing of
Odontogenic Tumours, 1992)

 firm or fluctuant swelling of midline of
hard palate posterior to palatine papilla
 most frequently in young adults
 often asymptomatic
 Some complain of pain and expansion
 average size is 2 x 2 cm, sometimes it
can be quite large
 must be stressed out that a true medial
palatal cyst should exhibit clinical
enlargement of palate
 midline radiolucency without clinical
evidence of expansion is probably a
nasopalatine duct cyst
CLINICAL FEATURES :

 Occlusal radiographs
demonstrate well-
circumscribed radiolucency in
midline of hard palate
 occasional reported cases
have been associated with
divergence of central incisors
RADIOLOGY :

HISTOLOGY :
Lining consists of stratified squamous epithelium or
pseudostratified ciliated columnar epithelium
overlying a relatively dense fibrous connective
tissue band which may show chronic inflammatory
cell infiltration

DIFFERENTIAL DIAGNOSIS :
 Nasopalatine cyst
 Nasoalveolar cyst
 Surgical ciliated
cyst

 surgical removal
 recurrence should not
be expected
TREATMENT :

GLOBULOMAXILLARY CYST
 The globulomaxillary cyst has traditionally been
described as a fissural cyst.
 It is found within the bone at the junction of the
globular portion of the medial nasal process & the
maxillary process, the globulomaxillary fissure, usually
the maxillary lateral incisor & cuspid teeth.
 It is also called ‘premaxilla-maxillary cyst’ because of
the evidence of its formation in the bone suture
between the premaxilla & maxilla.

It appears as an inverted, pear-shaped radiolucent area between
the roots of the lateral incisor & cuspid, usually causing divergence
of the roots of these teeth.
The teeth associated with a cyst are vital unless coincidentally
infected.
RADIOGRAPHIC FEATURES

HISTOLOGIC FEATURES
The cyst is lined by either stratified squamous or ciliated
columnar epithelium.
The remainder of the wall is made up of fibrous connective
tissue, usually showing inflammatory cell infiltration.

TREATMENT
This type of cyst should be surgically removed, preserving the
adjacent teeth if possible.

MEDIAN MANDIBULAR CYST
It occur in the midline of the mandible.
CLINICAL FEATURES
It is clinically asymptomatic.
They seldom produce obvious expansion of the cortical plates of
bone, and the associated teeth; unless otherwise involved, they
react normally to pulp vitality tests.

RADIOGRAPHIC FEATURES
It is generally of a unilocular, well-circumscribed radiolucency,
although it may also appear multilocular.

HISTOLOGIC FEATURES
Histologic examination of the lesion shows a thin, stratified
squamous epithelium, often with many folds & projections, lining a
central lumen.

TREATMENT
The surgical excision with preservation of associated teeth.

EXTRAOSSEOUS
DEVELOPMENTAL
NON
ODONTOGENIC
CYST

PALATAL CYST OF NEONATE
(EPSTEIN PEARL, BOHN’S
NODULE)
 Commonly found in post. Midline of the hard
palate.
 It arises from the epi. Remnants remaining in
the stroma after fusion of the palatal processes
which meet medially to form palate.
 Two types(on the basis of origin)
 Epstein pearls-the cyst along the medially
raphe of the palate
 Bohn’s nodule-cyst originated from the palatal
gland structure.

CLINICAL
FEATURES
Present as multiple(<6) 1-4
mm, sessile mucosal
papules of the post. hard
palate and occasionally of
the ant. soft palate.
Larger and less numerous
than the gingival cyst of the
alveolar process in
newborns.

H/F-
 Palatal cyst of newborn show thin,stratified
sqamous epithelium cyst lining with a
fibrovascular connective tissue stroma,
usually without an inflammatory cell
infiltration.
 Cyst lumen is filled with degenerated
keratin,usually formed into concentric
layers(like onion rings) and epithelium lacks
rete processes.

TREATMENT AND PROGNOSIS
 No treatment required as cyst are very superficial
and within weeks will rupture and spill their
content into the oral environment, some larger
cyst which are situated deeply in the
submucosal stroma will remain for 6-8 months.
 The cyst lining then fuses with the overlying
mucosa and becomes part of it.

NASOLABIAL CYST
(NASOALVEOLAR CYST)
 It is a rare fissural cyst that may involve bone
secondarily.
 It arises at the junction of the globular process,the
lateral nasal process and the maxillary process as a
result of proliferation of the entrapped epithelium
along the fusion line.
 It originates from the lower ant. part of nasolacrimal
duct.

CLINICAL FEATURES
 Located near the attachment of the ala over the
maxilla and may cause swelling in the mucolabial
fold as well as in the floor of the mouth.
Superficial erosion of outer surface of maxilla is
due to pressure produced by the nasolabial cyst.
 Cyst is three times more common in women.

H/F-
 Cyst may be lined by psuedostratified columnar
epithelium which is sometimes ciliated, often with
goblet cells or by stratified sqamous epithelium.
TREATMENT-
 the cyst should be surgically excised.

THYROGLOSSAL DUCT CYST
(THYROGLOSSAL TRACT CYST)
 Rare, but occasional cause of a benign midline
neck mass.
 Located at the midline of the neck.
 Most often occurs before age of 20,but may be
found in the older population as well.
 The cyst result from the dilatation of a remnant at
the site where the primitive thyroid descended
from its origin at the base of the tongue to its
permanent location,low in the neck.
 Failure of subsequent closure and obliteration of
thus tract lead to cyst formation.

C/F-
 Cyst present with a palpable asymptomatic midline
neck mass at or below the level of the hyoid bone.
 Neck mass moves with swallowing.
 It is associated with neck or throat pain or
dysphagia.
 Since the persistent duct or sinus can promote oral
secretion, and such cyst become infected.
 Infection sometimes causes transient appearance of
a mass or enlargement of the cyst, at times with
periodic recurrences.

H/F-
 Cyst may be lined by stratified sqamous epithelium,
ciliated columnar or intermediate transition type.
 The connective tissue wall of the cyst will frequently
contain small patches of lymphoid tissue, thyroid tissue
and mucous glands.
Treatment-
 Definitive surgical management requires excision not
only of the cyst but also of the path’s tract and branches.
 It is mandatory to remove the central portion of the hyoid
bone to ensure complete removal of the tract.
 Recurrence is unlikely.

 The oral lymphoepithelial cyst develops within a
benign lyphoid aggregates or accessory tonsil of the
oral or pharyngeal mucosa .
The surface of such aggregates may be indented
with tonsillar crypts , as are the much larger
pharyngeal walls .
Outside of the head and neck region,
lymphoepithelial cyst is found most frequently in the
pancreas and testes
ORAL LYMPHOEPITHELIAL
CYST

CLINICAL
FEATURES
 Oral lymphoepithelial cyst present as a
movable , painless sub mucosal nodule with a
yellow or yellow – yellow white discoloration .
 Occasional cyst are transparent.
 They are less than 0.6 cm in diameter.
 Half of all the intraoral examples are found on
the oral floor .Also found in the lateral and the
ventral tongue and especially the mucosa
above the pharyngeal tonsil .
 Superficial cyst rupture to release a foul-tasting
, cheesy ,keratinous material
 This cyst has a clinical appearance similar to
that of an epidermoid cyst or dermoid cyst of
oral/pharyngeal mucosa .
 The lymphoepithelial cyst never occurs on the
alveolar mucosa , hence , can easily be
distinguished from the gingival cyst of adult or
from an unruptured parulis or pus pocket at

HISTOLOGIC FEATURES
 The lymphoepithelial cyst is lined by
atrophic degenerated stratified squamous
epithelium , usually lacking rete processes
and usually demonstrating a minimal
granular cell layer .
 Orthokeratin is seen to be sloughing from
the epithelial surface into the cystic lumen
, often completely filling the lumen and
sometimes dystrophic calcification .
 Rarely , mucus –filled goblet cells may be
seen within the superficial layers of the
epithelium – lined communication with the
overlying mucosal surface
 The cyst is entrapped within a well-
demarcated aggregate of mature
lymphocytes
 The combination of epithelium-lined cyst

TREATMENT
 No treatment is usually necessary for the oral
lymphoepithelial cyst unless its location is such that it is
constantly being traumatized .

EPIDERMOID CYST
 Also known as epidermal cyst ,epidermal
inclusion cyst epithelial cyst, keratin cyst, milia.
 Epidermal inclusion cyst are the result of
implantation of epiermal elemnts and subsequent
transformation
 The term epidermoid cyst is used in a general
context in that irrespective of the source of the
epithelium.
 Milia rarely represent miniature epidermoid cyst

AETIOLOGY
 The origin of epidermoid cyst is varied.
 They may form by sequencestration and implantation
of epidermal rest,during embryonal period,occlusion
of the pilosebacious unit,surgical implantation of
epithelium into the jaw mesenchyme.
 HPV infection and accrine duct occlusion may be the
additional factors in the developement of epidermoid
cyst.
 Epidermoid cyst result from the proliferation of
epidermal cells within a circumscribed space of the
dermis.
 The source of the epiermis is oftened the
infundibulum of the hair follicle.
 Inflammation is in part mediated by the horny material
conatained in epidermoid cyst.

CLINICAL FEATURES
 Indolent in nature , slow to progress and remain asymptomatic
untill or unless secondarily infected
 Appear firm, round , mobile , flesh coloured to yellow or white
subcutaneous nodules of variable size
 A central pore or punctum is an inconsistent finding that may
adhere the cyst to overlying epidermis and form thick cheesy
material .
 Epidermoid cyst may be pigmented .
 This cyst mainly reported in sites of face , the trunk , the neck ,
the extremities and the and the scalp .
 While facial involvement is also frequent in Gardner syndrome
 Epidermoid cyst are more twice as common in men as in
women .
 Occur at any time in life but more common in third and fourth
decades of life .
 Discharge of foul smelling cheese like material
 Cyst become inflammed or infected , resulting in pain and
tenderness .
 When located orally they cause difficulty in feeding , swallowing
or even speaking

HISTOLOGICAL FEATURES
 The cystic lining is comprised of stratified
squamous epithelium with glandular
differentiation. and it is filled with
desquamated keratin disposed in the
laminar pattern.
 Dystrophic calcification and reactive
foreign body reaction are seen
associated with cystic capsule
 Pigmented epidermoid cyst may
demonstrate melanin pigment in the wall
and a keratin mass.
 Infiltration of melanocytes and
melanophages may also be observed in
surroundings.
 They include intracytoplasmic
eosinophillic inclusion bodies in the cyst
wall, vacuolated cells and the cells with

 Surgical removal seems to be the mainstay in the
management protocol
 Malignancies have identified in epidermoid cyst

DERMOID CYST
 It is also known as dermoid cystic tumour, Cystic
Teratoma, Ovarian cystic teratoma, Cystic tumour
of omentum and spinal dermoid cyst.
 It is an hamartomatous tumour containing
multiple sebaceous glands and almost all skin
adnexa, may contain substances' such as nails
an dental cartilage and bone like structures.
 The origin of this cyst is probably by
sequecestration of skin subsequent implantation
of it along the lines of embryonic closure.

CLINICAL
FEATURES
 Commonly mostly occur on face, neck or
scalp
 In addition to skin dermoid cyst can be
intracranial, intraspinal or perispinal.
 Intra abdominal cyst such as cystic tumour
of the ovary or the omentum,occur as well.
 Mostly occurs in whites.
 Dermoid cyst are described in the persons
of all ages.
 Intracranial or perispinal dermoid cyst are
most often find in infants, children's or
young adolescents.
 Intraabominal dermoid cyst are described
in females aged between 15 to 40 years of
age.
 Most dermoid cyst on the floor of the mouth
occur in the individual aged between 10 to
30 years.
 Three subclasses of congenital mouth cyst

HISTOLOGICAL
FEATURES
 Dermoid cyst in the skin are lined by
epidermis that possesses various
epidermal appendages.
 Hair follicles containing hair that
project into the lumen of the cyst are
often present.
 The dermis of dermoid cyst usually
contains sebacious glands , accrine
glands and apocrine glands.
 The lining epithelium may proliferate
as papillary boundaries externally or
inward toward the lumen of the cyst.

 Surgical excision is the treatment of the choice in
any localization.

INFLAMMATORY
NON
ODONTOGENIC
CYSTS

TRAUMATIC INFLAMMATORY
NON ODONTOGENIC CYSTS
The most common cause leading to the
such cysts are physical or mechanical
trauma.
They can be true or pseudo cyst.
All other inflammatory cysts are
intraosseous except salivary cysts and
parasitic cysts

SALIVARY CYST
Cysts associated with salivary
glands are of two types-
1. Extravasation cyst
- Mucocele
- Ranula
2. Retention cyst

MUCOUS EXTRAVASATION
CYST
Most common benign lesion of salivary gland
Occurs due to rupture of salivary gland or their
ducts leading to spillage of mucin in surrounding
soft tissue.
mucocele-
1. Rupture of minor salivary gland or ducts
2. Smaller the ranula
Ranula –
1. Rupture of ducts of submand./sub lingual
gland.
2. larger

Traumatic severance
produced by biting lip, cheek
leading to its development.
1. Mucocele
C/F-
Common site-lower lip
Other sites-upper lip,
palate, cheek, tongue,(gland
of blandin nuhn) and floor
of mouth.
ETIOLOGY

LESION
 Deep
 Painless
swelling
 Appears as
normal mucosa.
 Superficial
 Raised,
circumscribed
vesicle
 Diameter -(mm-
cm) with bluish
translucent cast

H/F
 Being a psedocyst,contains areas of
spilled mucus within fibrous connective
tissue lining.
 Granulation tissue with inflammatory
reaction (macrophages containg
phagocytized mucus.)
TREATMENT
 excision with strict removal of any
projecting peripheral salivary gland.

2. Ranula -
 Latin word rana
 C/F-
 Slowly developing painless
mass on one side of floor of
mouth.
 Blue dome shaped.
 Elevates the tongue.
 Lesion-deep seated
lesions(with normal
appearing mucosa)
-superficial lesion(with
translucent bluish mucosa)

MUCOUS RETENTION CYST
 True cyst
 Occurs due to obstruction of constriction of salivary
gland duct leading to retention of saliva within duct.
AETIOLOGY AND PATHOGENESIS
 Due to partial or total obstruction of salivary duct by
-salivary calculi
 -mucous plug
 Continuous use of mouth washes leading to
constriction of ductal orifice.

 Mainly involves major gland such as
parotid presenting.
 Slowly growing, fluctuant and painless
swelling.
 Deeper lesion appear normal, nodular
and firm.
 Superficial lesion appear bluish and
vesicular
C/F-

H/F-
 Lining epithelium-non
keratinised stratified
sqamous or columnar
epithelium.
 Lumen may contain
eosinophlic material.
 Lining epi. may undergo
oncocytic metaplasia
exhibiting papillary folds.

HISTOLOGICAL SUBTYPES
 True mucous retention cyst - lined by
nononcocytic ductal epi. With minimum
inflammation.
 Reactive oncocytic cyst - non oncocytoid
metaplasia
 Mucopapillary cysts - with papillary
multicystis growth pattern.

TREATMENT
Surgical excision along with gland.

TRAUMATIC BONE CYST
 Pseudocyst
 Uncommon comprising about
1% of all jaw cysts
 May occur in other bones.

ETIOLOGY
 Various theories are given:-
1) Trauma –hemorrhage theory
Widely accepted
Intramedullary hemorrhagic following traumatic
injury
Rather than organizing, the clot breaks down,
leaving an empty bony cavity.
Alternative developmental pathways include
 cystic degeneration of primary tumors of bone,such
as central giant cell granuloma.
 Disorders of calcium metabolism
 Ischemic necrosis of bone marrow

C/F-
 Teenagers commonly affected
 Common sites-post. Portion of mandible commonly
involved than ant.
 (numerous cases in incisor region in young patients as
this area contains hemopoetin marrow)
 Swelling is present occasionally.
R/F-
 Radiolucent area with scalloping
borders b/w the roots of teeth.
 Occasional root resorption
 Radiolucency usually lie below
mand. Canal.

H/F -
 Loose vascular fibrous tissue memb.of
variable thickness with no epi. lining.
 Hemosidrin pigment
 Multinucleated giant cell tumor present.

ANTRAL CYSTS
Associated with maxillary
antrum
Retention cyst of max.
sinus
Surgical ciliated cyst of
maxilla
Retention cyst of max. sinus
Lesion represents retention phenomenon
of mucous gland associated with lining of
max. sinus.

ETIOLOGY-
 Blockage of ducts of sero mucous gland
of sinus lining.
 Obstruction of sinus opening, blocking
the drainage of sinus secretion.
 Others-sinusitis, allergy and sinus
infection.
C/F-
Mostly they are asymptomatic.
Represents pain and soreness of face and teeth and
numness of upper lip.
Buccal expansion of max. antrum may also be seen.

R/F-
 Radiopaque lesion of varying density.
 Appears as soft tissue mass rather than calcified
area.
 Entire sinus may appear cloudy.

H/F-
Accumulation of fluid within CT space showing epi.
Lining
Epithelial psedostratified ciliated columnar or
stratified squamous with goblet cells.
Also called secretory type of antral cyst.
Inflammatory infiltrate with CT wall.
TREATMENT-
No treatment is necessary as it disappears
spontaneously with short period.

SURGICAL CILIATED CYST
ETIOLOGY-
Develops either after surgical entry into max.
sinus.
Damage to floor of sinus due to complicated
extraction of upper teeth.
Ostial obstruction
C/F-
Present non specific, poorly localized pain
,tenderness in maxilla.
Extra or intra oral swellings may also be seen.
Mucopyocele is the lesion where content in the

 Well defined unilocular radiolucent area closed to
max. sinus
 Anatomically separate from it, which can be
demonstrated by injecting radiopaque material called
filing defect of cyst.
H/F-
 Epithelial lining- pseudo stratified ciliated columnar
identical to maxillary sinus.
R/F-

ANEURYSMAL BONE CYST
 Uncommon; expanding osteolytic lesion of blood filled spaces of
variable size separated by connective tissue septa with osteoclast
giant cells and variable reactive bone
 Usually ages 1 - 20 years, no gender preference
 Benign but grows rapidly; simple curettage is followed by
recurrence in 20%; rarely transforms to osteosarcoma
 May also be secondary to trauma or arise in preexisting bone
lesion (giant cell tumor, chondroblastoma, fibrous dysplasia)
 Aneurysmal bone cysts are benign lesions that occur
predominantly in the metaphyses of tubular long bones; their
occurrence in the jaw region is very rare.
Although aneurysmal bone cysts are principally benign lesions,
they can cause extensive bone destruction when diagnosed at a
late stage
SITES : metaphysis of posterior vertebrae (often multiple), flat
bones, shaft of long bones; rarely within wall of major artery or in soft

PATHOLOGY :
4 phases of pathogenesis :
1) OSTEOLYTIC INITIAL PHASE
2) ACTIVE GROWTH PHASE – Rapid destruction
of bone and subperiostal blow out pattern
3) MATURE STAGE – (STAGE OF
STABILIZATION)- Formation of a distinct
peripheral bony shell and internal bony septa
and trabeculae that produce the classic soap
bubble like appearance
4) HEALING PHASE – progressive calcification
and ossification of cyst and eventual
transformation into a dense bony mass with
irregular structure

HISTOLOGY :
 Large cystic spaces filled with
blood and separated by
fibrous septa, alternating with
solid areas
 Cysts and septa lined by
fibroblasts, myofibroblasts
and histiocytes but not
endothelium
 Clusters of osteoclast-like
multinucleated giant cells with
loose spindly stroma to
cellular stroma, reactive
woven bone, degenerated
calcifying fibromyxoid tissue
 Variable mitotic figures and

RADIOLOGY :
 Eccentric expansion of
bone, cortical erosion
and destruction, small
peripheral area of
periosteal bone
formation
 Fluid levels detectable
by CT
 MRI shows
honeycomb

DIFFERENTIAL DIAGNOSIS
 Odontogenic cyst
Haemangioma
 Giant cell granuloma
 Eosinophilic granuloma
 Myxoma
 Ameloblastoma
 Metastasis

TREATMENT :
25% recur after curettage so aggressive
curettage with bone grafting or en bloc resection
recommended

PARASITIC INFECTIOUS
INFLAMMATORY NON
ODONTOGENIC CYST
 Usually echinococcal, as part of disseminated hydatid
disease
 Primary hydatid cyst of the adrenal gland is extremely
rare
 Rarely caused by visceral leishmaniasisEPIDIMIOLOGY :Hydatid disease accounts for
6% - 7% of all adrenal cysts
CLINICAL FEATURES :Mostly
asymptomatic, occasionally with abdominal
pain

HISTOLOGY :
Wall contains many eosinophils, also
evidence of parasite

TREATMENT :
 Surgical excision
 Anthelmintic agents

NON ODONTOGENIC CYSTS

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