12 May 2009

Odontogenic Cysts and Tumors



Odontogenic Cysts and Tumors
Presentation lecture by:Michael Underbrink, MD
Anna Pou, MD

Introduction
* Variety of cysts and tumors
* Uniquely derived from tissues of developing teeth
* May present to otolaryngologist

Odontogenesis
* Projections of dental lamina into ectomesenchyme
* Layered cap (inner/outer enamel epithelium, stratum intermedium, stellate reticulum)
* Odontoblasts secrete dentin ameloblasts (from IEE) enamel
* Cementoblasts cementum
* Fibroblasts periodontal membrane

Diagnosis
* Complete history
o Pain, loose teeth, occlusion, swellings, dysthesias, delayed tooth eruption
* Thorough physical examination
o Inspection, palpation, percussion, auscultation
* Plain radiographs
o Panorex, dental radiographs
* CT for larger, aggressive lesions

Diagnosis
* Differential diagnosis
* Obtain tissue
o FNA – r/o vascular lesions, inflammatory
o Excisional biopsy – smaller cysts, unilocular tumors
o Incisional biopsy – larger lesions prior to definitive therapy
Odontogenic Cysts
* Inflammatory
o Radicular
o Paradental
* Developmental
o Dentigerous
o Developmental lateral periodontal
o Odontogenic keratocyst
o Glandular odontogenic

Radicular (Periapical) Cyst
* Most common (65%)
* Epithelial cell rests of Malassez
* Response to inflammation
* Radiographic findings
o Pulpless, nonvital tooth
o Small well-defined periapical radiolucency
* Histology
* Treatment – extraction, root canal

Radicular Cyst
Residual Cyst
Paradental Cyst
* Associated with partially impacted 3rd molars
* Result of inflammation of the gingiva over an erupting molar
* 0.5 to 4% of cysts
* Radiology – radiolucency in apical portion of the root
* Treatment – enucleation

Dentigerous (follicular) Cyst
* Most common developmental cyst (24%)
* Fluid between reduced enamel epithelium and tooth crown
* Radiographic findings
o Unilocular radiolucency with well-defined sclerotic margins
* Histology
o Nonkeratinizing squamous epithelium
* Treatment – enucleation, decompression

Dentigerous Cyst
Developmental Lateral Periodontal Cyst
Odontogenic Keratocyst
Treatment of OKC
Glandular Odontogenic Cyst
Treatment of GOC
Nonodontogenic Cysts
Incisive Canal Cyst
Stafne Bone Cyst
Traumatic Bone Cyst
Surgical Ciliated Cyst
Odontogenic Tumors
Ameloblastoma
Treatment of Ameloblastoma
Calcifying Epithelial Odontogenic Tumor
Treatment of CEOT
Adenomatoid Odontogenic Tumor
Squamous Odontogenic Tumor
Calcifying Odontogenic Cyst
Mesenchymal Odontogenic Tumors
Odontogenic Myxoma
Cementoblastoma
Mixed Odontogenic Tumors
Related Jaw Lesions
Central Giant Cell Granuloma
Brown Tumor
Aneurysmal Bone Cyst
Fibrous Dysplasia
Ossifying Fibroma
Condensing Osteitis
Conclusion
Case Presentation
Physical Examination
Radiographs
Pathology
Treatment

Odontogenic Cysts and Tumors.ppt

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Male Reproductive System



Male Reproductive System
presentation lecture from: Evergreen University

Adolescence
* Puberty
* Burst of hormones activate maturation of the gonads: testes
* Begins: 9 – 14 yrs of age
* Abnormally early = precocious puberty
* Delayed = eunuchoidism

General Physical Changes
* Enlargement of the external and internal genitalia
* Voice changes
* Hair growth
* Mental changes
* Changes in body conformation and skin
* Sebaceous gland secretions thicken/increase acne

External Genitalia
* Gonads = testes undescended by birth= cryptorchidsim
* Scrotum
* Penis
Testes
* Each testis is an oval structure about 5 cm long and 3 cm in diameter
* Covered by: tunica albuginea
* Located in the scrotum
* There are about 250 lobules in each testis. Each contains 1 to 4 -seminiferous tubules that converge to form a single straight tubule, which leads into the rete testis.
* Short efferent ducts exit the testes.
* Interstitial cells (cells of Leydig), which produce male sex hormones, are located between the seminiferous tubules within a lobule.

scrotum
* consists of skin and subcutaneous tissue
* A vertical septum, of subcutaneous tissue in the center divides it into two parts, each containing one testis.
* Smooth muscle fibers, called the dartos muscle, in the subcutaneous tissue contract to give the scrotum its wrinkled appearance. When these fibers are relaxed, the scrotum is smooth.
* the cremaster muscle, consists of skeletal muscle fibers and controls the position of the scrotum and testes. When it is cold or a man is sexually aroused, this muscle contracts to pull the testes closer to the body for warmth.

Epididymis
* a long tube (about 6 meters) located along the superior and posterior margins of the testes.
* Sperm that leave the testes are immature and incapable of fertilizing ova. They complete their maturation process and become fertile as they move through the epididymis. Mature sperm are stored in the lower portion, or tail, of the epididymis

spermatic cord
* contains the proximal ductus deferens, testicular artery and veins, lymph vessels, testicular nerve, cremaster muscle and a connective tissue covering.

Duct System
* Sperm cells pass through a series of ducts to reach the outside of the body. After they leave the testes, the sperm passes through the epididymis, ductus deferens, ejaculatory duct, and urethra.

Ductus Deferens [vas deferens]

* a fibromuscular tube that is continuous with the epididymis.
* enters the abdominopelvic cavity through the inguinal canal and passes along the lateral pelvic wall, behind bladder & toward the prostate gland. Just before it reaches the prostate gland, each ductus deferens enlarges to form an ampulla.
* Sperm are stored in the proximal portion of the ductus deferens, near the epididymis

Ejaculatory Duct
* Each ductus deferens, at the ampulla, joins the duct from the adjacent seminal vesicle (one of the accessory glands) to form a short ejaculatory duct.
* Each ejaculatory duct passes through the prostate gland and empties into the urethra.

Urethra
* extends from the urinary bladder to the external urethral orifice at the tip of the penis.
* It is a passageway for sperm and fluids from the reproductive system and urine from the urinary system.
* divided into three regions: The prostatic urethra, the membranous urethra & the penile urethra (also called spongy urethra or cavernous urethra)

accessory glands
* are the seminal vesicles, prostate gland, and the bulbourethral glands. These glands secrete fluids that enter the urethra.

Seminal Vesicles
* glands posterior to the urinary bladder.
* Each has a short duct that joins with the ductus deferens at the ampulla to form an ejaculatory duct, which then empties into the urethra.
* The fluid is viscous and contains fructose, prostaglandins and proteins.

Prostate
* a firm, dense structure about the size of a walnut that is located just inferior to the urinary bladder.
* encircles the urethra as it leaves the urinary bladder.
* Numerous short ducts from the prostate gland empty into the prostatic urethra. The secretions of the prostate are thin, milky colored, and alkaline. They function to enhance the motility of the sperm.

Bulbourethral Glands
* small, about the size of a pea, and located near the base of the penis. A short duct from each enters the proximal end of the penile urethra.
* In response to sexual stimulation, the bulbourethral glands secrete an alkaline mucus-like fluid

Seminal Fluid or Semen
* a slightly alkaline mixture of sperm cells and secretions from the accessory glands.
* Secretions from the seminal vesicles make up about 60 percent of the volume of the semen, with most of the remainder coming from the prostate gland. The sperm and secretions from the bulbourethral gland contribute only a small volume.
* The volume of semen in a single ejaculation may vary from 1.5 to 6.0 ml. There are between 50 to 150 million sperm per milliliter of semen. Sperm counts below 10 to 20 million per milliliter usually present fertility problems.

penis
* is a cylindrical pendant organ located anterior to the scrotum and functions to transfer sperm to the vagina.
* consists of three columns of erectile tissue that are wrapped in connective tissue and covered with skin. The two dorsal columns are the corpora cavernosa. The single, midline ventral column surrounds the urethra and is called the corpus spongiosum.
* 3 parts: a root, body (shaft), and glans penis.
* The root of the penis attaches it to the pubic arch
* the body is the visible, pendant portion.
* The corpus spongiosum expands at the distal end to form the glans penis.
* The urethra, which extends throughout the length of the corpus spongiosum, opens through the external urethral orifice at the tip of the glans penis. A loose fold of skin, called the prepuce, or foreskin, covers the glans penis.

Erection

* Involves increase in length, width & firmness
* Changes in blood supply: arterioles dilate, veins constrict
* The spongy erectile tissue fills with blood
* Erectile Dysfunction [ED] also known as impotence

Hormones
* Follicle-stimulating hormone (FSH) stimulates spermatogenesis
* Interstitial Cell Stimulating Hormone (ICSH) stimulates the production of testosterone
* testosterone stimulates the development of male secondary sex characteristics & spermatogenesis.

Spermatogenesis
* Sperm are produced within the seminiferous tubules.
* Interspersed within the tubules are large cells which are the sustentacular cells (Sertoli's cells), which support and nourish the other cells.
* Early in embryonic development, primordial germ cells enter the testes and differentiate into spermatogonia
* Spermatogonia are diploid cells, each with 46 chromosomes (23 pairs) located around the periphery of the seminiferous tubules.
* At puberty, hormones stimulate these cells to begin dividing by mitosis. Some remain at the periphery as spermatogonia.
* Others become primary spermatocytes. Because they are produced by mitosis, primary spermatocytes, like spermatogonia, are diploid and have 46 chromosomes.
* Each primary spermatocytes goes through the first meiotic division, meiosis I, to produce two secondary spermatocytes, each with 23 chromosomes (haploid). Just prior to this division, the genetic material is replicated
* During meiosis I, one chromosome, goes to each secondary spermatocyte. In the second meiotic division, meiosis II, each secondary spermatocyte divides to produce two spermatids. There is no replication of genetic material in this division, but a single-stranded chromatid goes to each cell.
* As a result of the two meiotic divisions, each primary spermatocyte produces four spermatids.
* each spermatid has 23 chromosomes (haploid), one from each pair in the original primary spermatocyte.

* The final step in the development the spermatids formed from spermatogenesis become mature spermatozoa, or sperm.
* The mature sperm cell has a head, midpiece, and tail. The head, also called the nuclear region, contains the 23 chromosomes surrounded by a nuclear membrane. The tip of the head is covered by an acrosome, which contains enzymes that help the sperm penetrate the female gamete. The midpiece, metabolic region, contains mitochondria that provide adenosine triphosphate (ATP). The tail, locomotor region, uses a typical flagellum for locomotion.

Male Reproductive System.ppt

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Endocrine Disruption



♂Endocrine Disruptors♀
Presentation Lecture by:By Sandy Poulos

Endocrine Disruption
* Endocrine System-a complex network of glands that produce and secrete the hormones that regulate all the major body functions.
* Endocrine Disruptor-chemical that interferes with the endocrine system to produce an undesired response, which may affect health, growth, and reproduction.

Mechanisms of Action
* Mimics
* Stimulators
* Blockers
* Endocrine flushers
* Enzyme flushers
* Destructors

EDCs
* Estrogens: any family of steroid hormones that regulate and sustain female sexual development and reproductive function
* Androgen: a class of male sex hormones related to the steroid androstane and produced in the adrenal cortex and the testes
* Substances mimicking feminizing effects are estrogenic and those mimicking masculinizing effects are androgenic
* Also anti-estrogenic and anti-androgenic

Classification
* Pesticides, herbicides, fungicides
* Polyaromatic compounds - PAHs
* Organic oxygen compounds (phthalates, bisphenol A)
* Surfactants
* Drugs
* Metals
* Phytoestrogens

Pesticide-DDT
* 1950’s to 1960’s – DDT
o Estogenic
o Affected reproduction system of birds
o Disrupted the eagle's endocrine system, interfering with calcium metabolism and produced weak egg shells, feminized frogs
o DDT metabolite (DDE) → anti-androgens
* Atrazine & Endosulfan

Bisphenol A & Phthalates
* Bisphenol A
o Used in the manufacture of some clear plastics (e.g. baby feeding bottles), and used in the resin which lines most tin cans
o Potency 4 to 6 times less than 17b-estradiol
+ Weakly estrogenic, anti-androgenic
* Phthalates
o Potency 6 to 7 times less than 17b-estradiol
+ Weakly estrogenic
Phthalates
Surfactants
Drug Example - DES
Sewage Treatment
Metals
Organotins
EDCs in Cosmetics & Toiletries
Parabens?
Dioxin
Phytoestrogens
Isoflavones
Soy-based specialty formula
Lignans
Precocious Puberty
Fertility in Danger ?
EDCs & People
References

Endocrine Disruption.ppt

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