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Oral Pathology Exam 2 > 2 Odontogenic Tumors > Flashcards

2 Odontogenic Tumors Flashcards

1
Q
  • broad spectrum of clinical behavior and microscopic appearance
  • some are true neoplasms, others behave more like hamartomas
A

odontogenic tumors

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2
Q

Odontogenic tumors are classified according to composition and derivation (3):

A
  • odontogenic epithelium
  • odontogenic ectomesenchyme
  • mixed
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3
Q

What are the odontogenic epithelium tumors? Ectomesenchyme? Mixed?

A

Epithelial

  • ameloblastoma
  • adenomatoid odontogenic tumor (AOT)
  • calcifying epithelial odontogenic tumor (CEOT)

Ectomesenchyme

  • odontogenic myxoma
  • cementoblastoma

Mixed

  • odontoma
  • ameloblastic fibroma
  • ameloblastic fibro-odontoma
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4
Q

2nd most common odontogenic tumor

A

ameloblastoma

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5
Q
  • benign tumor, but behaves aggressively

- slow growing, locally invasive

A

ameloblastoma

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6
Q

3 types of ameloblastomas:

A
  • solid/multicystic (majority)
  • unicystic (5-22%)
  • peripheral (1-10%)
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7
Q

many of these tumors have BRAF V600E mutation

A

solid/multicystic ameloblastoma

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8
Q
  • wide age range (peak incidence in 4th-5th decades)
  • M = F
  • mandible (80-85%) > maxilla
  • SLOW painless expansion of the jaw
A

ameloblastoma

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9
Q

common location of ameloblastoma

A
  • mandible (80-85%) > maxilla
  • especially molar and ramus area
  • +/- association with an impacted tooth
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10
Q

can grow to huge proportions, uncontrolled tumor growth can be fatal

A

ameloblastoma

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11
Q

x-ray: radiolucency, often multilocular, may have a “soap bubble” or “honeycomb” appearance, root resorption of adjacent teeth

A

ameloblastoma

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12
Q
  • combination of solid and cystic features

- several histologic patterns (most common = follicular)

A

ameloblastoma

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13
Q

Histology:

  • islands of neoplastic epithelium within a fibrous CT stroma
  • tall, columnar cells at the periphery
  • reverse polarity of nucleus
  • center of the islands resembles stellate reticulum (loosely arranged angular cells)
A

ameloblastoma

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14
Q

Tx:

  • lesion is infiltrative and extends beyond the apparent radiographic margin
  • conservative tx (curettage) = 60-80% recurrence
  • resection (15% recurrence)–> removal of the entire lesion AND 1 cm beyond apparent radiographic margin
  • long term follow-up (25 years)
A

ameloblastoma

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15
Q

follow-up time for ameloblastoma

A

25 years

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16
Q
  • younger pts (2nd decade most common)
  • SINGLE CYSTIC ACTIVITY
  • posterior mandible is most common location
A

unicystic ameloblastoma

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17
Q

radiograph: unilocular radiolucency, often around an impacted 3rd molar (dentigerous cyst mimic)

A

unicystic ameloblastoma

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18
Q

Management is controversial/variable

  • can be treated more conservatively?
  • at least 30% recurrence after enucleation
  • specific subtype may influence decision
A

unicystic ameloblastoma

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19
Q
  • an ameloblastoma that metastasizes
  • histology looks benign like the primary tumor (conventional ameloblastoma)
  • usually goes to lungs
A

metastasizing ameloblastoma

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20
Q

metastasizing/malignant ameloblastoma vs ameloblastic carcinoma

A

Metastasizing/malignant ameloblastoma

  • an ameloblastoma that metastasizes
  • histology looks benign like the primary tumor (conventional ameloblastoma)
  • usually goes to lungs

Ameloblastic carcinoma

  • an ameloblastoma that has cytologic malignancy
  • may or may not metastasize
  • ill-defined radiographic margins
  • aggressive
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21
Q

AOT

A

adenomatoid odontogenic tumor

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22
Q

2/3rds rule

A

AOT:

  • teenagers
  • females
  • maxilla

*uncommon in pts older than 30

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23
Q
  • strong predilection for anterior jaws
  • 75% are associated with an impacted tooth
  • can cause expansion but has limited growth potential
  • not painful
A

AOT

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24
Q

most common tooth affected by AOT

A

canines

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25
Q

x-ray:

  • unilocular, often pericoronal radiolucency
  • may extend apically past the CEJ
  • may contain fine “snowflake” calcifications
A

AOT

26
Q

histo: thick fibrous capsule, duct-like tubular structures

A

AOT

27
Q

tx: enucleation, unlikely to recur

A

AOT

28
Q

CEOT

A

calcifying epithelial odontogenic tumor

29
Q

another name for CEOT

A

Pindborg tumor

30
Q
  • relatively uncommon
  • adults (age 30-50 most common)
  • M = F
  • posterior mandible
  • +/- association with an impacted tooth
A

CEOT

31
Q

x-ray: most are mixed RL/RO but can also be totally RL, unilocular or multilocular

A

CEOT

32
Q

Histopathology

  • epithelial cells
  • tumor cells secrete a unique odontogenic amyloid protein called ODAM
  • amyloid deposits calcify to form Liesegang ring calcifications (concentric, purple)
A

CEOT

33
Q

tx: conservative local resection, 15% recurrence rate

A

CEOT

34
Q
  • mandible > maxilla
  • wide age range, peak is 2-4th decades
  • painless expansion is an early and consistent feature
  • may displace or resorb teeth
A

odontogenic myxoma

35
Q

X-ray:

  • unilocular or multilocular radiolucency
  • “soap-bubble” or honeycomb pattern
  • residual trabeculae may be oriented ar right angles to one another “tennis racquet” trabeculae
A

odontogenic myxoma

36
Q

gelatinous consistency

A

odontogenic myxoma

37
Q

Histopathology:

  • gelatinous loose, myxoid tissue
  • few collagen fibrils
  • haphazardly-arranged stellate cells
A

odontogenic myxoma

38
Q

Tx:

  • curettage for small lesions
  • large lesions usually require resection
  • lesion tends to infiltrate surrounding bone
A

odontogenic myxoma

39
Q

prognosis: average recurrence rate is 25%

A

odontogenic myxoma

40
Q

neoplasm of cementoblasts

A

cementoblastoma

41
Q
  • children and young adults (75% occur before age 30)
  • mandible > maxilla
  • molar/premolar region
A

cementoblastoma

42
Q

50% occur at mandibular 1st molar

A

cementoblastoma

43
Q

MC location of cementoblastoma

A

mandibular 1st molar (50%)

44
Q

pain and expansion (2/3 of cases), pain described as similar to a toothache

A

cementoblastoma

45
Q

X-ray:

  • well-defined RO mass of cementum FUSED TO THE ROOT APEX
  • no visible PDL between root and lesion
  • thin RL border around the lesion
A

cementoblastoma

46
Q

tx: surgical extraction of tooth with attached lesion, alternative is root amputation and endo

A

cementoblastoma

47
Q

most common odontogenic tumor, prevalence exceeds all other odontogenic tumors combined

A

odontoma

48
Q

probably a developmental anomaly (hamartoma) rather than a true neoplasm in most cases

A

odontoma

49
Q
  • kids and teens
  • frequently associated with unerupted teeth
  • often blocks eruption of teeth
  • large lesions can cause expansion
  • consists of varying amounts of dentin, enamel, cementum, and pulp
A

odontoma

50
Q

2 type of odontomas:

A

compound

complex

51
Q

compound vs complex odontoma (MC location? x-ray?)

A

Compound

  • anterior maxilla is most common site
  • x-ray: looks like multiple “tooth-like” structures of varying size and shape with a RL rim

Complex

  • posterior jaws (mandible or maxilla)
  • x-ray: irregular mass of calcified material with a RL rim
52
Q

tx: conservative excision, recurrence is rare

A

odontoma

53
Q

true mixed tumor (both the epithelial and mesenchymal tissues are neoplastic)

A

ameloblastic fibroma

54
Q
  • children and teens (80%)
  • posterior mandible
  • 80% associated with an unerupted tooth
  • root resorption, jaw expansion
A

ameloblastic fibroma

55
Q

x-ray: unilocular or multilocular radiolucency, well-defined border

A

ameloblastic fibroma

56
Q

tx: complete excision, variable % recurrence

A

ameloblastic fibroma

57
Q

recurrent lesions get more aggressive tx (malignant transformation to ameloblastic fibrosarcoma is possible)

A

ameloblastic fibroma

58
Q

Histo:

  • background of tissue that resembles dental papilla
  • islands of odontogenic epithelium resembling those of ameloblastoma
  • no production of hard tissue
A

ameloblastic fibroma

59
Q

ameloblastic fibro-odontoma compared to ameloblastic fibroma

A

ameloblastic fibro-odontoma is very similar to ameloblastic fibroma, but the tumor also produces enamel and dentin

60
Q
  • children (average age = 10)
  • posterior jaws, mandible > maxilla
  • often associated with an unerupted tooth
A

ameloblastic fibro-odontoma

61
Q

x-ray: well-defined radiolucency, usually unilocular, contains a variable amount of calcifications within

A

ameloblastic fibro-odontoma

62
Q

tx: conservative excision, recurrence is uncommon

A

ameloblastic fibro-odontoma

Oral Pathology Exam 2 (8 decks)

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