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oral path 2 > 4 - odontogenic neoplasms > Flashcards

4 - odontogenic neoplasms Flashcards

1
Q

odontogenic neoplasms
tumors of _

enamel organ ( out and inner enamel epi, stellate reticulum, stratum intermedium, ameloblasts, reduced enamel epi)

A

tumors of odontogenic epithelium

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2
Q

odontogenic neoplasms

mixed tumors of _ and _

A

odontogenic epi and odontogenic ectomesenchyme

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3
Q

odontogenic neoplasms
tumors of _

dental papilla (dental sac, dentin, pulp, cementum)

A

tumors of odontogenic ectomesenchyme

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4
Q

3 tumors of odontogenic epithelium

A

ameloblastoma - peripheral ameloblastoma

adenoid odontogenic tumor AOT

calcifying epi odontogenic tumor CEOT - pindbord tumor

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5
Q

3 mixed tumors of odontogenic epi and odontogenic ectomesenchyme

A

ameloblastic fibroma

ameloblastic fibro-odontoma

odontoma

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6
Q

tumors of odontogenic ectomesenchyme

A

odontogenic myxoma

cementoblastoma

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7
Q

odontogenic neoplasms

benign, but locally aggressive
painless
frequency equals combined frequency of all other odontogenic tumors

only 0.2% of oral pathology cases

A

ameloblastoma

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8
Q

odontogenic neoplasms : Ameloblastoma

gender
age
fast/flow growing
expand/none

A

no gender

33 years old average

slow growing
usually expands - rather than perforates bone - expansion can be DRAMATIC

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9
Q

most common to least common jaw sites for ameloblastoma

A 
66 posterior mandi
11 premolar mandi
10 anterior mandi
6 posterio maxilla
6 anterior maxilla
1 PM maxilla
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10
Q

radiographic features:

most in molar/ramus region of mandible, but can occur anywhere

unilocular/multiocular with well defined but not sclerotic borders, espeically small lesions - mutiocular expansile radioluceny “soap bubble” or honeycomb
may displace teeth/resorb roots

~20% associated with impacted tooth

A

Ameloblastoma - odontogenic epi neoplasms

straight trabeculae may mimic odontogenic myxoma

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11
Q

histopathologic features

resembles ameloblasts of the enamel organ
no enamel is produced by lesional cells
several different patterns - most common are follicular and plexiform

tumor often infiltrates bony trabeculae (recurrence)

A

ameloblastoma

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12
Q

histopathological features

tumor islands showing cuboidal or columnar cells at the periphery

center of the tumor islands is composed of loosely arranged polyhedral epi cells that resemble stellate reticulum

ameloblast-like cells with reverse polarization: nuclei are polarized away from the basement membrane

A

ameloblastoma

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13
Q

tx for ameloblastoma

A

small - aggressive curettage or small enbloc resection

large - en bloc resection or segmental resection with reconstruction

maxillary - tx more aggressively due to anatomic location

curettage - 50-90% recurrence rae

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14
Q

Px of ameloblastoma

A

guarded

simple curettage - 50-90% recurrence

even with resection recurrence rates reported up to 15%

can be fatal - esp. maxillary lesions

rare malignant transfer

annual radiographic followup for 8-10 years

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15
Q

soft tissue variant of ameloblastoma

gingival mass - usually less than 2cm in diameter
can look like any gingival bumps

asymptomatic - usually posterio mandible
middle-aged adult - 52

A

peripheral ameloblastoma

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16
Q

radiographic features

no radiographic findings - no or limited bone involvement - may have superficial erosion

A

ameloblastoma

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17
Q

histopathological features

tumor islands showing cuboidal or columnar cells at the periphery

center of the tumor islands is composed of loosely arranged polyhedral epi cells that resemble stellate reticulum

the lesion is located under the surface epi

A

peripheral ameloblastoma

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18
Q

Peripheral ameloblastoma tx and px

A

tx - biopsy is often curative - innocuous lesion easily cured by local excision
little tendency to recur - retx curative

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19
Q

tumors of odontogenic epithelium

most patients under 20
often no change to alveolar bone - can also have expansion and swelling 
asymptomatic
2:1female
2:1maxilla
75% anterior jaws
75%associated with impacted tooth
A

adenomatoid odontogenic tumor - AOT

peripheral AOT rare - soft tissue

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20
Q

Adenomatoid odontogenic tummor - Epi

common locations

A 
53 - anterior maxillary
27 - anterior mandible 
9 - PM max
7 - PM mandi 
2 for posteriormax
2posterio mandi
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21
Q

radiographic features

often incidental finding
well-circumscribed unilocular radiolucency
+/- radiopaque flecks

often causes divergence of adjacent roots
pericoronal lucency may extend apically beyond CEJ

A

adenomatoid odontogenic tumor AOT

apical migration of the cyst

22
Q

histopathologic features

well-developed capsule
swirling spindle-cell nests and duct-like structured “adenomatoid”
foci basophilic calcified material may be seen

A

Adenomatoid odontogenic tumor AOT

23
Q

tx and px of the adenomatoid odontogenic tumor

A

tx - enucleation

px - excellent: recurrence is rare

24
Q

tumor of odontogenic epi

initially described as Pindborg tumor
prior to that time probably confused with ameloblastoma
histogenesis presumed stratum intermedium

A

calcidying epithial odontogenic tumor - CEOT (Pindborg tumor)

25
Q

Epi neoplasm Calcifying epi odontogenic tumor - CEOT

common/rare
male/female
age
mandi/max
symp/asymp
A 
rare
no gender predilection 
40
2:1 mandible - usualy posterior
may have expansion - otherwise asymptomatic 
often associated with impacted tooth
26
Q

most to least common calcifying epithelial odontogenic tumor

A

57% posterior mandible
21 - posterior maxilla
14 - anterior mandible
8 - anterior maxilla

27
Q

radiographic features

driven snow pattern

well-circumscribed radiolucency when small, multiocular when enlarges
margins usually well-defined, but may be ill-defined

A

calcifying epi odontogenic tumor

- CEOT

28
Q

histopatholgoical features

proliferation of polyhedral epi cells with eosinophilic pink cytoplasm
nuclei frequently pleomorphic
rare mitoses
epi cells may be associated with amyloid (eosinophilic, homogenous)
calcifications - liesegang rings (lamellated)

A

calcifying epi odontogdnic tumor - CEOT

29
Q

tx and px of Calcifying epi odontogenic tumor

A

tx - conservative excision: radical surgery not warranted

good - 15% recurrence rate - periodic radiographic follow-up

30
Q

mixed odontogenic epi /ectomesenchyme

epi and ectomesenchymal cells both neoplastic
younger patients, 1-2 decade
small lesions asymo - larger ones produce painless expansion
70% posterior mandible

A

ameloblastic fibroma

31
Q

radiographic features

uniocular when small , multiocular when large
margins may be well-defined or sclerotic

A

ameloblastic fibroma

32
Q

histopathologic features

proliferating odontogenic epi in a cellular ectomesenchyme resembling dental papilla 
myxoid CT (looks like primitive dental pulp contains strands and islands of odontogenic epi resembling dental lamina 
may resemble ameloblastoma
A

ameloblastic fibroma

33
Q

tx and px of ameloblastic fibroma

A

tx - aggressive curettage

px - good, 15% recurrence, periodoic radiographic follow-up
rare malignant transformation

34
Q

mixed odontogenic epi /ectomesenchyme

1-2 decade, average age 10
asymp- although large lesions cause swelling
may be associated with failure of tooth eruption
equal frequency mandible and maxilla
may be confuded with developing odontoma

A

ameloblastic fibro-odontoma

mixed odontogenic epi /ectomesenchyme

35
Q

radiographic features

well-circumscribed unilocular radiolucency, but may be multilocular
varying amounts calcified material with density of tooth
often overlies impacted tooth

A

ameloblastic fibro-odontoma

36
Q

histopathological features

features of ameloblastic fibroma with an odontoma
amount of each type os tissue varies
areas of ameloblastic fibroma seen
odontoma usually complex type

A

ameloblastic fibro-odontoma

37
Q

tx and px of ameloblastic fibro-odontoma

A

tx - conservative excision

px - excellent (recurrence unusual)

38
Q

mixed odontogenic epi /ectomesenchyme

2 forms compound - usually anterior jaw
complex - usually posterior

probably not a true neoplasm, but rather an odontogenic hamartoma
1-2 decade, average 14
may be assocaited with failure of tooth eruption
slightly more frequent in maxilla than mandible

A

odontoma

39
Q

radiographic features

collection of small malformed teeth surrounded by narrow radiolucent rim
often overlies impacted tooth

A

compound odontoma

40
Q

radiographic features

calcified mass, if fully formed has density of tooth structure
surround by narrow radiolucent rim
typically overlies impacted tooth

A

odontoma

41
Q

histopathological features

formation of multiple small malformed teeth

A

compound odontoma

42
Q

histopathological features

admixture of dentin, enamel, matrix, cementum, odontogenic epi and dental papilla

A

complex odontoma

43
Q

tx and px of odontoma

A

tx - enucleation

px - excellent

44
Q

ectomesenchyme tumor
benign neoplasma assumed to be of odontogenic origin because it only affects the jaw bones as a central lesion - no other bones
young adults but wide range - 25-30
mandible slightly more offen than maxilla
larger lesions may have expansion

A

odontogenic myxoma

45
Q

radiographic features

unilocular radioluceny when small 
multilocular when large 
may be soap bubble appearance 
may displace rotos
may cause root resorption
thin,wispy trabeculae of residual bone, often at right angles
A

odontogenic myxoma

soap bubble - Ameloblastoma also

gross specimen - jelly like

46
Q

histopathological features

spindle-shaped or stellate-shaped fibroblastic cells set in a myxoid background
lesional proliferation tends to infiltrate adjacent bony trabeculae(recurrence)

A

odontogenic myxoma

47
Q

tx and px for odontogenic myxoma

A

small - curettage
large - enbloc or segmental resection, depending on the size and site

px - good , 25% recurrence - infiltrate contributes to recurrence rate, especially if only tx with curettage

48
Q

tumors of odontogenic ectomesenchyme

most patients under 25
most mandibular molar region - usually first molar 
no gender.
slow growing
pain and welling 2/3 cases
A

cementoblastoma

49
Q

radiographic features

well-circumscribed radiopaque mass with fine radiolucent border (PDL)
usually obscures the outline of root
can cause resorption

A

cementoblastoma

virtually pathognomonic

PDL surrounds the opaque mass)

50
Q

histopathological features

distinguishing feature - fused to root
trabeculae of mineralized material which resembles cementum
trabeculae are rimmed by plump. angular cells that represent neoplastic cementoblasts
DD - osteoblastoma, osteosarcoma

A

cementoblastoma

51
Q

tx and px of cementoblastoma

A

tx - surgical extraction of involved tooth with enucleation of the lesion
alternatively, the tooth can be endo tx and lesion enucleated along with amputation of the involved root

px - excellent

oral path 2 (7 decks)

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