4 - odontogenic neoplasms Flashcards
odontogenic neoplasms
tumors of _
enamel organ ( out and inner enamel epi, stellate reticulum, stratum intermedium, ameloblasts, reduced enamel epi)
tumors of odontogenic epithelium
odontogenic neoplasms
mixed tumors of _ and _
odontogenic epi and odontogenic ectomesenchyme
odontogenic neoplasms
tumors of _
dental papilla (dental sac, dentin, pulp, cementum)
tumors of odontogenic ectomesenchyme
3 tumors of odontogenic epithelium
ameloblastoma - peripheral ameloblastoma
adenoid odontogenic tumor AOT
calcifying epi odontogenic tumor CEOT - pindbord tumor
3 mixed tumors of odontogenic epi and odontogenic ectomesenchyme
ameloblastic fibroma
ameloblastic fibro-odontoma
odontoma
tumors of odontogenic ectomesenchyme
odontogenic myxoma
cementoblastoma
odontogenic neoplasms
benign, but locally aggressive
painless
frequency equals combined frequency of all other odontogenic tumors
only 0.2% of oral pathology cases
ameloblastoma
odontogenic neoplasms : Ameloblastoma
gender
age
fast/flow growing
expand/none
no gender
33 years old average
slow growing
usually expands - rather than perforates bone - expansion can be DRAMATIC
most common to least common jaw sites for ameloblastoma
66 posterior mandi 11 premolar mandi 10 anterior mandi 6 posterio maxilla 6 anterior maxilla 1 PM maxilla
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
Ameloblastoma - odontogenic epi neoplasms
straight trabeculae may mimic odontogenic myxoma
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)
ameloblastoma
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
ameloblastoma
tx for ameloblastoma
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
Px of ameloblastoma
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
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
peripheral ameloblastoma
radiographic features
no radiographic findings - no or limited bone involvement - may have superficial erosion
ameloblastoma
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
peripheral ameloblastoma
Peripheral ameloblastoma tx and px
tx - biopsy is often curative - innocuous lesion easily cured by local excision
little tendency to recur - retx curative
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
adenomatoid odontogenic tumor - AOT
peripheral AOT rare - soft tissue
Adenomatoid odontogenic tummor - Epi
common locations
53 - anterior maxillary 27 - anterior mandible 9 - PM max 7 - PM mandi 2 for posteriormax 2posterio mandi
radiographic features
often incidental finding
well-circumscribed unilocular radiolucency
+/- radiopaque flecks
often causes divergence of adjacent roots
pericoronal lucency may extend apically beyond CEJ
adenomatoid odontogenic tumor AOT
apical migration of the cyst
histopathologic features
well-developed capsule
swirling spindle-cell nests and duct-like structured “adenomatoid”
foci basophilic calcified material may be seen
Adenomatoid odontogenic tumor AOT
tx and px of the adenomatoid odontogenic tumor
tx - enucleation
px - excellent: recurrence is rare
tumor of odontogenic epi
initially described as Pindborg tumor
prior to that time probably confused with ameloblastoma
histogenesis presumed stratum intermedium
calcidying epithial odontogenic tumor - CEOT (Pindborg tumor)
Epi neoplasm Calcifying epi odontogenic tumor - CEOT
common/rare male/female age mandi/max symp/asymp
rare no gender predilection 40 2:1 mandible - usualy posterior may have expansion - otherwise asymptomatic often associated with impacted tooth
most to least common calcifying epithelial odontogenic tumor
57% posterior mandible
21 - posterior maxilla
14 - anterior mandible
8 - anterior maxilla
radiographic features
driven snow pattern
well-circumscribed radiolucency when small, multiocular when enlarges
margins usually well-defined, but may be ill-defined
calcifying epi odontogenic tumor
- CEOT
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)
calcifying epi odontogdnic tumor - CEOT
tx and px of Calcifying epi odontogenic tumor
tx - conservative excision: radical surgery not warranted
good - 15% recurrence rate - periodic radiographic follow-up
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
ameloblastic fibroma
radiographic features
uniocular when small , multiocular when large
margins may be well-defined or sclerotic
ameloblastic fibroma
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
ameloblastic fibroma
tx and px of ameloblastic fibroma
tx - aggressive curettage
px - good, 15% recurrence, periodoic radiographic follow-up
rare malignant transformation
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
ameloblastic fibro-odontoma
mixed odontogenic epi /ectomesenchyme
radiographic features
well-circumscribed unilocular radiolucency, but may be multilocular
varying amounts calcified material with density of tooth
often overlies impacted tooth
ameloblastic fibro-odontoma
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
ameloblastic fibro-odontoma
tx and px of ameloblastic fibro-odontoma
tx - conservative excision
px - excellent (recurrence unusual)
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
odontoma
radiographic features
collection of small malformed teeth surrounded by narrow radiolucent rim
often overlies impacted tooth
compound odontoma
radiographic features
calcified mass, if fully formed has density of tooth structure
surround by narrow radiolucent rim
typically overlies impacted tooth
odontoma
histopathological features
formation of multiple small malformed teeth
compound odontoma
histopathological features
admixture of dentin, enamel, matrix, cementum, odontogenic epi and dental papilla
complex odontoma
tx and px of odontoma
tx - enucleation
px - excellent
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
odontogenic myxoma
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
odontogenic myxoma
soap bubble - Ameloblastoma also
gross specimen - jelly like
histopathological features
spindle-shaped or stellate-shaped fibroblastic cells set in a myxoid background
lesional proliferation tends to infiltrate adjacent bony trabeculae(recurrence)
odontogenic myxoma
tx and px for odontogenic myxoma
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
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
cementoblastoma
radiographic features
well-circumscribed radiopaque mass with fine radiolucent border (PDL)
usually obscures the outline of root
can cause resorption
cementoblastoma
virtually pathognomonic
PDL surrounds the opaque mass)
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
cementoblastoma
tx and px of cementoblastoma
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
