4 - odontogenic neoplasms

Question 1

odontogenic neoplasms
tumors of _

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

Answer 1

tumors of odontogenic epithelium

Question 2

odontogenic neoplasms

mixed tumors of _ and _

Answer 2

odontogenic epi and odontogenic ectomesenchyme

Question 3

odontogenic neoplasms
tumors of _

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

Answer 3

tumors of odontogenic ectomesenchyme

Question 4

3 tumors of odontogenic epithelium

Answer 4

ameloblastoma - peripheral ameloblastoma

adenoid odontogenic tumor AOT

calcifying epi odontogenic tumor CEOT - pindbord tumor

Question 5

3 mixed tumors of odontogenic epi and odontogenic ectomesenchyme

Answer 5

ameloblastic fibroma

ameloblastic fibro-odontoma

odontoma

Question 6

tumors of odontogenic ectomesenchyme

Answer 6

odontogenic myxoma

cementoblastoma

Question 7

odontogenic neoplasms

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

only 0.2% of oral pathology cases

Answer 7

ameloblastoma

Question 8

odontogenic neoplasms : Ameloblastoma

gender
age
fast/flow growing
expand/none

Answer 8

no gender

33 years old average

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

Question 9

most common to least common jaw sites for ameloblastoma

Answer 9

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

Question 10

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

Answer 10

Ameloblastoma - odontogenic epi neoplasms

straight trabeculae may mimic odontogenic myxoma

Question 11

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)

Answer 11

ameloblastoma

Question 12

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

Answer 12

ameloblastoma

Question 13

tx for ameloblastoma

Answer 13

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

Question 14

Px of ameloblastoma

Answer 14

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

Question 15

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

Answer 15

peripheral ameloblastoma

Question 16

radiographic features

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

Answer 16

ameloblastoma

Question 17

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

Answer 17

peripheral ameloblastoma

Question 18

Peripheral ameloblastoma tx and px

Answer 18

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

Question 19

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

Answer 19

adenomatoid odontogenic tumor - AOT

peripheral AOT rare - soft tissue

Question 20

Adenomatoid odontogenic tummor - Epi

common locations

Answer 20

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

Question 21

radiographic features

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

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

Answer 21

adenomatoid odontogenic tumor AOT

apical migration of the cyst

Question 22

histopathologic features

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

Answer 22

Adenomatoid odontogenic tumor AOT

Question 23

tx and px of the adenomatoid odontogenic tumor

Answer 23

tx - enucleation

px - excellent: recurrence is rare

Question 24

tumor of odontogenic epi

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

Answer 24

calcidying epithial odontogenic tumor - CEOT (Pindborg tumor)

Question 25

Epi neoplasm Calcifying epi odontogenic tumor - CEOT ``` common/rare male/female age mandi/max symp/asymp ```

Answer 25

``` rare no gender predilection 40 2:1 mandible - usualy posterior may have expansion - otherwise asymptomatic often associated with impacted tooth ```

Question 26

most to least common calcifying epithelial odontogenic tumor

Answer 26

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

Question 27

radiographic features driven snow pattern well-circumscribed radiolucency when small, multiocular when enlarges margins usually well-defined, but may be ill-defined

Answer 27

calcifying epi odontogenic tumor | - CEOT

Question 28

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)

Answer 28

calcifying epi odontogdnic tumor - CEOT

Question 29

tx and px of Calcifying epi odontogenic tumor

Answer 29

tx - conservative excision: radical surgery not warranted good - 15% recurrence rate - periodic radiographic follow-up

Question 30

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

Answer 30

ameloblastic fibroma

Question 31

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

Answer 31

ameloblastic fibroma

Question 32

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 ```

Answer 32

ameloblastic fibroma

Question 33

tx and px of ameloblastic fibroma

Answer 33

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

Question 34

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

Answer 34

ameloblastic fibro-odontoma mixed odontogenic epi /ectomesenchyme

Question 35

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

Answer 35

ameloblastic fibro-odontoma

Question 36

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

Answer 36

ameloblastic fibro-odontoma

Question 37

tx and px of ameloblastic fibro-odontoma

Answer 37

tx - conservative excision px - excellent (recurrence unusual)

Question 38

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

Answer 38

odontoma

Question 39

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

Answer 39

compound odontoma

Question 40

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

Answer 40

odontoma

Question 41

histopathological features formation of multiple small malformed teeth

Answer 41

compound odontoma

Question 42

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

Answer 42

complex odontoma

Question 43

tx and px of odontoma

Answer 43

tx - enucleation px - excellent

Question 44

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

Answer 44

odontogenic myxoma

Question 45

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 ```

Answer 45

odontogenic myxoma soap bubble - Ameloblastoma also gross specimen - jelly like

Question 46

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

Answer 46

odontogenic myxoma

Question 47

tx and px for odontogenic myxoma

Answer 47

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

Question 48

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 ```

Answer 48

cementoblastoma

Question 49

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

Answer 49

cementoblastoma virtually pathognomonic PDL surrounds the opaque mass)

Question 50

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

Answer 50

cementoblastoma

Question 51

tx and px of cementoblastoma

Answer 51

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