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Pathology > Ameloblastoma > Flashcards

Ameloblastoma Flashcards

1
Q

What is the origin of ameloblastoma

A

Rests of Serres

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2
Q

What are the rests of serres

A

Rests of seres are epithelial remnants in fibrous gingival tissue

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3
Q

What is a key component of histology in ameloblastoma

A

Reverse polarity of nuclei pathognomonic is a key part of ameloblastoma histology.

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4
Q

Name the 6 histologic subtypes;

A
  • Follicular
  • Plexiform (most common)
  • Granular
  • Acanthomatous
  • Desmoplastic
  • Basal Cell
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5
Q

What is the most common histologic subtype of ameloblastoma?

A

Plexiform

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6
Q

What is the histology of folicular ameloblastoma?

A

Palisaded ameloblastlike cells and inner zone of triangular-shaped cells resembling stellate reticulum in bell stage.

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7
Q

What is the common appearnce of plexiform ameloblastoma

A

epithelium that proliferates in a fisnhet pattern

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8
Q

What is the radiographic appearnce ofameloblastoma

A

Radiolucency with multilocularated-soap bubble appearance except for desmoplastic subtype which is radiopaque due to collagenized stroma,; root resoprtion is common

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9
Q

What is the clinical presenation of ameloblastoma?

A

Solid and/or cystic, buccolingual expansion, peripheral painless warty appearance

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10
Q

What is the location of ameloblastoma

A

Posterior mandible in desmoplastic, anterior maxilla in peripheral

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11
Q

What is the treatment and recurrence rate of solid or multicystic ameloblastoma?

A
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12
Q

What decade does solid or mulitcystic ameloblastoma usually occur?

A

4th decade

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13
Q

What is the treatment and recurrence rate of unicystic ameloblastoma?

A
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14
Q

What decade do unicystic subtypes typically occur?

A

3rd decade

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15
Q

What is the treatment and recurrence rate of peripheral ameloblastoma?

What decade of life does it occur?

A

6th decade of life, excision, with no recurrence

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16
Q

T/F: Ameloblastoma’s incidence exceeds that of all other odontogenic tumors

A

True

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17
Q

The tumors of course arise from the Rests of seres but also can say they arise from…

A

Rests of dental lamina, a developing enamel organ, the epithelial lining of an adontogenic cysts, or the basal cells of the oral mucosa

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18
Q

Three different variants of ameloblastoma

A
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19
Q

Which variant of ameloblastoma is most common?

A

Solid/multicystic which is 92% of the cases

20
Q

Describe multicystic or solid ameloblastomas for me (

A
  1. About 85% occur in the posterior mandible near the ramus or mollar
  2. 15% occur in the posterior maxilla
  3. There is a painless expansion of the jaws with neursensory changes being uncommon
  4. Thre can be tremendous facil disfigurment.
  5. Most commmon radiographic feature is a multilocular radiolucency with buccal/lingual cortical expansion to the point of perforation.
  6. Resorption of roots is common
21
Q

What is the stellate reticulum

A

The stellate reticulum is

  • a group of cells located in the center of the enamel organ of a developing tooth.
  • These cells are star-shaped and synthesize glycosaminoglycans. As glycosaminoglycans are produced, water is drawn in between the cells, stretching them apart.
  • As they are moved further away from one another, the stellate reticular cells maintain contact with one another through desmosomes, resulting in their unique appearance.
  • The stellate reticulum is lost after the first layer of enamel is laid down. This brings cells in the inner enamel epithelium closer to blood vessels at the periphery
22
Q

Describe a picture of the stellate reticulum

A
23
Q

Describe a diagram of the stellate reticulum.

A
24
Q

How do the different types of multicycstic ameloblastoma (follicular and plexiform) relate to the stellate reticulum.

A
  1. Follicular in which the stellate reticulum is located within the center of the odontogenic island
  2. Plexiform-stellate reticulumis located outside of the odontogenic rests
25
Q

What is the histological pattern of acanthomatous multicystic/solid ameloblastoma?

A

Squamous differentiation of the odontogenic epithelium is present

26
Q

What is the histological pattern of granular cell multicystic/solid ameloblastoma?

A

Tumor islands exhibit cells that demonstrate abundant granular eosinophilic cytoplasm

Eosin is a bright-pink protein based dye that will therefore react or ‘stain’ proteins suspended in the cytoplasm of cells as well as extracellular proteins such as collagen. Thus, we get the term ‘eosinophilic cytoplasm’. A more inclusive term, ‘Acidophilic’, refers to all cellular tissues which react to an acid dye.

The eosinophil is a specialized cell of the immune system. This proinflammatory white blood cell generally has a nucleus with two lobes (bilobed) and cytoplasm filled with approximately 200 large granules containing enzymes and proteins with different (known and unknown) functions.

27
Q

What is the histological pattern of desmoplastic multicystic/solid ameloblastoma?

A

Extremely dense collagenized stronga tha tsupports the tumor

28
Q

What is the histological pattern of basal cell multicystic/solid ameloblastoma?

A

nests of uniform basaloid cells are presents with a strong resemblance to basal cell carcinoma. In this stellate reticulum is not present in the central portion o fthe nests.

29
Q

What makes desmoplastic ameloblastoma unique radiographically?

A

It is generally not radilucent tumor due to the high content of collagenized stroma.

30
Q

What pathogenetic finding is associated with the recurrence rate of ameloblastoma

A

Highest number of PNCA-positive cells

It aslso includes an overexpression of BCL2 and BCLX as well as the expression of IL-1 and IL-6

Multicystic/solid ameloblastomas have higher PNCA positive cells than unicystic.

31
Q

T/F: There is no concensus on the biolgoic behavior of ameloblastoma

A

True

32
Q

Why does the actual margin of ameloblastoma usually extend beyond its apparent radiographic or clinical margin?

A

The solid of multicystic ameloblastoma tends to infiltrate between intact cancellous bone trabeculae at the periphery of the tumor before bone resorption becomes radiographically evident so it usually extends beyond that.

33
Q

Due to the agressive nature of solid/multicystic ameloblastoma, what should the resection margin be?

A

It should be 1.0 cm with interaoperative specimen radiographs.

34
Q

Does an anatomical barrier need to be sacrificed with solid/multicystic ameloblastomas?

A

Yes, one uninvolved surrounding anatomic barrier should be sacrificed on the periphery of the specimen.

35
Q

Is ameloblastoma malignant or benign?

A

Some would say malignant because it is locally invasive and prone to reoccur.

It has been compared to basal cell carcinoma which is slow growin, infiltrative, capable of greater destuction of soft tissue and bone, recurrent when not completely eradicated, capable of infading vital structures, seldom metastatic but capable of metastasis, presenting a numbe rof histological patterns

36
Q

When do unicystic ameloblastomas typically form?

A

2nd decade, 50% happen around then and the average age is reported at 22.1

37
Q

Why does unicystic ameloblastoma mimic a dentigerous cysts

A

Because it appears as a unilocular radiolucency is the posterior mandible

38
Q

One of the histological variants of unicystic ameloblastoma is a

luminal unicystic ameloblastoma

Describe is histologiclly.

A

Confined to the luminal surface of the cyst. Consits of a fibrous cyst wall with a lining that consists totally or partially of ameloblastic epithelium.

39
Q

One of the histological variants of unicystic ameloblastoma is a

intraluminal unicystic ameloblastoma

Describe is histologiclly.

A

Contains one or more nodules of ameloblastoma projecting from the cystic lining into the lumen of the cyst.

These nodules may be relatively small or largely fill the cystic lumen and are noted to show a plexiform pattern that resemles the plexiform pattern seen in conventional ameloblastomas.

These are often called plexiform unicystic ameloblastomas

40
Q

One of the histological variants of unicystic ameloblastoma is a

mural ameloblastoma

Describe is histologiclly.

A

The fibrous wall of the cyst is infiltrated by typical follicular or plexiform ameloblastoma. The extent and depth may vary considerably

41
Q

Walk me through an algorithm of a large unicystic lesion with

A
42
Q

Luminal

Intraluminal

Mural

Treatment options

A

Luminal and intraluminal are usually enuclation and curretage

Mural is resection

43
Q

When to resect a unicystic ameloblastoma

A

1-Recurrent unicystic ameloblastoma after failed enuclation and curretage

2-mural amelblastoma because it is more aggressive than luminal and intraluminal owing to the presence of the tumor in the cyst wall and its proximity to surrounding bone.

3-Management of a large tumor where enucleation and curretage would not be effective.

44
Q

How do peripheral ameloblastomas present?

A

tumors present as non-ulcerated sessile or pedunculated gingival lesions. Most are smaller than 1.5 cm and usually occur over a wide age range.

45
Q

Peripheral ameloblastomas and malignant transformation. Common or rare?

A

Rare

Pathology (2 decks)

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