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Oral Pathology > Benign Odontogenic Tumors Dr. T > Flashcards

Benign Odontogenic Tumors Dr. T Flashcards

1
Q

What is the relationship between lesion’s agrressivness, rate of reccurance and follow up duration ?

A

the more aggressive the biologic behavior, the higher risk of
recurrence, and the longer the follow up needed for the patient

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2
Q

What is the spectrum of benign and malignant lesions

A
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3
Q

Which lesions are considered benigns

A

Things that have a very low rate of recurrence when you do a conservative excision or a nucleation ►they’re going to be very benign and they’re not going to be likely to be recurrent:
▪ Odontoma and radicular cysts are way down here near the benign side
▪ AOT (Adenomatoid Odontogenic Tumor) is benign.
▪ COCs (Calcifying odontogenic cyst) are benign.
▪ OKCs (Odontogenic keratocyst) ‐ they’re benign.
▪ Even Ameloblastomas are benign

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4
Q

which lesions are on the malignant side?

A

But eventually you get over to the side over here where you can have something like an Ameloblastic carcinoma ‐ truly malignant –> We know that it can metastasize and it can lead to death
▪ Lesions like Ameloblastomas and CEOTs will need to be managed more aggressively. (Not just curettage, aka surgical scraping or cleaning)
o You have a resection ‐ either a portion of the mandible is
removed or a segment of the mandible is removed.

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5
Q

What are the 3 Classification of
benign tumors?

A
  1. Epithelial
  2. Mesenchymal
  3. Mixed
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6
Q

What are the list of Epithelial Benign Tumors?

(5)

A

▪ Ameloblastoma
▪ Adenomatoid odontogenic tumor
▪ Calcifying epithelial odontogenic tumor
▪ Squamous odontogenic tumor
▪ Odontogenic keratocyst (aka Keratocystic odontogenic tumor)

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7
Q

What are the list of Mesenchymal Benign Tumors?

(5)

A

▪ Odontogenic myxoma
▪ Central Odontogenic fibroma
▪ Cementifying fibroma
▪ Cementoblastoma
▪ Granular cell odontogenic tumor

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8
Q

What are the list of Mixed Benign tumors?

5

A

▪ Odontoma (complex and compound)
▪ Ameloblastic fibroma/odontoma
▪ Primordial odontogenic tumor
▪ Dentinogenic ghost cell tumor
▪ Calcifying cystic odontogenic tumor(aka COC, ghost cell tumor)

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9
Q

Ameloblastoma

Charcterstics

A
  • An epithelial odontogenic neoplasm (Tumor of Epithelial Origin)
  • with a close histologic resemblance to the enamel organ
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10
Q

Ameloblastoma

Origin

A

Potential sources of epithelium include:

o Enamel organ – look like they’re about to deposit a
substance but never do

o Odontogenic rests (Malassez, Serres)

o Reduced enamel epithelium

o Epithelial lining of odontogenic cysts ‐ can actually have an ameloblastoma arise within a dentigerous cyst

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11
Q

Ameloblastoma

Radiographically

A

-Osteolytic tumor (radiolucent – no hard tissue formed)

  • Well-circumscribed uni- or multilocular radiolucency
  • Often with sclerotic or corticated borders
  • May see blunt root resorption and displacement of teeth
  • Frequently seen in association with unerupted teeth
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12
Q

Ameloblastoma

Clinically

A
  • Rather slow growing tumor
  • Larger lesions present as painless expansion or swelling of bone
  • Smaller ones are asymptomatic, can be seen on routine imaging
  • Buccal and lingual cortical expansion is common
  • May perforate cortical plate and invade surrounding soft tissue
  • Can arise in a dentigerous cyst (see transition from stratified
  • squamous to ameloblastic epithelium)
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13
Q

Ameloblastoma

Demographics

A

▪ 11‐18% of non‐cystic lesions of the maxillofacial bones
▪ 4th and 5th decade most common, but occurs over a broad age range (rare in first decade)
o Usually starts 2nd decade, can go up to 80‐90s. Late 30s/early 40s are usually the peak
▪ > 80% occur in the mandible (most in molar/ramus area)

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14
Q

ameloblastoma

location

A

▪ Almost 80% or a little over 80% (of ameloblasts) are down in the mandible.
▪ And the vast majority are in the posterior mandible
▪ Do occur in maxilla but at lower rate

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15
Q

Ameloblastoma

Etiology

A

▪ Over expression of Bcl‐2 (anti‐apoptotic protein)
▪ Expression of fibroblast growth factor (FGF)
▪ Over expression of matrix metalloproteinases (MMPs 9 and 20) – like in OKC, allowing tumor to grow into surrounding area
▪ Surprisingly, no significant increase in Ki‐67 expression (cell
proliferation marker) – ameloblastomas do NOT turn over rapidly

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16
Q

What is

the second most common

odontogenic neoplasm?

A

Ameloblastoma

(after odontoma)
o although odontomas are more like hamartomas

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17
Q

Which tumor can arise in a dentigerous cyst?

A

Ameloblastoma

(we see transition from stratified squamous to ameloblastic epithelium)

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18
Q

Ameloblastoma

Types

A

Conventional/multicystic/solid/ (~ 80%)

  • Unicystic (~6-15%) need entire specimen (excision) to know
  • Desmoplastic
  • Peripheral
  • Malignant
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19
Q

What is this radiographic finding?

A

Unilocular and unicystic ‐ An example of a unilocular ameloblastoma that is
not associated with an impacted tooth
▪ Is between roots of two teeth, may be confused with lateral
periodontal cyst. Well‐circumscribed radiolucency

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20
Q

What is this radiographic finding?

A

▪ Typical appearance for ameloblastoma

Multilocular, very well‐circumscribed, associated with impacted tooth.

Can see bowing of inferior aspect of mandible

lateral oblique radiograph.was used here

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21
Q

What is this radiographic & clinical finding?

A

Ameloblastoma

clinically: Have expansion of the buccal plate, obliterating the vestibule in this area.

Radiographically: Root resorption of molar, unilocular radiolucency in mandible

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22
Q

What is this radiographic finding?

A

Ameloblastoma

  • Small lesion distal to impacted tooth.
  • Unilocular radiolucency with elevation of alveolar ridge + some expansion of soft tissue
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23
Q

What is this radiographic finding?

A

Ameloblastoma

▪ Well‐circumscribed radiolucency with a sclerotic or
corticated margin.

▪ If you had a CBCT, it would probably show you that there
was a thin septa in this area of residual bone trabeculae.

▪ Fracture could be caused by very large cysts.

▪ Resolve by decompressing unless with odontogenic tumor – need to remove the mandible 1cm+ on either side of lesion

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24
Q

Conventional/Solid Ameloblastoma

Treatment

A
  • Resection (treatment depends on extent of the lesion and anatomy of involved bone)
  • Segmental
  • Composite
  • Long term (decades) follow up is needed for these patients
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25
Q

Case

16yo female

Describe the lesion and what is the diagnosis?

A

▪Left mandible, multilocular radiolucency associated with impacted tooth
▪ It’s well circumscribed, edge may be a little bit sclerotic or corticated
▪ It has displaced an impacted tooth down towards the inferior
aspect of the mandible
▪ Appears to be expanding the cortex of the mandible in areas
▪ There’s blunt resorption of the teeth adjacent (PMs and molar)

Ameloblastoma

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26
Q

Case

▪ Well‐circumscribed radiolucency, no impacted tooth
▪ But notice that it’s coming up to posterior aspect of first molar
▪ Surgery done to remove lesion, left inferior aspect of mandible

Follow‐up image: conservative surgery but still removed bone up to mesial aspect. Less conservative would be removing entire mandible
▪ Concern with that is paresthesia (from removing the nerve as well)

A

Conventional/Solid Ameloblastoma

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27
Q

Unicystic
ameloblastoma

types

Subgroup of
ameloblastomas

A

▪ Unicystic (Simple or luminal)

  • lumina- confined to the surface lining of the cystic space

▪ Plexiform (intraluminal)

  • intralumina-one or more areas of the ameloblastic epithelial lining, proliferate into the lumen of the cystic space

▪ Mural – hard to distinguish from conventional,
so pathologists think they should NOT be treated the same as unicystic (which would be a more conservative treatment)
▪ Ameloblastoma arising in a cyst ‐ can usually be treated in a similar way as unicystic ameloblastoma.

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28
Q

Unicystic Ameloblastoma

Demographcics and Locations

A

▪ Younger initial presentation (~ 50% in 2nd decade)
▪ 90% in MD (mandibular)
▪ Typically asymptomatic and found on routine radiographic exam

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29
Q

Unicystic Ameloblastoma

Radiographically

A
  • Commonly a well‐circumscribed radiolucency that surrounds the crown of an unerupted tooth
  • Commonly accompanied by root resoprtion
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30
Q

Unicystic Ameloblastoma

radiographically can be confused with which cyst?

A
  • Radiographically can be confused with dentigerous cyst
    • Presence of root resorption should increase your suspicion of ameloblastoma
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31
Q

What is this radiographic finding?

A

Unicystic Ameloblastoma

but could be

Dentigerous Cyst

based on clinical presentation!

So radiograph is not diagonstic

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32
Q

Unicystic Ameloblastoma

Treatment

A
  • Treatment is typically enucleation and curettage
    • Reports of lower rate of recurrence (10‐20%) than conventional ameloblastoma (50‐90%) with similar treatment
    • Some recommend decompression prior to surgery
  • Use of Carnoy’s solution after enucleation- resulted in a recurrence rate lower
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33
Q

Desmoplastic
Ameloblastoma

Location

A
  • Anterior jaws (particularly maxilla)
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34
Q

Desmoplastic
Ameloblastoma

Radiographically

A
  • looks “fibro‐osseous” due to mixed radiolucentradiopaque appearance
    • Mineralization of dense collagen
  • Well‐circumscribed, corticated.
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35
Q

What is this radiographic finding?

A

Desmoplastic
Ameloblastoma

  • Spherical growth. Within it, has both radiodense and radiolucent areas (is
  • mixed radiolucent‐radiopaque)– similar appearance to benign fibro‐osseous lesions.
  • Well‐circumscribed, corticated.
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36
Q

Peripheral
Ameloblastoma

Origin and Charcterstics

A
  • Thought to arise from epithelial rests or basal cells in the gingiva
  • Uncommon
  • Does not invade underlying bone
  • Histology is the same as conventional type
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37
Q

Peripheral
Ameloblastoma

location

A
  • Found on gingiva or alveolar mucosa (*that’s why it’s named peripheral or extraosseous)
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38
Q
A

Peripheral
Ameloblastoma

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39
Q

What are the two types of “Malignant”
Ameloblastomas ?

A
  1. Malignant ameloblastoma
  2. Ameloblastic carcinoma
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40
Q

What is a malignant ameloblastoma?

A

▪ Malignant ameloblastoma
o Primary lesion and metastasis have normal welldifferentiated
ameloblastic (benign) histology
o Most commonly to lung

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41
Q

What is Ameloblastic carcinoma?

A
  • a primary lesion has atypical poorly‐differentiated
  • neoplastic(malignant) histology
  • may metastasize
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42
Q

CALCIFYING EPITHELIAL ODONTOGENIC TUMOR

CEOT

also known as ?

A

Pindborg Tumor

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43
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT)

A

▪ Uncommon (~1% of odontogenic tumors)
▪ Does not have inductive effect

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44
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT)

Demographics and Location

A

o 2nd to 10th decades, peak ~ 4th decade
o MD (mandibular) 2 : 1 MX (maxillary)
o Usually posterior mandible

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45
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT)

Clinically

A
  • Presents as painless slowly expanding swellings
  • sessile swellings of the gingiva or alveolus ( 2 times more on mandible than maxilla
  • Peripheral lesion may be seen, but are rare
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46
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT)

Radiographically

A
  • May be unilocular, but most commonly as a multilocular lesion
  • May be entirely radiolucent or a mixed radiolucent-radiopaque lesion
  • Often associated with an unerupted tooth
    • MD third molar most common
  • Calcifications in the lesion, if present, are typically prominent around the crown of the impacted tooth.
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47
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT) have clinical presentation similar to what lesion?

A
  • CEOT clinically is similar to ameloblastoma
  • Also, CEOT has potential to be locally invasive, if in the right anatomic location, but has a less aggressive biologic behavior compared to ameloblastoma
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48
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT)

Treatment

A

▪ Enucleation _with peripheral ostectom_y
▪ Resection with rim of normal bone
▪ Recurrence rate is ~12%
▪ ~ 2% demonstrate malignant transformation

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49
Q

case

A

Calcifying Epithelial Odontogenic Tumor

(CEOT)

Clinically: we see a little expansion on inferior aspect of mandible + lingual too

Radiographically: we see well‐circumscribed, a little corticated/sclerotic edge, impacted tooth
▪ we can see bowing of inferior aspect of mandible
▪ Within areas of radiolucency, see areas of opacity (calcified lesions = classic CEOT)
▪ When smaller► could have looked *unilocular*

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50
Q

What is this radiographic finding?

A

Calcifying Epithelial Odontogenic Tumor(CEOT)

  • flecks of calcifications.
  • Calcifications all around crown is common
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51
Q

What is this radiographic finding?

A

Calcifying Epithelial Odontogenic Tumor(CEOT)

  • Multilocular radiolucency with calcifications.
  • an expansion up to PMs and back to 2nd molar
  • as well as bowing of mandible.
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52
Q

What is this radiographic finding?

A

Calcifying Epithelial Odontogenic Tumor(CEOT)

  • Fewer calcifications here, well‐circumscribed and corticated, impacted tooth.
  • periosteal reaction causing elevation at the bottom of image!
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53
Q
A

Calcifying Epithelial Odontogenic Tumor(CEOT)

  • well‐circumscribed radiolucency with calcifications in lower anteriors
54
Q

Adenomatoid odontogenic tumor

(AOT)

Demographics and Location

A

▪ 2/3 anterior jaws
▪ 2/3 females
▪ 2/3 associated with an impacted canine
▪ 2/3 MX
▪ 2/3 2nd decade – kids and teenagers\

That’s why it’s known as the tumor of two thirds

▪ ~ 3‐7% of all odontogenic tumors

New research showing more in _ant md_ though

55
Q

Adenomatoid odontogenic tumor

(AOT)

Clinical charcterstics

A
  • Frequently asymptomatic, discovered upon routine radiographic exam or when lesion becomes large enough to expand bone
  • Tumor of Epithelial Origin
56
Q

Adenomatoid odontogenic tumor

(AOT)

Origin

A
  • thought to arise from remnants of the dental lamina in the gubernacular cord /canal
57
Q

Adenomatoid odontogenic tumor

(AOT)

Radiographically

A

▪ ~ 75% are well‐circumscribed unilocular radiolucency involving the crown of an unerupted tooth
o less often, they are found between the roots of teeth
▪ Mixed radiolucent/radiopaque appearance is likened to “snowflake” calcifications
▪ May be totally radiopaque in some cases
▪ Divergence of roots is frequently seen

58
Q

If an Adenomatoid odontogenic tumor (AOT) is not showing any calcifications yet, it’s in the differential
diagnosis with —— ?

A

a dentigerous cyst.

59
Q

Adenomatoid odontogenic tumor

(AOT)

Treatment

A
  • Treatment is usually enucleation
  • recurrence is rare
60
Q

What is the DD?

A

well‐circumscribed radiolucency at crown of an impacted canine
Hard to tell if attaches at CEJ.

If further down, less likely a dentigerous cyst and more likely AOT, ameloblastoma, or OKC

61
Q

What is this radiographic finding?

A

we see calcifications forming, with both radiolucent and radiolucent areas.
▪ Dentingerous cyst, ameloblastoma, and OKC are NO LONGER in the differential diagnosis.

This is clearly AOT

_(_Adenomatoid odontogenic tumor)

62
Q

What is this clinical finding?

A

Adenomatoid odontogenic tumor

(AOT)

Swelling in maxillary vestibule

63
Q

What is this clinical finding?

A

Adenomatoid odontogenic tumor

(AOT)

fibrous capsule of AOT is at least partially encapsulated.

Easy to remove; “popped right out”.

64
Q

What is this clinical finding?

A

Adenomatoid odontogenic tumor

(AOT)

An expansion into lingual area as well as into vestibule

65
Q

What is this radiographic finding?

A

Adenomatoid odontogenic tumor

(AOT)

Snowflake‐like calcifications within mixed, well‐circumscribed radiolucency

66
Q

What is this radiographic finding?

A

Adenomatoid odontogenic tumor

(AOT)

  • Teardrop shape / inverted pear between roots of teeth.
  • Well-circumscribed, corticated margin & snowflake‐like calcifications within
67
Q

Squamous Odontogenic Tumor

(SOT)

Demographics and Location

A

▪ Typically involves alveolar ridge
▪ Anterior > Posterior jaws
▪ Seen from 2nd to 7th decade (mean 40 years of age)

68
Q

Squamous Odontogenic Tumor

(SOT)

Clinical charcterstics

A
  • Tumor of Epithelial Origin
  • Rare
  • Usually asymptomatic, but may present with tooth mobility and slight pain
  • Multiquadrant ~ 20-25%
    • A couple reported cases in families
69
Q

Squamous Odontogenic Tumor

(SOT)

Radiographically

A
  • Well‐circumscribed radiolucency , often a semilunar radiolucency of alveolar ridge
    • Can mimic periodontal disease
70
Q

Squamous Odontogenic Tumor

(SOT)

Origin

A
  • Thought to arise from epithelial rests (Malassez) in the periodontal ligament space
71
Q

Squamous Odontogenic Tumor

(SOT)

Treatment

A
  • Treatment is conservative local excision
  • Recurrence is rare
72
Q

Squamous Odontogenic Tumor SOT
Histologically may be mistaken for what other lesions?

A
  • Ameloblastoma
  • Squamous cell carcinoma (SCCa)
73
Q

What is this radiographic finding?

A

In addition to fracture, there is semilunar loss of bone around the molars ► (SOT)

Squamous Odontogenic Tumor

74
Q

What is this radiographic finding?

A

SOT

Squamous Odontogenic Tumor

  • Semilunar loss of bone.
  • Alveolar bone is gone due to impacted canine that is visible
75
Q

Central odontogenic fibroma (COF)

also known as ?

A
  • *Odontogenic Fibroma
    (central) **
76
Q

Central odontogenic fibroma

(COF)

Origin

A
  • Tumors of Mesenchymal Origin
  • Some believe represents the counterpart to the peripheral ossifying (odontogenic) fibroma (in soft tissue)
77
Q

Central odontogenic fibroma

(COF)

Location

A
  • MX ≈ MD
  • lesions in MX tend to be anterior to first molar
  • those in MD anterior ≈ posterior
  • 1/3 associated with an unerupted tooth
78
Q

Central odontogenic fibroma (COF)

Clinically

A

-Small lesion tend to be asymptomatic

-Larger lesions can cause cortical expansion and tooth mobility

79
Q

Central odontogenic fibroma

(COF)

Radiographically

A
  • Small lesions tend to be well-circumscribed unilocular radiolucencies
    • often periradicular
      • can mimic periapical granulomas and cysts
  • Larger lesions tend to be well-circumscribed multilocular radiolucencies
  • Borders are usually sclerotic
  • Root resorption or divergence may be seen
  • ~ 10- 15% will show radiopaque flecks within the radiolucency
80
Q

Central odontogenic fibroma

(COF)

Treatment

A
  • Enucleation with curettage or excision
  • usually don’t recur
81
Q

What is the Microscopic Differential Diagnosis of Central odontogenic fibroma (COF)?

A

o Desmoplastic fibroma ‐ a more aggressive lesion
o Fibromyxoma ‐ variant of odontogenic myxoma with
abundant collagen
o Hyperplastic tooth follicle ‐ typically loose immature stroma, but when hyperplastic can have abundant collagen

82
Q

What is this radiographic finding?

A

Central odontogenic fibroma (COF)

  • well‐circumscribed radiolucency posterior to molar
83
Q

What is this radiographic finding?

A

Central odontogenic fibroma (COF)

round mass of opacity due to FCT. Ground glass‐like appearance

84
Q

Odontogenic Myxoma

Origin

A
  • Tumors of Mesenchymal Origin
  • Thought to arise from the tooth follicle or dental papilla
85
Q

Odontogenic Myxoma

Demographics and Location

A
  • ~3-5% of all odontogenic tumors
  • Wide age range, but 3rd decade most common
  • Found anywhere in the MD or MX
86
Q

Odontogenic Myxoma

Radiographically

A
  • Small lesions present as asymptomatic radiolucencies found upon routine exam
  • Larger lesions can cause painless expansion of bone
  • All are radiolucent lesions, but the appearance can vary from well‐ circumscribed to irregular and diffuse
  • Unilocular to, more commonly, multilocular (“soap bubble” or “honeycomb”) radiolucency
  • Borders are often scalloped, can see sc_alloping around the roots of teeth_
    • But can cause displacement of teeth and resorption of the roots of teet
87
Q

Odontogenic Myxoma

Grossly

A
  • the tumor is described as loose, soft and gelatinous
88
Q

Odontogenic Myxoma

Treatment

A
  • Surgical excision or resection
  • Because the lesion is not encapsulated and has a gelatinous loose consistency► it is difficult to remove completely
    • this is thought to be why myxoma has a fairly high recurrence rate
  • Maxillary posterior lesions should be treated more aggressively
89
Q

What is this radiographic finding?

A

Odontogenic Myxoma

  • Classic example of enlargement of the mandible caused by multilocular radiolucency.
  • Enlarged into oral cavity ‐ alveolar ridge elevated
90
Q

What is this radiographic finding?

A

Odontogenic Myxoma

91
Q

Case

A

Clinically: obliteration of vestibule on patient’s left mandible

Radiographically:lesion running from posterior by third molar all the way anterior to canine. Well‐circumscribed, multilocular radiolucency is scalloping up
between teeth, causing some root divergence

Grossly: gelatinous appearance of myxoma makes it hard to remove

After treatment: post‐surgery; had excised all the way to right 2nd PM

This is Odontogenic Myxoma

92
Q

CEMENTOBLASTOMA

Origin

(True Cementoma)

A
  • Tumor of Mesenchymal origin
  • Benign tumor of cementoblasts
93
Q

CEMENTOBLASTOMA

Demographics and Location

(True Cementoma)

A
  • Typically present in 2nd and 3rd decade (~75% prior to the age of 30)
  • 75% MD
    • ▪ ~ 90% in molar/premolar region
      *
94
Q

CEMENTOBLASTOMA
(True Cementoma)

Clinically

A
  • 2/3 of cases have pain and swelling
  • Can cause cortical expansion if large enough
95
Q

CEMENTOBLASTOMA
(True Cementoma)

Radiographically

A
  • Radiopaque mass fused to the root of the affected tooth
  • Usually has a thin radiolucent halo or rim surrounding the radiopacity
96
Q

CEMENTOBLASTOMA

Treatment

(True Cementoma)

A
  • surgical extraction of the involved tooth with attached tumor
  • Root amputation (with attached tumor) and endo is an option for smaller lesions
  • Recurrence is unlikely
97
Q
A

CEMENTOBLASTOMA
(True Cementoma)

  • First molar has tumor attached to the root.
  • Mostly radiopaque but has some less radiodense areas within = classic for cementoblastoma.
  • Radiolucent halo around region.
98
Q

Cementoblastoma has similar histologic presentation to what?

A

osteoblastoma

Difference is Osteoblastoma is NOT a_ttached to the root of a tooth_ (whereas cementoblastoma must be)

99
Q

What is this gross and histological finding?

A

Cementoblastoma

Grossly continuous growth from tumor to the root of the tooth. Brownish
areas were more vascular.
Histologically: tubular dentin in tooth, attached to mass of tissue with calcifications

100
Q

What are Odontogenic Tumors
of
Mixed Origin
(Epithelial and
Mesenchymal)

A

They are tumors in which the _odontogenic epithelial componen_t causes induction of the mesenchymal component to produce a product

Examples:

  • Odontomas
  • Ameloblastic fibroma
    • (and Ameloblastic fibrosarcoma)
  • Ameloblastic fibro-odontoma
101
Q

Odontoma

Origin

A
  • Odontogenic Tumors of Mixed Origin (Epithelial and Mesenchymal
  • They are hamartomas rather than true neoplasms
  • They are masses of enamel and dentin with variable amounts of pulp and cementum
102
Q

What is the most common odontogenic “tumor”?

A

Odontoma

103
Q

Odontoma

Demographics and Locations

A

▪ First 2 decade most common (mean age of 14)

Location is based on the type of Odontoma

  • Compound Odontoma
    • Anterior jaws (esp. MX)
    • **Well developed rudimentary “tooth” forms
  • Complex Odontoma
    • Posterior jaws (esp. MD)
    • **Poorly developed mass of calcified deposits
104
Q

Odontoma

Charcterstics

A
  • Often associated with an unerupted tooth
  • Lesions may prevent eruption of teeth
  • Usually small in size, but rare cases of > 6cm reported
  • large lesions can cause bone expansion
105
Q

Odontoma

Radiographically

A

▪ Radiographically see a radiopaque structure(s) surrounded by a radiolucent rim
▪ As with any calcified lesion, those found early in development may appear totally or predominantly radiolucent
▪ Compound odontomas appear as small tooth‐like structures
▪ Complex odontomas look like masses of radiopaque material with variable densities

106
Q

Odontoma

Treatment

A

▪ Simple excision or enucleation
▪ Unlikely to recur

107
Q

Compound Odontoma

Vs

Complex Odontoma

A

Compound Odontoma

  • Mature normal appearing pulp, enamel and dentin
  • Organization like teeth, with enamel surrounding dentin which surrounds pulp ( Well developed rudimentary “tooth” forms)
  • appear as small tooth‐like structures in the Anterior jaws (esp. MX)

Complex Odontoma

  • Mature pulp, enamel and dentin
  • No organization, mass of dentin and enamel matrix and pulp tissue (**Poorly developed mass of calcified deposits)
  • appear as masses of radiopaque material with
  • variable densities in the Posterior jaws (esp. MD)
108
Q

What is this radiographic finding?

A

Classic appearance of Odontoma

  • multiple tooth‐like shapes aggregated together
  • Typically with some sort of radiolucent halo around them
109
Q

What is this radiographic finding?

A

Compound Odontoma

little teeth‐like structures blocking canine eruption

110
Q

What is this radiographic finding?

A

Complex Odontoma

  • 2‐2.5cm mass overlaying the molar.
  • radiolucent rim/halo that is mixed, mostly radiopaque
111
Q

Primordial
odontogenic tumor
(POT)

Origin

A
  • Tumor of mixed origin
  • Very rare! first reported in 2014 -less than 30 cases so far
112
Q

Primordial
odontogenic tumor
(POT)

Demographics and Location

A
  • Most common in 1st and 2nd decades
    • Mean age 12.5 years
  • MD:MX 6:1
113
Q

Primordial
Odontogenic Tumor
(POT)

Clinical Charcterstics

A
  • Asymptomatic found on routine imaging
  • Can cause tooth displacement and cortical expansion
114
Q

Primordial
Odontogenic Tumor
(POT)

Radiographically

A
  • Well-defined radiolucency associated with an impacted tooth
    • Most commonly a third molar
115
Q

Primordial
Odontogenic Tumor
(POT)

Treatment

A
  • conservative excision/enucleation
  • So far no recurrence
116
Q

Case

A

Primordial
Odontogenic Tumor
(POT)

unilocular radiolucency

117
Q

Ameloblastic fibroma (AF) and ameloblastic fibro-odontoma (AFO)

Charcterstics

A
  • Uncommon benign mixed odontogenic neoplasms.
  • Considered together because it is thought they are variations of the same process
118
Q

Ameloblastic fibroma (AF) and ameloblastic fibro-odontoma (AFO)

demographics and location

A
  • Typically presents in first 2 decades
    • mean is 12 years of age
  • ~ 70% occur in the posterior mandible
  • ~ 75% associated with unerupted teeth
119
Q

Ameloblastic Fibroma (AF)

clinical and radiographic presentations

A
  • Small lesions are asymptomatic and found on routine exam
  • Large lesions can cause bone expansion
  • Smaller lesions are unilocular Radiolucencies
  • Large ones are multilocular radiolucencies
  • Border is well defined and often sclerotic
  • Untreated, can grow to very large size
120
Q

What is this radiographic finding?

A

Ameloblastic Fibroma
(AF)

1‐3 potential locules, no impacted tooth associated

121
Q

Ameloblastic Fibro-odontoma (AFO)

Clinical and Radiographic features

A
  • Clinical features similar to Ameloblastic Fibroma AF (Small lesions are asymptomatic and found on routine exam
    & Large lesions can cause bone expansion)

Radiographically, we see a mixed radiolucent/radiopaque lesion because of the formation of odontomas

122
Q

What is this radiographic finding?

A

Ameloblastic Fibro-odontoma (AFO)

  • well‐circumscribed radiolucency
  • corticated edge + calcification
123
Q

What is this radiographic finding?

A

Ameloblastic Fibro-odontoma (AFO)

has expansion into oral cavity. Flecks of calcification
in lesion with impacted tooth = odontoma

124
Q

Ameloblastic fibroma (AF) and ameloblastic fibro-odontoma (AFO)

Treatment

A
  • Conservative surgical excision or curettage,
    easily removed from surrounding bone
  • Prognosis is excellent, recurrence is unusual
  • ▪ Rare cases reported of development of ameloblastic fibrosarcoma in area of AF or AFO
125
Q

Ameloblastic
Fibrosarcoma

Charcterstics & Origin

A
  • _Malignant counterpar_t of ameloblastic fibroma
  • Rare lesion which may arise in the site of a previous AF/AFO or arise de novo
126
Q

Ameloblastic
Fibrosarcoma

Demographics and location

A
  • 1.5 times more common in males
  • ~ 80% MD
127
Q

Ameloblastic
Fibrosarcoma

Clinically

A
  • Pain, swelling and rapid growth are common presenting signs
128
Q

Ameloblastic
Fibrosarcoma

Radiographically

A
  • presents as an ill-defined destructive radiolucency with irregular borders
129
Q

Ameloblastic
Fibrosarcoma

Treatment

A
  • Radical surgical excision as the tumor is very aggressive and infiltrative
  • Prognosis is dependent on complete removal of tumor
130
Q

What is this radiographic finding?

A

Ameloblastic Fibrosarcoma

in the mandible developed after two years from AF

131
Q

Odontogenic carcinomas

List them (5)

A

-Ameloblastic carcinoma

-Primary intraosseous carcinoma, NOS

-Sclerosing odontogenic carcinoma

-Clear cell odontogenic carcinoma

-Ghost cell odontogenic carcinoma

All fairly rare lesions!

132
Q

What is the Differential Diagnosis D/D of Multilocular Radiolucency

A

MOCHA

  • M odontogenic Myxoma
  • O Odontogenic keratocyst
  • C Central giant cell granuloma
  • H Central Hemangioma
  • A _A_meloblastoma

Others:

  • Aneurysmal bone cyst
  • early CEOT
  • ameloblastic fibroma AF
  • central MECa

Oral Pathology (23 decks)

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