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Benign Tumours Flashcards

1
Q

What is a Tori?

A

An exophytic nodular growth of dense cortical bone

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2
Q

Clinical Presentation of a Tori

A
  1. Small but slowly increases in size throughout life
  2. Thin overlying mucosa may become ulcerated
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3
Q

Clinical Implications of a Tori

A

May Interfere with speech, tongue movement, denture and oral hygiene

Prone to medication-related osteoradionecrosis

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4
Q

What is an Enostosis/ Dense bone island?

A

It is a localized area of dense sclerotic bone not related to any specific cause, commonly at premolar-molar area (mandible and maxilla)

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5
Q

Clinical Presentation of Dense Bone Island

A
  1. Asymptomatic and non-expansile
  2. Usually one sclerotic focus but two or four possible
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6
Q

Common sites of Dense Bone Island

A

90% in mandible, first molar > second premolar > second molar

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7
Q

Radiographic Features of Dense Bone Island

A

L: Periapical region of teeth or interradicular

E: Well-defined border, no radiolucent rim

S: 0.2-2cm, round, elliptical or irregular

I: Radiopaque, larger lesions may be non-homogeneous

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8
Q

Differential Diagnosis of Dense Bone Island

A
  1. Condensing Osteitis
  2. Multiple lesions: Multiple osteomas in Gardner’s syndrome
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9
Q

What is the most common odontogenic tumour excluding odontomas?

A

Ameloblastoma

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10
Q

What is Ameloblastoma?

A

Benign but locally aggressive epithelial neoplasm with a high rate of recurrence

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11
Q

What is the Pathogenesis of Ameloblastoma?

A

Odontogenic epithelium derived from

  1. Rests of dental lamina
  2. REE
  3. Epithelial lining of odontogenic cysts → Unicystic variant
  4. Basal cells of oral mucosa → Peripheral variant

Locally invasive and tumour islands can invade into cancellous bone without causing bone destruction

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12
Q

Three types of ameloblastoma

A
  1. Conventional solid or multi-cystic intraosseous (80%)
  2. Unicystic (15%)
  3. Peripheral (1-4%)
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13
Q

Demographics of Conventional solid/multi-cystic Ameloblastoma

A
  1. 3rd - 7th decade
  2. Mostly in mandible, in molar and ascending ramus region
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14
Q

Clinical Features of Conventional solid/multi-cystic Ameloblastoma

A
  1. Painless swelling and expansion of jaw
  2. Slow-growing and can grow to massive proportions
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15
Q

Radiographic Features of Conventional solid/multi-cystic Ameloblastoma

A

L: Posterior mandible
E: Well-defined, thick corticated borders
S: -
I: Multilocular and unilocular radiolucency, honeycomb or soap bubble appearance with thick curved septa
O: Buccal and lingual cortical expansion, extensive root resorption and tooth displacement, pathological fractures

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16
Q

Histopathological Findings of Conventional solid/ multi-cystic Ameloblastoma

A

Follicular Pattern

a. Multiple islands of odontogenic epithelium demonstrating peripheral columnar differentiation with reverse polarization.

b. The central zones resemble stellate reticulum and exhibit foci of cystic degeneration

Plexiform Pattern

a. Anastomosing cords of odontogenic epithelium

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17
Q

Differential Diagnosis of Conventional solid/ multi-cystic Ameloblastoma

A

Other odontogenic tumours with areas of odontogenic epithelium
- Ameloblastic fibroma
- AOT
- CEOT

Odontogenic cysts
- Dentigerous cyst
- OKC

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18
Q

Investigations of Ameloblastoma

A

Biopsy

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19
Q

Management of Conventional solid/ multi-cystic Ameloblastoma

A
  1. Simple enucleation and curettage OR en bloc resection

Marginal Enbloc Resection involves excision with 1cm of margin of clinically normal bone, followed by bone grafting

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20
Q

Prognosis of Unicystic Variant

A

Best prognosis but long-term follow up is recommended

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21
Q

Prognosis of Peripheral Variant

A

Good prognosis, local excision

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22
Q

Prognosis of Solid/mulit-cystic variant

A

Worst, higher recurrence rate due to small islands of tumour of bone left behind

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23
Q

Demographics of Unicystic Ameloblastoma

A
  1. Younger patients in 2nd decade
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24
Q

Radiographic Features of Unicystic Ameloblastoma

A

L: Posterior mandible
E: Well-circumscribed, well-defined, thickly corticated
S: -
I: Unilocular radiolucency
O: Surrounding the crown of an unerupted mandibular third molar

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25
Histopathological Findings of Unicystic Ameloblastoma
1. Luminal Cyst lined by ameloblastic epithelium showing a hyperchromatic, polarized basal layer. The overlying epithelial cells area loosely cohesive and resemble stellate reticulum 2. Intraluminal Intraluminal mass arising from cyst wall 3. Mural Islands of follicular ameloblastoma infiltrate into the fibrous connective tissue
26
Histopathological Findings of Peripheral (extraosseous) Ameloblastoma
Interconnecting cords of ameloblastic epithelium that occupy the lamina propria underneath epithelium
27
What is Adenomatoid Odontogenic Tumour?
Benign neoplasm of odontogenic epithelium (enamel organ epithelium, ree, rests of malassez, remnants of dental lamina)
28
Demographics of Adenomatoid Odontogenic Tumour
1st and 2nd decade (adolescents) Females
29
Most common location of Adenomatoid Odontogenic Tumour
Anterior maxilla , often associated with impacted maxillary canine
30
Clinical Features of AOT
1. Small, maximum 3cm 2. Asymptomatic 3. Larger lesions cause painless expansion of bone
31
Radiographic Features of AOT
1. Circumscribed unilocular radiolucency 2. Involves the crown of an unerupted tooth, most often a canine
32
Radiographic Features of AOT
L: Mostly anterior jaw, sometimes extend apically along root past CEJ E: Well-circumscribed, well-defined, corticated S: - I: Unilocular radiolucency, may contain fine snowflake-like calcifications O: Crown of unerupted tooth
33
Histopathologic Findings of AOT
Epithelial component 1. Densely packed whorls and solid islands of odontogenic epithelium 2. Some islands may have microcysts appear like cross-section of ducts 3. Periphery of islands: Tall columnar cells with darkly stained nuclei oriented towards the centre of follicle 4. Centre of islands: Polyhedral, densely packed epithelial cells Stromal component: Minimal, cellular CT Capsule: Well-defined fibrous capsule
34
Differential Diagnosis of AOT
1. Dentigerous cyst 2. Central odontogenic tumour 3. Calcifying cystic odontogenic tumour 4. Ameloblastic fibro-odontoma 5. Calcifying epithelial odontogenic tumour
35
Treatment of AOT
Enucleation is curative
36
What is a Calcifying Epithelial Odontogenic Tumour?
1. Locally aggressive benign tumour 2. Origin: Dental lamina remnants or stratum intermedium
37
Demographics of Calcifying Epithelial Odontogenic Tumour
3rd - 5th decade
38
Most common site for Calcifying Epithelial Odontogenic Tumour
Mandible, premolar-molar area
39
Clinical Features of Calcifying Epithelial Odontogenic Tumour
1. Painless and slow-growing swelling 2. Associated with unerupted/impacted tooth
40
Radiographic Features of Calcifying Epithelial Odontogenic Tumour
L: Posterior mandible E: Well-defined S: - I: Unilocular (More common in maxilla), multilocular, radiolucent or mixed O: Unerupted/impacted tooth
41
Management of Calcifying Epithelial Odontogenic Tumour
1. Less aggressive than ameloblastoma 2. Conservative local resection to include a narrow rim of surrounding bone
42
What is Odontoma?
Non-neoplastic developmental anomaly (Not a true tumour) that contains enamel, dentine, pulp and/or cementum Mixed lesion - Epithelial → Enamel - Mesenchymal → Dentin,pulp and cementum
43
What are the Types of Odontoma?
1. Complex: Mass of disorganized odontogenic tissues 2. Compound: Well-organised, miniature tooth-like structures
44
Demographics of Odontoma
1st and 2nd decade
45
Common site for Complex Odontoma
Posterior
46
Common site for Compound Odontoma
Anterior
47
Clinical Features of Odontoma
1. Slow-growing, expansile and painless lesions 2. Unerupted/impacted tooth
48
Radiographic Features of Complex Odontoma
Encapsulated radiolucency with amorphous radiopacity
49
Radiographic Features of Compound Odontoma
Encapsulated radiolucency with multiple miniature tooth-like structures (toothlets)
50
Histopathologic Findings of Complex Odontome
Disorderly arranged dental tissues but well-formed enamel, dentine, pulp and cementum
51
Histopathologic Findings of Compound Odontome
Cross sections of miniature toothlets with well-organised and well-formed enamel, dentine and cementum
52
Differential Diagnosis of Complex Odontoma
Ossifying fibroma
53
Management of Odontomas
Enucleation is curative
54
What is Ameloblastic Fibroma?
Mixed odontogenic tumour in which both the epithelial and ectomesenchymal components are neoplastic No hard tissue formation
55
Demographics of Ameloblastic Fibroma
Young patients 1st and 2nd decades
56
Most common location of Ameloblastic Fibroma
Posterior mandible, Molar-ramus area
57
Clinical Features of Ameloblastic Fibroma
Painless, slow-growing expansile lesion - Smaller: Asymptomatic - Larger: Bony hard swelling
58
Radiographic Features of Ameloblastic Fibroma
L: Posterior mandible E: Well-defined with radiopaque borders (may be corticated) I: Unilocular (smaller) to multilocular (larger) radiolucency O: Impacted/unerupted teeth (75% of cases)
59
Management of Ameloblastic Fibroma
Well-encapsulated and easily separates from surrounding bone → enucleation Recurrent lesions → Wider excision
60
What is Ameloblastic Fibro-odontoma?
Tumour with the general features of ameloblastic fibroma but contains enamel and dentine
61
Radiographic Features of Ameloblastic Fibro-odontoma
E: Well-circumscribed I: Unilocular, mixed Multiple small radiopacities or a solid conglomerate mass O: Impacted/unerupted teeth
62
Histopathologic Features of Ameloblastic Fibro-odontoma
Radiolucent areas = Soft tissue that resembles ameloblastic fibroma Radiopaque areas = Hard tissue that resembles complex odontome
63
Histopathologic Findings of Ameloblastic Fibroma
Odontogenic Epithelium - Thin strands, cords (2-3 layers wide) or nests (tiny circular islands) that resemble dentinal lamina or cap stage Stroma - Loose tissue that resembles embryonic CT (pulp tissue) with randomly arranged fibroblasts
64
Management of Ameloblastic Fibro-odontoma
Well-encapsulated and easily separates from surrounding bone → enucleation Recurrent lesions → Wider excision
65
What is Calcifying Cystic Odontogenic Tumour?
Characterised by odontogenic epithelium containing ghost cells which then may undergo calcification (may be identified as dysplastic dentin) Most grow in cystic fashion, some as solid-tumour growths
66
Demographics of Calcifying Cystic Odontogenic Tumour
2nd to 4th decade Associated with odontomas 17 year old
67
Clinical Presentation of Calcifying Cystic Odontogenic Tumour (CCOT)
Usually intraosseous, may occur in soft tissues Extraosseous: Localised sessile, pedunculated gingival masses
68
Radiographic Features of Calcifying Cystic Odontogenic Tumour
L: 65% incisor and canines area, maxilla or mandible same E: Well-defined S: - I: Unilocular radiolucency usually, with radiopaque structures within the lesion (irregular calcification or tooth like densities) O: Usually associated with unerupted tooth, root resorption or divergence of adjacent teeth
69
Histopathological Findings of Calcifying Cystic Odontogenic Tumour
Lining of cyst - Resembles ameloblastoma with cuboidal or ameloblast-like basal cells in epithelium - Thick layer of stellate reticulum Well-defined cyst lesion within fibrous capsule with odontogenic epithelial lining and variable number of eosinophilic ghost cells within epithelial component
70
Differential Diagnosis of Calcifying Cystic Odontogenic Tumour
1. Calcifying epithelial odontogenic tumour 2. Ameloblastic fibro-odontoma 3. Adenomatoid Odontogenic Tumour
71
Management of Calcifying Cystic Odontogenic Tumour
1. Simple enucleation 2. Surgical excision for peripheral examples
72
What is Cementoblastoma?
Benign, well-circumscribed neoplasm of cementoblast Forms a mass of cementum-like tissue that is continuous with the apical cementum later of molar or premolar
73
Pathogenesis of Cementoblastoma
Derived from ectomesenchymal cells of periodontium including cementoblasts Evolved in 3 stages 1. Periapical bone removed and replaced by cementum matrix (Radiolucent) 2. Cementoblastic stage (mixed RL and RO) 3. Inactive stage of maturation and calcification
74
Demographics of Cementoblastoma
1. 2nd-3rd decades 2. Mandible 3. Molar-premolar area (>80%)
75
Clinical Features of Cementoblastoma
1. Pain!!! 2. Vital tooth 3. Bony hard swelling: Expansion of buccal and lingual cortical plates
76
Radiographic Features Of Cementoblastoma
L: Fused with root apex of associated tooth E: Thin, well-defined radiolucent border I: Dense radiopaque mass
77
Differential Diagnosis of Cementoblastoma
Fibro-osseous lesions 1. Cemento-ossifying fibroma/dysplasia 2. Osteoblastoma 3. Complex odontoma RO at periapex of tooth 1. Periapical osseous dysplasia 2. Condensing osteitis (not encapsulated by RL border)
78
Management of Cementoblastoma
Regardless of size: Enucleation of tumour mass and extraction of associated teeth - Easy and does not recur
79
What is Odontogenic Myxoma?
Aggressive intra-osseous tumour derived from embryonic odontogenic connective tissue Primarily composed of embryonic material (mucoid or gelatinous connective tissue) with undifferentiated mesenchymal cells
80
Demographic of Odontogenic Myxoma
1. 2nd- 4th decade 2. Mandible
81
Clinical Features of Odontogenic Myxoma
Painless, slow-growing expansile lesion Smaller: Asymptomatic Larger: Painless expansion of involved bone/bony hard swelling
82
Radiographic Features of Odontogenic Myxoma
L: Almost all areas of jaw E: Irregular or scalloped I: Unilocular or multilocular radiolucency. Tennis racket-like to step ladder-like appearance. Thin wispy trabeculae O: May displace or cause teeth resorption
83
Differential Diagnosis of Odontogenic Myxoma
Ameloblastoma
84
Management of Odontogenic Myxoma
Ill-defined and gelatinous nature -> Difficult to remove intact -> High chance of recurrence Small: Curettage with careful periodic reevaluation for at least 5 years Large: Extensive resection Lesions of posterior mandible should be treated more aggressively
85
What is Osteoma?
Benign, slow-growing tumour Multiple osteomas associated with Gardner's syndrome
86
Dental Abnormalities associated with Gardner's Syndrome
1. Unerupted teeth 2. Supernumerary teeth and odontomas 3. Epidermal cysts
87
What is Gardner's syndrome?
Rare familial autosomal dominant trait Multiple intestinal polyps with high malignant potential (colon cancer)
88
Clinical Features of Osteomas
1. Exophytic nodular growth of dense bone -> Facial swelling 2. Solitary and asymptomatic with slow growth 3. Superficial, lies on bone
89
Radiographic Features of Osteomas
Circumscribed sclerotic masses
90
Management of Osteomas
Large: Conservative surgical excision Small: Periodic follow-up

OMOPOR (7 decks)

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