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OMOPOR > Benign Tumours > Flashcards

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
Q

Histopathological Findings of Unicystic Ameloblastoma

A
  1. Luminal

Cyst lined by ameloblastic epithelium showing a hyperchromatic, polarized basal layer. The overlying epithelial cells area loosely cohesive and resemble stellate reticulum

  1. Intraluminal

Intraluminal mass arising from cyst wall

  1. Mural

Islands of follicular ameloblastoma infiltrate into the fibrous connective tissue

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26
Q

Histopathological Findings of Peripheral (extraosseous) Ameloblastoma

A

Interconnecting cords of ameloblastic epithelium that occupy the lamina propria underneath epithelium

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27
Q

What is Adenomatoid Odontogenic Tumour?

A

Benign neoplasm of odontogenic epithelium (enamel organ epithelium, ree, rests of malassez, remnants of dental lamina)

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28
Q

Demographics of Adenomatoid Odontogenic Tumour

A

1st and 2nd decade (adolescents)
Females

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29
Q

Most common location of Adenomatoid Odontogenic Tumour

A

Anterior maxilla , often associated with impacted maxillary canine

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30
Q

Clinical Features of AOT

A
  1. Small, maximum 3cm
  2. Asymptomatic
  3. Larger lesions cause painless expansion of bone
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31
Q

Radiographic Features of AOT

A
  1. Circumscribed unilocular radiolucency
  2. Involves the crown of an unerupted tooth, most often a canine
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32
Q

Radiographic Features of AOT

A

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

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33
Q

Histopathologic Findings of AOT

A

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

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34
Q

Differential Diagnosis of AOT

A
  1. Dentigerous cyst
  2. Central odontogenic tumour
  3. Calcifying cystic odontogenic tumour
  4. Ameloblastic fibro-odontoma
  5. Calcifying epithelial odontogenic tumour
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35
Q

Treatment of AOT

A

Enucleation is curative

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36
Q

What is a Calcifying Epithelial Odontogenic Tumour?

A
  1. Locally aggressive benign tumour
  2. Origin: Dental lamina remnants or stratum intermedium
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37
Q

Demographics of Calcifying Epithelial Odontogenic Tumour

A

3rd - 5th decade

38
Q

Most common site for Calcifying Epithelial Odontogenic Tumour

A

Mandible, premolar-molar area

39
Q

Clinical Features of Calcifying Epithelial Odontogenic Tumour

A
  1. Painless and slow-growing swelling
  2. Associated with unerupted/impacted tooth
40
Q

Radiographic Features of Calcifying Epithelial Odontogenic Tumour

A

L: Posterior mandible
E: Well-defined
S: -
I: Unilocular (More common in maxilla), multilocular, radiolucent or mixed
O: Unerupted/impacted tooth

41
Q

Management of Calcifying Epithelial Odontogenic Tumour

A
  1. Less aggressive than ameloblastoma
  2. Conservative local resection to include a narrow rim of surrounding bone
42
Q

What is Odontoma?

A

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
Q

What are the Types of Odontoma?

A
  1. Complex: Mass of disorganized odontogenic tissues
  2. Compound: Well-organised, miniature tooth-like structures
44
Q

Demographics of Odontoma

A

1st and 2nd decade

45
Q

Common site for Complex Odontoma

A

Posterior

46
Q

Common site for Compound Odontoma

A

Anterior

47
Q

Clinical Features of Odontoma

A
  1. Slow-growing, expansile and painless lesions
  2. Unerupted/impacted tooth
48
Q

Radiographic Features of Complex Odontoma

A

Encapsulated radiolucency with amorphous radiopacity

49
Q

Radiographic Features of Compound Odontoma

A

Encapsulated radiolucency with multiple miniature tooth-like structures (toothlets)

50
Q

Histopathologic Findings of Complex Odontome

A

Disorderly arranged dental tissues but well-formed enamel, dentine, pulp and cementum

51
Q

Histopathologic Findings of Compound Odontome

A

Cross sections of miniature toothlets with well-organised and well-formed enamel, dentine and cementum

52
Q

Differential Diagnosis of Complex Odontoma

A

Ossifying fibroma

53
Q

Management of Odontomas

A

Enucleation is curative

54
Q

What is Ameloblastic Fibroma?

A

Mixed odontogenic tumour in which both the epithelial and ectomesenchymal components are neoplastic

No hard tissue formation

55
Q

Demographics of Ameloblastic Fibroma

A

Young patients
1st and 2nd decades

56
Q

Most common location of Ameloblastic Fibroma

A

Posterior mandible, Molar-ramus area

57
Q

Clinical Features of Ameloblastic Fibroma

A

Painless, slow-growing expansile lesion
- Smaller: Asymptomatic
- Larger: Bony hard swelling

58
Q

Radiographic Features of Ameloblastic Fibroma

A

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
Q

Management of Ameloblastic Fibroma

A

Well-encapsulated and easily separates from surrounding bone → enucleation

Recurrent lesions → Wider excision

60
Q

What is Ameloblastic Fibro-odontoma?

A

Tumour with the general features of ameloblastic fibroma but contains enamel and dentine

61
Q

Radiographic Features of Ameloblastic Fibro-odontoma

A

E: Well-circumscribed
I: Unilocular, mixed
Multiple small radiopacities or a solid conglomerate mass
O: Impacted/unerupted teeth

62
Q

Histopathologic Features of Ameloblastic Fibro-odontoma

A

Radiolucent areas = Soft tissue that resembles ameloblastic fibroma

Radiopaque areas = Hard tissue that resembles complex odontome

63
Q

Histopathologic Findings of Ameloblastic Fibroma

A

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
Q

Management of Ameloblastic Fibro-odontoma

A

Well-encapsulated and easily separates from surrounding bone → enucleation

Recurrent lesions → Wider excision

65
Q

What is Calcifying Cystic Odontogenic Tumour?

A

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
Q

Demographics of Calcifying Cystic Odontogenic Tumour

A

2nd to 4th decade

Associated with odontomas 17 year old

67
Q

Clinical Presentation of Calcifying Cystic Odontogenic Tumour (CCOT)

A

Usually intraosseous, may occur in soft tissues

Extraosseous: Localised sessile, pedunculated gingival masses

68
Q

Radiographic Features of Calcifying Cystic Odontogenic Tumour

A

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
Q

Histopathological Findings of Calcifying Cystic Odontogenic Tumour

A

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
Q

Differential Diagnosis of Calcifying Cystic Odontogenic Tumour

A
  1. Calcifying epithelial odontogenic tumour
  2. Ameloblastic fibro-odontoma
  3. Adenomatoid Odontogenic Tumour
71
Q

Management of Calcifying Cystic Odontogenic Tumour

A
  1. Simple enucleation
  2. Surgical excision for peripheral examples
72
Q

What is Cementoblastoma?

A

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
Q

Pathogenesis of Cementoblastoma

A

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
Q

Demographics of Cementoblastoma

A
  1. 2nd-3rd decades
  2. Mandible
  3. Molar-premolar area (>80%)
75
Q

Clinical Features of Cementoblastoma

A
  1. Pain!!!
  2. Vital tooth
  3. Bony hard swelling: Expansion of buccal and lingual cortical plates
76
Q

Radiographic Features Of Cementoblastoma

A

L: Fused with root apex of associated tooth

E: Thin, well-defined radiolucent border

I: Dense radiopaque mass

77
Q

Differential Diagnosis of Cementoblastoma

A

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
Q

Management of Cementoblastoma

A

Regardless of size: Enucleation of tumour mass and extraction of associated teeth
- Easy and does not recur

79
Q

What is Odontogenic Myxoma?

A

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
Q

Demographic of Odontogenic Myxoma

A
  1. 2nd- 4th decade
  2. Mandible
81
Q

Clinical Features of Odontogenic Myxoma

A

Painless, slow-growing expansile lesion

Smaller: Asymptomatic

Larger: Painless expansion of involved bone/bony hard swelling

82
Q

Radiographic Features of Odontogenic Myxoma

A

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
Q

Differential Diagnosis of Odontogenic Myxoma

A

Ameloblastoma

84
Q

Management of Odontogenic Myxoma

A

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
Q

What is Osteoma?

A

Benign, slow-growing tumour

Multiple osteomas associated with Gardner’s syndrome

86
Q

Dental Abnormalities associated with Gardner’s Syndrome

A
  1. Unerupted teeth
  2. Supernumerary teeth and odontomas
  3. Epidermal cysts
87
Q

What is Gardner’s syndrome?

A

Rare familial autosomal dominant trait

Multiple intestinal polyps with high malignant potential (colon cancer)

88
Q

Clinical Features of Osteomas

A
  1. Exophytic nodular growth of dense bone -> Facial swelling
  2. Solitary and asymptomatic with slow growth
  3. Superficial, lies on bone
89
Q

Radiographic Features of Osteomas

A

Circumscribed sclerotic masses

90
Q

Management of Osteomas

A

Large: Conservative surgical excision

Small: Periodic follow-up

OMOPOR (7 decks)

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