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Neville and Damm > Ch15- Epithelial Odontogenic Tumors > Flashcards

Ch15- Epithelial Odontogenic Tumors Flashcards

1
Q

What are the three categories of Odontogenic tumors and how many entities are within each?

A
  1. Odontogenic epithelium (5) 2. Mixed (6) 3. Odontogenic Ectomesenchyme (4)
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2
Q

What are the 5 tumors derived from odontogenic epithelium?

A

1.Ameloblastoma 2. Clear cell odontogenic carcinoma 3. AOT 4.CEOT 5.Squamous Odontogenic Tumor

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3
Q

What are the 6 tumors derived from mixed epithelium and ectomesenchyme?

A

1.ameloblastic fibroma 2.ameloblastic fibro-odontoma 3.ameloblastic fibrosarcoma 4. Odontoameloblastoma 5. Compound odontoma 6. Complex odontoma

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4
Q

What are the 4 tumors derived from odontogenic ectomesenchyme?

A

1.Odontogenic fibroma 2.Granular cell odontogenic tumor 3.Odontogenic myxoma 4.Cementoblastoma

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5
Q

What are the 4 possible origins of an ameloblastoma?

A

1.rests of dental lamina 2. developing enamel organ 3.epithelial lining of an odontogenic cyst 4.basal cells of the oral mucosa

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6
Q

What are the three clinicoradiographic presentations of ameloblastoma?

A
  1. conventional solid or multicystic 2. unicystic 3.peripheral
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7
Q

Conv solid/mulitcystic Ameloblastoma: age? gender? race? location?

A

30-70 (but can occur younger), no pref, blacks but debatable, 80-85% in mandible (66% in posterior mandible)

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8
Q

Conv solid/mulitcystic Ameloblastoma: what is usually the first clinical symptom/presentation?

A

painless swelling / expansion

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9
Q

Conv solid/mulitcystic Ameloblastoma: what are the buzzwords for radiographic appearance?

A

soap bubble or honeycomb

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10
Q

Conv solid/mulitcystic Ameloblastoma: +/- expansion? +/- root resorption?

A

+ expansion, + root resorption

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11
Q

What flavor of ameloblastoma is more often found in the anterior jaw(s)? Predilection for mand vs max?

A

Desmoplastic ameloblastoma…equal mand / max

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12
Q

RL vs RO: Desmoplastic ameloblastoma. What is the mechanism?

A

Mixed, thus confused for a fibro-osseus lesion.. metaplasia w/in the dense fibrous septa of the lesion

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13
Q

What are the 6 microscopic subtypes of conventional ameloblastoma?

A

Follicular, plexiform, acanthomatous, granular cell, desmoplastic, and basal cell

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14
Q

Ameloblastoma (follicular) histo: buzz words for the ameloblastic cell orientation in the epithelial islands?

A

REVERSE-polarity (the columnar / cuboidal ameloblasts have the nucleus away from the basement membrane and towards the stellate reticulum)

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15
Q

Name that ameloblastoma pattern: long, anastomosing cords / larger sheets of odontogenic epithelium

A

Plexiform

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16
Q

Name that ameloblastoma pattern: extensive squamous metaplasia, often associated with keratin formation..is this more aggressive?

A

acanthomatous..not more aggressive, just can be confused with SCC or SOT

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17
Q

Name that ameloblastoma pattern: cells have abundant cytoplasm filled with eosinophilic granules that resemble lysosomes ultrastructurally…WHAT is the AGE demographic for this pattern?

A

Granular cell pattern….YOUNG patients

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18
Q

Name that ameloblastoma pattern: small islands and cords of odontogenic epithelium in a densely collagenized stroma.. What is responsible for the stromal proliferation??

A

Desmoplastic…TGF-beta

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19
Q

Name that ameloblastoma pattern: the least common
type. These lesions are composed of nests of uniform basaloid cells, No stellate reticulum is present in the central portions of the nests…what shape are the peripheral cells?

A

Basal Cell pattern…cuboidal

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20
Q

Conv solid/mulitcystic Ameloblastoma: recurrence s/p currettage? Recurrence s/p marginal resection?

A

curettage: 50-90%…marginal resection: 15%

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21
Q

Unicystic Ameloblastomas: age? location?

A

young! 23 yrs avg…90% in posterior mandible

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22
Q

What are the three histopathologic varients of UNICYSTIC ameloblastoma?

A
  1. luminal 2. intraluminal (sometimes plexiform) 3. mural
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23
Q

Although the numbers vary widely, what is a good estimate for recurrence of Unicystic ameloblastoma following enucliation and curettage?

A

30% (systematic review pre 2005)..but other studies have shown 10, 20, 60% so. whatever.

24
Q

What are the two proposed etiologies for the peripheral ameloblastoma?

A

1.dental lamina beneath the oral mucosa 2. basal epithelial cells of the surface epithelium

25
Q

Where are peripheral ameloblastomas most likely to be found?

A

posterior mandibular gingiva

26
Q

What very common dermatologic diagnosis has been described on the gingiva, but is likely better diagnosed as a peripheral ameloblastoma?

A

Basal Cell Carcinoma

27
Q

What other odontogenic tumor can be confused microscopically with a peripheral ameloblastoma?

A

peripheral odontogenic fibroma (POF won’t have the reverse polarity and will likely have dysplastic dentin/cementum like elements)

28
Q

What is the recurrence of peripheral ameloblastoma?

A

15-20%, malignant change has been recorded, but rare

29
Q

Which term is used for a tumor that shows the histopath features of ameloblastoma, both in the primary tumor and the metastatic deposits?

A

M-alignant ameloblastoma (so looks like a benign ameloblastoma, but it has M-etastasized) ((SHOULD just be called metastatic ameloblastoma))

30
Q

Which term is used for an ameloblastoma that has cytologic features of malignancy in the primary tumor, in a recurrence, or in any metastatic deposit?

A

Ameloblastic C-arcinoma ((the C-ytologic features are malignant: high N:C, hyperchrom, mitoses, necroses, dystrophic calcs))

31
Q

Which happens later in life: malignant ameloblastoma or ameloblastic carcinoma?

A

ameloblastic carcinoma

32
Q

What are the 2 most common metastatic sites for ameloblastoma?

A
  1. lungs (thought to be from aspiration or implantation..BUT acually in the periphery of the lungs so blood/lymph route more likely) 2.Cervical Lymph Nodes
33
Q

What is the associated gene rearrangement in Clear Cell Odontogenic Carcinoma? What is the other entity this gene is associated with?

A

EWSR1…hyalinizing clear cell carcinoma (salivary gland malignancy)

34
Q

Clear Cell Odontogenic Carcinoma: age? location?

A

older than 50…80% of lesions in the mandible

35
Q

What are the three histologic patterns for Clear Cell Odontogenic Carcinoma?

A

1.biphasic (clear and polyagonal eosinophilic) 2. monophasic (clear cells in nest and cords) 3.ameloblastoma like

36
Q

How do you differentiate Clear Cell Odontogenic Carcinoma from an intraosseous muco ep?

A

negative mucin stain = CCOC

37
Q

How do you differentiate a Clear Cell Odontogenic Carcinoma from CEOT?

A

Stain for Amyloid (+ amyloid = clear cell variant of CEOT)

38
Q

What are the two documented sites of metastasis for Clear Cell Odontogenic Carcinoma (20-25% of cases)?

A

Regional nodes and lung

39
Q

Woah lots of proposed origins for AOTs…What are they? (4)

A

1.enamel organ epithelium 2.reduced enamel epithelium 3. rests of Malassez 4.dental lamina assoc w GUBERNACULAR cord

40
Q

What is the most common tooth associated with an AOT? (Young, female, anterior maxilla) What radiographi feature can SOMETIMES help?

A

Canine…the RL will extend to the apex of the impacted tooth (not just CEJ to CEJ like a dentigerous cyst)

41
Q

What is the radiographic BUZZWORD for AOT?

A

Snowflake calcifications

42
Q

AOT: the rosettes can have an eosinophilic material in the center…what does it stain for?

A

amyloid

43
Q

AOT: the tubular / duct-LIKE structures are lined by what type of cell(s)? What is unique about the nuclei?

A

cuboidal or columnar..nuclei polarized AWAY from the central space

44
Q

Abortive enamel formation leads to what feature in AOTs?

A

calcifications

45
Q

AOTs have some histological crossover with what 3 other entities?

A
  1. CEOT 2.Odontoma 3.COC
46
Q

The tumor cells of a CEOT resemble what part of the developing tooth? (2 theories)

A

Stratum intermedium of the enamel organ OR dental lamina remnants

47
Q

A small subset of CEOTs have mutations in WHAT gene?

A

PTCH1 (also assoc w NBCCS)

48
Q

CEOT: age? location?

A

30-50 yrs…66% of cases in the posterior mandible

49
Q

What is the MOST common presenting sign of a CEOT?

A

painless, slow-growing swelling

50
Q

What is the BUZZWORD for the radiographic appearance of a CEOT? (Although it is not really that common)

A

“driven snow”

51
Q

What is the BUZZWORD for the calcifications in a CEOT histologically? What is the material LIKE in these concentric rings?

A

LIES-E-GANG RING CALCIFICATIONS…AMYLOID-LIKE

52
Q

What is the name of the protein that stains for congo red in a CEOT?

A

ODAM (odontogenic ameloblast-assocated protein)

53
Q

What is the recurrence rate of a CEOT?

A

15%

54
Q

What are the two theories for SOT formation?

A

Neoplastic transformation of the dental lamina rests OR rests of Malassez

55
Q

SOT: average age? site?

A

38 yrs…NO predilection, just the alvolar processes of the maxilla and mandible

56
Q

Buzz word: what entity has a RL TRIANGULAR defect usually lateral to the roots of teeth?

A

SOT

57
Q

Name that tumor: Vacuolization and individual cell keratinization within the epithelial islands are common features. Small microcysts are sometimes observed within the epithelial islands. Laminated calcified bodies and globular eosinophilic structures, which do not stain for amyloid, are present within the epithelium in some cases. The former probably represents dystrophic calcifications; the nature of the latter is unknown.

A

SOT

Neville and Damm (72 decks)

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