Malignant Odontogenic tumours

Question 1

Types of malignant odontogenic tumours?

Answer 1

• Sclerosing odontogenic carcinoma
• Ameloblastic carcinoma
• Clear cell odontogenic carcinoma
• Ghost cell odontogenic carcinoma
• Primary intraosseous carcinoma, NOS
• Odontogenic carcinosarcoma
• Odontogenic sarcomas

Question 2

Ameloblastoma carcinoma?

Answer 2

• Rare, highly invasive and can metastasize.
• Primary or arise by de- differentiation from
  conventional ameloblastoma.

Question 3

Histopathology of ameloblastoma carcinoma?

Answer 3

• Sheets and islands of basaloid cells with peripheral
  palisading.
• Mitotic figures, nuclear and cellular pleomorphism,
  and necrosis.
• Neural and vascular invasion.

Question 4

Management of ameloblasts is carcinoma?

Answer 4

• Similar to oral squamous cell carcinoma and
  involves surgical excision with clear margins.
• Depending on the clinical stage of disease, a neck
  dissection may be required to remove the regional
  lymph nodes.

Question 5

Primary intra-osseous squamous carcinoma?

Answer 5

Look like squamous cell carcinoma of the jaw

• The majority of oral squamous cell carcinomas arise
  from surface mucosa but a small number arise from
  odontogenic epithelium in the jaws.
• Some arise de novo and others in a pre- existing
  odontogenic cyst.
• These neoplasms expand the jaws, show rapid
  growth, and may cause pathological fracture.
• Histopathologically, they resemble conventional
  squamous cell carcinoma
  *Similar management

Question 6

Clear cell odontgoenic carcinoma?

Answer 6

• Rare, malignant with potential to metastasize.
• Histopathologically, a biphasic pattern is often present with islands of epithelial cells possessing
  clear to faintly eosinophilic cytoplasm along with
  cords of dark- staining basaloid cells.
• Management is similar to oral squamous cell carcinoma.

Question 7

Ghost cell odontogenic carcinoma?

Answer 7

• Very rare.
• Behaviour is uncertain but some reported cases have metastasized.
• Management is decided on a case by case basis but if worrying features are present, then treatment is planned as for oral squamous cell carcinoma

Question 8

Odontogenic sarcomas?

Answer 8

• Extremely rare.
• Two variants:
• Ameloblastic fibrosarcoma, the malignant counterpart of amleoblastic fibroma
• Ameloblastic fibrodentinoma (ameloblastic fibroodontosarcoma), in which dental hard tissue
  formation may additionally be seen.
• Both are treated by surgery with wide margins to ensure clearance.

Question 9

Peduculated?

Answer 9

On a stalk

Question 10

Congenital tumours of possible odontogenic origin?

Answer 10

• Congenital epulis.
• Melanotic neuroectodermal tumour
  of infancy.
• Congenital odontogenic myxoma.

Question 11

Clinical presentation of Congenital epulis?

Answer 11

• Rare.
• Newborn infants.
• Incisor region of the maxilla.
• The swelling is rounded and often pedunculated.

Question 12

Histopathology of congenital epulis?

Answer 12

• Large closely packed granular cells covered by oral
  mucosa.
• Congenital gingival granular cell tumour.
• Unlikely to be neoplastic and does not recur after
  excision.

Question 13

Origin of Melanotic Neuroectodermal Tumour of Infancy?

Answer 13

Cells of neural crest

Question 14

Clinical presentation of Melanotic Neuroectodermal Tumour of
Infancy?

Answer 14

• Rare tumour in infants during the first year of life.
• More frequent in the anterior maxilla.
• Behaves aggressively and tends to recur.
• Requires multiple attempts at excision.

Question 15

Congenital odontogenic myxoma?

Answer 15

• Rarely, odontogenic myxoma is present at birth.
• The lesion expands the jaw and treatment is often delayed to allow some facial growth, with removal in early childhood.