Odontogenic Mixed & Radiopaque Lesions Flashcards
RL or mixed RL-RO Odontogenic lesions
These lesions are RL but may produce a pdt causing them to have a mixed radiographic appearance
- Calcifying odontogenic cyst
- Adenomatoid odontogenic cyst
- Calcifying epithelial odontogenic tumor
-
Ameloblastic fibro-odontoma**
- Always MIXED, never RL
- Cemento-osseous dysplasia
Another name for Calcifying Odontogenic Cyst
Gorlin Cyst
Calcifying Cystic Odontogenic Tumor
Calcifying Odontogenic Cyst
RL or Mixed RL-RO Odontogenic Lesions
- AKA Gorlin Cyst, Calcifying Cystic Odontogenic Tumor
- Presents as a cyst or solid benign neoplasm
- Has capacity to produce a calcified pdt
- If enough calcified pdt is present, lesion will have RO areas
- Can be be associated w/ other odontogenic tumors, esp odontomas
- Well defined RL, w/ or w/o RO areas
- Can cause root resorption or divergene of adjacent roots, just like any other odontogenic cysts
-
Less common than other odontogenic cysts
- Displays unique rad & histo features
- May or may not be assoc w/ an unerupted tooth
- Can become large and destructive
- Any odontogenic bearing area of the jaw can be involved
- 30% show RO
- 30% show unerupted tooth is present
-
30% of tumors are peripheral
- Of all tumors and cysts that occur, all can be central and all can be peripheral
- THE ONLY CYST THAT CAN BE MIXED; ALL OTHER CYSTS ARE ALWAYS RL
Calcifying Odontogenic Cyst: Rad
RL or Mixed RL-RO Odontogenic Lesions
- RO center surrounded by RL zone, surrounded by corticated border
- Well-defined RL
- Usually unilocular
Calcifying Odontogenic Cyst: Clinical behavior
RL or Mixed RL-RO Odontogenic Lesions
- Majoriy of these lesions occur w/in bone
- Can be associated w/ unerupted tooth
Calcifying Odontogenic Cyst: Tx
RL or Mixed RL-RO Odontogenic Lesions
- Tx’d w/ surgery
- Recurrence is UNcommon (esp if peripheral)
- Good px w/ few recurrences after simple enucleation
Calcifying Odontogenic Cyst: Differential dx
RL or Mixed RL-RO Odontogenic Lesions
- Peripheral ossifying
- Peripheral giant cell
- Pyogenic granuloma
- Parulis
- Plain fibroma
Calcifying Epithelial Odontogenic Tumor
RL or Mixed RL-RO Odontogenic Lesions
- May produce mineralized pdt - so it can be mixed
- Pts b/w 30-50yo - don’t get hung up on age
- No gender predilection
- Painless, slow growing swelling
Calcifying Epithelial Odontogeic Tumor: Rad
RL or Mixed RL-RO Odontogenic Lesions
- Well-defined, corticated, odontogenic, MIXED
- Unilocular or multilocular RL, usually containing calcified structures
Calcifying Epithelial Odontogenic Tumor: Tx
RL or Mixed RL-RO Odontogenic Lesions
- Remove some normal bone surrounding the lesions
- Tx w/ conservative surgery
- Recurrence of 15%
- Less aggressive than ameloblastoma
- Conservative local resection is tx of choice
- Overall px good
Adenamatoid Odontogenic Tumor
RL or Mixed RL-RO Odontogenic Lesions
-
2/3 tumor
- 2/3 Impacted tooth - assoc w/ unerupted tooth
- 2/3 b/w 10-19yo - teenagers
- 2/3 seen in females
- Anterior
- MX
- Does not infiltrate bone
- Has ST capsule, easily removed
- Gets name bc histologically, looks glandular
- Completely benign
Adenomatoid Odontogenic Tumor: Tx
RL or Mixed RL-RO Odontogenic Lesions
- Easily excised
- No recurrence expected
- Enucleates easily from adjacent bone
Ameloblastic Fibro-Odontoma
RL or Mixed RL-RO Odontogenic Lesions
- Represents a developing odontoma
- Most common <20yo
- Only occurs under age of 20
- Does not infiltrate surrounding bone
- ALWAYS MIXED IN RADS
Ameloblastic Fibro-Odontoma: Tx
RL or Mixed RL-RO Odontogenic Lesions
- Conservative removal
Neoplasm
- New growth of abnormal tissue, uncoordinated w/ growth of surrounding tissue persisting after cessation of the stimuli which evoked the change
- Benign:Localized
- Malignant = Cancer: Invades and destroys adjacent structures and metastasizes
Teratoma
- Neoplasm that arises from stem cells or plurpotent cells
- Made up of multiple germ cell laayers
- Can be malignant or benign
Hamartoma
- Overgrowth of mature cells/tissue that normally occur in the affected part, but disorganized
- An overgrowth of tooth tissues that STOPS so it is not a true tumor
- Ex: Odontoma
Choristoma
- Overgrowth of mature cells/tissue in the body other than the s ite which it is normally located
- Aberrant rest, heterotropic tissue
- Stops growing when normal tissue stops growing
RO w/ a thin RL periphery
- Odontomas
- Cementoblastoma
End of spectrum development
Ameloblastic fibroma ⇒ Ameloblastic Fibro-Odontoma ⇒ Odontoma
Odontoma
RO Odontogenic Tumor
- Most commonly dx’d/common type of odontogenic tumor
- Better classified as a hamartoma rather than a tumor
- Disorganized growth of enamel, dentin, cementum, pulpal tissue
- Most seen in young pts (avg 14yo), but this is the time they develop. A pt can be unaware of it until 40-60s, depending on when rad exam shows it
- Key: RO area surrounded by RL line, surrounded by RO line
- Asymptomatic, slow growing
- Typically found in anterior MX, but can occur anywhere
- May be associated w/ dentigerous cyst or prevent tooth eruption
Two types of odontomas
RO Odontogenic Tumor
- Compound
- Complex
Odontoma: Compound
RO Odontogenic Tumor
- Multiple tooth like structures
- Various ROs w/in central region
- Little toothlets
- Outside looks more like RO and more translucent inside
Odontoma: Complex
RO Odontogenic Tumor
- Does not resemble tooth
- Typically found in posterior MN, but can occur anywhere
- No resemblance to tooth whatsoever
- Various ROs w/in central region
Odontoma: Tx
RO Odontogenic Tumor
- Conservative surgical removal
Cementoblastoma
RO Odontogenic Tumor
- Benign neoplasm of cementoblasts
-
Dx’c radiographic appearance
- RO mass, surrounded by RL line and then RO line
- Fused to tooth root and causes partial root resorption
- 65% pain & swelling
- Originates from cementoblasts
Cementoblastoma: Tx
RO Odontogenic Tumor
- Surgical removal of tooth or root amputation w/ removal of lesion
- Remove lesion & tooth (less recurrence)
- Remove lesion & endo
- Up to 20% recurrence rate
- Total removal of lesion minimizes recurrence
What are Radiopaque Odontogenic Lesions?
- Odontoma
- Cementoblastoma
