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oral path 2, exam 3 > Odontogenic Neoplasms > Flashcards

Odontogenic Neoplasms Flashcards

1
Q

A ________ is a benign but locally aggressive neoplasm of odontogenic epithelial origin

A

Ameloblastoma

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2
Q

microscopically, what do Ameloblastoma cells resemble?

A

Microscopically, cells resemble the ameloblasts of the enamel organ, but no enamel is produced

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3
Q

what is the Prevalence of ameloblastomas? what groups are at the highest risk for developing them?

A

A) While considered the most common odontogenic neoplasm, it only constitutes about 0.2% of oral pathology biopsy cases

B) No sex predilection
C) Wide age range, from 3rd to 7th decades

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4
Q

Clinical characteristics of Ameloblastomas:

A

1) Most (80-85%) occur in the mandible, usually the molar-ramus region
2) About 20% are associated with an impacted tooth
3) Lesion grows slowly, destroying tissue, but usually expanding rather than perforating bone

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5
Q

Radiographic features of Ameloblastomas:

A

A) A small lesion usually presents as a unilocular radiolucency with well-defined borders

B) As the lesion progresses, the classic multilocular expansile radiolucency frequently develops

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6
Q

what are the characteristics of the “desmoplastic variant” Ameloblastoma?

A

A) Described initially in 1984

B) Distinctive radiologically as well as histologically

C) Radiographs usually show a poorly demarcated radiolucency with numerous radiopaque flecks

B) Similar in appearance to benign fibro-osseous lesion

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7
Q

Histological characteristics of Ameloblastomas:

A

1) Several different patterns, follicular and plexiform are most common
2) Small tumor islands which show cuboidal or columnar cells at their periphery
3) The center of the tumor islands is composed of loosely arranged polyhedral epithelial cells that resemble stellate reticulum

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8
Q

what is the treatment protocol for Ameloblastomas?

A

Depends on the size and site of the lesion

1) Small lesion - aggressive curettage or small en bloc resection
2) Large lesion - large en bloc resection or marginal segmental resection with reconstruction

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9
Q

what is the prognosis for Ameloblastomas?

A
  • Prognosis: Guarded
    1) With simple curettage, recurrence rates reported to be 50-90%
    2) Even with marginal resection, recurrence rates up to 15%
    3) Maxillary lesions warrant more aggressive surgical removal due to their anatomic location
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10
Q

what is the clinical presentation for Peripheral Ameloblastomas?

A

present as an asymptomatic gingival mass in a middle-aged adult, usually mandible

Typically less than 2 cm in diameter

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11
Q

T/F: Peripheral Ameloblastomas can easily be cured by local excision, and have little tendency to recur

A

True

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12
Q

what is the Histogenesis of Calcifying Epithelial Odontogenic Tumors?

A

Thought to be derived from cells of the stratum intermedium

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13
Q

what population groups are at the highest risk for Calcifying Epithelial Odontogenic tumors? where do most arise?

A

1) Mean age at diagnosis - 40 years, with no sex predilection
2) Most arise in the posterior mandible
3) Asymptomatic; swelling may be noted
4) 50% associated with an impacted tooth

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14
Q

Calcifying Epithelial Odontogenic tumors are also known as _______ tumors

A

Pindborg Tumor

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15
Q

radiographic findings for Calcifying Epithelial Odontogenic tumors:

A

A) Diffuse or well-circumscribed radiolucency unilocular when small

B) With growth, lesion may become multilocular

C) Radiopaque flecks often develop as lesion enlarges

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16
Q

histological findings for Calcifying Epithelial Odontogenic tumors:

A

1) Sheets or strands of polyhedral epithelial cells with eosinophilic cytoplasm
2) The nuclei are frequently pleomorphic, but mitoses are rare

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17
Q

in what material does calcification occur in Calcifying Epithelial Odontogenic Tumors?

A

Calcifications develop in a unique amyloid material

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18
Q

The lamellated structures formed in Calcifying Epithelial Odontogenic Tumors are called “________rings”

A

Liesegang rings

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19
Q

when would an Adenomatoid Odontogenic Tumor extend apically past the CEJ?

A

When associated with an impacted tooth

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20
Q

How can a Adenomatoid Odontogenic Tumor be differentiated from a dentigerous cyst?

A

you can see the Adenomatoid Odontogenic Tumor extend Apically beyond the CEJ

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21
Q

Histological features of Adenomatoid Odontogenic tumors:

A

1) Well-encapsulated lesion
2) The tumor cells form swirling spindle-cell nests with duct-like structures of varying sizes
3) Foci of basophilic calcified material may also be seen

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22
Q

what population groups are at risk for Adenomatoid Odontogenic tumors? where do these lesions occur?

A

A) Usually arises in a younger patient, mean age - 18 years, with 75% under 20 years of age

B) 2:1 female predilection

C) 2:1 maxillary predilection

D) 75% of these lesions develop in the anterior jaws, 75% are associated with an impacted tooth

23
Q

General radiographic features of Adenomatoid Odontogenic tumors:

A

1) Well-circumscribed unilocular radiolucency that may contain radiopaque flecks
2) Separation of roots or displacement of adjacent teeth occurs frequently

24
Q

Ameloblastic Fibromas are often found in what population groups? where are they usually found?

A

A) Younger patients: 1st – 2nd decades of life

B) Posterior mandible - (70% of cases)

25
Q

T/F: the only clinical symptom of Ameloblastic fibromas is painless swelling

A

true

26
Q

radiographic findings of Ameloblastic Fibromas:

A

Unilocular when small
Larger lesions can become multilocular
Margins tend to be well-defined

27
Q

list the histological features of Ameloblastic Fibromas:

A

A) Myxoid connective tissue that resembles dental papilla that contains strands and islands of odontogenic epithelium that resembles dental lamina

B) Connective tissue resembles dental papilla

C) Epithelial islands can resemble follicular or plexiform ameloblastoma

28
Q

what is the prognosis/treatment for Ameloblastic Fibromas?

A

1) Treatment consists of aggressive curettage
2) Prognosis: good
3) Recurrence rate is low (0-18%)
4) Rare malignant transformation

29
Q

what is a “Ameloblastic Fibro-Odontoma”?

A

Odontogenic tumor with features of ameloblastic fibroma as well as odontoma

30
Q

Clinical features of Ameloblastic Fibro-Odontomas:

A

1) Usually diagnosed in children, average age of 10 years
2) Asymptomatic swelling with large lesions
3) Failure of tooth eruption may be noted
4) Equal frequency in mandible and maxilla

31
Q

radiographic features of Ameloblastic Fibro-Odontomas:

A

1) Well-circumscribed unilocular, or occasionally multilocular, radiolucency
2) Varying amounts of calcified material having the density of tooth structures
3) Often associated with an impacted toot

32
Q

Histology of Ameloblastic Fibro-Odontomas:

A
  • Odontoma areas (usually complex odontoma) together with areas of ameloblastic fibroma
  • Relative amounts of each type of tissue vary from lesion to lesion
33
Q

Ameloblastic Fibro-Odontomas may be confused with what other lesion?

A

A developing Odontoma

34
Q

Treatment/prognosis/recurrence for Ameloblastic Fibro-Odontomas:

A

Tx: Conservative curettage
Prognosis: Excellent
Recurrence is unusual

35
Q

____________ are probably not a true neoplasm, but rather an odontogenic hamartoma

A

Odontoma

36
Q

what are the 2 forms of Odontomas?

A
  • Complex

- Compound

37
Q

what age groups are at the highest risk for Odontomas? where are they usually found?

A

A) Most are detected during the first two decades of life, mean age of 14 years

C) Slightly more frequent in the maxilla compared to the mandible

38
Q

T/F: Most Odontomas are associated with an unerupted tooth

A

True

39
Q

Where are Compound Odontomas usually found? where are Complex Odontomas usually found?

A

A) Compound odontomas are seen predominantly in the anterior maxilla

B) Complex odontomas usually present in the posterior portion of the maxilla or mandible

40
Q

characteristics of Compound Odontomas:

A

a collection of small malformed teeth surrounded by a narrow radiolucent rim, often overlying an impacted tooth

41
Q

characteristics of Complex Odontomas:

A

a calcified mass that, if fully formed, has the density of tooth structure

  • This is also surrounded by a narrow radiolucent rim, and typically overlies an impacted tooth
42
Q

what are the histopathological features of Odontomas?

give both compound and complex

A

A) The compound odontoma shows the formation of multiple small malformed teeth

B) The complex odontoma shows a mixture of dentin, enamel matrix, cementum, odontogenic epithelium and dental papilla

43
Q

what is a Odontogenic Myxoma?

A

Benign neoplasm assumed to be of odontogenic origin because the jaw bones are the only skeletal sites affected

44
Q

what population groups are at risk for Odontogenic Myxomas? what regions are effected?

A

1) Primarily affects young adults, but seen over a wide age range
2) Average is 25-30 years

3) Mandible affected slightly more than maxilla

45
Q

what are the radiographic features of Odontogenic Myxomas?

A

Unilocular when small; multilocular when large

May have a “soap-bubble” appearance

46
Q

list the histological characteristics of Odontogenic Myxomas:

A

A) Spindle-shaped or stellate-shaped fibroblastic cells set in a myxoid background

B) The lesional proliferation tends to infiltrate the adjacent bony trabeculae

47
Q

what is the treatment protocol for Odontogenic Myxomas?

A

Small lesions - curettage

Large lesions - En bloc or segmental resection, depending on the size and site

48
Q

T/F: Odontogenic myxomas have a high reoccurrence rate, up to 25% in some cases

A

true

49
Q

General characteristics of Cementoblastomas:

A
  • Most present in the mandibular molar region
  • Usually in patients under 25 years of age
  • No sex predilection
  • Slow-growing, may produce expansion or pain
50
Q

what are the radiographic findings for Cementoblastomas?

A

A) Virtually pathognomonic radiographic features

B) Well-circumscribed radiopaque mass with a fine radiolucent border

C) Fused to the resorbed root of a tooth, usually a mandibular first molar

51
Q

what histological characteristics would you see in Cementoblastomas?

A
  • Trabeculae of mineralized material that resembles cementum

- The trabeculae are rimmed by plump, angular cells that represent neoplastic cementoblasts

52
Q

what are the differential diagnoses for Cementoblastomas?

A

osteoblastoma

osteosarcoma

53
Q

what 2 treatment options are available to treat cementoblastomas?

A

1) Surgical extraction of the involved tooth with enucleation of the lesion
2) Alternatively, the tooth can be endodontically treated followed by root amputation and removal of the lesion with the involved root

oral path 2, exam 3 (4 decks)

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