odontogenic neoplasms Flashcards
Ameloblastoma benign or malignant?
benign, but aggressive
Ameloblastoma orgin
odontogenic epithelial origin
Ameloblastoma Microscopically, cells resemble
the ameloblasts of the enamel organ, but no enamel is produced
whats the most common ondontogenic neoplasm
ameloblastoma
Ameloblastoma seen when
wide age range 30-70’s
Ameloblastoma makes up ___% of oral pathology biopsy
.2%
Ameloblastoma where
Most (80-85%) occur in the mandible, usually the molar-ramus region
Ameloblastoma 20% associated with what
impacted tooth
Ameloblastoma growth
grows slowly, destroying tissue, but usually expanding rather than perforating bone
Ameloblastoma clinical
Typically asymptomatic except for swelling
Ameloblastoma radiographic
A small lesion usually presents as a unilocular radiolucency with well-defined borders
As the lesion progresses, the classic multilocular expansile radiolucency frequently develops
Ameloblastoma (desmoplastic variant)
Distinctive radiologically as well as histologically
Radiographs usually show a poorly demarcated radiolucency with numerous radiopaque flecks
Similar in appearance to benign fibro-osseous lesion
Ameloblastoma patterns
follicular and plexiform
Ameloblastoma histo
Small tumor islands which show cuboidal or columnar cells at their periphery
The center of the tumor islands is composed of loosely arranged polyhedral epithelial cells that resemble stellate reticulum
Ameloblastoma trt
en bloc resection
Ameloblastoma prognosis
guarded
Ameloblastoma recurrence rates
With simple curettage, recurrence rates reported to be 50-90%
Even with marginal resection, recurrence rates up to 15%
Ameloblastoma, maxilla or mandible require more aggressive trt
maxilla
Peripheral Ameloblastoma
asymptomatic gingival mass in a middle-aged adult, usually mandible
Peripheral Ameloblastoma size
Typically less than 2 cm in diameter
Peripheral Ameloblastoma trt and reoccurrence
Important to note that this is an innocuous lesion that can easily be cured by local excision, little tendency to recur
Calcifying Epithelial Odontogenic Tumor
Rare odontogenic epithelial neoplasm initially described by Pindborg in 1956
CEOT (Pindborg Tumor) histo, derived from what
stratum intermedium
CEOT (Pindborg Tumor) who and when
Mean age at diagnosis - 40 years, with no sex predilection
CEOT (Pindborg Tumor) where
Most arise in the posterior mandible
CEOT (Pindborg Tumor) clinically
Asymptomatic; swelling may be noted
50% associated with an impacted tooth
CEOT (Pindborg Tumor) radiographically
Diffuse or well-circumscribed radiolucency unilocular when small
With growth, lesion may become multilocular
Radiopaque flecks often develop as lesion enlarges
CEOT (Pindborg Tumor) histo
Sheets or strands of polyhedral epithelial cells with eosinophilic cytoplasm
The nuclei are frequently pleomorphic, but mitoses are rare
CEOT (Pindborg Tumor) major histo characteristics
amyloid material that calcifies, forming lamented structures called Liesegang rings
CEOT (Pindborg Tumor) trt
Conservative excision with peripheral ostectomy
CEOT (Pindborg Tumor) recurrence rate
15% recurrence rate
Adenomatoid Odontogenic Tumor who and when
Usually arises in a younger patient, mean age - 18 years, with 75% under 20 years of age
females
Adenomatoid Odontogenic Tumor where
maxillary more
75% in anterior
Adenomatoid Odontogenic Tumor 75% associated with _____ teeth
impacted
Adenomatoid Odontogenic Tumor clinical
asymptomatic
sometimes swelling
Adenomatoid Odontogenic Tumor radiographically
Well-circumscribed unilocular radiolucency that may contain radiopaque flecks
Separation of roots or displacement of adjacent teeth occurs frequently
radiographic features that distinguish Adenomatoid Odontogenic Tumor from dentigerous cyst
When associated with an impacted tooth, the lesion often extends apically beyond the cemento-enamel junction
Adenomatoid Odontogenic Tumor histo
Well-encapsulated lesion
The tumor cells form swirling spindle-cell nests with duct-like structures of varying sizes
Adenomatoid Odontogenic Tumor histo feature that sometimes need to be seen
Foci of basophilic calcified material may also be seen
Adenomatoid Odontogenic Tumor trt
enucleation
Adenomatoid Odontogenic Tumor prognosis and recurrence
excellent
rare
Ameloblastic Fibroma who and when
younger patients in first two decades of life
Ameloblastic Fibroma where
posterior mandible (70 percent)
Ameloblastic Fibroma clinically
small lesions are asymptomatic, larger ones produce painless swelling
Ameloblastic Fibroma radiographic
smaller lesions are unlocular, bigger lesions can become multilocular with well defined boarders
Ameloblastic Fibroma histo
Myxoid connective tissue that resembles dental papilla that contains strands and islands of odontogenic epithelium that resembles dental lamina
Ameloblastic Fibroma, CT resembles what
dental papilla
Ameloblastic Fibroma epithelial islands can resemble what?
ameloblastoma
Ameloblastic Fibroma odontogenic epithelial resembles what
dental lamina
Ameloblastic Fibroma trt
aggressive curettage
Ameloblastic Fibroma prognosis
good
Ameloblastic Fibroma recurrence rate
low
Ameloblastic Fibro-Odontoma
Odontogenic tumor with features of ameloblastic fibroma as well as odontoma
Ameloblastic Fibro-Odontoma who and when
children, 10 years old average age
Ameloblastic Fibro-Odontoma where
Equal frequency in mandible and maxilla
Ameloblastic Fibro-Odontoma clinically
Asymptomatic swelling with large lesions Failure of tooth eruption may be noted
Ameloblastic Fibro-Odontoma radiographically
Well-circumscribed unilocular, or occasionally multilocular, radiolucency
Varying amounts of calcified material having the density of tooth structures
Ameloblastic Fibro-Odontoma, often associated with what
impacted tooth
Ameloblastic Fibro-Odontoma histo
Odontoma areas (usually complex odontoma) together with areas of ameloblastic fibroma. characteristics of both
Ameloblastic Fibro-Odontoma trt
conservative curettage
Ameloblastic Fibro-Odontoma prognosis
excellent
Odontoma
probably not a true neoplasm but a odontogenic hamartoma.
Odontoma, two forms
compound and complex
Odontoma when
Most are detected during the first two decades of life, mean age of 14 years
Odontoma where
Slightly more frequent in the maxilla compared to the mandible
Odontoma associated with what
unerupted tooth
compound odontomas seen mainly where
anterior maxilla
complex odontomas seen mainly where
posterior portion or maxilla or mandible
compound odontoma clinically
as a collection of small malformed teeth surrounded by a narrow radiolucent rim, often overlying an impacted tooth

compound odontoma histopath
shows the formation of multiple small malformed teeth
complex odontoma histopath
shows a mixture of dentin, enamel matrix, cementum, odontogenic epithelium and dental papilla
odontoma trt and prognosis
enucleation
excellent
Odontogenic Myxoma
Benign neoplasm assumed to be of odontogenic origin because the jaw bones are the only skeletal sites affected
Odontogenic Myxoma when
Primarily affects young adults, but seen over a wide age range
Average is 25-30 years
Odontogenic Myxoma where
Mandible affected slightly more than maxilla
Odontogenic Myxoma, larger lesion present with what
asymptomatic expansion of bone
Odontogenic Myxoma radiographically
Unilocular when small; multilocular when large
May have a “soap-bubble” appearance
Odontogenic Myxoma histo
Spindle-shaped or stellate-shaped fibroblastic cells set in a myxoid background
The lesional proliferation tends to infiltrate the adjacent bony trabeculae
Odontogenic Myxoma trt and prognosis
small lesions- curettage
large lesions en bloc segmental resection
prognosis- good
Odontogenic Myxoma recurrence rates
up to 25%
Cementoblastoma when
under 25 years old usually
Cementoblastoma where
mandibular molar region
Cementoblastoma growth
slow growing, may produce expansion or pain
Cementoblastoma radiographically
Well-circumscribed radiopaque mass with a fine radiolucent border
Fused to the resorbed root of a tooth, usually a mandibular first molar
Cementoblastoma usually fused to what
resorbed root of a tooth
cementoblastoma look like if excised
Trabeculae of mineralized material that resembles cementum
The trabeculae are rimmed by plump, angular cells that represent neoplastic cementoblasts
Cementoblastoma differential diagnosis
osteoblastoma, osteosarcoma
Cementoblastoma trt
Surgical extraction of the involved tooth with enucleation of the lesion
Alternatively, the tooth can be endodontically treated followed by root amputation and removal of the lesion with the involved root
Cementoblastoma prognosis
excellent
