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*AU15 - Oral Pathology Exam 3 > Odontogenic Neoplasms > Flashcards

Odontogenic Neoplasms Flashcards

1
Q

What is a condition that is benign but locally aggressive neoplasm of odontogenic epithelial origin?

A

ameloblastoma

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2
Q

True or false: The cells of ameloblastoma produce enamel.

A

FALSE

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3
Q

What is the most common odontogenic neoplasm? What percentage of oral path lesions does it make up?

A
  • ameloblastoma

- 0.2%

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4
Q

What age is most commonly affected by ameloblastoma? Gender? Part of the oral cavity most affected?

A
  • 3rd to 7th decade
  • no gender preference
  • molar/ramus area of mandible
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5
Q

What are the signs and symptoms of ameloblastoma?

A
  • asymptomatic swelling
  • unilocular radiolucency with well-defined borders (multilocular as it grows larger)
  • 20% associated with impacted tooth
  • lesion grows slowly, destroying tissue, but usually expanding rather than perforating bone

*note: sometimes the only way to tell it is ameloblastoma is through biopsy

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6
Q

Describe the ameloblastoma desmoplastic variant. What is it similar to?

A
  • radiographs show poorly demarcated radiolucency with numerous radiopaque flecks (due to dense connective tissue and bone trabeculae)
  • benign fibro-osseous lesion
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7
Q

Describe ameloblastoma histologically.

A
  • follicular and plexiform are the 2 most common patterns
  • small tumor islands that have cuboidal and columnar cells at periphery
  • center of tumor islands has polyhedral epithelial cells that resemble stellate reticulum

*note: desmoplastic variant has islands of epithelium enclosed by dense CT and trabeculae of bone

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8
Q

What is the treatment for ameloblastoma?

A
  • SMALL LESION: aggressive curettage or small en bloc resection
  • LARGE LESION: large en bloc resection or marginal segmental resection with reconstruction
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9
Q

What is the prognosis for ameloblastoma?

A

GUARDED

  • with simple curettage, recurrence rates of 50-90%
  • with marginal resection, recurrence of 15%
  • maxillary lesions warrant more aggressive surgical removal due to their anatomic location
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10
Q

Describe a peripheral ameloblastoma. Who and where does it often occur? What is the proper treatment and prognosis?

A
  • asymptomatic gingival mass less than 2 cm in diameter
  • middle aged adult, usually in the mandible
  • local excision with little tendency to recur
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11
Q

What condition is also known as Pindborg’s tumor?

A

calcifying epithelial odontogenic tumor

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12
Q

How common is the calcifying epithelial odontogenic tumor? How does it form?

A
  • rare

- derived from cells of the stratum intermedium

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13
Q

What is the average age for calcifying epithelial odontogenic tumor? Gender? Area of the oral cavity?

A
  • mean age 40 years
  • no gender preference
  • posterior mandible
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14
Q

What are the signs and symptoms of calcifying epithelial odontogenic tumor?

A
  • asymptomatic, swelling may be noted
  • 50% associated with impacted tooth
  • diffuse or well-circumscribed radiolucency (unilocular –> multilocular) with radiopaque flecks as lesion grows larger
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15
Q

Describe the histology of calcifying epithelial odontogenic tumor.

A
  • sheets or strands of polyhedral epithelial cells with eosinophilic cytoplasm
  • nuceli are pleomorphic, but mitoses are rare
  • epithelial cells may be associated with variable amounts of eosinophilic acellular material that stains amyloid
  • calcifications develop in amyloid forming lamellated structures called Liesegang rings

*note: amyloid is distinctive for CEOT

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16
Q

What is the treatment and prognosis of calcifying epithelial odontogenic tumors?

A
  • TREATMENT: conservative excision with peripheral ostectomy

- 15% recurrence rate

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17
Q

What age is most susceptible to adenomatoid odontogenic tumor? Gender? Area of oral cavity?

A
  • younger patient, mean age 18 years
  • females 2:1
  • maxillary 2:1 (anterior jaws 75%)
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18
Q

What are the signs and symptoms of adenomatoid odontogenic tumor?

A
  • asymptomatic swelling
  • well-circumscribed unilocular radiolucency with radiopaque flecks
  • separation of roots or displacement of adjacent teeth occurs frequently
  • if associated with impacted tooth, lesion extends apically beyond CEJ (distinguishes from dentigerous cyst)
19
Q

Describe the histology of adenomatoid odontogenic tumor.

A
  • well-encapsulated lesion
  • tumor cells form swirling spindle-cell nests with duct-like structures of varying sizes
  • foci of basophilic calcified material
20
Q

What is the treatment and prognosis of adenomatoid odontogenic tumor?

A
  • TREATMENT: enucleation

- PROGNOSIS: excellent, recurrence rare

21
Q

What age group is most common for ameloblastic fibroma? What area in the oral cavity?

A
  • younger patients (first 2 decades)

- posterior mandible (70%)

22
Q

What are the signs and symptoms of ameloblastic fibroma?

A
  • asymptomatic; large lesions have painless swelling
  • unilocular (multilocular when large)
  • well-defined margins
  • no calcifications!
23
Q

Describe the histology of ameloblastic fibroma.

A
  • myxoid connective tissue (resembles dental papilla) that contains strands/islands of odontogenic epithelium (resembles dental lamina)
  • epithelial component may resemble ameloblastoma (follicular or plexiform)
24
Q

What is the treatment and prognosis of ameloblastic fibroma?

A
  • TREATMENT: aggressive curettage

- PROGNOSIS: good; low recurrence (0-18%); rare malignant transformation

25
Q

What is an odontogenic tumor with features of ameloblastic fibroma as well as odontoma?

A

ameloblastic fibro-odontoma

26
Q

What age is usually affected by ameloblastic fibro-odontoma? Mandible or maxilla?

A
  • children, average age 10

- mandible = maxilla

27
Q

What are the signs and symptoms of ameloblastic fibro-odontoma?

A
  • asymptomatic swelling with large lesions
  • often associated with impacted tooth (failed tooth eruption)
  • well-circumscribed unilocular or multilocular radiolucency
  • variable amount of calcified materail
28
Q

Describe the histology of ameloblastic fibro-odontoma.

A

odontoma areas together with ameloblastic fibroma
(relative amounts of each type of tissue vary from lesion to lesion)

*note: developing odontoma may be confused with this lesion

29
Q

What is the treatment and prognosis of ameloblastic fibro-odontoma?

A
  • TREATMENT: conservative curettage

- PROGNOSIS: excellent; recurrence is unusual

30
Q

What is also known as an odontogenic hamartoma?

A

odontoma

31
Q

What age is most common for an odontoma? Maxilla or mandible?

A
  • first 2 decades of life, average age 14

- maxilla > mandible

32
Q

What is the difference between a compound odontoma and a complex odontoma?

A
  • COMPOUND: anterior maxilla; collection of small malformed teeth surrounded by radiolucent rim often overlying impacted tooth
  • COMPLEX: posterior maxilla or mandible; calcified mass that is the density of tooth structure and contains mixture of dentin, enamel matrix, cementum, odontogenic epithelium, and dental papilla, surrounded by radiolucent rim and overlying impacted tooth
33
Q

What is the treatment and prognosis of an odontoma?

A
  • TREATMENT: enucleation

- PROGNOSIS: excellent

34
Q

What is a benign neoplasm assumed to be of odontogenic origin because the jaw bones are the only skeletal bone affected?

A

odontogenic myxoma

35
Q

What age is most affected by odontogenic myxoma? Mandible or maxilla?

A
  • young adults, average age 25-30 years

- mandible > maxilla

36
Q

What are the signs and symptoms of odontogenic myxoma?

A
  • asymptomatic expansion of the bone in larger lesions
  • unilocular when small, multilocular when large
  • “soap bubble” appearance
37
Q

Describe the histology of odontogenic myxoma.

A
  • spindle-shaped or stellate-shaped fibroblastic cells in a myxoid background
  • lesional proliferation tends to infiltrate the adjacent bony trabeculae
38
Q

What is the recommended treatment and prognosis of odontogenic myxoma?

A
  • TREATMENT: small lesions = curettage, large lesions = en bloc or segmental resection (depending on size and site)
  • PROGNOSIS: good, 25% recur
39
Q

What is the most common age for cementoblastoma? Gender? What area of the oral cavity?

A
  • 25 years of age
  • no gender preference
  • mandiblular molar (especially 1st molar)
40
Q

What are the signs and symptoms of cementoblastoma?

A
  • slow-growing, may produce expansion or pain
  • well-circumscribed radiopaque mass with fine radiolucent border
  • fused to resorbed root of a tooth, usually mandibular first molar
41
Q

Describe the histology of cementoblastoma.

A
  • trabeculae that resembles cementum

- trabeculae rimmed by plump angular cells (neoplastic cementoblasts)

42
Q

What are some differential diagnoses for cementoblastoma?

A
  • osteoblastoma

- osteosarcoma

43
Q

What is the recommended treatment and prognosis of cementoblastoma?

A
  • TREATMENT: surgical extraction of involved tooth and enucleation of lesion OR endo treat the tooth followed by root amputation and removal of lesion with involved root
  • PROGNOSIS: excellent

*AU15 - Oral Pathology Exam 3 (3 decks)

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