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Oral Pathology > Odontogenic Neoplasms > Flashcards

Odontogenic Neoplasms Flashcards

1
Q

What are the three tumors of odontogenic epithelium?

A
  1. ameloblastoma - peripheral ameloblastoma
  2. adenomatoid odontogenic tumor
  3. calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor)
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2
Q

What are three mixed odontogenic tumors?

A
  1. ameloblastic fibroma
  2. ameloblastic fibro-odontoma
  3. Odontoma
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3
Q

What are two tumors of odontogenic ectomesenchyme?

A
  1. odontogenic myxoma

2. cementoblastoma

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4
Q

Ameloblastoma is a ___ but locally aggressive neoplasm of odontogenic epithelial origin that histologically resembles the ameloblasts of the ___ ___, but no ___ is produced by lesional cells.

A

benign; enamel organ; enamel

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5
Q

T/F. The frequency of ameloblastoma equals the combined frequency of all other odontogenic tumors.

A

True.

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6
Q

Even tho ameloblastoma is among the more common of the odontogenic neoplasms, it still constitutes only about ___ % of oral pathology accessions.

A

0.2%

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7
Q

T/F. Ameloblastoma is commonly seen in women around the age of 20.

A

False, ameloblastoma has NO SEX predilection and is diagnosed around 33 years of age.

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8
Q

Most ameloblastomas occur in the ___ usually in the ___-___ region and about ___% are associated with an ___ tooth.

A

mandible; molar-ramus; 20%; impacted

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9
Q

T/F. Ameloblastomas are fast-growing lesions that destroy tissue by perforating bone.

A

False, Ameloblastomas are SLOW growing lesions that destroy tissue by expanding (very dramatically) rather than perforating bone.

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10
Q

T/F. Typically ameloblastomas are asymptomatic except for swelling.

A

True.

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11
Q

T/F. Ameloblastomas are small lesions that present as unilocular radiolucencies with well-defined, sclerotic borders.

A

False, Ameloblastomas are small lesions that present as unilocular radiolucencies with well-defined, but NOT sclerotic borders.

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12
Q

As ameloblastomas progress, the classic multilocular, expansile radiolucency develops, known as “___ ___” or “___”. They may displace teeth and/or resorb roots

A

soap bubble; honeycomb

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13
Q

What are the most often seen forms of ameloblastoma?

A

follicular and plexiform

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14
Q

Ameloblastomas have small tumor ___ and show a single layer of tall ___ or ___ cells at their periphery with ___ ___. What does this mean?

A

islands; reverse polarization

the nuclei are polarized away from the basement membrane

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15
Q

What is found in the center of an ameloblastoma’s tumor islands?

A

loosely arranged polyhedral epithelial cells that resemble stellate reticulum

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16
Q

How is ameloblastoma treated?

A

depends on size

small: aggressive curettage or small en bloc resection
large: en bloc resection or segmental resection with reconstruction

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17
Q

___ ameloblastomas are treated more aggressively due to their anatomic location near the sinus.

A

Maxillary

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18
Q

Prognosis of ameloblastoma is guarded because with simple curettage, recurrence is reported to be ___-___%. Even with marginal resection, recurrence rates up to ___% have been reported.

A

55-90%; 15%

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19
Q

T/F. Ameloblastomas can be fatal, especially with lesions in the maxilla. Malignant transformation is rare and ameloblastoma requires follow-up for 8-10 years.

A

Both statements are true.

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20
Q

What is a soft tissue variant of ameloblastoma that has no or limited bone involvement, no radiographic findings, is asymptomatic and presents as a gingival mass in middle-aged adults, usually in the mandible?

A

peripheral ameloblastoma

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21
Q

Peripheral ameloblastoma looks like many gingival ___, is less than ___cm in diameter and can be cured with ___. It has little tendency to recur.

A

bumps; 2; biopsy

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22
Q

What disease is a asymptomatic swelling discovered incidentally whose histogenesis is enamel organ or dental lamina rests?

A

Adenomatoid Odontogenic Tumor

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23
Q

T/F. AOT is seen in the mandible of male patients over 20

A

False, AOT is seen in the MAXILLA of FEMALE patients UNDER 20

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24
Q

What percentage of AOTs are found in the anterior jaws? What percentage of AOTs are associated with an impacted tooth?

A

75%

75%

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25
Q

AOTs are well-circumscribed (capsule) unilocular radiolucencies that may contain radiopaque ___. Separation of the roots or displacement of adjacent teeth occurs ___ (rarely/frequently). Percoronal lucency may extend apically beyond the ___.

A

flecks; frequently; CEJ

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26
Q

T/F. AOTs have a well-developed capsule.

A

True

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27
Q

AOT cells form swirling spindle-cell nests that contain duct-like structures of varying sizes known as ___.

A

adenomatoid

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28
Q

T/F. In addition to adenomatoid, foci of basophilic calcified material may be seen with AOTs.

A

True

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29
Q

How are AOTs treated and what is the prognosis and recurrence rate?

A

tx: enucleation
prognosis: excellent
recurrence: very rare

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30
Q

What is a rare odontogenic epithelial neoplasm that was initially described by Pindborg in 1956 and probably confused with ameloblastoma prior to that time?

A

CEOT (Pindborg Tumor)

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31
Q

What is the histogenesis of CEOT?

A

stratum intermedium

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32
Q

What is the mean age of diagnosis and sex predilection of CEOT?

A

40 years with no sex predilection

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33
Q

What is the predominance of the mandible compared to the maxilla in CEOT? What segment predominates?

A

2:1

posterior

34
Q

T/F. In CEOT, if symptoms are present they usually consist only of swelling in the area.

A

True.

35
Q

T/F. Unlike AOT, CEOT is not associated with an impacted tooth.

A

False, CEOT is often associated with an impacted tooth

36
Q

CEOT is a well-circumscribed radiolucency when small that becomes ___ when it enlarges. Radiopaque ___ may or may not be seen. The ___ are usually well-defined but can be ill-defined.

A

multilocular; flecks; margins

37
Q

CEOT has proliferation of ___ epithelial cells with eosinophilic cytoplasm. The nuclei are frequently ___ but mitosis is rarely observed.

A

polyhedral; pleomorphic

38
Q

How do eosinophilic, homogeneous materials associated with epithelial cells of CEOT stain?

A

amyloid

39
Q

In CEOT, calcifications may develop in the ___ material, forming lamellated structures called ___ ___.

A

amyloid; Liesegang rings

40
Q

T/F. CEOT is treated with radical surgery due to its high recurrence rate.

A

False, Conservative excision is done. The recurrence rate is 15% so radical surgery is not warranted

41
Q

What is the odontogenic origin of ameloblastic fibroma?

A

Mixed odontogenic origin of epithelial and ectomesenchymal tissues

42
Q

T/F. Both tissues of ameloblastic fibroma are neoplastic.

A

True.

43
Q

Ameloblastic fibromas have proliferating odontogenic epithelium in a cellular ectomesenchyme resembling the ___ ___.

A

dental papilla

44
Q

Ameloblastic fibromas are found in younger patients during the first ___ decades of life and in the ___ mandible in ___% of cases.

A

two; posterior; 70

45
Q

Small ameloblastic fibroma lesions are ____ (symptomatic/asymptomatic), while larger ones produce ___ swelling.

A

asymptomatic; painless

46
Q

T/F. When small, ameloblastic fibromas are unilocular and tend to become multilocular when large. The margins can be either well-defined or sclerotic.

A

Both statements are true.

47
Q

Ameloblastic fibromas have ___ connective tissue that resembles dental ___ that contains strands and islands of odontogenic epithelium that resembles dental ___.

A

myxoid; papilla; lamina

48
Q

T/F. Sometimes the epithelial islands of an ameloblatic fibroma are large enough to vaguely resemble ameloblastoma.

A

True.

49
Q

What is the treatment and the prognosis and recurrence rate of ameloblastic fibroma? Does it become malignant?

A

tx: aggressive curettage
prognosis: good
recurrence rate: low (15%)
rare malignant transformation

50
Q

What disease is an odontogenic tumor with features of ameloblastic fibroma admixed with an odontoma?

A

Ameloblastic Fibro-Odontoma

51
Q

When is Ameloblastic Fibro-Odontoma usually diagnosed?

A

in children, average age of 10 yrs

52
Q

When is Ameloblastic Fibro-Odontoma symptomatic?

A

when there is failure of tooth eruption is noted or swelling is observed with large lesions.

53
Q

T/F. Ameloblastic Fibro-Odontoma occurs more frequently in the mandible. It often overlies an impacted tooth.

A

1st statement is false, 2nd is true

Ameloblastic Fibro-Odontoma occurs equally in mandible and maxilla

54
Q

Ameloblastic Fibro-Odontoma is a well-circumscribed, unilocular or multilocular radiolucency with varying amounts of calcified material having the density of ___ ___.

A

tooth structure.

55
Q

What type of Odontoma is usually associated with Ameloblastic Fibro-Odontoma?

A

complex odontoma

56
Q

What is the treatment and the prognosis and recurrence rate of Ameloblastic Fibro-Odontoma?

A

tx: conservative curettage
prognosis: excellent
recurrence: unusual

57
Q

T/F. Odontoma is a true neoplasm.

A

False, it is probably not a true neoplasm, but rather an odontogenic hamartoma

58
Q

What and where are the two forms of an Odontoma?

A

compound - anterior jaw

complex - posterior jaw

59
Q

Odontoma ar most detected during the first ___ decades of life with a mean age of ___ years.

A

two; 14

60
Q

Odontomas are associated with an ___ tooth and it is slightly more frequent in the ___.

A

unerupted; maxilla

61
Q

Describe a compound odontoma.

A

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

62
Q

Describe a complex odontoma.

A

A calcified mass, that, if fully formed, has the density of tooth structure. It is also surrounded by a narrow radiolucent rim, typically overlying an impacted tooth.

63
Q

The complex odontoma shows a admixture of what?

A

dentin, enamel matrix, cementum, odontogenic epithelium and dental papilla

64
Q

How is an odontoma treated and what is its prognosis?

A

tx: enucleation
prognosis: excellent

65
Q

An odontogenic myxoma is considered a ___ neoplasm of odontogenic origin because it only affects the ___ bones as a central lesion - no other bones.

A

benign; jaw

66
Q

Odontogenic myxoma affects ___ adults (average age ___-___ years), but it is seen over a wide age range.

A

young; 25-30

67
Q

What jaw is more affected in odontogenic myxoma?

A

mandible

68
Q

T/F. Larger odontogenic myxoma lesions are symptomatic with expansion of the bone.

A

False, they are asymptomatic with expansion of the bone

69
Q

When small, odontogenic myxomas are ___ and ___ when large. They may have a “___ ___” appearance and can displace and resorb ___.

A

unilocular; multilocular; soap bubble; roots

70
Q

Odontogenic myxomas have thin, ___ trabeculae of residual bone often at ___ ___.

A

wispy; right angles

71
Q

Odontogenic myxomas have ___-shaped or ___-shaped fibroblastic cells set in a ___ background.

A

spindle; stellate; myxoid

72
Q

The lesion proliferation seen in odontogenic myxoma tends to infiltrate the adjacent bony trabeculae and this contributes to what?

A

recurrence rate, especially if only treated with curettage

73
Q

How are small and large lesions of odontogenic myxomas treated?

A

small - curettage

large - en bloc or segmental resection, depending of the size and site.

74
Q

What is the prognosis and recurrence rate of odontogenic myxomas?

A

prognosis: good

recurrence rate: up to 25%

75
Q

What disease has very pathognomonic radiographic features?

A

cementoblastoma

76
Q

Cemetoblastoma is a well-circumscribe radiopaque ___ with a fine radiolucent border. It is ___ to the resorbed root of a tooth usually a ___ ___ ___, usually obscures the outline of the root.

A

mass; fuses; mandibular first molar

77
Q

Cementoblastomas have trabeculae of mineralized material that resembles ___ and are rimmed by plump, ___ cells that represent neoplatic ___.

A

cementum; angular; cemntoblasts

78
Q

What are two differential diagnoses for cementoblastoma?

How is the cementoblastomas distinguishing feature?

A

osteoblastoma, osteosarcoma

fused to root

79
Q

How is cementoblastoma treated?

A

surgical extraction of the involved tooth with enucleation of the lesion OR the tooth can be endodontically treated and the lesion enucleated along with amputation of the involved root

80
Q

What is the prognosis of cementoblastoma?

A

excellent

Oral Pathology (5 decks)

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