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Oral Disease > Odontogenic Neoplasms and 'Tumours' > Flashcards

Odontogenic Neoplasms and 'Tumours' Flashcards

Aim: To provide an overview of odontogenic tumours Objectives: At the end of this lecture you should: - Know how odontogenic tumours are classified - Be aware of the range of odontogenic tumours - Know the basic pathology of the most common lesions - Be aware of how odontogenic tumours present - Be aware of malignant odontogenic tumours.

1
Q

How can Odontogenic Neoplasms be classified? What types of Neoplasms go in each category? (1+3, 1+1)

A

Benign:

  • Odontogenic epithelium alone
  • Odontogenic epithelium and odontogenic mesenchyme +/- dental hard tissues
  • Odontogenic mesenchyme alone Malignant:
  • Carcinomas and Sarcomas
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2
Q

What are common clinical presentations of Odontogenic Tumours? (3)

A
  • Present as radiolucent lesions
  • Some may contain calcifications
  • Most often at angle of mandible
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3
Q

List the odontogenic epithelium tissues (5)

A
  • Oral epithelium
  • Dental lamina
  • Enamel organ
  • Reduced enamel epithelium
  • Rests of Malassez
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4
Q

List the odontogenic mesenchyme tissues (3)

A
  • Dental papilla
  • Dental follicle
  • Periodontal ligament
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5
Q

Where do the remnants of Odontogenic Epithelium come from in Radicular Cysts? (1)

A

Hertwigs root sheath

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6
Q

Where do the remnants of Odontogenic Epithelium come from in Dentigerous Cysts? (1)

A

Reduced enamel epithelium

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7
Q

Where do the remnants of Odontogenic Epithelium come from in ameloblastomas, ameloblastic fibroma, CEOT, keratocysts and gingival cysts? (1)

A

Dental lamina

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8
Q

What is the dental lamina? (3)

A
  • First evidence of tooth development in humans occurs at 6weeks of fetal life
  • Proliferation of a horseshoe-shaped epithelial ridge from the basal layer of the primitive oral epithelium into the underlying mesoderm in the position of the future jaws; known as the dental lamina
  • The dental lamina proliferates backwards in each arch, successively giving rise to the enamel organs of the future second deciduous molar and the three permanent molars
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9
Q

What is the epidemiology of odontogenic tumours? (4)

A
  • Odontogenic neoplasms are rare
  • Less than 1% of all oral tumours
  • Ameloblastoma is most common neoplasm
  • Odontomes are not neoplasms
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10
Q

What are the percentage prevalence’s of Ameloblastoma, Myxoma/myxofibroma, Calcifying odontogenic cyst (COC), Adenomatoid odontogenic tumour (AOT), Ameloblastic fibroma, Calcifing epithelial odontogenic tumour (CEOT), Squamous odontogenic tumour (SOT), Odontomes? What types of odontogenic tumours are they all? (15)

A

Ameloblastoma, 15% - Odontogenic epithelium alone (E)
Myxoma/myxofibroma, 10% Odontogenic mesenchyme alone (M)
Calcifying odontogenic cyst (COC), 4% Odontogenic epithelium and Odontogenic mesenchyme +/- dental hard tissue (E+M)
Adenomatoid odontogenic tumour (AOT), 3% Odontogenic epithelium alone (E)
Ameloblastic fibroma 2% Odontogenic epithelium and Odontogenic mesenchyme +/- dental hard tissue (E+M)
Calcifing epithelial odontogenic tumour (CEOT) 1.5% Odontogenic epithelium alone (E)
Squamous odontogenic tumour (SOT) 0.5% Odontogenic epithelium alone (E)

Odontomes 50%

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11
Q

List the Group 1: Odontogenic Epithelium alone – Odontogenic tumours (5)

A
  • Ameloblastoma
  • Adenomatoid odontogenic tumour (AOT)
  • Calcifying epithelial odontogenic tumour (CEOT)
  • Squamous odontogenic tumour (SOT)
  • Clear cell odontogenic tumour
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12
Q

List the Group 2: Odontogenic epithelium and Odontogenic mesenchyme +/- dental hard tissue – odontogenic tumours (4)

A
  • Calcifying odontogenic cyst (COC)
  • Ameloblastic fibroma
  • Ameloblastic fibro-odontome
  • Odontomes – covered in an earlier lecture
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13
Q

List the Group 3: Odontogenic mesenchyme alone – odontogenic tumours (3)

A
  • Myxoma/fibromyxoma
  • Odontogenic Fibroma
  • Cementoblastoma
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14
Q

List the prevalence and names of malignant odontogenic tumours (1,1+4,1)

A
  • Very rare
  • Odontogenic carcinomas
  • Malignant ameloblastoma
  • Primary intraosseous carcinoma
  • Clear cell odontogenic carcinoma
  • Malignant variants of other tumours/cysts
  • Odontogenic sarcomas
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15
Q

What is the epidemiology of an Ameloblastoma? (2)

A
  • Age: 30 - 50

- 80% in mandible, most at the angle

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16
Q

Describe an Ameloblastoma clinically (5)

A
  • Benign but locally invasive
  • Often asymptomatic
  • Bucco-lingual expansion
  • Root resorption
  • Uni- or multi-locular radiolucency
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17
Q

What are the Ameloblastoma subtypes and what are their percentage prevalences? (1+2, 2)

A
  • Solid/multicystic: intra-osseous 85%
  • Follicular
  • Plexiform
  • Unicystic: intra-osseous 14%
  • Peripheral: extra-osseous 1%
18
Q

Describe the histology of the follicular subtype of Ameloblastoma (2)

A
  • The epithelium resembles the enamel organ

- Cysts form in stellate reticulum

19
Q

Describe the histology of the plexiform subtype of Ameloblastoma (1)

A

Cysts form in stroma

20
Q

What are the three subtypes of Unicystic Ameloblastomas (3)

A
  1. Simple cyst ‘lumenal’
  2. Plexiform unicystic ‘intralumenal’
  3. Mural ameloblastoma
21
Q

What are the prognoses and treatment for the different unicystic ameloblastomas? (2)

A
  • 1 & 2: good prognosis and require enucleation only

- 3: behaves as a conventional ameloblastoma and must be managed accordingly

22
Q

Describe the epidemiology of an Adenomatoid Odontogenic Tumour (2)

A
  • Age: 10-20

- Often in maxilla

23
Q

Describe the Adenomatoid Odonotgenic Tumour clinically (2)

A
  • Benign, does not recur, probably a hamartoma

- Radiolucency often around a tooth crown, may have calcifications

24
Q

What is the histology of an Adenomatoid Odonotgenic Tumour? (2)

A
  • Epithelial cells forming sheets and duct-like structures

- Calcification common

25
Q

What is the epidemiology of Calcifying Epithelial Odontogenic Tumour (‘Pindborg’s tumour’)? (2)

A
  • Age: 10-60

- 2/3 in mandible, molar region +/- u/e tooth

26
Q

Describe Calcifying Epithelial Odontogenic Tumour (‘Pindborg’s tumour’) clinically (2)

A
  • Benign but locally invasive

- Radiolucency with speckled calcifications

27
Q

Describe the histology of Calcifying Epithelial Odontogenic Tumour (‘Pindborg’s tumour’) (1)

A

Composed of ‘pleomorphic’ epithelium with calcifications, ‘dentinoid’ and amyloid

28
Q

What is the clinical and genetic evidence to suggest that the odontogenic keratocyst in a tumour? What was its new suggested name? (1+2, 1+2, 1)

A
  • Clinical evidence
  • Pattern of recurrence
  • Link to Basal Cell Carcinomas (Gorlin-Goltz)
  • Genetic evidence
  • PTCH mutations (9q22-31)
  • Clonality?
  • Keratocystic odontogenic tumour (KCOT) WHO 2005
29
Q

What is the epidemiology of a Calcifying odontogenic cyst (COC)? (2)

A
  • Age: 10-30

- Mandible or maxilla

30
Q

Describe the Calcifying odontogenic cyst (COC) clinically

A
  • Benign

- Radiolucency, may have calcifications

31
Q

What is the histology of the Calcifying odontogenic cyst (COC)?

A
  • Cyst lined by ameloblastoma-like epithelium with ghost cells and dentine in the wall
  • May be solid – ‘odontogenic ghost cell tumour’
32
Q

What is the epidemiology of the Ameloblastic Fibroma? (2)

A
  • Age: < 20

- Often in mandible

33
Q

Describe the Ameloblastic Fibroma (2)

A
  • Benign

- Well defined radiolucency

34
Q

Describe the histology of the Ameloblastic Fibroma (2)

A
  • Branching cords and islands of epithelium resembling enamel organ or dental lamina
  • Characteristic fine cellular stroma
35
Q

Describe Odontomes (4)

A
  • Hamartomas: benign malformations
  • Age: up to 20 (developing dentition)
  • May be mandible or maxilla
  • Radiolucency containing tooth-like structures
36
Q

Describe Compound Odontomes include prevalence and epidemiology (5)

A
  • Twice as common as complex odontome
  • Maxilla > Mandible
  • Incisor / Canine regions
  • Small and non-aggressive
  • A collection of ‘denticles’ (mini-teeth)
37
Q

Describe Compound Odontomes include prevalence and epidemiology (5)

A
  • Mandible > Maxilla
  • Premolar / Molar regions
  • 10 – 25 year age group
  • Often a missing tooth in the arch
  • A fused mass of haphazardly arranged tooth tissues but normal morphogenetic relations are preserved
38
Q

Describe Myxoma/fibromyxoma (5)

A
  • Benign but locally invasive
  • Epidemiology: 10 – 30 years
  • Clinically slow growing painless swelling
  • Uni- or multi-locular radiolucency
  • “soap-bubble” appearance
39
Q

Describe the epidemiology of the Cementoblastoma (2)

A
  • Age: 10-40

- Usually mandible, affecting molar teeth

40
Q

Describe the Cementoblastoma clinically (1)

A

Radiopaque lesion attached to tooth root

41
Q

Describe the histology of the Cementoblastoma (2)

A
  • Sheets of cementum and osteoid in a mosaic pattern; many plump cementoblasts
  • Resembles osteoblastoma

Oral Disease (9 decks)

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