Odontogenic Tumors

Question 1

Not true neoplasms =

Answer 1

reactive hyperplastic rxns of

connective tissue to

chronic injruy or irriation

reactive proliferations

Question 2

reactive proliferations

Answer 2

1. sef limiting growth of
   - fibroblastic tissue or
   - mix of fibrous AND vascular tissue

from chronic irritation: cheek biting, ill fitting dentures, etc.

Question 3

true benign neoplasms

Answer 3

conn tissue arise from:

fibroblast

endothelia

skeletal msucle

smooth muscle

lipcytes

Question 4

harmatomas

Answer 4

odontogenic tumor like malformations

Question 5

waht are the 3 categories of odonotgenic tumors?

[hint: origin of the tumor]

Answer 5

1. tumors of odontogenic epithelium - only odon epithelium
2. mixed odontogenic tumors:
   - odon epithelium AND ectomesenchyme

• may have dental hard tissues
  3. tumors of odontogenic ectomesenchyme:
• MOSTLY odon ectomesenchyme
• may have odon epithelium

Question 6

waht are the 5 tumor of odonotgenic epithelium

Answer 6

1. ameloblastoma [4 subtypes]
2. clear cell odontogenic carcinoma
3. adenomatoid odontogenic tumor
4. calcifying epithelial odontogenic tumor
5. squamous odontogenic tumor

Question 7

what are the 4 subtypes of ameloblastoma that are also included as a tumor of odontogenic epithelium

Answer 7

1. conventional solid = multicystic ameloblastoma
2. unicystic ameloblastoma
3. peripheral ameloblastoma = extraosseous ameloblastoma
4. malignant ameloblastoma = ameloblastic carcinoma

Question 8

what is the most common CLINICAL significant odontogenic tumor?

Answer 8

ameloblastoma

Question 9

Theoretically ameloblastoma can arise from 4 things:

Answer 9

1. rests of dental lamina
2. developing enamel organ
3. epithelial lining of odontogenic cyst
4. basal cells of the oral mucosa

Question 10

ameloblastoma:

____ growing, _____ invasive, benign or malignant?

Answer 10

slow growing

locally invasive

benign

Question 11

3 clinico radiographic situations w/

different prognosis and therapies

Answer 11

1. conventional solid = multicystic ameloblastoma
2. unicystic ameloblastoma
3. peripheral ameloblastoma = extraosseous ameloblastoma

Question 12

of the 3 clinicoradiographic situations which is the most -> least common

Answer 12

conventional solid [86%]

unicystic [13%]

extraosseous [1%]

Question 13

1) Assymptomatic, painless, small swelling/lesion
2) detected upon radiographic exam
3) jaw expansion:
- 85% mandible [molar and ascending region]
- 15% maxilla [posterior region]
4) rarely 10 yo >

commonly 10 - 19 yo

5) if left untreated may be massive
6) paresthesia and pain is UNCOMMON [even with large tumors]

Answer 13

conventional solid

multicystic ameloblastoma

Question 14

multilocular radioleucent lesion

soap bubbly when large

**honeycombed ** when small

B - L cortical expansion is freq

commonly root resorption of teeth adj to tumor

Answer 14

conventional ameloblastoma

multicystic ameloblastoma

Question 15

Hx: follicular pattern

most common recognizable pattern for ameloblastoma, 4 things

Answer 15

1. multiple islands of odontogenic epithelium

in mature fibrous CT stroma

2. core resemblems
   - STELLATE RETICULUM of enamel organ
   - exhibits foci of cystic degeneration
3. peripheral columnar cells with

reverse polarity in nuclei

Question 16

multicystic ameloblastoma can

exhibit _____ pattern and ___ common

Answer 16

plexiform pattern

less common

Question 17

tx of multicystic ameloblastoma

Answer 17

1. curretage
2. simple enucleation
3. en bloc resection
4. marginal resection

Question 18

of the 4 which is the mostly widely used treatmetn and ___% reoccurance

Answer 18

marginal resection

15% reoccurence

Question 19

waht is the most optimal tx of ameloblastoma

Answer 19

controversial and is conventional to:

infiltrate bt the intact cancellous bone trabeculae

at the periphery of the lesion

**before **bone resorption bc radiographic evident

Question 20

__ leaves islands of tumor within bone

later __% reoccurence

Answer 20

curretage

50 - 90% reoccurence

Question 21

removal of tumor followed by

____ ___

reduces need for extensive reconstructive surgery

Answer 21

peripeheral ostectomy

Question 22

marginal resction should be

**at least ** ____ to ____ PAST radiographic limits of tumor

Answer 22

1.0 - 1.5 com **past radiographic limits of tumor **

Question 23

___ _____ ____ particular dangerous bc of

difficulty obtaining ___ ___

Answer 23

ameloblastomas of posterior maxilla

dangerous

for good surgical margin

Question 24

1. localized ameloblastoma in young patient
2. less aggressive
3. circumscribed radioleuncy may or may not around unerupted crown
4. DDx: dentigerous cyst, radicular cyst, and residual cyst
5. surgical finding may think this lesion is a cyst but upon microscopic evaluation is actually this

Answer 24

unicystic ameloblastoma

Question 25

unilocular cystic lesion that may Hx be presented in 3 ways

Answer 25

unicystic ameloblastoma luminal intraluminal = plexiform mural

Question 26

what other ameloblastoma that can be present in plexiform but less common?

Answer 26

multicystic ameloblastoma unicystic ameloblastoma

Question 27

luminal Hx of unicystic ameloblastoma

Answer 27

tumor confined to the luminal surface of the cystic wall 1. fibrous cyst wall 2. hyperchromatic nuclei 3. polarized basal layer 4. overlying epithelium: - loosely cohesive - resemblems stellate reticulum

Question 28

stellate reticulum

Answer 28

core resembles stellate reticulm and foci cystic degeneration = multicystic ameloblastoma overlying epithelium resembles stellate reticulum = unicystic ameloblastoma

Question 29

intraluminal = plexiform Hx of unicystic ameloblastoma

Answer 29

1 or 1+ nodules of ameloblastic that project from cystic lining to the lumen of the cyst - nodules may present with edematous plexiform pattern - may be 2ndary to inflamm always accompanies this pattern

Question 30

mural Hx of unicystic ameloblastoma

Answer 30

fibrous wall of cyst infiltrated by typical follicular or plexiform ameloblastoma

Question 31

tx of unicystic ameloblastoma

Answer 31

individualized but, if its intraluminal can do conservative surgical curretage

Question 32

\_\_\_\_ is uncommon and accounts for 1 - 10% of ameloblastomas

Answer 32

peripheral ameloblastoma aka extraosseous ameloblastoma

Question 33

TF malignant ameloblastoma ameloblastic carcinoma rarely metastasize \<1%

Answer 33

true

Question 34

tumor that shows histopathologic features of ameloblastoma in: - primary tumor - metastatic deposits

Answer 34

malignant ameloblastoma

Question 35

ameloblastoma w/ cytological features of malignancy in: - primary tumor - metastatic deposits

Answer 35

ameloblastic carcinoma

Question 36

1. both primary tumor and metastasis look like **regular ameloblastoma** 2. generally, the primary and metastasis both have **features of ameloblastoma, but also features of ** **malignancy.**

Answer 36

Malignant ameloblastoma ameloblastic carcinoma

Question 37

Young teens, not common to 30+ yo 2x females \> males tendency affects **anterior jaws** 2x maxilla \> mandible

Answer 37

adenomatoid odontogenic tumor

Question 38

75% circumsribed unilocular radioleuncy involes the **crown of unerupted tooth **

Answer 38

adenomatoid odontogenic tumor

Question 39

which tooth does this circumscribed, unilocular, radioleuncy around the crown of the unerupted tooth mostly affect?

Answer 39

k9

Question 40

radiographically IMPOSSIBLE to differentiate adenomatoid odontogenic tumor and dentigerous cyst BUT can by?

Answer 40

completely radioleucent lesion with **fine "snowflake calcifications" **so that is adenomatoid odontogenic tumor

Question 41

Hx of adenomatoid odontogenic tumr

Answer 41

1. thick fibrous capsule 2. duct - like epithelial sturctures: - central spaces surrounded by columnar and cuboidal cells - columnar cells w/ polarized nuclei away from central space

Question 42

tx for adenomatoid odontogenic tumor

Answer 42

benign thick firbous capsule makes enucleation away from bone easy does not reoccur

Question 43

calcifying epithelial odontogenic tumor aka \_\_\_\_

Answer 43

pindborg tumor

Question 44

-DD: dentigerous cyst – ______ and \_\_\_\_\_\_ – but both AOT and DC are UNILOCULAR radiolucency involving an unerupted tooth!

Answer 44

no calcifications and respect the CEJ rule

Question 45

uncommon, \<1% odontogenic tumor, **impacted tooth, posterior mandible, mostly men ** **amyloid accumulation d**etected by Congo red **sclerotic border with fleks of opacity** seen radiographically can be unilocular, multilocular, scalloped well defined, ill defined, cortical concentric **lisegang ring calcifications **

Answer 45

CEOT calcifying epithleial odontogenic tumor

Question 46

what are the 3 mixed odontogenic tumors

Answer 46

ameloblastic fibroma ameloblastic fibro-odontoma odontoma

Question 47

young, posterior mandible, islands of ameloblastic epithelium peripherally palisaded nuclei surrounded by fibromyxomatous CT . Well circumscribed and **not aggressive,** sclerotic borders. may or may not have capsule.

Answer 47

amelobastic fibroma

Question 48

posterior mandible and sclerotic borders

Answer 48

Calcifying eptihelial odontogenic tumor ameloblastic fibroma

Question 49

unerupted tooth follicle

Answer 49

adenomatoid odontogenic tumor calcifying epithelial odontogenic tumor ameloblastic fibroma

Question 50

**true mixed odontogenic tumor **

Answer 50

ameloblastic fibroma

Question 51

TF ## Footnote some lesions that were diagnosed as ameloblastic fibroma may actually have represented the early developing stage of an odontoma.

Answer 51

true

Question 52

for DD, differences bt ameloblastoma vs. ameloblastic fibroma how do you differentiate the two?

Answer 52

**ameloblastoma:** more stellate reticulum in the center -laerger islands of ameloblastic epithelium **ameloblastic fibroma: **MORE CT surrounding the islands XRAY TO DIFFERENTIATE

Question 53

TF ameloblastic fibroma ## Footnote 1. younger patients; most lesions are diagnosed in the first **two decades of life.** 2. Radiographically, either a unilocular or multilocular radiolucent lesion

Answer 53

true true

Question 54

waht is amelobastic fibro-odontoma

Answer 54

features of ameloblastic fibroma contains: **enamel and dentin**

Question 55

**what 2 mixed odontogenic tumors have this?** -Radiographically, either a unilocular or multilocular radiolucent lesion is seen, with the smaller lesions tending to be unilocular -Some investigators believe that the ameloblastic fibro- odontoma is only a **stage** in the **development of an ** **odontoma** and do not consider it to be a separate entity.

Answer 55

ameloblastic fibroma ameloblastic fibro-odontoma

Question 56

TF 1. ameloblastic fibroma plus an odontoma. = ameloblastic fibro-odontoma 2. soft tissue component of tumor is indishinguishable from amelobastic fibroma vs. amelobalastic fibro-odontoma

Answer 56

true true

Question 57

most common type of odontogenic tumor

Answer 57

odontoma

Question 58

TF odontoma prevalence exceeds that of all other odontogenic tumors combined.

Answer 58

true

Question 59

Odontomas are considered to be developmental anomalies \_\_\_\_\_\_ rather than \_\_\_\_\_\_\_

Answer 59

hamartomas true neoplasms.

Question 60

odontomas is divided into:

Answer 60

compound odontoma complex odontoma

Question 61

compound odontoma

Answer 61

1. multiple, small single rooted ,toothlike structures, loose fibrous matrix 2. more often seen in the **anterior maxilla** 3. radiographically: collection of toothlike structures of varying size and shape **surrounded** by a **narrow radiolucent zone**

Question 62

complex odontoma

Answer 62

1. **conglomerate mass** of enamel and dentin, NO anatomic resemblance to a tooth. 2. molar regions of either jaw. 3. **calcified mass** with the **radiodensity of tooth structure,** which is also surrounded by a **narrow radiolucent rim.** **4. **mixed-up aggregates of dental hard and soft tissue without significant recognizable tooth-like formations.

Question 63

TF odontoma ## Footnote odontoma will develop completely within the gingival soft tissues

Answer 63

true

Question 64

\_\_\_ causes delayed eruption more than -\_\_\_\_

Answer 64

compound more delayed eruption than complex