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opath 5 > Odontogenic Tumors > Flashcards

Odontogenic Tumors Flashcards

1
Q

Not true neoplasms =

A

reactive hyperplastic rxns of

connective tissue to

chronic injruy or irriation

reactive proliferations

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2
Q

reactive proliferations

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

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

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3
Q

true benign neoplasms

A

conn tissue arise from:

fibroblast

endothelia

skeletal msucle

smooth muscle

lipcytes

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4
Q

harmatomas

A

odontogenic tumor like malformations

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5
Q

waht are the 3 categories of odonotgenic tumors?

[hint: origin of the tumor]

A
  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
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6
Q

waht are the 5 tumor of odonotgenic epithelium

A
  1. ameloblastoma [4 subtypes]
  2. clear cell odontogenic carcinoma
  3. adenomatoid odontogenic tumor
  4. calcifying epithelial odontogenic tumor
  5. squamous odontogenic tumor
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7
Q

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

A
  1. conventional solid = multicystic ameloblastoma
  2. unicystic ameloblastoma
  3. peripheral ameloblastoma = extraosseous ameloblastoma
  4. malignant ameloblastoma = ameloblastic carcinoma
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8
Q

what is the most common CLINICAL significant odontogenic tumor?

A

ameloblastoma

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9
Q

Theoretically ameloblastoma can arise from 4 things:

A
  1. rests of dental lamina
  2. developing enamel organ
  3. epithelial lining of odontogenic cyst
  4. basal cells of the oral mucosa
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10
Q

ameloblastoma:

____ growing, _____ invasive, benign or malignant?

A

slow growing

locally invasive

benign

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11
Q

3 clinico radiographic situations w/

different prognosis and therapies

A
  1. conventional solid = multicystic ameloblastoma
  2. unicystic ameloblastoma
  3. peripheral ameloblastoma = extraosseous ameloblastoma
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12
Q

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

A

conventional solid [86%]

unicystic [13%]

extraosseous [1%]

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13
Q

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]

A

conventional solid

multicystic ameloblastoma

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14
Q

multilocular radioleucent lesion

soap bubbly when large

**honeycombed ** when small

B - L cortical expansion is freq

commonly root resorption of teeth adj to tumor

A

conventional ameloblastoma

multicystic ameloblastoma

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15
Q

Hx: follicular pattern

most common recognizable pattern for ameloblastoma, 4 things

A
  1. multiple islands of odontogenic epithelium

in mature fibrous CT stroma

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

reverse polarity in nuclei

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16
Q

multicystic ameloblastoma can

exhibit _____ pattern and ___ common

A

plexiform pattern

less common

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17
Q

tx of multicystic ameloblastoma

A
  1. curretage
  2. simple enucleation
  3. en bloc resection
  4. marginal resection
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18
Q

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

A

marginal resection

15% reoccurence

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19
Q

waht is the most optimal tx of ameloblastoma

A

controversial and is conventional to:

infiltrate bt the intact cancellous bone trabeculae

at the periphery of the lesion

**before **bone resorption bc radiographic evident

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20
Q

__ leaves islands of tumor within bone

later __% reoccurence

A

curretage

50 - 90% reoccurence

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21
Q

removal of tumor followed by

____ ___

reduces need for extensive reconstructive surgery

A

peripeheral ostectomy

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22
Q

marginal resction should be

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

A

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

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23
Q

___ _____ ____ particular dangerous bc of

difficulty obtaining ___ ___

A

ameloblastomas of posterior maxilla

dangerous

for good surgical margin

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24
Q
  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
A

unicystic ameloblastoma

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25
Q

unilocular cystic lesion that may Hx be presented in 3 ways

A

unicystic ameloblastoma

luminal

intraluminal = plexiform

mural

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26
Q

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

A

multicystic ameloblastoma

unicystic ameloblastoma

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27
Q

luminal Hx of unicystic ameloblastoma

A

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
28
Q

stellate reticulum

A

core resembles stellate reticulm and foci cystic degeneration = multicystic ameloblastoma

overlying epithelium resembles stellate reticulum = unicystic ameloblastoma

29
Q

intraluminal = plexiform Hx of unicystic ameloblastoma

A

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
30
Q

mural Hx of unicystic ameloblastoma

A

fibrous wall of cyst

infiltrated by

typical follicular or plexiform ameloblastoma

31
Q

tx of unicystic ameloblastoma

A

individualized

but, if its intraluminal can do conservative surgical curretage

32
Q

____ is uncommon and accounts for 1 - 10% of ameloblastomas

A

peripheral ameloblastoma aka extraosseous ameloblastoma

33
Q

TF

malignant ameloblastoma

ameloblastic carcinoma rarely metastasize <1%

A

true

34
Q

tumor that shows histopathologic features of

ameloblastoma in:

  • primary tumor
  • metastatic deposits
A

malignant ameloblastoma

35
Q

ameloblastoma w/ cytological

features of malignancy in:

  • primary tumor
  • metastatic deposits
A

ameloblastic carcinoma

36
Q
  1. both primary tumor and metastasis

look like regular ameloblastoma

  1. generally, the primary and metastasis

both have **features of ameloblastoma, but also features of **

malignancy.

A

Malignant ameloblastoma

ameloblastic carcinoma

37
Q

Young teens, not common to 30+ yo

2x females > males

tendency affects anterior jaws 2x maxilla > mandible

A

adenomatoid odontogenic tumor

38
Q

75% circumsribed

unilocular

radioleuncy

involes the **crown of unerupted tooth **

A

adenomatoid odontogenic tumor

39
Q

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

A

k9

40
Q

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

A

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

41
Q

Hx of adenomatoid odontogenic tumr

A
  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
42
Q

tx for adenomatoid odontogenic tumor

A

benign

thick firbous capsule makes enucleation away from bone easy

does not reoccur

43
Q

calcifying epithelial odontogenic tumor

aka

____

A

pindborg tumor

44
Q

-DD: dentigerous cyst – ______ and ______ – but both AOT and DC are

UNILOCULAR radiolucency involving

an unerupted tooth!

A

no calcifications

and

respect the CEJ rule

45
Q

uncommon, <1% odontogenic tumor,

**impacted tooth, posterior mandible, mostly men **

amyloid accumulation detected 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 **

A

CEOT

calcifying epithleial odontogenic tumor

46
Q

what are the 3 mixed odontogenic tumors

A

ameloblastic fibroma

ameloblastic fibro-odontoma

odontoma

47
Q

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.

A

amelobastic fibroma

48
Q

posterior mandible

and sclerotic borders

A

Calcifying eptihelial odontogenic tumor

ameloblastic fibroma

49
Q

unerupted tooth follicle

A

adenomatoid odontogenic tumor

calcifying epithelial odontogenic tumor

ameloblastic fibroma

50
Q

**true mixed odontogenic tumor **

A

ameloblastic fibroma

51
Q

TF

some lesions that were diagnosed as ameloblastic

fibroma may actually have represented the early developing

stage of an odontoma.

A

true

52
Q

for DD, differences bt ameloblastoma vs. ameloblastic fibroma

how do you differentiate the two?

A

ameloblastoma: more stellate reticulum in the center

-laerger islands of ameloblastic epithelium

**ameloblastic fibroma: **MORE CT surrounding the islands

XRAY TO DIFFERENTIATE

53
Q

TF ameloblastic fibroma

  1. younger patients; most lesions are diagnosed in the first two decades of life.
  2. Radiographically, either a unilocular or multilocular

radiolucent lesion

A

true

true

54
Q

waht is amelobastic fibro-odontoma

A

features of ameloblastic fibroma

contains:

enamel and dentin

55
Q

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.

A

ameloblastic fibroma

ameloblastic fibro-odontoma

56
Q

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
A

true

true

57
Q

most common type of odontogenic tumor

A

odontoma

58
Q

TF

odontoma

prevalence exceeds that of all other odontogenic tumors combined.

A

true

59
Q

Odontomas are considered to be developmental anomalies

______ rather than _______

A

hamartomas

true neoplasms.

60
Q

odontomas is divided into:

A

compound odontoma

complex odontoma

61
Q

compound odontoma

A
  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
62
Q

complex odontoma

A
  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.

63
Q

TF odontoma

odontoma will develop completely within the gingival soft tissues

A

true

64
Q

___ causes delayed eruption more than -____

A

compound more delayed eruption than complex

65
Q
A

opath 5 (7 decks)

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