Odontogenic Tumors Flashcards
Not true neoplasms =
reactive hyperplastic rxns of
connective tissue to
chronic injruy or irriation
reactive proliferations
reactive proliferations
- sef limiting growth of
- fibroblastic tissue or
- mix of fibrous AND vascular tissue
from chronic irritation: cheek biting, ill fitting dentures, etc.
true benign neoplasms
conn tissue arise from:
fibroblast
endothelia
skeletal msucle
smooth muscle
lipcytes
harmatomas
odontogenic tumor like malformations
waht are the 3 categories of odonotgenic tumors?
[hint: origin of the tumor]
- tumors of odontogenic epithelium - only odon epithelium
- mixed odontogenic tumors:
- odon epithelium AND ectomesenchyme
- may have dental hard tissues
3. tumors of odontogenic ectomesenchyme: - MOSTLY odon ectomesenchyme
- may have odon epithelium
waht are the 5 tumor of odonotgenic epithelium
- ameloblastoma [4 subtypes]
- clear cell odontogenic carcinoma
- adenomatoid odontogenic tumor
- calcifying epithelial odontogenic tumor
- squamous odontogenic tumor
what are the 4 subtypes of ameloblastoma that are also included as a tumor of odontogenic epithelium
- conventional solid = multicystic ameloblastoma
- unicystic ameloblastoma
- peripheral ameloblastoma = extraosseous ameloblastoma
- malignant ameloblastoma = ameloblastic carcinoma
what is the most common CLINICAL significant odontogenic tumor?
ameloblastoma
Theoretically ameloblastoma can arise from 4 things:
- rests of dental lamina
- developing enamel organ
- epithelial lining of odontogenic cyst
- basal cells of the oral mucosa
ameloblastoma:
____ growing, _____ invasive, benign or malignant?
slow growing
locally invasive
benign
3 clinico radiographic situations w/
different prognosis and therapies
- conventional solid = multicystic ameloblastoma
- unicystic ameloblastoma
- peripheral ameloblastoma = extraosseous ameloblastoma
of the 3 clinicoradiographic situations which is the most -> least common
conventional solid [86%]
unicystic [13%]
extraosseous [1%]
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]
conventional solid
multicystic ameloblastoma
multilocular radioleucent lesion
soap bubbly when large
**honeycombed ** when small
B - L cortical expansion is freq
commonly root resorption of teeth adj to tumor
conventional ameloblastoma
multicystic ameloblastoma
Hx: follicular pattern
most common recognizable pattern for ameloblastoma, 4 things
- multiple islands of odontogenic epithelium
in mature fibrous CT stroma
- core resemblems
- STELLATE RETICULUM of enamel organ
- exhibits foci of cystic degeneration - peripheral columnar cells with
reverse polarity in nuclei
multicystic ameloblastoma can
exhibit _____ pattern and ___ common
plexiform pattern
less common
tx of multicystic ameloblastoma
- curretage
- simple enucleation
- en bloc resection
- marginal resection
of the 4 which is the mostly widely used treatmetn and ___% reoccurance
marginal resection
15% reoccurence
waht is the most optimal tx of ameloblastoma
controversial and is conventional to:
infiltrate bt the intact cancellous bone trabeculae
at the periphery of the lesion
**before **bone resorption bc radiographic evident
__ leaves islands of tumor within bone
later __% reoccurence
curretage
50 - 90% reoccurence
removal of tumor followed by
____ ___
reduces need for extensive reconstructive surgery
peripeheral ostectomy
marginal resction should be
**at least ** ____ to ____ PAST radiographic limits of tumor
1.0 - 1.5 com **past radiographic limits of tumor **
___ _____ ____ particular dangerous bc of
difficulty obtaining ___ ___
ameloblastomas of posterior maxilla
dangerous
for good surgical margin
- localized ameloblastoma in young patient
- less aggressive
- circumscribed radioleuncy may or may not around unerupted crown
- DDx: dentigerous cyst, radicular cyst, and residual cyst
- surgical finding may think this lesion is a cyst but upon microscopic evaluation is actually this
unicystic ameloblastoma
unilocular cystic lesion that may Hx be presented in 3 ways
unicystic ameloblastoma
luminal
intraluminal = plexiform
mural
what other ameloblastoma that can be present in plexiform but less common?
multicystic ameloblastoma
unicystic ameloblastoma
luminal Hx of unicystic ameloblastoma
tumor confined to the luminal surface of the cystic wall
- fibrous cyst wall
- hyperchromatic nuclei
- polarized basal layer
- overlying epithelium:
- loosely cohesive
- resemblems stellate reticulum
stellate reticulum
core resembles stellate reticulm and foci cystic degeneration = multicystic ameloblastoma
overlying epithelium resembles stellate reticulum = unicystic ameloblastoma
intraluminal = plexiform Hx of unicystic ameloblastoma
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
mural Hx of unicystic ameloblastoma
fibrous wall of cyst
infiltrated by
typical follicular or plexiform ameloblastoma
tx of unicystic ameloblastoma
individualized
but, if its intraluminal can do conservative surgical curretage
____ is uncommon and accounts for 1 - 10% of ameloblastomas
peripheral ameloblastoma aka extraosseous ameloblastoma
TF
malignant ameloblastoma
ameloblastic carcinoma rarely metastasize <1%
true
tumor that shows histopathologic features of
ameloblastoma in:
- primary tumor
- metastatic deposits
malignant ameloblastoma
ameloblastoma w/ cytological
features of malignancy in:
- primary tumor
- metastatic deposits
ameloblastic carcinoma
- both primary tumor and metastasis
look like regular ameloblastoma
- generally, the primary and metastasis
both have **features of ameloblastoma, but also features of **
malignancy.
Malignant ameloblastoma
ameloblastic carcinoma
Young teens, not common to 30+ yo
2x females > males
tendency affects anterior jaws 2x maxilla > mandible
adenomatoid odontogenic tumor
75% circumsribed
unilocular
radioleuncy
involes the **crown of unerupted tooth **
adenomatoid odontogenic tumor
which tooth does this circumscribed, unilocular, radioleuncy around the crown of the unerupted tooth mostly affect?
k9
radiographically IMPOSSIBLE to differentiate adenomatoid odontogenic tumor and dentigerous cyst BUT can by?
completely radioleucent lesion with **fine “snowflake calcifications” **so that is adenomatoid odontogenic tumor
Hx of adenomatoid odontogenic tumr
- thick fibrous capsule
- duct - like epithelial sturctures:
- central spaces surrounded by columnar and cuboidal cells
- columnar cells w/ polarized nuclei away from central space
tx for adenomatoid odontogenic tumor
benign
thick firbous capsule makes enucleation away from bone easy
does not reoccur
calcifying epithelial odontogenic tumor
aka
____
pindborg tumor
-DD: dentigerous cyst – ______ and ______ – but both AOT and DC are
UNILOCULAR radiolucency involving
an unerupted tooth!
no calcifications
and
respect the CEJ rule
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 **
CEOT
calcifying epithleial odontogenic tumor
what are the 3 mixed odontogenic tumors
ameloblastic fibroma
ameloblastic fibro-odontoma
odontoma
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.
amelobastic fibroma
posterior mandible
and sclerotic borders
Calcifying eptihelial odontogenic tumor
ameloblastic fibroma
unerupted tooth follicle
adenomatoid odontogenic tumor
calcifying epithelial odontogenic tumor
ameloblastic fibroma
**true mixed odontogenic tumor **
ameloblastic fibroma
TF
some lesions that were diagnosed as ameloblastic
fibroma may actually have represented the early developing
stage of an odontoma.
true
for DD, differences bt ameloblastoma vs. ameloblastic fibroma
how do you differentiate the two?
ameloblastoma: more stellate reticulum in the center
-laerger islands of ameloblastic epithelium
**ameloblastic fibroma: **MORE CT surrounding the islands
XRAY TO DIFFERENTIATE
TF ameloblastic fibroma
- younger patients; most lesions are diagnosed in the first two decades of life.
- Radiographically, either a unilocular or multilocular
radiolucent lesion
true
true
waht is amelobastic fibro-odontoma
features of ameloblastic fibroma
contains:
enamel and dentin
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.
ameloblastic fibroma
ameloblastic fibro-odontoma
TF
- ameloblastic fibroma plus an odontoma. = ameloblastic fibro-odontoma
- soft tissue component of tumor is indishinguishable from amelobastic fibroma vs. amelobalastic fibro-odontoma
true
true
most common type of odontogenic tumor
odontoma
TF
odontoma
prevalence exceeds that of all other odontogenic tumors combined.
true
Odontomas are considered to be developmental anomalies
______ rather than _______
hamartomas
true neoplasms.
odontomas is divided into:
compound odontoma
complex odontoma
compound odontoma
- multiple, small single rooted ,toothlike structures, loose fibrous matrix
- more often seen in the anterior maxilla
- radiographically: collection of toothlike structures of varying size and shape surrounded by a narrow radiolucent zone
complex odontoma
- conglomerate mass of enamel and dentin, NO anatomic resemblance to a tooth.
- molar regions of either jaw.
- 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.
TF odontoma
odontoma will develop completely within the gingival soft tissues
true
___ causes delayed eruption more than -____
compound more delayed eruption than complex
