Odontogenic Tumors

Question 1

EPITHELIAL Odontogenic tumors

Answer 1

Ameloblastoma AOT SOT CEOT KCOT

Question 2

MESENCHYMAL tumors

Answer 2

Odontogenic myxoma Odontogenic fibroma Cementoblastoma CGC odontogenic tumor

Question 3

MIXED epithelial and mesenchymal tumors

Answer 3

Ameloblastic fibroma Ameloblastic fibroodontoma (AFO) Odontoma Gorlin cyst (calcifying cystic odontogenic tumor)

Question 7

What are tumors with high recurrence?

Answer 7

Ameloblastoma OKC CEOT Odontogenic myxoma

Question 8

What are treatment for tumors with high recurrence?

Answer 8

Resection with 1cm margin Surgical enucleation with adjunctive therapy: Carnoys solution or Cryotherapy

Question 9

What is Carnoys solution?

Answer 9

Fixative agent that contains Ethanol: chloroform: glacial acetic acid (6:3:1)

Question 10

What is the penetration rate of Carnoys solution?

Answer 10

Nerve: Soft tissue: Bony tissue: 1.54mm in 5mins Cyst lining:

Question 11

What is cryotherapy?

Answer 11

Liquid nitrogen that induces freezing tempt to cause cell death

Question 17

AMELOBLASTOMA Pathogenesis

Answer 17

Rests of Serres - epithelial remnants in fibrous gingival tissues

Question 18

AMELOBLASTOMA histopathology

Answer 18

1. Palisaded ameloblast cells - tall columnar or cuboidal cells 2. Reverse polarization 3. Hyperchromatism nuclei 4. Basilar cytoplasmic vacuolization 5. Disconnected islands, cords, strands within the collagenized fibrous CT stroma

Question 19

AMELO clinical pathology types

Answer 19

Solid multicystic ameloblstoma Unicystic ameloblastoma Extraosseous ameloblastoma Malignant ameloblastoma Ameloblastic Ca

Question 20

Histo type of SMA

Answer 20

Follicular Plexiform Granular Acanthomatous Basal cell Desmoplastic

Question 21

Radiographic features of SMA

Answer 21

1. Multilocular radiolucency Honeycomb appearance Soap-bubble appearance *except Desmoplastic - more radiopaque dt collagenized stroma 2. Posterior mandible 3. Root resorption or displacement

Question 22

Clinical features of SMA

Answer 22

Bony expansion buccolingually Facial disfigurement Mobile teeth

Question 23

Histological types of Unicystic ameloblastoma

Answer 23

Intraluminal - ameloblastic lining that contains nodules that protrudes from the luminal epithelium into the cystic lumen Luminal - ameloblastic lining confined in the luminal lining Mural - ameloblastic lining that infiltrates the fibrous CT wall of the cyst

Question 24

Clinical and Radiographic features of UNICYSTIC amelo

Answer 24

Unilocular radiolucency that causes bony expansion in bucco-lingual direction

Question 25

What are recurrence rate of UNICYSTIC amelo

Answer 25

Resection: 0-3% Enucleation+Carnoys: 16% Enucleation alone: 30%

Question 26

What are the recurrence rate for SMA

Answer 26

Enucleation alone: 60-80% Resection with margin: 15%

Question 27

Pathogenesis of AOT

Answer 27

Remnant of Hertwigs epithelial root sheath

Question 28

Clinical features of AOT

Answer 28

Pear shaped radiolucency around an impacted tooth that extends beyond the CEJ of tooth

Question 29

Differential diagnosis of multilocular radiolucencies

Answer 29

SMA OKC CGCT Browns tumor odontogenic myxoma - cobweb appearance / multiloculations produced by thin and straight septa that resembling stepladder or tennis racket pattern.

Question 30

Diff dx of histopathological finding of multinucleated giant cells

Answer 30

CGCT Browns Cherubism Aneurysmal bone cyst

Question 31

How to diagnose browns tumor of hyperparathyroidism

Answer 31

Radiogrpahic: multilocular radiolucencies Blood ix: RP - chronic renal disease. Serum calcium reduced increase PTH

Question 32

Types of CGCG

Answer 32

Aggressive lesion: Pain Rapid growth Cortical perforation Root resorption High recurrence Nonaggressive lesion: Painless Slow growing No cortical perforation No resorption Low to no recurrence

Question 33

Radiographic features of CGCG

Answer 33

Non cortical well demarcated radiolucency Unilocular or Multilocular Commonly affecting anterior mandible & maxilla

Question 34

What jaw lesions contain multinucleated giant cells

Answer 34

CGCG/CGT Browns tumor - require blood ix for hyperPTH Cherubism Aneurysmal bone cyst

Question 35

What genetic diseases are CENTRAL giant cell lesions associated with

Answer 35

Brown tumors of hyperPTH a/w NFM-1 Cherubism Noonan syndrome

Question 36

What is cherubism?

Answer 36

developmental jaw abnormality that is inherited as autosomal dominant trait - disease appear early as 1 yr - cherublike face with bilateral posterior mandible enlargement - increase scleral show (upturned eye) dt involvment of infraorbital bones - bilateral multilocular radiolucencies - malocclusion dt impacted teeth, resorption of teeth -usually resolves at forth decade

Question 37

Bilateral multilocular radiolucency with no cortical borders

Answer 37

CHERUBISM

Question 38

Treatment for CGCG

Answer 38

Tumor excision. High recurrent risk for aggressive type En bloc resection for aggressive type Corticosteroids (intralesional injection weekly x 6/52) Calcitonin (given ystemically - subQ 50-100IU x 6-9/12) Interferon alpha 2a (its an antiangiogenic - 3million units/m2 SQ - depends on size of lesion) For cherubism: Observation if no facial disfigurement Becos surgical enucleation leads to more aggressive recurrence Usually resolves at second-third decade of life For Brown tumor: Blood ix - renal profile; serum calcium; PTH levels