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cysts, tumours, bone pathology > odontogenic tumours > Flashcards

odontogenic tumours Flashcards

1
Q

incidence

A

rare - 1% of OMF lesions sent for histopathological assessment in UK

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2
Q

are most benign or malignant?

A

benign 100:1

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3
Q

how are the majority discovered and why?

A

due to non-eruption of teeth, late-stage bony expansion or imaging for other reasons (ie incidental)
because the majority are asymptomatic

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4
Q

where do most arise?

A

within the bone of jaws

- rare cases within surrounding ST

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5
Q

what usually causes symptoms?

A

pain usually secondary to infection or pathological fracture

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6
Q

how are they classified?

A

based on their tissue of origin

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7
Q

classification

A

epithelial
mesenchymal
mixed (epithelium and mesenchyme)

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8
Q

which are the only tumours that can have dentine and enamel formation and why?

A

mixed tumours
due to the concept of induction - D forms first (odontoblasts) from mesenchyme then this induces ameloblasts and E formation - cannot have E without D first

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9
Q

odontogenic sources of epithelium

A

rests of malassez
rests/glands of serres
reduced enamel epithelium

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10
Q

rests of malassez

A

remnants of Hertwig’s epithelial root sheath

can get inactive ‘clumps’ remaining in PDL

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11
Q

rests/glands of serres

A

remnants of the dental lamina

forms tooth germs - can get inactive clumps remaining within jaws

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12
Q

reduced enamel epithelium

A

remnants of the enamel organ

covers crown of UE tooth

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13
Q

examples of epithelial tumours

A

ameloblastoma
adenomatoid odontogenic tumour (AOT)
calcifying epithelial odontogenic tumour (CEOT)

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14
Q

example of mesenchymal tumour

A

odontogenic myxoma

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15
Q

example of mixed tumour

A

odontoma (odontome)

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16
Q

radiographic appearance

A

highly variable
entirely radiolucent/mixed/entirely radiopaque
may change as tumour progresses

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17
Q

what % of cases are either ameloblastoma or odontoma?

A

> 50%

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18
Q

what is an ameloblastoma?

A

benign epithelial tumour

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19
Q

typical features of an ameloblastoma

A

locally destructive but slow growing

typically painless

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20
Q

incidence of ameloblastoma

A

1% of OMF tumours

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21
Q

what age range is ameloblastoma most common in and gender?

A

4th-6th decades

M>F

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22
Q

location of ameloblastoma

A

80% in posterior mandible

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23
Q

types of ameloblastoma - radiological

A 
multi cystic (85-90%) - tends to be older patients
unicystic - younger patients, lower recurrence risk
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24
Q

types of ameloblastoma - histological

A

follicular
plexiform
desmoplastic
(several other less common types)

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25
Q

ameloblastoma margins

A 
well-defined, corticated
potentially scalloped (not unicystic)
26
Q

feature of multi cystic ameloblastoma

A

may have thick, curved septa - soap bubble appearance

27
Q

ameloblastoma radiographic appearance

A 
primarily radiolucent (but rare variants can be mostly radiopaque)
 - desmoplastic
28
Q

ameloblastoma effects on adjacent structures

A

displacement
thinning of bony cortices
“knife edge” external RR

29
Q

characteristic expansion of ameloblastoma

A

all directions equally

30
Q

histology of follicular ameloblastoma

A 
ameloblast-like cells
stellate reticulum like tissue
cystic changes within
islands within fibrous tissue background
tissues within follicles loose
can get squamous metaplasia change
31
Q

histology of plexiform ameloblastoma

A

ameloblast-like cells - strands
may have small amount of stellate reticulum like tissue between
fibrous tissue stroma

32
Q

does ameloblastoma have a CT capsule and what is the consequence?

A

no
cells can grow and infiltrate
reason for high recurrence rate

33
Q

management of ameloblastoma

A

surgical resection with margin

34
Q

recurrence of ameloblastoma

A

relatively common - up to 15% of cases

35
Q

risk of malignant transformation of ameloblastoma

A

<1% of cases

ameloblastic carcinoma

36
Q

what type of tumour is an adenomatoid odontogenic tumour?

A

benign epithelial tumour

37
Q

classic presentation of AOT

A

unilocular radiolucency with internal calcifications around crown of unerupted maxillary canine

38
Q

incidence of AOT

A

3% of odontogenic tumours
most common in 2nd decade
F>M

39
Q

where do most AOTs occur?

A

anterior maxilla

40
Q

what percentage of AOTs are associated with an UE tooth and what tooth commonly is it?

A

75%

commonly U3 - impedes eruption

41
Q

presentation of an AOT

A

similar to dentigerous cyst but typically attached apical to CEJ
- asymmetric, involves root and crown
unilocular radiolucency
majority have internal calcifications/radiopacities
- increase as tumour matures
margins well-defined and corticated/sclerotic
may displace adjacent structures but external root resorption rare

42
Q

histology of AOT

A

distinctive with patchy calcification
duct-like structure/sheets/rosette - epithelial
fibrous capsule - removal simple and low recurrence rate

43
Q

what type of tumour is a calcifying epithelial odontogenic tumour?

A

benign epithelial tumour

44
Q

what is CEOT also known as?

A

Pindborg tumour

45
Q

incidence of CEOT

A

1% of odontogenic tumours
most common in 5th decade
M>F

46
Q

most common site for CEOT

A

posterior mandible

47
Q

presentation of CEOT

A 
slow-growing but can become large
1/2 associated with UE tooth
radiolucency often with internal radiopacities
 - calcifications of varying sizes
variable radiographic presentation otherwise
 - unilocular/multilocular
 - margins: well/poorly defined
 - internal septal: none/fine/coarse
48
Q

what type of tumour is an odontogenic myxoma?

A

benign mesenchymal tumour

49
Q

incidence of odontogenic myxoma

A

3-6% of odontogenic tumours
most common in 3rd decade
F=M

50
Q

site of predilection for odontogenic myxoma

A

mandible>maxilla

51
Q

presentation of odontogenic myxoma

A

well-defined radiolucency +/- thin corticated margin

  • smaller lesions unilocular
  • larger lesions multilocular with scalloped margins
    • soap bubble appearance
    • tennis racket pattern of internal septa suggestive of myxoma but only occurs in minority of cases - septa geometric and at right angles

slow growth along bone before causing notable BL expansion
scallops between teeth but larger lesions may cause displacement
- external root resorption rare

52
Q

histology of odontogenic myxoma

A

loose myxoid tissue with stellate cells
- loose type of CT can be gelatinous
may contain islands of inactive odontogenic epithelium
- vital but don’t divide (inert)
no capsule - locally invasive and infiltrate, harder to surgically remove, recurrence

53
Q

management of odontogenic myxoma

A

curettage or resection (depending on size)

  • scrape out if small
  • cut a block out if larger
54
Q

recurrence of odontogenic myxoma

A

high rate 25%
follow up important
lower recurrence rate if unilocular

55
Q

what type of tumour is an odontoma?

A

benign mixed tumour
technically a hamartoma
malformation of dental tissue - E, D, C, P

56
Q

odontoma similarities to teeth

A

mature to a certain stage (ie do not grow indefinitely)
can be associated with other odontogenic lesions (e.g. dentigerous cysts)
surrounded by dental follicle
lie above IDC

57
Q

incidence of odontoma

A

1/5-2/3 of all odontogenic tumours
most common in 2nd decade
F=M

58
Q

types of odontoma

A

compound
complex
compound>complex 2:1

59
Q

compound odontoma

A

ordered dental structures
may appear as multiple “mini teeth” (denticles)
more common in anterior maxilla

60
Q

complex odontoma

A

disorganised mass of dental tissue

more common in posterior body of mandible

61
Q

histology of odontoma

A

enamel space
- inorganic so dissolved during prep - get spaces
- unless not fully calcified - may still see some parts
dentine
may see cementum

cysts, tumours, bone pathology (4 decks)

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