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odontogenic tumours Flashcards

1
Q

where do odontogenic tumours arise from?

what is the most common?

A

arise from epithelium within bones of the jaw

ameloblastoma is most common

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2
Q

what is the classification of odontogenic tumours based on?

A

on the stages of normal tooth development

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3
Q

what are the 3 groups of benign odontogenic tumours?

A
  1. odontogenic epithelium only
    • only with mature fibrous stroma
    • without odontogenic mesenchyme
  2. mixed odontogenic epithelium
    • with odontogenic ectomesenchyme
    • with or without dental hard tissue formation
  3. mesenchyme and/or odontogenic ectomesenchyme
    • with ot without odontogenic epithelium
    • no evidence of dental hard tissue formation
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4
Q

name malignant odontogenic tumours

A
  • ameloblastic carinoma
  • primary intraosseous carcinoma
  • sclerosing odontogenic carcinoma
  • clear cell odontogenic carcinoma
  • ghost cell odontogenic carcinoma
  • odontogenic carcinosarcoma
  • odontogenic sarcomas
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5
Q

what is an ameloblastoma?

what is the classification?

A

benign odontogenic tumour

odontogenic epithelium without odontogenic mesenchyme

locally invasive neoplasm

  • continues to grow if not removed and invade local tissues
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6
Q

what are the types of ameloblastoma

A

3 types

  1. solid / multicystic, intraosseous 85%
  2. unicystic ameloblastoma 14%
  3. peripheral ameloblastoma 1%
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7
Q

ameloblastoma clinical features

age

sex

site

A
  • age
    • wide range
    • majority 4th,5th decades
  • sex
    • equal distribution
  • site
    • 80% mandible 20% maxilla
    • in mandible
      • 70% molar region
      • mostly in angle of mandible
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8
Q

symptoms of ameloblastoma

A
  • slow growing
  • may be asymptomatic
  • gradually increasing facial deformity and expansion of the jaw
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9
Q

signs of ameloblastoma

A
  • bony, hard, non-tender ovoid swelling
  • egg shell crackling of bone in advanced cases
  • perforation of bone and spread into soft tissues late features
  • in maxilla
    • swelling may produce little swelling if extended into maxillary antrum
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10
Q

what are the radiographic features of an ameloblastoma

A
  • multilocular mostly
  • well defined corticated outline
  • uniformly radiolucent
  • radiopaque septa
  • effect on adjacent structures
    • expansion of buccal/lingual bone
    • teeth displaced
    • roots of involved teeth may be resorbed
  • may be associated with unerupted tooth, particularly lower third moalrs mimicking dentigerous cyst
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11
Q

what radiographic features are shown here

identify this

A
  • multilocular appearance
  • angle of the mandible
  • resorbing distal root of lower 2nd molar
  • displacement of 3rd molar

ameloblastoma

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12
Q

what radiographic features are shown here

identify

A
  • radiolucency at angle of the mandible
    • involving ramous
  • resorption of the roots
  • multilocular appearance

ameloblastoma

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13
Q

what are the different patterns of histopathology in ameloblastoma

A

follicular or plexiform

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14
Q

describe the follicular pattern of histopathology in an ameloblastoma

A
  • rounded islands or follicles
    • surrounded by fibrous tissue
  • resembling enamel organ of tooth germ
    • central mass resembling stellate reticulum
    • periheral layer resembling ameloblasts
  • nuclei of peripheral cells show reverse polarity
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15
Q

what is reverse nuclear polarity?

A

nuclei are polarised to the opposite end of the cell to the basement membrane

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16
Q

describe the plexiform histology of an ameloblastoma

A
  • tangled network of
    • anastamosing strands
    • irregular massess
  • peripheral layer of ameloblast like columnar cells with central stellate reticulum like cells
  • cyst formation common but due to stromal degeneration
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17
Q

what is the treatment for an ameloblastoma

A
  • solid/multicycstic ameloblastoma
    • surgery essential
    • high recurrence after curettage
    • complete resection with margin of normal bone
    • radio and chemotherapy is insensitive
    • mxaillar tumours are often more destructive
    • long term follow up required
    • recurrence > 10 years post op
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18
Q

what is an adenomatoid odontogenic tumour?

what is the classification?

A

duct like structures

slow but progressive growth

odontogenic epithelium without odontogenic ectomesenchyme

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19
Q

what are the clinical features of an adenomatoid odontogenic tumour

age

sex

site

A
  • age
    • 2nd/3rd decades of life
  • sex
    • F>M
  • site
    • maxilla 2x more than mandible
    • canine area + anterior part of maxilla mostly
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20
Q

what are the symptoms and signs of adenomatoid odontogenic tumour?

A
  • symptoms
    • slowly enlarging painless swelling
  • signs
    • often associated with unerupted tooth
    • rare extra-osseous lesions
      • usually anterioe mxillary gingiva
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21
Q

what are the radiographic features of an adenomatoid odontogenic tumour?

A
  • well defined radiolucency
  • unilocular, often surrounding whole tooth
  • corticated outline
  • radiolucent, calcification may produce faint radiopaicities
  • may mimic dentigerous cyst
22
Q

what radiographic features are present here?

identify

A

well defined radiolucency

unilocular & surrounding the whole tooth

corticated outline

simialar to dentigerous cyst

adenomatoid odonteogenic tumour

23
Q

describe the histology of an adenomatoid odontogenic tumour

A
  • well encapsulated
  • whorled masses of epithelium
  • columnar cells form duct-like structures with eosinophilic material in central spcaes
24
Q

what is the management for an adenomatoid odontogenic tumour?

A

is benign

readily enucleated

does not recur

25
what is a calcifying epithelial odontogenic tumour?
benign odontogenic epithelium without odontogenic mesenchyme rare locally invasive epithelial neoplasma aka pindborg tumour
26
name mixed odontogenic tumours - epithelium and mesenchyme
* ameloblastic fibroma * primordial odontogenic tumour * odontoma * compound type * complex type * dentinogenic ghost cell tumour
27
what is an ameloblastic fibroma classification?
* rare benign tumour * both epithelial and mesenchymal elements are neoplastic * odontogenic epithelium with odontogenic ectomesenchyme * does not contain dental hard tissues
28
what are the clinical features of an ameloblastic fibroma? age sex site
* age * uncommon over age 21 * sex * equal distribution * site * premolar - molar of mandible
29
what are the symptoms and signs of ameloblastic fibroma
slowly enlarging painless swelling
30
what are the radiographic features of an ameloblastic fibroma?
well defined radiolucency unilocular well defined corticated outline uniformly radiolucent with radiopaque septa
31
describe the histology of an ameloblastic fibroma
* strands and islands of odontogenic epithelium * in highly cellular fibroblastic stroma * resembles dental papilla of developing tooth * peripheral layer of columnar or cuboidal ameloblast-like cells * enclosing small amounts of stellate reticulum like cells * may be narrow cell free zone of hyaline connective tissue around epithelium
32
describe the behaviour of an ameloblastic fibroma
benign non-invasive very rarely recur
33
what are the signs and symptoms of complex and compound odontomes
may be found investigated unerupted tooth may be large enough to expand bone secondary infection may produce pain and swelling
34
what are the radiographic features of complex and compound odontomes
* full formed appear as **radiopaque mass** * developing lesions show well defined radiolucency containing radiopaque areas
35
what is a compound odontome? classification clinical features
painless slow growing structure 1-2cm mixed odontogenic tumour in children in anterior maxilla
36
radiographic features? identify
collection of denticles radiopacities within the radiolucency **compound odontome**
37
what is a complex odontome? classification clinical features
spherical radiopaque mass impacts teeth or prevents eruption \<3cm mixed odontogenic tumour \<20 years of age posterior mandible
38
radiographic features? identify
displaces crown of partially developed third molar tooth preventing eruption spherical radiopacity with radiolucent rim haphazard dental structures **complex odontome**
39
describe the histoplathology of a compound odontome
* **seperate denticles embedded in fibrous tissue** * denticles - have enamel, dentine, cementum, pulp arranged like normal tooth
40
describe the histopathology of a complex odontome
* **mass of irregularly arranged but well formed enamel, dentine and cementum** * **​**surrounded by fibrous capisule * dentine forms bulk of lesion * pulp-like tissue on surfaces not covered by enamel or cementum
41
describe the behaviour of complex and compound odontomes
hamartomas with limited growth potential * benign tumourlike malformation * stops growing when tooth structure is fully formed
42
name mesenchymal odontogenic tumours
* odontogenic fibroma * odontogenic myxoma / myxofibroma * cementoblastoma * cemento-ossifying fibroma
43
what is a cementoblastoma what are the clinical features age sex site
true benign neoplasm * age * under 25 years * sex * males * site * molar or premolar area * attached to root of tooth * mandibular 1st permanent molar most common
44
symptoms and signs of cementoblastoma
slowly enlarging swelling may be painful
45
radiographic features of cementoblastoma?
* well demarcated * **mottled or dense radiopaque mass with radiolucent margin** * attached to root of tooth * may show root resorption
46
what radiographic features are present identify
mottled radiopaque mass with radiolucent margin attached to tooth root root resorption **cementoblastoma**
47
describe the histopathology of a cementoblastoma
* mass of calcified cementum-like tissue with many reversal lines * scattered cells in lacunae * uncalcified matrix at the periphery formed by plump cementoblasts * similar to osteoblastoma of bone
48
describe the behaviour of a cementoblastoma and treatment
benign tumour does not recur need to remove associated tooth and lesion
49
where and in whom does odontogenic myxoma most commonly occur?
in adults posterior mandible / ramus
50
radiographic features of odontogenic myxoma? size: shape: outline: radiodensity: effects on adjacent structures:
* size: * may become large if left untreated * shape: * **multilocular** * outline: * well defined corticated outline * radiodensity: * uniformly radiolucent with radiopque septa * effects on adjacent structures: * **teeth displaced and resorbed** * expansion of buccal/lingual bone
51
radiographic features present? identify
multilocular lesion in posterior mandible well defined, corticated teeth displaced and resorbed **odontogenic myxoma**
52
name malignant odontogenic tumours

z oral surgery / oral diseases (13 decks)

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