odontogenic tumours Flashcards
what are the different classifications of odontogenic tumours? (4)
- odontogenic epithelium without odontogenic ectomesenchyme
- odontogenic epithelium with odontogenic ectomesenchyme +/- dental hard tissues
- odontogenic ectomesenchyme +/- included odontogenic epithelium
- malignant odontogenic tumours (carcinomas or sarcomas)
what are some general differentials for odontogenic tumours? (6)
- localised or spreading infection
- cysts
- non-odontogenic tumours and neoplasms
- giant cell lesions
- early fibro-osseous lesions
- idiopathic lesions
describe the dental papilla histology (3)
- gelatinous myxoid tissue
- cells in a background matrix, rich in proteoglycans, lots of water
- stains with Alcian blue
give some tissues that are included in odontogenic epithelium (~4)
- dental lamina
- rests of Serres
- enamel epithelium
- Hertwig’s root sheath
what is an odontogenic tumour
swelling derived from tooth-forming tissues
what are the main presenting complaints with odontogenic tumours? (3)
- swellings
- failed eruption
- displaced teeth
what is the difference between histodifferentiation and morphodifferentiation?
- histodifferentiation = differentiation of cells (into types of tissues)
- morphodifferentiation = differentiation of tissues into shapes (of teeth)
which odontogenic tumours are odontogenic epithelium only? (4)
- ameloblastoma
- calcifying epithelial odontogenic tumour (Pindborg)
- squamous odontogenic tumour
- adenomatoid odontogenic tumour
which odontogenic tumours are in the category epithelium and ectomesenchyme +/- dental hard tissues? (5)
- ameloblastic fibroma
- calcifying odontogenic cyst/tumour
- odontoma/e
- primordial odontogenic tumour
- dentinogenic ghost cell tumour
which odontogenic tumours are in the category of odontogenic ectomesenchyme +/- included epithelium? (4)
- odontogenic fibroma
- odontogenic myxoma
- granular cell odontogenic tumour
- cementoblastoma
list some odontogenic carcinomas (5)
- ameloblastic carcinoma
- primary intraosseous carcinoma
- sclerosing odontogenic carcinoma
- clear cell odontogenic carcinoma
- ghost cell odontogenic carcinoma
name the odontogenic sarcomas (2)
- ameloblastic fibrosarcoma
- ameloblastic fibro-odonto-sarcoma
describe conventional ameloblastoma (what, demographic, presentation, radiograph)
- benign odontogenic tumour (epithelial), but locally infiltrative, slow growing
- middle aged Afrocaribbean (30-50yo)
- facial asymmetry, painless unless infected
S = posterior mandible
S =
S = multilocular
O = well-defined, corticated
R = RL with radiopaque septae
E = jaw expansion, displacement, especially root resorption
what is the commonest odontogenic neoplasm?
ameloblastoma
conventional ameloblastoma radiographic appearance
S = posterior mandible
S =
S = multilocular
O = well-defined, corticated
R = RL with radiopaque septae
E = jaw expansion, displacement, especially root resorption
conventional ameloblastoma demographic
middle aged Afrocaribbean (30-50yo)
ameloblastoma histology and variants (2)
conventional/multicystic:
- ameloblasts in islands
- variants = follicular, plexiform, granular cell, basal cell, desmoplastic
conventional ameloblastoma common site
posterior mandible
ameloblastoma types
solid multicystic
unicystic
which histological type of ameloblastoma has honeycomb radiographic appearance?
desmoplastic
treatment of ameloblastoma (2)
- gold standard = surgical resection with 1cm bone margin BUT mutilating, hard to reconstruct, only 20% are beyond radiographic margin
- may enucleate well localised ones and monitor
describe unicystic ameloblastoma (what, age, radiographic)
- benign odontogenic tumour (epithelium only)
- young adults 20-30yo
- can be enucleated without recurrence
- ameloblasts not obvious histologically
S = posterior mandible, associated with unerupted displaced 8 in dentigerous relationship
S =
S = unilocular
O = well-defined, corticated
R = RL
E = displacement, jaw expansion
which type of ameloblastoma may be enucleated without recurrence?
unicystic
unicystic ameloblastoma radiographic appearance
S = posterior mandible, associated with unerupted displaced 8 in dentigerous relationsip
S =
S = unilocular
O = well-defined, corticated
R = RL
E = displacement, jaw expansion
unicystic ameloblastoma age group
20-30yo
describe calcifying epithelial odontogenic tumour (Pindborg) (what, age, radiographic, histology)
- benign odontogenic tumour (epithelium only), locally infiltrative, slow-growing
- 50-60yo
- unusual features
S = mandible, premolar-molar area
S =
S = multilocular > unilocular
O = variably defined, corticated
R = RL with internal mineralisations
E = jaw expansion, displacement, root resorption
histology: - nuclear atypia (degenerative)
- strands of epithelium
- amyloid protein deposits between cells +/- mineralisation
- apple-green birefringence
calcifying epithelial odontogenic tumour (Pindborg) age group
50-60yo at presentation
calcifying epithelial odontogenic tumour (Pindborg) radiographic appearance
S = mandible, premolar-molar area
S =
S = multilocular > unilocular
O = variably defined, corticated
R = RL with internal mineralisations
E = jaw expansion, displacement, root resorption
calcifying epithelial odontogenic tumour (Pindborg) histology (4)
- nuclear atypia (degenerative)
- strands of epithelium
- amyloid protein (ODAM) deposits between cells +/- mineralisation
- apple-green birefringence with Congo Red stain of amyloid
why does calcifying epithelial odontogenic tumour (Pindborg) have internal mineralisations radiographically?
mineralisation of amyloid protein deposits between cells
what is an important histological misdiagnosis of calcifying epithelial odontogenic tumour (Pindborg) ?
squamous cell carcinoma
describe ameloblastic fibroma (what, age, radiographic, histology)
- benign odontogenic tumour (epithelium and ectomesenchyme +/- dental hard tissues)
- young 5-20yo
S = premolar/molar region
S =
S = multilocular
O = well-defined, corticated
R = RL with internal septae
E = jaw expansion, displacement
histology - no hard tissues - many odontogenic fibroblasts in gelatinous matrix
- islands or branching strands of odontogenic epithelium
- tooth germ-like buds of ameloblast-like cells
ameloblastic fibroma age group
young 5-20yo
ameloblastic fibroma radiographic appearance
S = premolar/molar region
S =
S = multilocular
O = well-defined, corticated
R = RL with internal septae
E = jaw expansion, displacement
ameloblastic fibroma histology (4)
no hard tissues
- many odontogenic fibroblasts in gelatinous matrix
- islands or branching strands of odontogenic epithelium
- tooth germ-like buds of ameloblast-like cells
ameloblastic fibroma presenting complaint (2)
painless swelling or missing tooth
describe adenomatoid odontogenic tumour (what, age, radiograph, histology)
- benign odontogenic tumour (epithelium)
- slow-growing, non-infiltrative
- teens 10-20yo
S = anterior maxilla (UE canine/lateral)
S =
S = unilocular
O = well-defined, corticated
R = RL –> small internal calcifications
E = jaw expansion, displacement or UE teeth
histology: - pre-ameloblast-like cells, pink enamel matrix +/- mineralisation
- duct-like structures
- whorled epithelial cells
- dentinoid tissue (close to epithelium)
adenomatoid odontogenic tumour age group
teens (10-20yo)
adenomatoid odontogenic tumour radiographic appearance
S = anterior maxilla (UE canine/lateral)
S =
S = unilocular
O = well-defined, corticated
R = RL –> small internal calcifications
E = jaw expansion, displacement or UE teeth
adenomatoid odontogenic tumour histology (4)
- pre-ameloblast-like cells, pink enamel matrix +/- mineralisation
- duct-like structures
- whorled epithelial cells
- dentinoid tissue (close to epithelium)
describe calcifying odontogenic cyst/tumour (what, types, age, radiograph, histology)
- benign odontogenic cyst/tumour (epithelium and ectomesenchyme +/- hard tissues)
- cystic and solid variants
- wide age range
S = associated with UE tooth
S = small (4cm)
S = uni or multilocular
O = well-defined, corticated
R = RL, may develop small internal calcifications
E = displacement or resorption of teeth, bony expansion
histology: - odontogenic epithelial lining (ameloblasts)
- “ghost cells” - stacked flattened epithelial cells, nuclear “hole”, may calcify
calcifying odontogenic cyst/tumour radiographic appearance
S = associated with UE tooth
S = small (4cm)
S = uni or multilocular
O = well-defined, corticated
R = RL, may develop small internal calcifications
E = displacement or resorption of teeth, bony expansion
calcifying odontogenic cyst/tumour histology (2)
- odontogenic epithelial lining (ameloblasts)
- “ghost cells” - stacked flattened epithelial cells, nuclear “hole”
what other tumour may calcifying odontogenic cyst/tumour look like histologically, and what feature differentiates them?
- ameloblastoma
- calcifying odontogenic cyst/tumour has ghost cells
calcifying odontogenic cyst/tumour treatment (2)
cystic = enucleation
solid = excision with small margin
describe odontoma/e (what, types, effects)
- commonest and best differentiated odontogenic tumour, hamartoma, (epithelium and ectomesenchyme +/- dental hard tissues)
- compound = denticles in a tooth-like crypt, anterior maxilla
- complex = enamel and dentine tissue, little pulp space; premolar-molar mandible
- jaw expansion, displacement or UE teeth
what is the commonest odontogenic tumour?
odontoma/e (esp compound)
what are ameloblastic fibrodentinomas and ameloblastic fibro-odontomas?
odontomes which have not yet fully matured/mineralised
what terms may be used to describe immature odontomes? (2)
ameloblastic fibrodentinoma
ameloblastic fibro-odontoma
describe odontogenic fibroma (what, age, radiograph, histology)
- benign, odontogenic tumour, (ectomesenchyme +/- included odontogenic epithelium)
- wide age range
- 50% recur
S = premolar-molar mandible
S = usually 2-4mm at dx
S = unilocular
O = well-defined, corticated
R = RL
E = jaw expansion, displace or resorb teeth
histology: - mostly fibrous tissue (plump fibroblasts, collagen)
- rests of odontogenic epithelium
odontogenic fibroma treatment
enucleation (but 50% recur)
odontogenic fibroma radiographic appearance
S = premolar-molar mandible
S = usually 2-4mm at dx
S = unilocular
O = well-defined, corticated
R = RL
E = jaw expansion, displace or resorb teeth
odontogenic fibroma histology (2)
- mostly fibrous tissue (plump fibroblasts, collagen)
- rests of odontogenic epithelium
describe odontogenic myxoma (what, growth, age, radiograph, histology)
- benign odontogenic tumour (ectomesenchyme with included epithelium)
- grows by ground substance secretion
- young adults 10-30yo
S = posterior mandible
S =
S = multilocular
O = scalloped, well-defined, variable cortication
R = RL with fine wispy internal septae, tennis racket-like
E = jaw expansion, displacement or resorption of teeth
histology: (diagnostic) - thin, straight, criss-crossing septae
- few fibroblasts in “empty” space, little collagen
- Alcian Blue stain for proteoglycans
odontogenic myxoma age group
young adults 10-30yo
odontogenic myxoma treatment
resection (bone permeation), recurrence is common
odontogenic myxoma radiographic appearance
S = posterior mandible
S =
S = multilocular
O = scalloped, well-defined, variable cortication
R = RL with fine wispy internal septae, tennis racket-like
E = jaw expansion, displacement or resorption of teeth
odontogenic myxoma histology (3)
- thin, straight, criss-crossing septae
- few fibroblasts in “empty” space, little collagen
- Alcian Blue stain for proteoglycans
describe cementoblastoma (what, radiograph, histology)
- benign odontogenic tumour (ectomesenchyme +/- included odontogenic epithelium)
- progressive growth of cementum-like tissue on tooth root
S = lower 6, end of root
S = 2-3cm
S = round
O = well-defined with radiolucent rim
R = radiopaque
E = root resorption
histology: - 0.5mm fibrous rim
- lines of cementum matrix growing out in a radial pattern, gradually mineralises
- few cementoblasts
- many resting and reversal lines
cementoblastoma presenting complaint
painful bony swelling
cementoblastoma treatment
excision with extraction of tooth (unlikely to recur)
cementoblastoma radiographic appearance
S = lower 6, end of root
S = 2-3cm
S = round
O = well-defined with radiolucent rim
R = radiopaque
E = root resorption
cementoblastoma histology (4)
- 0.5mm fibrous rim
- lines of cementum matrix growing out in a radial pattern, gradually mineralises
- few cementoblasts
- many resting and reversal lines
features of malignancy on radiographs (7)
- ill-defined, moth eaten, ragged
- bone destruction, pathological fractures, non-healing sockets
- punched out appearance
- “floating” teeth
- destruction of anatomical structures (rather than displaced)
- sunray appearance (bone cancers)
- uniformly widened PDL space in absence of periodontal disease
how can you differentiate radiographically between periapical cemento-osseous dysplasia and cementoblastoma? (4)
cementoblastoma:
- attached to SINGLE tooth
- no PDL space between
- RESORBS the tooth
- keeps GROWING
radiographic features of benign lesions (6)
- well-defined
- corticated
- displacement of teeth or anatomical structures (outlines intact)
- bony expansion
- periosteal bone layering, bone deposition
- bone perforation and tracking
