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BDS5 oral disease > odontogenic tumours > Flashcards

odontogenic tumours Flashcards

1
Q

what are the different classifications of odontogenic tumours? (4)

A
  • odontogenic epithelium without odontogenic ectomesenchyme
  • odontogenic epithelium with odontogenic ectomesenchyme +/- dental hard tissues
  • odontogenic ectomesenchyme +/- included odontogenic epithelium
  • malignant odontogenic tumours (carcinomas or sarcomas)
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2
Q

what are some general differentials for odontogenic tumours? (6)

A
  • localised or spreading infection
  • cysts
  • non-odontogenic tumours and neoplasms
  • giant cell lesions
  • early fibro-osseous lesions
  • idiopathic lesions
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3
Q

describe the dental papilla histology (3)

A
  • gelatinous myxoid tissue
  • cells in a background matrix, rich in proteoglycans, lots of water
  • stains with Alcian blue
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4
Q

give some tissues that are included in odontogenic epithelium (~4)

A
  • dental lamina
  • rests of Serres
  • enamel epithelium
  • Hertwig’s root sheath
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5
Q

what is an odontogenic tumour

A

swelling derived from tooth-forming tissues

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6
Q

what are the main presenting complaints with odontogenic tumours? (3)

A
  • swellings
  • failed eruption
  • displaced teeth
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7
Q

what is the difference between histodifferentiation and morphodifferentiation?

A
  • histodifferentiation = differentiation of cells (into types of tissues)
  • morphodifferentiation = differentiation of tissues into shapes (of teeth)
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8
Q

which odontogenic tumours are odontogenic epithelium only? (4)

A
  • ameloblastoma
  • calcifying epithelial odontogenic tumour (Pindborg)
  • squamous odontogenic tumour
  • adenomatoid odontogenic tumour
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9
Q

which odontogenic tumours are in the category epithelium and ectomesenchyme +/- dental hard tissues? (5)

A
  • ameloblastic fibroma
  • calcifying odontogenic cyst/tumour
  • odontoma/e
  • primordial odontogenic tumour
  • dentinogenic ghost cell tumour
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10
Q

which odontogenic tumours are in the category of odontogenic ectomesenchyme +/- included epithelium? (4)

A
  • odontogenic fibroma
  • odontogenic myxoma
  • granular cell odontogenic tumour
  • cementoblastoma
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11
Q

list some odontogenic carcinomas (5)

A
  • ameloblastic carcinoma
  • primary intraosseous carcinoma
  • sclerosing odontogenic carcinoma
  • clear cell odontogenic carcinoma
  • ghost cell odontogenic carcinoma
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12
Q

name the odontogenic sarcomas (2)

A
  • ameloblastic fibrosarcoma
  • ameloblastic fibro-odonto-sarcoma
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13
Q

describe conventional ameloblastoma (what, demographic, presentation, radiograph)

A
  • 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
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14
Q

what is the commonest odontogenic neoplasm?

A

ameloblastoma

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15
Q

conventional ameloblastoma radiographic appearance

A

S = posterior mandible
S =
S = multilocular
O = well-defined, corticated
R = RL with radiopaque septae
E = jaw expansion, displacement, especially root resorption

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16
Q

conventional ameloblastoma demographic

A

middle aged Afrocaribbean (30-50yo)

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17
Q

ameloblastoma histology and variants (2)

A

conventional/multicystic:
- ameloblasts in islands
- variants = follicular, plexiform, granular cell, basal cell, desmoplastic

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18
Q

conventional ameloblastoma common site

A

posterior mandible

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19
Q

ameloblastoma types

A

solid multicystic
unicystic

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20
Q

which histological type of ameloblastoma has honeycomb radiographic appearance?

A

desmoplastic

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21
Q

treatment of ameloblastoma (2)

A
  • 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
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22
Q

describe unicystic ameloblastoma (what, age, radiographic)

A
  • 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
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23
Q

which type of ameloblastoma may be enucleated without recurrence?

A

unicystic

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24
Q

unicystic ameloblastoma radiographic appearance

A

S = posterior mandible, associated with unerupted displaced 8 in dentigerous relationsip
S =
S = unilocular
O = well-defined, corticated
R = RL
E = displacement, jaw expansion

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25
Q

unicystic ameloblastoma age group

A

20-30yo

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26
Q

describe calcifying epithelial odontogenic tumour (Pindborg) (what, age, radiographic, histology)

A
  • 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
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27
Q

calcifying epithelial odontogenic tumour (Pindborg) age group

A

50-60yo at presentation

28
Q

calcifying epithelial odontogenic tumour (Pindborg) radiographic appearance

A

S = mandible, premolar-molar area
S =
S = multilocular > unilocular
O = variably defined, corticated
R = RL with internal mineralisations
E = jaw expansion, displacement, root resorption

29
Q

calcifying epithelial odontogenic tumour (Pindborg) histology (4)

A
  • nuclear atypia (degenerative)
  • strands of epithelium
  • amyloid protein (ODAM) deposits between cells +/- mineralisation
  • apple-green birefringence with Congo Red stain of amyloid
30
Q

why does calcifying epithelial odontogenic tumour (Pindborg) have internal mineralisations radiographically?

A

mineralisation of amyloid protein deposits between cells

31
Q

what is an important histological misdiagnosis of calcifying epithelial odontogenic tumour (Pindborg) ?

A

squamous cell carcinoma

32
Q

describe ameloblastic fibroma (what, age, radiographic, histology)

A
  • 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
33
Q

ameloblastic fibroma age group

A

young 5-20yo

34
Q

ameloblastic fibroma radiographic appearance

A

S = premolar/molar region
S =
S = multilocular
O = well-defined, corticated
R = RL with internal septae
E = jaw expansion, displacement

35
Q

ameloblastic fibroma histology (4)

A

no hard tissues
- many odontogenic fibroblasts in gelatinous matrix
- islands or branching strands of odontogenic epithelium
- tooth germ-like buds of ameloblast-like cells

36
Q

ameloblastic fibroma presenting complaint (2)

A

painless swelling or missing tooth

37
Q

describe adenomatoid odontogenic tumour (what, age, radiograph, histology)

A
  • 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)
38
Q

adenomatoid odontogenic tumour age group

A

teens (10-20yo)

39
Q

adenomatoid odontogenic tumour radiographic appearance

A

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

40
Q

adenomatoid odontogenic tumour histology (4)

A
  • pre-ameloblast-like cells, pink enamel matrix +/- mineralisation
  • duct-like structures
  • whorled epithelial cells
  • dentinoid tissue (close to epithelium)
41
Q

describe calcifying odontogenic cyst/tumour (what, types, age, radiograph, histology)

A
  • 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
42
Q

calcifying odontogenic cyst/tumour radiographic appearance

A

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

43
Q

calcifying odontogenic cyst/tumour histology (2)

A
  • odontogenic epithelial lining (ameloblasts)
  • “ghost cells” - stacked flattened epithelial cells, nuclear “hole”
44
Q

what other tumour may calcifying odontogenic cyst/tumour look like histologically, and what feature differentiates them?

A
  • ameloblastoma
  • calcifying odontogenic cyst/tumour has ghost cells
45
Q

calcifying odontogenic cyst/tumour treatment (2)

A

cystic = enucleation
solid = excision with small margin

46
Q

describe odontoma/e (what, types, effects)

A
  • 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
47
Q

what is the commonest odontogenic tumour?

A

odontoma/e (esp compound)

48
Q

what are ameloblastic fibrodentinomas and ameloblastic fibro-odontomas?

A

odontomes which have not yet fully matured/mineralised

49
Q

what terms may be used to describe immature odontomes? (2)

A

ameloblastic fibrodentinoma
ameloblastic fibro-odontoma

49
Q

describe odontogenic fibroma (what, age, radiograph, histology)

A
  • 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
49
Q

odontogenic fibroma treatment

A

enucleation (but 50% recur)

50
Q

odontogenic fibroma radiographic appearance

A

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

51
Q

odontogenic fibroma histology (2)

A
  • mostly fibrous tissue (plump fibroblasts, collagen)
  • rests of odontogenic epithelium
52
Q

describe odontogenic myxoma (what, growth, age, radiograph, histology)

A
  • 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
53
Q

odontogenic myxoma age group

A

young adults 10-30yo

54
Q

odontogenic myxoma treatment

A

resection (bone permeation), recurrence is common

55
Q

odontogenic myxoma radiographic appearance

A

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

56
Q

odontogenic myxoma histology (3)

A
  • thin, straight, criss-crossing septae
  • few fibroblasts in “empty” space, little collagen
  • Alcian Blue stain for proteoglycans
57
Q

describe cementoblastoma (what, radiograph, histology)

A
  • 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
58
Q

cementoblastoma presenting complaint

A

painful bony swelling

59
Q

cementoblastoma treatment

A

excision with extraction of tooth (unlikely to recur)

60
Q

cementoblastoma radiographic appearance

A

S = lower 6, end of root
S = 2-3cm
S = round
O = well-defined with radiolucent rim
R = radiopaque
E = root resorption

61
Q

cementoblastoma histology (4)

A
  • 0.5mm fibrous rim
  • lines of cementum matrix growing out in a radial pattern, gradually mineralises
  • few cementoblasts
  • many resting and reversal lines
62
Q

features of malignancy on radiographs (7)

A
  • 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
63
Q

how can you differentiate radiographically between periapical cemento-osseous dysplasia and cementoblastoma? (4)

A

cementoblastoma:
- attached to SINGLE tooth
- no PDL space between
- RESORBS the tooth
- keeps GROWING

64
Q

radiographic features of benign lesions (6)

A
  • well-defined
  • corticated
  • displacement of teeth or anatomical structures (outlines intact)
  • bony expansion
  • periosteal bone layering, bone deposition
  • bone perforation and tracking

BDS5 oral disease (26 decks)

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