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4 - radiology > odontogenic tumours > Flashcards

odontogenic tumours Flashcards

1
Q

How are odontogenic tumours classified?

A

Based on tissue of origin:
- epithelial
- mesenchymal
- mixed (epithelial and mesenchymal)

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2
Q

What type of odontogenic tumours can have dentine/enamel formation and why is this?

A

Only mixed tumours due to the concept of induction:
Dentine forms first from odontoblasts which are mesenchymal in origin
Ameloblasts don’t start forming enamel until dentine starts getting laid down
So the presence of dentine is needed for induction and maturation of ameloblasts for enamel formation

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3
Q

What are the odontogenic sources of epithelium that form odontogenic tumours?

A

Rests of Malassez - remnants of Hertwig’s epithelial root sheath
Rests of Serres - remnants of the dental lamina
Reduced enamel epithelium - remnants of the enamel organ

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4
Q

Give 3 examples of odontogenic tumours?

A

Ameloblastoma
Adenomatoid odontogenic tumour
Calcifying odontogenic tumour

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5
Q

Give an example of a mesenchymal odontogenic tumour

A

Odontogenic myxoma

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6
Q

Give an example of a mixed odontogenic tumour

A

Odontoma (odontomes)

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7
Q

How do odontogenic tumours appear radiographically?

A

Highly variable - can be entirely radiolucent, mixed or entirely radiopaque
May change as tumour progresses
50% of cases are either ameloblastoma or odontoma

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8
Q

Describe the presentation of an ameloblastoma

A

Benign epithelial tumour
Locally destructive but slow-growing
Typically painless

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9
Q

What is the incidence of ameloblastomas?

A

Makes up 1% of oral and maxillofacial tumours
Most common in 4th-6th decades
80% occur in posterior mandible
Affects males more than females

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10
Q

What are the radiological types of ameloblastoma?

A

Multicystic (85-90%)
Unicystic - affects younger patients and has a lower recurrence risk

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11
Q

What are the histological types of ameloblastoma?

A

Follicular
Plexiform
Desmoplastic
Several other less common types

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12
Q

Describe the margins of ameloblastomas

A

Usually well-defined and corticated
Potentially scalloped
If Multicystic have thick curved septa giving a soap-bubble appearance

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13
Q

How do ameloblastomas affect adjacent structures?

A

May cause displacement of structures, thinning of bony cortices and a knife edge external root resorption

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14
Q

Describe the histology of follicular ameloblastomas

A

Ameloblast-like cells
Stellate reticulum like tissue
Cystic changes and fibrous changes are seen

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15
Q

Describe the histology of Plexiform ameloblastomas

A

Ameloblast-like cells are seen in between stellate reticulum-like tissues
Fibrous tissue present

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16
Q

What are Adenomatoid odontogenic tumours (AOT) and how does it present?

A

A benign epithelial tumour
Classically presents as a unilocular radiolucency with internal calcifications around crown of unerupted maxillary canine

17
Q

What is the incidence of AOTs?

A

Makes up 3% of odontogenic tumours
Most common in 2nd decades
Affects females more than males
Majority occur in anterior maxilla

18
Q

How do AOTs present radiographically?

A

75% associated with an unerupted tooth - commonly a maxillary canine, similar to a dentigerous cysts but typically attached apical to the CEJ
Unilocular radiolucency
Majority have internal calcifications/radiopacities which increase as the tumour matures
Margins well-defined and corticated/sclerotic
May displace adjacent structures but ERR is rare

19
Q

Describe the histology of AOTs

A

Duct like structure seen
Distinctive patchy calcification seen
Recurrence rate very low

20
Q

What are calcifying epithelial odontogenic tumours (CEOT)?

A

A benign epithelial tumour
Aka - Pindborg tumour

21
Q

What is the incidence of CEOTs?

A

Makes up 1% of odontogenic tumours
Most common in 5th decade
Affects males more than females
Posterior mandible is most common site

22
Q

How do CEOT present?

A

Slow growing but can become large
Half are associated with an unerupted tooth
Radiolucency often with internal radiopacities - calcifications
Variable radiographic presentation otherwise - unilocular/multilocular, margins well/poor defined, internal septa can be fine/coarse/none at all

23
Q

What is an odontogenic myxoma?

A

A benign mesenchymal tumour

24
Q

What is the incidence of odontogenic myxomas?

A

Makes up 3-6% of odontogenic tumours
Most common in 3rd decade
Equal male to female ratio
More common in the mandible

25
Q

How do odontogenic myxomas present?

A

Well-defined radiolucency +/- thin corticated maergins
Larger lesions tend to be multilocular with scalloped margins - soap bubble appearance
Slow growth along bone before causing buccal-lingual expansion
Scallops between teeth but larger lesions may cause displacement - ERR is rare

26
Q

Describe the histology of odontogenic myxomas

A

Loose myxoid tissue with stellate cells
May contain islands of inactive odontogenic epithelium
No capsule so is locally invasive

27
Q

How are odontogenic myxomas managed?

A

Curettage or resection depending on size
High recurrence rate - 25%
Follow up is important
Lower recurrence rate if unilocular

28
Q

What is an odontoma?

A

A benign mixed tumour
Technically a hamartoma
Malformation of dental tissue - enamel, dentine, cementum and pulp

29
Q

What similarities do odontomes have to teeth?

A

Mature to a certain stage ie - do not grow indefinitely
Can be associated with other odontogenic lesions eg - dentigerous cysts
Surrounded by dental follicle
Lie above the inferior alveolar canal

30
Q

What is the incidence of odontomes?

A

1/5 to 2/3 of all odontogenic tumours
Most common in 2nd decade
Affects males and females equally

31
Q

What are the types of odontomes?

A

Compound
Complex

32
Q

Describe compound odontomes and where they are found

A

Ordered dental structures
May appear as multiple mini teeth ie - denticles
More common in the anterior maxilla

33
Q

Describe complex odontomes and where they are found

A

Disorganised mass of dental tissues
More common in posterior body of mandible

34
Q

What type of odontome is more common?

A

Compound more common than complex with 2:1 ratio

35
Q

Describe the histology of odontomes

A

Will have dental hard tissue as it is a mixed odontogenic tumour
Will see areas of enamel, dentine, cementum and pulp
If enamel isn’t fully calcified it is more organic and may be present
Acid during slide prep will dissolve the calcified enamel

4 - radiology (8 decks)

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