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Oral Disease for FINALS > Odontogenic tumours > Flashcards

Odontogenic tumours Flashcards

1
Q

Odontogenic tissues (8)

A 
Epithelium
-oral epithelium
-dental lamina
-enamel organ
-reduced enamel epithelium
-rests of Malassez
Mesenchyme
-dental papilla
-dental follicle
-periodontal ligament
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2
Q

Remnants of odontogenic tumours and their possible consequences (3)

A

Hertwig’s root sheath –> radicular cysts
Reduced enamel epithelium –> dentigerous cysts
Dental lamina –> ameloblastoma, ameloblastic fibroma, CEOT, keratocyst, gingival cysts

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3
Q

Odontogenic tumours (3)

A

Most present as as radiolucent lesions
Some may contain calcifications
Most often at angle of mandible

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4
Q

Classification of odontogenic tumours (4)

A 
Benign:
-odontogenic epithelium alone
-odontogenic epithelium and odontogenic mesenchyme +/- dental hard tissues
-odontogenic mesenchyme alone
Malignant:
-carcinomas and sarcomas
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5
Q

Epidemiology of odontogenic tumours (4)

A

Odontogenic neoplasms are rare
Less than 1% of all tumours
Ameloblastoma is most common neoplasm
Odontomes are not neoplasms

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6
Q

Ameloblastoma epidemiology (3)

A

Benign, but locally destructive
Age 30-50
80% in mandible, most at the angle

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7
Q

Ameloblastoma: clinical (4)

A

Often asymptomatic
Bucco-lingual expansion
Root resorption or displaceent
Uni- or multi-locular radiolucency

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8
Q

Ameloblastoma - subtypes (3)

A
  1. Conventional type: intra-osseus (85%)
    - follicular
    - plexiform (many tumour contain both patterns)
  2. Unicystic: intra-osseus (14%)
  3. Peripheral: extra-osseus/ gingiva (1%)
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9
Q

The follicular pattern of ameloblastoma (histology) (4)

A

Columnar ameloblast like cells at the periphery
Stellate reticulum-like area in the centre
The epithelium resembles the enamel organ
Cysts form in stellate reticulum-like areas

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10
Q

The plexiform pattern of ameloblastoma (histology) (3)

A

Columnar ameloblast like cells forming cords
Little or no stellate reticulum-like areas
Cysts form in stroma

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11
Q

Unicystic ameloblastoma types (literature supporting this is very poor) (4)

A

True unicystic ameloblastomas - can be ennucleated:
-luminal type
-intraluminal type
Variants of conventional ameloblastoma - should be excised with a margin (2)
-mural type
-multicystic type

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12
Q

Management of ameloblastoma: conventional ameloblastoma (3)

A 
Requires excision (with margins)
Reconstruction
Maxilla can be very challenging
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13
Q

Management of ameloblastoma: true uicystic (very rare) (2)

A

Enucleation

Careful follow up

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14
Q

Adenomatoid odontogenic tumour epidemiology and cure (4)

A

Benign, does not recur, probably a hamartoma
Age 10-20, F>M
Most often in maxilla
Enucleation sufficient to cure

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15
Q

Adenomatoid odontogenic tumour radiology (2)

A

Radiolucency often around a tooth crown, may have calcifications
Differential diagnosis: dentigerous cyst

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16
Q

Adenomatoid odontogenic tumour histology (2)

A

Epithelial cells forming sheets and duct-like structures

Calcification common

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17
Q

Calcifying epithelial odontogenic tumour (‘Pindborg tumour’) epidemiology (3)

A

Benign but locally destructive
Age 10-60
2/3 in mandible, molar region +/- u/e tooth

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18
Q

Calcifying epithelial odontogenic tumour (‘Pindborg tumour’) radiology (1)

A

Radiolucency with speckled calcifications

19
Q

Calcifying epithelial odontogenic tumour (‘Pindborg tumour’) histology (2)

A

Composed of ‘pleomorphic’ epithelium with calcifications, ‘dentinoid’ and amyloid
Cuboidal cells with ‘prickles’

20
Q

Calcifying epithelial odontogenic tumour (‘Pindborg tumour’) treatment (1)

A

As for ameloblastoma

21
Q

Is the odontogenic keratocyst a tumour? (3)

A 
Clinical evidence
-pattern of recurrence
-link to NBCCS (gorlin-Goltz)
Genetic evidence
-PTCH mutations (9q22-31)
-clonality?
In 2005, the WHO changed the name to keratocystic odontogenic tumour (KCOT): this was reversed in the 2017 classification
22
Q

Group 2: Odontogenic epithelium and

Odontogenic mesenchyme +/- dental hard tissue (3)

A

Ameloblastic fibroma
Dentinogenic ghost cell tumour
Odontomes - covered in an earlier lecture

23
Q

Ameloblastic fibroma epidemiology (3)

A

Benign
Age <20
Often in mandible

24
Q

Ameloblastic fibroma radiology (2)

A

Well defined radiolucency

80% associated with unerupted tooth

25
Q

Ameloblastic fibroma histology

A

Branching cords and islands of epithelium resembling enamel organ or dental lamina
Characteristic fine cellular stroma

26
Q

Dentinogenic ghost cell tumour epidemiology (4)

A 
Benign
Very rare
Age most 40.60
M>F
Mandible or maxilla
27
Q

Dentinogenic ghost cell tumour radiology (1)

A

Radiolucency, may have calcifications

28
Q

Dentinogenic ghost cell tumour histology (3)

A

Epithelium resembling ameloblastoma
Ghost cells and dentine
Overlap with calcifying odontogenic cyst

29
Q

Odontomes (4)

A

Hamartomas: benign malformations
Age: up to 20 (developing dentition)
May be mmandible or maxilla
Radiolucency containing tooth-like structure

30
Q

Compound odontome (5)

A
  • Twice as common as complex odontome
  • Maxilla > Mandible
  • Incisor / Canine regions
  • Small and non-aggressive
  • A collection of ‘denticles’ (mini-teeth)
31
Q

Complex odontome (5)

A 
• Mandible > Maxilla
• Premolar / Molar regions
• 10 – 25 year age group
• Often a missing tooth in the arch
• A fused mass of haphazardly arranged
tooth tissues but normal morphogenetic
relations are preserved
32
Q

Group 3: odontogenic mesenchyme alone (3)

A
  • Myxoma/myxo-fibroma
  • Odontogenic Fibroma
  • Cementoblastoma
33
Q

Myxoma and fibromyxoma epidemiology (3)

A

Benign but locally destructive
10-30 years
Most in mandible

34
Q

Myxoma and fibromyxoma: clinical (1)

A

Slow growing painless swelling

35
Q

Myxoma and fibromyxoma radiology (3)

A

Uni- or multi-locular radiolucency
‘Soap-bubble’ appearance
Root displacement or resorption

36
Q

Myxoma and fibromyxoma histolgoy (2)

A

Triangular/ stellate cells in loose myxoid stroma

37
Q

Myxoma and fibromyxoma treatment (1)

A

As for ameloblastoma

38
Q

Odontogenic fibroma (4)

A

• Wide age range, F

39
Q

Odontogenic fibroma histolgoy (2)

A

• mature fibrous tissue,
• variable amounts of inactive
odontogenic epithelium

40
Q

Cementoblastoma epidemiology (3)

A

Benign
Age 10-40
Usually mandible, affecting molar teeth

41
Q

Cementoblastoma radiology (2)

A

Radiopaque lesion attached to tooth root

42
Q

Cementoblastoma histology (2)

A

Sheets of cementum and osteoid in a mosaic pattern; many plump cementoblasts
Resembles osteoblastoma

43
Q

Malignant odontogenic tumour (3)

A 
Very rare
Odontogenic carcinomas
• Ameloblastic carcinoma
• Primary intra-osseous carcinoma
• Clear cell odontogenic carcinoma
• Malignant variants of other tumours/cysts
Odontogenic sarcomas

Oral Disease for FINALS (34 decks)

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