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Oral Disease > Odontogenic Tumours > Flashcards

Odontogenic Tumours Flashcards

1
Q

What epithelium can odontogenic tissues arise from?

A 
Epithelium:
Oral epi
Dental lamina
Enamel organ
Reduced enamel epi
Rests of malassez

Mesenchyme:

  • Dental papilla
  • Dental follicle
  • Periodontal ligament
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2
Q

What arises from hertwig’s root sheath?

A

Radicular cysts

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3
Q

What arises from the reduced enamel epithelium?

A

Dentigerous cysts

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4
Q

What arises from the dental lamina?

A 
Ameloblastoma
Ameloblastic fibroma
CEOT
Keratocyst
Gingival crest
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5
Q

What are odontogenic tumours most present as? Where?

A

Most present as radiolucent lesions
Some may contain calcifications
Most often at angle of mandible as arise from dental lamina = 8 is last use of dental lamina

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6
Q

Classification of odontogenic tumours?

A

Benign

  • Odontogenic epithelium alone = GROUP 1
  • Odontogenic epithelium and odontogenic mesenchyme +/- dental hard tissues
  • Odontogenic mesenchyme alone

Malignant
- Carcinomas and sarcomas

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7
Q

Epidemiology of odontogenic tumours?

A

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

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8
Q

What makes up group 1: odontogenic epithelium alone?

A

Ameloblasoma
Adenomatoid odontogenic tumour (AOT)
Calcifying epithelial odotogenic tumour (CEOT)
Squamous odontogenic tumour (SOT)

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9
Q

Ameloblastoma features?

A

Benign but locally destructive

Uni or multi-locular radiolucency

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10
Q

Ameloblastoma epidemiology?

A

Epidemiology:

  • Age: 30-50
  • 80% in mandible, most at angle
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11
Q

Clinical presentation of ameloblastomas?

A

Clinical:

  • Often asymp until obstruction of nerves
  • Bucco-lingual expansion
  • Root resorption or displacement

Uni or multi-locular radiolucency
Medial pterygoid muscle attachment onto pterygoid plates at lingual side of mandible - muscle can be affected

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12
Q

Ameloblastoma subtypes?

A
  1. Conventional types: intra-osseous
    - Follicular
    - Plexiform
    = 85%
  2. Unicystic: intra-osseous 14%
    - Younger patients 10-20
    - Mainly posterior mandible
  3. Peripheral: extra-osseous/gingiva 1%
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13
Q

Ameloblastoma histology?

A

Follicular pattern: Columnar ameloblast like cells at the periphery with reverse polarity
Stellate reticulum like area in the centre
Epithelium resembles the enamel organ and there are islands and trabeculae of epithelial cells in a CT stroma
Cysts form in stellate reticulum like areas

Plexiform pattern:

  • Columnar ameloblasts like cells forming cords
  • Epithelium forms strands and trabeculae of small, darkly staining epithelial cells in a CT stroma with few cells
  • Little or no stellate reticulum like areas
  • Cysts form in stroma
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14
Q

Management of ameloblastoma?

A

Diagnosis via biopsy

Conventional ameloblastoma:

  • Requires excision (1-2cm with margins of normal bone to remove any extension into the surrounding bone)
  • Reconstruction if removing part of mandible
  • Maxilla can be very challenging: Bones are thinner and are weak barriers to spread. Can invade up into the orbit ad the brain.

True unicystic (v rare, types 1 and 2)

  • Enucleation but risk of recurrence
  • Careful follow up
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15
Q

Features of adenomatoid odontogenic tumour? How to treat?

A

Benign, does not recur, probably a hamartoma

Enucleation sufficient to cure - do not reoccur

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16
Q

Epidemiology of adenomatoid odontogenic tumour?

A

Age 10-20, F>M

Most often in maxilla, especially unerupted maxillary canine

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17
Q

Radiological appearance of of adenomatoid odontogenic tumour?

A

Radiolucency often around a tooth crown, may have calcifications - fine and speckled like a snow storm radiopaque appearance

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18
Q

Histology of adenomatoid odontogenic tumour?

A

Epithelial cells forming sheets and duct like structures

Calcified material a bit like dentine

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19
Q

Differential diagnosis of of adenomatoid odontogenic tumour?

A

Dentigerous cyst

20
Q

Calcifying epithelial odontogenic tumour (Pindborg tumour) features?

A

Benign but locally destructive

21
Q

Calcifying epithelial odontogenic tumour epidemiology?

A

10-60
2/3 in mandible, molar region +/- unerupted tooth
Symptoms lacking until a swelling appears

22
Q

Calcifying epithelial odontogenic tumour radiological appearance?

A

Radiolucency with speckled calcifications, increasing radiopacity as it matures
Poorly defined margins

23
Q

Calcifying epithelial odontogenic tumour histology?

A

Composed of pleomorphic epithelium with calcifications, dentinoid and amyloid
Enamel matrix material which may calcify
Cuboidal cells with prickles
Large flat cells with a single nucleus in them

24
Q

Calcifying epithelial odontogenic tumour treatment?

A

Like ameloblastoma - surgical removal with margins, reconstruction or enucleation

25
Q

Is the odontogenic keratocyst a tumour?

A

Clinical evidence:

  • Pattern of recurrence
  • Link to NBCCS (gorlin goltz)

Genetic evidence

  • PTCH mutations (9q22-31)
  • Clonality evidence?
26
Q

Group 2 odontogenic epithelium and odontogenic mesenchyme +/- dental hard tissues types?

A

Ameloblastic fibroma
Dentinogenic ghost cell tumour

Odontomes

27
Q

Benign or malignant - ameloblastic fibroma?

A

Benign

28
Q

Ameloblastic fibroma epidemiology?

A

<20

Often in mandible

29
Q

Ameloblastic fibroma radiology?

A

Well defined radiolucency

80% associated with unerupted tooth

30
Q

Ameloblastic fibroma histology?

A

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

31
Q

Dentinogenic ghost cell tumour features?

A

Benign

32
Q

Dentinogenic ghost cell tumour epidemiology?

A

V rare
40-60
M>F
Mandible or maxilla

33
Q

Dentinogenic ghost cell tumour radiology?

A

Radiolucency, may have calcifications

34
Q

Dentinogenic ghost cell tumour histology?

A 
Epithelium resembling ameloblastoma
Ghost cells (nuclei disappear leaving white spots) and dentine
Overlap with calcifying odontogenic cyst
35
Q

Odontomes features?

A

Hamartomas: benign malformations
Up to 20 yrs old (developing dentition)
May be mandible or maxilla
Radiolucency containing tooth like structures

36
Q

Compound odontome features?

A 
2X more common as complex odontome
Maxilla>mandible
Incisor/canine regions
Small and non-aggressive
A collection of denticles (mini teeth)
37
Q

Complex odontome features?

A 
Mandible > maxilla
Premolar/molar regions
10-25yr age group
Often a missing tooth in the arch 
A fused mass of haphazardly arranged tooth tissues but normal morphogenic relations are preserved
Enucleated and removed = do not recur
38
Q

Group 3 odontogenic mesenchyme alone types?

A

Myxoma/myxo-fibroma
Odontogenic fibroma
Cementoblastoma

39
Q

Myxoma and fibromyxoma features?

A

Benign but locally destructive

40
Q

Myxoma and fibromyxoma epidemiology?

A

10-30yrs

Most in mandible

41
Q

Myxoma and fibromyxoma clinical features?

A

Slow growing, painless swelling

42
Q

Myxoma and fibromyxoma radiology?

A

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

43
Q

Myxoma and fibromyxoma histology?

A

Triangular/stellate cells in loose myxoid stroma

Pale staining with spindle cells

44
Q

Myxoma and fibromyxoma treatment?

A

As for ameloblastoma

- excision with a margin

45
Q

Odontogenic fibroma features?

A 
Wide age range
M>F
Md = Mx
Central and peripheral types
Most often unilocular radiolucency
Histology: mature fibrous tissue, variable amounts of inactive odontogenic epithelium
46
Q

Cementoblastoma?

A

Benign
10-40
Usually mandible, affecting molar teeth
Radiopaque lesion ATTACHED TO TOOTH ROOT

Histo:
Sheets of cementum and osteoid in a mosaic pattern, many plump cementoblasts
Resembles osteoblastoma

47
Q

Malignant odontogenic tumours? Types?

A

V rare

Odontogenic carcinomas

  • Ameloblastic carcinoma
  • Primary intra-osseous carcinoma
  • Clear cell odontogenic carcinoma
  • Malignant variants of other tumours/cysts

Odontogenic sarcomas

Oral Disease (42 decks)

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