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Odontogenic tumours Flashcards

1
Q

What can the odontogenic tumours be categorised into?

A
  • Odontogenic epithelium without mesenchyme
  • Odontogenic epithelium with odontogenic ectomesenchyme, with or without hard tisuse formation
  • Odontogenic ectomesenchyme
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2
Q

What are the sources of odotogenic epithelium?

A
  • Rest of Serres
  • Dental lamina
  • Reduced enamel epithelium
  • Root sheath of Hertwig
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3
Q

What are the sources of odontogenic mesenchyme?

A
  • Dental papilla

- Dental follicle

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4
Q

What can occur in the presence of both odontogenic epithelium and mesenchyme?

A
  • Formation of hard tissue, resulting in a mixed RO/RL lesion
  • However note that hard tissue is not always formed even if both are present
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5
Q

What is histodifferentiation?

A

Differentiation of embryological cells into their cell types - in this case into ameloblasts and odontoblasts

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6
Q

What is morphodifferentiation?

A
  • Differentiation of tissues into the shape of the future tissue - e.g. into the shape of the future crown of the tooth
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7
Q

What is the differential diagnosis for odontogenic tumours?

A
  • Localised infection
  • Spreading infection
  • Cysts (odontogenic and non-odontogenic)
  • Non-odontogenic tumours and neoplasms
  • Giant cell lesions
  • Early fibro-osseous lesions
  • Idiopathic lesions
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8
Q

Where can odontogenic tumours arise?

A

In tooth bearing areas, the alveolar ridge and the soft tissues overlying them

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9
Q

List the benign epithelial odontogenic tumours

A
  • Ameloblastoma
  • Squamous odontogenic tumour
  • Adenomatoid odontogenic tumour
  • Calcifying epithelial odontogenic tumour (CEOT or Pindborg)
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10
Q

What is the most common odontogenic neoplasm

A

Ameloblastoma

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11
Q

What is an ameloblastoma

A

Benign neoplasm of ameloblasts (epithelial odontogenic tumour)

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12
Q

What is the key causative mutation highlighted in ameloblastomas?

A

BRAF V600E

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13
Q

What are the types of ameloblastoma

A

Multicystic/solid (most common)
Unicystic
Peripheral
Desmoplastic

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14
Q

Epidemiology of multicystic alemoblastomas

A

Age 30-40

More common in Africans and Afro-carribeans

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15
Q

Describe the effects of multicystic ameloblastomas

A
  • Locally infiltrative
  • Slow growing
  • Rarely metastasizes
  • Usually asymptomatic or a swelling with a jaw that becomes obstructive
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16
Q

Describe the invasive nature of ameloblastomas

A

It pushes islands of odontogenic epithelium unto the surrounding medullary spaces a few mm beyond the main bony cavity

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17
Q

Describe the radiographic appearance of ameloblastomas

A

Site: 80% in the mandible (premolar region and lower ramus)
Size - variable
Shape - multilocular with honeycomb appearance (distinct septa)
Outline - scalloped and smooth, well-defined and corticated
RD - RL with internal RO septa
Effects - adjacent teeth displaced, resorbed or loosened. extensive expansion in all dimensions

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18
Q

Where are maxillary amelbolastomas very dangerous?

A

Maxilla is thinner than the mandible therefore it spreads quicker
It spreads upwards invading the sinonasal passages, pterygomaxillary fossa, orbit and cranium

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19
Q

Histology of ameloblastoma

A
  • Variable
  • Common feature of islands or strands of epithelium with a peripheral layer of pre-ameloblast like cells with reverse polarity
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20
Q

What are the two main histological patterns of ameloblastomas

A
  • Follicular (most common)

- Plexiform

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21
Q

Describe the follicular histological pattern of ameloblastomas

A

Islands of odontogenic epithelium within a fibrous stroma (pre-ameloblasts like cells surrounding a core of loosely arranged cells resembling stellate reticulium)

22
Q

Describe the plexiform histological pattern of ameloblastomas

A

Basal cells arranged in long, anastomosing strands with fibrous stoma

23
Q

Tx of ameloblastomas

A
  • Complete excision with a small margin (1-2cm) of normal tissue - therefore large tumours may require jaw resection
24
Q

Can enucleation be used for ameloblastomas?

A
  • ONLY for well-localised mandibular lesions
  • Requires close monitoring and gold standard treatment at any sign of recurrence
  • NOT FOR MAXILLARY
25
What is the recurrence rate of ameloblastomas
10% after 10 years
26
What are unicystic ameloblastomas
- Variant of an ameloblastoma that presents as a single cyst
27
How many ameloblastomas are unicystic?
5-15%
28
Epidemiology of unicystic ameloblastomas
10-30 year olds
29
Describe the radiographic appearance of unicystic ameloblastomas
- Site - almost always mandibular lower 8 area (may have false dentigerous relationship) or with apices (false radicualr) - Size - variable - Shape - unilocular - Outline - smooth and well corticated - RD - RL
30
How is a unicystic ameloblastoma diagnosed?
After through histological assessment of the entire capsular wall - It has to be unicystic radiographically and histologically
31
Tx of unicystic ameloblastomas
- Enucleation is successful with low risk of recurrence
32
Why can unicystic ameloblastomas be treated with enucleation?
Because the epithelium is enclosed by a fibrous cyst wall (it does not infiltrate the surrounding bone)
33
What are mural ameloblastomas?
Appear as unicystic - however they have one large cavity and lots of small ones
34
What is a metastasising ameloblastoma?
Very rare tumour | It appears histologically like an ameloblastoma but it metastasizes, usually to the lung
35
What is an ameloblastic carcinoma?
Very rare tumour that initially resembles an ameloblastoma histologically, but develops into a carcinoma and spreads to the lymph nodes and beyond (it may appear like a SCC histologically)
36
What is a squamous odontogenic tumour?
Very rare benign neoplasm that is locally infiltrative
37
What is the proposed origin of squamous odontogenic tumours
Cell rests of Malassez or remnants of the dental lamina
38
Where are squamous odontogenic tumours found?
Between the roots of teeth, producing a triangular or unilocular radiolucent lesion, which may become mulilocular when larger
39
Tx of squamous odontogenic tumours
Local excision has good success
40
What are adenomatoid odontogenic tumours?
Uncommon, slow-growing benign odontogenic tumour, that is probably a hamartoma
41
Describe the patient and clinical features of an adenomatoid odontogenic tumour
- 15-20 yo - Females 2x > males - Maxilla > mandible - Asyptomatic, but may cause jaw expansion or displacement
42
Describe the radiographic appearance of an adenomatoid odontogenic tumour
Site - usually anterior maxilla, associated with an unerupted tooh Size - variable Shape - round or oval, unilocular Outline - smooth, well-defined and corticated RD - initially RL but can have small internal calcifications Effects - expansion of the jaw, displacement of teeth but rarely resorbs
43
Histology of adenomatoid odontogenic tumours
Solid nodules of odontogenic epithelim organised into rosettes There may be eosionophillc areas and globules of amyloid-like matrial
44
Tx of adenomatoid odontogenic tumours
Enucleation or conservative local excision (it is non-infiltrative)
45
What are calcifying epithelial odontogenic tumours (CEOT)?
Very rare, locally invasive odontogenic tumours
46
Describe patient and clinical features of CEOT
Age 20-60 (usually elderly pts) | Typically asymptomatic, slow growing and expands the jaw
47
Describe the histology of CEOT
- Cystic change is not a common feature - There are islands and sheets of epithelial cells in a connective tissue stroma - Bizarre pleomorphic and hyperchromatic nuclei and amyloid-like material
48
Tx of CEOT
- Complete excision with a margin of normal tissue
49
Describe the radiographic appearance of CEOT
- Site - premolar or posterior region of mandible > maxilla - Size - tend to be small - Shape - unilocular or multilocular Outline - smooth or scalloped, variably defined and corticated RD - Mixed Effects - expansion of jaw, displacement and resorption of teeth
50
What may CEOT be mistaken for histologically and why?
- For a SCC due to the enlarged and darkly stained nuclei
51
What produces amyloid in odontogenic lesions?
Odontogenic ameloblast associated protein

Oral Disease - Hard tissue (4 decks)

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