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BDS3 Oral Pathology > Odontogenic Tumours - ameloblastoma > Flashcards

Odontogenic Tumours - ameloblastoma Flashcards

1
Q
A
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2
Q

Whee o of odontogenic tumors originate?

A

Remanat of toot forming tissues

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3
Q

Ordontogenic tumours benign?

A

Yes and do not metastasise

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4
Q

Odontogenic tumors cause bone destruction?

A

some are locally invasive and cause bone
destruction.

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5
Q

Name the epithelial without odontogenic mesenchymal?

A

Ameloblastoma (all types)
* Squamous odontogenic tumour
* Calcifying epithelial odontogenic tumour
* Adenomatoid odontogenic tumour

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6
Q

Name the Epithelial with odontogenic mesenchyme
(mixed)?

A
  • Odontoma
  • Ameloblastic fibroma
  • Primordial odontogenic tumour
  • Dentinogenic ghost cell tumour
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7
Q

Name the mesenchymal benign odontogenic tumours?

A
  • Odontogenic fibroma
  • Odontogenic myxoma
  • Cementoblastoma
  • Cemento-ossifying fibroma
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8
Q

Name the malignant odontogenic tumours?

A
  • Sclerosing odontogenic carcinoma
  • Ameloblastic carcinoma
  • Clear cell odontogenic carcinoma
  • Ghost cell odontogenic carcinoma
  • Primary intraosseous carcinoma, NOS
  • Odontogenic carcinosarcoma
  • Odontogenic sarcomas
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9
Q

What type of tnour is ameloblastoma?

A

Benign but locally invasive

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10
Q

Ameloblastoma rare or common?

A

Rare

Several variants but the most common is the
conventional/ solid/multi-cystic ameloblastoma

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11
Q

Clinical presentation of ameloblastoma?

A

Clinical presentation:
* Most cases between 30 and 60, and rare before
20.
* Geographic variations.
* Mainly in the jaws, rarely in sinonasal cavities.
* 80% in the mandible (70% in the molar region and
ascending ramus). Population variation.
* In the maxilla, mainly in the molar region.

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12
Q

Ameloblastoma slow or fast growing tumour?

A

Slow growing tumour

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13
Q

Ameloblastoma symptomatic?

A

Asymptomatic at early stages

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14
Q

Growth of ameloblastoma?

A

Slow growing tumour, asymptomatic at early
stages.
* Gradually increasing facial deformity and
expansion of jaw bones.
* Perforation of bone and extension into soft
tissues in late stages.
* Expansion into the sinus and may invade skull
base.
* Loose teeth due to root resorption.

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15
Q

Radiography of ameloblastoma?

A
  • Unilocular or multilocular radiolucency
    resembling a cyst.
  • Scalloped borders are sometimes seen.
  • An unerupted tooth may be present.
  • Resorption of the roots of adjacent teeth is
    common.

Soap bubble appearance
Multilocular
Unilocular

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16
Q

Histopathology of ameloblastoma?

A
  • Macroscopically, ameloblastoma may show
    extensive cystic changes.
  • Thickened mural areas must be sampled by
    biopsy to establish the diagnosis.
  • Microscopically, many variations
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17
Q

Variations of ameloblastoma?

A

Follicular and plexiform are the two main patterns.

18
Q

Can 2 forms of ameloblastoma exist n tumour?

A

Yes, can coexist

They describe the distribution of the odontogenic
epithelium within the stroma in the tumour.

19
Q

Follicular pattern of ameloblastoma?

A
  • The odontogenic
    epithelium is arranged in
    islands (follicles) within
    fibrous stroma.
  • The follicles resemble the
    enamel organ.
  • Central mass resembling
    the stellate reticulum
    surrounded by columnar
    ameloblast like cells
    (reversed polarity).

Can get cystic formation

20
Q

What can happen in the stellate area of ameloblastoma? (Follicular)

A

Cystic breakdown

Granular cell changes

Squamous metaplasia (acanthomatous)

21
Q

Histopathology of plexiform pattern (ameloblastoma)?

A

Plexiform Pattern:
* The epithelium is arranged
as a tangled network of
anastomosing strands and
irregular masses.
* Same cell layers as the
follicular pattern.
* Cyst formation due to stromal degeneration.

22
Q

Behaviour of ameloblastoma?

A

Benign but invasive - fade narrow spaces in bone

  • Intraosseous tumours are locally invasive with islands of the tumour
    invading the marrow spaces.
  • High recurrence rates (50-90%). Long- term follow- up is mandatory
    because recurrence has been found after more than 10 years.
  • Pulmonary metastasis.
  • Ameloblastic carcinoma.
23
Q

Recurrent rate of ameloblastoma?

A

High recurrent - 50-90%

24
Q

Ameloblastoma malignant or locally invasive?

A

Locally invasive

25
Q

Management of ameloblastoma?

A
  • Management:
  • Biopsies may show mainly cystic areas, in these cases, it is necessary to
    correlate the biopsy and imaging appearances to reach a definitive
    diagnosis.
  • Current treatment aims at achieving complete excision with a small margin
    of uninvolved tissue.
  • In some cases a more conservative approach may be adopted.
  • Radiotherapy and chemotherapy are not advocated.
26
Q

Rare variant of ameloblastoma?

A

Desmoplastic ameloblastoma

27
Q

Where is the desmoplastic amleoblasoma found?

A

Anterior mandible and maxilla

28
Q

Desmoplastic ameloblastoma?

A
  • Most frequently in the anterior mandible and maxilla.
  • Similar age range to conventional ameloblastoma.
  • Radiographs show a distinctive appearance
    consisting of a mottled, diffuse, mixed radiodense
    and radiolucent lesion, often associated with tooth
    displacement and/ or resorption.
  • Treatment is similar to that of conventional
    ameloblastoma— complete excision.
29
Q

Microscpically desmoplastic ameloblastoma?

A

abundant stromal component with
compressed islands of odontogenic epithelium that
resemble ameloblastoma but are jagged in outline.

Metaplastic bone trabeculae, microcytic change, and
myxoid areas may be present.

30
Q

Clinical presentation of uni cystic ameloblastoma?

A
  • Younger age group than conventional ameloblastoma.
  • Posterior Mandibular (over 90% of the cases)
31
Q

Radiographing presentation of unicystic ameloblastoma?

A
  • Well defined unilocular radiolucency that looks like a cyst.
  • Many cases are associated with an unerupted tooth,
    especially third molars.
32
Q

3 variants of unicystic ameloblastoma?

A
  • Luminal type: the cyst is lined by ‘ameloblastomatous’
    epithelium.
  • Intra-luminal type: the cyst has projections of plexiform
    ameloblastoma into the central cystic cavity.
  • Mural type: the ameloblastomatous cyst lining shows
    complex budding and invasion of the cyst wall.
33
Q

Recurrence of mural type unicystsic ameloblastoma?

A

High risk

34
Q

Management of unicystic ameloblastoma?

A
  • The luminal and intra- luminal types show no invasion of the
    cyst wall and the majority are eradicated by enucleation.
  • The mural type has a risk of recurrence and treatment is the
    same as for conventional ameloblastoma; complete excision.
35
Q

Clinical presentation of perineal ameloblastoma?

A
  • Presents mostly in the gingiva as a red,
    sometimes papillary, mucosal patch.
  • May be raised
  • Although there may be ‘saucerization’
    of the underlying bone, the tumour is
    entirely extra- osseous

Bone not effected, completely inside soft tissue

36
Q

Histopathology of peripheral ameloblastoma?

A

May resemble conventional ameloblastoma.
* Mainly baseloid cells.
* The neoplasm appears to originate from the surface
epithelium.
*The oral counterpart of basal cell carcinoma?

37
Q

Management of peripheral ameloblastoma?

A
  • Local excision, often involving a rim resection or block of
    underlying alveolar bone.
  • In rare cases, can de- differentiate and give rise to
    ameloblastic carcinoma that invades the underlying jaw.
38
Q

Pathogenesis of ameloblastoma? (6)

A
  • Residues of the dental lamina (majority).
  • Lining of the dentigerous cyst (Unicystic ameloblastoma).
  • Basal layer of the oral epithelium (peripheral ameloblastoma).
  • Epithelial rests of Malassez.
  • Reduced enamel epithelium.
  • The cells express amelogenin, but with no enamel or dentine
    formation they are considered preameloblasts.

Ant structure with ameloblasts or preameloblasts can form ameloblastoma

39
Q

When could metastasis occur?

A

No real evidence

  • An ameloblastoma that has metastasized despite its benign
    histopathological appearance.
  • Lung
  • Aspiration, surgical implantation as causes
  • Debate about classification

It is just locally invasive

40
Q

New ameloblastoma?

A

Adenoid ameloblastoma

BDS3 Oral Pathology (31 decks)

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