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8/9/2019 Odontogenic Tumors Oral Sugery
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INDEX
1 . Definition
2. Classification
3. Ameloblastoma4. Malignant ameloblastoma
5. Adenomatoid odontogenic tumor
6. Calcifying epithelium odontogenic tumor
7. Odontoma
8. Calcifying odontogenic cyst
9. Ameloblasic fibroma
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DEFINITION:Odontogenic tumors are the lesions derived from cellular elements that
are forming the tooth structure.
NEOPLASM
A). Benign
1). Odontogenic epithelium
(i). Ameloblastoma
(ii). Squamous odontogenic tumor
(iii). Calcifying epithelial odontogenic tumor
(iv).Clear cell odontogenic tumor
(Pindborgs tumor)
2). Odontogenic epithelium with odontogenic ectomesenchyme
(i). Ameloblastic fibroma
(ii). Ameloblastic fibro dentinoma and ameloblastic fibro odontoma
(iii). Odontoameloblastoma
(iv). Adenomatoid OdontogenicTumor
(v). Calclifying odontogenic cyst(vi). Complex odontoma
(vii). Compound odontoma
3). Odontogenic ectomesenchyme
(i). Odontogenic fibroma
(ii). Myxoma / Odontogenic myxofibroma
(iii). Benign cementoblastoma (True Cementoblastoma)
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B). Malignant
1). Odontogenic carcinomas
(i). Malignant Ameloblastoma(ii). Primary intraosseous carcinoma (iii). Malignant variant of other odontogenic epithelial tumor(iv). Malignant changes in odontogenic epithelial tumors
(v). Malignant changes in odontogenic epithelial cyst
2). Odontogenic sarcomas
(i). Ameloblastic fibrosarcoma (Ameloblastic sarcoma)
(ii). Ameloblastic fibrodentine sarcoma & Amleoblastic fibroodontosarcoma3). Odontogenic carcinosarcoma
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AMELOBLASTOMA
DefinitionAn epithelial tumor arising from the odontogenic apparatus or from cells
with a potentiality for forming tissues of the enamel organ.
WHO Defined it as
Unicentric, non functional, intermittent in growth, anatomically benign
and clinically persist
Origin of the ameloblastic cells
1). Odontogenic epithelium
a). Remenants of Dental lamina
b). Reduced enamel epithelium
c). Rests cells of malassez
2). Basal cell layer o overlying surface epithelium
3). Epithelial lining of odontogenic cyst
Three clinical subtypes
1). Common polycystic Ameloblastoma (80% of all cases)2). Unicystic Ameloblastoma (13% of all cases)3). Peripheral (Extraosseous) Ameloblastoma (1% of all
cases)
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1). Common polycystic ameloblastoma
Also called conventional, Intraosseous , MulticysticClinical features
wAge - 20 to 40yrs
Site - mandible > maxilla
slow growing, painless, bony expansion
initially Tennis ball like consistency
Egg shell like cracking
Radiographic features
Round cyst like radiolucency
Honey comb (if small loculations)
wor soap bubble like consistency(if large loculations)
Histopathology:
(Vickers and Gorlins criteria).
1). Hyperchromatism
2). Palisading cells
3). Vacuolization4). Hyalinization
Histopathological variants
1). Follicular ameloblastoma
2). Plexiform ameloblastoma
3). Plexiform unicystic ameloblastoma
4). Acanthomatous ameloblastoma
5). Papilliferous keratoameloblastoma
6).Granular cell ameloblastoma7). Desmolytic ameloblastoma
8). Basal cell ameloblastoma
9). Clear cell Ameloblastoma
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Follicular Ameloblastoma
Consists of different shapes & sizes of epithelial islands in the form of
epithelial nests or follicles.
Plexiform ameloblastoma
Consists of interlacing strands of odontogenic epithelial trabeculae
Acanthomatous Ameloblastoma
central epithelial cells squamous cell metaplasia keratin deposition.
Desmoplastic Ameloblastoma
Small epithelial islands widely separated by dense, scar like fibrous tissue.
Granular cell Ameloblastoma
central cells appears swollen & densely packed with eiosinophillic granules.
Basal cell pattern
Islands of uniform basaloid cells.
Treatment options
1). Simple Curettage - high recurrence rate. In mandible, wide marginal
resection leaving compact bone of lower border intact provided the lower
border is not involved radiographically
Large tumors invading lower border of mandible, segment resection using
bone grafts. In maxilla, wide excision is treatment of choice
b).Unicystic Ameloblastoma
Definition :
Is defined as a single unicystic cavity that shows ameloblastomatous
differentiation in the lining.
origin - a). De-novo as a neoplasm
b). Result of neoplastic transformation.
Clinical features
age - 16 to 20yrs (younger patients).
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Site - mandible > maxilla
Large lesions painless swelling in the jaw.
Radiographic features
Well-circumscribed, radiolucent area that surrounds the crown of an
unerupted molar.
3 histopathological variants.
1). Luminal unicystic2). Intaluminal unicystic
3). Mural unicystic
Differential diagnosis
(1). Dentigerous cyst
(2). Residual cyst
Treatment and prognosis
(1). Enucleation and curettage (recurrence rate - 10% to 20%) less
recurrence as surrounding fibrous connective tissue limits the lesion.
(2). If the lesion extends into fibrous cyst wall prophylactic measure Local
resection of the area
c). Peripheral or Extraosseous
Incidence- 1%origin - a). Remnants of dental lamina beneath the oral mucosa
b). Basal epithelial cells of surface epithelium
Clinical features
Age - middle age
site - posterior gingival &
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alveolar mucosa Mandible > maxilla
Painless, nonulcerated, sessile or pedunculated gingival or alveolar
mucosal
Histopathology:bear islands of ameloblastic epithelium occupying lamina propriaunderneath surface epithelium.
Treatment & prognosis
Surgical excision (Recurrence rate - 15 to 20%).
MALIGNANT AMELOBLASTOMABenign tumor that in the typical intraosseous form has a tendency to
infiltrate cancellous bone
AMELOBLASTIC CARCINOMA
Ameloblastoma that has a cytologic evidence of malignancy.
Clinical features:
swelling, pain and inflammation
Ulceration of mucosa & loosening of teeth
Epitaxis & nasal obstruction.
Radiographic features
unilocular or multilocular radiolucency, soap bubble appearance.
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Treatment
Simple curettage (high recurrence rate). In mandible, wide marginal
resection leaving compact bone of lower border is not involved
radiographically.
Large tumors - segmental resection followed by reconstruction using bonegraft
.
ADENOMATOID ODONTOGENIC
TUMOR
Origin - Tumor cell derived from
a). Enamel organ epithelium
b). Remnants of dental lamina
Clinical features
Age - younger patient (10 to 19yrs)
Site - anterior portion of the jaw maxilla > mandible
Asymptomatic, painless, slow growing. large lesions causes
expansion
AOT variants
Central Peripheral(intraosseous) (extraosseous)
1). Follicular type rare, small
involves crown of sessile masses on
an unerupted tooth facial gingiva of
maxilla
2). Extrafollicular type DD: Gingival
located b/w roots fibrous lesion
of erupted toothRadiographic features
Usually unilocular with well defined corticated border
may or may not contain a tooth
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often contains fine calcifications.
tubular or duct like structures
Histopathology:surrounded by fibrous capsule
Spindle shaped epithelial cells forming sheets, strands or whorled masses of
epithelial cellsCalcification- small foci as well as larger areas.
Treatment : Surgical enucleation (recurrence is rare).
CALCIFYING EPITHELIUM
ODONTOGENIC TUMOR
( Pindborgs tumor )
Definition:
It is a locally aggressive tumor consist of sheets & strands of polyhedral
cells in fibrous stroma with no inflammatory component & are often
accompanied by spherical calcifications & amyloid staining hyalinedeposits.
Origin
Rest of dental lamina
Reduced enamel epithelium1% of all odontogenic tumor
Clinical features
CEOT
Central Peripheral
(intraosseous) (extraosseous)
age - 40yrs site - anterior gingiva
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site - 2/3rdof appears as superficial
lesions in mandible soft tissue swelling
slow growing. of gingiva in a tooth
painless mass. bearing area or
edentulous area of jaw
Radiographic features:
Early lesions - unilocular, old lesions - multilocular or honey comb
appearance. Scalloped margins entire radiolucency with calcified structures
of varying size & density Snow driven appearance.
Histopathology:
sheets of polyhedral epithelial cells on fibrous stromacells show pleomorphism, prominent nucleoli & hyperchromatism.
Liesegang ring calcifications
ODONTOMA
Most common type of odontogenic tumor
Definition:
A non-neoplastic developmental anomaly or malformation that contains
fully formed enamel and dentin.
Types:
1). Invaginated odontome (Dens invaginatus, Dens in dente)
2). Evaginated odontome
3). Enamel pearl
4). Germinated odontome5). Complex odontome
6). Compound odontome
Clinical features:
Age- 10 to 20yrs
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Site - Maxilla > mandible
Slow growing , hard , painless mass
GARDNERS Syndrome is associated with it
(a). Multiple odontomas
(b). Multiple osteomas(c ). Intestinal polyps
(d). Epidermoid cyst
(e). Dermoid tumor(fibrous)
2 Types
(1). Complex
(2). Compound
(1). Compound odontoma
site - anterior part of maxilla
origin - repeated divisions of tooth germs. By overgrowths multiple
budding of dental lamina with formation of multiple tooth germ.
Radiographically -
Dense opacity with radioluscent rim surrounding it. Collection of tooth likestructures of varying size & shape surrounded by narrow radioluscent zone.
Histolopathology:
Numerous denticles having structures of normal teeth embedded in fibrous
connective tissue.
(2).Complex odontoma
site - posterior part of maxilla
Consist of congomerated mass of enamel & dentin which bears no anatomic
resemblence to a tooth.Cauliflower like mass of hard tissues.
Radiographically:
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Calcified mass with the radiodensity of tooth structures
Histolopathology:
Mass consist of enamel, mature tubular dentine, cementum together with
pulp & PDL members in varying amount
CALCIFYING ODOTOGENIC CYST
(Odontogenic ghost cell cyst)
Definition:
A rare well circumscribed solid or cystic lesion derived from odontogenic
epithelium that resembles follicular ameloblastoma but consists ghost cells
& spherical calcifications.
Cutaneous counterpart- Benign calcifying epithelioma of MALHERBE/Pilomatrixoma
Clinical features
Origin - remnants of dental lamina
Site - areas anterior to molar
Age - most common in 2nd decade
painless asymptomatic slow growing hard lesion causes expansion of buccal
cortical plate.
TYPES
Extaosseous Intraosseous
Focal localized generalized
swelling expansion of buccal cortical plates
DD. gingival fibroma Dentigerous cyst
peripheral giant Ameloblastoma
Gingival cyst Adenomatoid odontogenic
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Radiographic feature:
Well circumscribed unilocular radiolucency containing.
Flecks of indistinct radiopacities.
Histolopathology:
Epithelium lining a cystic space. Epithelium consist of pallisaded columnar
cells with reverse polarity of nuclei. Inner layer of stellate reticulum.
GHOST cells present.
Multiple spherical & diffuse calcification.
Deposites of hyaline material.
TREATMENT
1). Curettage
2). Recontouring
3). Resection with or without loss of continuity.
Curettage
Scrapping of the tumor tissue away from bone. Tumor usually comes out in
Ameloblastic fibroma
painless mixed tumor occurring in younger patients in the premolar andmolar region.
Sharply demarcated radiographic borders.
Microscopically epi. Cells lie in conn. Tissue stroma. Enucleation and
curettage
Ameloblasticfibro odontoma
Tumor with features of ameloblastic fibroma but that also contains enamel
and dentin.histologically epi. Islands in conn. Tissue stroma
.Radiographically well circumscribed unilocular. Treated by enucleation.
Ameloblastic fibrosarcoma
wMalignant counterpart of ameloblastic fibroma. Radiographically ill
defined destructive radiolucency.
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wCellular mesenchyme shows hyperchromatism and atypical cells with
island of ameloblastic epithelium
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