Central mucoepidermoid carcinoma.

Malignant ameloblastic & ameloblastic carcinoma.

Metastatic Tumors.

Osteosarcoma.

Presented by : an3’am a7mad abu 3’lyoun

20.11.2014

Epithelial tumor arising in bone (arising from

odontogenic epithelium or cyst lining).

Intact cortical plate.

Typical histologic finding consistent

with mucoepidermoid

tumor

Radiographic evidence of

bone destruction.

More likely mimic a benign tumor or cyst .

Painless swelling > cause facial asymmetry.

Teeth have been moved.

Non-fitting denture.

Tenderness.

Paresthesia.

Spreading to regional lymph nodes.

Female (more).

LOCATION

3-4 times in mandible > maxilla (PM & M ).

Commonly above the mandibular canal.

PERIPHERY & SHAPE:

Uni/multilocular expansile mass.

Well defined & well corticated border.

Thick peripheral cortication.

INTERNAL STRUCTURE : Similar to benign odontogenic tumor (recurrent

ameloblastoma).

Multilocular/soap bubble/honeycomb.

Amorphous sclerotic bone .

EFFECTS ON SURROUNDING STRUCTURE:

Expansion of adjacent cortical plates.

Perforation /extension into surrounding soft tissue.

Mandibular canal may be depressed or pushed

laterally/medially.

Lost of lamina dura .

Benign odontogenic tumor.

recurrent ameloblastoma.

odontogenic myxoma.

central giant cell granuloma (CGCG).

Surgery (en bloc resection).

Neck dissection & post operative radiation therapy

( to control the spread to lymph nodes ).

Malignant ameloblastoma: Typical benign histologic features

+ malignant biologic behavior.

Ameloblastic carcinoma: malignant histologic Features +

malignant behavior.

Males (>59 yr)

hard expansile mass of the jaw + displaced/loosened teeth +

normal overlying mucosa.

Tenderness.

Metastatic.

Local extension.

LOCATION

Mandible > maxilla (PM & M).

PERIPHERY & SHAPE:

well-defined border (+cortication).

scalloped border.

in malignant ameloblastoma loss + breaching of

cortical boundary ~> invading into soft tissue.

INTERNAL STRUCTURE :

Unilocular/Multilocular (more common).

Honeycomb/soap bubble .

Robust & thick septa.

EFFECTS ON SURROUNDING STRUCTURE:

Teeth displacement.

Root resorption.

Breached bony borders.

Erode lamina dura.

Displace normal anatomic boundaries.

mandibular canal >> displaced // eroded.

benign ameloblastoma.

Odontogenic keratocyst (OKC).

odontogenic myxoma.

central mucoepidermoid tumor.

central giant cell granuloma ( CGCG).

En bloc surgical resection.

“Secondary Malignancy”.

New foci of malignant disease ( blood vessels).

Arise from sites that anatomically inferior to the

clavicle ( of jaw).

Carcinoma .

In children : neuroblastome ,retinoblastoma &

wilms tumor.

Twice in women > men.

40-69 years .

Breast metastases.

LOCATION Posterior areas of the jaw.

Mandible ( bilateral ) > maxilla > maxillary sinus >anterior hard palate > mandibular condyle.

PDL.

Papilla of developing tooth . PERIPHERY & SHAPE:

Moderately well demarcated.

No cortication /no encapsulation of margins .

Ill-defined invasive margins.

Polymorphous in shape .

Sclerotic bone formation of the adjacent bone. ( prostate &

breast lesion ).

Enlarged jaw.

INTERNAL STRUCTURE :

Ragged Radiolucent.

Patchy sclerosis ( prostate & breast cancer).

Multi focal appearance with normal bone in between the foci .

General radiolucent appearance (similar to osteopenia).

EFFECTS ON SURROUNDING STRUCTURE:

Periosteal reaction (speculated pattern) >> prostate & neuroblastome.

Effect the lamina dura.

Irregular increase in PDL width.

Totally or partially destroyed crypt cortices .

Teeth seems to be floating in soft tissue mass. .

Altered position of the tooth .

Failure in healing of extraction socket ( or increase in size).

Teeth resorption (rare) .

Destructed cortical bone of adjacent structures.

Breaches the outer cortical plate of the jaw > extending in the

surrounding ST / intraoral mass.

Known primary malignancy.

Multiple myeloma.

Periapical inflammatory lesion.

Odontogenic cyst (2ry infected).

SCC

Metastatic tumor in the jaw ( poor prognosis).

Death in 1-2 years.

Chemotherapy / radiation therapy / surgery / immunotherapy / hormone treatment.

“Osteogenic sarcoma”.

Malignant neoplasm of bone.

Unknown cause.

occur in association with: Paget's Disease / fibrous

dysplasia (after radiotherapy).

Rare in jaw (7%).

Males (30- 39 yrs).

swelling (rapid), pain, tenderness, erythema, ulceration,

loose teeth, Epistaxis, hemorrhage, nasal obstruction,

exophthalmos, trismus & blindness.

Hypoesthesia ( neurovascular canals involvement).

chondroblastic

osteoblastic

fibroblastic

LOCATION Mandible > maxilla(posterior).

Mandible: tooth-bearing region, angle, vertical ramus.

Maxilla: alveolar ridge, antrum, palate.

May cross the midline.

PERIPHERY & SHAPE:

ill-defined border.

periosteum involvement > (sunray spicules)/”hair- on –end trabeculae).

Codman’s triangle at the periosteum edge.

Laminar periosteal bone (rarely).

Soft tissue mass emanating from the bone.

INTERNAL STRUCTURE :

1. Radiolucent/Radiolucent-radiopaque/Radiopaque.

2. Granular(sclerotic bone)/Cotton balls/Wisps /honeycombed. +

destruction of the preexisting osseous architecture.

3. Lost of normal trabecular structure of the jaw.

EFFECTS ON SURROUNDING STRUCTURE:

Widening of PDL.

Maxillary lesion >> lost of antral/ nasal wall .

Mandibular lesion: destroy the cortex of the ID canal +

adjacent lamina dura.

ID canal may be symmetrically widened and enlarged.

Fibrosarcoma.

metastatic carcinoma.

Chondrosarcoma.

prostate + breast metastases.

Ossifying fibroma .

fibrous dysplasia .

Ewing's sarcoma, solitary plasmacytoma, osteomyelitis.

Surgical resection (with large border of adjacent normal

bone).

Radiotherapy +chemotherapy.