Odontogenic Tumors Oral Sugery

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.


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.


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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Odontogenic Tumors Oral Sugery