5. odontogenic tumor (1)
-
Upload
qamar-olabi -
Category
Education
-
view
133 -
download
1
Transcript of 5. odontogenic tumor (1)
Neo: new; Plasia: formation. A neoplasm is defined as an uncoordinated proliferation of tissue, the growth of which
persists in a potentially unlimited fashion, even after cessation of the stimulus which evoked the change.
Definition
• Benign tumors represent a new uncoordinated growth.
• Benign tumors are slowly growing• No metastases• Histologically they tend to resemble the
tissue of origin.
Clinical Features
• Insidious onset • Grow slowly• Painless• Do not metastasize• Not life threatening (unless they interfere
with a vital organ by direct extension).
• Benign tumors are detected through:– Enlargement of the jaws– Accidentally during a radiographic examination– While investigating the reason of missing tooth
• When a preliminary dignosis of tumor is made:– a full radiologic examination should be made to
fully document the extent and characteristics of the lesion.
Radiographic features
Location:• Important in establishing the differential
diagnosis• Odontogenic lesions occur above the inferior
alveolar nerve canal.• Vascular or neural lesions may originate inside
the mandibular canal• Cartilagenous tumors occur in jaw locations
with residual cartilagenous cells(around mandibular condyle)
Periphery and shape• Smooth, well defined, and sometimes
corticated.(Because benign tumors enalrge slowly by
formation of additional internal tissue)• Sometimes tumor produce calcified material.(Mature=Center / Immature:periphery)
Internal structure• Radiolucent• Radiopaque• Mixed:
– Residual bone– Calcified material
Internal pattern is characteristic for specific types of tumors and may help with the diagnosis.
Effects on surrounding structures• Displacement of teeth or bony cortices(Growth is slow enough to allow remodeling)• Resorption of roots
CLASSIFICATIONBENIGN NEOPLASMS
Odontogenic tumors Non-odontogenic tumorsA. Epithelial origin
1. Ameloblastoma2. Adenomatoid odontogenic tumor3. Calcifying epithelial odontogenic tumor4. Squamous odontogenic tumor
B Mixed origin 1. Ameloblastic fibroma
2. OdontomesC Mesodermal origin
1. Myxoma & Myxofibroma2. Odontogenic fibroma3. Cementifying fibroma4. Periapical cemental dysplasia5. Benign cementoblastoma6. Familial multiple cementoma
A. Hyperplastic lesions1. Polyp2. Epulis3. Giant cell granuloma
B. Epithelial origin1. Papilloma2. Adenoma3. Pigmented nevus4. Keratoacanthoma
C. Mesenchymal1. Connective tissue origina. Fibromab. Lipoma / Fibrolipomac. Haemangiomad. Lymphangiomae. Chondromaf. Osteoma
C. Mesenchymal2. Muscle tissue origina. Leiomyomab. Rhabdomyomac. Granular cell myoblastoma3. Nerve tissue origina. Neurofibromab. Neurilemmomac. Melanotic progonoma
Common Clinical FeaturesAge of occurrence: Varies with each tumor
Sex predilection: Varies with each tumorSymptoms: Most of the tumors present as a painless, gradually / rapidly enlarging swelling. If infected, pain may be present. Other symptoms include facial deformity, mobility in teeth, numbness.
ODONTOGENIC TUMORS
Common Clinical FeaturesODONTOGENIC TUMORS
Signs: The swelling has the following features:Inspection: usually single, round or oval, well-
defined boundaries, smooth or nodular surface, normal overlying skin or mucosa, expansion of jaw bone, obliteration of vestibule
Palpation: Normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage), teeth mobility, paraesthesia
Additional features: missing tooth or normal dentition, displacement of teeth, pathological jaw fracture, signs of inflammation if tumor is infected
Common Radiographic FeaturesODONTOGENIC TUMORS
Common Radiographic FeaturesODONTOGENIC TUMORS
Common Radiographic FeaturesODONTOGENIC TUMORS
Ameloblastoma
• Definition• The ameloblastoma, a true neoplasm of
odontogenic epithelium, is a persistent and locally invasive tumor; it has aggressive but benign growth characteristics.
• Ameloblastomas may be divided into the solid/multicystic type, and unicystic type.
• Clinical Features• Occur more in men, more often in black• Ameloblastomas grow slowly, and few, if any, symptoms occur in
the early stages.• Usually the patient eventually notices gradually increasing facial
asymmetry• Swelling of the cheek, gingiva, or hard palate has been reported as
the chief complaint in 95% of untreated maxillary ameloblastomas.
• The mucosa over the mass is normal, but teeth in the involved region may be displaced and become mobile.
Signs: The swelling has the following features:Inspection: single, round or oval, well-defined boundaries, smooth
or lobulated, normal overlying skin or mucosa (ulcerated if large), expansion of jaw bone in all the 3 planes, obliteration of vestibule
Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage) or soft (if unicystic), teeth mobility, paraesthesia
Additional features: missing tooth or normal dentition, displacement of teeth, pathological jaw fracture, thin straw colored fluid on aspiration (unicystic variety) signs of inflammation if tumor is infected
ODONTOGENIC TUMORSAmeloblastoma(‘locally malignant’)
Clinical Features
ODONTOGENIC TUMORS
Type of lesion: radiolucentSite: usually mandibular 3rd molar-ramus regionSize: large lesionShape: unilocular (round or oval), multilocular (‘soap
bubble’, ‘honeycomb’) with locules separated by bony septae
Number: singleOutline: regular or scallopedBorder: well-defined hyperostotic (‘partially hyperostotic’)Contents: homogenous radiolucencyAdditional features: impaction of tooth with displacement
deep in the jaw, expansion of jaw bone bucco-lingually, antero-posteriorly and vertically, displacement & resorption of roots, displacement of inferior alveolar canal, obliteration of maxillary antrum, thinning of cortical plates, thinning of inferior border of mandible, ‘cyst-in-cyst’ appearance, pathological jaw fracture
Ameloblastoma(‘locally malignant’)
Radiographic Features
• An untreated tumor may grow to great size and is more of a concern in the maxilla, where it can extend into vital structures and reach into the cranial base
• Tumors that develop in the maxilla may extend into the paranasal sinuses, orbit, nasopharynx, or vital structures at the base of the skull.
Radiographic Features
• Location• Most ameloblastomas (80%) develop in the
molar ramus region of the mandible, but they may extend to the symphyseal area.
• Most lesions that occur in the maxilla are in the third molar area and extend into the maxillary sinus and nasal floor.
• Periphery• well defined and frequently delineated by a cortical border.• The periphery of lesions in the maxilla is usually more ill
defined.
• Internal Structure• varies from totally radiolucent to mixed with the presence of
bony septa creating internal compartments.• Septa can be straight but are more commonly coarse and curved• Generally the loculations are larger in the posterior mandible
and smaller in the anterior mandible.
• Effects on Surrounding Structures.• There is a pronounced tendency for ameloblastomas to cause
extensive root resorption• Tooth displacement is common
Ameloblastoma
Differential Diagnosis:Dentigerous cyst, odontogenic keratocyst, giant cell
granuloma, odontogenic myxoma, and ossifying fibroma
Ameloblastoma(‘locally malignant’)
ODONTOGENIC TUMORS
Treatment• The surgical procedure should take into account the
tendency of the neoplasm to invade adjacent bone beyond its apparent radiographic margins.
• CT and MRI are useful in determining the exact extent of the tumor.
• The maxilla is usually treated more aggressively because of the tendency of ameloblastoma to invade adjacent vital structures.
• Radiation therapy may be used for inoperable tumors, especially those in the posterior maxilla.
BENIGN NEOPLASMS
Odontogenic tumorsA. Epithelial origin
1. Ameloblastoma2. Adenomatoid odontogenic tumor3. Calcifying epithelial odontogenic tumor4. Squamous odontogenic tumor5. Ameloblastic fibroma6. Odontomes
B. Mesodermal origin1. Myxoma & Myxofibroma2. Odontogenic fibroma3. Cementifying fibroma4. Periapical cemental dysplasia5. Benign cementoblastoma6. Familial multiple cementoma
Non-odontogenic tumors
CLASSIFICATION
• Adenomatoid odontogenic tumors are uncommon nonaggressive tumors of odontogenic epithelium in variety of patterns mixed with mature connective tissue stroma.
• Can be central or peripheral• Central tumors can be follicular or extrafollicular• 73% of central lesions are of the follicular type
Adenomatoid Odontogenic Tumor(‘AOT’)
Age of occurrence: mostly in 2nd & 3rd decades of life
Sex predilection: 2:1 females predilection
Symptoms: Most of the tumors present as a painless, gradually enlarging swelling. Sometimes asymptomatic, being discovered radiographically.
Site: almost 75% of cases involve maxillary anterior teeth
ODONTOGENIC TUMORSAdenomatoid Odontogenic Tumor
(‘AOT’)
ODONTOGENIC TUMORSAdenomatoid Odontogenic Tumor
(‘AOT’)Clinical Features
Signs: The swelling has the following features:Inspection: single, round or oval, well-defined
boundaries, smooth, normal overlying skin or mucosa, little expansion of jaw bone, obliteration of vestibule
Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage)
Additional features: normal dentition, displacement of teeth
Type of lesion: radiolucent radiopacities develop in about two thirds of cases.
Site: maxillary anterior regionOften does not attach at the cementoenamel junction but
surrounds a greater area of the toothSize: about 3 cms in diameterShape: unilocular (round or oval)Number: singleOutline: regularBorder: well-defined hyperostoticContents: homogenous radiolucency interspersed with radiopaque
foci (‘driven snow’ appearance)Additional features: sometimes impaction of tooth, little expansion
of jaw bone, displacement & resorption of roots, thinning of cortical plates
Radiographic Features
ODONTOGENIC TUMORSAdenomatoid Odontogenic Tumor
(‘AOT’)
ODONTOGENIC TUMORSAdenomatoid Odontogenic Tumor
(‘AOT’)
Differential Diagnosis:No radiopaque foci – ameloblastoma,
ameloblastic fibroma, odontogenic fibroma, primordial cyst, lateral periodontal cyst
Radiopaque foci – CEOC, CEOTManagement: surgical enucleation
Image: Atlas of Oral Diagnostic Imaging by Higashi
An adenomatoid odontogenic tumor in the region of the right maxillary canine and lateral incisor. Calcifi cation is present within the tumor mass, and the canine and lateral incisor have been displacedby the lesion.
Examples of adenomatoid odontogenic tumor with various amount of internal calcification.A, A cropped panoramic film with a totally radiolucent lesion associated with a mandibularcuspid. B, A lesion with sparse pebblelike calcifications associated with a maxillary cuspid. C, A lesion related to a maxillary lateral incisor with abundant calcification.
• Calcifying epithelial odontogenic tumors (CEOTs) are rare neoplasms.
• They account for about 1% of odontogenic tumors
• These tumors usually are located within bone and produce a mineralized substance
• Epithelium resembles the stratum intermedium of the enamel organ
Calcifying Epithelial Odontogenic Tumor(‘CEOT’, Pindborg tumor)
Age of occurrence: mostly in middle aged patients
Sex predilection: more common in men
Symptoms: Most of the tumors present as a painless, gradually enlarging swelling. Sometimes non-eruption of tooth / asymptomatic, being discovered radiographically
A CEOT is less aggressive than the ameloblastoma
Site: majority in mandibular premolar-molar region
ODONTOGENIC TUMORSCalcifying Epithelial Odontogenic Tumor
(‘CEOT’, Pindborg tumor)Clinical Features
Signs: The swelling has the following features:Inspection: single, round or oval, well-defined
boundaries, smooth, normal overlying skin or mucosa, little expansion of jaw bone, obliteration of vestibule
Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage)
Additional features: missing tooth, displacement of teeth
Type of lesion: unilocular or multilocular with numerous scattered, radiopaque foci of varying size and density.
The most characteristic and diagnostic finding is theappearance of radiopacities close to the crown of the embedded toothSite: mandibular premolar-molar regionSize: about 3 cms in diameterShape: somewhat irregularNumber: singleOutline: somewhat irregularBorder: well-defined, at times diffuseContents: homogenous radiolucency interspersed with diffuse radiopacitiesAdditional features: impaction of tooth is common, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates
Radiographic Features
ODONTOGENIC TUMORSCalcifying Epithelial Odontogenic Tumor
(‘CEOT’, Pindborg tumor)
ODONTOGENIC TUMORSCalcifying Epithelial Odontogenic Tumor
(‘CEOT’, Pindborg tumor)
Differential Diagnosis: CEOC, AOT, intermediate stages of fibro-osseous lesions
Management: The treatment of the CEOT is more conservative than the ameloblastoma,with local resection
Image: Lucas’s Pathology of Tumors of the Oral Tissues, 5 th edition
The tumor appears asa mixed radiolucent-radiopaque lesion associated with an unerupted tooth.
Calcifying odontogenic tumor, or Pindborg tumor (arrows).
BENIGN NEOPLASMS
Odontogenic tumorsA. Epithelial origin
1. Ameloblastoma2. Adenomatoid odontogenic tumor3. Calcifying epithelial odontogenic tumor4. Squamous odontogenic tumor5. Ameloblastic fibroma6. Odontomes
B. Mesodermal origin1. Myxoma & Myxofibroma2. Odontogenic fibroma3. Cementifying fibroma4. Periapical cemental dysplasia5. Benign cementoblastoma6. Familial multiple cementoma
Non-odontogenic tumors
CLASSIFICATION
• The term odontoma is used to identify a tumor that is radiographically and histologically characterized by the production of mature enamel, dentin, cementum, and pulp tissue.
• It may vary from nondescript masses of dental tissue referred to as a complex odontoma to multiple well-formed teeth (denticles) of a compound odontoma.
• Odontomas are the most common odontogenic tumor. • They often interfere with the eruption of permanent teeth
Odontome(‘complex/compound composite odontome’, Odontoma)
Age of occurrence: mostly in young adultsSex predilection: (compound )no sex predilection.
(complex) 60% occur in women
Symptoms: mostly asymptomatic, being discovered radiographically for non-eruption of tooth, sometimes slowly enlarging swelling
Site: complex more common in mandibular premolar-molar region, compound more common in maxillary anterior region
ODONTOGENIC TUMORSOdontome
(‘complex/compound composite odontome’, Odontoma)
Clinical Features
Type of lesion: radiopaque mass surrounded by a radiolucent line and further by a radiopaque line, ‘mixed’ in early stages
Site: mandibular premolar-molar region / maxillary anterior region
Size: complex can be large, compound usually smallShape: round or ovalNumber: singleOutline: regularBorder: well-defined hyperostoticContents: Irregular mass of calcifi ed tissue (‘complex’) or a
number of toothlike structures or denticles that look like deformed teeth(‘compound’)
Additional features: associated with supernumerary tooth, impaction of tooth, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates
Radiographic Features
ODONTOGENIC TUMORSOdontome
(‘complex/compound composite odontome’, Odontoma)
ODONTOGENIC TUMORSOdontome
(‘complex/compound composite odontome’, Odontoma)
Images: Atlas of Oral Diagnostic Imaging by Higashi
Differential Diagnosis:in the early stage: CEOC, AOT,
intermediate stage of fibro-osseous lesions
in the mature stage: mature stage of fibro-osseous lesions, osteoma
Management: surgical removal to allow eruption of impacted tooth and avoid cystic changes
ODONTOGENIC TUMORSOdontome
(‘complex/compound composite odontome’, Odontoma)
Odontogenic Myxoma• Odontogenic myxomas are uncommon, accounting for only 3% to 6%
of odontogenic tumors.
• They are benign, intraosseous neoplasms that arise from odontogenic ectomesenchyme
• These myxomas are not encapsulated and tend to infi ltrate the surrounding cancellous bone but do not metastasize.
• If odontogenic myxomas have a sex predilection, they slightly favor females.
• Second decade of life• 25% recurrence rate
• Radiographic picture• More commonly affect the mandible by a margin of 3 : 1. premolar/ molar
area• Residual bone trapped within the tumor will remodel into curved and straight,
coarse or fine septa.• A characteristic septa identified with this tumor is a straight, thin-etched septa
(a tennis racket – like or stepladder-like pattern)(rare)• The tumor displaces and loosens teeth but rarely causes resorption of teeth
• Differential diagnosis:• Ameloblastoma, central giant cell granuloma
Treatment:• Resection with margin
Thank you!!!!