Odontogenic tumors
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Transcript of Odontogenic tumors
Hazrat Abu Huraira narratedThe Prophet (PBUH) said, “Beware of suspicion( about others)
as suspicision is the falsest talk, and do not spy upon each other, and do not listen to the evil talk of
people about other’s affairs and do not have enemity with one
another but be brothers” Bukhari Book#62 Hadith# 74
ODONTOGENIC TUMORS
DR SAMREEN YOUNAS FCPS RESIDENT OMFS
MAYO HOSPITAL LAHORE
Outline What is an odontogenic tumor Odontogenic tissues giving rise to
tumors Classification Clinical, radiographic and
histopathological features Take home message
WHAT IS A TUMOR?Abnormal growth of tissue resulting from
uncontrolled progressive multiplication of cells, serving no physiologic function.
ODONTOGENIC TUMOR?Tumor arising from odontogenic tissue.
The Origin Of Odontogenic Tumors
Ectodermal(epithelial)
Dental lamina /Epithelial rests of serres
Enamel organ /Reduced enamel epithelium
Epithelial root sheath of Hertwig’s /Epithelial rest of Malassez
Classification Odontogenic
epithelium
Ameloblastoma
CEOT(Pindborg tumor)
AOT
SOT
Clear Cell odontogenic Carcinoma
EPITHELIAL ODONTOGENIC TUMORS
AMELOBLASTOMALocally aggressive neoplasm of odontogenic epithe-
-lium that has a wide spectrum of histologic pattern resembling early odontogenesis.
1. Dental lamina/Rest of serres2. Enamel organ/Reduced enamel epithelium3. Basal layer of oral mucosa4. Epithelial lining of dentigerous cyst
Origin;
TYPES OF AMELOBLASTOMA
Clinico-radiographic types
Multicystic
Unicystic
Peripheral
Solid, Multicystic Ameloblastoma
Clinical features;1. Occurs over a broad age range2. F=M3. Mandible > Maxilla, Common in molar areas Raiographic features;4. Multilocular radiolucency, soap bubble
appearance[ large loculations], honeycomb[small loculatons].
5. Expansion of cortices6. Root resorption
Raiographic Features
Soap bubble
Destructive radiolucent lesion and root resorption
Desmoplastic A More common in anterior regions esp maxilla. Radiographicaly margins are ill defined Mixed radiolucent and radio-opaque appearance
HISTOPATHOLOGY
Follicular Pattern Plexiform pattern
Histopathology
Granular cell variant Acanthomatous
Histopathology
Desmoplastic variant Basal cell variant
UNICYSTIC AMELOBLASTOMA
Radiographic features•Well circumscribed Unilocular radiolucency
Younger age group most commonly affected
Histological variants of Unicystic Ameloblastoma
Luminal
MuralIntraluminal
HISTOPATHOLOGY
Mural Variant Intraluminal variant
Mural variant
Peripheral Ameloblastoma Painless non ulcerated, sessile or
pedunculated masses in gingival or alveolar mucosa.
Some lesions may cause superficial bone erosion.
Histological features are same as intraoseous Ameloblastoma.
MALIGNANT A and AMELOBLASTIC CA Malignant A; Tumors that show histopatho
features of ameloblastoma both in primary tumor and metastatic deposits.
Ameloblastic CA; Ameloblastoma that show cytological features of malignancy both in primary tumor and metastatic deposits.
Lungs most common site of metastasis followed by lymph nodes, bones, liver, spleen, kidney and skin.
TREATMENT Solid Ameloblastoma are treated with block
excision or resection followed by immediate reconstruction.
Margin of resection 1-1.5 cm past radiographic margins.
Luminal and intraluminal Enucleation Intramural resection with peripheral
osteotomy Perioheral types conservative local excision Ameloblastic CA and Malignant A treated more
aggressively but prognosis is v poor. Patients should be followed indefinitely.
Question Resection / en bloc resection ?
Marginal / segmental resection ? Partial resection ? Total resection ? Composite resection ?
Resection Removal of tumor by incising
through uninvolved tissue around the tumor.Marginal resection; bony continuity not
disruptedPartial resection; portion of jaw is removed
creating a continuity defectTotal resection; Complete bone is removed
with tumor, e.g mandibulectomyComposite resection; tumor resection with
bone, soft tissue and lymph channels.
CEOT ( PINDBORG TUMOR)Cells of origin unknown, dental lamina remnants
and stratum intermedium suggested.
Clinical features•Mean age 40 yrs•Mandible> maxilla•Molar-ramus area
Radiographic features•Unilocular or multilocular giving honeycomb appearance•May be complete radiolucent or may contain small opacities•Well circumscribed but sclerotic margins may not always be seen.
HISTOPATHOLOGY•Large polyhedral cells in a fibrous stroma•Nucei show considerable variation in size and shape•Extracellular amyloid of epithelial origin typical of these tumors.Liesegang rings•Concentric calcific rings with annular staining pattern seen in amyloid material.
TRAETMENT Conservative local resection with a
narrow rim of surrounding bone is treatment of choice.
Recurrence 15% Rare malignant transformation
Adenomatoid Odontogenic TumorProbably originates from reduced enamel epithelium
Clinical features; Teenagers mostly
affected F>M Anterior portion of jaws Maxilla>mandible Associated with crown
of an impacted tooth
9%53%2%
2% 7%27%
AOT
Adenomatoid OTHISTOPATHOOGY•Thick capsule•Polyhedral and spindle cells•Ductlike structures of columnar epithelium Adenomatoid appearance
VARIANTS OF AOT
Follicular73%
Peripheral3%
Extrafollicular24%
Adenomatoid OTRadiographic features;Folliclar; Well circumscribed unilocular
lesion, around the crown of an impacted tooth.
Extrafolicular; Same but appear above, between or superimposed over roots of an unerupted tooth.
Small opaque foci are distributed throughout the lesion.
TREATMENTConservatively treated, enucleation is all
that is required.
SQUAMOUS ODONTOGENIC TUMOR
Rare tumor thought to arise from dental lamina rests or rests of Malassez.
Occurs over a wide age range and are randomly distributed through mandible and maxilla.
Radiographically well circumscribed lucency associated with cervical region of roots of teeth.
Microscopically has some similarity to ameloblastoma, but lacks peripheral columnar palisaded layer.
CLEAR CELL ODONTOGENIC TUMOR (CARCINOMA) Rare neoplasm Origin is unknown but location and histology
suggests odontogenic origin Usually found in women older than 60 years Locally aggressive and poorly circumscribed Metastasis to lungs and lymph nodes Radical surgery is required and recurrence rates
upto 50% are reported.
MESENCHYMAL TUMORSODONTOGENIC MYXOMA Resembles microscopically dental pulp or
follicular C.T.
Clinical features
Smaller asymptomatic, may cause bony expansion.
More common in mandible Mean age 30 yrs
RADIOGRAPHIC FEATURES Unilocular or
Multilocular lucency “ Soap bubble appe-
arance “ Margins are irregular Lucent defect may
contain thin whispy trabeculi of bone arr-
anged at right angle to each other “Stepladder pattern”
HISTOPATHOLOGY Cells are haphazardly
distributed through loose abundant myxoid stroma containing only few collagen fibrils.
Bony islands
TREATMENT Surgical excision is treatment of choice Due to lack of encapsulation recurrence
rates are high if treated conservatively.
CENTRAL ODONTOGENIC FIBROMA Rare tumor, more common in females Aprox 45% occur anterior to 1st molar
region in maxilla. Usually appears as multilocular
radiolucency causing bony expansion. Surgical excision or enucleation is
traetment Recurrence is rare
CEMENTOBLASTO MA/ TRUE CEMENTOMA Rare benign neoplasm of cementoblasts Microscopically resembles
osteoblastoma but is connected or fused to the root of a tooth.
More common in posterior mandible Radiographically it is an opaque tumor,
usually surrounded by thick, uniform radiolucent ring, contiguous with PDL space.
MIXED TUMORSAmeloblastic Fibroma and Fibro-odontoma Except for presence of odontoma both are same
and considered together…Clinical Features; Younger age group mean 12yrs F=M Mandibular molar area is favoured location Commonly asymptomatic
Radiographic features Well circumscribed with
sclerotic margins Unilocular/ multilocular AF complete radiolucent,
AFO opaque focus appears
May be associated with crown of impacted tooth
HISTOPATHOLOGY Fibrous capsule Myxoid C.T Evenly distributed
strands of epithelium In fibro-odontoma
one or more foci containing enamel, dentine and cementum are found
TREATMENTBecause of encapsulation and general
lack of invasive capacity treated through conservative surgical approaches like curettage or excision.
Rare malignant counterpart Mlignant Ameloblastic Fibrosarcoma has been reported
ODONTOMAMost common odontogenic tumorBiologicaly may be considered as
Hamartomas, composite of enamel and dentine.
Compound Odontoma; Miniature or rudimentary teeth.Complex odontoma; Amorphous conglomeration of hard
tissue.
Question ?Hamartoma ?
Choristoma ?
Hamartoma; Excess of normal tissue in normal
location, e.g odontomas
Choristoma; Excess of normal tissue in abnormal
location e.g osseous choristomas in tongue
Clinical Features Histopathology Younger adults Maxilla > mandible Compound O more
common in anterior Complex O more
common in posterior regions
Mostly associated with impacted or retained tooth
Normal appearing enamel, dentine, pulp or cementum may be seen
Radiographic FeaturesCompound O; Numerour tiny opaque masses in a
single focus Typically in tooth bearing area.Complex O; Amorphous opaque masses
TREATMENTLimited growth potentialEnucleation is curative
TAKE HOME MESSAGE Most of the bony tumors of mandible
and maxilla have odontogenic origin. Clinical, radiographic and histopathology
correlation is required for diagnosis. Excision is treatment of choice.
THANK YOU