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Oral Path > odontogenic neoplasms > Flashcards

odontogenic neoplasms Flashcards

1
Q

what is ameloblastoma?

A

benign but locally aggressive neoplasm of odontogenic epithelial origin

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2
Q

what does ameloblastoma looks like microscopically?

A

cells resemble the ameloblasts of the enamel organ, but no enamel is produced

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3
Q

what are the characteristics of ameloblastoma?

A

while considered the most common odontogenic neoplasm, it only constitutes about 0.2% of oral pathology biopsy cases
no sex predilection
wide age range, from 3rd to 7th decades
most (80-85%) occur in the mandible, usually the molar ramus region
about 20% are associated with an impacted tooth
lesion grows slowly, destroying tissue, but usually expanding rather than perforating bone
typically asymptomatic except for swelling

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4
Q

what does ameloblastoma look like radiographically?

A

a small lesion usually presents as a unilocular radiolucency with well-defined borders
as the lesion progresses, the classic multilocular expansile radiolucency frequently develops

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5
Q

what is the ameloblastoma desmoplastic variant?

A

described initially in 1984
distinctive radiologically as well as histologically
radiographs usually show a poorly demarcated radiolucency with numerous radiopaque flecks
similar in appearance to benign fibro-osseous lesion

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6
Q

what does ameloblastoma look like histologically?

A

several different patterns, follicular and plexiform are most common
small tumor islands which show cuboidal or columnar cells at their periphery
the center of the tumor islands is composed of loosely arranged polyhedral epithelial cells that resemble stellate reticulum

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7
Q

what is the treatment of ameloblastoma?

A

depends on size and site of the lesion
small lesion- aggressive currettage or small en bloc resection
large lesion- large enbloc resection or maginal segmental resection with reconstruction

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8
Q

what is the prognosis of ameloblastoma?

A

guarded
with simple curettage, recurrence rates reported to be 50-90%
even with marginal resection, recurrence rates up to 15%
maxillary lesions warrant more aggressive surgical removal due to their anatomic location

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9
Q

what is peripheral ameloblastoma?

A

clinically present as an asymptomatic gingival mass in a middle aged adult, usually mandible
typically less than 2 cm in diameter
important to note that this is an innocuous lesion that can easily be cured by local excision, little tendency to recur

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10
Q

what is calcifying epithelial odontogenic tumor?

A

CEOT, pindborg tumor

rare odontogenic epithelial neoplasm initially described by Pindborg in 1956

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11
Q

what is the histogenesis of the calcifying epithelial odontogenic tumor?

A

thought to be derived from cells of stratum intermedium

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12
Q

what are the characteristics of calcifying epithelial odontogenic tumor?

A

mean age at diagnosis- 40 years with no sex predilection
most arise in the posterior mandible
asymptomatic, swelling may be noted
50% associated with an impacted tooth

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13
Q

what is the radiographic characteristics of calcifying epithelial odontogenic tumor?

A

diffuse or well circumscribed radiolucency unilocular when small
with growth, lesion may become multilocular
radiopaque flecks often develop as lesion enlarges

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14
Q

what does calcifying epithelial odontogenic tumor look like histologically?

A

sheets or strands of polyhedral epithelial cells with eosinophilic cytoplasm
the nuclei are frequently pleomorphic, but mitoses are rare
epithelial cells may be associated with variable amounts of eosinophilic, acellular material that stain as amyloid
calcifications develop in this unique amyloid material, forming lamellated structures called liesegang rings

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15
Q

what is the treatment and prognosis of calcifying epithelial odontogenic tumor?

A

conservative excision with peripheral ostectomy

prognosis- 15% recurrence rate

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16
Q

what are the characteristics of adenomatoid odontogenic tumor?

A

usually arises in a younger patient, mean age- 18 years, with 75% under 20 years of age
2:1 female predilection
2:1 maxillary predilection
75% of these lesions develop in the anterior jaws
75% are associated with an impacted tooth
rarely, extraosseous lesions have been reported
other than possible swelling, these tumors are asymptomatic

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17
Q

what does adenomatoid odontogenic tumor look like radiographically?

A

well-circumscribed unilocular radiolucency that may contain radiopaque flecks
separation of roots or displacement of adjacent teeth occurs frequently
when associated with an impacted tooth, the lesion often extends apically beyond cemental enamel junction
this feature may help distinguish AOT radiographically from dentigerous cyst

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18
Q

what does adenomatoid odontogenic tumor look like histologically?

A

well encapsulated lesion
the tumor cells form swirling spindle cell nests with duct like structures of varying sizes
foci of basophilic calcified material may also be seen

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19
Q

what is the treatment and prognosis of adenomatoi odontogenic tumor?

A

tx- enucleation
prognosis- excellent
recurrence is very rare

20
Q

what are the characteristics of ameloblastic fibroma?

A

diagnosed most frequently in younger patients, typically during the first two decades of life
posterior mandible is the most common site (70% of all cases)
small lesions are asymptomatic, while larger ones produce painless swelling

21
Q

what are the radiographic characteristics of ameloblastic fibroma?

A

unilocular when small
larger lesions can become multilocular
margins tend to be well-defined

22
Q

what are the histologic characteristics of ameloblastic fibroma?

A

myxoid connective tissue that resembles dental papilla that contains strands and islands of odontogenic epithelium that resembles dental lamina
the epithelial component occasionally resembles ameloblastoma
connective tissue resembles dental papilla
admixed with strands and islands of odontogenic epithelium that resembles dental lamina
epithelial islands can resemble follicular or plexiform ameloblastoma

23
Q

what is the treatment and prognosis of ameloblastic fibroma?

A

treatment consists of aggressive curettage
prognosis- good
recurrence rate is low (0-18%)
rare malignant transformation

24
Q

what are the characteristics of ameloblastic fibro-odontoma?

A

odontogenic tumor with features of ameloblastic fibroma as well as odontoma
usually diagnosed in children, average age of 10 years
asymptomatic swelling with large lesions
failure of tooth eruption may be noted
equal frequency in mandible and maxilla

25
Q

what does ameloblastic fibro-odontoma look like radiographically?

A

well circumscribed unilocular, or occasionally multilocular, radiolucency
varying amounts of calcfied material having the density of tooth structures
often associated with impacted tooth

26
Q

what is the histology of ameloblastic fibro-odontoma?

A 
odontoma areas (usually complex odontoma) together with areas of ameloblastic fibroma
relative amounts of each type of tissue vary from lesion to lesion
developing odontoma may be confused with this lesion
27
Q

what is the treatment and prognosis of ameloblastic fibro-odontoma?

A

conservative curettage
prognosis is excellent
recurrence is unsual

28
Q

what is odontoma?

A

probably not a true neoplasm but rather an odontogenic hamartoma
presents in two forms- compound and complex

29
Q

what are the characteristics of odontoma?

A

most are detected during the first two decades of life, mean age of 14 years
usually associated with an unerupted tooth
slightly more frequent in the maxilla compared to the mandible

30
Q

where are compound odontomas most frequently seen?

A

compound odontomas are seen predominantly in anterior maxilla

31
Q

where are complex odontomas most frequently seen?

A

complex odontomas usually present in the posterior portion of the maxilla or mandible

32
Q

how does compound odontomas present?

A

collection of small malformed teeth surrounded by narrow radiolucent rim often overlying an impacted tooth

33
Q

how does complex odontoma present?

A

calcified mass that if fully formed has the density of tooth structure
also surrounded by a narrow radiolucent rim, typically overlies an impacted tooth

34
Q

what is the histopath of compound odontoma?

A

formation of multiple small malformed teeth

35
Q

what is the histopath of complex odontoma?

A

mixture of dentin, enamel matrix, cementum, odontogenic epithelium and dental papilla

36
Q

what are the treatment and prognosis of odontoma?

A

enucleation

excellent

37
Q

what is odontogenic myxoma?

A

benign neoplasm assumed to be of odontogenic origin because the jaw bones are the only skeletal sites affected

38
Q

what are the characteristics of odontogenic myxoma?

A

primarily affects yound adults, but seen over a wide age range
average is 25-40 years
mandible affected slightly more than maxilla
larger lesions present with asymptomatic expansion of the bone

39
Q

what is the radiographic appearance of odontogenic myxoma?

A

unilocular when small, multilocular when large

may have soap bubble appearance

40
Q

what is the histopath appearance of odontogenic myxoma?

A

spindle shaped or stellate shaped fibroblastic cells set in myxoid background
lesional proliferation tends to infiltrate the adjacent bony trabeculae

41
Q

what are the treatments for odontogenic myxoma?

A

small lesions- curettage

large lesions- en bloc or segmental resection, depending on the size and site

42
Q

what is the prognosis of odontogenic myxoma?

A

good

recurrence rates of up to 25% have been reported

43
Q

what are the characteristics of cementoblastoma?

A

most present in mandibular molar region
usually in patients under 25 years of age
no sex predilection
slow growing, may produce expansion or pain

44
Q

what are the radiographic features of cementoblastoma?

A

virtually pathognomonic radiographic features
well- circumscribed radiopaque mass with a fine radiolucent border
fused to a resorbed root of a tooth usually mandibular first molar

45
Q

what is the histopath of cementoblastoma?

A

trebeculae of mineralized material that resembles cementum
the trabeculae are rimmed by plump, angular cells that represent neoplastic cementoblasts
differential: osteoblastoma, osteosarcoma

46
Q

what are the tx and prognosis of cementoblastoma?

A

tx- surgical extraction of the involved tooth with enucleation of the lesions
alternatively the tooth can be endo treated followed by root amputation and removal of the lesion with the involved root
prognosis- excellent

Oral Path (3 decks)

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