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Flashcards in ODONTOGENIC TUMORS Deck (23):
1

What are the 4 types of ectodermal ( epithelial) odontogenic tumors?

1. Ameloblastoma
2. Calcifying Epithelial Odontogenic Tumor (Pindborg tumor) (CEOT)
3. Adenomatoid Odontogenic Tumor (AOT)
4. Squamous Odontogenic Tumor (SOT)

2

Radiographic, pathology and treatment of amelobalstoma

Radiographic: May be pericoronal, always radiolucent, fairly well
circumscribed. resorption
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Pathology:
Classically multilocular, move teeth, root
Epithelial islands and cords where peripheral cells show palisading (columnar) and reverse nuclear polarity. Tumor islands tend to become cystic and most neoplasms show cystic areas grossly. Tumor invades medullary bone but tends to expand cortex.
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Treatment:
Surgical, aggressive curettage (50% recur) vs. resection

3

Characteristics of amelobalstoma( age, man or max more affected?)

All ages (↑ middle age)
75% Md (↑ post) Most painless
± cortical expansion

4

4 types of ameloblastoma?
PUMA
A. Benign
1. Intrabony
a. Conventional
b. Unicystic
2. Peripheral
B. Malignant
1. Malignant ameloblastoma
2. Ameloblastic carcinom

1. Peripheral (extraosseous) : less aggressive
2. Unicystic : a solitary cyst in which the ameloblastoma is confined to the epithelial lining or cyst lumen; less aggressive, recurrence 10-25% with enucleation Cannot definitively diagnose on incisional biopsy
3. Malignant ameloblastoma: “benign” but metastasizes
4. Ameloblastic carcinoma: histologic features of malignancy, aggressive, metastasizes.

5

what are clinical( age, max or man), radiographic, pathology and treatment feature of Calcifying Epithelial Odontogenic Tumor (Pindborg tumor) (CEOT)

Clinical: All ages, ↑ Md, ↑ midbody
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Radiographic: Lucent to mixed lucent/opaque (“driven snow”)
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Pathology:
Often associated with unerupted teeth.
Islands and sheets of pleomorphic epithelial cells.
Tumor cells functional and produce protein matrix similar to enamel matrix (stains with amyloid stains) and may calcify.
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Treatment: Surgical

6

what are clinical(age, max or man female or male location in the jaw), radiographic, pathology and treatment feature of Adenomatoid Odontogenic Tumor (AOT)

Clinical: 1-3 decades (↑ teens), ↑ Mx, ↑ female, 3⁄4 ant jaws, ↑ unerupted teeth asymptomatic.
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Radiographic: Lucent (pericoronal), may contain flecks of opacity.
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Pathology: Encapsulated, swirls of epithelial cells containing rosettes or duct-like spaces lined by cuboidal or columnar cells.
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Treatment: Enucleation(
surgical removal of something without cutting into it)

7

what are radiographic, pathology and treatment feature of Squamous Odontogenic Tumor (SOT)

Radiographic: Lucency around tooth roots
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Pathology: Islands of well-differentiated squamous epithelium. Peripheral layer of cells flattened.
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Treatment: Curettage( to remove tissue by scraping or scooping)

8

what are the 4 types of II. Mesodermal (Connective Tissue)

1. Central Odontogenic fibroma
2. Peripheral Odontogenic fibroma (covered under non-neoplastic lesions)
3. “Odontogenic”myxoma
4. Cementum Lesions

9

what are radiographic, pathology and treatment feature of Central Odontogenic fibroma?

Radiographic: Lucent to mixed lucent/opaque
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Pathology: Simple type: Delicate fibrillar stroma of collagen containing and fibroblasts.
WHO type: Stroma collagenous but may be more mature; variable amounts of odontogenic
epithelium and calcifications.
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Treatment: Surgical remova

10

What are two clinical( age, gingiva location)
and pathology characteristics of B. Peripheral Odontogenic fibroma (covered under non-neoplastic lesions)?

Clinical: Reactive gingival lesion of PDL origin, ↑ young, ↑ anterior gingiva.
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Pathology: Cellular fibrous connective tissue with calcifications, bone, cementum, dystrophic.

11

What are clinical , radiographic, pathology, and treatment characteristics of “Odontogenic”myxoma?

Clinical: All ages (↑ young) Asymptomatic
± Expansion
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Radiographic: Lucency often containing residual opaque trabeculae
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Pathology: Hypocellular tumor, scattered plump fibroblastic cells.
Delicate collagen fibrils and abundant ground substance (glycosaminoglycans). Histology often mistaken for normal anatomic structures (dental papilla or follicle).
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Treatment: Block resection

12

Two types of cementum lesions

1. Central cemento-ossifying fibroma. (Ossifying fibroma, cementifying fibroma)
2. Benign cementoblastoma (true cementoma)

13

What are clinical , radiographic, pathology, and treatment characteristics of Central cemento-ossifying fibroma. (Ossifying fibroma, cementifying fibroma).
Neoplasm of PDL original

Central cemento-ossifying fibroma. (Ossifying fibroma, cementifying fibroma).
Neoplasm of PDL original
Clinical: Adults, sig ↑ Md, ↑ female, ↑ blacks Asymptomatic
± Expansion
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Radiographic: Well circumscribed. Associated with tooth roots. Completely lucent to mixed lucent/opaque to mostly opaque
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Pathology: Very cellular fibroblastic stroma (fibroma) containing trabeculae of bone with cellular
inclusions (ossifying) or “globules” of acellular cementum (cementifying) or both (cemento- ossifying). Usually encapsulated.
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Treatment: Enucleation

14

What are clinical , radiographic, pathology, and treatment characteristics of Benign cementoblastoma (true cementoma)

Clinical: 2-4 decades, ↑Md (Md1M), pain and/or expansion. Tooth vital/vs condensing osteitis – non-vital.
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Radiographic: Pathognomonic – sclerotic mass with peripheral radiolucent zone. Fused with tooth root.
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Pathology: Sclerotic trabeculae of cementum with variable
amounts of “active” fibroblastic stroma with giant cells. Peripheral trabeculae characteristically at right angles to surface. trabeculae fused to tooth root.
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Treatment: Surgical removal Recurrence Low

15

What are clinical , radiographic, pathology, and treatment characteristics of Gigantiform cementoma

Clinical: Must be autosomal dominant.
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Radiographic: Multiquadrant globular opacities.
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Pathology: Globular, sclerotic masses of cementum. Histology not diagnostic.
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Treatment: Usually, none.

16

What are the 3 types of Mixed (epithelial and connective tissue)?

1. Ameloblastic fibroma
2. Ameloblasticfibro-odontoma
3. Odontoma

17

What are clinical , radiographic, pathology, and treatment characteristics of Ameloblastic fibroma

Clinical: Young, 1-3 decades, ↑ post Md Asymptomatic.
Radiographic: Always lucent.
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Pathology: Long strands or cords of epithelial cells resembling dental lamina in a highly cellular connective tissue of fibroblasts and delicate collagen fibrils.
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Treatment: Surgical removal

18

What are clinical , radiographic, pathology, and treatment characteristics of Ameloblasticfibro-odontoma

Clinical: Young, 1-3 decades Asymptomatic.
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Radiographic: Mixed lucent/opaque, often overlying unerupted tooth.
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Pathology:
Some areas like ameloblastic fibroma. Other areas contain products of odontogenesis (enamel, dentin, cementum). In functional areas, morphology recapitulates normal odontogenesis in that epithelial component “opens up” like enamel organ with central stellate reticulum and peripheral
cells showing palisading and reverse nuclear polarity. This is a manifestation of function, not neoplastic transformation.
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Treatment: Surgical removal.

19

What are clinical , radiographic, pathology, and treatment characteristics of odontoma?

Clinical: Young, 1-3 decades
Asymptomatic.
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Radiographic: Radiopaque with thin lucent border (follicle) often overlying unerupted teeth.
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Treatment: Complications:
Compound – tooth-like - ↑ anterior jaws. Complex – random deposition - ↑ posterior jaws.
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Pathology:
Early lesions more active like ameloblastic fibro-odontoma. Late lesions with more mature enamel, dentin, cementum and pulp.
Surgical removal.

20

what is the most common odontogenic tumor?

odontoma is the most common odontogenic tumor. Epithelial and mesenchymal cells functional and produce products of odontogenesis. Viewed as a developmental hamartoma, not a neoplasm

21

What is Ameloblastic fibrosarcoma

Ameloblastic fibrosarcoma – rare malignant transformation of mesenchymal (fibrous connective tissue) component.

22

what is the complication of odontoma

Dentigerous cyst, ameloblastoma

23

3 types of Odontogenic Tumors
Ectodermal Mesodermal

Ectodermal
Mesodermal
Mixed