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cysts, tumours, bone pathology > odontogenic tumours > Flashcards

odontogenic tumours Flashcards

(61 cards)

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1
Q

incidence

A

rare - 1% of OMF lesions sent for histopathological assessment in UK

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2
Q

are most benign or malignant?

A

benign 100:1

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3
Q

how are the majority discovered and why?

A

due to non-eruption of teeth, late-stage bony expansion or imaging for other reasons (ie incidental)
because the majority are asymptomatic

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4
Q

where do most arise?

A

within the bone of jaws

- rare cases within surrounding ST

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5
Q

what usually causes symptoms?

A

pain usually secondary to infection or pathological fracture

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6
Q

how are they classified?

A

based on their tissue of origin

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7
Q

classification

A

epithelial
mesenchymal
mixed (epithelium and mesenchyme)

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8
Q

which are the only tumours that can have dentine and enamel formation and why?

A

mixed tumours
due to the concept of induction - D forms first (odontoblasts) from mesenchyme then this induces ameloblasts and E formation - cannot have E without D first

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9
Q

odontogenic sources of epithelium

A

rests of malassez
rests/glands of serres
reduced enamel epithelium

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10
Q

rests of malassez

A

remnants of Hertwig’s epithelial root sheath

can get inactive ‘clumps’ remaining in PDL

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11
Q

rests/glands of serres

A

remnants of the dental lamina

forms tooth germs - can get inactive clumps remaining within jaws

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12
Q

reduced enamel epithelium

A

remnants of the enamel organ

covers crown of UE tooth

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13
Q

examples of epithelial tumours

A

ameloblastoma
adenomatoid odontogenic tumour (AOT)
calcifying epithelial odontogenic tumour (CEOT)

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14
Q

example of mesenchymal tumour

A

odontogenic myxoma

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15
Q

example of mixed tumour

A

odontoma (odontome)

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16
Q

radiographic appearance

A

highly variable
entirely radiolucent/mixed/entirely radiopaque
may change as tumour progresses

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17
Q

what % of cases are either ameloblastoma or odontoma?

A

> 50%

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18
Q

what is an ameloblastoma?

A

benign epithelial tumour

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19
Q

typical features of an ameloblastoma

A

locally destructive but slow growing

typically painless

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20
Q

incidence of ameloblastoma

A

1% of OMF tumours

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21
Q

what age range is ameloblastoma most common in and gender?

A

4th-6th decades

M>F

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22
Q

location of ameloblastoma

A

80% in posterior mandible

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23
Q

types of ameloblastoma - radiological

A 
multi cystic (85-90%) - tends to be older patients
unicystic - younger patients, lower recurrence risk
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24
Q

types of ameloblastoma - histological

A

follicular
plexiform
desmoplastic
(several other less common types)

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25
ameloblastoma margins
``` well-defined, corticated potentially scalloped (not unicystic) ```
26
feature of multi cystic ameloblastoma
may have thick, curved septa - soap bubble appearance
27
ameloblastoma radiographic appearance
``` primarily radiolucent (but rare variants can be mostly radiopaque) - desmoplastic ```
28
ameloblastoma effects on adjacent structures
displacement thinning of bony cortices "knife edge" external RR
29
characteristic expansion of ameloblastoma
all directions equally
30
histology of follicular ameloblastoma
``` ameloblast-like cells stellate reticulum like tissue cystic changes within islands within fibrous tissue background tissues within follicles loose can get squamous metaplasia change ```
31
histology of plexiform ameloblastoma
ameloblast-like cells - strands may have small amount of stellate reticulum like tissue between fibrous tissue stroma
32
does ameloblastoma have a CT capsule and what is the consequence?
no cells can grow and infiltrate reason for high recurrence rate
33
management of ameloblastoma
surgical resection with margin
34
recurrence of ameloblastoma
relatively common - up to 15% of cases
35
risk of malignant transformation of ameloblastoma
<1% of cases | ameloblastic carcinoma
36
what type of tumour is an adenomatoid odontogenic tumour?
benign epithelial tumour
37
classic presentation of AOT
unilocular radiolucency with internal calcifications around crown of unerupted maxillary canine
38
incidence of AOT
3% of odontogenic tumours most common in 2nd decade F>M
39
where do most AOTs occur?
anterior maxilla
40
what percentage of AOTs are associated with an UE tooth and what tooth commonly is it?
75% | commonly U3 - impedes eruption
41
presentation of an AOT
similar to dentigerous cyst but typically attached apical to CEJ - asymmetric, involves root and crown unilocular radiolucency majority have internal calcifications/radiopacities - increase as tumour matures margins well-defined and corticated/sclerotic may displace adjacent structures but external root resorption rare
42
histology of AOT
distinctive with patchy calcification duct-like structure/sheets/rosette - epithelial fibrous capsule - removal simple and low recurrence rate
43
what type of tumour is a calcifying epithelial odontogenic tumour?
benign epithelial tumour
44
what is CEOT also known as?
Pindborg tumour
45
incidence of CEOT
1% of odontogenic tumours most common in 5th decade M>F
46
most common site for CEOT
posterior mandible
47
presentation of CEOT
``` slow-growing but can become large 1/2 associated with UE tooth radiolucency often with internal radiopacities - calcifications of varying sizes variable radiographic presentation otherwise - unilocular/multilocular - margins: well/poorly defined - internal septal: none/fine/coarse ```
48
what type of tumour is an odontogenic myxoma?
benign mesenchymal tumour
49
incidence of odontogenic myxoma
3-6% of odontogenic tumours most common in 3rd decade F=M
50
site of predilection for odontogenic myxoma
mandible>maxilla
51
presentation of odontogenic myxoma
well-defined radiolucency +/- thin corticated margin - smaller lesions unilocular - larger lesions multilocular with scalloped margins - soap bubble appearance - tennis racket pattern of internal septa suggestive of myxoma but only occurs in minority of cases - septa geometric and at right angles slow growth along bone before causing notable BL expansion scallops between teeth but larger lesions may cause displacement - external root resorption rare
52
histology of odontogenic myxoma
loose myxoid tissue with stellate cells - loose type of CT can be gelatinous may contain islands of inactive odontogenic epithelium - vital but don't divide (inert) no capsule - locally invasive and infiltrate, harder to surgically remove, recurrence
53
management of odontogenic myxoma
curettage or resection (depending on size) - scrape out if small - cut a block out if larger
54
recurrence of odontogenic myxoma
high rate 25% follow up important lower recurrence rate if unilocular
55
what type of tumour is an odontoma?
benign mixed tumour technically a hamartoma malformation of dental tissue - E, D, C, P
56
odontoma similarities to teeth
mature to a certain stage (ie do not grow indefinitely) can be associated with other odontogenic lesions (e.g. dentigerous cysts) surrounded by dental follicle lie above IDC
57
incidence of odontoma
1/5-2/3 of all odontogenic tumours most common in 2nd decade F=M
58
types of odontoma
compound complex compound>complex 2:1
59
compound odontoma
ordered dental structures may appear as multiple "mini teeth" (denticles) more common in anterior maxilla
60
complex odontoma
disorganised mass of dental tissue | more common in posterior body of mandible
61
histology of odontoma
enamel space - inorganic so dissolved during prep - get spaces - unless not fully calcified - may still see some parts dentine may see cementum

cysts, tumours, bone pathology (4 decks)

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