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Oral Disease - Hard tissue > Odontogenic tumours > Flashcards

Odontogenic tumours Flashcards

1
Q

What can the odontogenic tumours be categorised into?

A
  • Odontogenic epithelium without mesenchyme
  • Odontogenic epithelium with odontogenic ectomesenchyme, with or without hard tisuse formation
  • Odontogenic ectomesenchyme
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2
Q

What are the sources of odotogenic epithelium?

A
  • Rest of Serres
  • Dental lamina
  • Reduced enamel epithelium
  • Root sheath of Hertwig
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3
Q

What are the sources of odontogenic mesenchyme?

A
  • Dental papilla

- Dental follicle

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4
Q

What can occur in the presence of both odontogenic epithelium and mesenchyme?

A
  • Formation of hard tissue, resulting in a mixed RO/RL lesion
  • However note that hard tissue is not always formed even if both are present
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5
Q

What is histodifferentiation?

A

Differentiation of embryological cells into their cell types - in this case into ameloblasts and odontoblasts

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6
Q

What is morphodifferentiation?

A
  • Differentiation of tissues into the shape of the future tissue - e.g. into the shape of the future crown of the tooth
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7
Q

What is the differential diagnosis for odontogenic tumours?

A
  • Localised infection
  • Spreading infection
  • Cysts (odontogenic and non-odontogenic)
  • Non-odontogenic tumours and neoplasms
  • Giant cell lesions
  • Early fibro-osseous lesions
  • Idiopathic lesions
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8
Q

Where can odontogenic tumours arise?

A

In tooth bearing areas, the alveolar ridge and the soft tissues overlying them

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9
Q

List the benign epithelial odontogenic tumours

A
  • Ameloblastoma
  • Squamous odontogenic tumour
  • Adenomatoid odontogenic tumour
  • Calcifying epithelial odontogenic tumour (CEOT or Pindborg)
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10
Q

What is the most common odontogenic neoplasm

A

Ameloblastoma

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11
Q

What is an ameloblastoma

A

Benign neoplasm of ameloblasts (epithelial odontogenic tumour)

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12
Q

What is the key causative mutation highlighted in ameloblastomas?

A

BRAF V600E

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13
Q

What are the types of ameloblastoma

A

Multicystic/solid (most common)
Unicystic
Peripheral
Desmoplastic

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14
Q

Epidemiology of multicystic alemoblastomas

A

Age 30-40

More common in Africans and Afro-carribeans

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15
Q

Describe the effects of multicystic ameloblastomas

A
  • Locally infiltrative
  • Slow growing
  • Rarely metastasizes
  • Usually asymptomatic or a swelling with a jaw that becomes obstructive
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16
Q

Describe the invasive nature of ameloblastomas

A

It pushes islands of odontogenic epithelium unto the surrounding medullary spaces a few mm beyond the main bony cavity

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17
Q

Describe the radiographic appearance of ameloblastomas

A

Site: 80% in the mandible (premolar region and lower ramus)
Size - variable
Shape - multilocular with honeycomb appearance (distinct septa)
Outline - scalloped and smooth, well-defined and corticated
RD - RL with internal RO septa
Effects - adjacent teeth displaced, resorbed or loosened. extensive expansion in all dimensions

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18
Q

Where are maxillary amelbolastomas very dangerous?

A

Maxilla is thinner than the mandible therefore it spreads quicker
It spreads upwards invading the sinonasal passages, pterygomaxillary fossa, orbit and cranium

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19
Q

Histology of ameloblastoma

A
  • Variable
  • Common feature of islands or strands of epithelium with a peripheral layer of pre-ameloblast like cells with reverse polarity
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20
Q

What are the two main histological patterns of ameloblastomas

A
  • Follicular (most common)

- Plexiform

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21
Q

Describe the follicular histological pattern of ameloblastomas

A

Islands of odontogenic epithelium within a fibrous stroma (pre-ameloblasts like cells surrounding a core of loosely arranged cells resembling stellate reticulium)

22
Q

Describe the plexiform histological pattern of ameloblastomas

A

Basal cells arranged in long, anastomosing strands with fibrous stoma

23
Q

Tx of ameloblastomas

A
  • Complete excision with a small margin (1-2cm) of normal tissue - therefore large tumours may require jaw resection
24
Q

Can enucleation be used for ameloblastomas?

A
  • ONLY for well-localised mandibular lesions
  • Requires close monitoring and gold standard treatment at any sign of recurrence
  • NOT FOR MAXILLARY
25
Q

What is the recurrence rate of ameloblastomas

A

10% after 10 years

26
Q

What are unicystic ameloblastomas

A
  • Variant of an ameloblastoma that presents as a single cyst
27
Q

How many ameloblastomas are unicystic?

A

5-15%

28
Q

Epidemiology of unicystic ameloblastomas

A

10-30 year olds

29
Q

Describe the radiographic appearance of unicystic ameloblastomas

A
  • Site - almost always mandibular lower 8 area (may have false dentigerous relationship) or with apices (false radicualr)
  • Size - variable
  • Shape - unilocular
  • Outline - smooth and well corticated
  • RD - RL
30
Q

How is a unicystic ameloblastoma diagnosed?

A

After through histological assessment of the entire capsular wall
- It has to be unicystic radiographically and histologically

31
Q

Tx of unicystic ameloblastomas

A
  • Enucleation is successful with low risk of recurrence
32
Q

Why can unicystic ameloblastomas be treated with enucleation?

A

Because the epithelium is enclosed by a fibrous cyst wall (it does not infiltrate the surrounding bone)

33
Q

What are mural ameloblastomas?

A

Appear as unicystic - however they have one large cavity and lots of small ones

34
Q

What is a metastasising ameloblastoma?

A

Very rare tumour

It appears histologically like an ameloblastoma but it metastasizes, usually to the lung

35
Q

What is an ameloblastic carcinoma?

A

Very rare tumour that initially resembles an ameloblastoma histologically, but develops into a carcinoma and spreads to the lymph nodes and beyond (it may appear like a SCC histologically)

36
Q

What is a squamous odontogenic tumour?

A

Very rare benign neoplasm that is locally infiltrative

37
Q

What is the proposed origin of squamous odontogenic tumours

A

Cell rests of Malassez or remnants of the dental lamina

38
Q

Where are squamous odontogenic tumours found?

A

Between the roots of teeth, producing a triangular or unilocular radiolucent lesion, which may become mulilocular when larger

39
Q

Tx of squamous odontogenic tumours

A

Local excision has good success

40
Q

What are adenomatoid odontogenic tumours?

A

Uncommon, slow-growing benign odontogenic tumour, that is probably a hamartoma

41
Q

Describe the patient and clinical features of an adenomatoid odontogenic tumour

A
  • 15-20 yo
  • Females 2x > males
  • Maxilla > mandible
  • Asyptomatic, but may cause jaw expansion or displacement
42
Q

Describe the radiographic appearance of an adenomatoid odontogenic tumour

A

Site - usually anterior maxilla, associated with an unerupted tooh
Size - variable
Shape - round or oval, unilocular
Outline - smooth, well-defined and corticated
RD - initially RL but can have small internal calcifications
Effects - expansion of the jaw, displacement of teeth but rarely resorbs

43
Q

Histology of adenomatoid odontogenic tumours

A

Solid nodules of odontogenic epithelim organised into rosettes
There may be eosionophillc areas and globules of amyloid-like matrial

44
Q

Tx of adenomatoid odontogenic tumours

A

Enucleation or conservative local excision (it is non-infiltrative)

45
Q

What are calcifying epithelial odontogenic tumours (CEOT)?

A

Very rare, locally invasive odontogenic tumours

46
Q

Describe patient and clinical features of CEOT

A

Age 20-60 (usually elderly pts)

Typically asymptomatic, slow growing and expands the jaw

47
Q

Describe the histology of CEOT

A
  • Cystic change is not a common feature
  • There are islands and sheets of epithelial cells in a connective tissue stroma
  • Bizarre pleomorphic and hyperchromatic nuclei and amyloid-like material
48
Q

Tx of CEOT

A
  • Complete excision with a margin of normal tissue
49
Q

Describe the radiographic appearance of CEOT

A
  • Site - premolar or posterior region of mandible > maxilla
  • Size - tend to be small
  • Shape - unilocular or multilocular
    Outline - smooth or scalloped, variably defined and corticated
    RD - Mixed
    Effects - expansion of jaw, displacement and resorption of teeth
50
Q

What may CEOT be mistaken for histologically and why?

A
  • For a SCC due to the enlarged and darkly stained nuclei
51
Q

What produces amyloid in odontogenic lesions?

A

Odontogenic ameloblast associated protein

Oral Disease - Hard tissue (4 decks)

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