odontogenic tumors of oral cavity

Odontogenic Tumors Of Oral Cavity

Dr. Deepak K. Gupta

WHO ClassificationBenign

• Odontogenic epithelium without odontogenic ectomesenchyme

– Ameloblastoma

– Squamous odontogenic tumor

– Pindborg’s tumor

– Clear cell odontogenic tumor

• Odontogenic epithelium with odontogenic ectomesenchymewith or without dental hard tissue formation

– Ameloblastic fibroma

– Ameloblastic fibro-odontoma

– Ameloblastic fibro-dentinoma

– Odontoameloblastoma

– Adenomatoid odontogenic tumor

– Complex and compound odontoma

• Odontogenic ectomesenchyme with or without includingodontogenic epithelium

– Odontogenic fibroma

– Odontogenic myxoma

– Benign cementoblastoma www.facebook.com/notesdental

WHO Classification

Malignant tumor

• Odontogenic carcinoma– Malignant ameloblastoma

– Primary intraosseous carcinoma

– Malignant variant of other odontogenic epithelialtumors

– Malignant changes in odontogenic cyst

• Odontogenic sarcoma– Ameloblastic fibrosarcoma

– Ameloblastic fibrodentinosarcoma

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AMELOBLASTOMA


Calcifying Epithelial OdontogenicTumor (CEOT)


Calcifying Epithelial OdontogenicTumor (CEOT)

• Pindborg’s tumor or calcifying ameloblastoma

• Arises from the Reduced enamel epithelium (REE) or dental epithelium

• 1% of all odontogenic tumors


Clinical Features

• Age and sex: common in men, 8 to 92 years with a mean age of 42 years

• Site: mandible is more commonly affected (2:1), developed in premolar & molar area

• Symptoms– Asymptomatic - painless swelling

– rare cases, there is associated mild paresthesia

• Signs• cortical expansion occurs

• hard tumor with well defined or diffuse border

• locally invasive with a high recurrence rate.


Radiographic Features

• Driven snow appearance: Combined pattern of radiolucency and radiopacities

– Radiopacity due to mineralization of amorphous proteinaceous material generated by the tumor cells

– Multilocular or honeycomb pattern

• Scalloped margin

• May displace the developing tooth or prevent its eruption

• Expansion of cortical plate


Histopathological Features

• Consist of sheets or strands of epithelial cells in a connective tissue stroma

• epithelial cells are polyhedral and typically have distinct outlines

• Nuclei - Gross variation in size, including giant nuclei, hyperchromatic

• Unlike most carcinomas, a stromal inflammatory reaction is typically absent.

• Typically homogeneous hyaline areas, similar to the staining characteristics of amyloid

• These may calcify and form concentric rings in and around degenerating epithelial cells


Differential Diagnosis

• Mixed radiolucent and radiopaque– Calcifying odontogenic cyst,– Adenomatoid odontogenic tumor,– Ameloblastic fibro-odontoma– Fibro-osseous lesion– Osteoblastoma

• Radiolucency predominates• Dentigerous cyst, • Odontogenic keratocyst• Ameloblastoma• Odontogenic myxoma


Treatment

• Local, conservative excision including a thin rim of normal bone

• Peripheral lesions with a narrow periphery of normal – appearing mucosa

• Prognosis

– Very good

– Recurrence rate is low, from 10 to 15%

– Long-term follow-up recommended


Odontoma


Odontoma

• Nonaggressive lesions that are more likely to be hamartomatous (development) than neoplastic

• Once fully calcified they do not develop further.

• They may be further classified

– Complex Odontoma

– Compound Odontoma


Odontoma

• Compound odontome– enamel and dentin are laid down in such a fashion

that the structure bears a considerableanatomical resemblance to that of normal teeth

– Except they are often smaller than the typical teeth

• Complex odontome– Dental structure are simply arranged in an irregular

mass

– bearing no morphological similarity even to rudimentary tooth


Etiology

• Unknown origin

• Trauma: local trauma or infection

• Genetic:they are either inherited or are due to a mutant gene

Mechanism

• Both the epithelial and mesenchymal cells exhibit complete differentiation

• Results in formation of functional ameloblasts and odontoblasts form enamel and dentin.

• These are laid down in an abnormal pattern– failure of cells to reach the morphodifferentiation stage


Clinical Features

• Age: first and second decade of life. • Sex: Slight males predilection• Site

– Compound odontome : incisor, canine area of maxilla– Complex odontome: mandibular 1st and 2nd molar area.– Unusual situation includes the maxillary sinus, inferior border of

the mandible, ramus and condylar region.

• Frequency: compound odontome is twice as commonas complex odontome

• Size– Compound odontoma : 1 to 3 cm in diameter. It usually remains

small , occasionally increases than that of the tooth.– Complex odontoma: varies in size


Clinical Features

• Symptom

– Alveolar swelling in the jaw - facial asymmetry

– In some cases, signs of infection may be present.

• Signs

– it is common for a tooth or teeth to be absent from the arch in the presence of an odontome.

– On palpation expansion of the jaw may be noticed.


Clinical Features

• Teeth

– impaction malpositioning, diastema, aplasia,malformation and deviation of adjacent teeth

– 70% of odontoma.

• Development of cyst

– sometime, cyst develops in relation with a complex odontome and compound odontome,

– but it is very rare.


Compound odontome


Complex Odontome



• intermediate stage of mixed radiolucency, finally denselyradiopaque

• Internal structure– cluster of small shapeless dense masses of solid tissue – having equal or more density, depending on the size of the

mass. – In some cases, there may be presence of two or more teeth-like

masses

• Margin– borders are well defined in both the cases – But vary from smooth to irregular and may have hyperostotic

borders.


Complex Odontoma


Compound Odontoma



• Presence of ghost cells (20%)• Compound Odotome

– Normal appearing enamel or enamel matrix, dentin, pulp tissues and cementum

– denticles are embedded in fibrous connective tissue, and have a fibrous capsule

• Complex Odontome– Mass consists of all the dental tissues in a

disordered arrangement,– But frequently with a radial pattern.– Pulp is usually finely branched so that the mass is

perforated


Histopathological Features : Compound


Histopathological Features: Complex



• Cementifying or ossifying fibroma

• Adenomatoid odontogenic tumor

• Periapical cemental dysplasia

• Calcifying epithelial odontogenic tumor

• Fibrous dysplasia


Treatment

• Simple local surgical excision is the treatment of choice.

• These lesions are not expected to recur


Adenomatoid Odontogenic Tumor


Adenomatoid Odontogenic Tumor

• Adenoameloblastoma• Ameloblastic adenomatoid tumor• Uncommon nonaggressive tumors of

odontogenic epithelium in variety of patterns mixed with mature connective tissue stroma.

• Some consider it benign neoplasm and others, Hamartomatous malformation – limited size and lack of recurrence

• Odontogenic epithelium origin - enamel organ epithelium

• 3% of all oral tumors


Clinical Features

• Age: range of 5 to 50 years; 70% occur in the second decade

• Sex: 2 : 1 female predilection

• Classified in 2 types

– Central tumors

• Follicular type : associated with the crown of an embedded tooth, 73% of all central type

• Extrafollicular type: those with no embedded tooth

– Peripheral tumors


Clinical Features


Clinical Features

• Site: commonly in the maxilla, in the anterior region and especially in the cuspid area

• Signs & symptom

– often associated with a missing tooth – maxillary canine

– Slow growing

– Presents as a gradually enlarging, painless swelling or asymmetry


Radiographic Features• Often appears radiographically as a unilocular dentigerous

cyst

• Periphery: well-defined corticated or sclerotic border

• Internal Structure– its presented as mixed radio-opacity and radio-lucency

– radiopacities in about two thirds of cases

– some may show dense clusters of ill-defined radiopacities -cluster of small pebbles

– radiolucent circumferential halo which envelops a dense, central and round radiodense mass.

• Effect on surrounding structure• separation of roots or displacement of a adjacent tooth occurs frequently

• cortical expansion and root resorption


Histological Features• Macroscopic features

– Roughly spherical mass with a distinct fibrous capsule

– Cross section: white to tan solid with yellowish brown fluid or fine gritty material

– Sometimes embedded with tooth or walls of cyst

• Microscopic features– Multinodular proliferation of spindle, cuboidal and

columnar cells

– Comprises of duct like structures, eosiniphillic material –hyaline ring: distinctive features of most of AOT

– Ducts are lined by columnar cells similar to ameloblasts

– Microcysts - tumours being called adenomatoid


Low Power


High Power



• Radiolucent

– Dentigerous cyst

• Radiopacities

– Ameloblastoma

– Ameloblastic fibroma

– Ameloblastic fibro-odontoma

– Calcifying odontogenic cyst

– Odontogenic fibroma or myxoma


Treatment

• Conservative surgical excision is adequate

• Because the tumor is

– Not locally invasive,

– Well encapsulated,

– Separated easily from the bone

• Recurrence rate is 0.2%.



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odontogenic tumors of oral cavity

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