odontomes & odontogenic tumors ii (slide 18+19)

7/30/2019 Odontomes & Odontogenic Tumors II (Slide 18+19)

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Dent 356-11:

Odontomes & Odontogenic Tumors II

Dr. Rima Safadi


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Squamous Odontogenic Tumor

Rare tumor presenting with toothmobility.

Radiographically presents as awell-circumscribed, semilunar ortriangular radiolucency associatedwith roots of teeth.

Histologically consists of islands of

benign, well-differentiatedsquamous epithelium. Thought to b e derived from

epithelial rests ofMalassez. Although some lesions may be

aggressive, curettage is thetreatment of choice.


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Calcifying Epithelial Odontogenic Tumor

(Pindborg Tumor*)

Rare, benign, but locally invasive epithelial neoplasm.

Wide age range.

Mandible > maxilla.

Most arise in molar and premolar areas.

~50% associated with crown of unerupted tooth.

Extraosseous examples reported.

Locally invasive but less aggressive than ameloblastoma.


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(Pindborg Tumor): Radiographic Features

Irregularradiolucent area,may or may not beclearlydemarcated.

May contain

varying amounts ofradiopaque bodiesdue to calcification.
http://www.usc.edu/hsc/dental/opfs/OT/048bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/049big.html


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(Pindborg Tumor): Histopathologic Features

Sheets and strands ofpolyhedral epithelial cellswith abundant eosinophiliccytoplasm in fibrousstroma.

Cells have prominentintercellular bridges andmarked nuclearpleomorphism,nevertheless it is notmalignant.

Amyloid-like material maybe present, it may becomecalcified.
http://www.usc.edu/hsc/dental/opfs/OT/050bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/050bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/050bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/050bb.html


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Adenomatoid Odontogenic Tumor:

Clinical & Radiographic Features 2nd and 3rd decades.

Majority in anterior maxilla,especially canine area.

Slowly enlarging swelling.

Well-defined radiolucency,may have radiopacities. oftenassociated with uneruptedtooth, simulating dentigerouscyst.

Rare extraosseous variant.

Treatment is conservativeenucleation.
http://www.usc.edu/hsc/dental/opfs/OT/039bb.html


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Adenomatoid Odontogenic Tumor:

Histopathologic Features

Well-encapsulated, solid orcystic.

Sheets, strands, masses ofepithelium which in some

places forms duct-likestructures lined bycolumnar epithelium.

Small foci of calcificationand occasional dentin andenamel matrix may beseen.

Treatment is conservativeenucleation.
http://www.usc.edu/hsc/dental/opfs/OT/043bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/043bb.html


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Ameloblastic Fibroma

Rare benign tumor withboth epithelial andmesenchymal componentsneoplastic.

Important to differentiatefrom ameloblastoma sinceit is not invasive and doesnot require aggressivetherapy.

Presents in young agegroups.

Slowly enlarging swellingmostly in posterior parts ofmandible.


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Ameloblastic Fibroma: Radiographic Features

Radiographically, well-defined unilocularradiolucency.

May be associated with an

unerupted tooth and mimica dentigerous cyst.

Treated conservatively. Recurrence rates of~18%.


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Ameloblastic Fibroma: Histopathologic Features

Proliferating strands ofodontogenic epithelium lyingin highly cellular fibroblastictissue resembling dentalpapilla.

Epithelium resembles that ofameloblastoma but stellatecells are much less abundant.

Ifdentin is present, the tumoris designated ameloblasticfibrodentinoma.

If there is also enamelformation, they aredesignatedameloblasticfibro-odontoma.
http://www.usc.edu/hsc/dental/opfs/OT/057bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/057bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/056bb.html


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Calcifying Cystic Odontogenic Tumor

(Calcifying Odontogenic Cyst or Gorlin Cyst)

& Dentinogenic Ghost Cell Tumor

The calcifying cystic odontogenic tumor is a grossly cystictumor and may be a hamartoma rather than a trueneoplasm.

The dentinogenic ghost cell tumor is histologically similarexcept that it is solid.

It was originally considered to represent the solid variant ofthe calcifying cystic odontogenic tumor (calcifyingodontogenic cyst or Gorlin cyst).

Increasing evidence that they are distinct entities.

Both present centrally within the jaws, but peripheralgingival lesions also occur.


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(Calcifying Odontogenic Cyst or Gorlin Cyst)Clinical Features

The calcifying cysticodontogenic tumor usuallyoccurs below age 40.

75% intraosseous.

Majority arise anterior to

1st

molar in either jaw.

Slowly enlarging swelling.
http://www.usc.edu/hsc/dental/opfs/OC/50bb.html


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(Calcifying Odontogenic Cyst or Gorlin Cyst)Radiographic Features

Well-defined unilocular ormultilocular raadiolucencywith variable amounts ofradiopaque material.

May be associated withcrown of an uneruptedtooth.

Usually responds toconservative treatment.
http://www.usc.edu/hsc/dental/opfs/OC/50bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OC/49bb.html


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(Calcifying Odontogenic Cyst or Gorlin Cyst)Histopathologic Features

Cyst lined with epitheliumsimilar to ameloblastoma,but showsghost cell

keratinization.

Ghost cells may undergocalcification.

There may be dentin-likemasses.
http://www.usc.edu/hsc/dental/opfs/OC/52bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OC/51bb.html


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(Calcifying Odontogenic Cyst or Gorlin Cyst)Histopathologic Features
http://www.usc.edu/hsc/dental/opfs/OC/51bb.html


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Dentinogenic Ghost Cell Tumor

The dentinogenic ghost cell tumor tends tooccur in an older age group than thecalcifying cystic odontogenic tumor.

Some cases respond to conservativetreatment.

Other cases pursue a more aggressivecourse and are locally invasive likeameloblastoma.


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Odontogenic Fibroma and Myxoma

Derived from mesenchymal dental tissues.

May arise in relation to root, crown, or

replace a tooth.

These different presentations reflect the

different mesenchymal tissues that maygive rise to the tumors-PDL, dental follicle,and dental papilla.


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Odontogenic FibromaClinical Features

The central variant isan uncommon, well-demarcated benignfibroblastic neoplasm.

Readily enucleatedwith no tendency forrecurrence.

Peripheralodontogenic fibromaarises on the gingiva.


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Odontogenic FibromaHistopathological Features

Cellular fibro-collagenous tissuecontaining inactive

odontogenic epithelialislands.

Foci of cementum-like

and dentin-likematerial may bepresent.


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Odontogenic FibromaHistopathological Features


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Odontogenic MyxomaClinical Features

Myxoma is benignbut locally

invasive.

More common thanodontogenic

fibroma.


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Odontogenic MyxomaRadiographic Features

Multilocualrradiolucency,

soap-bubble, or

tennis-racketappearance, oftenwith well-definedmargins.

Root resorption.


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Odontogenic MyxomaHistopathological Features

Nonencapsulated,infiltrative pattern ofgrowth.

Stellate, fibroblast-likecells with longanastomosingprocesses.

Abundant connectivetissue groundsubstances,predominnaltlyglycosaminoglycans.


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Some cases contain afew strands ofodontogenicepithelium.

Variable amounts ofcollagen, and ifprominent it may bedesignated asmyxofibroma orfibromyxoma.
http://www.usc.edu/hsc/dental/opfs/OT/092bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/092bb.html


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Odontogenic Myxoma: Behavior

Unlike fibroma, thelocally invasivegrowth of myxoma

and friable myxoidtissue predisposeto local recurrence.

Recurrence rates of10-30%.


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Cementoblastoma

Although cementum isconsidered to be amodified form of bone,cementoblastoma is stillclassified as an

odontogenic tumorbecause of its uniqueassociation with the root ofa tooth.

Identical to osteoblastoma

except for association withtooth roots.


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CementoblastomaClinical Features

A rare, benign neoplasm.

Mostly seen < 25 years ofage.

Usually mandibular molar-premolar area attached toa root of a tooth.

Most cases involvemandibular 1st permanent

molar.

Slowly enlarging swellingwhich sometimes gives riseto pain.

Involved tooth is vital. May recur if incompletely

removed.


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CementoblastomaRadiographic Features

well-circumscribed,mottled or denseradiopaque masswith a radiolucentmargin attached tothe root of a tooth

which usuallyshows resorption.


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CementoblastomaHistopathologic Features

Mass of calcifiedcementum-like

tissue containingscattered cellslying in lacunaegrowing in

continuity with theapical cementallayer of the root.
http://rds.yahoo.com/S=96062857/K=cementoblastoma/v=2/SID=w/l=II/R=10/SS=i/OID=46c8cb2431680bc2/SIG=1k46ti1h4/EXP=1122578818/*-http%3A//images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dcementoblastoma%26ei%3DUTF-8%26fr%3Dsfp%26fl%3D0%26x%3Dwrt&h=2000&w=2544&imgcurl=www.mor.aichi-gakuin.ac.jp%2Fsigakubu%2Fkiso%2Fbyouri%2Fimage%2F1benigncment02.jpg&imgurl=www.mor.aichi-gakuin.ac.jp%2Fsigakubu%2Fkiso%2Fbyouri%2Fimage%2F1benigncment02.jpg&size=159.9kB&name=1benigncment02.jpg&rcurl=http%3A%2F%2Fwww.mor.aichi-gakuin.ac.jp%2Fpublic%2Fbyouri%2Fhtml%2Febcb03.html&rurl=http%3A%2F%2Fwww.mor.aichi-gakuin.ac.jp%2Fpublic%2Fbyouri%2Fhtml%2Febcb03.html&p=cementoblastoma&type=jpeg&no=10&tt=13&ei=UTF-8http://rds.yahoo.com/S=96062857/K=cementoblastoma/v=2/SID=w/l=II/R=9/SS=i/OID=718f3298bbbb9d1c/SIG=1k0n8hpbq/EXP=1122578818/*-http%3A//images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dcementoblastoma%26ei%3DUTF-8%26fr%3Dsfp%26fl%3D0%26x%3Dwrt&h=298&w=224&imgcurl=www.mor.aichi-gakuin.ac.jp%2Fsigakubu%2Fkiso%2Fbyouri%2Fimage%2F1benigncment01.jpg&imgurl=www.mor.aichi-gakuin.ac.jp%2Fsigakubu%2Fkiso%2Fbyouri%2Fimage%2F1benigncment01.jpg&size=36.4kB&name=1benigncment01.jpg&rcurl=http%3A%2F%2Fwww.mor.aichi-gakuin.ac.jp%2Fpublic%2Fbyouri%2Fhtml%2Febcb01.html&rurl=http%3A%2F%2Fwww.mor.aichi-gakuin.ac.jp%2Fpublic%2Fbyouri%2Fhtml%2Febcb01.html&p=cementoblastoma&type=jpeg&no=9&tt=13&ei=UTF-8


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Cementoblastoma

Histopathologic Features

Around theperiphery and inactively grwoingparts, extensivesheets ofuncalcified matrix

formed by plump,deeply stainingcementoblasts.


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Malignant Odontogenic TumorsMalignant Ameloblastoma & Ameloblastic Carcinoma

Very rarely, anameloblastoma shows truemalignant behavior withmetastasis.

The primary andmetastatic neoplasmsshow histopathologicfeatures of typicalameloblastoma, i.e. noatypia is seen.

If only lung metastasis isseen the possibility ofseeding due to aspirationduring surgery should beconsidered.

If the tumor showsfeatures of atypia, it isgiven the diagnosis ofameloblastic carcinoma.


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Malignant Odontogenic TumorsPrimary Intraosseous Carcinoma

Rarely, carcinomasarise within the jawswithout a pre-existingcyst.

They are presumed toarise from residues ofodontogenicepithelium.

They may also bereferred to asodontogeniccarcinomas.


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Malignant Odontogenic TumorsMalignant Change in Odontogenic Cysts

A squmaous cell carcinma may present withclinical and radiographic or histological evidenceconsistent with an origin from an odontogeniccysts.

The cysts include radicular, residual, dentigerousand keratocysts.

Possibility of cystic degeneration within anexisting carcinoma or carcinoma involving anadjacent cyst.

Dysplasia is seen sometimes in long standingodontogenic cysts.


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Malignant Odontogenic TumorsOdontogenic Sarcomas

Malignant counterpart ofameloblastic fibroma and relatedlesions.

Fibrosarcomas containing non-neoplastic odontogenic epithelium

and occasionally dental hard tissues,e.g. ameloblastic fibrosarcoma,fibrodentinosarcoma.


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Tumors of Debatable OriginMelanotic Neuroectodermal Tumor of Infancy

Rare tumor whichoccurs in infantsusually in the firstyear of life.

Most common inmaxilla tha mandibleor elsewhere.

Symptomless massexpanding the bone.


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Tumors of Debatable OriginMelanotic Neuroectodermal Tumor of Infancy

Evidence of neural

crest origin.

Most are benign andrecurrence isuncommon following

conservative excision.


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Tumors of Debatable OriginCongenital Epulis

Also known as: congenitalgingival granular cell tumor,congenital granular cellepulis, congenital epulis ofthe newborn.

A unique and rare congenitaltumor of the alveolar mucosaof the jaws that occurs only innewborns.

10 times more common infemales.

Predilection for anteriormaxilla.


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Tumors of Debatable OriginCongenital Epulis

Large, closelypacked granularcells.

Resemblesgranular celltumor, buthistogenesisunknown.

odontomes & odontogenic tumors ii (slide 18+19)

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