odontogenic tumors - dental.uop.edu according to histogenesis • epithelial: tumors with...

ODONTOGENIC TUMORS

Classification According to Histogenesis

• Epithelial: tumors with ameloblastic characteristics, without inductive changes in mesenchymal components of tooth germ

• Mixed: both epithelial(ameloblastic) and mesenchymal(pulpal) tissues

• Mesenchymal: only connective tissue elements (follicular, PDL)

EPITHELIAL ODONTOGENIC

TUMORSInvasive AmeloblastomaUnicystic AmeloblastomaPeripheral Ameloblastoma

Odontogenic Adenomatoid TumorOdontogenic Ghost Cell Tumor

Calcifying Epithelial Odontogenic Tumor

Ameloblastoma (Invasive)

• Radiolucent, unilocular, multilocular• Invasive type “soap bubble”• Mandible > Maxilla (both posterior)• Adult Onset• Histologic Subtypes are not prognostic

– Follicular, acanthomatous, granular cell

• Mandible -- curettage, resection• Maxilla -- resection

Ameloblastoma

Ameloblastoma

Ameloblastoma

Ameloblastoma

Granular cell variant• Granular ameloblasts and stellate reticulum cells

Desmoplastic Ameloblastoma

All invasive ameloblastomas behave the same

• Mandible: Curettage, a recurrence can always be resected and reconstructed

• Maxilla: Big Problem, after curettage, tumors may recur and extend into sinuses, skull base, even brain. Resection at the onset is recommended.

Unicystic Ameloblastoma• Teenage Years• Impacted Third Molar• Expansile• Histology• Ameloblastic Cyst

Lining• Mural• Luminal Plexiform• Curettage • <10% recurrence, up to

40% with long term FU

Unicystic Ameloblastoma

Unicystic AmeloblastomaLUMINAL

plexiform

lumen

tumor

Fibrous wall

Unicystic Ameloblastoma

Cyst lining

Mural extention

lumen

Mural extention

Unicystic Ameloblastoma

Ameloblastoma (Plexiform)This pattern is seen with intraluminal

extention

Ameloblastoma – UnicysticMural Invasion

Mural vrs Luminal

• Luminal proliferations less likely to recur

• Mural invasion may progress into marrow spaces with recurrence after simple curettage

Peripheral Ameloblastoma

• Cells of origin: surface epithelium• Possibly rest of Serres• Entirely extraosseous, yet may invade

underlying bone• Origin from surface is typically evident• Local excision, rare to recur

Peripheral Ameloblastoma

Peripheral Ameloblastoma

Odontogenic Adenomatoid Tumor

• Anterior Jaw• Impacted anterior tooth with

peridental radiolucency or interradicular

• Teens, young adults• Females>males• Expansile• Enucleation, no recurrences

Adenomatoid Odontogenic Tumor

AOTCysticlumen

Adenomatoid Odontogenic Tumor

Adenomatoid Odontogenic Tumor

Adenomatoid Odontogenic Tumor

Ductal Structures

Calcifying Epithelial Odontogenic Cyst (Gorlin)

• Radiolucent with or without Irregular calcifications, well marginated

• Adults• Expansion• Failure of eruption• Often with Odontoma• Enucleation• Solid types are termed

“odontogenic ghost cell tumor”

Gorlin Cyst

Calcifying Epithelial Odontogenic Cyst

• Peripheral, Gingival

Gorlin Cyst (CEOC)

Ghost Cell Epithelial Odontogenic Tumor

Calcifying Epithelial Odontogenic Tumor (Pindborg)

• Irregular calcifications, often poorly marginated

• Adults• Expansion• Failure of eruption• Encleation/En bloc

Resection

Calcifying Epithelial Odontogenic Tumor

Calcifying Epithelial OdontogenicTumor

MIXED ODONTOGENIC

TUMORSAmeloblastic fibroma

OdontomaAmeloblastic Fibro-Odontoma

Odontoameloblastoma

Ameloblastic Fibroma• Mandibular First or Second Molar with

pericoronal radiolucency, uni- or multilocular

• Teenagers• Expansile, nonaggressive• Dental Lamina and Cap Stage

Structures, Pulp-like mesenchyme• Enucleation/Curettage• Some may progress to ameloblastic

fibrosarcoma

Ameloblastic Fibroma

Ameloblastic Fibroma

Ameloblastic fibroma

Odontoma

• Configuration:– Toothlike – composite– Irregular - complex

• Teens, young adults• Usually less than 2 cm• Expansion• Failure of eruption• Enucleation

Odontoma

Odontoma

Ameloblastic Fibro-Odontoma• Multiple toothlike opacities• Teens, young adults• Large, over 2 cm• Expansion• Failure of eruption• Enucleation• Microscopic: Areas of

complete dental tissue differentiation with foci of ameloblastic fibroma

Ameloblastic FibroOdontoma

Ameloblastic FibroOdontoma

Ameloblastic FibroOdontoma

Ameloblastic FibroOdontoma

Odontoameloblastoma• Very rare tumor• An odontoma with

ameloblastoma• Teens, young adults• Large > 2 cm• Expansion• Failure of eruption• Enucleation or

Resection

Odontoameloblastoma

Odontoameloblastoma

Mesenchymal Odontogenic

TumorsPeriapical Cemental Dysplasia

Benign CementoblastomaGigantiform Cementoma

Odontogenic FibromaOdontogenic Myxoma

Granular Cell Odontogenic Tumor

Periapical Cemental DysplasiaPreviously termed cementomas, these self limited lesionsare no longer considered to be neoplastic

Begin as a small radiolucency at the apex of mandibularincisor teeth then over time show central calcification without further enlargement

Tendency to be multiple

African descent predilection, rarely seen in other racesFemales

Teeth test vital

Tx: none

Periapical Cemental Dysplasia

Benign Cementoblastoma• True neoplasm of cementoblasts• Counterpart in bone is Osteoblastoma• First molars: Mand>Max• Expansile• Sound ankylosed on percussion• Begin radiolucent and progressively become

opaque masses fused to the roots, typically midway up the roots towards the furcation

• Diffuse sheets of cementum with peripheral fringe and large stacked cementoblasts

• Tx: Extract tooth along with attached tumor

Benign Cementoblastoma

Benign Cementoblastoma

Benign Cementoblastoma

Gigantiform Cementoma

• Massive tumors that may involve all four quadrants

• Childhood onset• A variant of Ossifying Fibroma• Frequently, yet not always, Familial• Fibroosseous lesion with prominent

cemental calcifications

Gigantiform Cementoma

Gigantiform Cementoma

Gigantiform CementomaDr. Tom Indresano

UOP/Highland Hospital OMFS

Gigantiform Cementoma

Gigantiform Cementoma

Gigantiform Cementoma

Odontogenic Fibroma

• A neoplasm of odontogenic mesenchyme• Maxilla>Mandible• Adult onset• Dimpling of the palate overlying the tumor• Interradicular radiolucency• Root resorption is common

Odontogenic Fibroma

Odontogenic Fibroma

AmyloidProducing

OdontogenicFibroma

Odontogenic fibromacytokeratin

Arrows: epithelial islands

Amyloid Producing Odontogenic Fibroma

• Congo red/green birefringence

Cytokeratin

Odontogenic Myxoma• Expansile• Loculations: fine mesh, “icicle-like”

septations• Adults• Mandibular body• Connective tissue consistency

– Mucoid – higher recurrence– Fibrous – lower recurrence

• Resection

Odontogenic Myxoma

Odontogenic Myxoma

Odontogenic Myxoma

Odontogenic Myxoma

Granular Cell Odontogenic TumorWALDRON CA, THOMPSON CW, CONNER WA.: GRANULAR-CELL AMELOBLASTIC FIBROMA. REPORT OF TWO CASES.Oral Surg Oral Med Oral Pathol. 1963 Oct;16:1202-13.

BRANNON RB, GOODE RK, EVERSOLE LR, CARR. The central granular cell odontogenic tumor: report of 5 new cases.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Nov;94(5):614-21.

Piattelli A, Rubini C, Goteri G, Fioroni M, Maiorano E.Central granular cell odontogenic tumour: report of the first malignant case and review of the literature.Oral Oncol. 2003 Jan;39(1):78-82..