ODONTOGENIC TUMORS

Classification

WHO KRAMER, PINDBORG AND

SHEAR 1992

Benign

Odontogenic epithelium with mature, fibrous stroma; odontogenic ctomesenchyme not present

1. Ameloblastomas• Solid/multicystic• Extraosseous/ perlpheral• Desmoplastic• Unicystic

2. Squamous odontogenic tumor3. Calcifying epithelial odontogenic tumor4. Adenomatoid odontogenic tumor5. Keratinizing cystic odontogenic tumor"

Odontogenic epithelium with odontogenic ectomesenchyme with or without dental hard tissue formation1. Ameloblastic fibroma2. Ameloblastic fibrod entinoma3. Ameloblastic fibro-odontoma4. Complex odontoma5. Compound odontoma6. Odo ntoameloblastoma7. Calcifying cystic odontogenic tumor8. Dentinogenic ghost cell tumor

Mesenchyme and/ or odontogenic ectomesenchyme with or without included odontogenic epithelium1. Odontogenic flbroma (epithelium-poor and epithelium-

rich types)2. Odontogenic myxoma or fibromyxom a3. Cementoblastoma

Malignant tumors (odontogenic carcinomas)

1. Metastasizing, malignant ameloblastoma2. Ameloblastic carcinoma

(a) primary(b) secondary (dedifferentiated), intraosseous(c) secondary (dedifferenti ated), extraosseous

3. Primary intraosse ous squamous cell carcinoma (PIOSCC)(a) PIOSCC solid type(b) PIOSCC derived from odontogenic cysts(c) PIOSCC derived from keratinizing cystic odontogenic tumo r

4. Clear cell odontogenic carcinoma5. Ghost cell odontogenic carcinoma

Malig nant tumors (odontogenic sarcomas)1. Ameloblastic fibrosarcoma2. Ameloblastic fibrodentino- and fibro-

odontosarcoma

CLASSIFICATION BASED ON CONNECTIVE TISSUE INDUCTION BY EPITHELIAL TISSUE

• EPITHELIAL ODONTOGENIC TUMORS

1. Minimal inductive change in CT – AMELOBLASTOMA.– CEOT (PINDBORG’S)– AOT

2. Extensive inductive changes in connective tissue

– AMELOBLASTIC FIBROMA – AMELOBLASTIC FIBRO-ODONTOMA – ODOTO- AMELOBLASTOMA – ODONTOMA – COMPLEX

COMPOUND

AMELOBLASTOMA

•WHO (1992) “Is a true neoplasm of

enamel organ like tissue which does not undergo differentiation to the point of enamel formation”

Robinson described it as• A TUMOUR THAT IS USUALLY

UNICENTRIC, NONFUNCTIONAL INTERMITTENT IN GROWTH ANATOMICALLY BENIGN

CLINICALLY PERSISTENT

Synonyms :

–Admantinoma–Multilocular cyst–Admantoblastoma–Eve’s Diesease

History :• CUZACK (1827)- FIRST RECOGNIZED • FALKSON (1879) – DESCRIPTION• MALASSEZ (1885) – ADMANTINOMA• IVY &CHURCHILL (1934) –

AMELOBLASTOMA• Unicystic ameloblastoma- Robinson and

Martinez in 1977

ORIGIN• CELL RESTS OF ENAMEL ORGAN DENTAL LAMINA REMNANTS HERS RESTS OF MALASSEZ

–Epithelium of Odontogenic cysts (Dentigerous cyst)

–Disturbances in developing enamel organ.

–Heterotropic epithelium in other parts of the body, especially the Pituitary Gland.

–Basal cells of oral epithelium.

extra osseous

• Dental lamina ameloblast

• Oral epithelium

Incidence

–1% of oral tumors–18-20% of odontogenic tumors

Clinical features

–20-50 years–Number of cases reported in

children–Youngest reported one month old –Oldest 98 yrs

–Frequent in mandible than maxilla–3:1

Signs & symptoms

–Asymptomatic–Asymmetry–Slow growing –

non tender–Later stages pain

–Secondary infection–Ulceration–Egg shell crackling–Extra osseous Small nodule

classification

Anatomic site–Central /intraosseous•Solid/Multicystic/Conventional•Unicystic•Desmoplastic

–Peripheral/ extra osseous

Radiological features

• Numerous well defined radioluscency of varying diameter• Honey comb • Soap bubble appearance• Unicystic radiolucent lesion

indistinguishable with cysts

AmeloblastomaWith in medullary cavity Scalloping of inner cortexPressure erosionShell remains

–When maxillary sinus involved –Cloudiness of sinus–Destruction of wall –Unicystic in maxilla

Histopathology

–Follicular–Plexiform–Acanthomatous–Granular cell –Desmoplastic–Basal cell type

follicular

Plexiformplexiform

Acanthomatousacanthomatous

Granular cell granular

Desmoplasticdesmoplastic

Basal cell Basal cell

Other varients• Hemangiomatous• Clear cell• Mucous cell differentiation

Rx

• Complete Surgical excision

• Recurrence: 50-90%

Unicystic Amelo

Incidence: 5-22%Age: 1-2 decadeGender: M:F

1.6:1Site: Maxi:mand

1:7 [dentigerous varient]1:4.7 [non dentigerous varient]

• Pathogenesis: Reduced enamel epi Arising with DC lining Degeneration of SMA Denovo

C/F• Local swelling• Pain• Lip numbness• So infection

R/F• Uni/miltilocular r/l• Root resorption

DENTIGEROUS VARIENT

NON-DENTIGEROUS VARIENT

H/FVickers & Gorlin criteria• Palisaded basal cell• Nuclear- Polarised & hyperchromatism • Vacuolated cytoplasm• Subepi hyalinization• Stroma- loose

Ackerman in 19881. Type-I Luminal (consisted of unilocular cystic lesions lined by epithelium

exhibiting features of ameloblastoma).

2. Type-II Intra luminal (showed epithelial nodules arising from the cystic lining and projecting into the cyst lumen. These nodules comprised epithelium with a plexiform or follicular pattern resembling that seen in intraosseous ameloblastoma.).

3. Type-III Mural ameloblastoma (characterized by the presence of invasive islands of ameloblastomatous epithelium in the connective tissue wall of the cyst, and these islands may or may not be connected to the cyst lining)

Rx

• Enucleation• Wide surgical excision- intramural type

Recurrence: • 10-20 % [Intramural type]

Desmoplastic Amelo

Incidence: 4-13 %Age: 4-6 decadeGender: M:F

1:0.9Site: Maxi=mandPathogenesis: Rests of Malassez

C/F• Painless growth• The tumor mass is often solid. whitish. and has a

gritty or "frozen ice-cream"-like consistency

R/F

• Uni / miltilocular r/l• Well defined border• Root resorption• Mixed r/l & r/o area

H/F

• Follicular islands- Animal like configuration • Increased collagen production- squeezes

Odon epi.• Myxoid changes around Odon epi islands• Tall columnar cells• Palisaded & polarised nucleus

Rx

• Wide surgical excision

Recurrence:• Less than SMA

Pheripheral Amelo

Incidence: 2-10 %Age: 5-7 decadeGender: M:F

1.9:1Site: Maxi : Mand

1 : 2.5• Pathogenesis: Rests of DL

Rests of Serre’s

C/F

• Painless, firm• Sessile, exhophytic, granular/pebbly/wart type

growth• Normal colour • Trauma causes ulcer

R/F

• Superficial erosion• Cuffing/ Saucerization of underlying bone due

to pressure by the lesion

H/F

Follicular & Acanthomatous type• Tall columnar cells• Palisaded & polarised nucleus• Centre of follicle shows Stellate reti like cells• Ghost cells also seen

Rx

• Wide excision

Recurrence:• 15-20%

SOT

Age: 3 decadeGender: M:F

1.4 : 1Site: Maxi = Mand

• Pathogenesis: Rests of DL

Rests of Malassez in PDL

C/F

• Locally invasive, Slow growth, Mobility Moderate pain

• Alveolar bone swelling • ass. impacted tooth

R/F

• Uni / miltilocular r/l• Saucerization• Triangular r/l

H/F

• Islands- cuboidal/flat cells• Varying size n shape of sq. cells• Single cell keratinization• Laminal calcified material• No ghost / clear cells

Rx

• Excision

Calcifying epithelial odontogenic tumor[CEOT]

Incidence: less than 1%Age: 3-5 decadeGender: M=FSite: Maxi : Mand

1 : 2Pathogenesis: Rests of Stratum intermedium

Rests of DLReduced enamel epi

C/F

• Slow growth• Painless • In maxi- nasal congestion, epistaxis, head ache• Extraosseous- painless, firm gingival swelling• Trauma causes ulcer

R/F

• Uni / miltilocular r/l• Radiopaque calcified mass• Wind driven Snow appearance / honey comb

H/F• Sheets & islands of cells• Well defined cell br • Polyhedral shape [Squamous cell] - closely packed• intercellular bridges, intracytoplasmic tonofilaments &

hemidesmosomes

• Cytoplasm- fine granular, eosinophilic

• Nucleus- pleomorphic, giant, mild hyperchromatic

• Calcified structures- concentric rings, may be amyloid• Liesegang ring calci. Calci. fuse to form large calci

Rx

• Enucleation• Local/conservative excision

Squamous Odontogenic Tumor[SOT]

Age: 3 decadeGender: M : F

1.4 : 1Site: Maxi = Mand

Pathogenesis: Rests of DL Rests of Malassez in PDL [Dropping off pheno.]

C/F

• Locally invasive• Slow growth• Mobility • Moderate pain• Alveolar bone swelling • ass. impacted tooth

R/F

• Uni / miltilocular r/l• Saucerization• Triangular r/l

H/F

• Islands- cuboidal/flat cells• Varying size n shape of sq. cells• Single cell keratinization• No ghost / clear cells

Rx

• Enucleation• Local excision

Adenomatiod Odontogenic Tumor[AOT]

Incidence: 5 %Age: 2 decadeGender: M : F

1 : 1.9Site: Maxi : Mand

3 : 1

Pathogenesis: Rests of DL

C/F

• 3/4th tumor- 3/4th in teenage 3/4th in female

3/4th in maxillary anteriors• Asymptomatic• Slow growing• Cortical expansion• Root resorption

R/F

• Unilocilar r/l

H/F

At the center of the lesion• Spindleshaped or cuboidal epithelial cells forming

rosettelike structures. • whorled cell arrangement• Characteristic tubular or duct like structures lined by a

single row of cuboidal or low• columnar epithelial cells• Calcified bodies with Liesegang patternAt the periphery of the lesion• Cribriform pattern of tumor cell strands at the nodule

Rx

• Excision

Keratinizing Cystic Odontogenic Tumor[KCOT]

Than - Q