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ODONTOGENIC TUMORS

ClassificationWHO 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 tumor 3. Calcifying epithelial odontogenic tumor 4. Adenomatoid odontogenic tumor 5. Keratinizing cystic odontogenic tumor"

Odontogenic epithelium with odontogenic ectomesenchyme with or without dental hard tissue formation 1. Ameloblastic fibroma 2. Ameloblastic fibrod entinoma 3. Ameloblastic fibro-odontoma 4. Complex odontoma 5. Compound odontoma 6. Odo ntoameloblastoma 7. Calcifying cystic odontogenic tumor 8. Dentinogenic ghost cell tumor

Mesenchyme and/ or odontogenic ectomesenchyme with or without included odontogenic epithelium 1. Odontogenic flbroma (epithelium-poor and epitheliumrich types) 2. Odontogenic myxoma or fibromyxom a 3. Cementoblastoma

Malignant tumors (odontogenic carcinomas) 1. Metastasizing, malignant ameloblastoma 2. 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 carcinoma 5. Ghost cell odontogenic carcinoma

Malig nant tumors (odontogenic sarcomas) 1. Ameloblastic fibrosarcoma 2. Ameloblastic fibrodentino- and fibroodontosarcoma

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

Incidence1% of oral tumors 18-20% of odontogenic tumors

Clinical features20-50 years Number of cases reported in children Youngest reported one month old Oldest 98 yrs

Frequent in mandible than maxilla 3:1

Signs & symptomsAsymptomatic Asymmetry Slow growing non tender Later stages painThe image part with relationship ID rId2 was not found in the file.

Secondary infection Ulceration Egg shell crackling Extra osseous Small nodule

classificationAnatomic 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

Ameloblastoma With in medullary cavity Scalloping of inner cortex Pressure erosion Shell remains

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

HistopathologyFollicular Plexiform Acanthomatous Granular cell Desmoplastic Basal cell type

follicular

Plexiform plexiform

Acanthomatous acanthomatous

granular Granular cell

Desmoplastic desmoplastic

Basal cell Basal cell

Other varients Hemangiomatous Clear cell Mucous cell differentiation

Rx Complete Surgical excision Recurrence: 50-90%

Unicystic AmeloIncidence: 5-22% Age: 1-2 decade Gender: M:F 1.6:1 Site: 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/F Vickers & 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). 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.). 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)

2.

3.

Rx Enucleation Wide surgical excision- intramural type Recurrence: 10-20 % [Intramural type]

Desmoplastic AmeloIncidence: 4-13 % Age: 4-6 decade Gender: M:F 1:0.9 Site: Maxi=mand Pathogenesis: 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 AmeloIncidence: 2-10 % Age: 5-7 decade Gender: M:F 1.9:1 Site: 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/FFollicular & 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%

SOTAge: 3 decade Gender: M:F 1.4 : 1 Site: 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 decade Gender: M=F Site: Maxi : Mand 1:2 Pathogenesis: Rests of Stratum intermedium Rests of DL Reduced 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 decade Gender: M : F 1.4 : 1 Site: 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 decade Gender: M : F 1 : 1.9 Site: Maxi : Mand3:1

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/FAt 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 pattern At the periphery of the lesion Cribriform pattern of tumor cell strands at the nodule

Rx Excision

Keratinizing Cystic Odontogenic Tumor [KCOT]

Than - Q