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