the radiology of benign neoplasms

TheRadiology

ofBenign Neoplasms

Juan F. Yepes, DDS, MD, MPHAssistant Professor

Department of Diagnostic RadiologyUniversity of Kentucky Chandler Medical Center

The Radiology of Benign Neoplasms

Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures

Displacement of periosteum

Internal structure: trabeculae & calcification

Unilocular / multilocular


Cyst orBenign Neoplasm Benign Neoplasm Malignant Neoplasm


TheRadiology

ofBenign Neoplasms

I. Odontogenic

• Epithelial• Epithelial with induction/Mixed

(epithelial and mesenchymal)• Mesenchymal


Odontogenic



Odontogenic


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Dental Lamina Ameloblastoma

Enamel organ Adenomatoid

Odontogenic Tumor

Root sheath of Hertwig Ameloblastic fibroma

Dental Lamina

Odontoma

• EpithelialAmeloblastomaSquamous odontogenic tumorAdenomatoid odontogenic tumor Calcifying epithelial odontogenic tumor Clear cell odontogenic tumor[Melanotic neuroectodermal tumor of infancy]

Odontogenic


Ameloblastoma

• Age: 20 - 50 years (predominantly 30s and 40s)

• Mandible:Maxilla = 85:15• 60% mandibular molar-ramus area


Ameloblastoma

10%

10%

3% 2%

15%60%

Ameloblastoma

• Unilocular• Multilocular (coarse septa) Soap bubble Honeycomb


Ameloblastoma

• Displacement or resorption of teeth• Extends beyond radiographic limits• Superior aspect often lost


Keratocyst Ameloblastoma


Simple Bone Cyst Ameloblastoma



Odontogenic


Adenomatoid odontogenic tumor(AOT)


Adenomatoid odontogenic tumor(AOT)

• 10-20 (18 years of age)• anterior maxilla or mandible• radiolucent with radiopaque foci• may mimic dentigerous cyst



Odontogenic


Calcifying epithelial odontogenic tumor (CEOT)


Calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor)

• 10-90 (mean 40)• maxilla:mandible = 1:2• ramus-molar region


Calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor)

• usually associated with impacted teeth

• unilocular or multilocular• radiolucent or with radiopaque foci




Odontogenic


• Epithelial with inductionAmeloblastic fibromaAmeloblastic fibro-odontomaCompound odontomaComplex odontoma

Odontogenic


The Radiology of Odontomas

Radiographically, the appearance of is that of

surrounded by a radiolucent linesurrounded by a radiopaque line

a radiopaque mass

Tooth

a tooth


Odontoma (Odontome)

Radiographically, the appearance of an odontoma is that of

a radiopaque masssurrounded by a radiolucent linesurrounded by a radiopaque line


Odontoma (Odontome)

Or, radiographically, the appearance of an odontoma is that ofseveral radiopaque massessurrounded by a radiolucent linesurrounded by a radiopaque line


Compound Odontoma


Complex Odontoma


Radiographically, an odontoma is

a radiopaque mass (or several masses), surrounded by a radiolucent line, surrounded by a radiopaque line.


Complex Odontoma

The Radiology of OdontomasComplex Odontoma

A malfomation in which all the dental tissues are represented, individual tissues being mainly well-formed, but occurring in a more or less disorderly pattern.


Compound Odontoma

The Radiology of OdontomasCompound Odontoma

A malfomation in which all the dental tissues are represented in a more orderly pattern than in the complex odontoma, so that the lesion consists of many toothlike structures.

The Radiology of OdontomasCompound Odontoma

Most of these structures do not represent, morphologically, the teeth of the normal dentition, but in each one, enamel, dentin, cementum and pulp are arranged as in a normal tooth.

Ameloblastic Fibroma

primitive myxoid connective tissue

resemblance to dental pulp

strands of odontogenic epithelium 2 cells wide

Ameloblastic Fibro-odontoma

primitive myxoid connective tissue

resemblance to dental pulp

strands of odontogenic epithelium 2 cells wide

cells differentiate to produce enamel and dentin


Ameloblastic Fibro-odontoma

prominent enamel matrix often seen before final maturation of hard tissue

enamel and dentin in the form of compound or complex odontoma

Compound OdontomaComplex odontoma

prominent enamel matrix often seen before final maturation of hard tissue

enamel and dentin in the form of compound or complex odontoma




Odontogenic


• Mesenchymal Odontogenic fibromaOdontogenic myxomaBenign cementoblastomaCementifying fibroma

Odontogenic


Odontogenic myxoma


Odontogenic myxoma

• 10-50 years (15-35, mean 30)• maxilla:mandible 1:1 • may be infiltrative and aggressive


Odontogenic myxoma

• “tennis racket” appearance (neither coarse nor fine septa)

• cortical expansion• root displacement rather than resorption


Benign cementoblastoma



• second or third decade, usually before 25• continuous with root , which is resorbed• pulp vitality unrelated



• radiopaque mass• surrounded by radiolucent line• surrounded by radiopaque line


the radiology of benign neoplasms

Documents

inductionmixed epithelial

years of ageanterior

dentigerous cyst

resorption of teethextends

radiopaque focimay