Odntogenic tumors


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Odntogenic tumors

  1. 1. Odontogenic tumors INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. DEFINITION: Odontogenic tumors are the lesions derived from cellular elements that are forming the tooth structure. www.indiandentalacademy.com
  3. 3. TOOTH FORMING APPARATUS Neoplastic Intersection Hamartomatous Benign Malignant Cystic changes Odontoma Amelobl Amelobl astoma astic Calcifying Cementoma Cementoma odontogenic cyst Ameloblastic fibro odontoma www.indiandentalacademy.com
  4. 4. CLASSIFICATION NEOPLASM A). Benign 1). Odontogenic epithelium (i). Ameloblastoma (ii). Squamous odontogenic tumor (iii).Calcifying epithelial odontogenic tumor (iv).Clear cell odontogenic tumor (Pindborg’s tumor) www.indiandentalacademy.com
  5. 5. 2). Odontogenic epithelium with odontogenic ectomesenchyme (i). Ameloblastic fibroma (ii). Ameloblastic fibro dentinoma and ameloblastic fibro odontoma (iii). Odontoameloblastoma (iv). Adenomatoid OdontogenicTumor (v). Calclifying odontogenic cyst (vi). Complex odontoma (vii). Compound odontoma www.indiandentalacademy.com
  6. 6. 3). Odontogenic ectomesenchyme (i). Odontogenic fibroma (ii). Myxoma / Odontogenic myxofibroma (iii).Benign cementoblastoma( True Cementoblastoma) www.indiandentalacademy.com
  7. 7. MALIGNANT 1). Odontogenic carcinomas (i). Malignant Ameloblastoma (ii). Primary intraosseous carcinoma (iii). Malignant variant of other odontogenic epithelial tumor (iv). Malignant changes in odontogenic epithelial tumors (v). Malignant changes in odontogenic epithelial cyst www.indiandentalacademy.com
  8. 8. 2). Odontogenic sarcomas (i). Ameloblastic fibrosarcoma (Ameloblastic sarcoma) (ii). Ameloblastic fibrodentine sarcoma & Amleoblastic fibro odontosarcoma 3). Odontogenic carcinosarcoma www.indiandentalacademy.com
  9. 9. AMELOBLASTOMA Definition An epithelial tumor arising from the odontogenic apparatus or from cells with a potentiality for forming tissues of the enamel organ. WHO Defined it as Unicentric, non functional, intermittent in growth, anatomically benign and clinically persistwww.indiandentalacademy.com
  10. 10. Origin of the ameloblastic cells 1). Odontogenic epithelium a). Remenants of Dental lamina b). Reduced enamel epithelium c). Rests cells of malassez 2). Basal cell layer o overlying surface epithelium 3). Epithelial lining of odontogenic cyst www.indiandentalacademy.com
  11. 11. Three clinical subtypes 1). Common polycystic Ameloblastoma (80% of all cases) 2). Unicystic Ameloblastoma (13% of all cases) 3). Peripheral (Extraosseous) Ameloblastoma (1% of all cases) www.indiandentalacademy.com
  12. 12. A). Common polycystic ameloblastoma Also called conventional, Intraosseous , Multicystic Clinical features Age - 20 to 40yrs Site - mandible > maxilla slow growing, painless, bony expansion initially Tennis ball like consistency “Egg shell” like cracking Jaw bone enlargement & parasthesiawww.indiandentalacademy.com
  13. 13. Radiographic features Round cyst like radiolucency Honey comb (if small loculations) or soap bubble like consistency(if large loculations) Histopathology: (Vicker’s and Gorlins criteria). 1). Hyperchromatism 2). Palisading cells 3). Vacuolization 4). Hyalinizationwww.indiandentalacademy.com
  14. 14. Histopathological variants 1). Follicular ameloblastoma 2). Plexiform ameloblastoma 3). Plexiform unicystic ameloblastoma 4). Acanthomatous ameloblastoma 5). Papilliferous keratoameloblastoma 6).Granular cell ameloblastoma 7). Desmolytic ameloblastoma 8). Basal cell ameloblastoma 9). Clear cell Ameloblastoma www.indiandentalacademy.com
  15. 15. Follicular Ameloblastoma Consists of different shapes & sizes of epithelial islands in the form of epithelial nests or follicles. Plexiform ameloblastoma Consists of interlacing strands of odontogenic epithelial trabeculae www.indiandentalacademy.com
  16. 16. Acanthomatous Ameloblastoma central epithelial cells squamous cell metaplasia keratin deposition. Desmoplastic Ameloblastoma Small epithelial islands widely separated by dense, scar like fibrous tissue. www.indiandentalacademy.com
  17. 17. Granular cell Ameloblastoma central cells appears swollen & densely packed with eiosinophillic granules. Basal cell pattern Islands of uniform basaloid cells. www.indiandentalacademy.com
  18. 18. Treatment options 1). Simple Curettage - high recurrence rate. In mandible, wide marginal resection leaving compact bone of lower border intact provided the lower border is not involved radiographically Large tumors invading lower border of mandible, segment resection using bone grafts. In maxilla, wide excision is treatment of choice www.indiandentalacademy.com
  19. 19. A 17-year-old girl with obvious facial expansion (A) related to a multilocular radiolucency of the left mandible associated with impacted tooth no. 17 (B). Note the aggressive nature of this tumor. The incisional biopsy showed solid/multicystic ameloblastoma. www.indiandentalacademy.com
  20. 20. Twenty years of undisturbed growth of a solid/multicystic ameloblastoma led to significant facial disfigurement (A), with an impressive radiographic appearance (B). A segmental resection of the right mandible was performed(C). www.indiandentalacademy.com
  21. 21. B). UNICYSTIC AMELOBALSTOMA Definition : Is defined as a single unicystic cavity that shows ameloblastous differentiation in the lining. origin - a). De-novo as a neoplasm b).result of neoplastic transformation. Clinical features age - 16 to 20yrs (younger patients). Site - mandible > maxilla Large lesions painless swelling in the jaw.www.indiandentalacademy.com
  22. 22. Radiographic features Well-circumscribed, radiolucent area that surrounds the crown of an unerupted molar. 3 histopathological variants. 1). Luminal unicystic 2). Intaluminal unicystic 3). Mural unicystic www.indiandentalacademy.com
  23. 23. Differential diagnosis (1). Dentigerous cyst (2). Residual cyst Treatment and prognosis (1). Enucleation and curettage (recurrence rate - 10% to 20%) less recurrence as surrounding fibrous connective tissue limits the lesion . (2). If the lesion extends into fibrous cyst wall Prophylactic measure Local resection of the area www.indiandentalacademy.com
  24. 24. A, Treatment of the ameloblastoma of the patient in Figure 30-17 required a disarticulation resection of the left mandible. B, The effectiveness of the bony linear margin should always be evaluated by intraoperative specimen radiographs. www.indiandentalacademy.com
  25. 25. A, The luminal unicystic ameloblastoma in Figure 30-21 is treated with an enucleation and curettage surgery. B, The 5-year postoperative radiograph shows an acceptable bony fill.www.indiandentalacademy.com
  26. 26. This 18-year-old presented with significant right facial expansion (A) associated with the destructive radiolucency of the right mandible noted on the panoramic radiograph (B). The incisional biopsy documented the mural variant of unicystic ameloblastoma (hematoxylin and eosin; original magnification ×20) (C). A disarticulation resection was performed (D). www.indiandentalacademy.com
  27. 27. 3).PERIPHERAL OR EXTRAOSSEOUS Incidence - 1% origin - a). Remnants of dental lamina beneath the oral mucosa b). Basal epithelial cells of surface epithelium Clinical features Age - middle age site - posterior gingival & alveolar mucosa Mandible > maxilla Painless, nonulcerated, sessile or pedunculated gingival or alveolar mucosal lesion. www.indiandentalacademy.com
  28. 28. Histopathology: bear islands of ameloblastic epithelium occupying lamina propria underneath surface epithelium. Treatment & prognosis Surgical excision (Recurrence rate - 15 to 20%). Earliest diagnosiswww.indiandentalacademy.com
  29. 29. MALIGNANT AMELOBLASTOMA Benign tumor that in the typical intraosseous form has a tendency to infiltrate cancellous bone AMELOBLASTIC CARCINOMA Ameloblastoma that has a cytologic evidence of malignancy. www.indiandentalacademy.com
  30. 30. Clinical features: swelling, pain and inflammation Ulceration of mucosa & loosening of teeth Epitaxis & nasal obstruction. Radiographic features unilocular or multilocular radiolucency, soap bubble appearance. www.indiandentalacademy.com
  31. 31. Treatment Simple curettage (high recurrence rate). In mandible, wide marginal resection leaving compact bone of lower border is not involved radiographically. Large tumors - segmental resection followed by reconstruction using bone graft. www.indiandentalacademy.com
  32. 32. A, The large destructive radiolucency of the right mandible was present in a 22-year-old man who complained of precipitous growth and pain. The incisional biopsy showed benign solid/multicystic ameloblastoma. B, A segmental resection was performed. D and E, Final histopathology of the resection specimen showed ameloblastic carcinoma www.indiandentalacademy.com
  33. 33. ADENOMATOID ODONTOGENIC TUMOR Origin - Tumor cell derived from a). Enamel organ epithelium b). Remnants of dental lamina Clinical features Age - younger patient (10 to 19yrs). Site - anterior portion of the jaw maxilla > mandible Asymptomatic, painless, slow growing. large lesions causes expansion of bone. www.indiandentalacademy.com
  34. 34. Site of occurance of AOT A well circumscrbed solid mass enveloping the cown of this tooth www.indiandentalacademy.com
  35. 35. AOT variants Central Peripheral (intraosseous) (extraosseous) 1). Follicular type rare, small involves crown of sessile masses on an unerupted tooth facial gingiva of maxilla 2). Extrafollicular type DD: Gingival located b/w roots fibrous lesion of erupted tooth DD: globulomaxillary cystwww.indiandentalacademy.com
  36. 36. Radiographic features Usually unilocular with well defined corticated border may or may not contain a tooth often contains fine calcifications. tubular or duct like structures Follicular Extrafollicular www.indiandentalacademy.com
  37. 37. Histopathology: surrounded by fibrous capsule Spindle shaped epithelial cells forming sheets, strands or whorled masses of cells epithelial cells Calcification- small foci as well as larger areas Treatment Surgical enucleation (recurrence is rare). www.indiandentalacademy.com
  38. 38. CALCIFYING EPITHELIUM ODONTOGENIC TUMOR ( Pindborg’s tumor ) Definition: It is a locally aggressive tumor consist of sheets & strands of polyhedral cells in fibrous stroma with no inflammatory component & are often accompanied by spherical calcifications & amyloid staining hyaline deposits. Origin -Rest of dental lamina -Reduced enamel epithelium 1% of all odontogenic tumor www.indiandentalacademy.com
  39. 39. Clinical features CEOT Central Peripheral (intraosseous) (extraosseous) age - 40yrs site - anterior gingiva site - 2/3rd of appears as superficial lesions in mandible soft tissue swelling slow growing. of gingiva in a tooth painless mass. bearing area or edentulous area of jawwww.indiandentalacademy.com
  40. 40. Radiographic features: Early lesions - unilocular, old lesions - multilocular or honey comb appearance. Scalloped margins entire radiolucency with calcified structures of varying size & density “Snow driven” appearance. www.indiandentalacademy.com
  41. 41. Histopathology: sheets of polyhedral epithelial cells on fibrous stroma cells show pleomorphism, prominent nucleoli & hyperchromatism. Liesegang ring calcifications • • amyloid stained by • congo red www.indiandentalacademy.com
  42. 42. A 40-year-old woman with a 5-year history of an expansile mass of the left maxilla. The patient with the Pindborg tumor in Figure 30- 38 is treated with hemimaxillectomy. www.indiandentalacademy.com
  43. 43. ODONTOMA Most common type of odontogenic tumor Hamartoma Definition: A non-neoplastic developmental anomaly or malformation that contains fully formed enamel and dentin. www.indiandentalacademy.com
  44. 44. Types: 1). Invaginated odontome(Dens invaginatus, Dens in dente) 2). Evaginated odontome 3). Enamel pearl 4). Germinated odontome 5). Complex odontome 6). Compound odontome Clinical features: Age- 10 to 20yrs Site - Maxilla > mandible Slow growing , hard , painless mass www.indiandentalacademy.com
  45. 45. GARDNER’S Syndrome is associated with it (a). Multiple odontomas (b). Multiple osteomas (c ). Intestinal polyps (d). Epidermoid cyst (e). Dermoid tumor(fibrous) 2 Types (1). Complex (2). Compound www.indiandentalacademy.com
  46. 46. Compound odontoma site - anterior part of maxilla origin - repeated divisions of tooth germs. By overgrowths multiple budding of dental lamina with formation of multiple tooth germ. Radiographically - Dense opacity with radioluscent rim surrounding it. Collection of tooth like structures of varying size & shape surrounded by narrow radiolescent zone.www.indiandentalacademy.com
  47. 47. Histolopathology Numerous denticles having structures of normal teeth embedded in fibrous connective tissue. www.indiandentalacademy.com
  48. 48. Complex odontoma site - posterior part of maxilla Consist of congomerated mass of enamel & dentin which bears no anatomic resemblence to a tooth.Cauliflower like mass of hard tissues. Radiographically: Calcified mass with the radiodensity of tooth structures www.indiandentalacademy.com
  49. 49. Histolopathology: Mass consist of enamel, mature tubular dentine, cementum together with pulp & PDL members in varying amount www.indiandentalacademy.com
  50. 50. CALCIFYING ODOTOGENIC CYST (Odontogenic ghost cell cyst) Definition: A rare well circumscribed solid or cystic lesion derived from odontogenic epithelium that resembles follicular ameloblastoma but consists ghost cells & spherical calcifications. Cutaneous counterpart- Benign calcifying epithelioma of MALHERBE/ Pilomatrixoma www.indiandentalacademy.com
  51. 51. Clinical features Origin - remnants of dental lamina Site - areas anterior to molar Age - most common in 2nd decade painless asymptomatic slow growing hard lesion expansion of buccal cortical plate. www.indiandentalacademy.com
  52. 52. TYPES Extaosseous Intraosseous Focal localized generalized swelling expansion of buccal cortical plates DD. gingival fibroma Dentigerous cyst peripheral giant Ameloblastoma Gingival cyst Adenomatoidwww.indiandentalacademy.com
  53. 53. Radiographic feature Well circumscribed unilocular radiolucency containing. Flecks of indistinct radiopacities. Histolopathology: Epithelium lining a cystic space. Epithelium consist of pallisaded columnar cells with reverse polarity of nuclei. Inner layer of stellate reticulum. GHOST cells present. Multiple spherical & diffuse calcification. Deposites of hyaline material. www.indiandentalacademy.com
  54. 54. 1). Curettage 2). Recontouring 3). Resection with or without loss of continuity. Curettage Scrapping of the tumor tissue away from bone. Tumor usually comes out in www.indiandentalacademy.com
  55. 55. A, The patient underwent a segmental resection of his odontogenic tumor B, As with the ameloblastoma, specimen radiographs should be obtained when resecting to verify the bony linear margin. A better depiction of the “stepladder” pattern of the odontogenic myxoma is noted on this specimen radiograph. www.indiandentalacademy.com
  56. 56. Ameloblastic fibroma painless mixed tumor occurring in younger patients in the premolar and molar region. Sharply demarcated radiographic borders. Microscopically epi. Cells lie in conn. Tissue stroma. Enucleation and curettage www.indiandentalacademy.com
  57. 57. An enucleation and curettage surgery is performed in the patient of 15-years of age. The associated permanent teeth are removed with the tumor. www.indiandentalacademy.com
  58. 58. Ameloblasticfibro - odontoma Tumor with features of ameloblastic fibroma but that also contains enamel and dentin.histologically epi. Islands in conn. Tissue stroma .Radiographically well circumscribed unilocular. Treated by enucleation. www.indiandentalacademy.com
  59. 59. Ameloblastic fibrosarcoma Malignant counterpart of ameloblastic fibroma. Radiographically ill defined destructive radiolucency. www.indiandentalacademy.com
  60. 60. Cellular mesenchyme shows hyperchromatism and atypical cells with island of ameloblastic epithelium www.indiandentalacademy.com
  61. 61. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com