AMELOBLASTOMA is most important topic in oral pathology

1. ORAL PATHOLOGY
DR.DEEPIKA R
BDS
AMELOBLASTOMA

2. CONTENT
1. Introduction
2. Types of ameloblastoma
3. Pathogenesis
4. Clinical features
5. Radiographic features
6. Histopathological feature
a) Multicystic ameloblastoma
1) follicular ameloblastoma
2) plexiform ameloblastoma
b) unicystic ameloblastoma
7. Treatment

3. Introduction
SYNONYMS: adamantinoma , adamantoblastoma,
multilocular cyst
DEFINATION:Ameloblastoma is a true neoplasm
of enamel organ type of tissue which does not
undergo differentiation to the point of enamel
formation.
2ND most common odontogenic neoplasm
worldwide.
By ROBINSON: 1) unicentric
2) non functional
{ UNIAC } 3) intermittent
4) anatomically benign
5) clinically persistent

4. TYPES OF
AMELOBLASTOMA
Clinico-radiographically [due to differing
therapeutic prognosis]:
*Conventional , solid or multicystic (about 86%
of all cases)
*Unicystic (13% of all cases)
*Peripheral (extraosseous)(1% of all cases)

5. PATHOGENESIS
Varied origin
• Cell rest of enamel organ (rest of serre’s/
malassez)
• Epithelium of odontogenic cyst ( dentigerous
cyst)
• Disturbances in developing tooth
• Basal cells of surface epithielium of oral cavity.

7. CLINICAL FEATURES
*AGE: 3rd to 7th decade ,rare in children with no
gender predilection.
*High recurrence rate even after treatment.
*Slow growing with no noticeable swelling in
early stages.
*EARLY STAGE: swelling is evident (hard boney in
consistency)
*LATER STAGE: tumor can perforate the bone
cause egg shell cracking and spreads into
surrounding soft tissues.
* displacment ,mobility and resorption of teeth
occur.
*Pain and paresthesia are uncommon.

8. *Most common site is MANDIBLE
MOLAR – ASCENDING RAMUS REGION
*MAXILLA
POSTERIOR REGION

9. RADIOGRAPHIC FEATURES
*Most commonly multilocular radiolucent lesion.
*Scalloped margins
“soap bubble” or “honey comb”like pattern.
*Resorption of root and bone adjacent to tumor.
*Buccal and lingual cortical expansion is
present.
*It can also be associated with unerupted tooth
as unilocular radioleucency.

11. HISTOPATHOLOGIC
FEATURES
AMELOBLASTOMA
MULTICYSTIC UNICYSTIC
Multicystic type have 6 histopathologic subtypes
of ameloblastoma are recognized:
1. Follicular ameloblastoma
2. Plexiform ameloblastoma
3. Acanthomatous ameloblastoma
4. Granular ameloblastoma
5. Basal cell ameloblastoma
6. Desmoplastic ameloblatoma

12. *The tumor features includes following:
Peripheral layer of tall columnar cells
Hyperchromasia
Reverse polarityof nuclei
Subnuclear vacoule formation
*Thus during the growth stage of tumor it mimic the
normal embrylogic development of tooth bud at the
stage of enamel matrix formation.

13. 1) Follicular type
*Most common variant.
*Composed of small descrete islands of tumor (
composed of peripheral tall columnar layer of
cells with central mass of polyhedral resembles
stellate reticullum)
*The stellate reticulum like tissue undergoes
breakdown or cystic degeneration, thus cyst
formation is common in this type.

15. 2) Plexiform type
*The tumor like cells are arranged as a network
of interconnecting strands of cells .
*Stellate reticulum like cells are less common .
*Ares of cystic degeneration of stroma
(connective tissue is common)

16. B) UNICYSTIC
AMELOBLASTOMA
*It is a cystic tumor ie , morphology as cyst by
behavior is like tumor.
*Tend to occur in younger patient with no sex
predilection.
*Recurrence rate is less than multicystic lesion.
*There is high chances of these lesions that are
associated with an impacted tooth and mostly have
provisional diagnosis with dentigerous cyst.
*It can be misdiagnosed as cyst thus confirmed
microscopically.
*Ameloblastomatous lining epithelium proliferating
into connective tissue wall ( mural growth)

18. TREATMENT
Preferable method of treatment of
ameloblastoma includes :
• Radical and conservative surgical exicision.
• Curettage
• Local resection
• Chemical and electrocautery

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