Odontogenic tumours part 1

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WHO Classification & Ameloblastoma

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Odontogenic tumours part 1

  1. 1. Dr. Ali Tahir
  2. 2. Index4. Odontogenic tumours 77. Mesenchymal tumours6. WHO classification 78. Odontogenic tumours11. Ameloblastoma 85. Odontogenic myxoma45. CEOT 90. Cementoblastoma56. AOT 97. Mixed tumours64. COC (Ghost cell tumour)72. Squamous odontogenic tumour Dr. Ali Tahir. M.Phil Oral Pathology
  3. 3. Tooth development Dr. Ali Tahir. M.Phil Oral Pathology
  4. 4. Odontogenic Tumours These tumors are unique to the jaws and originate from remnants of epithelium, ectomesenchyme or mesenchyme associated with tooth development, the abnormal tissue in each of these tumors can often be correlated with similar tissue in normal odontogenesis Dr. Ali Tahir. M.Phil Oral Pathology
  5. 5. Classification ODONTOGENIC TUMORS BENIGN MALIGNANT Dr. Ali Tahir. M.Phil Oral Pathology
  6. 6. WHO CLASSIFICATIONBENIGN ODONTOGENIC TUMORS According to the origin classified as:- a. EPITHELIAL b. MESENCHYMAL c. MIXED Dr. Ali Tahir. M.Phil Oral Pathology
  7. 7. BENIGN ODONTOGENIC TUMORS ODONTOGENIC EPITHELIUM 1. AMELOBLASTOMA 2. SQUAMOUS ODONTOGENIC TUMOR 3. CALCIFYING EPITHELIAL ODONTOGENIC TUMOR 4. ADENOMATOID ODONTOGENIC TUMOR 5. KERATOCYSTIC ODONTOGENIC TUMOR Dr. Ali Tahir. M.Phil Oral Pathology
  8. 8. BENIGN ODONTOGENIC TUMORS ODONTOGENIC MESENCHYME (CONNECTIVE TISSUE ONLY) 1. ODONTOGENIC FIBROM 2. ODONTOGENIC MYXOMA 3. BENIGN CEMENTOBLASTOMA. Dr. Ali Tahir. M.Phil Oral Pathology
  9. 9. BENIGN ODONTOGENIC TUMORS ODONTOGENIC EPITHELIUM WITH ODONTOGENIC MESENCHYME (MIXED) 1. AMELOBLASTIC FIBROMA 2. AMELOBLASTIC FIBRODENTINOMA 3. AMELOBLASTIC FIBRO-ODONTOMA 4. ODONTOAMELOBLASTOMA 5. ODONTOMA ODONTOMA COMPLEX TYPE ODONTOMA COMPOUND TYPE 6. CALCIFYING CYSTIC ODONTOGENIC TUMOR 7. ODONTOGENIC GHOST CELL TUMOR Dr. Ali Tahir. M.Phil Oral Pathology
  10. 10. MALIGNANT ODONTOGENIC TUMORSODONTOGENIC CARCINOMAS1. MALIGNANT AMELOBLASTOMA 2. AMELOBLASTIC CARCINOMA3. PRIMARY INTRAOSSEUS CARCINOMA4. PRIMARY INTRAOSSEUS CARCINOMADERIVED FROM ODONTOGENICTUMOR/CYSTS5. CLEAR CELL ODONTOGENIC CARCINOMA6. GHOST CELL ODONTOGENIC CARCINOMA Dr. Ali Tahir. M.Phil Oral Pathology
  11. 11. MALIGNANT ODONTOGENIC TUMORSODONTOGENIC SARCOMAS1. AMELOBLASTIC FIBROSARCOMA2. AMELOBLASTIC FIBRODENTINO ANDFIBRO- ODONTOSARCOMA. Dr. Ali Tahir. M.Phil Oral Pathology
  12. 12. Dr. Ali Tahir. M.Phil Oral Pathology
  13. 13. Ameloblastoma Ameloblastoma is a locally aggressive, epithelial benign odontogenic neoplasm having a close resemblance to the enamel organ Most common odontogenic tumour in our region Dr. Ali Tahir. M.Phil Oral Pathology
  14. 14. POSSIBLE EPITHELIAL SOURCES OF AMELOBLASTOMA Cystic lining of odontogenic cysts e.g.Dentigerous cystSurface Reducedepithelium enamel epithelium remnants of dental lamina Rests of malassez Dr. Ali Tahir. M.Phil Oral Pathology
  15. 15. TYPES OF AMELOBLASTOMAIt may present clinico-radiographically as:-1. Central (Intraosseous) I. Conventional, solid or multicystic (about 86% of all cases). II. Unicystic (about 13% of all cases)2. Peripheral (extraosseuos) about 1% of all cases. Dr. Ali Tahir. M.Phil Oral Pathology
  16. 16. Multicystic Unicystic Peripheral (extraosseous) Dr. Ali Tahir. M.Phil Oral Pathology
  17. 17. COMMON OR MULTICYSTIC OR SOLID AMELOBLASTOMA(INTRAOSSEOUS) This is also referred to as Simple or Follicular or True ameloblastoma. Most common type. Occurs usually 20 to 40 years of age. Usually originate de novo, but may evolve from unicystic or peripheral subtypes Dr. Ali Tahir. M.Phil Oral Pathology
  18. 18. Clinical features May produce extensive, even grotesque deformities of jaws. More common in mandible (80% of all cases) than maxilla. Generally asymptomatic Can cause pain and paresthesia when gets infected. Dr. Ali Tahir. M.Phil Oral Pathology
  19. 19. Dr. Ali Tahir. M.Phil Oral Pathology
  20. 20. Clinical features Eggshell cracking:- It has tendency to expand the boney cortices as their slow growth results in a thin shell of bone and it cracks easily when palpated--- a diagnostic sign. Dr. Ali Tahir. M.Phil Oral Pathology
  21. 21. Radiographically These lesions usually give MULTILOCLATION (boney compartments) appear as “SOAP BUBBLE” or “HONEY COMB” In rapidly growing lesions roots may be resorbed Dr. Ali Tahir. M.Phil Oral Pathology
  22. 22. AmeloblastomaHoney comb appearance Dr. Ali Tahir. M.Phil Oral Pathology
  23. 23. HISTOPATHOLOGYIt has following histological variants Folicular ameloblastoma Plexiform ameloblastom Basal ameloblastom Granular cell ameloblastom Acanthomatous ameloblastom Desmoplastic ameloblastomCommon to all is the presence of neoplastic ameloblasts with palisaded appearance and reverse polarisation Dr. Ali Tahir. M.Phil Oral Pathology
  24. 24. Follicular variant Islands or follicles of epithelial cells composed centrally of loosely arranged stellate cells with columnar ameloblast-like cells at the periphery. These islands resemble the enamel organ seen during normal tooth development Cystic change may be seen within the follicles or in the stroma Dr. Ali Tahir. M.Phil Oral Pathology
  25. 25. Follicular variant Dr. Ali Tahir. M.Phil Oral Pathology
  26. 26. Plexiform variant Long anastomosing cords or large sheets of odontogenic epithelium which may lack reverse polarization & may not resemble any stage of odontogenesis Also called “Fishnet Pattern” Cystic change is uncommon, if present it is found in the stroma Dr. Ali Tahir. M.Phil Oral Pathology
  27. 27. Acanthomatous variant When extensive squamous metaplasia often associated with keratin formation occurs in the central portions of the epithelial islands of a follicular ameloblastoma May be confused with SCC Dr. Ali Tahir. M.Phil Oral Pathology
  28. 28. Desmoplastic ameloblastoma Small islands and cords of odontogenic epithelium in a densely collagenized stroma More common in anterior jaws Radiographically resembles a fibro-osseous lesion Clinically more aggressive & more recurrence Dr. Ali Tahir. M.Phil Oral Pathology
  29. 29. Granular Cell Variant Shows cells with abundant cystoplasm filled with eosinophilic granules Clinically aggressive Dr. Ali Tahir. M.Phil Oral Pathology
  30. 30. Basal Cell Variant Least common type Nests of basaloid cells & histologically resembles a BCC of skin No stellate reticulum can be appreciated Dr. Ali Tahir. M.Phil Oral Pathology
  31. 31. Treatment Treatments have ranged from simple enucleation and curettage to en bloc resection. Marginal resection is the most widely used method of treatment with the least recurrences reported (up to 15 %). Most surgeons advocate a margin of at least 1.0 cm beyond the radiographic limits of the tumor as the tumor often extends beyond the apparent radiologic/clinical margins Dr. Ali Tahir. M.Phil Oral Pathology
  32. 32. UNICYSTIC AMELOBLASTOMA A biological subtype of ameloblastoma that is predominantly cystic has been referred to as the unicystic or cystic ameloblastoma Usually arises in a Dentigerous cyst Can be associated with impacted molar Usually occurs at 16 to 20 years More in mandible (90%)than maxilla Dr. Ali Tahir. M.Phil Oral Pathology
  33. 33. Radiographically Well demarcated unilocular lesion May be corticated Impacted tooth may be present Roots may be displaced in premolar region. Dr. Ali Tahir. M.Phil Oral Pathology
  34. 34. Histology Dense uniform fibrous connective tissue Fluid filled lumen Lining made up of hyperchromatic, palisaded basal cells showing reverse polarization Rest of the layers resemble stellate reticulum Dr. Ali Tahir. M.Phil Oral Pathology
  35. 35. Types of Unicystic Ameloblastoma Intra-luminal U.A. Mural U.A. Plexiform U Dr. Ali Tahir. M.Phil Oral Pathology
  36. 36. Dr. Ali Tahir. M.Phil Oral Pathology
  37. 37. Peripheral Ameloblastoma These tumors are extraosseous and therefore occupy the lamina propria underneath the surface epithelium but outside of the bone Histologically, these lesions have the same features as the intraosseous forms of the tumor. Dr. Ali Tahir. M.Phil Oral Pathology
  38. 38. Clinical Features Patient Age: Wide age range but most occur during middle-age Location: Posterior gingival/alveolar mucosa is involved most frequently. Firm, sessile nodule Normal coloration, if arises from surface epith, may be ulcerated Slight predilection for the mandible. The buccal mucosa has been the site in a few reported cases. Dr. Ali Tahir. M.Phil Oral Pathology
  39. 39. Peripheral Ameloblastoma Radiographically:  A few cases have shown superficial erosion of alveolar bone Histologic Appearance:  Islands of ameloblastic epithelium are observed in the lamina propria; follicular patterns are the most common; acanthomatous pattern may be seen  In 50 % of the cases the tumor connects with the basal cell layer of the surface epithelium Dr. Ali Tahir. M.Phil Oral Pathology

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