Odontogenic tumours part 4

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Mixed Odontogenic tumours followed by malignant odontogenic tumours

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Odontogenic tumours part 4

  1. 1. Derived from Ectomesenchyme Dr. Ali Tahir. M.Phil Oral Pathology
  2. 2. Ameloblastic Fibroma A circumscribed lesion located over un-erupted molars in young patients consisting of odontogenic epithelium & connective tissue Dr. Ali Tahir. M.Phil Oral Pathology
  3. 3. Clinical & radiographical features Younger patients, average age of 14 yrs Slow growing Common in mandible, molar areas, 75% associated with un-erupted tooth Small are asymptomatic, larger ones cause swelling Well defined Unilocular/Multilocular radiolucency Dr. Ali Tahir. M.Phil Oral Pathology
  4. 4. Histopathology Thin stands & cords of odontogenic epithelium Background of embryonic connective tissue Zones of hyalinization Focal areas of calcification Dr. Ali Tahir. M.Phil Oral Pathology
  5. 5. Odontoma Most common odontogenic tumour in west Hamartomatous (not true neoplasm) lesion commonly associated with unerupted teeth & composed of enamel, dentin, pulp & cementum in either recognizable tooth shapes (compound) or a solid, gnarled mass (complex) Dr. Ali Tahir. M.Phil Oral Pathology
  6. 6. Odontoma Dr. Ali Tahir. M.Phil Oral Pathology
  7. 7. Clinical Features First & second decade, mean age 14 yrs Majority asymptomatic More common in maxilla Compound are common in anterior jaws Complex is common in post jaws Dr. Ali Tahir. M.Phil Oral Pathology
  8. 8. Radiographic Compound  Unilocular, containing multiple radiopaque structures resembling miniature teeth  May contain 2-3 or upto 20-30 tooth like structures Complex:  Unilocular,usually small but may grow upto 10cm  Solid radiopaque mass  Surrounded by thin zone of radiolucency  Cortication Dr. Ali Tahir. M.Phil Oral Pathology
  9. 9. Radiographic Usually associated with an unerupted tooth A developing odontoma may be radiolucent Radiographic findings are usually diagnostic Dr. Ali Tahir. M.Phil Oral Pathology
  10. 10. HistopathologyComplex odontoma, A singled gnarled mass of enamel, dentine, pulp May also contain reduced enamel epith, secretory ameloblasts & odontoblasts Spherical calcifications Dr. Ali Tahir. M.Phil Oral Pathology
  11. 11. HistopathologyCompound Enamel, dentin, pulp arranged in orderly fashion Surrounded by follicular connective tissue Dr. Ali Tahir. M.Phil Oral Pathology
  12. 12. Ameloblastic Fibro-odontoma Expansile growth in young patients containing soft tissue components of ameloblastic fibroma & hard tissue components of complex odontoma Greater potential for growth & destruction Differs from odonto-ameloblastoma Dr. Ali Tahir. M.Phil Oral Pathology
  13. 13. Clinical Features First & second decade Common in post mandible Presents as slow growing swelling Usually in area of un-erupted tooth Pain is rare Dr. Ali Tahir. M.Phil Oral Pathology
  14. 14. Radiographic Unilocular, well circumscribed, mixed radiopaque & radiolucent lesion Opacities are usually diffuse & nodular May contain an impacted tooth Variable amount of calcifications with radio-density of a tooth structure Dr. Ali Tahir. M.Phil Oral Pathology
  15. 15. Dr. Ali Tahir. M.Phil Oral Pathology
  16. 16. Histopathology Soft tissue component resembles ameloblastic fibroma  Strands & cords of epithelium resembling dental lamina  Background of embryonic CT containing fibroblasts Hard tissue component is mature or immature form of complex odontoma Dr. Ali Tahir. M.Phil Oral Pathology
  17. 17. Histopathology Dr. Ali Tahir. M.Phil Oral Pathology
  18. 18. Odontogenic Malignancies Dr. Ali Tahir. M.Phil Oral Pathology
  19. 19. Malignant Ameloblastoma andAmeloblastic Carcinoma Less than 1 % of the ameloblastomas show malignant behavior with the development of metastases. Malignant ameloblastoma is a tumor that shows histologic features of the typical (benign) ameloblastoma in both the primary and secondary deposits. Ameloblastic carcinoma is a tumor that shows cytologic features of malignancy in the primary tumor, in recurrence and any metastases. Dr. Ali Tahir. M.Phil Oral Pathology
  20. 20. Radiographic With the malignant ameloblastoma, the appearance is similar to the typical solid/multicystic ameloblastoma. The ameloblastic carcinoma is often more aggressive with the lesion appearing as an ill-defined radiolucency with cortical destruction Dr. Ali Tahir. M.Phil Oral Pathology
  21. 21. Dr. Ali Tahir. M.Phil Oral Pathology
  22. 22. Ameloblastic Carcinoma Dr. Ali Tahir. M.Phil Oral Pathology
  23. 23. Clear Cell Odontogenic Carcinoma Dr. Ali Tahir. M.Phil Oral Pathology
  24. 24. Clear Cell Odontogenic Carcinoma An aggressive & destructive intra-osseous lesion consisting of poorly differentiated epithelial cells and clear cells Dr. Ali Tahir. M.Phil Oral Pathology
  25. 25. CCOCClinical Features Uncommon Painful swelling of anterior mandible 5th-7th decade, mean age 58 years Female predilection Loosening of teeth Potentially aggressive, capable of frequent recurrences & metastasis Features indicative of odontogenic origin Dr. Ali Tahir. M.Phil Oral Pathology
  26. 26. CCOC Radiographically shows honeycomb poorly defined radiolucency Dr. Ali Tahir. M.Phil Oral Pathology
  27. 27. Histopathology Biphasic Mono-phasic Ameloblastomatous Dr. Ali Tahir. M.Phil Oral Pathology
  28. 28. HistopathologyBiphasic Nests of cells with clear cytoplasm mixed with cells containing eosinophilic cytoplasmMonophasic Only clear cellsAmeloblastomatous Nests of cells showing central cystic change & squamous differentiation Peripheral nuclear palisading with reverse polarity Dr. Ali Tahir. M.Phil Oral Pathology
  29. 29. Histopathology Dr. Ali Tahir. M.Phil Oral Pathology
  30. 30. Primary Intra-osseous Carcinoma Dr. Ali Tahir. M.Phil Oral Pathology
  31. 31. Primary Intra-osseous CarcinomaWHO DefinitionA squamous cell carcinoma arising within the jaw, having no initial connection with the oral mucosa, and presumably developing from residues of the odontogenic epithelium Two possible origins  Lining of odontogenic cysts  From remnants of odontogenic epithelium (arising de novo) 2/3rd cases arise from odontogenic cysts PIOC occurs only in the jaw bones Dr. Ali Tahir. M.Phil Oral Pathology
  32. 32. Primary Intra-osseous CarcinomaClinical & Radiographic features Male to female ration is 2.2:1 Mostly in elderly patients above 60 yrs Painful swelling Bony expansion may be present Destroys large areas of bone Root resorption Sensory disturbances/Neural involvement Local/regional metastasizes Dr. Ali Tahir. M.Phil Oral Pathology
  33. 33. Primary Intra-osseous Carcinoma Dr. Ali Tahir. M.Phil Oral Pathology
  34. 34. D.D (histological) Acanthomatous ameloblastoma Ameloblastic carcinoma Squamous odontogenic tumour Mucoepidermoid carcinoma Dr. Ali Tahir. M.Phil Oral Pathology
  35. 35. Diagnosis Clinical findings Ruling out the extension from oral, gingival or sinus epithelium Radiograph/CT Histopathology Dr. Ali Tahir. M.Phil Oral Pathology
  36. 36. Forgive your enemy... ...but remember the bastard’s name Dr. Ali Tahir. M.Phil Oral Pathology

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