Odontogenic tumors


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Odontogenic tumors

  1. 1. Odontogenic Tumors
  2. 2. Definition of Odontogenic Tumors• Tumor:- The word tumor means swelling.• Odontogenic tumor:- A group of neoplasm & tumors-like malformations arising from cells of odontogenic apparatus & their remnants.- In other words, odontogenic tumors arise from odontogenic tissues.
  3. 3. The Origin of Odontogenic Tumors (Odontogenic Tissues) Ectodermal Mesenchymal(epithelium) (C.T) Dental Lamina + Dental Papilla. (Epith. Rests of Serres) Enamel Organ+ Dental Sac.(Reduced Enamel Epith.) Epith. Root Sheath of Hertwig’s + (Epith. Rests of Malassez)
  4. 4. (Odontogenic Tissues)
  5. 5. Classification of Odontogenic Tumors From O.EpithFrom O. From + Epith. O.Mesenchyme Mesenchyme Ameloblastic OdontogenicAmeloblastoma Fibroma Fibroma. (CEOT) Odontogenic Odontoma (Pindborg T) Myxoma. Adenomatoid O.T (AOT)
  6. 6. Origin of AmeloblastomaSeveral origins have been suggested:• Dental Lamina + its remnants( epith. Rests of Serres).• Enamel organ + its remnants ( reduced enamel epith.).• Epith. Lining of Dentigerous cyst.• Basal layer of the oral mucosa.
  7. 7. Types of Ameloblastoma• 1- Simple, Solid,(Multicystic Ameloblastoma), with its histological variants:-Follicular A.-Plexiform A.• 2-(Unicystic Ameloblastoma), with its histological variants:-Luminal Unicystic A.-Intraluminal Unicystic A.-Mural Unicystic A.• 3-Peripheral (S.T) ameloblastoma.• 4-Desmoplastic ameloblastoma.
  8. 8. Solid, Multicystic Ameloblastoma• Def.:- It is a benign but locally invasive neoplasm consisting of epithelium lying in a fibrous stroma.- It is one of the few neoplasms that arise from odontogenic epith.- It has ↑ recurrence rate than other types of Ameloblastoma.
  9. 9. Clinical Features of Multicystic Ameloblastoma• Age: 4th- 5th decade.• Sex: male = female.• Race: ↑ in African.• Site: ↑mand. Molar area.• Signs & symptoms:-painless-Slowly growing.-gradula facial asymmetry.-Looseness of teeth.-NO metastasis (benign).
  10. 10. Macroscopic pictures of Multicystic, Solid Ameloblastoma• Starts in cancellous bone & enlarge slowly.• Extends buccal & lingual plate of bone.• There is always a continous sheet of paper thin bone covering the tumor.• May be solid or cystic.• Cystic tumor may be one large (unicystic) or microcysts (multicystic).
  11. 11. X-ray of Solid, Multicystic Ameloblastoma• Multilocular Radiolucency.• (Honeycomb) or (soap- bubble) appearance.• Recently diagnosed by:- Computed tomography (CT) scan.- Magnetic resonance imaging (MRI).
  12. 12. C.T (3d) MRI forscan for Ameloblastoma Ameloblastoma
  13. 13. Histological Features of Multicystic Ameloblastoma 1-Follicular 2-Plexiform Cystic Acanthomatous Granular Basaloid
  14. 14. Histology of Follicular Ameloblastoma• Epith.: Forms discrete islands. Surrounded by CT stroma.• Epith. Islands:- Central cells →polyhedral or angular cells similar to (stellate reticulum).- Surrounding layer →cuboidal or columnar cells similar to (internal enamel epith.)(preameloblasts).
  15. 15. Histological Variants of Follicular Ameloblastoma• Cystic follicular:- Due to cystic breakdown of the epith. Within the follicle.- The wall of the cyst is formed of (flat cells).
  16. 16. Histological Variants of Follicular Ameloblastoma• Acanthomatous follicular:- Due to squamous metaplasia of inner cells within follicle.- If ↑ keratin →(kerato ameloblastoma).- If some keratinised +- another microcysts with non-keratinised epith.+- papillary forms→ (papilliferous kerato- ameloblastoma).
  17. 17. Histological Variants of Follicular Ameloblastoma• Granular Follicular:- Granular cell metaplasia of inner cells.- Cuboidal rounded large cells.- Nuclei pushed to the cell wall.- Cytoplasm filled with (eosinophilic granules).
  18. 18. Histological Variants of Follicular Ameloblastoma• Basaloid(basal cell follicular):- Inner cells →compact.- Peripheral→ cuboidal.
  19. 19. Histology of Plexiform Ameloblastoma• Epith.: arranged in network.• Lined by columnar or cuboidal cells + cells similar to (Stelate reticulum).• Cystic formation → by stromal breakdown NOT epith.• Stromal blood vessels dialate → (Haemangio- Ameloblastoma)
  20. 20. Connective Tissue (Stroma) Variants• Acellular loose CT.• OR, hyalaynization around follicle (30µ m).• OR, more collagenous stroma + small nests & strands of epith. →called (Desmoplastic (Desmoplastic Ameloplastoma) Ameloplastoma)
  21. 21. Epith. Epith. C.T C.TPlixiform Multicystic Follicular Multicystic Ameloblastoma Ameloblastoma
  22. 22. Unicystic Ameloblastoma• Def.: Locally invasive tumor consists of a central large cystic cavity.• Age: ˂20 years.• Sex: male= female.• Site: mand.˂ maxilla.• Signs & symptoms:- ↓ aggressive.- ↓ recurrence rate.- Painless &Slowly growing.• X-ray:Unilocular radiolucent.
  23. 23. (3D) CT scan of Unictystic Ameloblastoma
  24. 24. Histology of Unicystic Ameloplastoma One largeexpansile cyst
  25. 25. Histological Variants of Unicystic Ameloblastoma 1- Luminal 2- Intraluminal 3-Mural
  26. 26. Histological Variants of Unicystic Ameloblastoma• Luminal type:- The change is confined within the luminal surface of the cyst.- Part of the epithelial lining changes into ameloblastic epithelium→ (columnar or cuboidal c)+hyperchromatic nuclei + reverse polarity.- basilar cytoplasmic vacoulation.- The overlying epithelial cells consist of loose stellate reticulum like cells.
  27. 27. Histological Variants of Unicystic Ameloblastoma• Intraluminal type:- The nodules of ameloblastoma proliferate and project into the cyst lining.- The lining often shows an arrangement similar to (plexiform ameloblastoma).
  28. 28. Histological Variants of Unicystic Ameloblastoma• Mural type:- The fibrous connective tissue wall of the cyst is infiltrated by ameloblastic masses.-The ameloblastic component showing (follicular or plexiform patterns).
  29. 29. Adenomatoid Odontogenic Tumor (AOT)• Def.:- A tumor of odontogenic epith.with duct structures & with varing degrees of inductive changes in the C.T stroma.- Its different clinically & histologically from ameloblastoma.- Its believed that the lesion is a (Hamartomatous) in nature.• Origin:-Enamel organ & its remnants(Reduced E.E)
  30. 30. Clinical features of Adenomatoid Odontogenic Tumor (AOT)• Age: 2nd decade.• Sex: F˂M.• Site: Maxilla˂ Mand.-↑↑impacted canine 50%.• Signs & symptoms:- Painless swelling.-Slowly growing(intraosseous)- Associated with impacted tooth.- Similar to (Dentigerous Cyst).
  31. 31. X-ray of (AOT)• Unilocular.• Well-defined.• Radiolucencent.• Associated with impacted tooth.• Especially upper canine.• Similar to (Dentigerous cyst) but its attachment beyond the CEJ.
  32. 32. Histological Features of (AOT)• The epith.:- Whorled masses of spindle cells or,Rings of columnar c.• Rings of columnar c:- Double layer tubular structure.- Duct like structure.- Convoluted bands.- In between double layer +ve to (PAS) stain.• C.T stroma:hayline (epith. Strands, dysplastic dentine& rarly enamel matrix).• Tumor is encapsulated
  33. 33. Rings Duct like structureWhorledmasses
  34. 34. AOT is encapsulated with thick fibrous band
  35. 35. Calcifying Epith. Odontogenic Tumor (CEOT) (Pindborg’s Tumor)• Def.:- It is a locally invasive epith. Neoplasm characterized by the development of intra- epith. Structure probably of an amyloid-like nature.- This amyloid-like structure may become calcified & liberated into the surrounding stroma.• Origin (Histogenesis):- (Reduced E.E) of associated unerupted tooth.
  36. 36. Clinical Features of (CEOT)(Pindborg’s Tumor)• Age: between 20-60 years.• Sex: M=F• Site:- Intraosseous →mand˂max (post.).- Extraosseous→anterior.• Signs & symptoms:- painless.- Slowly growing.- Associated with impacted tooth.
  37. 37. X-ray of (CEOT)(Pindborg’s Tumor)• Irregular radiolucent area.• Containing radioopaque masses close to unerupted tooth
  38. 38. (3D) CT scan of Pindborg’s Tumor (CEOT)
  39. 39. Histology of (CEOT)(Pindborg’s Tumor)• The epith.:• Sheets of polyhedral cells.• Well-defined cell border.• Giant nuclei, prominent nucleoli & darkly stained.• No mitosis ( benign).• Clear cell variant.• (Liesegang’s ring):- Rounded acidophilic homogenous amyloid masses→calcify→ring – shaped,+ve Thiovlavin T stain.
  40. 40. -Red rose→amyloid spaces.-Black arrows→Liesegang’s ring-E→ epith. Polyhedral cells
  41. 41. Sheet ofpolyhedral epith.
  42. 42. Mixed Odontogenic Tumors (Epith.+ Mesenchyme)•Ameloblastic fibroma.•Odontoma (complex & compound)
  43. 43. Ameloblastic Fibroma• Age: ˂ 21 years(young).• Site: mand (post.).• X-ray:- impossible to differentiated from ameloblastoma.- well-defined radiolucent.- Associated with impacted tooth• Diagnosis: by histological examination.
  44. 44. Histology of Ameloblastic Fibroma 1•1→C.T: ↑↑cellular than ameloblastoma ( rounded or angular cells+ ↓↓ collagen)•2→strands or islands of epith.
  45. 45. Histology of Ameloblastic Fibroma 2 1•1→Peripheral epith.Columnar or cuboidal. Cells.•2→narrow cell- free zone (halynization aroundepith.).•3→central stellate reticulum cells with NO cystformation.
  46. 46. Odontoma Compound Odontoma Complex Odontoma• Def.: a malformation in • Def.: a malformation in which all dental tissues which all dental tissues are represented in more are represented in more orderly pattern than disorderly pattern. comlex. • Contains many• Contains many tooth- disordered tooth-like like structures. structures.• Don’t resemble the • Don’t resemble the normal tooth normal tooth morphologically . morphologically .
  47. 47. X-ray of OdontomaCompound ComplexOdontoma Odontoma
  48. 48. Macroscopic Pictures of Odontoma (compound &complex)
  49. 49. Microscopic Pictures of Odontoma (compound &complex) Compound Complex Odontoma Odontoma
  50. 50. Mesenchymal Odontogenic Tumors from (Mesenchymal Tissues) •Odontogenic Fibroma. •Odontogenic Myxoma.
  51. 51. Odontogenic Fibroma• Def.:A fibroblastic neoplasm containing:- Inactive odontogenic epith.- More cellular fibrous tissue.- Hard tissue (dysplastic cementum or bone).• Origin:-Tooth follicle (dental sac) →fibroblastic elements or,- Its derivative ( periodontal ligament)
  52. 52. X-ray of Odontogenic Fibroma Well-defined (unilocular) monolocular radioucency
  53. 53. Histology of Odontogenic Fibroma• Primitive cellular fibroblastic tissue.• Strands or islands of inactive odontogenic epith.• Islands of ostoid or cement-like tissue scattered in the fibroblastic mass.• Invariable collagen.• The tumor is encapsulated.
  54. 54. 31 2•1→fibroblastic tissue•2→ostoid islands•3→ inactive epith. strands
  55. 55. Odontogenic Myxoma• Def.:It is a locally invasive neoplasm resembling dental follicle in location & structure & containing: - Angular spindle cells.- Lying in mucoid stroma.• Origin:- Odontogenic mesenchyme because:1- frequent inclusion of epith. Rests.2- missing associated tooth.3- no similar tumor in any bone type( only jaw).4- similar histologically with embryonic mesenchyme.
  56. 56. Odontogenic Myxoma Clinically• Age: young.• Sex:F=M• Site:-only jaw bone ↑mand.- In place of missing tooth.• Signs & symptoms:- Fusiform swelling.- Rapidly growing.- Difficult complete removal (little encapsulation)- may invade antrum.
  57. 57. Odontogenic Myxoma Radiographically •Multilocular radiolucencies •Soap-bubbles appearance.
  58. 58. Odontogenic Myxoma Histologically1 3 2 •1→myxoma filling marrow spaces. •2→bony trabaculea. •3→spindle cells in mucoid matrix.
  59. 59. Thanks Presented by:Marwa Assem Salama