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S A R A N G S U R E S H H OTC H A N D A N I
TUMOR LIKE SWELLINGS OF JAWS
• In olden time, tumor meant Lump or swelling due to any cause.
• In contemporary science, tu...
NEOPLASM….?
Abnormal Growth of
Tissues.
Cyst
• Odontogenic & Non Odontogenic
Tumor/Neoplasm
• Odontogenic & Non Odontogenic
• Metastatic
Giant Cell Lesion Fibro o...
INTRODUCTION…
•As the name indicates, odontogenic tumors
are derived from odontogenic tissues.
–Odontogenic tissues are th...
CLASSIFICATION
OdontogenicTumors
Benign
Epithelium
Ameloblastoma
Squamous Odontogenic
Tumor
Calcifying epithelial
odontoge...
INTRODUCTION
• Benign but locally invasive
neoplasm derived from one of the
following odontogenic epithelium;
– Surface ep...
TYPES OF AMELOBLASTOMA
Ameloblastoma On the basis of Clinical & Radiological
Features.
Central / Intra Osseous
Multicystic...
GENERAL FEATURES
OF AMELOBLASTOMA
• Most common neoplasm of
odontogenic origin.
• Usually in 3rd – 5th decade.
– Rare in c...
CLINICAL PRESENTATION
OF AMELOBLASTOMA
• Usually asymptomatic & slow growing.
• Results in facial deformity & jaw
expansio...
A CLINICAL
PHOTOGRAPH OF
GRANULAR CELL
AMELOBLASTOMA IN
THE ORAL CAVITY
SHOWS AN
ENORMOUS MASS ON
THE RIGHT MANDIBLE.
http...
CLINICAL PRESENTATION
(LATE FEATURES) OF AMELOBLASTOMA
•Pain
•Paresthesia
•Perforation of bone
•Extension of
neoplasm into...
R A D I O G R A P H I C
F E A T U R E S O F
A M E L O B L A S T O M A
Typically form
Rounded & Cyst like
Radiolucency with...
A panoramic radiograph displays a well defined multilocular
radiolucency with scalloped border (arrowheads) extending from...
HISTOPATHOLOGY
OF AMELOBLASTOMA
• Conventional ameloblastoma are usually made of mixture of
solid neoplasm & cysts.
• They...
FollicularAmeloblastoma
PlexiformAmeloblastoma
BasalAmeloblastoma
GranularAmeloblastoma
AcanthomatousAmeloblastoma
Desmopl...
FOLLICULAR AMELOBLASTOMA
• Most common type of ameloblastoma.
• Characterized by; islands of follicles of epithelial
cells...
FOLLICULAR AMELOBLASTOMA
PLEXIFORM AMELOBLASTOMA
• Here epithelium forms cords or strands and
trabeculae of small, darkly stained epithelial
cells ...
ACANTHOMATOUS
AMELOBLASTOMA
• It has similar histological appearance to follicular
ameloblastoma, except difference in;
– ...
BASAL
AMELOBLASTOMA
• Rare type
• Arranged as trabecular pattern
with peripheral cells cuboidal
rather than columnar.
• Mi...
GRANULAR
AMELOBLASTOMA
• In this appearance of epithelium & stroma is also
similar to follicular ameloblastoma but differe...
DESMOPLASTIC
AMELOBLASTOMA
• In this epithelium,
odontogenic
epithelium is
arranged in small
islands or cords
in dense & h...
BEHAVIOR OF AMELOBLASTOMA
• Although ameloblastoma is benign, but some cells of this
ameloblastoma may infiltrate the narr...
MANAGEMENT OF MULTICYSTIC
AMELOBLASTOMA
• Diagnosis is confirmed by biopsy.
• Treatment of choice is wide excision – takin...
MANAGEMENT OF MULTICYSTIC
AMELOBLASTOMA
• Maxillary Ameloblastoma are dangerous because;
–Bone is thinner in mandible.
–Ne...
UNICYSTIC
AMELOBLASTOMA
INTRODUCTION
UNICYSTIC AMELOBLASTOMA
• It is defined as ameloblastoma having single cyst or appear as single cyst.
• Howev...
FEATURES OF UNICYSTIC
AMELOBLASTOMA
• Mostly b/w 10 – 20 years of age.
• Mostly in posterior mandible.
• Sometimes arises ...
PERIPHERAL AMELOBLASTOMA
• In this type, ameloblastoma is present in gingival or alveolar soft tissues and does not
involv...
MALIGNANT OR METASTASIZING
AMELOBLASTOMA
• It is distant or metastasized ameloblastoma.
• Metastasis usually occur to lung...
AMELOBLASTIC CARCINOMA
• It arises when dysplastic changes occur in the primary
benign ameloblastoma.
• Rare
• Histologica...
AMELOBLASTIC CARCINOMA
MALIGNANT AMELOBLASTOMA
• Clinically primary &
secondary ameloblastoma
have same all clinical
histo...
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Ameloblastoma (Odontogenic Tumor) Oral Pathology

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a presentation from subject of oral pathology.

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Ameloblastoma (Odontogenic Tumor) Oral Pathology

  1. 1. S A R A N G S U R E S H H OTC H A N D A N I
  2. 2. TUMOR LIKE SWELLINGS OF JAWS • In olden time, tumor meant Lump or swelling due to any cause. • In contemporary science, tumor means neoplasm that has formed lump/swelling in any part of body.
  3. 3. NEOPLASM….? Abnormal Growth of Tissues.
  4. 4. Cyst • Odontogenic & Non Odontogenic Tumor/Neoplasm • Odontogenic & Non Odontogenic • Metastatic Giant Cell Lesion Fibro osseous Lesion Swellings of Jaws
  5. 5. INTRODUCTION… •As the name indicates, odontogenic tumors are derived from odontogenic tissues. –Odontogenic tissues are those which take part in tooth development. •Odontogenic Tumors are most common types of neoplasm of jaws.
  6. 6. CLASSIFICATION OdontogenicTumors Benign Epithelium Ameloblastoma Squamous Odontogenic Tumor Calcifying epithelial odontogenic tumor Adenomatoid odontogenic tumor Calcifying cystic tumor Mesenchymal Odontogenic fibroma Odontogenic myxoma cementoblastoma Mixed of Both Ameloblastic Fibroma Malignant Epithelium Odontogenic carcinoma Clear cell odontogenic tumor Mesenchymal Odontogenic sarcoma
  7. 7. INTRODUCTION • Benign but locally invasive neoplasm derived from one of the following odontogenic epithelium; – Surface epithelium – Reduced enamel – Remnants of dental lamina – Rest cells of Malessez – Lining of dentigerous cyst • It is rare & accounts for 1% of all tumors of oral cavity. • BUT, Ameloblastoma is common in our Society. (PAKISTAN)
  8. 8. TYPES OF AMELOBLASTOMA Ameloblastoma On the basis of Clinical & Radiological Features. Central / Intra Osseous Multicystic Ameloblastoma Solid Ameloblastoma Conventional Ameloblastoma Follicular Ameloblastoma True Ameloblastoma Unicystic Peripheral / Extra Osseous
  9. 9. GENERAL FEATURES OF AMELOBLASTOMA • Most common neoplasm of odontogenic origin. • Usually in 3rd – 5th decade. – Rare in children & elderly – Mostly in posterior region of mandible. • No specific gender prediction. • Locally invasive but does not metastasize – That’s why called benign. • About 80% of Ameloblastoma occur in Mandible.
  10. 10. CLINICAL PRESENTATION OF AMELOBLASTOMA • Usually asymptomatic & slow growing. • Results in facial deformity & jaw expansion. • In maxilla even large lesion of Ameloblastoma produce very little expansion because lesion can extend into sinuses & beyond. • Characteristics of Jaw Expansion by Ameloblastoma –Bony hard, non tender, ovoid or fusiform outline. –in advanced cases egg shell crackling due to thinning of bone.
  11. 11. A CLINICAL PHOTOGRAPH OF GRANULAR CELL AMELOBLASTOMA IN THE ORAL CAVITY SHOWS AN ENORMOUS MASS ON THE RIGHT MANDIBLE. http://www.nature.com/ijos/journal/v4/n1/full/ijos20129a.html
  12. 12. CLINICAL PRESENTATION (LATE FEATURES) OF AMELOBLASTOMA •Pain •Paresthesia •Perforation of bone •Extension of neoplasm into soft tissue.
  13. 13. R A D I O G R A P H I C F E A T U R E S O F A M E L O B L A S T O M A Typically form Rounded & Cyst like Radiolucency with moderately well defined margins and appear as multilocular – SOAP BUBBLE or HONEY COMB APPEARANCE.
  14. 14. A panoramic radiograph displays a well defined multilocular radiolucency with scalloped border (arrowheads) extending from the right second mandibular premolar to the mandibular ramus. Extensive root resorption of the right second mandibular premolar and thinning of the cortical plate is detected. Note that the inferior alveolar nerve canal has been displaced inferiorly to the inferior cortex of the mandible (arrows). http://www.nature.com/ijos/journal/v4/n1/full/ijos20129a.html
  15. 15. HISTOPATHOLOGY OF AMELOBLASTOMA • Conventional ameloblastoma are usually made of mixture of solid neoplasm & cysts. • They have variety of patterns histologically but there are some features which are common to all histological variety of ameloblastoma; –Presence of neoplastic ameloblasts with Palisaded appearance & reverse polarization (presence of nuclei away from basement membrane)
  16. 16. FollicularAmeloblastoma PlexiformAmeloblastoma BasalAmeloblastoma GranularAmeloblastoma AcanthomatousAmeloblastoma DesmoplasticAmeloblastoma
  17. 17. FOLLICULAR AMELOBLASTOMA • Most common type of ameloblastoma. • Characterized by; islands of follicles of epithelial cells in a connective tissue stroma. – Outer layer of these islands have well organized, tall columnar ameloblasts like cells with reverse polarity which are surrounding core of polyhedral or angular cells. – small cysts may be present within follicle or stoma – Here islands of epithelium are not interconnected.
  18. 18. FOLLICULAR AMELOBLASTOMA
  19. 19. PLEXIFORM AMELOBLASTOMA • Here epithelium forms cords or strands and trabeculae of small, darkly stained epithelial cells which may lack reverse polarization and does not resemble any stage of ameloblasts present in less cellular stroma. • This variant give Fish – net appearance.
  20. 20. ACANTHOMATOUS AMELOBLASTOMA • It has similar histological appearance to follicular ameloblastoma, except difference in; – Squamous metaplasia of core cells (stellate & angular cells) occurs producing prickle cells & keratin in core. • this variant is sometimes confused with squamous cell carcinoma.
  21. 21. BASAL AMELOBLASTOMA • Rare type • Arranged as trabecular pattern with peripheral cells cuboidal rather than columnar. • Mistaken with basal cell carcinoma.
  22. 22. GRANULAR AMELOBLASTOMA • In this appearance of epithelium & stroma is also similar to follicular ameloblastoma but difference in it is; central / core cells & some ameloblasts at peripheral cells undergo degenerative changes & form sheets of large PINK / eosinophilic granular cells in the center of island.
  23. 23. DESMOPLASTIC AMELOBLASTOMA • In this epithelium, odontogenic epithelium is arranged in small islands or cords in dense & highly collagenised stroma.
  24. 24. BEHAVIOR OF AMELOBLASTOMA • Although ameloblastoma is benign, but some cells of this ameloblastoma may infiltrate the narrow spaces without causing swelling and destruction of bone. • So that’s why simple curettage or enucleation of lesion cannot be done due to high recurrence. • So surgical resection with small normal tissue is best treatment option. (wide excision)
  25. 25. MANAGEMENT OF MULTICYSTIC AMELOBLASTOMA • Diagnosis is confirmed by biopsy. • Treatment of choice is wide excision – taking upto 2 cm of normal bone around margin of lesion. – Simple enucleation can cause Recurrence because of probability of invasion in surrounding space. • Regular radiographic follow up for detecting any recurrence.
  26. 26. MANAGEMENT OF MULTICYSTIC AMELOBLASTOMA • Maxillary Ameloblastoma are dangerous because; –Bone is thinner in mandible. –Neoplasm spread easily to following areas in maxilla. • Maxillary sinus • Pterygomaxillary fossa • Orbit • Cranium • Brain
  27. 27. UNICYSTIC AMELOBLASTOMA
  28. 28. INTRODUCTION UNICYSTIC AMELOBLASTOMA • It is defined as ameloblastoma having single cyst or appear as single cyst. • However, ameloblastoma radiographically appearing as single cyst can be Multicystic like mural ameloblastoma Explanations for a Unicystic presentation of ameloblastoma radiologically. The two patterns on the left are true Unicystic ameloblastoma while that on the right is a conventional ameloblastoma with one very large cyst.
  29. 29. FEATURES OF UNICYSTIC AMELOBLASTOMA • Mostly b/w 10 – 20 years of age. • Mostly in posterior mandible. • Sometimes arises with dentigerous cysts. • Radiological Features – Appear as unilocular radiolucency • Histology – Tumor cells forming cyst wall are flattened & can be mistaken for those or non – neoplastic cyst. • Treatment – Enucleation
  30. 30. PERIPHERAL AMELOBLASTOMA • In this type, ameloblastoma is present in gingival or alveolar soft tissues and does not involve bone. • These lesion may arise from; – Basal cells of oral epithelium – Extra osseous rests of dental lamina. • Histologically similar to intra osseous ameloblastoma.
  31. 31. MALIGNANT OR METASTASIZING AMELOBLASTOMA • It is distant or metastasized ameloblastoma. • Metastasis usually occur to lung. • Although it is benign and truly speaking does not metastasize but in some conditions as described under they may move from oral cavity to other places; – Aspiration of some cells of ameloblastoma into lungs during surgery. – Surgically disrupting primary site – Incomplete removal
  32. 32. AMELOBLASTIC CARCINOMA • It arises when dysplastic changes occur in the primary benign ameloblastoma. • Rare • Histologically poorly differentiated and shows dysplasia . • Metastasize to lymph nodes. • If metastasis is present, prognosis is poor.
  33. 33. AMELOBLASTIC CARCINOMA MALIGNANT AMELOBLASTOMA • Clinically primary & secondary ameloblastoma have same all clinical histological & other features. • Usually lungs. AMELOBLASTIC CARCINOMA • Primary has features of normal benign ameloblastoma, while secondary show dysplasia & malignant . • Metastasize to lymph nodes.

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