BENIGN TUMOUR : Is a new growth, which is limited by a capsule and grows by local expansion without causing any harm to the host, excepting its position in a vital organ. MALIGNANT TUMOUR : Is a new growth which is characterized by rapid growth, sign of invasion, absence of capsule and last of all dissemination to other parts of the body usually by hematogenous or lymphatic route or both.

2. REFERENCES
 Odontogenic tumours & Allied lesions- Peter A Reichart , Hans P Philipson
 Textbook of Oral Radiology- White & Pharoah (6th ed.)
 Diagnostic imaging of jaws- Langland & Langlais
 Differential Diagnosis of Oral & Maxillofacial lesions- Wood & Goaz (5th
ed.)
 Principles Practice Oral Radiologic Interpretation- H.M Worth
 Ameloblastic fibroma: A review of published studies with special reference
to its nature and biological behavior Yan Chen, Jing-Ming Wang, Tie-Jun Li
doi:10.1016/j.oraloncology.2007.05.009
 Martin-Granizo Lopez R, Ortega L, Gonzalez Corchon MA et al:
Ameloblastic fibroma of the mandible. Report of two cases, Med Oral
8(2):150-153, 2003

3. CONTENTS
 Introduction
 Definitions
 Benign tumours
- Clinical features
- Radiographic features
- Differential diagnosis
- Treatment
 Malignant tumours
 Odontogenic
 Non-odontogenic

4. DEFINITIONS
NEOPLASM : A neoplasm as defined by Willis is “ An abnormal mass of
tissue, the growth of which exceeds and is uncoordinated with that of the
normal tissues and persists in the same excessive manner after the cessation of
the stimuli which evoked the change. ”
BENIGN TUMOUR : Is a new growth, which is limited by a capsule and
grows by local expansion without causing any harm to the host, excepting
its position in a vital organ.
MALIGNANT TUMOUR : Is a new growth which is characterized by rapid
growth, sign of invasion, absence of capsule and last of all dissemination to
other parts of the body usually by hematogenous or lymphatic route or
both.

5. FEATURES OF BENIGN TUMOR
 Encapsulated
 Slow growing
 Painless
 No metastasis

6. FEATURES OF MALIGNANT
TUMOR

7. ODONTOGENIC TUMOURS
Classification
Benign Tumors
1) Odontogenic epithelium with mature, fibrous stroma; odontogenic
mesenchyme not present
 Ameloblastomas
 Calcifying epithelial odontogenic tumor
 Adenomatoid odontogenic tumor
 Squamous odontogenic tumour
Editorial and Consensus Conference -Lyon, France (WHO/ IARC) in July 2003

8. 2) Odontogenic epithelium with odontogenic mesenchyme with or
without dental hard tissue formation
 Ameloblastic fibroma
 Ameloblastic fibro-dentinoma
 Ameloblastic fibro-odontoma
 Complex odontoma
 Compound odontoma
 Odontoameloblastoma
 Calcifying cystic odontogenic tumor
Editorial and Consensus Conference -Lyon, France (WHO/ IARC) in July 2003

9. 3) Mesenchyme and/or odontogenic ectomesenchyme with or without
included odontogenic epithelium
 Odontogenic fibroma
 Odontogenic myxoma or fibromyxoma
 Cementoblastoma
Editorial and Consensus Conference -Lyon, France (WHO/ IARC) in July 2003

10. Malignant
I Odontogenic Carcinomas
 Metastasizing, malignant ameloblastoma
 Ameloblastic carcinoma
 Primary intraosseuos squamous cell carcinoma
 Clear cell odontogenic carcinoma
 Ghost cell odontogenic carcinoma
II Odontogenic Sarcomas
 Ameloblastic fibrosarcoma
 Ameloblastic fibrodentino and fibro-odontosarcoma
Editorial and Consensus Conference -Lyon, France (WHO/ IARC) in July 2003

11. AMELOBLASTOMA
WHO Definition -
• Ameloblastoma is a polymorphic neoplasm consisting of proliferating odontogenic
epithelium which usually has a follicular or
plexiform pattern lying in a fibrous stroma
Reichart and Slootweg Definition
• Ameloblastoma is a polymorphous neoplasm consisting of proliferating odontogeni
c epithelium usually occurring in follicular or
plexiform patterns embedded in mature connective tissue stroma.
As stated by Robinson,
Ameloblastoma is usually unicentric, non-functional, intermittent in growth,
anatomically benign and clinically persistent.

12. HISTORICAL BACKGROUND
 1826 – Guzack – a tumor of jaw
 1868 – Broca – 1st neoplasm of this nature in literature
 1879 – Falkson gave its thorough description.
 1885 – Malassez – ‘Admantinoma’
 1934 – Churchill – ‘Ameloblastoma’

13. PATHOGENESIS
 Resemblance to odontogenic apparatus – derived from the same.
 Malassez, 1885 – epithelial rests adj. roots of teeth – ‘les debris
épithéliaux’ - proliferate  Adamantine epithelioma
 Origin – varied origin
 Stimulus for initiation - unknown

14. GENETIC ALTERATION
Overexpressed genes
 Proto-oncogene FOS – most highly
-Fos protein – Activating protein-1 (transcription factor)
-Cell proliferation, differentiation, oncogenic transformation
-Bone development, regulator of osteoclast - macrophage
lineage determination, bone remodelling.
 TNFR 1A – induction of AP-1 activity
-TNF-α – signal transduction
-Inflammation, cell proliferation, differentiation & apoptosis
Heikinheimo et al (2002, J Dent Res)

15. Underexpressed genes –
 Cadherins, KRT7, NOTCH & TGFB1
 Disturbances in cell adhesion & cell-cell communication
 Sonic hedgehog (SHH) – (expression of PTCH)
 Dysregulation of signalling pathway for ectomecenchymal interactions
Heikinheimo et al (2002, J Dent Res)

16. VARIANTS
 Classical solid / multicystic ameloblastoma (SMA)
 Unicystic ameloblastoma (UA)
 Peripheral ameloblastoma (PA)
 Desmoplastic ameloblastoma (DA)

17. SOLID / MULTICYSTIC
AMELOBLASTOMA
Clinical features-
 Early stages – no clinical
signs
 Later –
 Facial deformity – swelling
(bony hard & bulky)
 Loosening of teeth
 Fractures
 Pain – less frequent
(pressure on nerves, sec.
infection)
 Large tumors – thinning of
cortices (egg shell crackling)
 Perforation – late feature
Age –
Mean age – 35.9 yrs (range 9-
92yrs)
Maxillary tumours – 47 yrs
Mandibular tumours – 35.2 yrs
Sex distribution –
Male : female – 1.1 : 1
Reichart et al 1995, biological profile of 3677
cases of ameloblastoma

18. RADIOGRAPHIC FEATURES
Honeycomb appearance
Spider-like appearance
Soap-bubble appearance
Mother-daughter cell appearance

19. Unilocular pattern

20. ROOT RESORPTION PATTERN
Knife edged root resorption Multiplanar root resorption

21. RADIOGRAPHIC DESCRIPTION OF AMELOBLASTOMA
WORTH (1963)
4 types
 Unilocular
 “Gross caricature of spider”
 Multilocular
 Replacement of normal bone with honeycomb appearance.

22. CT SCANS

23. CBCT

24. MRI
T2WI Gd – T1WI

25. HISTOPATHOLOGICAL VARIANTS
Islands –
Central polyhedral cells
Surrounded by layer of
cuboidal / Columnar cells
Cystic degenerations –
Within epithelial islands
Follicular
Plexiform
Tumor epithelium in a network
Cyst formation – within stroma
Acanthomatous
0 Extensive squamous metaplasia
0 Keratin formation
Granular
0 Granular transformation of central stellate cells –
round/columnar/cuboidal
0 Acidophillic granules – lysosomal aggregates
Basal

26. PERIPHERAL AMELOBLASTOMA
 Extraosseous, soft tissue
ameloblastoma
 Histology – similar to SMA
 Tooth bearing region
 Painless, sessile, firm,
 Surface – smooth / pebbly,
granular / papillary, warty
 Pink / red / dark red

27.  Duration – 2 days – 20 yrs
 2 - 10% of ameloblastomas
 R/F- cupping or saucerization
 Resemblance to –
 Epulis
 Papilloma
 Pyogenic granuloma

28. UNICYSTIC AMELOBLASTOMA
 ‘UNICYSTIC’ – macro & microscopic appearance – well defined,
monocystic cavity – lined focally / entirely of ameloblastomatous
epithelium.
Synonyms –
 Cystic ameloblastoma
 Mural ameloblastoma

29.  Age –
 Dentigerous variant –
younger (mean age – 16.5)
 Non dentigerous – mean age
– 32.2
 Male : female –
 Dentigerous - 1.6 : 1
 Non-dentigerous – 1 : 1.8
 Location – Mandible
 Posterior mandible, Asc.
Ramus
 Dentigerous variety – 3rd
molar

30. HISTOLOGICAL VARIANTS
(ACKERMAN ET AL, 1988 - SUBTYPES)
1. - Luminal UA
1.2 - Luminal & Intraluminal UA
1.2.3 - Luminal, Intraluminal & intramural
1.3 - Luminal & Intramural

31. RADIOLOGIC FEATURES

32. DESMOPLASTIC AMELOBLASTOMA
 Variant of SMA –
extensive stromal
collagenization /
desmoplasia
 Benign, locally infiltrative
 Location - Maxilla =
mandible
 Age – mean – 42.8 yrs
 Male : female – 1 : 0.9
 Origin – similar to SMA

33. OTHER TYPES
 Clear cell A
 KeratoA & Papilliferous A
 Mucus cell differentiation
 Hemangiomatous Ameloblastoma
 Extragnathic Adamantinoma
 Metastasizing Ameloblastoma

34. DIFFERENTIAL DIAGNOSIS
 OKC
 Odontogenic Myxoma
 Aneurysmal bone cyst
 Central gaint cell granuloma
 Central hemangioma

35. TREATMENT
 Treatment depends on the type of lesion –
 SMA – radical surgical intervention
 UA – conservative surgical enucleation
 Peripheral ameloblastoma – more conservative surgery
 Radiotherapy –
 1982 – Reynolds et al – effects of radiation on ameloblastoma –
usefulness
 Not used as 1st line of treatment

36. PROGNOSIS
 SMA –
 ↑ Recurrence
 Maxilla – spreads faster - ↑ morbidity & mortality
- Posterior maxilla – poorest prognosis
 Mandible – restricted by thick cortex
 Follow up – 5-10 yrs post-surgery
 DA – same rate of recurrence as SMA
 Peripheral ameloblastoma – low recurrence (16-19%)
 UA – 10.7%

37. CALCIFYING EPITHELIAL ODONTOGENIC
TUMOUR
 Also called as Pindborg tumor,
first described by
J.J PINDBORG in 1956
 Benign, odontogenic neoplasm
exclusively epithelial in origin
 1% of odontogenic tumors
 ORIGIN – remnants of
primitive dental lamina

38. CLINICAL FEATURES
 Age ; Sex – 4th decade ;
Males
 Site – Mandible : Maxilla = 2
:1
 Malignant - Locally invasive
with high recurrence rate

39. RADIOGRAPHIC FEATURES
 Expanded cortices in all dimensions
 Radiolucent ; poorly defined, non-
corticated borders
 Unilocular, multilocular or “moth-
eaten”
 “ Driven-snow ” appearance from
multiple radiopaque foci
 Root divergence / resorption ;
impacted tooth

40.  Histology
 Islands of eosinophilic
epithelial cells
 Cells infiltrate bony trabeculae
 Nuclear hyperchromatism and
pleomorphism
 Psammoma-like calcifications
(Liesegang rings)

41. DIFFERENTIAL DIAGNOSIS
 Dentigerous cyst
 Adematoid odontogenic tumor
 Ameloblastic fibro-odontoma

42. TREATMENT
 Behaves like ameloblastoma
 Low recurrence rate
 En bloc resection, hemimandibulectomy/partial maxillectomy.
 Recurrence rate
- Franklin & Pindborg (1976) : 14%

43. ADENOMATOID ODONTOGENIC TUMOUR
 Adenoameloblastoma , Ameloblastic adenomatoid tumor
 First reported by - STAFNE
 Term coined by PHILIPSEN & BIRN (1969)
 ORIGIN – Dental epithelium
 TYPES-
 Peripheral
 Central - Follicular & Extra-follicular

44. CLINICAL FEATURES
 Age - 2nd decade
 Male : Female – 1 : 2
 Slow growing expansile lesion
 Location : Anterior maxilla
 Associated with unerupted tooth

45. RADIOGRAPHIC FEATURES
 Well-corticated, non-scalloped
margin.
 Medial growth in maxilla
 Snowflake, animal prints, foot
prints
 Radiolucent band

47. HISTOLOGY
Thick fibrous capsule, clusters of spindle cells, columnar
cells (rosettes, ductal) throughout

48. DIFFERENTIAL DIAGNOSIS
 Dentigerous cyst
 Ameloblastic fibroma
 CEOT
Treatment – enucleation, recurrence is rare
Recurrence rate - Low : 0.2%

49. SQUAMOUS ODONTOGENIC TUMOUR
 Benign Epithelial Odontogenic Tumor
 Hamartomatous proliferation
 Origin
CLINICAL FEATURES
 2nd and 3rd decade
 1:1
 Tooth mobility
 Tenderness on percussion

50. RADIOGRAPHIC FEATURES

51. HISTOLOGY
 Oval nest of squamous epithelium in mature collagen stroma.

52. DIFFERENTIAL DIAGNOSIS
 Dentigerous & Radicular cyst
 Treatment – Conservative enucleation & thorough curettage ; low
recurrence rate.

53. II. ODONTOGENIC EPITHELIUM
WITH ODONTOGENIC
MESENCHYME WITH OR WITHOUT
DENTAL HARD TISSUE
FORMATION

54. AMELOBLASTIC FIBROMA
 AF – True mixed odontogenic tumor
 Consists of both epithelial and ectomesenchymal components are
neoplastic.
 1946, Thoma and Goldman were the first to classify this tumour as a
separate entity

55. CLINICAL FEATURES
 Hard swelling
 Mandibular posteriors
 2nd and 3rd decade
 Tumour size - 1 - 10 cm
 Recurrence rate - 33.3%
 Malignant transformation - 11.4%
Yan Chen, Jing-Ming Wang, Tie-Jun Li . Ameloblastic fibroma : A review of published studies
with special reference to its nature and biological behavior.

56. RADIOGRAPHIC FEATURES
Martin-Granizo Lopez R, Ortega L, Gonzalez Corchon MA et al: Ameloblastic fibroma of the
mandible. Report of two cases, Med Oral 8(2):150-153, 2003.

57. DIFFERENTIAL DIAGNOSIS
 Dentigerous cyst
 Ameloblastoma

58. TREATMENT
Conservative surgery
 Excision
 Enucleation
 Curettage
Radical surgery
 Marginal resection
 Segmental resection
 Hemisection

59. AMELOBLASTIC FIBRO-ODONTOMA
 Hooker -1967
 Ameloblastic fibroma + odontome
 2% incidence- Regezi et al

60. FEATURES
C/F
 83%- unerupted tooth
 2nd decade of life
 M : F - 1.4 : 1
 Posterior mandible - 53.2%
R/F-
 Expansile, smooth- well defined cortication
 Radiopaque flecks - 1 – 2 mm to 1cm
 Tooth displacement

61. DIFFERENTIAL DIAGNOSIS
 Odontome

62. TREATMENT
 Conservative enucleation
 Resection with removal of impacted teeth.

63. ODONTOME
 Benign Hamartoma
 1971 - Pindborg et al.
2 types - Compound and complex
 Pathogenesis
 Local trauma
 Infection
 Family history
 Genetic mutation

64. CLINICAL FEATURES
 Slow growing , expansile lesion
 Compound – 2nd decade of life ; before 20yrs of age
 Complex - 2nd decade of life ; before 30yrs of age
 M : F - 1.5 : 1
Location –
 Compound – anterior maxilla ; posterior mandible – 2 : 1
 Complex – anterior maxilla ; posterior mandible – 1 : 2
 Displacement of tooth

65. RADIOGRAPHIC FEATURES
Compound odontome Complex odontome

66. VARIANTS
 Cystic odontome
 28% incidence
 Amelobalstic odontome
Treatment : Surgical enucleation
Differential diagnosis
 Ameloblastic fibro-odontome

67. III. Mesenchyme or odontogenic
ectomesenchyme with or without included
odontogenic epithelium

68. ODONTOGENIC MYXOMA
 Benign non-encapsulated odontogenic neoplasm.
 In 1947- Thoma and Goldman
Pathogenesis
 Arises from mesenchymal portion of the tooth germ, dental papilla, the
follicle or the periodontal ligament.

69. CLINICAL FEATURES
 1-3%
 2nd and 4th decade
 M:F- 1:1.6
 Mand posteriors

70. RADIOGRAPHIC FEATURES
Two pattern depending on evolution of tumor:
 Osteoporotic appearance
 Breakout/destructive phase

71. HISTOLOGICAL FEATURE

72. DIFFERENTIAL DIAGNOSIS
 Ameloblatoma
 Central giant cell granuloma
 Central hemangioma
 Osteosarcoma
 Treatment : As infiltrative local recurrence rate - 33%
 Resection with 1-1.5 cm of bone

73. ODONTOGENIC FIBROMA
 Two variants can be distinguished: an intraosseous or central type
(COF) and an extraosseous or peripheral type (POF)
 Clinical variants- 1) hyperplastic, 2) simple, 3) WHO type
 C/F - age- 3rd decade
 M:F- 1:2.8
 Maxilla : mandible – 1 : 6.8
Siar C H et al ,Clinicopathological study of peripheral and central odontogenic fibromas (WHO –
type in Malaysians ( 1967 - 9 5 ). B r J Oral Maxillofac Su rg 2000 ;38: 19- 22 .

74. RADIOGRAPHIC FEATURES

75. BENIGN CEMENTOBLASTOMA
 True cementoma, Attached cementoma
 First reported by NORBERG (1930)
 Term given by KRAMER
 < 1% of all odontogenic tumors
 Unique in two ways:
 True neoplasm of cementoblasts
 Attached routinely to an involved tooth
 Origin - PDL

76. CLINICAL FEATURES
 2nd and 3rd decade
 Mand 1st premolar and molar
 M : F – 1 : 1.2
 SYMPTOMS
 Pain – 53% of cases
 SIGN
 Swelling-73% cases

77. RADIOGRAPHIC FEATURES
 Three radiologically distinct
stages:
 Uncalcified matrix stage
 Calcified blastic stage
 Mature stage

78. HISTOLOGY

79. DIFFERENTIAL DIAGNOSIS
 Periapical cemental dysplasia
 Enostosis
 Hypercementosis
 Sclerosing osteitis
TREATMENT
 Surgical extraction of involved tooth
 Tumor can be amputated from tooth & tooth endodontically
treated

80.  Pattern of flecks on CEOT
 According to histological criteria by Franklin and Pindborg, scattered
flecks are seen with central radiolucency
 Histopathologically, features of unilocular or multilocular ameloblastoma
are similar.
 Lichen planus of jaw – Odontogenic myxoma ; Traumatic bone cyst

81. Metastasizing malignant ameloblastoma
 Criteria for identifying metastatic diseases of the jaws –
1. Lesion must be a true metastasis localized to bone tissue, as distinguished from direct
invasion by a primary tumour of contiguous structure
2. Lesion must be verified microscopically as carcinoma
3. Primary site of the lesion must be known
 Ameloblastoma – metastasizes in spite of its benign histologic appearance.
 Associated with hypercalcemia
 Age – Third decade (5 - 74 yrs)
 Gender – M : F = 1 : 1.2
 Location : Posterior mandible

82.  Clinical features –
 Paresthesia / anesthesia
 Loosening of teeth
 Periodontal abscess
 Facial paralysis
 Pathologic fracture
 Radiographic features
 Frank destruction of bone without new bone formation
within the lesion or adjacent bone.
 Islands of bone with irregular margins

83. Ameloblastic Carcinoma
 Corio and associates – Any ameloblastoma in which there is histologic evidence
of malignant disease in the primary or recurrent tumour, independent of the
presence of metastasis.
 Most ameloblastic carcinomas presumably arise de novo, and less than 1%
of ameloblastomas undergo malignant transformation.
 Ameloblastic carcinoma, secondary type, is defined as a malignantly
transformed tumor within a pre-existing benign ameloblastoma, regardless of
the presence of metastasis.
Yukio Yoshioka, Shigeaki Toratani, Ikuko Ogawa and Tetsuji Okamoto. Ameloblastic Carcinoma, Secondary Type, of the
Mandible: A Case Report. J Oral Maxillofac Surg 71:e58-e62, 2013.

84. Clinical Features
 Age – 4th decade
 Female : Male - 1 : 2.7
 Swelling (61.5%), bleeding, ulceration and fistula (15.4%).
 Progressive types : cortical bone perforation, soft tissue invasion,
recurrences and metastases.

85. Radiographic Features
 Unilocular or multilocular
 Ragged borders
 Root resorption
 Cortical perforation

86. Histopathology
Kar, et al.:Ameloblastic carcinoma: A clinicopathologic dilemma – Report of two cases with total review of literature from 1984 to
2012. Annals of Maxillofacial Surgery | January - June 2014 | Volume 4 | Issue 1

87. Differential Diagnosis
 Metastatic carcinoma
 Squamous odontogenic tumour

88. TREATMENT
 Radical surgery with neck dissection
 Hemimandibulectomy / maxillectomy
 Postive margins : adjuvant radiotherapy - 5 fractions of 1.8 Gy each for a
period of 5 weeks (45 Gy).

89. Primary Intraosseous Squamous Cell
Carcinoma
WHO defines:
 “ Odontogenic carcinoma consisting of a squamous cell carcinoma arising within
the jaws having no initial connection with the oral mucosa and presumably
developing from residues of the odontogenic epithelium or from an odontogenic
cyst or tumour”.
Elzay 1982:
 Arising from odontogenic cysts
 Arising from ameloblastoma( malignant or AC)
 De novo

90. CLINICAL FEATURES
 Age : 6th and 7th decade
 M : F- 3 : 1
 Location : Posterior mandible
 Tooth mobility
 Paraesthesia
 Regional LN involvement
 Exfoliation
 Non-healing Extraction sockets (50-
60%)
Mitsuyoshi Iino et al. Solid type primary intraosseous squamous cell carcinoma in the maxilla: report of a new
case. Ear, Nose and Throat Disorders 2013, 13:13.

91. Radiographic Features
 Alveolar bone destruction
 Cortical perforations
 Pathologic fractures
 “Floating tooth”
 “ Bays within bays ”
Huang et al.: Primary Intraosseous Squamous Cell Carcinoma. Arch Pathol Lab Med—Vol 133, November 2009

92. HISTOPATHOLOGY

93. Differential diagnosis
 Gingival carcinomas
 Ameloblastic carcinoma

94. Treatment
 Partial or total maxillectomy or mandibulectomy.
 Radiotherapy - Fractionated in seven weeks each session of 50 Gy.
 Adjuvant chemotherapy
 Cisplatin 100 mg/m2 IV or 40-50 mg/m2 IV weekly for 6-7wk.
 Cetuximab 400 mg/m2 IV loading dose 1wk before the start of radiation therapy, then 250
mg/m2 weekly (premedicate with diphenhydramine and ranitidine)
.

95. Clear cell odontogenic carcinoma
 4th and 5th decade
 Mandible : Maxilla- 7 : 1
 M : F – 1 : 1.6
 Mandibular posterior region
 Poorly delineated radiolucency
 Radical resection and follow up
 Recurrence rate - 55%
Niharika Swain, Richa Dhariwal et al. Clear cell odontogenic carcinoma of maxilla : A case report and mini review.
J Oral Maxillofac Pathol. 2013 JanApr; 17(1): 89–94.

96. Ghost cell odontogenic carcinoma
 Gorlin 1962- “Malignant counterpart of calcifying odontogenic cyst”.
 Age – 4th and 5th decade
 Gender – M : F = 2.6 : 1
 Location – Maxilla > Mandible
 Clinical features
 Swelling with or without pain
 Osseous destruction with paresthesia

97.  Radiographic features
 Cortical destruction, obliteration of maxillary sinus
 Ill-defined radiolucency
 Opacification

98. Ameloblastic Fibrosarcoma
 It is a rare malignant neoplasm composed of benign , ameloblastomous
epithelium and malignant ectomesenchyme.
 Represents only 2% of all odontogenic tumors.
 Clinical features
 Pain and swelling
 Ulceration and bleeding
 Paresthesia of lower lip
 2nd decade
 Mandible : Maxilla = 2.3 : 1
 M : F - 2 : 1

99. Radiographic Features
 Ill-defined radiolucency
 Pathological fractures
 Treatment
 Wide local excision
 Partial maxilla or
mandibulectomy
 Post surgical radiotherapy /
chemotherapy
 Recurrence rate - 20%
Daniela Otero Pereira et al. Maxillary Ameloblastic Fibroma: A Case Report . Braz Dent J (2011) 22(2): 171-174

100. Osteosarcoma
 Osteosarcoma - Two types
 An osteoblastic (sclerosing) and
 An osteolytic type.
 Gender : Males > Females
 Age - 33 years (Mean)
 Location : Mandible > Maxilla
 Arise due to –
 Radiation induced
 Trauma

101. Clinical Features
 Pain, swelling, paraesthesia and ulceration.
 Affected teeth may be loosened and displaced
 Age- 4th & 5th decade
 M : F - 1.1 : 1

102. Radiographic Features
 Earliest radiographic sign - widening of the periodontal
ligament space or a radiolucency around one or more teeth.
 Later on, the lesion assumes an osteolytic radiolucent form,
an osteoblastic radiopaque form or a mixed radiolucent
image with radiopaque foci.
 Ill-defined borders.
 Expansion and destruction of the cortical plates.
 Characteristic sunray , sunburst or fan-shaped appearance
- thin spicules of new bone extend outwards away from the
bone cortex.
Chittaranjan B, Tejasvi MA, Babu BB, Geetha P. Intramedullary Osteosarcoma of the
Mandible: A Clinicoradiologic Perspective. J Clin Imaging Sci 2014;4, Suppl S1:6

103. TREATMENT
 The cornerstone of primary jaw osteosarcoma treatment is adequate surgical
resection.
 Radiotherapy or chemotherapy can be used in association with surgical resection
or alone as a palliative treatment in advanced cases.
 Literature review has shown that patients treated initially by aggressive local or
even radical procedures such as hemimandibulectomy fared better.
 Introduction of multi-agent chemotherapy has improved the survival rates, with
60-70% patients surviving after treatment.

104. CHONDROSARCOMA
 Malignant tumor of cartilaginous tissue
 Age : 3rd to 5th decade.
 Gender : Males > females.
 Painless swelling leading to the expansion of the
buccal and lingual cortical plates
 Regional lymphadenopathy is very rare
 Jaw lesions are rare.
 The teeth adjacent to the lesion may be resorbed,
loosened, or exfoliated.
SanChita kundu et al. Clinicopathologic correlation of chondrosarcoma of mandible with a case report. Contemporary Clinical
Dentistry | Oct-Dec 2011 | Vol 2| Issue 4.

105.  Single/ multiple radiolucencies with
poorly defined borders
 Moth-eaten radiolucencies to diffusely
opaque lesions.
 Localized widening of the periodontal
ligament space may be observed.
 In some cases, a sunray appearance
may be seen.

106. TREATMENT
 Wide surgical excision is the mainstay of treatment for
 These tumors are radioresistant and chemotherapy can be used as an adjuvant
therapy after wide surgical excision is made
 Prognosis is poor.
 Local recurrence occurs and may indicate subsequent metastasis; hence
adequate treatment and long-term follow-up, including periodic systemic
evaluation, are required.

107. EWING’S SARCOMA
 Malignant tumor of bone derived from mesenchymal
connective tissue of the bone marrow.
 Rarely occurs in the jaws
 Rapidly growing, highly invasive tumor
 Pain and swelling are the most common manifestations.
 Age : Children ; young adults
 Gender : M : F = 2 : 1

108.  The radiographic appearance is that of an ill-defined destructive
radiolucent lesion which may be unilocular or multilocular.
 Stimulates the periosteum to produce thin layers of bone, resulting in
an "onion skin" effect.
 Advanced cases may exhibit a sunburst appearance.

109.  Chemotherapy, radiation therapy and surgery, has led to an improvement in
prognosis.
 Poor prognostic factors are patients below 10 years of age, presence of
metastasis, presence of systemic symptoms, large tumor volume.
 ES of the mandible has got better prognosis than long bones since facial sites
are diagnosed earlier.
TREATMENT

110. BURKITT'S LYMPHOMA
 Characteristic form of non-Hodgkin's lymphoma that is endemic in Africa and
occurs sporadically in North America.
 The Epstein-Barr virus has been implicated in the etiology.
 Age : Peak : 5 years
 Primarily a tumor of childhood, with occasional cases seen in young adults.
 Location : Maxilla > Mandible.
 Gender : M : F = 2 : 1
Vasudevan V, Mohandas U, Manjunath V. Burkitt's lymphoma in leukemic phase in an Indian boy. Indian J
Dent Res 2011;22:340-4

111.  Clinical features –
 Loosening of teeth
 Bilateral jaw tenderness
 Swollen gingiva
 Cervical lymphadenopathy
 Radiographic features
 Ill defined radiolucency extending into tooth crypt
 Displacement of developing and erupting teeth
 Floating in air appearance
 Sunray spicules

112. TREATMENT
 Good response to chemotherapy, particularly cyclophosphamide.
 The tumor also has been shown to be sensitive to methotrexate, vincristine, and
cytarabine.
 Combinations of drugs have achieved remissions in more than 90% of patients.
Unfortunately, most of the cases recur and patients ultimately succumb to the
disease.
 Recent clinical trials with intensive, multiagent chemotherapeutic protocols have
shown a fair remission rate.
 Individuals who do not receive treatment are not likely to survive longer than 3 to
6 months.