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Benign connective tissue jaw tumors rl
- 1. BENIGN CONNECTIVE TISSUE JAW TUMORS SSEMAGANDA ADDINAN BDS 3
- 2. Over View Introduction Definition Evaluation Clinical examination Distribution Location Surface consistency Radiographical considerations Management
- 3. Introduction Tumors or neoplasms are new growths of abnormal tissue in the body. • They are broadly divided into two groups – benign and malignant. • A benign tumor grows slowly and is usually encapsulated and it enlarges by peripheral expansion, pushes away the adjoining structures and exhibits no metastasis, however it may be locally aggressive.
- 4. Cont… The tissues involved in odontogenesis are; Enamel organ Dental papilla Dental follicle Enamel organ is an epithelial structure derived from oral ectoderm. Dental papilla and dental follicle : they are considered ectomesenchymal in nature because they are derived from neural crest cells.
- 5. Connective tissue Fibrous tissue Adipose tissue Vascular tissue Osseous tissue Cartilage Neural tissue Muscle tissue
- 6. Specific features of benign tumors Grow slowly. Painless. Well circumscribed. Do not metastasize. Compresses surrounding structures without invading. Small size. Secondary changes less often. Resembles tissue of origin. Function is well maintained. Metastasis is absent.
- 7. Radiographic features of benign tumor Periphery & shape: Smooth, well defined & sometimes corticated. Internal structure: Completely radiolucent /radiopaque/both. Effects on surrounding structures Displacement of teeth or bony cortices. The cortex outline is maintained without perforation. Root resorption.
- 8. Oral Fibroma Synonyms: irritation fibroma, focal fibrous hyperplasia. Most common benign soft tissue neoplasm of the oral cavity. Clinical features : May occur at any oral site, most commonly on the buccal mucosa along the plane of occlusion. Appears as an elevated nodule of normal color with a smooth surface, and a sessile or pedunculated base. A well defined, slow growing lesion, most common in the 3rd, 4th, and 5th decades. Females are affected twice more commonly than the males.
- 9. Clinical features Elevated smooth surfaced pink nodule Hyperkeratosis Asymptomatic
- 10. Histologic features: Consists of bundles of interlacing collagen fibers interspersed with varying numbers of fibroblasts and blood vessels. Surface is covered by a layer of stratified squamous epithelium, which frequently appears stretched and shows shortening and flattening of rete pegs. Areas of focal or diffuse calcification or even ossification are found sometimes.
- 11. Histopathology: Pedunculated fibroma Atrophy of the epithelium, PSSE CT gradually blends Collagen bundles – streaming pattern
- 12. Cont… Dense, hyalinized collagen in sclerotic fibroma Hyperkeratosis due to irritation
- 13. Cont… Collagen bundles in whirling pattern with numerous blood capillaries – less inflammatory cell
- 15. Giant Cell Fibroma Clinical Features The giant cell fibroma is typically an asymptomatic sessile or pedunculated nodule, usually less than 1 cm in size. Surface of the mass often appears papillary. Mandibular gingiva is affected twice as often as the maxillary gingiva. The tongue and palate also are common sites.
- 16. Cont…
- 17. Histopathologic Features Mass of vascular fibrous connective tissue, which is usually loosely arranged. Numerous large, stellate fibroblasts within the superficial connective tissue. These cells may contain several nuclei. Frequently, the surface of the lesion is pebbly. The covering epithelium often is thin and atrophic, although the rete ridges may appear narrow and elongated.
- 18. Histopathology: Thin elongated rete ridges Avascular CT Lobulated growth, hyperparakeratinized SSE
- 19. Cont… Mono or multinucleated FibroblastsStellate fibroblasts within the superficial connective tissue
- 20. Treatment and Prognosis The giant cell fibroma is treated by conservative surgical excision. Recurrence is rare.
- 21. Lipoma Rare intraoral tumor though it is common in other areas, esp. subcutaneous tissues of the neck. Benign slow growing neoplasm composed of mature fat cells. Clinical features : Usually found in adults. Intraorally they occur in the tongue, floor of mouth, buccal mucosa and gingiva. Morphologically intraoral lipomas can be classified as diffuse form affecting the deeper tissues, and a superficial& encapsulated form.
- 22. Cont… Superficial form appears as a single or lobulated, sessile or pedunculated, painless lesion. It presents as a yellowish surface discoloration and well encapsulated. It is freely movable beneath the mucosa. Epithelium is usually thin and the superficial blood vessels are readily visible over the surface. When palpated, the diffuse form feels like fluid, sometimes leading to a mistaken diagnosis of ‘cyst’.
- 23. Cont…
- 24. Histologic features: Composed predominantly of mature adipocytes, admixed with collagen streaks, and is often well demarcated from the surrounding c.t. A thin fibrous capsule may be seen and a distinct lobular pattern may be present. When located within striated muscle, this variant is called intramuscular lipoma, but extensive involvement of a wide area of fibrovascular or stromal tissues might best be termed as lipomatosis.
- 25. Cont… Lesions with excessive fibrosis ……….. With excess number of vascular channels ………. With a myxoid background stroma ............. With spindle cells scattered ………….. When spindle cells appear dysplastic or mixed with pleomorphic giant cells ……………………. When spindle cells are of smooth muscle origin ……….
- 26. Types of odontogenic connective jaw tumours Benign connective tissue • Odontogenic fibroma • Odontogenic myxoma • Cementoblastoma Malignant neoplasm • Odontogenic carcinoma • Odontogenic sarcomas Mixed epithelial and connective • Ameloblastic fibroma
- 27. Odontogenic fibroma It’s a rare benign tumour of all age groups mostly between 11 to 39 years. Clinically, it frequently affects the mandible and mostly in females. A slow growing asymptomatic mass which eventually expands the jaw. Radiographically, it appears as a sharply defined rounded lucent area in a toothbearing region.
- 28. Pathology/ histology Consist of spindle-shaped fibroblasts and a bundle of whorled collagen fibres. It may also contain strands of odontogenic epithelium.
- 29. Radiographic features Location: mandible molar-premolar area maxilla anterior to first molar. Periphery: well defined Internal structure: smaller lesions are unilocular larger lesions are multilocular Internal septa may be fine and straight Or it may be granular Lesions are radiolucent and some may have internal calcifications. Effects on surrounding structure: jaw expansion Tooth displacement Root resorption
- 30. Differential diagnosis Desmoplastic fibroma Odontogenic myxoma Giant cell granuloma
- 31. Odontogenic myxoma Odontogenic myxoma are benign, intraosseous neoplasms that arise from Odontogenic ectomesenchyme and resembles mesenchymal portion of the dental papilla. They tend to infiltrate surrounding cancellous bone but do not metastasize.
- 32. Clinical features Age: Between 10 and 30yrs Sex predilection: females clinical presentation: Develops only in the bones of facial skeleton Slow growing may or may not cause pain Swelling Recurrence rate 25% due to lack of encapsulation and its poorly defined boundaries
- 33. Radiograhic features Location: mandible-premolar and molar area Periphery: well defined may have corticated margin Internal structure: it has a mixed radiolucent radiopaque pattern The internal septa are curved and straight giving the tumor multilocular appeareance A straight thin etched septa is a characteristic Feature-tennis Racket Like Or Stepladder Like Pattern Effects on surrounding structure: Displaces and loosens tooth Scalloping between the roots of adjacent teeth.
- 35. Pathology / histology Scanty, spindle-shaped or angular cells with long, fine, anastomosing processes distributed in loose mucoid material. Margins of the tumour are ill defined and peripheral bone is progressively resorbed. A few collagen fibres may also be seen.
- 36. Differential diagnosis Ameloblastoma Central giant cell granuloma Central hemangioma Osteogenic sarcoma Thin but intact outer cortex bone is seen in OM Thin sharp straight septa(tennis racquet) is the differentiating feature of odontogenic myxoma
- 37. Benign cementoblastomas Benign cementoblastomas are slow-growing mesenchymal neoplasms composed primarily of cementum like tissue. The tumor manefests as a bulbous growth around and attached to the apex of a tooth root.
- 38. Clinical features Age: 12 to 25 yrs most common in young patients. Sex predilection: males Clinical presentation: Solitary. Slow growing. Displace teeth; involved tooth is vital and painful.
- 39. Radiographic features Location: mandible-premolar or first molar area. Periphery: well defined with a corticated border surrounding this a well-defined radiolucent band just inside the cortical border. Internal structure: it is a mixed radiolucent-radiopaque lesion where the majority of the internal structure is radiopaque giving a wheel spoke pattern. Surrounding structure: External root resorption Expansion of mandible with intact outer cortex.
- 41. Differential diagnosis Periapical cemental dysplasia Periapical sclerosing osteitis Hypercementosis
- 42. Pathology The mass consists of cementum which often contains many reversal lines, resembling Paget's disease. Cells are enclosed within the cementum, and in the irregular spaces are many osteoclasts and osteoblastlike cells.
- 43. References • Textbook of oral pathology Shafer’s 6th edition. • Cawson R.A Bennie W. H 5th edition. Cawson, Essentials of Oral Pathology and oral medicine, 7th Edition. • Odontogenic tumours and allied lesions Reichart/ Philipsen 1st edition.