ODONTOGENIC TUMOUR CLASSIFICATION OF ODONTOGENIC TUMOR AMELOBLASTOMA ODNTOMA CEMENTOBLASTOMA

1. ODONTOGENIC TUMORS & TUMOR
LIKE LESIONS OF THE JAW
Dr. Haydar Munir Salih Alnamer
BDS, PhD (Board Certified)

2. Definition
• neoplasm is a type of abnormal and excessive growth,
called neoplasia, of tissue. The growth of a neoplasm is
uncoordinated with that of the normal surrounding
tissue, and it persists growing abnormally, even if the
original trigger is removed his abnormal growth usually
(but not always) forms a mass. When it forms a mass, it
may be called a tumor.

3. Neoplasm
• The word is from Ancient Greek neo ("new")
and plasma ("formation", "creation").

4. Important causes of tumors (swellings) of the jaws
• Cysts, predominantly odontogenic cysts
• Odontogenic tumors
• Giant cell lesions
• Fibro-osseous lesions
• Primary (non-odontogenic) neoplasms of bone
Metastatic neoplasms

5. Odontogenic tumour
Odontogenic tumors comprise a complex group of lesions of
diverse histopathologic types and clinical behavior. Some of
these lesions are true neoplasms and may rarely exhibit
malignant behavior. Others may represent tumor-like
malformations (hamartomas)

6. Classification of odontogenic tumors
I. Tumors of odontogenic epithelium
A. Ameloblastoma
1. Malignant ameloblastoma
2. Ameloblastic carcinoma
B. Clear cell odontogenic carcinoma
C. Adenomatoid odontogenic tumor
D. Calcifying epithelial odontogenic tumor
E. Squamous odontogenic tumor

7. Classification of Odontogenic Tumors
II. Mixed odontogenic tumors
A. Ameloblastic fibroma
B. Ameloblasticfibro-odontoma
C. Ameloblastic fibrosarcoma
D. Odontoameloblastoma
E. Compound odontoma
F. Complex odontoma

8. Classification of Odontogenic Tumors
III. Tumors of odontogenic ectomesenchyme
A. Odontogenic fibroma
B. Granular cell odontogenic tumor
C. Odontogenic myxoma
D. Cementoblastoma

9. I. TUMOURS OF ODONTGENIC EPITHELIUM

10. AMELOBLASTOMA
The ameloblastoma is the most common clinically significant
odontogenic tumor.
Ameloblastomas are slow-growing, locally invasive tumors
They occur in 4 different clinic-radiographic situations:
1. Conventional solid or multicystic (about 86% of all cases)
2. Unicystic (about 13% of all cases)
3. Peripheral (extraosseous) (about 1% of all cases)
4. Desmoplastic type

11. AMELOBLASTOMA
• is the second most common odontogenic tumor
• 80% to 85% of conventional ameloblastomas occur in the
mandible
• The most typical radiographic feature is a “soap bubble”
appearance (when the radiolucent loculations are large) or
as being “honeycombed” (when the loculations are small)
• Buccal and lingual cortical expansion is frequently present.
Resorption of the roots of teeth adjacent to the tumor is
common

12. AMELOBLASTOMA

13. Radiographic features
Soap bubbles appearance Honeycombed appearance

14. Treatment
• The conventional ameloblastoma tends to infiltrate between
intact cancellous bone trabeculae at the periphery of the
lesion before bone resorption becomes radiographically
evident. Therefore, the actual margin of the tumor often
extends beyond its apparent radiographic or clinical margin
• Solid/multicystic ameloblastomas should be treated radically
i.e., by resection with a margin of normal tissue around
the tumor. Long-term, even lifelong follow-up is indicated.

15. AMELOBLASTOMA

16. AMELOBLASTOMA
• Ameloblastomas of the posterior maxilla are
particularly dangerous because of the difficulty of
obtaining an adequate surgical margin around the
tumor. Orbital invasion by maxillary ameloblastomas
occasionally has been described

17. AMELOBLASTOMA

18. AMELOBLASTOMA

19. UNICYSTIC AMELOBLASTOMA

20. DESMOPLASTIC AMELOBLASTOMA

21. PRIPHERAL AMELOBLASTOMA

22. CARCINOMA OR CANCER ?
• Cancer has always been with us: dinosaur fossils from
over 60 million years ago show evidence of
malignancy; Egyptian mummies had cancer.

23. CANCER = CRAB

24. AMELOBLASTIC CARCINOMA/ MALIGNANT AMELOBLASTOMA

25. ADENOMATOID ODNTOGENIC TUMORS (AOT)
• largely limited to younger patients
• Females are affected about twice as often as males
• It has a striking tendency to occur in the anterior portions of
the jaws and is found twice as often in the maxilla as in the
mandible
• In about 75% of cases, the tumor appears as a
circumscribed, unilocular radiolucency that involves the
crown of an unerupted tooth, most often a canine
• tumor sometimes extends apically along the root and it it
may contains fine (snowflake) calcifications
• Treatment: enculeation

26. ADENOMATOID ODNTOGENIC TUMORS (AOT)

27. CALCIFYING EPITHELIAL ODNTOGENIC TUMOR (PINDBORG TUMOR)
• uncommon lesion that accounts for less than 1% of all
odontogenic
• found in the mandible, most often in the posterior areas
• unilocular or a multilocular radiolucent The margins of the
lytic defect are often scalloped and usually relatively well
defined
• The lesion may be entirely radiolucent, but the defect usually
contains calcified structures of varying size and density.
• The tumor is frequently associated with an impacted tooth,
most often a mandibular molar. Calcifications are usually
scattered within the tumor.

28. CALCIFYING EPITHELIAL ODNTOGENIC TUMOR (PINDBORG TUMOR)

29. SQUAMOUS ODNTOGENIC TUMOR (SOT)
• Squamous odontogenic tumor is locally aggressive
neoplasm
• Develop in the periodontal ligament between the
roots of vital, erupted permanent teeth. Mobility of
teeth, local pain, swelling of the gums, osseous
expansion, or mild gingival erythema may be observed
• Conservative surgical treatment is considered to be
sufficient. Recurrences are rare.

30. SQUAMOUS ODNTOGENIC TUMOR (SOT)

31. II. MIXED ODNTOGENIC TUMOURS

32. AMELOBLASTIC FIBROMA & AMELOBLASTIC FIBRO-ODNTOMA
• The ameloblastic fibroma is considered to be a true mixed
tumor in which the epithelial and mesenchymal tissues are both
neoplastic
• The posterior mandible is the most common site an unerupted
tooth is associated with the lesion in about 75% of cases
• The ameloblastic fibro-odontoma is defined as a tumor with the
general features of an ameloblastic fibroma but that also
contains enamel and dentin
• the tumor shows a well-circumscribed unilocular or, rarely,
multilocular radiolucent defect that contains a variable amount
of calcified material with the radiodensity of tooth structure.

33. AMELOBLASTIC FIBROMA

34. AMELOBLASTIC FIBRO-ODONTOMA

35. AMELOBLASTIC FIBROSARCOMA

36. ODONTOMA
• Odontomas are the most common types of
odontogenic tumors. Their prevalence exceeds that of
all other odontogenic tumors combined
• Odontomas are considered to be developmental
anomalies (hamartomas), rather than true neoplasms.
When fully developed odontomas consist chiefly of
enamel and dentin, with variable amounts of pulp and
cementum

37. ODONTOMA
• Odontomas are further subdivided into compound and
complex types.
• The compound odontoma is composed of multiple, small
tooth-like structures.
• The complex odontoma consists of a conglomerate mass of
enamel and dentin, which bears no anatomic resemblance
to a tooth. In most series, compound odontomas are more
frequently diagnosed than complex

38. Complex odontoma Compound odontoma

39. ODONTOMA
• Most are detected during the first two decades of life
• the compound type is more often seen in the anterior
maxilla; complex odontomas occur more often in the molar
regions of either jaw
• the compound odontoma appears as a collection of tooth-
like structures of varying size and shape surrounded by a
narrow radiolucent zone. The complex odontoma appears
as a calcified mass with the radiodensity of tooth structure,
which is also surrounded by a narrow radiolucent rim

40. COMPOUND ODNTOMA COMPLEX ODONTOMA

41. ODONTOMA
• An un-erupted tooth is frequently associated with the
odontoma, and the odontoma prevents eruption of the
tooth
• Odontomas may erupt!, displace teeth or block their
eruption or become involved in cyst formation
• Treatment: Odontomas are treated by simple local
excision, and the prognosis is excellent.

42. ERUPTED ODONTOMA

43. ODONTOMA

44. III. TUMORS OF ODONTOGENIC ECTOMESENCHYME

45. MYXOMA
• mandible is involved more commonly than the maxilla
• Larger lesions are often associated with a painless
expansion of the involved bone
• may show a “soap bubble” radiolucent pattern, which
is indistinguishable from that seen in ameloblastoma
• For larger lesions, more extensive resection may be
required because myxomas are not encapsulated and
tend to infiltrate the surrounding bone

46. MYXOMA

47. MYXOMA

48. MYXOMA

49. CEMENTOBLASTOMA
• Cementoblastoma is an odontogenic neoplasm of
cementoblasts
• Almost 50% involve the first permanent molar.
Cementoblastomas rarely affect deciduous teeth
• two thirds of reported patients signs of locally aggressive
behavior may be observed, including bony expansion,
cortical erosion, displacement of adjacent teeth,
envelopment of multiple adjacent teeth, maxillary sinus
involvement, and infiltration into the pulp chamber and root
canals

50. CEMENTOBLASTOMA
• Radiographic features: the tumor appears as a
radiopaque mass that is fused to one or more tooth
roots and is surrounded by a thin radiolucent rim
• Treatment: usually consists of surgical extraction of the
tooth together with the attached calcified mass.

51. CEMENTOBLASTOMA

52. CEMENTOBLASTOMA

53. OTHER TUMOURS AND DYSPLASIAS OF CEMENTUM
• CEMENTO-OSSEOUS DYPLASIAS
These are non-neoplastic proliferations. They are of
periodontal ligament origin and all the variants involve
the same pathological processes and differ mainly in their
extent and radiographic appearances.
Treatment is not indicated except rarely for cosmetic
reasons

54. PERIAPICAL CEMENTAL DYSPLASIA

55. FLORID CEMENTO-OSSOUS DYSPLASIA

56. FOCAL CEMENTO-OSSOUS DYSPLASIA