Odontogenic tumors iii/certified fixed orthodontic courses by Indian dental academy

ODONTOGENIC TUMORS
INDIAN DENTAL ACADEMY
LEADER IN CONTINUING
DENTAL EDUCATION
www.indiandentalacademy.com

LEARNING OBJECTIVES
At the end of the lecture student should be
able to
 Describe etiology,
 Enlist clinical features,
 Enlist radiological features,
 Enlist histopathological features of
Squamous odontogenic tumor &
Adenomatoid odontogenic tumor

SQUAMOUS
ODONTOGENIC TUMOR
 It is a rare, benign epithelial odontogenic tumor.
 It has occurred over a wide age range, & the
reported incidence peaks in the 3rd decade of
life.
 There is a slight male preponderance,& the
mandible commonly is involved.
 Usually asymptomatic. Maxillary anterior region
& mandibular cuspid molar region
 Radiographically semicircular or triangular
radiolucency

HISTOPATHOLOGY
 Islands of mature squamous
epithelium without peripheral
polarized or columnar cells
 Globular hyaline eosinophilic
structures
 Mature stroma

 Laminar calcifications
 Individual cell keratinization
but no pearl formation
 Microcyst formation

DIFFERENTIAL DIAGNOSIS
 Ameloblastoma
 Squamous cell carcinoma
Treatment
 Enucleation, curettage, local excision
 Rarely recurs

ADENOMATOID
ODONTOGENIC TUMOR
 AOT is a benign, non-neoplastic
(hamartomatous) lesion with slow but
progressive growth.
 Its distinctive, although not pathognomonic,
clinicopathologic profile is unique among
odontogenic tumors because most lesions
occur in association with an unerupted
maxillary cuspid in teenage girls.

HISTORY AND TERMINOLOGY
 The earliest case was reported from Norway
by Harbitz in 1915 as ‘‘adamantoma’’;
however, the case reported by James and
Forbes from England in 1909 as an
‘‘epithelial odontome’’ is almost certainly an
AOT.
 The first acceptable American case was
reported in 1916 as ‘‘tooth germ (or
chorioblastomatous) cyst of the jaw’’ by
Wohl of Omaha, Nebraska.

 Stafne reported it as ‘‘epithelial tumor associated with
developmental cysts of the maxilla’’.
 A list of the discarded terms includes ‘‘cystic complex
composite odontome’’ from England
 ‘‘An unusual pleomorphic adenoma-like tumor in the
wall of a dentigerous cyst’’ from Singapore
 ‘‘Tumor of enamel organ epithelium’’ from London
 ‘‘Adenomatoid ameloblastoma’’ from Japan,
 ‘‘Adenomatoid odontoma’’ from the United States.

 In 1961, Gorlin et al introduced the term
‘‘ameloblastic adenomatoid tumor.’’
 In 1968, Abrams et al suggested consideration of
the term ‘‘odontogenic adenomatoid tumor.’’
 Philipsen and Birn they proposed the name
‘‘adenomatoid odontogenic tumor’’ in 1969.

PATHOGENESIS
 Derived from dental lamina &/ its remnants
 Thoma - In this variant of the adamantoblastoma ‘‘the
epithelium in its differentiation may tend toward
glandular structure and arrangement.
 Bernier and Tiecke-‘‘Adeno-ameloblastoma.’’ &
emphasized the younger average age of affected
patients, the frequent association with impacted teeth,
& the lack of recurrence (with follow-up ranging up to
nearly 15 years)

EPIDEMIOLOGY
 AOT accounts for approximately 3% to 7% making it
the fourth most frequent odontogenic tumor
Demographic features
Age:
 Although AOT has been reported in patients from 3 to
82 years of age, its predilection for young patients is
well-established.
 more than two thirds (69%) are diagnosed between the ages of 10 and
19 years;
 more than half (53%) are diagnosed in teenagers;
 21% are diagnosed between ages 20 and 29;

Gender
 Twice as frequently in women. In the third decade
it is nearly four times more frequent in women
 In patients who are older than age 30 it is
diagnosed nearly twice as commonly in men.
 Female : Male ratio for gingival lesions is 14:1
Race
 Like ameloblastoma, the AOT may be more
common in blacks

CLINICAL FEATURES
 Like most odontogenic tumors, AOT may
occur within the jawbones or the gingiva.
95% of AOTs develop within the maxilla or
mandible.
 Before age 30, nearly twice as many
maxillary lesions are diagnosed, whereas
after age 30, almost twice as many lesions
are diagnosed in the mandible.


 Clinical signs
 Delayed eruption of permanent tooth or slow-
growing bony expansion (with or without
displacement of adjacent teeth)
 Mobility of teeth, swelling of the cheek, and
asymmetrical facial swelling
 Peripheral lesions present as a gingival mass
that ranges from 1 to 1.5 cm
 10 times more prevalent in the maxillary gingiva
than mandibular gingiva

CLINICAL SYMPTOMS
 Usually, AOTs are asymptomatic; however
patients may be aware of a gingival swelling
or an area of jaw enlargement.
 Infection of the tumor or fracture of the
mandible or Nasal obstruction
 Gingival lesions most often are painless.

RADIOGRAPHIC FEATURES
Anatomic site
A significant number of AOTs are discovered
radiographically because more than 95%
occur intraosseously (centrally), usually as
small asymptomatic lesions.
Pericoronal
 About 71% of AOTs are associated with the
crown of an unerupted permanent tooth
 Nearly 60% of AOTs are associated with
cuspids—40% with the maxillary cuspids.
 Rarely with permanent molars & almost
exclusively related to third molars

Extracoronal
 Nearly 30% of the AOTs are not extracoronal & are
located at
 the roots of adjacent or nearby teeth
 lateral or interproximal
 periapical or
 no relationship at all.
 Superimposed on the apex radiographically

RADIOGRAPHIC SIGNS
 A well-demarcated, almost always
unilocular radiolucency that
generally exhibits a smooth
corticated (and sometimes
sclerotic) border.
 Rare, multilocular cases have been
reported with a scalloped border
 Most cases are between 1 & 3 cm
in greatest diameter and are
associated with impacted tooth

 About 65% of cases demonstrate faintly
detectable radiopaque
foci within the radiolucent lesion.
 Divergence of roots & displacement of
teeth occurs more frequently than root
resorption
 Gingival lesions rarely are detectable
radiographically but there may be slight
erosion of the underlying alveolar bone
cortex.

MACROSCOPIC FEATURES
 Reveals a soft, roughly
spherical mass with a
discernible fibrous capsule.
 Intact specimens
demonstrate the crown of a
tooth embedded in the solid
tumor mass or projecting
into a cystic cavity

MICROSCOPIC FEATURES
The tumor is made up of
 A cellular multinodular
proliferation of spindle,
cuboidal, and columnar cells
in a variety of patterns;
 Usually scattered ductlike
structures,
 Eosinophilic material,
 Calcifications in several
forms; and
 A fibrous capsule of variable
thickness.

 Cell-rich nests or nodules that
are composed of spindle to
cuboidal to polygonal epithelial
cells.
 At higher magnification, it is
apparent that some of the cells
are arranged in clusters,
frequently around small foci of
eosinophilic material (so-called
‘‘hyaline droplets’’ or ‘‘tumor
droplets’’)

 Lined by a single layer of cuboidal tcolumnar epithelial cells that
have nuclei that frequently are polarized away from the lumen.
 These ductlike or microcyst lumina frequently are lined by an
eosinophilic rim of varying thickness (the so-called ‘‘hyaline
ring’’)
 Usually, the columnar cells demonstrate clear cytoplasm and
form rosettes as well as linear, curved, convoluted, invaginated,
& occasionally
branching rows of opposing cells.

 A strip or band of noncalcified eosinophilic material
(that resembles the hyaline ring) usually is present
between the opposing rows of columnar cells that also
may demonstrate separations of varying width at
irregular intervals
 Small amounts of eosinophilic material or calcifications
also may be present between these cells

TREATMENT &PROGNOSIS
Enucleation and curettage
 Conservative complete surgical excision—usually
accomplished by enucleation and curettage—is the
treatment of choice.
Growth rate
 Rarely, a period of rapid growth is reported in a lesion
of considerable duration.
Recurrence rate
 Very low to negligible

SUMMARY
 Etiology, Clinical features, Radiological
features,& Histopathological features of
Squamous odontogenic tumor &
Adenomatoid odontogenic tumor

BIBLIOGRAPHY
 Text book of oral pathology Shafer's, 5 & 6th
edition
 Odontogenic Tumors & Allied Lesions
Reichart/ Philipsen Ist edition
 Color Atlas of Oral Diseases Cawson, R.
2nd edition
 Oral and Maxillofacial Pathology Neville,
Brad W. 2nd
 Lucas’s Pathology Of Tumor’s of the Oral
Tissues
 Cawson, R. A., Bennie, W. H 5th edition

Odontogenic tumors iii/certified fixed orthodontic courses by Indian dental academy

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