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Dr. Ali Tahir
Index
4. Odontogenic tumours                      77. Mesenchymal tumours
6. WHO classification                       78. Odontogenic tumours
11. Ameloblastoma                           85. Odontogenic myxoma
45. CEOT                                    90. Cementoblastoma
56. AOT                                     97. Mixed tumours
64. COC (Ghost cell
    tumour)
72. Squamous odontogenic
    tumour

             Dr. Ali Tahir. M.Phil Oral Pathology
Tooth development




       Dr. Ali Tahir. M.Phil Oral Pathology
Odontogenic Tumours
 These tumors are unique to the jaws and originate from
 remnants of epithelium, ectomesenchyme or mesenchyme
 associated with tooth development, the abnormal tissue in
 each of these tumors can often be correlated with similar
 tissue in normal odontogenesis




              Dr. Ali Tahir. M.Phil Oral Pathology
Classification
             ODONTOGENIC
               TUMORS




    BENIGN                                      MALIGNANT

         Dr. Ali Tahir. M.Phil Oral Pathology
WHO CLASSIFICATION
BENIGN ODONTOGENIC TUMORS
  According to the origin classified as:-
    a. EPITHELIAL
    b. MESENCHYMAL
    c. MIXED




               Dr. Ali Tahir. M.Phil Oral Pathology
BENIGN ODONTOGENIC TUMORS
  ODONTOGENIC EPITHELIUM
 1. AMELOBLASTOMA
 2. SQUAMOUS ODONTOGENIC TUMOR
 3. CALCIFYING EPITHELIAL ODONTOGENIC TUMOR
 4. ADENOMATOID ODONTOGENIC TUMOR
 5. KERATOCYSTIC ODONTOGENIC TUMOR




           Dr. Ali Tahir. M.Phil Oral Pathology
BENIGN ODONTOGENIC TUMORS
 ODONTOGENIC MESENCHYME (CONNECTIVE
 TISSUE ONLY)
    1. ODONTOGENIC FIBROM
    2. ODONTOGENIC MYXOMA
    3. BENIGN CEMENTOBLASTOMA.




          Dr. Ali Tahir. M.Phil Oral Pathology
BENIGN ODONTOGENIC TUMORS
 ODONTOGENIC EPITHELIUM WITH
 ODONTOGENIC MESENCHYME (MIXED)
  1. AMELOBLASTIC FIBROMA
  2. AMELOBLASTIC FIBRODENTINOMA
  3. AMELOBLASTIC FIBRO-ODONTOMA
  4. ODONTOAMELOBLASTOMA
  5. ODONTOMA
        ODONTOMA COMPLEX TYPE
        ODONTOMA COMPOUND TYPE
  6. CALCIFYING CYSTIC ODONTOGENIC TUMOR
   7. ODONTOGENIC GHOST CELL TUMOR

          Dr. Ali Tahir. M.Phil Oral Pathology
MALIGNANT ODONTOGENIC TUMORS
ODONTOGENIC CARCINOMAS
1. MALIGNANT AMELOBLASTOMA
 2. AMELOBLASTIC CARCINOMA
3. PRIMARY INTRAOSSEUS CARCINOMA
4. PRIMARY INTRAOSSEUS CARCINOMA
DERIVED FROM ODONTOGENIC
TUMOR/CYSTS
5. CLEAR CELL ODONTOGENIC CARCINOMA
6. GHOST CELL ODONTOGENIC CARCINOMA

       Dr. Ali Tahir. M.Phil Oral Pathology
MALIGNANT ODONTOGENIC TUMORS
ODONTOGENIC SARCOMAS


1. AMELOBLASTIC FIBROSARCOMA
2. AMELOBLASTIC FIBRODENTINO AND
FIBRO- ODONTOSARCOMA.




       Dr. Ali Tahir. M.Phil Oral Pathology
Dr. Ali Tahir. M.Phil Oral Pathology
Ameloblastoma
 Ameloblastoma is a locally aggressive, epithelial benign
  odontogenic neoplasm having a close resemblance to the
  enamel organ
 Most common odontogenic tumour in our region




                Dr. Ali Tahir. M.Phil Oral Pathology
POSSIBLE EPITHELIAL SOURCES OF
       AMELOBLASTOMA           Cystic lining of odontogenic
                                                           cysts e.g.Dentigerous cyst
Surface      Reduced
epithelium   enamel
             epithelium
                                 remnants of dental
                                 lamina




                                                Rests of malassez

                    Dr. Ali Tahir. M.Phil Oral Pathology
TYPES OF AMELOBLASTOMA
It may present clinico-radiographically as:-
1. Central (Intraosseous)
     I.     Conventional, solid or multicystic (about 86% of all
            cases).
     II.    Unicystic (about 13% of all cases)
2.        Peripheral (extraosseuos) about 1% of all cases.




                    Dr. Ali Tahir. M.Phil Oral Pathology
Multicystic                                    Unicystic




                                              Peripheral
                                              (extraosseous)
       Dr. Ali Tahir. M.Phil Oral Pathology
COMMON OR MULTICYSTIC OR SOLID AMELOBLASTOMA
(INTRAOSSEOUS)
 This is also referred to as Simple or Follicular or True
  ameloblastoma.
 Most common type.
 Occurs usually 20 to 40 years of age.
 Usually originate de novo, but may evolve from
  unicystic or peripheral subtypes




               Dr. Ali Tahir. M.Phil Oral Pathology
Clinical features
 May produce extensive,
  even grotesque
  deformities of jaws.
 More common in
  mandible (80% of all
  cases) than maxilla.
 Generally asymptomatic
 Can cause pain and
  paresthesia when gets
  infected.
              Dr. Ali Tahir. M.Phil Oral Pathology
Dr. Ali Tahir. M.Phil Oral Pathology
Clinical features
 Eggshell cracking:-
 It has tendency to
 expand the boney
 cortices as their slow
 growth results in a thin
 shell of bone and it
 cracks easily when
 palpated--- a diagnostic
 sign.


               Dr. Ali Tahir. M.Phil Oral Pathology
Radiographically
 These lesions usually
  give MULTILOCLATION
  (boney compartments)
  appear as “SOAP
  BUBBLE” or “HONEY
  COMB”
 In rapidly growing
  lesions roots may be
  resorbed


              Dr. Ali Tahir. M.Phil Oral Pathology
Ameloblastoma
Honey comb appearance




                        Dr. Ali Tahir. M.Phil Oral Pathology
HISTOPATHOLOGY
It has following histological variants
 Folicular ameloblastoma
 Plexiform ameloblastom
 Basal ameloblastom
 Granular cell ameloblastom
 Acanthomatous ameloblastom
 Desmoplastic ameloblastom
Common to all is the presence of neoplastic ameloblasts
 with palisaded appearance and reverse polarisation

              Dr. Ali Tahir. M.Phil Oral Pathology
Follicular variant
 Islands or follicles of epithelial cells composed
  centrally of loosely arranged stellate cells with
  columnar ameloblast-like cells at the periphery.
  These islands resemble the enamel organ seen
  during normal tooth development
 Cystic change may be seen within the follicles or in
  the stroma



              Dr. Ali Tahir. M.Phil Oral Pathology
Follicular variant




         Dr. Ali Tahir. M.Phil Oral Pathology
Plexiform variant
 Long anastomosing cords
  or large sheets of
  odontogenic epithelium
  which may lack reverse
  polarization & may not
  resemble any stage of
  odontogenesis
 Also called “Fishnet
  Pattern”
 Cystic change is
  uncommon, if present it is
  found in the stroma

               Dr. Ali Tahir. M.Phil Oral Pathology
Acanthomatous variant
 When extensive
  squamous metaplasia
  often associated with
  keratin formation
  occurs in the central
  portions of the epithelial
  islands of a follicular
  ameloblastoma
 May be confused with
  SCC

               Dr. Ali Tahir. M.Phil Oral Pathology
Desmoplastic ameloblastoma
 Small islands and cords of
  odontogenic epithelium in
  a densely collagenized
  stroma
 More common in anterior
  jaws
 Radiographically
  resembles a fibro-osseous
  lesion
 Clinically more aggressive
  & more recurrence
                Dr. Ali Tahir. M.Phil Oral Pathology
Granular Cell Variant
 Shows cells with
  abundant cystoplasm
  filled with eosinophilic
  granules
 Clinically aggressive




               Dr. Ali Tahir. M.Phil Oral Pathology
Basal Cell Variant
 Least common type
 Nests of basaloid cells &
  histologically resembles
  a BCC of skin
 No stellate reticulum can
  be appreciated




               Dr. Ali Tahir. M.Phil Oral Pathology
Treatment
 Treatments have ranged from
  simple enucleation and
  curettage to en bloc
  resection.
 Marginal resection is the
  most widely used method of
  treatment with the least
  recurrences reported (up to 15
  %).
 Most surgeons advocate a
  margin of at least 1.0 cm
  beyond the radiographic
  limits of the tumor as the
  tumor often extends beyond
  the apparent
  radiologic/clinical margins


                 Dr. Ali Tahir. M.Phil Oral Pathology
UNICYSTIC AMELOBLASTOMA
 A biological subtype of ameloblastoma that is
    predominantly cystic has been referred to as the unicystic
    or cystic ameloblastoma
   Usually arises in a Dentigerous cyst
   Can be associated with impacted molar
   Usually occurs at 16 to 20 years
   More in mandible (90%)than maxilla




                  Dr. Ali Tahir. M.Phil Oral Pathology
Radiographically
 Well demarcated unilocular lesion
 May be corticated
 Impacted tooth may be present
 Roots may be displaced in premolar region.




                 Dr. Ali Tahir. M.Phil Oral Pathology
Histology
 Dense uniform fibrous connective tissue
 Fluid filled lumen
 Lining made up of hyperchromatic, palisaded basal
  cells showing reverse polarization
 Rest of the layers resemble stellate reticulum




               Dr. Ali Tahir. M.Phil Oral Pathology
Types of Unicystic Ameloblastoma
 Intra-luminal U.A.
 Mural U.A.
 Plexiform U




                Dr. Ali Tahir. M.Phil Oral Pathology
Dr. Ali Tahir. M.Phil Oral Pathology
Peripheral Ameloblastoma
 These tumors are extraosseous and therefore occupy
  the lamina propria underneath the surface epithelium
  but outside of the bone
 Histologically, these lesions have the same features as
  the intraosseous forms of the tumor.




               Dr. Ali Tahir. M.Phil Oral Pathology
Clinical Features
 Patient Age: Wide age
    range but most occur
    during middle-age
   Location: Posterior
    gingival/alveolar mucosa is
    involved most frequently.
   Firm, sessile nodule
   Normal coloration, if arises
    from surface epith, may be
    ulcerated
   Slight predilection for the
    mandible. The buccal
    mucosa has been the site
    in a few reported cases.
                  Dr. Ali Tahir. M.Phil Oral Pathology
Peripheral Ameloblastoma
 Radiographically:
    A few cases have shown superficial erosion of alveolar
     bone
 Histologic Appearance:
    Islands of ameloblastic epithelium are observed in the
     lamina propria; follicular patterns are the most
     common; acanthomatous pattern may be seen
    In 50 % of the cases the tumor connects with the basal
     cell layer of the surface epithelium


                Dr. Ali Tahir. M.Phil Oral Pathology

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Odontogenic tumours part 1

  • 2. Index 4. Odontogenic tumours 77. Mesenchymal tumours 6. WHO classification 78. Odontogenic tumours 11. Ameloblastoma 85. Odontogenic myxoma 45. CEOT 90. Cementoblastoma 56. AOT 97. Mixed tumours 64. COC (Ghost cell tumour) 72. Squamous odontogenic tumour Dr. Ali Tahir. M.Phil Oral Pathology
  • 3. Tooth development Dr. Ali Tahir. M.Phil Oral Pathology
  • 4. Odontogenic Tumours These tumors are unique to the jaws and originate from remnants of epithelium, ectomesenchyme or mesenchyme associated with tooth development, the abnormal tissue in each of these tumors can often be correlated with similar tissue in normal odontogenesis Dr. Ali Tahir. M.Phil Oral Pathology
  • 5. Classification ODONTOGENIC TUMORS BENIGN MALIGNANT Dr. Ali Tahir. M.Phil Oral Pathology
  • 6. WHO CLASSIFICATION BENIGN ODONTOGENIC TUMORS According to the origin classified as:- a. EPITHELIAL b. MESENCHYMAL c. MIXED Dr. Ali Tahir. M.Phil Oral Pathology
  • 7. BENIGN ODONTOGENIC TUMORS ODONTOGENIC EPITHELIUM 1. AMELOBLASTOMA 2. SQUAMOUS ODONTOGENIC TUMOR 3. CALCIFYING EPITHELIAL ODONTOGENIC TUMOR 4. ADENOMATOID ODONTOGENIC TUMOR 5. KERATOCYSTIC ODONTOGENIC TUMOR Dr. Ali Tahir. M.Phil Oral Pathology
  • 8. BENIGN ODONTOGENIC TUMORS ODONTOGENIC MESENCHYME (CONNECTIVE TISSUE ONLY) 1. ODONTOGENIC FIBROM 2. ODONTOGENIC MYXOMA 3. BENIGN CEMENTOBLASTOMA. Dr. Ali Tahir. M.Phil Oral Pathology
  • 9. BENIGN ODONTOGENIC TUMORS ODONTOGENIC EPITHELIUM WITH ODONTOGENIC MESENCHYME (MIXED) 1. AMELOBLASTIC FIBROMA 2. AMELOBLASTIC FIBRODENTINOMA 3. AMELOBLASTIC FIBRO-ODONTOMA 4. ODONTOAMELOBLASTOMA 5. ODONTOMA ODONTOMA COMPLEX TYPE ODONTOMA COMPOUND TYPE 6. CALCIFYING CYSTIC ODONTOGENIC TUMOR 7. ODONTOGENIC GHOST CELL TUMOR Dr. Ali Tahir. M.Phil Oral Pathology
  • 10. MALIGNANT ODONTOGENIC TUMORS ODONTOGENIC CARCINOMAS 1. MALIGNANT AMELOBLASTOMA 2. AMELOBLASTIC CARCINOMA 3. PRIMARY INTRAOSSEUS CARCINOMA 4. PRIMARY INTRAOSSEUS CARCINOMA DERIVED FROM ODONTOGENIC TUMOR/CYSTS 5. CLEAR CELL ODONTOGENIC CARCINOMA 6. GHOST CELL ODONTOGENIC CARCINOMA Dr. Ali Tahir. M.Phil Oral Pathology
  • 11. MALIGNANT ODONTOGENIC TUMORS ODONTOGENIC SARCOMAS 1. AMELOBLASTIC FIBROSARCOMA 2. AMELOBLASTIC FIBRODENTINO AND FIBRO- ODONTOSARCOMA. Dr. Ali Tahir. M.Phil Oral Pathology
  • 12. Dr. Ali Tahir. M.Phil Oral Pathology
  • 13. Ameloblastoma  Ameloblastoma is a locally aggressive, epithelial benign odontogenic neoplasm having a close resemblance to the enamel organ  Most common odontogenic tumour in our region Dr. Ali Tahir. M.Phil Oral Pathology
  • 14. POSSIBLE EPITHELIAL SOURCES OF AMELOBLASTOMA Cystic lining of odontogenic cysts e.g.Dentigerous cyst Surface Reduced epithelium enamel epithelium remnants of dental lamina Rests of malassez Dr. Ali Tahir. M.Phil Oral Pathology
  • 15. TYPES OF AMELOBLASTOMA It may present clinico-radiographically as:- 1. Central (Intraosseous) I. Conventional, solid or multicystic (about 86% of all cases). II. Unicystic (about 13% of all cases) 2. Peripheral (extraosseuos) about 1% of all cases. Dr. Ali Tahir. M.Phil Oral Pathology
  • 16. Multicystic Unicystic Peripheral (extraosseous) Dr. Ali Tahir. M.Phil Oral Pathology
  • 17. COMMON OR MULTICYSTIC OR SOLID AMELOBLASTOMA (INTRAOSSEOUS)  This is also referred to as Simple or Follicular or True ameloblastoma.  Most common type.  Occurs usually 20 to 40 years of age.  Usually originate de novo, but may evolve from unicystic or peripheral subtypes Dr. Ali Tahir. M.Phil Oral Pathology
  • 18. Clinical features  May produce extensive, even grotesque deformities of jaws.  More common in mandible (80% of all cases) than maxilla.  Generally asymptomatic  Can cause pain and paresthesia when gets infected. Dr. Ali Tahir. M.Phil Oral Pathology
  • 19. Dr. Ali Tahir. M.Phil Oral Pathology
  • 20. Clinical features  Eggshell cracking:- It has tendency to expand the boney cortices as their slow growth results in a thin shell of bone and it cracks easily when palpated--- a diagnostic sign. Dr. Ali Tahir. M.Phil Oral Pathology
  • 21. Radiographically  These lesions usually give MULTILOCLATION (boney compartments) appear as “SOAP BUBBLE” or “HONEY COMB”  In rapidly growing lesions roots may be resorbed Dr. Ali Tahir. M.Phil Oral Pathology
  • 22. Ameloblastoma Honey comb appearance Dr. Ali Tahir. M.Phil Oral Pathology
  • 23. HISTOPATHOLOGY It has following histological variants  Folicular ameloblastoma  Plexiform ameloblastom  Basal ameloblastom  Granular cell ameloblastom  Acanthomatous ameloblastom  Desmoplastic ameloblastom Common to all is the presence of neoplastic ameloblasts with palisaded appearance and reverse polarisation Dr. Ali Tahir. M.Phil Oral Pathology
  • 24. Follicular variant  Islands or follicles of epithelial cells composed centrally of loosely arranged stellate cells with columnar ameloblast-like cells at the periphery. These islands resemble the enamel organ seen during normal tooth development  Cystic change may be seen within the follicles or in the stroma Dr. Ali Tahir. M.Phil Oral Pathology
  • 25. Follicular variant Dr. Ali Tahir. M.Phil Oral Pathology
  • 26. Plexiform variant  Long anastomosing cords or large sheets of odontogenic epithelium which may lack reverse polarization & may not resemble any stage of odontogenesis  Also called “Fishnet Pattern”  Cystic change is uncommon, if present it is found in the stroma Dr. Ali Tahir. M.Phil Oral Pathology
  • 27. Acanthomatous variant  When extensive squamous metaplasia often associated with keratin formation occurs in the central portions of the epithelial islands of a follicular ameloblastoma  May be confused with SCC Dr. Ali Tahir. M.Phil Oral Pathology
  • 28. Desmoplastic ameloblastoma  Small islands and cords of odontogenic epithelium in a densely collagenized stroma  More common in anterior jaws  Radiographically resembles a fibro-osseous lesion  Clinically more aggressive & more recurrence Dr. Ali Tahir. M.Phil Oral Pathology
  • 29. Granular Cell Variant  Shows cells with abundant cystoplasm filled with eosinophilic granules  Clinically aggressive Dr. Ali Tahir. M.Phil Oral Pathology
  • 30. Basal Cell Variant  Least common type  Nests of basaloid cells & histologically resembles a BCC of skin  No stellate reticulum can be appreciated Dr. Ali Tahir. M.Phil Oral Pathology
  • 31. Treatment  Treatments have ranged from simple enucleation and curettage to en bloc resection.  Marginal resection is the most widely used method of treatment with the least recurrences reported (up to 15 %).  Most surgeons advocate a margin of at least 1.0 cm beyond the radiographic limits of the tumor as the tumor often extends beyond the apparent radiologic/clinical margins Dr. Ali Tahir. M.Phil Oral Pathology
  • 32. UNICYSTIC AMELOBLASTOMA  A biological subtype of ameloblastoma that is predominantly cystic has been referred to as the unicystic or cystic ameloblastoma  Usually arises in a Dentigerous cyst  Can be associated with impacted molar  Usually occurs at 16 to 20 years  More in mandible (90%)than maxilla Dr. Ali Tahir. M.Phil Oral Pathology
  • 33. Radiographically  Well demarcated unilocular lesion  May be corticated  Impacted tooth may be present  Roots may be displaced in premolar region. Dr. Ali Tahir. M.Phil Oral Pathology
  • 34. Histology  Dense uniform fibrous connective tissue  Fluid filled lumen  Lining made up of hyperchromatic, palisaded basal cells showing reverse polarization  Rest of the layers resemble stellate reticulum Dr. Ali Tahir. M.Phil Oral Pathology
  • 35. Types of Unicystic Ameloblastoma  Intra-luminal U.A.  Mural U.A.  Plexiform U Dr. Ali Tahir. M.Phil Oral Pathology
  • 36. Dr. Ali Tahir. M.Phil Oral Pathology
  • 37. Peripheral Ameloblastoma  These tumors are extraosseous and therefore occupy the lamina propria underneath the surface epithelium but outside of the bone  Histologically, these lesions have the same features as the intraosseous forms of the tumor. Dr. Ali Tahir. M.Phil Oral Pathology
  • 38. Clinical Features  Patient Age: Wide age range but most occur during middle-age  Location: Posterior gingival/alveolar mucosa is involved most frequently.  Firm, sessile nodule  Normal coloration, if arises from surface epith, may be ulcerated  Slight predilection for the mandible. The buccal mucosa has been the site in a few reported cases. Dr. Ali Tahir. M.Phil Oral Pathology
  • 39. Peripheral Ameloblastoma  Radiographically:  A few cases have shown superficial erosion of alveolar bone  Histologic Appearance:  Islands of ameloblastic epithelium are observed in the lamina propria; follicular patterns are the most common; acanthomatous pattern may be seen  In 50 % of the cases the tumor connects with the basal cell layer of the surface epithelium Dr. Ali Tahir. M.Phil Oral Pathology