Odontogenic Tumors Quiz 2

Front 1

Odontogenic Tumors of Epithelial origin

Back 1

Ameloblastoma
Calcifying epithelial odontogenic tumor
Adenomatoid odontogenic tumor
Squamous odontogenic tumor
Clear cell odontogenic tumor

Front 2

Ameloblastoma characteristics, factors, Histology, types

Back 2

Most common odontogenic neoplasm not counting odontoma
- Non inductive
- Often seen with unerupted teeth
- Presents as painless expansion of bone

- Overexpression of Fibroblast growth factor and MMPs 9&20 assist in infiltration into surrounding tissue.

- Palisaded basal cell layer
- Hyperchromatic and reverse polarity Nuclei
- Subnuclear Vacuolization
- Stellate reticulum-like cells
- Subepithelial Hyalinization

- Follicular
- Plexiform
- Acanthomatous
- Granular cell

Front 3

Unicystic Ameloblastoma

Back 3

Ameloblastoma arising in a cyst
- Well circumscribed radiolucency surrounding the crown of an unerupted tooth
- Enucleation and curretage has much lower rate of recurrence than regular ameloblastoma

Luminal - Confined to surface lining of the cystic space
Intraluminal - One or more areas of epithelial lining proliferating into cystic lumen
Mural - Small islands of cells in surrounding FCT wall

Front 4

Desmoplastic Ameloblastoma

Back 4

Mixed radiopaque-radiolucent lesion
- Islands become so compressed that they lose the typical histology of columnar epithelim associated with ameloblastoma

Front 5

Peripheral Ameloblastoma

Back 5

Found on gingiva or alveolar mucosa and does not invade underlying bone
- Local exicision is treatment of choice and not as aggressive as central lesions

Front 6

Conventional/Solid Ameloblastoma treatment

Back 6

Due to high risk of recurrence, most surgeons don't do Enucleation and Curettage

Use resection based on extent of lesion and anatomy of involved bone
- Segmental, Enbloc, Composite/Commando procedure

Long term followup of decades is needed

Front 7

Malignant Ameloblastomas

Back 7

Malignant Ameloblastoma
- Primary lesion with well differentiated benign histology
- Most commonly metastasizes to lung

Ameloblastic carcinoma
- Poorly differentiated hisology and may metastasize

Front 8

CEOT characteristics, histology, treatment

Back 8

Calcifying Epithelial Odontogenic tumor
- Similar presentation to ameloblastoma and also does not have inductive effect
- Also painless slowly expanding swellings that may appear multilocular or unilocular with calcifications
- Often associated with an unerupted tooth

- Cellular and Nuclear PLEOMORPHISM
- AMYLOID-like deposits that stain eosinophilic
- Liesegang rings which are concentric lamellar ring calcifications responsible for radiopacity

- Treat with Enucleation with peripheral ostectomy

Front 9

AOT characteristics, radiology, Histology

Back 9

Adenomatoid odontogenic tumor
- Tumor of 2/3: Females, Maxilla, Anterior jaws, Impacted canine, 2nd decade
- 75% are well circumscribed unilocular lesion associated with an unerupted tooth

- Radiolucency may extend down root of tooth to help differentiate from a dentigerous cyst
- Mixed radiolucent/radiopaque appearance compared to snowflakes

- Well defined fibrous capsule
- Epithelial cells may form duct-like spaces. Not true ducts because they have a blind end - Adenomatoid
- Also contains Amyloid-like material

Front 10

SOT characteristics, radiology, Histology, treatment,

Back 10

Squamous Odontogenic Tumor
- Typically involves alveolar ridge derived from epithelial rests
- Can be multiquadrant 1/4 of the time

- Appears as semilunar radiolucency of alveolar ridge

- Islands of benign looking squamous epithelium mistaken for ameloblastoma and SCC

- Treatment with conservative exicsion. Rare recurrence

Front 11

Tumors of Mesenchymal origin

Back 11

Odontogenic Fibroma
Odontogenic Myxoma
Granular Cell Odontogenic tumor
Cementoblastoma
Cementifying fibroma

Front 12

Central Odontogenic Fibroma characteristics, types, treatment

Back 12

Believed to be the counterpart of peripheral ossifying odontogenic fibroma in soft tissue
- 1/3 associated with unerupted tooth
- Often peri-radicular so can mimic periapical granulomas/cysts
- Well circumscribed but unencapsulated

Simple: Scant odontogenic epithelium
WHO type: Islands of odontogenic epithelium throughout the lesion

- Enuclation with Curettage. Don't recur

Front 13

Microscopic differential diagnosis of Odontogenic fibroma

Back 13

Desmoplastic fibroma - More aggressive
Fibromyxoma - Variant of odontogenic myxoma with abundant collagen
Hyperplastic tooth follicle - Loose immature stroma

Front 14

Odontogenic Myxoma characteristics, radiology, and treatment

Back 14

Arise from tooth follicle or dental papilla
- Mimics histology of pulp

- All radiolucent
- Can see scalloping around the roots of teeth

- Surgical excision
- Because its not encapsulated and is gelatinous, difficult to remove completely and has high recurrence rate

Front 15

Cementoblastoma characteristics, radiology, histology

Back 15

- Benign tumor of Cementoblasts attached to a VITAL tooth root
- Many cases have Pain and Swelling

- Thin radiolucent halo or rim surrounding radiopacity

- Similar histology to Osteoblastoma but is attached to a root

Front 16

Odontogenic Tumors of Mixed origin

Back 16

- Ameloblastic Fibroma/Fibrosarcoma
- Amelobastic Fibro-odontoma
- Odontoma

*- Odontogenic epithelial component causes induction of the mesenchymal tissue produce product

Front 17

AF and AFO characteristics, treatment

Back 17

Ameloblastic Fibroma and Amoloblastic Fibro-Odontoma
- 12yrs mean age associated with unerupted teeth

AF
- Immature mesenchymal stroma with stellate shaped cells in a loose matrix

AFO
- Mixed radiolucent/radiopaque due to formation of odontomas
- Development of enamel and dentin matrix

- Treat with conservative removal. Recurrence is rare

Front 18

Ameloblastic Fibrosarcoma characteristics, histology

Back 18

- 1.5 times more common in males
- Presents with rapid growth with pain

- Ameloblastic epithelium surrounded by Atypical mesenchymal stroma

Front 19

Odontoma characteristics, types

Back 19

Most common odontogenic tumor made of masses of enamel and dentin with some cementum/pulp
- Often associated with an unerupted tooth

Compound: Often Maxillary anterior. Well developed rudimentary tooth forms
Complex: Posterior mandible. Poorly developed masses of calcified deposits

Front 20

Concrescence

Back 20

Fusion of two or more teeth by cementum only
- Mx second and 3rd molars most commonly affected

Front 21

Taurodontism

Back 21

Teeth with elongated crowns and pulp chambers with an increase in occlusal height

Front 22

Dentin Dysplasia Types

Back 22

Type 1:
Rootless teeth due to loss of organization of root dentin
- Presents with tooth mobility

Type II
- Root length is normal
- Pulp stones are common
- Atubular and amorphous dentin

Front 23

Regional Odontodysplasia

Back 23

aka Ghost teeth
- Maxilla 2.5x more likely
- Due to disruption in blood supply so affects several contiguous teeth in an arch
- Thin enamel and dentin surrounding enlarged pulp chambers

Front 24

Cleidocranial dysplasia

Back 24

Lack of clavicle
- Numerous unerupted permanent supernumerary teeth
- Small or absent MX sinuses

Front 25

Crouzon's syndrome

Back 25

Characterized by Craniosyostosis: Premature closure of cranial sutures
- Cloverleaf head associated with PATERNAL age

- Beaten metal apperance
- Underdeveloped maxilla leading to midface hypoplasia
- Expansion of posterior lateral palate causing pseudocleft

Front 26

Apert syndrome

Back 26

Also shows Craniosynostosis like Crouzon's
- Syndactyly of second and fourth digits is common
- Also shows pseudocleft due to expansion of maxillary soft tissue along lateral hard palate

Front 27

Mandibulofacial Dysostosis

Back 27

aka Treacher Collins
- 60% of cases are new mutations
- Hypoplasia of zygomatic arch and some have lateral facial clefting

Front 28

Ectodermal dysplasia

Back 28

Number of teeth markedly reduced and crowns are malformed

Front 29

Obliteration of pulp chamber

Back 29

Dentinogenesis Imperfecta

Dentin dysplasia

Front 30

Malignancy order

Back 30

Amelobastic Carcinoma
Ameloblastoma
CEOT
OKC
AOT/COC
Radicular cyst
Odontoma