Oral Pathology Exam 4 Odontogenic Tumors

Front 1

Some odontogenic tumor lesions are not true neoplasms. Instead they are tumor-like developmental malformations known as what?

Back 1

Hamartomas

Front 2

"Odontogenic tumors" are defined as: a complex group of lesions of diverse histopathologic types and clinical behaviors. Some are true neoplasms while others are tumor-like developmental malformations (hamartomas). T/F?

Back 2

T

Front 3

What are the 3 histologic classifications of Odontogenic Tumors?

Back 3

1. Epithelial Odontogenic Tumors
2. Mixed Odontogenic Tumors
3. Mesenchymal Odontogenic Tumors

Front 4

Epithelial Odontogenic Tumors are composed of cells with characteristics of Odontogenic Epithelium. Tumors show no participation of odontogenic ectomesenchyme. What are some examples?

Back 4

1. Ameloblastoma
2. Adenomatoid Odontogenic Tumor
3. Calcifying Epithelial Odontogenic Tumor
4. Squamous Odontogenic Tumor
5. Clear Cell Odontogenic Carcinoma

Front 5

Mixed Odontogenic Tumors are composed of 2 populations of cells- one derived from odontogenic epithelium and one derived from odontogenic ectomesenchyme. Dental hard tissue may or may not be formed in these lesions. What are 4 examples?

Back 5

1. Ameloblastic Fibroma
2. Compound Odontoma
3. Complex Odontoma
4. Ameloblastic Fibro-Odentoma

Front 6

Mesenchymal Odontogenic Tumors are composed of cells with characteristics of Odontogenic Ectomesenchyme. Odontogenic epithelium may be induced within these lesions, but it does not play any essential role in their pathogenesis. What are 3 examples?

Back 6

1. Myxoma
2. Cementoblastoma
3. Odontogenic Fibroma

Front 7

T/F- Odontogenic epithelium may be induced within Mesenchymal Odontogenic tumors even if they are not mixed.

Back 7

True- Odontogenic epithelium may be induced within Mesenchymal Odontogenic Tumors but it doesn't play any essential role in the pathogenesis.

Front 8

What are the 4 classification systems based on Biologic Behavior?

Back 8

1. Innocuous "Tumors"
2. Benign Tumor
3. Benign Aggressive Tumors
4. Malignant Tumors

Front 9

Innocuous "tumors" aren't harmful. An example would be an Odontoma. T/F?

Back 9

True- Innocuous "tumors" = once formed, these lesions are self-limiting and have no significant potential for further growth, impingement on vital structures or invasion of surrounding tissue!

Front 10

I am a classification system based on biologic behavior - once formed, these lesions are self-limiting and have no significant potential for further growth, impingement on vital structures or invasion of surrounding tissue. What I am?

Back 10

Innocuous "Tumor"

Front 11

Benign Tumors grow slowly by expansion and do not metastasize. Do most odontogenic tumors fall into this category?

Back 11

Yes- Most Odontogenic tumors are Benign Tumors!

Front 12

I am a classification system based on biological behavior- I grow slowly by expansion and don't metastasize. Most of my homies are Odontogenic tumors. Which classification system am I?

Back 12

Benign Tumor

Front 13

Benign Aggressive Tumors do not metastasize but may infiltrate surrounding tissues or be locally destructive. They may cause disfigurement, severe illness or death due to impingement on vital structures. Their growth rate is slow to moderately rapid. What's an example?

Back 13

Conventional Ameloblastoma.

Front 14

I am classification system based on Biological Behavior that describes a conventional Ameloblastoma. I- do not metastasize but may infiltrate surrounding tissues or be locally destructive. They may cause disfigurement, severe illness or death due to impingement on vital structures. Their growth rate is slow to moderately rapid. Which classification am I?

Back 14

Benign Aggressive Tumors

Front 15

Conventional Ameloblastoma is often a Benign Tumor. T/F?

Back 15

False- Conventional Ameloblastoma is a Benign Aggressive tumor

Front 16

Malignant tumors invade and destroy surrounding tissue. It is capable of metastasis and grwoth rate is usually rapid. What's an example?

Back 16

Clear Cell Odontogenic Carcinoma

Front 17

Clear cell odontogenic carcinoma is an example of what type of classification system based on biological behavior?

Back 17

Malignant Tumor

Front 18

Keratocystic odontogenic Tumor was previously known as what?

Back 18

Odontogenic Keratocyst- this happened in the most recent WHO classification of odontogenic cysts and tumors in 2005. It was long recognized as the most aggressive of the odontogenic cysts. Both old and new terms are in common usage.

Front 19

Keratocystic Odontogenic Tumors occur over a wide range. 60% of cases occur btwn ages ___ and ___ yrs.

Back 19

10 and 40 years.

Front 20

Keratocysitc odontogenic Tumor's site of predilection may occur anywhere in the mandible or maxilla, but it is more common in the ________; more common in _______ jaws.

Back 20

Keratocystic odontogenic tumor is more common in the mandible; more common in the posterior jaws.

Front 21

50% of Keratocystic odontogenic tumors are symptomatic. T/F? What are the symptoms?

Back 21

True- 50% of Keratocystic odontogenic Tumors are symptomatic! Symptoms include:
1. Pain
2. Bone or Soft Tissue Swelling
3. Drainage
4. Paresthesia
-may be large without producing bone expansion (tends to grow in anterior-posterior direction within the meduallary cavity of the bone without causing obvious bone expansion)

Front 22

Obvoius bony expansion is often seen in Keratocystic Odontogenic Tumors. T/F?

Back 22

False- Obvious bony expansion is often NOT seen in Keratocystic odontogenic Tumors which tend to grow in anterior-posterior direction within the medullary cavity of the bone.

Front 23

If you see multiple Keratocystic Odontogenic Tumors which Syndrome would you think of?

Back 23

Nevoid Basal Cell Carcinoma (Gorlin) Syndrome.

Front 24

Nevoid Basal Cell Carcinoma (Gorlin) Syndrome occurs when there are multiple tumors of which kind?

Back 24

Keratocystic Odontogenic tumors

Front 25

A well-defined lucency which may be solitary or multiple (for multiple lesions-must consider possibility of syndrome). Usually is unilocular when small, but may become multilocular when larger. If multilocular, the loculations are BIG. Typically has a corticaded border and may/not be associated with an unerupted tooth (25-50% cases). May displace teeth and resorb roots. This is a radiographic features of what? (hint: syndrome to think of is Gorlin syndrome)

Back 25

Keratocystic Odontogenic tumor

Front 26

Histological features seen on a slide include:
1. Sac with thin, uniform cuboidal to squamous epithelial lining (up to 8 cells thick)
2. Basal epithelial cells are cuboidal to columnar, with deply basophilic nuclei. Reverse polarization (palisading) of basal cells is excepted.
3. Luminal surface is Corrugated, with a thin layer of surface parakeratin.
4 Fibrous capsule is quite thin and may contain small "satellite" cysts.
What tumor am I?

Back 26

Keratocystic odontogenic tumor

Front 27

Surgical excision is not necessary for the Keratocystic Odontogenic Tumor because of the thin capsule. T/F?

Back 27

false- surgical excision is NECESSARY!

Front 28

Which is method of choice for Keratocystic Odontogenic Tumor- Enucleation, Curretage, En Block, radical excision?

Back 28

En block excision is preferred (esp for large or multilocular lesions) because of the thin capsule and enucleation and curretage is not prevered.

Front 29

Is there a significang recurrence rate for the Keratocystic Odontogenic tumor? What % is reported? What does risk usually depend on?

Back 29

Keratocystic Odontogenic Tumor has a HIGH significant recurrence rate.
25-60% reported.
Risk = depends greately on type (adequacy) of initial therapy. Pts require long-term radiographic follow up bc of tendency for LATE recurrence.

Front 30

Late recurrence is associated with which tumor? Normal recurrence rate is 25-60%.

Back 30

Kreatocystic Odontogenic Tumor

Front 31

What is the most common clinically significant Odontogenic tumor?

Back 31

Ameloblastoma!

Front 32

Ameloblastoma is the most common clinically significant odontogenic tumor. T/F?

Back 32

True!

Front 33

What are the 3 types of Ameloblastomas? and what are their %?

Back 33

1. Common (Solid, Infiltrating, Multicystic, Conventional) Ameloblastoma - 86%
2. Unicystic Ameloblastoma- 13%
3. Peripheral Ameloblastoma- 1%

Front 34

This type of ameloblastoma occurs over a wide age range- it's rare before age 10; uncommon btwn ages 10-19 yrs. Nearly equal prevalence in the 3rd to 7th decades. But most occur AFTER 30 yrs of age. Which type is it?

Back 34

Conventional Ameloblastoma.

Front 35

There is a female predilection for Infiltrating Ameloblastomas. T/F?

Back 35

False- no gender preferance.

Front 36

What is the racial predilection for Infiltrating Ameloblastomas?

Back 36

Prob no racial predelection but may be more common in blacks.

Front 37

Site predilection for Infiltrating Ameloblastomas are?

Back 37

1. Mandible is 80-85%, most often in the Molar-Ascending Ramus area
2. Maxilla is 15-20%, usually in the posterior region.

Front 38

If an infiltrating ameloblastoma was to occur in the mandible (80-85% of the time it does), what part of hte mandible would it prefer?

Back 38

The molar- ascending Ramus area of hte mandible

Front 39

If an infiltrationg ameloblastoma occured in the maxilla, what part would it happen in?

Back 39

the posterior part of the maxilla

Front 40

Infiltrating ameloblastoma is more likely to be multilocular even if it is pretty small. Cysts don't get multilocular when they are small. T/F?

Back 40

True

Front 41

Infiltrating Ameloblastomas will make dentin, enamel, soft tissue or tooth material in mature stages. T/F?

Back 41

False- infiltrating ameloblastomas are PURE epitheial neoplasms and won't make those things.

Front 42

radiographic features include:
1. Multilocular pure radiolucency- classical
2. May expand buccal and/or Lingual cortices
3. Root resorption is common
4. Often associated with an unerupted tooth
5. May be unilocular, if so- borders may show irregular scalloping
6. Considered to be a pure radiolucency- the tin opaque lines that separate the loculations are residual host bone and are not made by the tumor.
What type of Ameloblastoma is this?

Back 42

Infiltrating

Front 43

Infiltrating Ameloblastomas have a Histologic Feature of-
1. Nests of Odontogenic epithelium have a central core that resembles __________ ________ and a rim of Columnar Ameloblasts
2. Epthelial nests are separated by modest amount of ___________ CT stroma.

Back 43

Nests of Odontogenic epithelium have a central core that resembles STELLATE RETICULUM and a rim of Columnar Ameloblasts
2. Epthelial nests are separated by modest amount of FIBROUS CT stroma.

Front 44

Are Infiltrating Ameloblastomas encapsulated?

Back 44

No- thus they infiltrate into surroudning trabecular bony tissue!

Front 45

Numerous histologic subtypes of Conventional Ameloblastomas exist but are of little clinical significance - they don't indicate differences in behavior. T/F?

Back 45

T

Front 46

What Tx is widely used for Infiltrating Ameloblastoma?

Back 46

Marginal or En Bloc Resection- with a minimum of 1.5 cm border of normal tissue beyond radiographic margin of lesion.

Front 47

Marginal or En Bloc Resection- with a minimum of _____ cm border of normal tissue beyond radiographic margin of lesion.

Back 47

1.5 cm

Front 48

Inferior border of the mandible can be saved in many cases of Infiltrating Ameloblastomas. T/F?

Back 48

true

Front 49

Larger lesions may require Segmental Resection or hemimandibulectomy for infiltrating ameloblastomas. T/F?

Back 49

true

Front 50

Curettage of Infiltrating Ameloblastomas result in a reccurence rate of how much? (with many Late recurrences)

Back 50

50-90% recurrence rate for Infiltrating ameloblastomas

Front 51

Marginal/En block resection may have up to ___ % recurrence rate, while curettage has ____ % recurrence rate for Conventional Ameloblastomas

Back 51

15% for en bloc
50-90% for curretage

Front 52

A large infiltrating tumor will impinge on vital structure, causing death. This is a very common case. T/F?

Back 52

False- rarely will a large tumor impinge on vital structures causing death.

Front 53

Will Unicystic Ameloblastoma progress over time to Infiltrating Ameloblastoma?

Back 53

No- it will stay a unicystic ameloblastoma

Front 54

Unicystic ameloblastoma is a distinct clinicopathologic entity, lacking the aggressive behavior of its infiltrative counter part. T/F?

Back 54

True

Front 55

Which ameloblastoma occurs in Pts YOUNGER than 30 yrs old?
Which occurs AFTER age 30?

Back 55

YOUNGER than 30 = Unicystic
OLDER than 30 = Conventional

Front 56

For Unicystic Ameloblastoma, what is the average age? 50% are diagnosed in second decade (10-19 yrs). Occurs most often in pts YOUNGER than 30 yrs old.

Back 56

Average age is 23 yrs old for Unicystic Ameloblastoma

Front 57

The site predelection of Unicystic Ameloblastomas (more than 90%) is ?

Back 57

the mandible! usually posterior area

Front 58

Most lesions of Unicystic Ameloblastoma are asymptomatic, but may cause painless swelling. T/F?

Back 58

T

Front 59

Unicystic Ameloblastomas appear radiographically most commonly as well-circumscribed Unilocular radioLUCENCY. Does it often surround the crown of an unerupted tooth?

Back 59

Yes- Unicystic Ameloblastoma often surrounds the crown of an unerupted tooth.

Front 60

Most Unicystic Ameloblastomas appear as a cystic cavity lined with epithelium resembling ameloblastoma. The cyst lining shows basal cell layer resembling ameloblasts. More luminal cell layers resemble what?

Back 60

In Unicystic Ameloblastoma, the more luminal cell layers resemble STELLATE RETICULUM.

Front 61

Some cases of Unicystic Ameloblastomas may have tumor nodules proliferating into the lumen of the cyst. These are known as what type of Unicystic ameloblastomas?

Back 61

Plexiform Unicystic Ameloblastoma = tumor nodules proliferating into the lunmen of the cyst

Front 62

Sometimes the cyst in Unicystic Ameloblastoma contains proliferating nests of Ameloblastoma within its fibrous capsule. What type is this?

Back 62

Mural Unicystic Ameloblastoma = proliferating nests of ameloblastomas within fibrous capusule.

Front 63

Tx for Unicystic ameloblastoma is?

Back 63

Enucleation is adequte usually (this is good bc most lesions are clinically interpreted to be odontogenic cysts and enucleated before the real diag is known!)

Front 64

Which type of Ameloblastoma lesions are clinically interpreted to be odontogenic cysts most of the time and enucleated before the real diag is known?

Back 64

Unicystic Ameloblastomas

Front 65

Prior to 2005, reported recurrence rate following enucleation was 30% for Unicystic Ameloblastomas. Most recent studies report what type of recurrence rate- higher or lower?

Back 65

Higher- 50-80% recurrence rate for Unicystic Ameloblastomas thave have been Enucleated

Front 66

Peripheral Ameloblastoma- 1% of ameloblastomas are Extraosseous in soft tissue overlying the jaws. T/F?

Back 66

True

Front 67

what % of ameloblastomas are extraosseious?

Back 67

1%

Front 68

Peripheral Ameloblastomas occur in a wide range, but most commonly in middle-aged adults. Most lesions occur in where?

Back 68

Peripheral Ameloblastomas- most lesions occur in
1. Posterior Gingiva or
2. Alveolar mucosa

Front 69

Posterior Gingiva or Alveolar Mucosa - sites where which lesions occur most? (A type of Ameloblastoma)

Back 69

Periopheral Ameloblastoma

Front 70

Periopheral Ameloblastomas have mandibular lesions more commonly than maxillary ones. Most lesions are less than _____ cm in diameter.

Back 70

< 1.5 cm in diameter.

Front 71

Peripheral Ameloblastomas histologically resemble the infiltrating type, but are well defined. T/F?

Back 71

True

Front 72

Simple, local surgical excision is usually curative for which Amelobastoma?

Back 72

Peripheral

Front 73

Recurrence rate for Peripheral Ameloblastoma is?

Back 73

10-15%

Front 74

What are the recurrence rates for Ameloblastomas?

Back 74

1. Infitrating- curretage = 50-90%, En Bloc = 15%
2. Unicystic- Enucleation 50-80%
3. Peripheral- simple, local surgical excision = 15-20%

Front 75

Which tumors accounts for 3% of ALL Odontogenic Tumors and arises from the Enamel Organ or the Dental Lamina?

Back 75

AOT = Adenomatoid Odontogenic Tumor- 3% of all Odontogenic Tumors and it comes from the Dental Lamina or the Enamel Organ

Front 76

Adenomatoid Odontogenic Tumors do NOT live in the Posteriors. T/F?

Back 76

True- Adenomatoid Odontogenic Tumors have a striking predilection of the Anterior Jaws! Maybe this is because they arise with association of Primary teeth.

Front 77

2/3 of cases of Adenomatoid Odontogenic Tumors occur btwn the ages of 10-19 yrs old. It is Common over age 30 with a Male predilecetion. T/F?

Back 77

True- Adenomatoid Odontogeic Tumor occurs btwn ages of 10-19 yrs old

FALSE- it is UNCOMMON over age 30 yrs.

FALSE- it actually has a FEMALE predilection!

Front 78

What % of Adenomatoid Odontogenic Tumor cases are associated with Unerupted tooth? What tooth is it usually?

Back 78

75% of cases of Adenomatoid Odontogenic Tumor are associated with Unerupted tooth. Usually A CANINE!

Front 79

Do Adenomatoid Odontogenic Tumors frequently occur in the Peripheral (Extraosseious lcation?)
Do they have glands ( since they are called Adenomatoid?)

Back 79

NO- rarely do they occur in periopheral (extraosseous location.
No- they do not have glands! They are gland like.

Front 80

Most Adenomatoid Odontogenic Tumors are asymptomatic. Why?

Back 80

Most Adenomatoid Odontogenic Tumors are Asymptomatic because they are SMALL. aka < 3 cm

Front 81

Most Adenomatoid Odontogenic Tumors are < 3cm. T/F?

Back 81

True.

Front 82

Your patient has an Adenomatoid Odontogenic Tumors. What is one dental complaint she may have (which could be seen radiographically)? Her larger lesions may cause what? (also seen radiographically)

Back 82

Adenomatoid Odontogenic Tumors - complaints of delayed or unerupted teeth!
Larger lesions may cause Painless Bone Expansion!

Front 83

Bone expansion causes pain in Adenomatoid Odontogenic Tumor. T/F?

Back 83

False- painless bony expansion occurs in Adenomatoid odontogenic tumors.

Front 84

75% of adenomatoid odontogenic tumors appear as well-circumsribed lucency surroudning a crown of an unerupted tooth(most often a canine). Unlike a dentigerous cyst, AOT often extends along the root BEYOND the CEJ (likes to attach further up the root). Are snowflakes seen?

Back 84

yes

Front 85

Your pt's radiograph presents with:
1. Fine flecks (snowflakes!) of calcifications
2. The lesion extends along the root beyond the CEJ
3. It's well-circumscribed lucency surroudning a crown of a Canine
4. It's < 3cm diameter
What does your pt have?

Back 85

Adenomatoid Odontogenic Tumor = AOT!

Front 86

You're looking at a histology of a tumor and you see:
1. Epithelial cells varying in morphology
2. Columnar cells arranged in a duct-like (adenomatoid) fashion
3. Polyhedral cells are arranged in loose sheets
4. Foci of calcification (may be present)
5. Tumor (usually) has a fibrous capsule.
Which tumor is it?

Back 86

Adenomatoid Odontogenic Tumor

Front 87

Adenomatoid odontogenic tumor behaves in a completely benign fashion and can be innocuous. T/F?

Back 87

true

Front 88

Conservative surgical excision (Enucleation) is usually curative for Adenomatoid Odontogenic Tumor. Recurrence is common. T/F?

Back 88

True- Enucleation is usually curative

FALSE- Recurrence is actually RARE!

Front 89

What tumor may be mistaken for Squamous Cell Carcinoma because of pleomorphism, infiltration and presence of (often) intercellular bridges?

Back 89

CEOT- Calcifying Epithelial Odontogenic Tumor aka Pindborg Tumor

Front 90

What's another name for Pindborg Tumor?

Back 90

Calcifying Epithelial Odontogenic Tumor

Front 91

What's another name for Calcifying Epithelial Odontogenic Tumor?

Back 91

Pindborg tumor

Front 92

Which tumor accounts for <1% of all odontogenic tumors?

Back 92

Pindborg Tumor

Front 93

Pindborn Tumor occurs in wide age range, most commonly from ages 30 to 50. Mean age of 40 yrs. 71% occur in the mandible. Most occur in the posterior (molar/bicuspid) areas. What's the gender predilection?

Back 93

Male: Female = 1:1.

Front 94

Calcifying Epithelial Odontogenic Tumor commonly presents as a painless, slow growing swelling. It may occur as peripheral lesion (extraosseous), presenting as non-specific, sessile gingival mass in anterior jaws. T/F?

Back 94

True.

Front 95

Amyloid or amyloid-like material is often present and may contain focal calcifications in what tumor?

Back 95

Calcifying Epithelial Odontogenic Tumor

Front 96

Your radiograph presents with:
1. Multilocular lucency (but may be unilocular)
2. Pure LUCENCY (or can contain calcified[raidopaque] structures of varying size and density)
3. Often "associated" with an impacted tooth, in which case, tumor opacities are often localized around the crown of the tooth.
Histologically you see Amyloid material.
What tumor are we talking about?

Back 96

Calcifying Epithelial Odontogenic Tumor

Front 97

Histologically you see:
1. Sheets or islands of Polyhedral epithelial cells that may have large pleomorphic nuclei or multiple nuclei. Tumor cells closely resemble cells of the stratum intermedium of the enamel organ.
2. Amyloid or amyloid-like material often present and may contain focal calcifications
3. May show infiltration of bone (** Diagnostic for Tumor!)
4. May be mistaken for Squamous Cell Carcinoma due to- pleopmorphism, infiltration and presence of (often) intercellular bridges.
Which tumor is this?

Back 97

Pindborg Tumor

Front 98

Which tumor has cells that closely resemble cells of the stratum intermedium of the enamel ?

Back 98

Calcifying Epithelial Odontogenic Tumor

Front 99

Often intercelullar bridges infiltration and pleomorphism occurs in Calcifying Epithelial Odontogenic Tumors which can get mixed up with which Carcinoma?

Back 99

Squamous Cell Carcinioma

Front 100

Accumulating evidence indicates that these rare Pindborg lesions behave as benign tumors. T/F?

Back 100

True

Front 101

What ist he treatment of choice for Calcifying Epithelial Odontogenic Tumor?

Back 101

Local Excision with a narrow rim of surrounding bone (Limited en bloc excision). More aggressive tx is indicated for lesions in the posterior maxilla.

Front 102

More aggressive tx is indicated for Pindborg lesions located where?

Back 102

Posterior Maxilla

Front 103

Recurrence rate for Calcifying Epithelial Odontogenic Tumor is about ___ % and usually recurrence occurs in lesions which were treated by what method?

Back 103

15 %
curettage

Front 104

A rare benign Odontogenic tumor first described in 1975. It appears to originate from the periodontal ligament and is presumed to arise from neoplastic transformation of the rests of Malassez. Which tumor is it?

Back 104

Squamous Odontogenic Tumor

Front 105

Squamous Odontogenic Tumor age ranges from 8 to 74 years with the mean age being 38 years old. There is no gender predilection. It usually occurs lateral to a root surface at or near the ________ _______. Does it have predilection for any specific site?

Back 105

Occurs Lateral to a ROOT SURFACE at or near the ALVEOLAR CREST.
No, does NOT have predilection for any specific site.

Front 106

Cases of multiple lesions in different quads have been reported in Pindborg Tumor. It can be painless or mildly painful gingival swelling and may have tooth mobility. What is the mean average age?

Back 106

38 years old

Front 107

Radiographically you see:
1. Triangular radiolucency LATERAL to tooth roots = small pure lucency may mimic perio defects
2. Mimics vertical periodontal bone defect = destroys crestal bone but still has PDL attachment
3. Seldom more than 1.5cm greatest diameter
What tumor am I?

Back 107

Squamous Odontogenic Tumor

Front 108

Histologically the big thing seen in this tumor is-
Nests of Bland Squamous Epithelium. Maxillary cases may be more aggressive or invasive and few recurrences have responded to further local excsion. Conservative local excision or curettage is usually effective. What tumor am I?

Back 108

Squamous Odontogenic Tumor

Front 109

Treatment for Squamous Odontogenic Tumor is?

Back 109

Conservative Local Excision or Curettage- usually effective. Few recurrences have responded to further local excision. Max cases may be more aggressive or invasive.

Front 110

This Uncommon Tumor is considered to be a True MIXED tumor where both the epithelial and mesenchymal tissue are neoplastic. It usually occurs in teens or younger, especially in mixed dentition ages 6-14 yrs old. There is a slight predilection for males, and like ameloblastoma there is 70% occurance in the posterior mandible. Which tumor is this?

Back 110

Ameloblastic Fibroma

Front 111

Ameloblastic Fibroma is usually asympotmatic. There may be pain or swelling of the jaw if the lesion is large. 18% recur following conservative excision. What % is associated with an unerupted tooth?

Back 111

75% of Ameloblastic Fibromas are related with an unerupted tooth

Front 112

Radiographically this tumor presents with:
1. Well-defined Unilocular or Multilocular LUCENCY
2. Borders may be SCLEROTIC
3. 75% are associated with an unerupted tooth.
It's more common in teens and kids, has a predilection for boys and an 18% recurrence rate following conservative excision. What is it?

Back 112

Ameloblastic Fibroma

Front 113

Histologically we see:
1. Small islands and NARROW CORDS of Odontogenic Epithelium resembling the DENTAL LAMINA or a developing Tooth Germ
2. The STROMAL PORTION is distinctive; it is a primitive and cellular CT that closely resembles primitive dental papilla.
It's border may be sclerotic, 75% are associated with an unerupted tooth and there's an 18% recurrence. What is it?

Back 113

Ameloblastic Fibroma

Front 114

Odontomas are the most common types of Odontogenic tumors, exceeding the prevalence of ALL other ODONTOGENIC tumors combined! T/F?

Back 114

TRUE

Front 115

What is the most COMMON type of Odontogenic Tumor, exceeding the prevalence of all other Odontogenic tumor combined?

Back 115

Odontoma!

Front 116

Odontomas are considered to be developmental anomalies, Harmatomas, rather than TRUE NEOPLASMS. Biologically they are classified as Innocuous "tumors." What are the 2 types?

Back 116

1. Compound Odontoma
2. Complex Odontoma

Front 117

Differentiate btwn Compound Odontoma and Complex.

Back 117

1. Compound Odontoma- Composed of multiple, small structures with recognizable tooth morphology
2. Complex Odontoma- composed of conglomerate masses of enamel and dentin, which bears no anatomic resemblance to a tooth.

Front 118

Odontomas are usually detected within the first two decades of life. The mean age of diagnosis is what age?

Back 118

14 years old

Front 119

Most Odontomas are asymptomatic and discovered on routine examination. If associated with unerupted tooth, there may be delayed eruption. What is the mean age of diagnosis?

Back 119

14 years old

Front 120

What are the SITE predilection for the 2 types of Odontomas?

Back 120

1. Compoud Odontoma (little teeth)- Anterior jaws, esp Maxilla, often btwn roots of teeth
2. Complex Odontoma- posterior jaws, esp in mandible, often associated with impacted tooth

Front 121

Which Odontoma type is associated more frequently with the posterior mandible and often with an impacted tooth?

Back 121

Complex Odontoma

Front 122

Which Odontoma type is associated more frequently with the anterior jaw, eps the maxilla, often btwn roots of teeth?

Back 122

Compound Odontoma

Front 123

Radiographically compare the 2 Odontomas.

Back 123

1. Compound Odontoma-appears as Collection of TOOTH like structures of varying sizes surrounded by a THIN RADIOLUCENT ZONE
2. COMPLEX Odontoma- Calcified mass with radiodensity of tooth structure but showing NO tooth morphology. Also, surrounded by a radiolucenct zone.

Front 124

Both types of Odontomas are often associated with an unerupted tooth and may block the path of eruption for the tooth. Complex Odontoma is associated with an Impacted tooth. T/F?

Back 124

true

Front 125

Histologically compare the odontomas.

Back 125

1. Compound Odontoma- Small tooth like structures have well formed dentin, pulp and enamel matrix; contains epithelial rests.
2. Complex Odontoma- Enamel matrix, dentin and pulp tissue are arranged randomly; also has odontogenic epithelial rests.

Front 126

Both odontomas have epithelial rests and enamel matrix, dentin and pulp. T/F?

Back 126

true

Front 127

What is the Tx & prognosis for Odontomas?

Back 127

Simple Local Excision is Curative & prognosis is excellent!

Front 128

Ameloblastic Fibro-Odontoma represents an early stage of development of an Odontoma. Sometimes they show progressive or destructive growth, warranting consideration as a distinct entity. T/F?

Back 128

True

Front 129

What is the age for Ameloblastic Fibro-Odontomas?

Back 129

Most are found before age 20 yrs, average age is 10 yrs.

Front 130

What's most are found before age 20 yrs; average age is 10 yrs. 65% occur in the mandible; particularly in posterior. Most lesions are asymptomatic and discovered on routine examination. May have history of failure of eruption. What lesion is it?

Back 130

Ameloblastic Fibro-ODontoma

Front 131

Radiographically you see:
1. well-circumscribed unilocular primarily lucent lesion with variable amounts of Opacities having the density of tooth structure. It's often associated with an impacated tooth, commonly blocking the pat of eruption. Epithelial nests are involved and small islands and narrow cords of odontogenic epithelium resemble dental lamina. What lesion is this?

Back 131

Ameloblastic Fibro-Odontoma

Front 132

Histologically seen is:
1. Soft Tissue component IDENTICAL to Ameloblastic Fibroma.
2. Dentin and Enamel structures are in close association to the Epithelial nests
3. If the only hard tissue present is dentin matrix or dentinoid, then what term is used?

Back 132

Ameloblastic Fibro-Odontoma.
If only hard tissue present is dentin matrix or dentinoid, the the term: Ameloblastic Fibro-Dentinoma is used.

Front 133

What's the Tx and prog for Ameloblastic Fibro-Odontoma?

Back 133

Conservative Excision (Curettage) ; recurrence is rare.

Front 134

What are the 2 Odontogenic Fibromas?

Back 134

1. Periopheral Odontogenic Fibroma
2. Central Odontogenic Fibroma

Front 135

The soft tissue counterpart of the Central Odontogenic Fibroma is?

Back 135

the Peripheral Odontogenic Fibroma

Front 136

The Peripheral Odontogenic Fibroma is a rare tumor. It represents the MOST COMMON clinical pattern of Odontogenic Fibroma. Where does it occur most commonly?

Back 136

On the FACIAL gingiva of MANDIBULAR teeth!

Front 137

The MOST COMMON clinical pattern of Odontogenic Fibroma is ?

Back 137

Peripheral Odontogenic Fibroma

Front 138

The FACIAL gingiva of Mandibular teeth is the place where which lesion likes to grow?

Back 138

Peripheral Odontogenic Fibroma

Front 139

Peripheral Odontogenic Fibromas appear as a solitary firm, slow-gorwing, usually sessile, gingival mass with normal mucosal covering that may displace teeth. What is the normal sizes?
What's the age range?

Back 139

Sizes of Periopheral Odontogenic Fibroma = 1.5- 3.5 cm diameter.
Age range is WIDE

Front 140

Radiographs of Periopheral Odontogenic Fibroma may show a soft tissue density which does NOT affect underlying bone. T/F?

Back 140

T

Front 141

Histologically this is seen:
1. Odontogenic Epithelial nests or strands are present throughout and may be prominent
2. Fibrous CT stroma is cellular, and may be myxoid or highly collagenized. What tumor is this?

Back 141

Peripheral Odonotogenic Fibroma

Front 142

What's the Tx and prog for Periopheral Odontogenic Fibroma?

Back 142

Local surgical Excision.
Recurrence is RARE

Front 143

Central Odontogenic Fibroma is very uncommon and convtroversial. It has 2 types ofclassifications when it comes to histology. What are the 2 types?

Back 143

1. Simple Odontogenic Fibroma
2. WHO Odontogenic Fibroma

Front 144

Central Odontogenic Fibroma age ranges from 4 to 80 years old; mean age is 40 years. There is a marked FEMALE predilection and 45% occur in the maxilla- where in the maxilla?

Back 144

Mostly ANTERIOR to the first molar.

Front 145

Mandibular lesions most coften occur in the posterior and body areas in the Central Odontogenic Fibroma. Small lesions are usually asymptomatic while larger lesions may cause bony expansion and loosening of teeth. What is common in the maxillary lesions?

Back 145

Palatal Mucosal Groove

Front 146

Palatal Mucosal Groove is commonly seen in which Odontogenic Fibroma?

Back 146

Central Odontogenic Fibroma

Front 147

Central Odontogenic Fibroma Radiographically can be described:
1. Small lesions are usually well-defined, Unilocular lesions in the APICAL region of tooth-bearing areas. Sclerotic Border is common.
2. One third of lesions are associated with an unerupted tooth
3. Larger lesions tend to be multilocular lucencies
4. Root resorption and root divergence are common.
T/F?

Back 147

TRUE

Front 148

what's the difference btw the WHO and the simple Odontogenic Fibroma?

Back 148

1. Simple Odontogenic Fibroma =
a. Stellate Fibroblasts in a WHORLED pattern poplate a FIBROCOLLAGENOUS stroma of variable density and cellularity.
b. May or may not have Odontogenic Epithelial Rests.
c. May contain Foci of dystrophic Calcifications
2. WHO Odontogenic Fibroma:
a. Odontogenic Epithelial nests or strands are present throughout and may be prominent.
b. Fibrous CT stroma is cellular and may be myxoid.

Front 149

What's the Tx/prog for central odontogenic fibroma?

Back 149

Enucleation and curettage.
Appears to have limited growth potential and recurrence is rare!

Front 150

Odontogenic Myxoma is a neoplasm believed to arise from what?

Back 150

Odontogenic Ectomesenchyme

Front 151

Odontogenic myxoma bears a close resemblance to the mesenchymal portion of a developing tooth. It occurs over a wide range but most commonly in young adults. Average age ranges from how many years?

Back 151

25-30 yrs.

Front 152

What's the gender predilection for Odontgenic Myxoma?

Back 152

male:female = 1:1

Front 153

Odontogenic Myxomas may be found in any area of the jaws. It's how many times as common in the mandible than max?

Back 153

twice as common in mand than max

Front 154

Radiographically this was seen:
1. Pure Radiolucency- usually multilocular but may be unilocular
2. Loculations are often small giving a honeycomb appearance
3. Residual Host bone separating the loculations often shows a DELICATE WHISPY appearnce; these thin remnants are often at right angles to each other
4. Margins are often irregular or scalloped
What lesion is this?

Back 154

Odontogenic Myxoma

Front 155

Histologically this is seen:
1. Poor Cellular neoplasm with loosely arranged STELLATE or FUSIFORM cells
2. Abundant MUCOID GROUND SUBSTANCE btwn cells, very little collagen
3. Called MYXOfibroma if it has more collagen fibrillar component
4. May have small few nests of Odontogenic epithelium
5. Lesions are NOT encapsulated and tend to infiltrate surrounding bone.
What lesion is this?

Back 155

Odontogenic Myxoma

Front 156

A Odontogenic myxoma that has more collagen fibrillar component is called what?

Back 156

Myxofibroma

Front 157

When do we use the term Myxofibroma?

Back 157

When an Odontogenic myxoma that has more collagen fibrillar component.

Front 158

What's treatment for Odontogenic Myxoma?

Back 158

Small lesions = Curettage (but require at least 5 yrs follow up)
Most lesions = EN BLOC because:
1. Tumors may show FOCAL INFILTRATION
2. Tumor is SOFT, mushy, GELATINOUS; thus clean margins are difficult to obtain if curettage is attempted.

Front 159

Recurrence % of Odontogenic Myxoma is?

Back 159

25%

Front 160

A Soft, Jello like tumor that has 25% recurrence rate andsmall lesions (usually asymptomatic and disvoered on routine xray exam) and large lesions (often cause painless jaw expansion, may grow rapidly) that needs En bloc excision is called?

Back 160

Odontogenic Myxoma

Front 161

Cementoblastoma is a true neoplasm that is presumed to be derived from cementoblasts, is fused ot the roots of a tooth and is histologically indistinguisable from what?

Back 161

Osteoblastoma!

Front 162

Cementoblastoma is indistinguishable histologically from Osteoblastomas. T/F?

Back 162

TRUE

Front 163

Cementoblastomas occur from childhood to young adult. 50% arise before age 20, 75% occur before age 30. They occur in the root bearing portion of what?

Back 163

ALVEOLAR BONE!

Front 164

Cementoblastomas occur in the root bearing portion of ALVEOLAR bone. T/F?

Back 164

T

Front 165

75% of Cementoblastomas arise in the mandible, while 90% occur int he mandibular bicuspid or molar area. What is the SINGLE MOST COMMON SITE (50%) for the Cementoblastoma?

Back 165

Mandibular First Molar

Front 166

Teeth are non vital with cementoblastomas. T/F?

Back 166

FALSE- teeth are vital :)

Front 167

Cementoblastomas are slow growing, but causes expansion of rotical plates. 66% of pts report pain or swelling. It may recur how many %?

Back 167

22% recurrence for Cementoblastomas.

Front 168

Radiographically we see:
1. Mixed Radiopaque-lucent lesion
2. Radiopaque mass will obscure root outline of the affected tooty
3. Central opaque portion is surrounded by a thin radiolucent line
4. Radiographic features are distintive, leading to a reliable clinical diagnosis
What is it?

Back 168

Cementoblastoma

Front 169

Histologically we see:
1. Formed masses of cementum-like tissue showing REVERSAL LINES
2. Many Cementoblasts may be seen RIMMING trabeculae
3. Resembles Osteoblastoma and may be MISTAKEN for Osteosarcoma.
What is it?

Back 169

Cementoblastoma

Front 170

Tx and prog for Cementoblastoma is?

Back 170

Excision of the tooth together with the attached clacified mass.
If the tumor comprmises only a small portion of the root structure of the affected tooth, may consider rooth canal therapy with partial root amputation and conservative surgical excision of hte mass.
Recurrence will not occur if the lesion is completely excised! However, recurrence rates up to 22% have been recently reported