Odontogenic tumor

Odontogenic tumor
DR: Mazen Abood Bin Thabit. M.D, FRCPath
Assistant Prof Of General pathology
Senior lecturer of Oral pathology and oral
histology

Introduction
 The most common
neoplasm of the jaws is
odontogenic and it is
unique to the jaws.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Classification
 Benign epithelial Odontogenic T
– ameloblastoma
– Adenomatoid odontogenicT
– Squamous odontogenic T
– Calcifing odontogenic T
 Benign Mixed odontogenic T
– Ameloblastic Fibroma
– Ameloblastic Fibrodintinoma
– Ameloblastic fibro-odontoma
– Odonto ameloblastoma
 Benign mesenchymal odontogenic T
– odontogenic fibroma
– Odontogenic myxoma
– Cemento blastoma.
 Hamartomas
– Odontomas
• Compound odontomas
• Complex odontomas
 Malignant epithelial Tumor.
– Odontogenic carcinoma
 Malignant mesenchymal tumor
– Odontogenic Sarcoma.


Ameloblastoma
 Is a benign locally aggressive
odontogenic tumor arises
from odontogenic epithelium

Enamel organ

The cause unknown


Ameloblastoma
 Clinical feature :
 The most common
 30-40 years
 Male.
 Rare in children .
 80% in mandible
 70% in posterior region ( Ramus )
2o% premolar 10% incisor .
 Usually asymptomatic .
 Slow grow expansion of the jaw
cortical bone produce shell bone



 Egg shell cracking .
 Pain , paresthesia, mobility of
regional teeth .
 Pathological fracture .
 The overlying mucosa normal
 Maxillary lesion may produces
pressure effect and nasal
obstruction


Ameloblastoma
 Radiography:
 Uni or Multilocular radiolucent
areas

Soap bubbles


Ameloblastoma
 Radiography:

Soap bubbles appearance


Ameloblastoma
 Histopathology:
 Usually there are many histological
Variants of ameloblastoma.
1. Follicular ameloblastoma.
Islands or trabeculae of epithelial cells
in a connective tissue stroma
Ameloblast-like cells" which have "
reversed polarity“
These pattern of growth resembling
the early stages of tooth development
Core of loosely arranged polyhedral
or angular cells resembling satellite
reticulum

1.

2. Plexiform ameloblastoma:
Arranged in a network or
anastomosing strands
3. acanthomatous amploblastoma.
central core of the neoplastic
epithelium shows squamous
metaplasia

Plexiform

acanthotic


4. Basal cell ameloblastoma.
Trabecular pattern of growth with
little evidence of palisading at the
periphery. They have been mistakes
with basal cell carcinoma
5. Granular cell ameloblastoma.
6. Desmoplastic ameloblastoma:


7. Flexiform unicystic ameloblastoma:
Children between 10-19 years
Typically in the mandible .
80% ,the cyst enclose the crown
of impacted .
severely displaced mandibular 3rd
molar
Unilocular radio-lucency


8. 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
 Patients respond well to local surgical
excision.


Ameloblastoma.
 Ameloblastoma is locally
aggressive tumor and may
extened to the bone or
surrounding soft tissue

Treatment:
Enaculation with thorough bone
curettage .
Radical surgical approch


Adenomatoid tumor
 Uncommon benign tumor,
originated from reduced
enamel epithelium of post
secretory phase of enamel
development

3-7% of all odontogenic tumors

REE


Adenomatoid tumor
 Associated with an impacted.
 Asymptomatic
 Late adolescent or young
adulthood .
 Female .
 65% in the maxilla
 75% associated with impacted
teeth
 Small slow growing mass on the
anterior maxilla, rarely premolar
 Cause an elevation of the upper
lip.
 Pain and tooth placement.
Radiolucent area surrounding impacted tooth
 Rarely extra-osseous (Gingival)

Adenomatoid tumor

Radiography:
 AOTs typically appear as
pericoronal radiolucencies, which
may have radiopaque material
(“snowflake” calcifications) within
the lucency


Adenomatoid tumor
 Histopathology:
 Sheets or islands of epithelial cells
arrange around microcyst ( Ducts or
ductules ) .
 Surrounded by thin vascularized stroma .
 The ductules bordered by ameloblast like
cells .
 The lumen filled by homogenous
eosinophilic material .
 Small foci of calcification .


Calcifying epithelial odontogenic tumor
 Benign , locally aggressive
tumor originated from the rest
of dental lamina and/or REE .
 " Bindborg" tumor.
 Rare tumor ( Less than 1%)
,could be mistaken with poorly
differentiated squamous cell
carcinoma


 Clinically :
 Affect adult ,40 years.
 More common in the mandible
 Molar and premolar region
 crown of the unerupted teeth.
 Either central or peripheral
 Intraosseous lesion mainly
produce slowly growing painless
mass at the mandible.
 Nasal obstruction, epistaxis are
some time present in the
maxillary lesion.
 Peripheral ( Extraosseous) is
most commonly present in the
anterior part of the mouth .


 Radiograph:
The lesion appears as
radiolucent area with poorly
defined margin with fine flecks
of radio-opacities (due to
calcification).

Impacted tooth and flicks of
calcification


 Histopathology:
 Sheets or strands of epithelial
cells
 Cells are polyhedral exhibit
pleomorphism, including
multinucleated giant .
 Stroma lacks of inflammatory
infiltrate
 Pools of homogenous
eosinophilic material seen within
and between the epithelial
sheets with spherical
calcification


 Treatment:
 Conservative local resection
is the treatment of choice as
these lesions are typically
less aggressive than the
ameloblastoma.
 With this treatment the
recurrence rate is
approximately 15 % and the
overall prognosis is good


Squamous odontogenic tumor
 Rare tumour, believed to
be arise from neoplastic
transformation of rest of
malassiz

Rest of malassiz


 Clinical feature:
 Affect the patient 2nd -7th decade
( Mean age 40).
 Occur in mandible and maxilla in
equal frequency.
 Typically involve the alveolar
process anterior to the molars of
either jaws. Close to the roots of
erupted tooth.
 Painless swelling or as loosening
of teeth


 Appear as non-specific
radiolucent lesions. They may
be well-circumscribed or ill-
defined. They often appear
triangular in shape and lateral
to the tooth root.
 Some time mimic sever bone
loss from periodontitis.


Squamous odontogenic tumors

 Histologically, they appear as
islands of bland-appearing
well differentiated squamous
epithelium in a mature
fibrous connective tissue
stroma.
 The peripheral cells flattening
do not show the
characteristic polarization
seen in the ameloblastoma

Treatment:
Conservative local excision or curettage
appears to be effective treatment and there
have only be a few recurrences reported

Ameloblastic fibroma
 Rare biphasic tumor,
because the epithelial
and mesendymal
components are part of
the neoplastic process.
 Resembles dental
papillae


 Young adult and children.
 70% in mandible
 frequently located at mandibular
molar area, often over an
unerupted tooth


 Radiography:
 Generally, these lesions
appear as either a unilocular
or multilocular radiolucency.
 They tend to be well-defined
and may have a sclerotic
border.
 Approximately, 50 % are
associated with an unerupted
toot


Odontogenic fibroma
 Histopathology :
 Microscopically characterize
by thin strand and cords of
odontogenic epithelium that
resemble dental lamina at the
cap and bell stages of early
odontogenesis.
 The background compose of
loose but cellular fibromyxoid
connective tissue wildly
separated by fibroblast,
which resemble the immature
dental papillae.


Ameloblastic fibro-odontomas
 In these pathological entity
cells in one or more foci
continue the differentiation
process and produce enamel,
dentin and cementum in the
form of compound or
complex


Ameloblastic fibro-odontomas

 Most common in the 5-12 year age
 More common in the
premolar/molar regions of both
jaws.
 Radiographic Features: Usually
appears as a well-defined
unilocular or rarely multilocular
radiolucency with variable
amounts of calcified material
which is radiopaque. Therefore, it
may appear as a
mixed, radiolucent-radiopaque
lesion.


Ameloblastic fibro-odontoma
 Histopathology :
 Identical to the ameloblastic
fibroma. The calcified portion
consists of foci of enamel and
dentin matrix formation in
close relationship to the
epithelial structures.

The ameloblastic fibro-odontoma is usually
treated by conservative curettage .
Prognosis is excellent and recurrence is unusual

Dentin


Odontogenic fibroma
 Benign neoplasm derived from
connective tissue of
odontogenic origin containing
widely scattered islands and
strands of embryonic
odontogenic epithelium and
calcification.

Two types:
1. Central ( Intraosseous) WHO type
odontogenic fibroma .
2. Peripheral odontogenic fibroma .

Peripheral odontomas


Odontogenic fibroma
 Uncommon
 Patient age ranged from 9-80
years old with a mean of 40
years.
 More common in Female
 60 % in the maxilla ,anterior
to the first molar.
 In the mandible, 50 % occur
in the posterior jaw.
 Small lesion usually
asymptomatic.
 The larger associated with
localized bony expansion or
with the loosening of
adjacent teeth

Odontogenic fibroma.
 Histopathology:
 The WHO type odontogenic
fibroma appears as a fairly
cellular fibrous connective tissue
with collagen fibers arranged in
interlacing bundles.
 Odontogenic epithelium in the
form of long strands or isolated
nests is present throughout the
lesion.
 Calcifications composed of
cementoid and/or dentinoid may
be present.


Odontogenic myxoma
 Locally aggressive intraosseous
lesion derived from dental
mesenchymal tissue,
resembling microscopically the
dental pulp or follicular
connective tissue.

Dental papilla


Odontogenic myxoma
 Young people without sex
predilection.
 More common in the mandible
 Mandibular lesion found in molar
and premolar areas often
extended into ramus.
 Maxillary lesion erode into sinus
 Most lesion are show growing
painless, fusiform swelling that
some time displace teeth


Odontogenic myxoma
 Histopathology:
 The tumor is composed of
loosely arranged stellate,
spindle-shaped and round
cells in an abundant, loose
myxoid stroma with few
collagen bundles.

Myxoma


Odontogenic myxoma
 Radiography:
 Typically appears as multi
locular radiolucent area with
well defined scalloped margin
or soap bubble.


Odontogenic myxoma
 Treatment :
 Small odontogenic myxomas are
treated by curettage, while
larger lesions may require
surgical resection.
 Odontogenic myxomas are not
encapsulated and tend to
infiltrate adjacent tissues.
 Recurrence rates of up to 25 %
are reported.
 Overall, the prognosis is good for
most odontogenic myxomas.


Cementoblastoma
 Benign neoplasm of the
cementoblastic origin
compose of cementum like
tissue growing in continuity
with apical cemental layer of
molar and premolar that
produce expansion of cortical
bone and pain.

Cementoblastoma


Cementoblastoma
 2nd and 3rd decade.
 Comentoblastoma forms an
irregular or rounded mass
attached to the apical ⅓ of the
roots.
 They are slow growing and the jaw
is not usually expanded
 Pain is diagnostic feature , usually
of low grade intermittent pain and
become more intense when the
area is palpated.
 The tooth is vital
 More often seen in mandible than
the maxilla .



Cementoblastoma
 Radiography:
 Typically appears as radio
opaque rounded mass with
thin radiolucent margin.
 Attached to the root.
 Resorption of the related root
is common.

Cementoblastoma


Cementoblastoma
 Histopathology:
 Conglomerate of cementum
which often contain reversal
line and cells are enclosed in
lacunae.
 Peripheral zone has unmine
ralized tissue while the
center more mineralized .
 Intervening soft tissue is
loose very cellular and
vascularized, contain
multinucleated cementoclast
and cementoblast.

Reversal lines

Odontomas
 Odontomas are developmental
malformation ( hamartoma) of
dental tissue, it is not neoplasim

Compound

1. Compound: Composed of Complex
multiple small tooth-like
structures.
2. Complex: composed of a
conglomerate mass of enamel
and dentin, which bears no
anatomic resemblance to a
tooth

Odontomas
 70% of odontogenic tumor .
 More common in the maxilla.
 The compound type is more
often in the anterior maxilla .
 complex type occurs more
often in the posterior regions
of either jaw.
 Most odontomas are small
and do not exceed the size of
a normal tooth in the region.


Odontomas
 Large lesion cause expansion
of the jaw.
 Most odontomas are
asymptomatic.
 Odontomas may block the
eruption of a permanent
tooth .

Erupted odontomas


Odontomas

Compound Complex
The compound type shows apparent tooth shapes while
the complex type appears as uniform opaque mass with
no apparent tooth shapes present

Odontomas
 Histopathology:
 The compound odontoma is
composed of enamel, dentin
and cementum arrange in
recognizable tooth forms;
some enamel matrix may be
retained in immature and
hypomineralized specimens. Compound
 The complex odontoma is
composed of enamel, dentin
and cementum but these
tissues are arranged in a
random manner that bears no
morphological resemblance
to a tooth.

Complex

Malignant Ameloblastoma and Ameloblastic Carcinoma

 Less than 1 % of the
ameloblastomas show malignant
behavior with the development of
metastases.
 Malignant ameloblastoma is a
tumor that shows histologic
features of the typical (benign)
ameloblastoma in both the
primary and secondary deposits. Carcinoma
 Ameloblastic carcinoma is a
tumor that shows cytologic
features of malignancy in the
primary tumor, in recurrence and
any metastases


Ameloblastic fibrosarcoma
 Malignant counterpart of
the ameloblastic fibroma
in which the mesenchymal
portion shows features of
malignancy.
 The ameloblastic
fibrosarcoma may arise as
malignant transformation
of an ameloblastic fibroma


Ameloblastic fibrosarcoma
 Histopathology:
 The epithelial component
histologically benign.
 The mesenchymal portion is
highly cellular. The cells are
hyperchromatic and quite
pleomorphic. Mitoses are
usually prominent

Mitosis


Odontogenic tumor

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