odontogenic tumors

Hazrat Abu Huraira narratedThe Prophet (PBUH) said, “Beware of suspicion( about others)

as suspicision is the falsest talk, and do not spy upon each other, and do not listen to the evil talk of

people about other’s affairs and do not have enemity with one

another but be brothers” Bukhari Book#62 Hadith# 74

ODONTOGENIC TUMORS

DR SAMREEN YOUNAS FCPS RESIDENT OMFS

MAYO HOSPITAL LAHORE

Outline What is an odontogenic tumor Odontogenic tissues giving rise to

tumors Classification Clinical, radiographic and

histopathological features Take home message

WHAT IS A TUMOR?Abnormal growth of tissue resulting from

uncontrolled progressive multiplication of cells, serving no physiologic function.

ODONTOGENIC TUMOR?Tumor arising from odontogenic tissue.

The Origin Of Odontogenic Tumors

Ectodermal(epithelial)

Dental lamina /Epithelial rests of serres

Enamel organ /Reduced enamel epithelium

Epithelial root sheath of Hertwig’s /Epithelial rest of Malassez

Classification Odontogenic

epithelium

Ameloblastoma

CEOT(Pindborg tumor)

AOT

SOT

Clear Cell odontogenic Carcinoma

EPITHELIAL ODONTOGENIC TUMORS

AMELOBLASTOMALocally aggressive neoplasm of odontogenic epithe-

-lium that has a wide spectrum of histologic pattern resembling early odontogenesis.

1. Dental lamina/Rest of serres2. Enamel organ/Reduced enamel epithelium3. Basal layer of oral mucosa4. Epithelial lining of dentigerous cyst

Origin;

TYPES OF AMELOBLASTOMA

Clinico-radiographic types

Multicystic

Unicystic

Peripheral

Solid, Multicystic Ameloblastoma

Clinical features;1. Occurs over a broad age range2. F=M3. Mandible > Maxilla, Common in molar areas Raiographic features;4. Multilocular radiolucency, soap bubble

appearance[ large loculations], honeycomb[small loculatons].

5. Expansion of cortices6. Root resorption

Raiographic Features

Soap bubble

Destructive radiolucent lesion and root resorption

Desmoplastic A More common in anterior regions esp maxilla. Radiographicaly margins are ill defined Mixed radiolucent and radio-opaque appearance

HISTOPATHOLOGY

Follicular Pattern Plexiform pattern

Histopathology

Granular cell variant Acanthomatous

Histopathology

Desmoplastic variant Basal cell variant

UNICYSTIC AMELOBLASTOMA

Radiographic features•Well circumscribed Unilocular radiolucency

Younger age group most commonly affected

Histological variants of Unicystic Ameloblastoma

Luminal

MuralIntraluminal

HISTOPATHOLOGY

Mural Variant Intraluminal variant

Mural variant

Peripheral Ameloblastoma Painless non ulcerated, sessile or

pedunculated masses in gingival or alveolar mucosa.

Some lesions may cause superficial bone erosion.

Histological features are same as intraoseous Ameloblastoma.

MALIGNANT A and AMELOBLASTIC CA Malignant A; Tumors that show histopatho

features of ameloblastoma both in primary tumor and metastatic deposits.

Ameloblastic CA; Ameloblastoma that show cytological features of malignancy both in primary tumor and metastatic deposits.

Lungs most common site of metastasis followed by lymph nodes, bones, liver, spleen, kidney and skin.

TREATMENT Solid Ameloblastoma are treated with block

excision or resection followed by immediate reconstruction.

Margin of resection 1-1.5 cm past radiographic margins.

Luminal and intraluminal Enucleation Intramural resection with peripheral

osteotomy Perioheral types conservative local excision Ameloblastic CA and Malignant A treated more

aggressively but prognosis is v poor. Patients should be followed indefinitely.

Question Resection / en bloc resection ?

Marginal / segmental resection ? Partial resection ? Total resection ? Composite resection ?

Resection Removal of tumor by incising

through uninvolved tissue around the tumor.Marginal resection; bony continuity not

disruptedPartial resection; portion of jaw is removed

creating a continuity defectTotal resection; Complete bone is removed

with tumor, e.g mandibulectomyComposite resection; tumor resection with

bone, soft tissue and lymph channels.

CEOT ( PINDBORG TUMOR)Cells of origin unknown, dental lamina remnants

and stratum intermedium suggested.

Clinical features•Mean age 40 yrs•Mandible> maxilla•Molar-ramus area

Radiographic features•Unilocular or multilocular giving honeycomb appearance•May be complete radiolucent or may contain small opacities•Well circumscribed but sclerotic margins may not always be seen.

HISTOPATHOLOGY•Large polyhedral cells in a fibrous stroma•Nucei show considerable variation in size and shape•Extracellular amyloid of epithelial origin typical of these tumors.Liesegang rings•Concentric calcific rings with annular staining pattern seen in amyloid material.

TRAETMENT Conservative local resection with a

narrow rim of surrounding bone is treatment of choice.

Recurrence 15% Rare malignant transformation

Adenomatoid Odontogenic TumorProbably originates from reduced enamel epithelium

Clinical features; Teenagers mostly

affected F>M Anterior portion of jaws Maxilla>mandible Associated with crown

of an impacted tooth

9%53%2%

2% 7%27%

AOT

Adenomatoid OTHISTOPATHOOGY•Thick capsule•Polyhedral and spindle cells•Ductlike structures of columnar epithelium Adenomatoid appearance

VARIANTS OF AOT

Follicular73%

Peripheral3%

Extrafollicular24%

Adenomatoid OTRadiographic features;Folliclar; Well circumscribed unilocular

lesion, around the crown of an impacted tooth.

Extrafolicular; Same but appear above, between or superimposed over roots of an unerupted tooth.

Small opaque foci are distributed throughout the lesion.

TREATMENTConservatively treated, enucleation is all

that is required.

SQUAMOUS ODONTOGENIC TUMOR

Rare tumor thought to arise from dental lamina rests or rests of Malassez.

Occurs over a wide age range and are randomly distributed through mandible and maxilla.

Radiographically well circumscribed lucency associated with cervical region of roots of teeth.

Microscopically has some similarity to ameloblastoma, but lacks peripheral columnar palisaded layer.

CLEAR CELL ODONTOGENIC TUMOR (CARCINOMA) Rare neoplasm Origin is unknown but location and histology

suggests odontogenic origin Usually found in women older than 60 years Locally aggressive and poorly circumscribed Metastasis to lungs and lymph nodes Radical surgery is required and recurrence rates

upto 50% are reported.

MESENCHYMAL TUMORSODONTOGENIC MYXOMA Resembles microscopically dental pulp or

follicular C.T.

Clinical features

Smaller asymptomatic, may cause bony expansion.

More common in mandible Mean age 30 yrs

RADIOGRAPHIC FEATURES Unilocular or

Multilocular lucency “ Soap bubble appe-

arance “ Margins are irregular Lucent defect may

contain thin whispy trabeculi of bone arr-

anged at right angle to each other “Stepladder pattern”

HISTOPATHOLOGY Cells are haphazardly

distributed through loose abundant myxoid stroma containing only few collagen fibrils.

Bony islands

TREATMENT Surgical excision is treatment of choice Due to lack of encapsulation recurrence

rates are high if treated conservatively.

CENTRAL ODONTOGENIC FIBROMA Rare tumor, more common in females Aprox 45% occur anterior to 1st molar

region in maxilla. Usually appears as multilocular

radiolucency causing bony expansion. Surgical excision or enucleation is

traetment Recurrence is rare

CEMENTOBLASTO MA/ TRUE CEMENTOMA Rare benign neoplasm of cementoblasts Microscopically resembles

osteoblastoma but is connected or fused to the root of a tooth.

More common in posterior mandible Radiographically it is an opaque tumor,

usually surrounded by thick, uniform radiolucent ring, contiguous with PDL space.

MIXED TUMORSAmeloblastic Fibroma and Fibro-odontoma Except for presence of odontoma both are same

and considered together…Clinical Features; Younger age group mean 12yrs F=M Mandibular molar area is favoured location Commonly asymptomatic

Radiographic features Well circumscribed with

sclerotic margins Unilocular/ multilocular AF complete radiolucent,

AFO opaque focus appears

May be associated with crown of impacted tooth

HISTOPATHOLOGY Fibrous capsule Myxoid C.T Evenly distributed

strands of epithelium In fibro-odontoma

one or more foci containing enamel, dentine and cementum are found

TREATMENTBecause of encapsulation and general

lack of invasive capacity treated through conservative surgical approaches like curettage or excision.

Rare malignant counterpart Mlignant Ameloblastic Fibrosarcoma has been reported

ODONTOMAMost common odontogenic tumorBiologicaly may be considered as

Hamartomas, composite of enamel and dentine.

Compound Odontoma; Miniature or rudimentary teeth.Complex odontoma; Amorphous conglomeration of hard

tissue.

Question ?Hamartoma ?

Choristoma ?

Hamartoma; Excess of normal tissue in normal

location, e.g odontomas

Choristoma; Excess of normal tissue in abnormal

location e.g osseous choristomas in tongue

Clinical Features Histopathology Younger adults Maxilla > mandible Compound O more

common in anterior Complex O more

common in posterior regions

Mostly associated with impacted or retained tooth

Normal appearing enamel, dentine, pulp or cementum may be seen

Radiographic FeaturesCompound O; Numerour tiny opaque masses in a

single focus Typically in tooth bearing area.Complex O; Amorphous opaque masses

TREATMENTLimited growth potentialEnucleation is curative

TAKE HOME MESSAGE Most of the bony tumors of mandible

and maxilla have odontogenic origin. Clinical, radiographic and histopathology

correlation is required for diagnosis. Excision is treatment of choice.

THANK YOU