odontogenic tumor pptx - د.اسماء

• Odontogenic tumor

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

• Introduction

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

yright 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.
• Cop

• Ameloblastoma

• Is a benign locally aggressive odontogenic tumor arises from odontogenic epithelium

• Enamel organ

• The cause unknown
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• 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
• 

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• Egg shell cracking .

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

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• 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
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• Variants of ameloblastoma.

• 2. Plexiform ameloblastoma:

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

• Plexiform

• acanthotic

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• Variants of ameloblastoma.

• 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:

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• 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

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• Variants of ameloblastoma.

• 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.

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• 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
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• Adenomatoid tumor

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

• REE

• 3-7% of all odontogenic tumors
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• Adenomatoid tumor

• Clinical feature :
• 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.
• Rarely extra-osseous (Gingival)

• Radiolucent area surrounding impacted tooth

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• Adenomatoid tumor

• Radiography:

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

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• 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 .

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• 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

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• Calcifying epithelial odontogenic tumor

• 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 .

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• Calcifying epithelial odontogenic tumor

• 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

• Calcifying epithelial odontogenic tumor

• 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

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• Squamous odontogenic tumor

• Rare tumour, believed to be arise from neoplastic transformation of rest of malassiz

• Rest of malassiz

• Squamous odontogenic tumor

• 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

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• Squamous odontogenic tumor

• 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.

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• 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

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• Clinical feature:

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

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• 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

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• 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.

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• 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

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• Ameloblastic fibro-odontomas

e
• Most common in the 5-12 year ag
• 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.

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• 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.

Dentin

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

• Central ( Intraosseous) WHO type odontogenic fibroma .
• 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

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• 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.

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• Odontogenic myxoma

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

• Dental papilla

• Odontogenic myxoma

• Clinical feature :
• 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

• Clinical feature:
• 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 .
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• 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

• 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

• 1. Compound: Composed of

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

• Compound

• Complex

• Odontomas

• Clinical feature :
• 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
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• 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.
• 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.

• Compound

• 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.
• Ameloblastic carcinoma is a tumor that shows cytologic features of malignancy in the primary tumor, in recurrence and any metastases

• Carcinoma

• 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