odonto tumors
TRANSCRIPT
ODONTOGENIC TUMORS
Classification
WHO KRAMER, PINDBORG AND
SHEAR 1992
Benign
Odontogenic epithelium with mature, fibrous stroma; odontogenic ctomesenchyme not present
1. Ameloblastomas• Solid/multicystic• Extraosseous/ perlpheral• Desmoplastic• Unicystic
2. Squamous odontogenic tumor3. Calcifying epithelial odontogenic tumor4. Adenomatoid odontogenic tumor5. Keratinizing cystic odontogenic tumor"
Odontogenic epithelium with odontogenic ectomesenchyme with or without dental hard tissue formation1. Ameloblastic fibroma2. Ameloblastic fibrod entinoma3. Ameloblastic fibro-odontoma4. Complex odontoma5. Compound odontoma6. Odo ntoameloblastoma7. Calcifying cystic odontogenic tumor8. Dentinogenic ghost cell tumor
Mesenchyme and/ or odontogenic ectomesenchyme with or without included odontogenic epithelium1. Odontogenic flbroma (epithelium-poor and epithelium-
rich types)2. Odontogenic myxoma or fibromyxom a3. Cementoblastoma
Malignant tumors (odontogenic carcinomas)
1. Metastasizing, malignant ameloblastoma2. Ameloblastic carcinoma
(a) primary(b) secondary (dedifferentiated), intraosseous(c) secondary (dedifferenti ated), extraosseous
3. Primary intraosse ous squamous cell carcinoma (PIOSCC)(a) PIOSCC solid type(b) PIOSCC derived from odontogenic cysts(c) PIOSCC derived from keratinizing cystic odontogenic tumo r
4. Clear cell odontogenic carcinoma5. Ghost cell odontogenic carcinoma
Malig nant tumors (odontogenic sarcomas)1. Ameloblastic fibrosarcoma2. Ameloblastic fibrodentino- and fibro-
odontosarcoma
CLASSIFICATION BASED ON CONNECTIVE TISSUE INDUCTION BY EPITHELIAL TISSUE
• EPITHELIAL ODONTOGENIC TUMORS
1. Minimal inductive change in CT – AMELOBLASTOMA.– CEOT (PINDBORG’S)– AOT
2. Extensive inductive changes in connective tissue
– AMELOBLASTIC FIBROMA – AMELOBLASTIC FIBRO-ODONTOMA – ODOTO- AMELOBLASTOMA – ODONTOMA – COMPLEX
COMPOUND
AMELOBLASTOMA
•WHO (1992) “Is a true neoplasm of
enamel organ like tissue which does not undergo differentiation to the point of enamel formation”
Robinson described it as• A TUMOUR THAT IS USUALLY
UNICENTRIC, NONFUNCTIONAL INTERMITTENT IN GROWTH ANATOMICALLY BENIGN
CLINICALLY PERSISTENT
Synonyms :
–Admantinoma–Multilocular cyst–Admantoblastoma–Eve’s Diesease
History :• CUZACK (1827)- FIRST RECOGNIZED • FALKSON (1879) – DESCRIPTION• MALASSEZ (1885) – ADMANTINOMA• IVY &CHURCHILL (1934) –
AMELOBLASTOMA• Unicystic ameloblastoma- Robinson and
Martinez in 1977
ORIGIN• CELL RESTS OF ENAMEL ORGAN DENTAL LAMINA REMNANTS HERS RESTS OF MALASSEZ
–Epithelium of Odontogenic cysts (Dentigerous cyst)
–Disturbances in developing enamel organ.
–Heterotropic epithelium in other parts of the body, especially the Pituitary Gland.
–Basal cells of oral epithelium.
extra osseous
• Dental lamina ameloblast
• Oral epithelium
Incidence
–1% of oral tumors–18-20% of odontogenic tumors
Clinical features
–20-50 years–Number of cases reported in
children–Youngest reported one month old –Oldest 98 yrs
–Frequent in mandible than maxilla–3:1
Signs & symptoms
–Asymptomatic–Asymmetry–Slow growing –
non tender–Later stages pain
–Secondary infection–Ulceration–Egg shell crackling–Extra osseous Small nodule
classification
Anatomic site–Central /intraosseous•Solid/Multicystic/Conventional•Unicystic•Desmoplastic
–Peripheral/ extra osseous
Radiological features
• Numerous well defined radioluscency of varying diameter• Honey comb • Soap bubble appearance• Unicystic radiolucent lesion
indistinguishable with cysts
AmeloblastomaWith in medullary cavity Scalloping of inner cortexPressure erosionShell remains
–When maxillary sinus involved –Cloudiness of sinus–Destruction of wall –Unicystic in maxilla
Histopathology
–Follicular–Plexiform–Acanthomatous–Granular cell –Desmoplastic–Basal cell type
follicular
Plexiformplexiform
Acanthomatousacanthomatous
Granular cell granular
Desmoplasticdesmoplastic
Basal cell Basal cell
Other varients• Hemangiomatous• Clear cell• Mucous cell differentiation
Rx
• Complete Surgical excision
• Recurrence: 50-90%
Unicystic Amelo
Incidence: 5-22%Age: 1-2 decadeGender: M:F
1.6:1Site: Maxi:mand
1:7 [dentigerous varient]1:4.7 [non dentigerous varient]
• Pathogenesis: Reduced enamel epi Arising with DC lining Degeneration of SMA Denovo
C/F• Local swelling• Pain• Lip numbness• So infection
R/F• Uni/miltilocular r/l• Root resorption
DENTIGEROUS VARIENT
NON-DENTIGEROUS VARIENT
H/FVickers & Gorlin criteria• Palisaded basal cell• Nuclear- Polarised & hyperchromatism • Vacuolated cytoplasm• Subepi hyalinization• Stroma- loose
Ackerman in 19881. Type-I Luminal (consisted of unilocular cystic lesions lined by epithelium
exhibiting features of ameloblastoma).
2. Type-II Intra luminal (showed epithelial nodules arising from the cystic lining and projecting into the cyst lumen. These nodules comprised epithelium with a plexiform or follicular pattern resembling that seen in intraosseous ameloblastoma.).
3. Type-III Mural ameloblastoma (characterized by the presence of invasive islands of ameloblastomatous epithelium in the connective tissue wall of the cyst, and these islands may or may not be connected to the cyst lining)
Rx
• Enucleation• Wide surgical excision- intramural type
Recurrence: • 10-20 % [Intramural type]
Desmoplastic Amelo
Incidence: 4-13 %Age: 4-6 decadeGender: M:F
1:0.9Site: Maxi=mandPathogenesis: Rests of Malassez
C/F• Painless growth• The tumor mass is often solid. whitish. and has a
gritty or "frozen ice-cream"-like consistency
R/F
• Uni / miltilocular r/l• Well defined border• Root resorption• Mixed r/l & r/o area
H/F
• Follicular islands- Animal like configuration • Increased collagen production- squeezes
Odon epi.• Myxoid changes around Odon epi islands• Tall columnar cells• Palisaded & polarised nucleus
Rx
• Wide surgical excision
Recurrence:• Less than SMA
Pheripheral Amelo
Incidence: 2-10 %Age: 5-7 decadeGender: M:F
1.9:1Site: Maxi : Mand
1 : 2.5• Pathogenesis: Rests of DL
Rests of Serre’s
C/F
• Painless, firm• Sessile, exhophytic, granular/pebbly/wart type
growth• Normal colour • Trauma causes ulcer
R/F
• Superficial erosion• Cuffing/ Saucerization of underlying bone due
to pressure by the lesion
H/F
Follicular & Acanthomatous type• Tall columnar cells• Palisaded & polarised nucleus• Centre of follicle shows Stellate reti like cells• Ghost cells also seen
Rx
• Wide excision
Recurrence:• 15-20%
SOT
Age: 3 decadeGender: M:F
1.4 : 1Site: Maxi = Mand
• Pathogenesis: Rests of DL
Rests of Malassez in PDL
C/F
• Locally invasive, Slow growth, Mobility Moderate pain
• Alveolar bone swelling • ass. impacted tooth
R/F
• Uni / miltilocular r/l• Saucerization• Triangular r/l
H/F
• Islands- cuboidal/flat cells• Varying size n shape of sq. cells• Single cell keratinization• Laminal calcified material• No ghost / clear cells
Rx
• Excision
Calcifying epithelial odontogenic tumor[CEOT]
Incidence: less than 1%Age: 3-5 decadeGender: M=FSite: Maxi : Mand
1 : 2Pathogenesis: Rests of Stratum intermedium
Rests of DLReduced enamel epi
C/F
• Slow growth• Painless • In maxi- nasal congestion, epistaxis, head ache• Extraosseous- painless, firm gingival swelling• Trauma causes ulcer
R/F
• Uni / miltilocular r/l• Radiopaque calcified mass• Wind driven Snow appearance / honey comb
H/F• Sheets & islands of cells• Well defined cell br • Polyhedral shape [Squamous cell] - closely packed• intercellular bridges, intracytoplasmic tonofilaments &
hemidesmosomes
• Cytoplasm- fine granular, eosinophilic
• Nucleus- pleomorphic, giant, mild hyperchromatic
• Calcified structures- concentric rings, may be amyloid• Liesegang ring calci. Calci. fuse to form large calci
Rx
• Enucleation• Local/conservative excision
Squamous Odontogenic Tumor[SOT]
Age: 3 decadeGender: M : F
1.4 : 1Site: Maxi = Mand
Pathogenesis: Rests of DL Rests of Malassez in PDL [Dropping off pheno.]
C/F
• Locally invasive• Slow growth• Mobility • Moderate pain• Alveolar bone swelling • ass. impacted tooth
R/F
• Uni / miltilocular r/l• Saucerization• Triangular r/l
H/F
• Islands- cuboidal/flat cells• Varying size n shape of sq. cells• Single cell keratinization• No ghost / clear cells
Rx
• Enucleation• Local excision
Adenomatiod Odontogenic Tumor[AOT]
Incidence: 5 %Age: 2 decadeGender: M : F
1 : 1.9Site: Maxi : Mand
3 : 1
Pathogenesis: Rests of DL
C/F
• 3/4th tumor- 3/4th in teenage 3/4th in female
3/4th in maxillary anteriors• Asymptomatic• Slow growing• Cortical expansion• Root resorption
R/F
• Unilocilar r/l
H/F
At the center of the lesion• Spindleshaped or cuboidal epithelial cells forming
rosettelike structures. • whorled cell arrangement• Characteristic tubular or duct like structures lined by a
single row of cuboidal or low• columnar epithelial cells• Calcified bodies with Liesegang patternAt the periphery of the lesion• Cribriform pattern of tumor cell strands at the nodule
Rx
• Excision
Keratinizing Cystic Odontogenic Tumor[KCOT]
Than - Q