Odontogenic tumors

Neoplasms of mostly benign behavior, however they may very rarely be malignant.
There are three different types.
TUMORS OF ODONTOGENIC EPITHELIUM:
Composed of only odontogenic epithelium
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Ameloblastoma

Calcifying Epithelial Odontogenic Tumor

Adenomatoid Odontogenic Tumor

MIXED ODONTOGENIC TUMORS:

Composed of odontogenic epithelium and ectomesenchymal elements
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Ameloblastic Fibroma

Compound & Complex Odontoma

TUMORS OF ODONTOGENIC ECTOMESENCHYME:

Composed of ectomesenchymal elements
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Odontogenic Myxoma

Cementoblastoma

AMELOBLASTOMA

Common INVASIVE odontogenic tumor that arises from

Rests of dental lamina of enamel organ
Epithelial lining of od. Cyst
Basal cells of oral mucosa

3 Types:
1. Solid or Multicystic (86%)
2. Unicystic (13%)
3. Peripherial or Extraosseous (1%)

SOLID OR MULTICYSTIC
30 70 years
80% in the mandible ascending ramus area
Desmoplastic pattern occurs in the anterior region of Maxilla
Asymptomatic and if it expands can cause painless swelling
Pain only occurs if it impinges on other structures
RADIOGRAPHICALLY: Multiloculated soap bubble appearance (rarely
unilocular with irregular scalloping) Desmoplastic pattern presents as fibroosseus lesion because the osseus metaplasia is within a fibrous septa
Root resorption can occur
Common in unerupted mandibular third molar
HISTOPATHOLOGY:
Reverse Polarization = Nucleus tends to move away from basement
membrane
Follicular pattern consists of islands of epithelium in a fibrous stroma
and epithelial nests consist of arranged angular cells resembling
stellate reticulum of enamel organ
Cyst formation can occur in Follicular pattern
Plexiform pattern consists of anastomosing large sheets of odontogenic
epithelium bounded by columnar ameloblast-like cells surrounding
more loosely arranged epithelial cells
Cyst formation is uncommon in Plexiform pattern, associated with
stromal degeneration
Other variants or patterns which are not as common include
Acanthomatous
Granular Cell
Desmoplastic
Basal Cell
TREATMENT:
Enucleation and Curettage ( Recurrence rate of 50 to 90% )
En bloc or marginal resection
UNICYSTIC
Seen more often in younger patients
90% found in mandible posterior regions with unerupted third molars
Painless swelling of the jaws

RADIOGRAPHICALLY: Presents as unicystic radiolucency with scalloped

margin
PERIPHERAL OR EXTRAOSSEUS
Middle aged persons
Found on posterior gingival and alveolar mucosa
Mandibular > Maxillary
Painless, nonulcerated, sessile lesion
Alveolar bone becomes slightly eroded
Shows similar pattern to follicular pattern histopathologically

ADENOMATOID ODONTOGENIC TUMOR

-

Make up 3 to 7% of all odontogenic tumors

10 19 years
Maxillary > Mandible ( Anterior portion ) ( associated with unerupted teeth;
canine )
Female > Male
Usually small, 3 cm in diameter, and rarely peripheral
Difficult to differentiate from Gingival Fibrous Lesion
Asymptomatic, larger lesions cause painless expansion of bone
Can be located between roots of two erupted teeth
RADIOGRAPHICALLY:
Unilocular radiolucency that extends to the apex of tooth
{ differentiates it from a dentigerous cyst (at cementoenamel
junction)}
Contains fine snowflake calcifications
HISTOPATHOLOGY:
Tumor is surrounded by a fibrous capsule
Tumor is solid inside ( Miroscopically: made up of spindle shaped
epithelial cells that form sheets )
These cells form a rosette like structure about a central space ( Can
sometimes contain eosinophilic material )
TREATMENT: Enuculeation

CALCIFYING EPITHELIAL ODONTOGENIC TUMOR (PINDBORG TUMOR)

-

Uncommon tumor, makes up less than 1% of all tumors

30 50 years

Posterior area of mandible

Painless, slow growing swelling
RADIOGRAPHICALLY:
Multilocular radiolucency (Unilocular when found in Maxilla)
Often scalloped and well defined
Can contain calcified structures known as driven snow pattern
( Uncommon )
Associated with impacted tooth
HISTOPATHOLOGY:
Sheets of polyhedral epithelial tumor cells in a fibrous stroma
Tumor cells contain eosinophilic cytoplasm and intracellular bridging
Liesegang Ring Calcification = Deposits of amyloid-like material and
forms concentric rings
Can contain giant nuclei as well as nuclear pleomorphism
TREATMENT: Curettage ( 15% recurrence rate)

AMELOBLASTIC FIBROMA
-

Epithelial and Mesenchymal tissue are both neoplastic

Younger patients
Males > Females
Small = Asymptomatic / Large = Associated with swelling of jaw
Found 70% in posterior mandible
RADIOGRAPHICALLY:
Unilocular or Multilocular ( Smaller lesions are unilocular )
Margins are well-defined and sclerotic
75% of cases associated with unerupted tooth
HISTOPATHOLOGY:
Soft tissue mass with smooth outer surface
Tumor is composed of mesenchymal tissue and odontogenic
epithelium
Odontogenic epithelium: Has 2 pattern types,
A) Long, narrow cords of odontogenic epithelium supported by rich,
cellular primitive CT ( most common )
B) Basophilic epithelial islands with peripheral nuclear palisading
Mesenchymal tissue: Fibroma onsists of plump stellate and ovoid
cells in a loose matrix, collagen formation
TREATMENT: Excision or curettage
ODONTOMAS
Most common type of odontogenic tumors
Harmatomas: Developmental anomalies
Made up of enamel and dentin
Subdivided into COMPOUND and COMPLEX
10 20 years
Asymptomatic, and prevents eruption
Rarely exceeds size of tooth but can be up to 6 cm
Maxilla > Mandible
COMPOUND

Found more in anterior maxilla

Made up of a collection of toothlike structures surrounded by a
radiolucent zone
HISTOPATHOLOGY: Multiple, small, single rooted teeth, in a fibrous
matrix ( Enamel matrix also present )
Radiographically diagnostic
COMPLEX
Occur in molar regions of either jaws
Large calcified mass with a radiodensity of a tooth surrounded by a thin
radiolucent rim
Can be confused with an Osteoma
HISTOPATHOLOGY: Large mature tubular dentin that encloses a
hollow circular structure which may contain enamel matrix and ghost
cells ( 20 % ) ( Eosinophilic staining ) Also has a thin layer of cementum
and dentigerous cyst can arise from epithelial lining
TREATMENT: Simple local excision ( excellent prognosis )

ODONTOGENIC MYXOMA
-

Arise from ectomesenchyme

20 30 years
Mandible > Maxilla ( Any area of jaw )
Small = Asymptomatic / Large = Painless expansion of bone
Myxoid substance in tumor can cause rapid growth
RADIOGRAPHICALLY:
Unilocular or multilocular radiolucency
Fine residual bone trabeculae arranged at right angles to one another
Stepladder pattern
Scalloped margind
Large myxomas can have soap bubble pattern
HISTOPATHOLOGY:
White gelatinous mass
Microscopically: Stellate shaped cells and fine collagen fibrils
TREATMENT: Small = Curettage / Large = Surgical resection ( Recurrence
rate 25% )

CEMENTOBLASTOMA
-

True neoplasm of cementum ( 1% of Od. Tumors )

Mandible > Maxilla ( Molar and Premolar region )
10 20 years
Pain and swelling
Includes bony expansion, cortical erosion, displacement and envelopment of
adjacent teeth, maxillary sinus involvement, infiltration into pulp chambers
and root canals
RADIOGRAPHICALLY: Radiopaque mass fused to one or more tooth roots
surrounded by a thin radiolucent rim

HISTOPATHOLOGY:
Tumor is fused with involved tooth ( Infiltrates into pulp chambers and
root canals )
Tumor consists of sheets and thick trabeculae of mineralized material
with irregularly placed lacunae and prominent basophilic reversal lines
Cellular fibrovascular tissue is present between mineralized trabeculae
Giant cells are present
Peripherally, uncalcified matrix is arranged in radiating columns
TREATMENT: Surgical extraction or excision