Odntogenic Tumors Oral Patho / Orthodontic Courses by Indian Dental Academy

Odontogenic tumors
INDIAN DENTAL ACADEMY

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DEFINITION:

Odontogenic tumors
are the lesions
derived from
cellular elements
that are forming
the tooth
structure.

TOOTH FORMI NG APPARATUS
Neoplastic Intersection Hamartomatous

Benign Malignant Cystic
changes
Odontoma
Amelobl Amelobl
astoma astic Calcifying
Cementoma Cementoma odontogenic cyst
Ameloblastic fibro odontoma
CLASSIFICATION
NEOPLASM
A). Benign
1). Odontogenic epithelium
(i). Ameloblastoma
(ii). Squamous odontogenic tumor
(iii).Calcifying epithelial
odontogenic tumor
(iv).Clear cell odontogenic tumor
(Pindborgs tumor)
2). Odontogenic epithelium with
odontogenic ectomesenchyme
(i). Ameloblastic fibroma
(ii). Ameloblastic fibro dentinoma and
ameloblastic fibro odontoma
(iii). Odontoameloblastoma
(iv). Adenomatoid OdontogenicTumor
(v). Calclifying odontogenic cyst
(vi). Complex odontoma
(vii). Compound odontoma

3). Odontogenic ectomesenchyme
(i). Odontogenic fibroma
(ii). Myxoma / Odontogenic
myxofibroma
(iii).Benign cementoblastoma( True
Cementoblastoma)

MALIGNANT
1). Odontogenic carcinomas
(i). Malignant Ameloblastoma
(ii). Primary intraosseous carcinoma
(iii). Malignant variant of other
odontogenic epithelial tumor
(iv). Malignant changes in odontogenic
epithelial tumors
(v). Malignant changes in odontogenic
epithelial cyst

2). Odontogenic sarcomas
(i). Ameloblastic fibrosarcoma
(Ameloblastic sarcoma)
(ii). Ameloblastic fibrodentine
sarcoma & Amleoblastic fibro
odontosarcoma

3). Odontogenic carcinosarcoma
AMELOBLASTOMA
Definition
An epithelial tumor arising
from the odontogenic
apparatus or from cells
with a potentiality for
forming tissues of the
enamel organ.
WHO Defined it as
Unicentric, non functional,
intermittent in growth,
anatomically benign and
clinically persist
Origin of the ameloblastic cells
1). Odontogenic epithelium
a). Remenants of Dental lamina
b). Reduced enamel epithelium
c). Rests cells of malassez
2). Basal cell layer o overlying surface
epithelium
3). Epithelial lining of odontogenic cyst

Three clinical subtypes
1). Common polycystic Ameloblastoma
(80% of all cases)
2). Unicystic Ameloblastoma (13% of
all cases)
3). Peripheral (Extraosseous)
Ameloblastoma (1% of all cases)
A). Common polycystic ameloblastoma
Also called conventional, Intraosseous ,
Multicystic
Clinical features
Age - 20 to 40yrs
Site - mandible > maxilla
slow growing, painless, bony expansion
initially Tennis ball like consistency

Egg shell like cracking

Jaw bone enlargement & parasthesia
Radiographic features
Round cyst like radiolucency
Honey comb (if small
loculations)
or soap bubble like
consistency(if large
loculations)
Histopathology:
(Vickers and Gorlins criteria).
1). Hyperchromatism
2). Palisading cells
3). Vacuolization
4). Hyalinization
Histopathological variants
1). Follicular ameloblastoma
2). Plexiform ameloblastoma
3). Plexiform unicystic ameloblastoma
4). Acanthomatous ameloblastoma
5). Papilliferous keratoameloblastoma
6).Granular cell ameloblastoma
7). Desmolytic ameloblastoma
8). Basal cell ameloblastoma
9). Clear cell Ameloblastoma
Follicular
Ameloblastoma
Consists of different
shapes & sizes of
epithelial islands in
the form of epithelial
nests or follicles.
Plexiform
ameloblastoma
Consists of interlacing
strands of
odontogenic epithelial
trabeculae

Acanthomatous
Ameloblastoma
central epithelial cells
squamous cell metaplasia
keratin deposition.

Desmoplastic
Ameloblastoma
Small epithelial islands
widely separated by
dense, scar like fibrous
tissue.


Granular cell
Ameloblastoma
central cells appears
swollen & densely
packed with
eiosinophillic
granules.

Basal cell pattern
Islands of uniform
basaloid cells.

Treatment options
1). Simple Curettage - high
recurrence rate. In mandible, wide
marginal resection leaving compact
bone of lower border intact
provided the lower border is not
involved radiographically
Large tumors invading lower border
of mandible, segment resection
using bone grafts. In maxilla, wide
excision is treatment of choice
A 17-year-old girl with obvious facial expansion
(A) related to a multilocular radiolucency of the
left mandible associated with impacted tooth no.
17 (B). Note the aggressive nature of this tumor.
The incisional biopsy showed solid/multicystic
ameloblastoma.

Twenty years of undisturbed growth of a solid/multicystic
ameloblastoma led to significant facial disfigurement
(A), with an impressive radiographic appearance (B). A
segmental resection of the right mandible was
performed(C).

B). UNICYSTIC AMELOBALSTOMA
Definition :
Is defined as a single unicystic cavity that
shows ameloblastous differentiation in the
lining.
origin - a). De-novo as a neoplasm
b).result of neoplastic
transformation.
Clinical features
age - 16 to 20yrs (younger patients).
Site - mandible > maxilla
Large lesions painless swelling in the jaw.
Well-circumscribed,
radiolucent area that
surrounds the crown of
an unerupted molar.
3 histopathological
variants.
1). Luminal unicystic
2). Intaluminal
unicystic
3). Mural unicystic
Differential diagnosis
(1). Dentigerous cyst
(2). Residual cyst
Treatment and prognosis
(1). Enucleation and curettage (recurrence
rate - 10% to 20%) less recurrence as
surrounding fibrous connective tissue
limits the lesion .
(2). If the lesion extends into fibrous cyst
wall Prophylactic measure Local
resection of the area
A, Treatment of the ameloblastoma of the patient
in Figure 30-17 required a disarticulation
resection of the left mandible. B, The
effectiveness of the bony linear margin should
always be evaluated by intraoperative specimen
radiographs.

A, The luminal unicystic
ameloblastoma in Figure 30-21 is treated with
an enucleation and curettage surgery. B, The
5-year postoperative radiograph shows an
acceptable bony fill.
This 18-year-old presented with significant right facial expansion
(A) associated with the destructive radiolucency of the right
mandible noted on the panoramic radiograph (B). The incisional
biopsy documented the mural variant of unicystic ameloblastoma
(hematoxylin and eosin; original magnification 20) (C). A
disarticulation resection was performed (D).

3).PERIPHERAL OR EXTRAOSSEOUS
Incidence - 1%
origin - a). Remnants of dental lamina beneath
the oral mucosa
b). Basal epithelial cells of
surface epithelium
Clinical features
Age - middle age
site - posterior gingival &
alveolar mucosa Mandible > maxilla
Painless, nonulcerated, sessile or
pedunculated gingival or alveolar mucosal
lesion.
Histopathology:
bear islands of
ameloblastic epithelium
occupying lamina propria
underneath surface
epithelium.

Treatment & prognosis
Surgical excision
(Recurrence rate - 15
to 20%).
Earliest diagnosis

MALIGNANT AMELOBLASTOMA
Benign tumor that in the typical
intraosseous form has a tendency to
infiltrate cancellous bone

AMELOBLASTIC CARCINOMA
Ameloblastoma that has a
cytologic evidence of malignancy.
Clinical features:
swelling, pain and
inflammation
Ulceration of mucosa
& loosening of teeth
Epitaxis & nasal
obstruction.

Radiographic
features
unilocular or
multilocular
radiolucency, soap
bubble
appearance.

Treatment
Simple curettage (high
recurrence rate). In mandible, wide
marginal resection leaving compact bone
of lower border is not involved
radiographically.
Large tumors - segmental resection
followed by reconstruction using bone
graft.
A, The large destructive radiolucency
of the right mandible was present in a 22-year-old
man who complained of precipitous growth and
pain. The incisional biopsy showed benign
solid/multicystic ameloblastoma. B, A segmental
resection was performed. D and E, Final
histopathology of the resection specimen showed
ameloblastic carcinoma
ADENOMATOID ODONTOGENIC
TUMOR
Origin - Tumor cell derived from
a). Enamel organ epithelium
b). Remnants of dental lamina
Clinical features
Age - younger patient (10 to 19yrs).
Site - anterior portion of the jaw
maxilla > mandible
Asymptomatic, painless, slow growing.
large lesions causes expansion of
bone.

Site of occurance
of AOT

A well circumscrbed
solid mass enveloping
the cown of this tooth

AOT variants

Central Peripheral
(intraosseous) (extraosseous)
1). Follicular type rare, small
involves crown of sessile masses on
an unerupted tooth facial gingiva of
maxilla
2). Extrafollicular type DD: Gingival
located b/w roots fibrous lesion
of erupted tooth
DD: globulomaxillary cyst
Usually unilocular with well defined
corticated border
may or may not contain a tooth
often contains fine calcifications.
tubular or duct like structures

Follicular Extrafollicular
Histopathology:
surrounded by fibrous capsule
Spindle shaped epithelial cells forming
sheets, strands or whorled masses of
cells
epithelial cells
Calcification-
small foci as
well as larger
areas
Treatment
Surgical enucleation (recurrence is rare).
CALCIFYING EPITHELIUM
ODONTOGENIC TUMOR
( Pindborgs tumor )
Definition:
It is a locally aggressive tumor consist of sheets
& strands of polyhedral cells in fibrous stroma
with no inflammatory component & are often
accompanied by spherical calcifications &
amyloid staining hyaline deposits.
Origin -Rest of dental lamina
-Reduced enamel epithelium
1% of all odontogenic tumor
Clinical features
CEOT

Central Peripheral
(intraosseous) (extraosseous)
age - 40yrs site - anterior gingiva
site - 2/3
rd
of appears as superficial
lesions in mandible soft tissue swelling
slow growing. of gingiva in a tooth
painless mass. bearing area or
edentulous area of
jaw
Radiographic features:
Early lesions - unilocular, old lesions -
multilocular or honey comb appearance.
Scalloped margins
entire radiolucency with calcified
structures of varying size & density
Snow driven appearance.
Histopathology:
sheets of polyhedral epithelial cells on
fibrous stroma
cells show pleomorphism, prominent
nucleoli & hyperchromatism.
Liesegang ring calcifications

amyloid stained by
congo red

A 40-year-old woman with a 5-year history
of an expansile mass of the left maxilla. The
patient with the Pindborg tumor in Figure 30-
38 is treated with hemimaxillectomy.

ODONTOMA
Most common type of odontogenic tumor
Hamartoma
Definition:
A non-neoplastic developmental anomaly or
malformation that contains fully formed
enamel and dentin.
Types:
1). Invaginated odontome(Dens invaginatus,
Dens in dente)
2). Evaginated odontome
3). Enamel pearl
4). Germinated odontome
5). Complex odontome
6). Compound odontome
Clinical features:
Age- 10 to 20yrs
Site - Maxilla > mandible
Slow growing , hard , painless mass
GARDNERS Syndrome is
associated with it
(a). Multiple odontomas
(b). Multiple osteomas
(c ). Intestinal polyps
(d). Epidermoid cyst
(e). Dermoid
tumor(fibrous)
2 Types
(1). Complex
(2). Compound
Compound odontoma
site - anterior part of maxilla
origin - repeated divisions of
tooth germs. By overgrowths
multiple budding of dental lamina
with formation of multiple tooth
germ.
Radiographically -
Dense opacity with radioluscent rim
surrounding it.
Collection of tooth like structures of
varying size & shape surrounded by
narrow radiolescent zone.
Histolopathology
Numerous denticles having structures of
normal teeth embedded in fibrous
connective tissue.

Complex odontoma
site - posterior part of maxilla
Consist of congomerated mass of enamel &
dentin which bears no anatomic resemblence to
a tooth.Cauliflower like mass of hard tissues.
Radiographically:
Calcified mass with the radiodensity of tooth
structures

Histolopathology:
Mass consist of enamel, mature tubular
dentine, cementum together with pulp &
PDL members in varying amount

CALCIFYING ODOTOGENIC CYST
(Odontogenic ghost cell cyst)
Definition:
A rare well circumscribed solid or cystic
lesion derived from odontogenic epithelium
that resembles follicular ameloblastoma but
consists ghost cells & spherical
calcifications.
Cutaneous counterpart- Benign calcifying
epithelioma of MALHERBE/ Pilomatrixoma
Clinical features
Origin - remnants of dental lamina
Site - areas anterior to molar
Age - most common in 2nd decade
painless asymptomatic slow growing
hard lesion
expansion of buccal cortical plate.

TYPES

Extaosseous Intraosseous
Focal localized generalized
swelling expansion of buccal
cortical plates

DD. gingival fibroma Dentigerous cyst
peripheral giant Ameloblastoma
Gingival cyst Adenomatoid
odontogenic cyst
Radiographic feature
Well circumscribed unilocular radiolucency
containing.
Flecks of indistinct radiopacities.
Histolopathology:
Epithelium lining a cystic space.
Epithelium consist of pallisaded columnar
cells with reverse polarity of nuclei. Inner
layer of stellate reticulum.
GHOST cells present.
Multiple spherical & diffuse calcification.
Deposites of hyaline material.
1). Curettage
2). Recontouring
3). Resection with or without loss of
continuity.
Curettage
Scrapping of the tumor tissue away
from bone. Tumor usually comes out
in
A, The patient underwent a segmental resection of
his odontogenic tumor B, As with the ameloblastoma,
specimen radiographs should be obtained when
resecting to verify the bony linear margin. A better
depiction of the stepladder pattern of the
odontogenic myxoma is noted on this specimen
radiograph.
Ameloblastic fibroma
painless mixed tumor occurring in younger
patients in the premolar and molar region.
Sharply demarcated radiographic borders.
Microscopically epi. Cells lie in conn. Tissue
stroma. Enucleation and curettage
An enucleation and curettage surgery is
performed in the patient of 15-years of age.
The associated permanent teeth are removed
with the tumor.
Ameloblasticfibro - odontoma
Tumor with features of ameloblastic fibroma
but that also contains enamel and
dentin.histologically epi. Islands in conn.
Tissue stroma .Radiographically well
circumscribed unilocular. Treated by
enucleation.
Ameloblastic fibrosarcoma
Malignant counterpart of ameloblastic
fibroma. Radiographically ill defined
destructive radiolucency.

Cellular mesenchyme shows
hyperchromatism and atypical cells with
island of ameloblastic epithelium

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