Odontogenic tumors

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1. Odontogenic tumors
Asok kumar RS OMFS

2. Introduction
DEFINITION: “An abnormal mass of tissue, the growth of which exceeds and is
uncoordinated with that of the normal tissues and persists in the same excessive manner after
cessation of the stimuli which evoked the change” (Willis 1952).
ODONTOGENIC TUMORS- Group of lesions of the jaw derived from the primordial tooth
forming tissues (odontogenic epithelium) and present with a large number of histologic
variants.
Asok kumar RS OMFS

3. Sources
Cells that give rise to their odontogenic tumours are:
i.Cell rests of Serres
ii.Cell rests of Malassez
iii.Oral epithelium
iv.Ectomesenchyme/mesenchyme
Asok kumar RS OMFS

4. Classification
Modified WHO classification
A. BENIGN
 Odontogenic epithelium without odontogenic ectomesenchyme
i. Ameloblastoma
ii.Squamous odontogenic tumor
iii.Calcifying epithelial odontogenic tumor (Pindborg’s tumor)
iv.Adenomatoid odontogenic tumor
 Odontogenic epithelium with odontogenic ectomesenchyme with or without hard tissue formation
i. Ameloblastic fibroma
ii.Ameloblastic fibrodentinoma
iii.Ameloblastic fibro-odontoma
iv. Complex odontoma
v.Compound odontoma
vi.Odontoameloblastoma
vii. Calcifying cystic odontogenic tumor Asok kumar RS OMFS

5.  Odontogenic ectomesenchyme with or without odontogenic epithelium
i. Odontogenic fibroma
ii. Odontogenic myxoma (myxofibroma)
iii. Cementoblastoma
B. MALIGNANT
 Odontogenic carcinomas
i. Malignant ameloblastoma
ii. Ameloblastic carcinoma
iii. Primary intraosseous carcinoma
iv. Clear cell odontogenic carcinoma
v. Ghost cell odontogenic carcinoma
 Odontogenic sarcomas
i. Ameloblastic fibrosarcoma
ii. Ameloblastic fibrodentinosarcoma
iii. Ameloblastic fibro-odontosarcoma
Classification
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6. Odontogenic epithelium without
odontogenic ectomesenchyme
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7. Ameloblastoma
[Adamantinoma, adamantoblastoma]
True neoplasm of enamel organ type
1885- Malassez coined the term ‘adamantinoma’.
1934 -Churchill replaced the term ‘adamantinoma’ and named as
Ameloblastoma
Usually unicentric, nonfunctional,intermittent in growth
,anatomically benign and clinically persistent” [ Robinson]

Asok kumar RS OMFS

8. Ameloblastoma is believed to be derived from
i.Cell rest of enamel organ, remanants of dental lamina or Hertwig’s sheath,epithelial rest of Malassez
ii.Epithelium of odontogenic cysts, particularly the dentigerous cyst and odontomas.
iii.Disturbances of the developing enamel organ.
iv.Basal cells of the surface epithelium of the jaws.
v.Heterotopic epithelium in other parts of the body, especially the pituitary gland.
CLINICAL CLASSIFICATION
Unicystic ameloblastoma
Conventional or multicystic or solid ameloblastoma
Peripheral (extraosseous) ameloblastoma
Malignant ameloblastoma
Pituitary ameloblastoma (craniopharyngioma or Rathke’s pouch tumour)


Ameloblastoma

Asok kumar RS OMFS

9. Based on histological type
1.Follicular ameloblastoma
2.Plexiform ameloblastoma
3.Acanthomatous ameloblastoma
4.Granular cell ameloblastoma
5.Basal cell type of ameloblastoma
6.Desmoplastic ameloblastoma
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10. Clinical features
AGE: 20 and 40 years.
No significant gender predilection
SITE: mandible > maxilla(more than 80% mandible)
Mandible -80% [75% -molar and ramus region]
Maxilla -20%
Slow growing , hard, non tender swelling which often enlarges in size.
Facial asymmetry
Palpation elicit hard sensation or crepitus.
Not encapsulated
Invades surrounding tissues
Bone destruction is a common finding by invasion to bone marrow

Asok kumar RS OMFS

11. Mobility of teeth and exfoliation
Paresthesia
Keeps on enlarging and cause “egg shell crackling’’& fluctuation
MAXILLARY AMELOBLASTOMA :
Common in tuberosity. More aggressive and dangerous as
It may cause nasal obstruction
Proptosis of eye
Damage vital structures
Involve cranial base
Cause gross facial distortion
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12. Peripheral (extraosseous)Ameloblastoma

Occurs in the soft tissue outside and overlying the alveolar
bone.
Originate from either surface epithelium or remnants of
dental lamina
Slight predilection for males, 2 : 1 ratio of mandible over the
maxilla
 Found as nodules on the gingiva, varied in size from 3mm- 2
cm in diameter
Lacks the persistent invasiveness of the intraosseous lesion
 Histologically resembles the typical central ameloblastoma
Very limited tendency for recurrence
Asok kumar RS OMFS

13. Radiographic features
Multilocular radiolucency with well-
defined cystic spaces.
Honeycomb or soap bubble configuration.
Scalloping of the inner cortex with thin
cortex remains at the periphery.
Lesions in dentulous regions cause root
resorption and tooth displacement
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14. Unicystic ameloblastoma

6% of ameloblastomas.
Occur in a younger population
Associated with an impacted tooth
Considerably better overall prognosis and reduced incidence of recurrence.
Three histopathologic variants :
LUMINAL: Tumor is confined to the luminal surface of the cyst.
INTRALUMINAL/PLEXIFORM : Tumor projects from the cystic lining;
sometimes resembles the plexiform type of solid/multicystic
ameloblastoma.
MURAL: Tumor infiltrates the fibrous cystic wall.

Asok kumar RS OMFS

15. Goal of treatment


Complete eradication of lesion
Preservation of normal tissue as permissible
Excision with least morbidity
Restoration of tissue loss , form and function
Long term follow up
Unicystic and peripheral subtypes have a better prognosis than the solid type.
Infiltration of the tumor can be seen within 0.25 cm of bone margin for unicystic ameloblastoma with no
infiltration seen after 0.50 cm.
The safe surgical margin for follicular subtype is 0.75 cm.
Carlson et al – Advocates a safety margin of 1-1.5 cm is essential for the macroscopic clearance of tumor


Asok kumar RS OMFS

16. Management
[GOLD,UPTON AND MARX (1991)]
Enucleation.
Curettage.
Marsupialisation.
Cryosurgery
Chemical cauterisation with carnoy solution.
Resection with continuity defect.
Resection without continuity defect.
Chemotherapy
 Radiation.
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17. Surgical resection of ameloblasroma
Exposure of lesion
Segmental resection using Oscillating Saw
Resected specimen
Preoperative radiographs
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18. Calcifying Epithelial Odontogenic Tumor
[Pindborg tumor]
First described by Dr Jens J Pindborg [1956].
Uncommon, benign, odontogenic neoplasm
Locally invasive epithelial odontogenic neoplasm,
characterized by the presence of amyloid material
Arises from remnants of the primitive dental
lamina epithelial rests from stratum intermedium or
reduced enamel epithelium.
Asok kumar RS OMFS

19. Clinical features
 AGE :Middle-age
 GENDER: 49% -Men and 51% - Women.
 SITE: Mandible > Maxilla by a ratio of 2 : 1.
 Prevalence in the molar region is three times that in the bicuspid region
 VARIANTS:
i. Intra osseous
ii.Extra osseous
 Slow-growing, painless, expansile, hard, bony swelling
 Tooth tipping, rotation, migration and/or mobility secondary to root resorption
Asok kumar RS OMFS

20. Calcifying Epithelial Odontogenic Tumor

RADIOGRAPHIC FEATURES:
Well-circumscribed unilocular, multilocular radiolucent area
Scattered flecks of calcification throughout the radiolucency have gives a ‘driven
snow’ appearance
HISTOLOGIC FEATURES:
Polyhedral epithelial cells, in either compact sheets or scattered small islands, in a
fibrous connective tissue stroma.
Presence of calcification, sometimes in large amounts, and often in the form of
Liesegang rings
Apple-green color birefringence [Congo red stain]
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21. Treatment
Small, intrabony lesions with well-defined borders -Enucleation or
curettage followed by judicious removal of a thin layer of bone
adjacent to the tumor
Recurrent or persistent tumors (greater than 4 cm) - Segmental
resections such as partial or hemimandibulectomy or
hemimaxillectomy.
Asok kumar RS OMFS

22. Adenamatoid odontogenic tumor
NAMED BY- PHILIPSEN and BIRN in 1969
AGE : Mean age of 18 years, with a range of 5–53 years.
73% of the patient were under 20 years of age.
GENDER : Females[64% ] > Males [36% ].
SITE :Maxilla (65%) > Mandible (35%).
Occurs mostly in association with an unerupted maxillary cuspid
Occur within the jaw bones or the gingiva.
PERIPHERAL LESIONS: Painless, gingival colored mass that ranges from 1–1.5 cm in diameter.
10 times more prevalent in the maxillary gingiva than in the mandibular gingiva. Female to male ratio for
the gingival lesion is 14: 1 (Philipsen HP et al, 1991)

Asok kumar RS OMFS

23. RADIOGRAPHIC FEATURES:
Well-demarcated, unilocular radiolucency with smooth corticated border.
Lesions are pericoronal or juxtacoronal but the radiolucency may extend apically beyond the
cementoenamel junction on at least one side of the root 1 and 3 cm in the greatest diameter.
HISTOLOGIC FEATURES
Macroscopic :
Soft, roughly spherical mass with a distinct fibrous capsule. On gross sectioning, the tumor
may exhibit white to tan, solid to crumbly tissue with yellowish brown fluid or semisolid
material
Microscopic :
Multinodular proliferation of the spindle, cuboidal and columnar cells in a variety of patterns
comprising of scattered duct-like structures, eosinophilic material and calcification hyaline ring
MANAGEMENT :
Curettage or enucleation.[Tumour is encapsulated and the marrow space around the lesions is
free of tumour] Asok kumar RS OMFS

24. Squamous odontogenic tumor
(Benign epithelial odontogenic tumor)
“A benign, but locally infiltrative neoplasm consisting of islands of well-
differentiated squamous epithelium in a fibrous stroma. The epithelial islands
occasionally show foci of central cystic degeneration” (WHO).
First described by Pullon et al in 1975.
Arise from rests of dental lamina or may be from epithelial rests of Malassez.
GENDER: Male predominance
SITE : Mandible [bicuspid-molar area] > maxilla[incisor-cuspid area],

Asok kumar RS OMFS

25. Asymptomatic but presenting manifestations included mobility of involved teeth, pain, tenderness to
percussion, and occasionally, abnormal sensations.
RADIOGRAPHIC FEATURES.
No radiographic features to suggest the diagnosis
Usually it presents as a semicircular or roughly triangular radiolucent area, with or without a sclerotic
border, usually in association with the cervical portion of the tooth root.
HISTOLOGIC FEATURES:
Composed entirely of islands of mature squamous epithelium without a peripheral palisaded or
polarized columnar layer
MANAGEMENT :
Enucleation, curettage, and local excision
Clinically aggressive lesions -en bloc excision.
Asok kumar RS OMFS

26. Odontogenic epithelium with
odontogenic ectomesenchyme with
or without hard tissue formation

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27. Ameloblastic fibroma
[Soft mixed odontogenic tumor, soft mixed odontoma,fi broadamantoblastoma]
Mixed odontogenic tumour histologically similar to ameloblastomas.
First reported by Kruse in 1891
Consists of odontogenic ecto-mesenchyme resembling the dental papilla
and epithelial strands and nests resembling dental lamina and enamel
organ.
No dental hard tissue is present.
AGE: First two decades of life.
SITE: Common in male s than females.
SITE: Posterior mandible [70%] Asok kumar RS OMFS

28. Small amelobastic fibromas are asymptomatic
Larger tumors are associated with swelling of the jaws
RADIOGRAPHIC FEATURES
Appears as a multilocular radiolucency with sclerotic margins.
SIZE: ranges from 1 to 8 cm in diameter.
HISTOPATHOLOGICAL FEATURES
Dense fibrous capsule enclosing epithelial and connective tissue components.
Epithelium consists of ameloblast like or cuboidal cells.
Connective tissue collagen production resembles that of the immature dental
papilla.
TREATMENT
Conservative excision is the treatment of choice.
Resection including 0.5–1 cm of clinically sound bone is advocated.
Asok kumar RS OMFS

29. Ameloblastic fibro-odontoma
Tumor with the general features of an ameloblastic fibroma but
contains enamel and dentin
CLINICAL FEATURES:
AGE :Children with an average age of 10 years
SITE : Posterior regions of the jaws
GENDER: No gender predilection
Slow growing, expansile lesion with little tendency to infiltrate bone.
Patient presents with swelling, mild pain, altered occlusion and
delayed eruption of teeth

Asok kumar RS OMFS

30. HISTOPATHOLOGICAL FEATURES
Lacks typical ameloblastoma epithelium and has
an abundant stroma of immature dental papilla
like mesenchyme.
RADIOGRAPHIC FEATURES
Well-circumscribed unilocular or multilocular
radiolucent defect that contains a variable
amount of calcified material with radiodensity
of tooth structure.
MANAGEMENT
Curettage
Asok kumar RS OMFS

31. Odontoma
Hamartomas and one of the most common odontogenic tumour.
End products of anomalous completion or incompletion of tooth formation by odontogenic epithelium and
ectomesenchyme.
Contain all the four dental tissues—enamel, dentine, pulp and cementum.
Divided into two types [radiologically and histologically]:
i. Complex odontoma and
ii. Compound odontoma.
COMPOUND ODONTOMA - Composed of multiple small tooth like structures.
COMPLEX ODONTOMA - Irregular mass bearing no morphologic similarity to tooth.
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32. AGE: First two decades of life.
Mean age 14 years
SITE: Maxilla [67%] > Mandible [33%].
COMPOUND ODONTOMA - Anterior maxilla
COMPLEX ODONTOMAS - Molar region
Occurs in association with unerupted or impacted teeth, retained
deciduous teeth, swelling and evidence of infection
RADIOGRAPHIC FEATURES:
Complex odontoma - Irregular dense radiopaque mass, surrounded
by a thin radiolucent area, overlying a displaced unerupted tooth
Compound odontoma - Malformed or dwarfed teeth or tooth like
forms surrounded by a thin radiolucent zone.

Asok kumar RS OMFS

33. TREATMENT :
Surgical removal

Compound odontoma
OPG showing multiple
small tooth-like structures in the region of
21, 22.
CBCT
Intraoperative
view
Excised specimen
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34. ODONTOGENIC ECTOMESENCHYME WITH OR
WITHOUT INCLUDED ODONTOGENIC EPITHELIUM
I.Odontogenic fibroma
II.Odontogenic myxoma (myxofibroma)
III.Cementoblastoma
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35. Odontogenic fibroma
Benign, relatively rare connective tissue tumour.
Contains a variable amount of inactive odontogenic epithelium.
Derived from the ectomesenchymal tissue of the periodontal ligament,
dental papilla or dental follicle
Found both Intraosseously - Central odontogenic fibroma and
Extraosseously – [Gingiva] Peripheral odontogenic fibroma
CLINICAL FEATURES:
AGE: Range between 11 to 66 years with a mean age of 40 years.
GENDER: Female predominance of 2.8:1 ratio.
SITE: Mandible > Maxilla

Asok kumar RS OMFS

36. MANDIBLE-Molar and premolar areas
MAXILLA- Anterior region was affected.
CENTRAL :
Asymptomatic with progressive enlargement of the jaw.
Related to the roots of the teeth.
Displacement of adjacent teeth and mobility of teeth
PERIPHERAL :
Pink, firm, sessile or pedunculated mass on the attached gingiva.
SIZE:1–3 cm and are found anterior to the second premolar.
HISTOLOGICAL FEATURES:
CENTRAL :Contains more abundant epithelium and foci of dentinoid or cementum like material.

Asok kumar RS OMFS

37. Consists of cellular fibrous connective tissue and spindle shaped
fibroblasts which are often arranged in interlacing bundles
More cellular and has a greater abundance of collagen
PERIPHERAL:
Consists of cellular and collagenous fibrous tissue and small discrete
strands or rests of epithelial content.
RADIOGRAPHIC FEATURES:
Unilocular radiolucent area with well-defined often-sclerotic borders
MANAGEMENT :
CENTRAL –Enucleation and curettage
PERIPHERAL –Surgical excision

Asok kumar RS OMFS

38. Odontognic myxoma
[Odontogenic fibromyxoma or myxofibroma]
Locally invasive neoplasm consisting of rounded and angular cells that lie in an abundant
mucoid stroma. (WHO)
Benign, nonencapsulated, slow growing, infiltrative tumour of mesenchymal tissue
CLINICAL FEATURES:
Predominant in young adults with range of 25 -30 years.
No gender predilection.
SITE: Mandible > Maxilla
Asymptomatic, slow growing fusiform swelling of the jaw with the overlying mucosa
uninvolved.
Begins as a central mass and tends to spread slowly through the marrow spaces; followed by
expansion of bone and destruction of the cortex Asok kumar RS OMFS

39. HISTOLOGIC FEATURES:
 Made up of loosely arranged, spindle-shaped and stellate cells, many of which have
long fibrillar processes that tend to intermesh.
 Histochemical study - Ground substance composed of glycosaminoglycans
[hyaluronic acid and chondroitin sulfate]
RADIOGRAPHIC FEATURES:
 Mottled or honeycombed appearance
MANAGEMENT :
 Enucleation and curettage are restricted to unilocular lesions of 1–2 cm in diameter
 Large lesions- Wide excision or enbloc resection [myxomas are not encapsulated and
tend to infiltrate the surrounding bone]

Asok kumar RS OMFS

40. Cementoblastoma
[Benign cementoblastoma, true cementoma]
True neoplasm of cementum
Presenting less than 1% of all odontogenic tumors.
CLINICAL FEATURES
AGE: Predominantly in children and young adults [50% -
under the age of 20 and 75% - occurs before 30 years of age].
No significant gender predilection.
SITE:75% arise in the mandible with 90% arising in the
molar and premolar region .

Asok kumar RS OMFS

41. 50% involve the first permanent molar.
Rarely affect deciduous teeth.
Slow growing, but eventually produces a large lesion that may expand and resorb the
lateral and medial cortical bone associated with pain and swelling.
HISTOLOGIC FEATURES:
Central part of the lesion consists of a cementum like tissue containing reversal lines
and has a pagetoid appearance.
Centre of the tumour have prominent cementoblasts.
Periphery-Broad zone of unmineralised tissue and the mass has a fibrous capsule.

Asok kumar RS OMFS

42. RADIOGRAPHIC FEATURES
Appears as a radiopaque mass that is fused to one or more tooth roots
and is surrounded by a thin radiolucent rim.
Outline of the root or roots of the involved tooth is obscured.
Tumor consists of sheets and thick trabeculae of mineralized material
with irregularly placed lacunae.
MANAGEMENT :
Surgical extraction of the tooth together with the attached calcified mass.

Asok kumar RS OMFS

43. MALIGNANT ODONTOGENIC TUMOR

CARCINOMA
I.Malignant ameloblastoma
II.Ameloblastic carcinoma
III.Primary intraosseous carcinoma
IV.Clear cell odontogenic carcinoma
V.Ghost cell odontogenic carcinoma
SARCOMA
I.Ameloblastic fibrosarcoma
II.Ameloblastic fibrodentinosarcoma
III.Ameloblastic fibro-odontosarcoma

Asok kumar RS OMFS

44. Metastatic ameloblastoma
Metastatic ameloblastoma - Describe the metastatic tumor that shows histologic features of
classic ameloblastoma of jaw.
Metastatic ameloblastomas also termed as malignant ameloblastoma due to its biological
behavior of low-grade, well-differentiated, low-grade carcinoma
CLINICAL FEATURES:
AGE: Mean age is 30 years but 33% younger than 20 years of age.
SITE: Mandible.
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45. Metastatic nodules develop in the lung (80%), cervical lymph nodes (15%), or extragnathic
bones.
Pulmonary metastases are multifocal and involve both lungs.
HISTOLOGIC FEATURES:
Histologically indistinguishable from conventional ameloblastoma
MANAGEMENT :
Primarily managed by surgical resection.
Cervical lymph node metastasis managed by neck dissection.
Pulmonary metastasis managed by lobectomy
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46. Ameloblastic carcinoma
Malignant epithelial proliferation associated with an ameloblastoma (carcinoma ex
ameloblastoma) or histologically resembles an ameloblastoma (de novo amelo
blastic carcinoma)
Demonstrates greater cytologic atypia and mitotic activity than ameloblastoma
CARCINOMA EX AMELOBLASTOMA : Carcinoma directly contiguous with
an ameloblastoma is appropriately termed a ‘carcinoma arising from an
ameloblastoma’ (carcinoma ex ameloblastoma, carcinoma in ameloblastoma)
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47. DE NOVO AMELOBLASTIC CARCINOMA - Carcinoma lacks a component of
conventional ameloblastoma.
Histologically resembles ameloblastoma with plexiform architecture that exhibits
budding and anastomosing epithelial processes with peripheral palisaded cuboidal to
columnar cells
CLINICAL FEATURES:
AGE: Mainly affect the elderly range between 15 to 84 years.
GENDER: Male > Female ratio of was 1.4:1
SITE: Mandible
MANAGEMENT :
Radical surgery with neck dissection
Asok kumar RS OMFS

48. Primary Intraosseous Carcinoma.
Squamous cell carcinoma that occurs in the jaw bone.
Termed ‘intraosseous’ because it develops centrally within bone
First described by LOOS in 1913.
PINDBORG suggested the term Primary Intraosseous Carcinoma
Arise from central odontogenic epithelium and incisive canal epithelium [Rare]
CLINICAL FEATURES:
AGE: 6
th
and 7
th
decade of life.
GENDER: Male > Female with a ratio of 2:1
SITE : Mandible > Maxilla

Asok kumar RS OMFS

49. Rapid and diffuse expansion of jaw
Alveolar bone destruction
Pathological fracture and lip paresthesia
Perforation of cortical plate may occur
Cervical lymphadenopathy.
VARIANTS:
i.Solid primary intra osseous carcinoma
ii.Cystic primary intra osseous carcinoma
iii.Carcinoma ex odontogenic cyst
iv.Carcinoma ex odontogenic keratocyst
v.Central mucoepidermoid carcinoma Asok kumar RS OMFS

50. HISTOLOGIC FEATURES:
Plexiform pattern of peripheral cells of the tumor masses showing
palisading arrangement
Tumor cells exhibit nuclear pleomorphism and hyperchromatism,
mitotic activity
RADIOGRAPHIC FEATURES :
 Osteolytic bone changes
Margins are poorly defined, diffuse, and irregular
MANAGEMENT :
Surgical resection

Asok kumar RS OMFS

51. Ghost Cell Odontogenic Carcinoma
[Odontogenic ghost cell carcinoma, malignant epithelial odontogenic ghost cell
tumor]
Variant of malignant ameloblastoma with evidence of ghost cell keratinization
CLINICAL FEATURES:
AGE: Mean age 38 years, range between 13–72 years
GENDER: [75%] Male predominance
SITE: [66%] Maxilla.
Locally aggressive with metastatic potential
Have a biologic behavior similar to that of an ameloblastoma or a low-grade ameloblastic
carcinoma

Asok kumar RS OMFS

52. HISTOLOGIC FEATURES:
Stratified squamous epithelium that exhibit ghost cell keratinization.
Palisaded columnar cells at the periphery of tumor islands can create an
ameloblastomatic pattern.
Cytologic atypia, increased mitotic activity, an infiltrative growth pattern (perineural or
intravascular invasion) and necrosis
RADIOGRAPHIC FEATURES:
Expansile multiloculated ,poorly delineated radiolucent lesion
MANAGEMENT :
Wide surgical excision and postoperative radiotherapy.
Asok kumar RS OMFS

53. Clear Cell Odontogenic Carcinoma
(Clear cell ameloblastic carcinoma, clear cell ameloblastoma,clear cell odontogenic
tumor)
Low-grade carcinoma characterized by presence of uniform cells with clear cytoplasm.
CLINICAL FEATURES:
AGE: Range between 17–89 years.
GENDER: Female predilection [70% ]
SITE: Mandible [90%]
METASTASIS: [20%] Cervical lymph node metastases; [17%] lung metastases
HISTOLOGIC FEATURES:
Biopsy shows nests of epithelial cells with clear or faintly eosinophilic cytoplasm which is
separated by thin strands of hyalinized material

Asok kumar RS OMFS

54. Tumor islands can display peripheral ameloblastomatous palisaded columnar cells
Recurrent lesions may be more proliferative than the original tumor, with cells showing
greater mitotic index.
RADIOGRAPHIC FEATURES:
Ranges from unilocular radiolucency with indistinct borders to multiloculated lesions having
well-circumscribed borders.
MANAGEMENT :
Extensive resection
Tumor has high recurrence rate (48%) after resection.
Mortality rate : 20 %
EXTENSIVE EXTRAOSSEOUS TUMORS - Postoperative radiotherapy.

Asok kumar RS OMFS

55. Malignant proliferation of connective tissue cells that contains benign odontogenic
epithelium
Similar to ameloblastic fibroma.
CLINICAL FEATURES:
AGE: Mean age of 33 years
GENDER: [60%] Men.
SITE: [80%] Mandible predominantly the posterior segment
Arises from ameloblastic fibroma [35%].

Ameloblastic Fibrosarcoma
(Odontogenic sarcoma, ameloblastic sarcoma)

Asok kumar RS OMFS

56. HISTOLOGIC FEATURES:
Mesenchymal tissue exhibits a remarkable increase in cellularity,
pleomorphic with hyperchromatic nuclei and numerous atypical
mitotic figures.
RADIOGRAPHIC FEATURES
Expansile radiolucency with indistinct margins and evidence of
extraosseous soft tissue extension.
Gross expansion and thinning of cortical bone
MANAGEMENT
Radical resection and postoperative radiotherapy.
Neck dissections are not recommended as the tumor is not known
to metastasize.
Asok kumar RS OMFS

57. Rare malignant odontogenic sarcomas
Ameloblastic fibrosarcoma demonstrate focal evidence of dentin formation or dentin and
enamel formation
Insignificant dental hard tissue component resulted in the terms ‘AMELOBLASTIC
DENTINOSARCOMA ’ and ‘AMELOBLASTIC ODONTOSARCOMA ’ respectively.
WHO in 1992 :
Odontogenic sarcomas without dental hard tissues - AMELOBLASTIC FIBROSARCOMAS
With evidence of dentinoid – AMELOBLASTIC FIBRODENTINO SARCOMAS
Dentinoid plus enameloid - AMELOBLASTIC ODONTOSARCOMAS .


Ameloblastic dentinosarcoma and Ameloblastic
odontosarcoma

Asok kumar RS OMFS

58. HISTOLOGICAL FEATURES:
Consists of an dysplastic epithelial and an ectomesenchymal
component, both including dentinoid.
The epithelial component is composed of follicles and strands of
odontogenic epithelium
MANAGEMENT :
Radical surgery
Asok kumar RS OMFS

59. Asok kumar RS OMFS