Odontogenic Tumours.pptx

ODONTOGENIC TUMORS

1. Odontogenic Tumours Dr. Anila K Reader Dept of Oral Pathology NDC, Raichur

2. Introduction Are tumours / neoplasms arising from tooth forming elements – Epithelial Mesenchymal Mixed Most of them are Neoplastic Benign Malignant Hamartomas Developmwental swellings Ectopic Conditions

3. Location – Intraosseous/ Central – Within the jaw –Maxilla / Mandible Extraosseous/ Peripheral – gingiva / palate Enamel Organ – Normal Series- Tooth will be missing Supernumerary teeth – No. Of teeth- Normal Clinical Features Middle age – 20-40 yrs

4. Nature : Benign Few are malignant – Not as aggressive Inductive Phenomena Odontogenic Epithelium induces underlying mesenchyme Dentine ,Cementum etc Dual Origin Epithelium + Mesenchymal Resemblance to normal odontogenic Tissue

5. Classification Depending on the nature Depending on the Origin Benign Malignant Epithelial Mesenchymal Mixed

6. Origin Enamel Organ Dental Lamina & Rests HERS Oral epithelium Epithelial Mesencymal Dental Papilla Dental Follicle Mixed Both Epithelial and Mixed

7. Benign Odontogenic Tumours Odontogenic Epithelium without ectomesenchyme Odontogenic ectomesenchyme with or without included epithelium Odontogenic Epithelium with odontogenic mesenchyme with or without hard tissue formation Malignant Odontogenic Tumours Odontogenic Carcinomas Odontogenic Sarcomas Odontogenic Carcinosarcomas

8. Odontogenic Tumours BENIGN Odontogenic Epithelium without ectomesenchyme Ameloblastoma Adenomatoid Odontogenic Tumour Calcifying Epithelial Odontogenic Tumour Squamous Odontogenic Tumour

9. Odontogenic Epithelium with odontogenic mesenchyme with or without hard tissue formation Ameloblastic Fibroma Ameloblastic Fibro-Odontoma Odontoameloblastoma Calcifying Odontogenic Cyst Complex/ Compound Odontoma

10. Odontogenic ectomesenchyme with or without included epithelium Odontogenic Fibroma Odontogenic Myxoma Cementoblastoma

11. MALIGNANT Odontogenic carcinoma Malignant ameloblastoma Ameloblastic Carcinoma Primary Intraosseous carcinoma Clear Cell Odontogenic Carcinoma Odontogenic Sarcoma Ameloblastic fibrosarcoma Ameloblastic Fibro- odontosarcoma

12. Ameloblastoma Adamantinoma Benign Epithelial Odontogenic Tumor Most Commonest odontogenic tumor Neoplasm of enamel organ without formation of enamel Robinson: “ Unicentric, nonfunctional, intermittent in growth, anatomically benign & Clinically persistent”

13. Clinical Features Age – Middle age – 20 -40 yrs Highest incidence -33yrs Rare in children Sex Males > Females

14. Site – Intraosseous Mandible > Maxilla = 5:1 Mandible Posterior – Molar & ascending Ramus PM & Symphsis Region Maxilla Anterior to premolar Antrum & Floor of nose

15. Extraosseous/Peripheral Ameloblastoma Gingiva Buccal Mucosa Extraoral Pituitary Gland- Craniopharyngioma Long Bones – Adamantinoma of Long Bones

16. Clinical Presentation Aymptomatic Hard swelling Slow growth Expansion of buccal & Lingual cortical plates Egg Shell Crackling Perforation Facial asymmetry Displacement, mobility, root resorption, malocclusion Later, Pain & paresthesia

17. Clinical Subtypes

18. Radiological features Multilocular radiolucency with well defined sclerotic margin Honey comb Soap Bubble

19. Soap Bubble Honey comb

20. Histopathology Mixed Histological Pattern Follicular Ameloblastoma Plexiform ameloblastoma Acanthamatous ameloblastoma Basal cell ameloblastoma Granular cell ameloblastoma Desmoplastic ameloblastoma Unicystic ameloblastoma

21. Follicular Ameloblastoma Most Common Variant Tumor Epithelium – Multiple round or ovoid follicles/ Islands Follicles resemble enamel organ of developing tooth germ Periphery – Cuboidal/ tall columnar cells –Resemble ameloblasts Nuclei – away from basement membrane – reversal of polarity Center : Loosely arranged polygonal/ angular cells- Resemble stellate reticulum

22. Follicles vary in size and shape Exhibit cystic degeneration in the center Affects the SR cells Stroma : Dense Fibrous Scanty and loosely arranged Hyalinised & Vascular

23. Plexiform Ameloblastoma Interconnecting, long anastomosing – cords / trabaculae of epithelium Less well defined ameloblast like cells Loosely arranged stellate reticulum like cells Stroma is loose and sparsely cellular Cyst formation in the stroma

24. Granular Cell Ameloblastoma Rare & Uncommon Aggressive High Recurrence rate SR Cells transform into granular cells Granular cells – large eosinophilic cells with abundant cytoplasm containing eosinophilic granules Granules contain – lysosomes – PAS +ve

25. Acanthematous ameloblastoma Central SR Cells – Squamous metaplasia Keratin Formation May be confused with Squamous cell carcinoma

26. Basaloid ameloblastoma Rare & Uncommon Central SR Cells – Basal cells Hyperchromatic cells, minimal basophilic cytoplasm Peripheral cells - Cuboidal May be confused with basal cell carcinoma

27. Desmoplastic ameloblastoma Very few tumor epithelial cells Dense Fibrous CT Desmoplasia – Increase collagen fibers Radiology – Mixed RL –Ro appearance Small islands & cords of epithelium No cystic degeneration Few ameloblast like cells – periphery Stroma – dense Calcification& bone formation - Occasionally

28. Unicystic ameloblastoma Cystic ameloblastoma “Single Cystic cavity that shows ameloblastomatous differentiation in the lining” Seen in Children – 2 nd decade Less aggressive Lower recurrence rate Site – Posterior region , mandible Asso. Impacted mand. 3 rd molar

29. Radiology Unilocular radiolucency asso. with unerupted teeth

30. Histopathology Cyst lined by epithelium Basal palisaded ameloblasat like cells – hyperchromatic nuclei & reversal of polarity Overlying cell – loose vacoulated Sr cells Tumour cells may exhibit Intraluminal Proliferation Mural Proliferation Plexiform Unicystic ameloblastoma

31. Extraosseous/ Peripheral ameloblastoma Middle aged pts M.F Mand > Max Site – Gingiva, buccal mucosa, alveolar mucosa Origin Remnant of dental lamina Basal cells of oral epithelium

32. H/P Typical ameloblastoma May be continuous with overlying epithelium Management Local Excision Recurrence - rare C/P : slow growing Nodular swelling Saucerisation of underlying bone

33. Extraoral ameloblastoma Arising from Pituitary gland – Craniopharyngioma Origin – Rathke ‘s pouch Children & Young adults Peripheral cells - Central nuclei Extensive Squamous metaplasia and keratinization Presence of ghost cells large eosinophilic cells-indistinct margins and remnants of nuclei Calcification

34. Extraoral ameloblastoma Arising in long bones – Adamantinoma of long bones Origin -Epithelial Entrapment Peripheral cells - Lack regular shape and reverse polarity Extensive cystic degeneration Locally invasive, metastasize and lethal

35. Malignant Change Malignant ameloblastoma Typical ameloblastoma Pulmonary and nodal metastasis Ameloblastic Carcinoma Ameloblastoma exhibiting malignant features -SCC Pulmonary and nodal metastasis

36. Adenomatoid Odontogenic Tumor Adenoameloblastoma Benign Epithelial Odontogenic Tumor Hamartoma – slow growth Limited size Circumscription Lack of recurrence 3-7 % of odontogenic tumours Remnants of dental lamina

37. Clinical Features Age : Younger Age – 2 nd -3 rd Decade Sex : F>M Site : Intraosseous Maxilla > Mand Max .Anterior Impacted Canine Mand – Posterior Impacted 3rd Molar Extraosseous – Gingiva - Maxilla

38. Clinical Presentation Asymptomatic Slow Growing Discovered on routine radiography May be associated with impacted tooth Swelling – hard, expansion of cortical plate Peripheral – Gingival Swelling Peripheral AOT

39. Radiologic Features Well circumscribed Unilocular radiolucency Specks of RO – Snow flakes Displacement of teeth Divergence of roots Gingival AOT – slight erosion of bone

40. Follicular Extra -Follicular

41. Histopathology Well Encapsulated Spindle, cuboidal cells arranged in Ducts Sheets whorls Rosettes Ducts – Lined by tall columnar cells Nuclei away from lumen

42. Lumen : Homogenous eosinophilic material - Hyaline Ring Pas +ve, Congo Red +ve Amyloid like material Basophilic Calcification : Cementum Dentinoid Connective tissue stroma Scanty –loose, less cellular Numerous thin walled BV

43. Behaviour And Treatment Conservative Enucleation Rarely Recur

44. Calcifying Epithelial Odontogenic Tumour Pindborg’s Tumor Uncommon Odontogenic Tumor Importance -Mistaken for poorly differentiated SCC Types Intraosseous Extraosseous Incidence -1-1.5%

45. Clinical features Age : 30-40 yrs Sex : No sex prelidiction Site : Mand > Maxilla Mand – Molar – Ramus area May be associated with impacted tooth

46. Clinical Presentation Slow growing asymptomatic swelling Peripheral Variant – Non specific sessile gingival mass

47. Radiologic Features Well circumscribed unilocular/ multilocular RL Diffuse RO within the lesion Driven snow appearance Especially around crown of impacted tooth

48. Histopathology Sheets Strands Islands Polygonal/ polyhedral cells Abundant eosinophilic cytoplasm Cell membrane distinct Prominent intercellular bridges Nuclear pleomorphism Gross variation in nuclear size Giant hyperchromatic nuclei Multinucleated cells Prominent nucleoli

49. Homogenous eosinophilic material Calcification- concentric masses Leisgang rings Amyloid like material Congo red + ve – Apple green bireferengence

50. Behavior And Treatment Locally invasive Similar to ameloblastoma Local excision/ resection

51. Mesenchymal Odontogenic Tumours

52. Odontogenic Fibroma Rare Benign Mesenchymal odontogenic tumour Incidence -3-4% Types Intraosseous Extraosseous

53. Clinical Features All ages, children & young Adults F>M Maxilla – anterior region Mand – post region Usually related to roots of teeth

54. Clinical Presentation Slow growing Asymptomatic swelling Discovered on routine R/G Mobility of teeth Peripheral : Sessile/pedunculated mass

55. Radiologic Features Well defined unilocular RL with sclerotic border Asso. – apices of erupted teeth Root divergence &Resorption

56. Histopathology Simple Type

57. Complex Type/WHO

58. Calcification occasionally Cementum Dentin Bone May have capsule

59. Odontogenic Myxoma Benign Mesenchymal Odontogenic tumour Rare in other bones Origin : Dental follicle// Dental Papilla Myxoblast/ Modified Fibroblast Incidence – 3-5 %

60. Clinical Features Age : young adults Sex : No Gender Prelidiction Site : Mand > Maxilla Mand : Ramus Region C/P : Slow growing, asymptomatic Locally Invasive Expansion of B&L cortical plate Loosening and displacement of teeth

61. Radiologic Features Multilocular RL with scalloped margins “Tennis Racket appearance” Thin Wispy septae at right angles to each other

62. Gross Appearance Slimy, Mucinous, gelatinous cut surface Floats in Formalin

63. Histopathology Scanty Cells Loose myxoid Stoma –Basophilic Hyalourinic acid & Chondroitin sulphate Cells – Stellate/Spindle Shaped Long Cell processes Collagen fibers If More – Myxofibroma Clumps and rests of odontogenic epithelium

64. Mixed Odontogenic Tumours

65. Ameloblastic Fibroma Ameloblastic Fibro-Odontoma Odontoameloblastoma Calcifying Odontogenic Cyst Complex/ Compound Odontoma

66. Ameloblastic Fibroma Rare Benign Odontogenic tumor Epithelial & Mesenchymal No differentiation to form Hard Tissue Resembles ameloblastoma

67. Age : Children & Young adults Sex : M> F Site : mandible – Post. Region C/P : Asymptomatic Slow Growth Expansion Of Jaws Clinical features

68. Radiologic Features Well circumscribed unilocular/multilocular RL surrounded by sclerotic border

69. Histopathology Mixed OT Epithelial Mesenchymal Epithelial Odontogenic Epithelium –Islands,Nests,Groups, long narrow cords Peripheral Cells – tall columnar, Reversal of polarity Central cells – Stellate reticulum Like SR cells are less numerous/ absent Cystic Changes unusual Epithelium sharply demarcated from surrounding stroma

70. Mesenchymal Component Resembles primitive mesenchyme-Immature Dental papilla Loose cellular, fibromyxoid Connective tissue Areas of juxtrapithelial hyalinization

71. Ameloblastic Fibro-Odontoma Mixed Odontogenic Tumor Dental Hard Tissue Formation Similar to Ameloblastic Fibroma Odontoma

72. Clinical features Age : Young Children <10yrs Sex : M>F Site : Max>Mand May be associated with unerupted tooth Asymptomatic Failure of eruption/Missing tooth

73. Radiologic Features RL asso. with RO

74. Histopathology Similar to Ameloblastic Fibroma Presence of dental hard tissue

75. Odontoma Not a true neoplasm Hamartoma Consists of mineralized tissue – varying proportions They do not develop further once fully calcified –Like teeth Develop during period of odontogenesis

76. Types of Odontome Compound Composite Odontome Complex Composite Odontome

77. Compound Composite Odontome Tooth tissues well organized Small teeth like structures - Denticle

78. Complex Composite Odontome Tooth tissues not well organized Irregular masses of varying proportions Appropriate anatomical relationships

79. Clinical features Age : Young Children , 1st /2 nd decade Sex : No gender prelediction Site : Max>Mand – anterior region Compound CO – Anterior maxilla Complex CO –Posterior Maxilla/Mand usually seen with permanent dentition May be associated with Unerupted tooth Dentigerous teeth

80. Asymptomatic Hard masses Detected on radiograph Failure of eruption/Missing tooth Problems Retention of Deciduous teeth Impacted/missing tooth Caries &Abscess formation Cyst formation

81. Radiologic Features RO lesion surrounded by RL Compound – Tooth Like Structures Complex – Irregular Calcified mass

82. Histopathology Complex CO Irregularly arranged enamel , dentin , cementum and pulp Compound CO Resemble denticles Arranged like normal tooth

83. COMPOUND COMPLEX