revCT Scan - Ameloblastoma - Ria, Ayu, Zul, Ama - 17102025[1].pptx

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1. CT Scan Station SPV In Charge: dr. Aulia Hanum, Sp. Rad SPV Advisor: dr. Dini Rachma Erawati, Sp. Rad (K) dr. Aulia Hanum, Sp. Rad Resident: dr. Ria - dr. Ayu - dr. Zul - dr. Ama

2. Identitas pasien

3. Anamnesis Benjolan di rahang bawah kiri sejak 1 tahun terakhir, nyeri (-), benjolan membesar secara perlahan

4. Kesimpulan Lesi osteolitik dengan cortical thinning-expansion pada angulus hingga corpus mandibula kiri dengan floating teeth didalamnya , mengesankan unilocular ameloblastoma

5. TERIMA KASIH

6. Theory

7. Differential Diagnosis Odontogenic Keratocyst OKC are cystic lesions most commonly located in the mandibular ramus and body . OKC arise from dental lamina and a solitary, radiolucent, unilocular/multilocular, expansile lesion with smooth, corticated borders  . These cortices are often scalloped around the roots of teeth.  If large enough, they will resorb the roots of adjacent teeth. Dentigerous (Follicular) Cyst Dentigerous cysts are the second most common odontogenic cysts after periapical cysts and are typically seen in individuals in the 3rd to 4th decades of life. In distinction to periapical cysts, dentigerous cysts form around the crown of an unerupted tooth . They may grow to be large and may dis- place adjacent teeth ; an area of lucency may be seen near the root of an adjacent tooth. Resorption of the underlying bone or adjacent tooth root is not typically seen. Ameloblastoma Ameloblastomas represent 10% of odontogenic tumors (43) and occur pre-dominantly in the mandible. The four forms of ameloblastoma are multicystic (solid), unicystic, extraosseous (peripheral), and desmo- plastic. The multicystic form is the most common, representing approximately 85% of these lesions. The radiologic features of a typical ameloblastoma include unilocular or multilocular expansile radiolucent lesions often associated with an unerupted tooth .

8. Ameloblastoma Ameloblastomas  are locally aggressive benign tumors that arise from the mandible , or, less commonly, from the maxilla. Usually present as a slowly but continuously growing hard painless lesion near the angle of the mandible in the 3 rd  to 5 th  decades of life, which can be severely disfiguring if left untreated. Ameloblastomas typically occur as hard, painless lesions near the angle of the mandible in the region of the 3 rd  molar tooth (48 and 38) although they can occur anywhere along the alveolus of the mandible (80%) and maxilla (20%). When the maxilla is involved, the tumor is located in the premolar region and can extend up into the maxillary sinus. Although benign, it is a locally aggressive neoplasm with a high rate of recurrence. Approximately 20% of cases are associated with dentigerous cysts and unerupted teeth. 13

9. Ameloblastoma Types of ameloblastoma: Solid/multicystic type Folicular Plexiform Acanthomatous basaloid Desmoplastic Unicystic Luminal Intraluminal Mural

10. Ameloblastoma Ameloblastomas are locally aggressive benign tumors that arise from the mandible, or, less commonly, from the maxilla. Usually present as a slowly but continuously growing hard painless lesion near the angle of the mandible in the 3rd to 5th decades of life.

11. Ameloblastoma Synonyms: Adamantinoma, adamantoblastoma, and epithelial odontoma Mechanism From odontogenic epithelium, invasive , aggresive, slow growth Solid/multicystic type, unicystic type, and desmoplastic type

12. Ameloblastoma Location (80%) molar ramus RB Periphery usually well defined, cortical border Internal Structure: totally radiolucent Effects on Surrounding Structures root resorption

13. Multicystic ameloblastomas account for 80-90% of cases which are classically expansile "soap-bubble" lesions, with well-demarcated borders and no matrix calcification. Resorption of adjacent teeth and “root blunting” is often a feature. Unicystic ameloblastomas are well-demarcated unilocular lesions that are often pericoronal in position. These are commonly found in the posterior mandible, particularly at the molars Multicystic ameloblastomas Unicystic ameloblastomas

14. Unicystic type of ameloblastoma A This appears as a unilocular radiolucency resembling a cyst . However, unlike a cyst, it causes a break or discontinuity in the peripheral cortex and may even show trabeculae within the lumen. Spider-web pattern B This is the most common appearance, where the lesion is seen as a large radiolucent area with scalloped borders. From the center of the lumen coarse strands of trabeculae radiate peripherally, giving rise to a gross caricature of a spider. Soap-bubble pattern C This lesion is seen as a multilocular radiolucency with large compartments of varying sizes, giving rise to the soap-bubble appearance or a multi-chambered or multicystic 'bunch of grapes' appearance. Honeycomb or solid pattern D This is also called a beehive pattern. These are tumors with multiple small radiolucencies , surrounded by hexagonal or polygonal thick-walled bony cortices, giving rise to a honeycomb appearance.

15. Differential Diagnosis Ameloblastoma Unilocular ameloblastoma pada mahkota gigi yang tidak erupsi → dentigerous cyst Giant cell granulomas → terjadi pada pasien muda, septa lebih granular, wispy ill-defined septa Adanya internal bony septa → odontogenic keratocyst, giant cell granuloma, odontogenic myxoma, and ossifying fibroma Odontogenic myxoma → terdapat septa seperti amelo, tetapi hanya memiliki 1 atau 2 septa tipis yang sama, septa lurus, mixoma tidak se expansive ameloblastoma OKC → Terdapat curved septa, biasanya tumbuh tanpa menyebabkan ekspansi tulang ossifying fibroma → septa lebar, granular, ill defined, ukuran kecil, trabekula irregular

16. Kista Dentigerous Kista Radikular Keratokista Odontogenik Myxoma Odontogenik Dewasa muda Lokasi di sekitar crown gigi yang belum erupsi (M3) Patognomonik 🡪 bentuk bulat/ovoid, unilokular, batas tegas, tidak ada septa, ekspansi buccolingual Ukuran > 2 cm 🡪 bone expansion Tidak menginvasi korteks sekitar Tidak melibatkan akar gigi Dekade 3-5 Lokasi di sekitar akar apeks gigi karies (periapikal) Patognomonik 🡪 bentuk unilocular, berbatas tegas, dengan rim sklerotik tipis Ukuran < 1 cm Dekade 2-4 Lokasi di ramus atau korpus mandibula Patognomonik 🡪 bentuk unilokular/ multilokuler, bersepta Menginvasi korteks sekitar, ekspansi anteroposterior (jarang ekspansi buccolingual ) Lokasi di antara regio molar & premolar Patognomonik 🡪 tennis racket radiolusensi Lesi hipodens (76,9%), bone septae prominen MRI 🡪 T1WI mixed low-intermediate, T2WI hiperintens

17. Odontogenic Keratocyst Unilocular or multilocular well-defined cyst with scalloped margins. Characteristic anteroposterior expansion. If associated with unerupted tooth, it can envelop the entire tooth when large including the roots. Intermediate-to-high signal on T1W MRI and low-to-high signal on T2W MRI with restriction of diffusion. Thin or thick rim enhancement. OKC is lined with odontogenic para keratinizing squamous epithelium and thin fibrous wall with cheese-like contents within Key Imaging Features

18. Dentigirous Cyst Well-defined unilocular round to ovoid cyst with smooth margins. Surrounds the crown of unerupted/impacted tooth, usually the third molar. Roots of the tooth project out of the lesion. Dentigerous cyst is the most common noninflammatory cystic lesion of the jaw Key Imaging Features

19. Unilocular Mandibular odontogenic keratocysts (OKCs) with mesial displacement of the impacted third molar (curved arrow). Multilocular Mandibular odontogenic keratocysts (OKCs) occupying the posterior mandible and ramus with a soap-bubble pattern

20. Dentigerous cyst Dentigerous cysts , also called  follicular cysts , are slow-growing benign and non-inflammatory  odontogenic cysts  that are thought to be developmental in origin. On imaging, they usually present as a well-defined and unilocular radiolucency surrounding the crown of an unerupted or impacted tooth within the mandible. 

21. Odontogenic keratocysts Odontogenic keratocysts (OKC) , previously known as  keratocystic odontogenic tumors (KCOT  or  KOT) , are rare benign cystic lesions involving the  mandible  or  maxilla  and are believed to arise from dental lamina.

22. TERIMA KASIH