Odontogenic Tumors Quiz

Ameloblastic Fibroma and Ameloblastic Fibro-odontoma

• Location: Mandibular molar-ramus region
• Age: Mean age 12 years, upper limit 40 years
• Gender: No gender predilection
• Radiographic Feature: Lesions well-circumscribed, usually surrounded by a sclerotic margin. May be unilocular or multilocular, associated with the crown of an impacted tooth. Ameloblastic fibro-odontoma shows an opaque focus due to odontoma; ameloblastic fibroma is completely radiolucent.
• Histopathologic Feature: Lesions are lobulated, usually surrounded by a fibrous capsule. Tumor mass composed of myxoid connective tissue. Ameloblastic fibro-odontoma may have one or more foci containing enamel and dentin.
• Differential Diagnosis (for Fibroma): Ameloblastoma, odontogenic myxoma, dentigerous cyst, odontogenic keratocyst, central giant cell granuloma, histiocytes.
• Differential Diagnosis (for Fibro-odontoma): CEOT (Calcifying odontogenic cyst), developing odontoma, adenomatoid odontogenic tumor.
• Treatment: Conservative surgical procedure
• Prognosis: Good, recurrence uncommon

Odontoma

• Location: Maxilla slightly more affected than mandible. Anterior jaws for compound odontoma; complex in posterior jaws.
• Age: Children and young adults, discovered in the 2nd decade, the age range extends into later adulthood. Deciduous & impacted teeth are common
• Gender: No gender predilection
• Clinical Feature: Clinical signs are suggestive of an odontoma, with retained deciduous teeth or impacted teeth, alveolar swelling, asymptomatic conditions.
• Radiographic Feature: Compound shows numerous tiny teeth in a single focus; roots or over the crown of an impacted tooth. Complex odontoma is amorphous, opaque mass in the region.
• Histopathologic Feature: Normal appearing enamel, dentin, and pulp in these lesions.
• Differential Diagnosis: Focal sclerosing osteitis, osteoma, periapical cemental dysplasia, ossifying fibroma, cementoblastoma
• Treatment: Enucleation
• Prognosis: Good, no recurrence.

Ameloblastic Odontoma

• Location: Mandibular premolar/molar regions, distal to the mandibular first molar.
• Age: Any age, children, 19 years old, known for some months to years prior
• Gender: No gender predilection
• Clinical Feature: Slowly expanding lesion, facial deformity, bone destruction (mild pain), delayed tooth eruption.
• Radiographic Feature: Presence of numerous radiopaque masses.
• Histopathologic Feature: Consists of a great variety of cells and tissues in a complex distribution.
• Differential Diagnosis: Similar to ameloblastoma.
• Treatment: Same as ameloblastoma
• Prognosis: Expect recurrence if not totally removed.

Teratoma

• Location: Ovaries, testes, mediastinum, retroperitoneal area, pineal head, neck.
• Age: Present at birth.
• Gender: No gender predilection
• Clinical Feature: Usually cystic lesion with solid thickening in the walls of the lesion
• Histopathologic Feature: Made up of different tissues such as hair, sweat glands, sebaceous glands, salivary glands, and teeth.
• Differential Diagnosis: Dermoid cysts
• Treatment: Conservative surgical excision
• Prognosis: Good, no recurrence.

Ossifying Fibroma

• Location: Head and neck (jaws & craniofacial bones). Specifically mandible premolar - molar region.
• Age: 3rd and 4th decade of female life.
• Gender: Female
• Clinical Feature: Slow growing, asymptomatic, expansive lesion, causes thinning of buccal and cortical plates.
• Radiographic Feature: Well-circumscribed, sharply defined border (LUCENT)
• Histopathologic Feature: Composed of fibrous connective tissue with well-differentiated spindle fibroblast
• Differential Diagnosis: Fibrous dysplasia, osteoblastoma, focal cemento-osseous dysplasia, focal osteomyelitis.
• Treatment: Surgical removal (curettage or enucleation).
• Prognosis: Good.

Fibrous Dysplasia

• Location: Maxilla more frequent than mandible; may extend to involve maxillary sinus, zygoma, sphenoid bone, and floor of the orbit.
• Age: First or second decade of life
• Gender: More frequent in females
• Clinical Feature: Asymptomatic, slow enlargement, presents as unilateral swelling, facial asymmetry, displacement of teeth, malocclusion, interference with tooth eruption.
• Radiographic Feature: Radiolucent to uniformly radiopaque mass. Mottled radiolucent and radiopaque appearance, fingerprint bone pattern & superior displacement of mandibular canal. Poorly defined radiographic and clinical margins.
• Histopathologic Feature: Slight to moderate cellular fibrous connective tissue stroma. Features fibrillar bony trabecular bone
• Differential Diagnosis: Ossifying fibroma; chronic osteomyelitis.
• Treatment: Small lesion: no treatment. Large lesion: surgical recontouring, block resection for complete removal.
• Prognosis: Malignant transformation is rare (less than 1% of cases). Good prognosis possible.

Osteoblastoma/Osteoid Osteoma

• Location: Posterior tooth-bearing regions of the maxilla and mandible, vertebrae, & long bones.
• Age: 2nd decade of life; 90% of lesions before age 30
• Gender: More common in males (2:1).
• Clinical Feature: Pain (severe in osteoid osteoma, relieved by aspirin), localized swelling, nocturnal pain.
• Radiographic Feature: Well-circumscribed, mixed lucent-opaque pattern. Thin radiolucency may be noted surrounding a central calcified tumor mass.
• Histopathologic Feature: Composed of irregular trabeculae of osteoid and immature bone within a stroma.
• Differential Diagnosis: Cementoblastoma, ossifying fibroma, fibrous dysplasia, osteosarcoma.
• Treatment: Conservative surgical approach (curettage or local excision).
• Prognosis: Good.

Osteoma

• Location: May arise in maxilla and mandible, facial and skull bones, and paranasal sinuses
• Age: 2nd & 5th decades of life
• Gender: Equal incidence in genders
• Clinical Feature: Usually solitary, headaches, recurrent sinusitis, ophthalmologic complaints (depending on the lesion location), periosteal osteoma -asymptomatic, slow-growing, bony (hard masses), endosteal is discovered during routine examination as dense radiopacities.
• Radiographic Feature: Well-circumscribed, mixed lucent-opaque pattern for Periosteal osteoma
• Histopathologic Feature: Composed of relatively dense, compact bone, sparse marrow tissue, lamellar trabeculae of cancellous bone, with abundant fibrofatty marrow.
• Differential Diagnosis: Exostoses of jaws, osteoblastoma, osteoid osteoma, odontoma
• Treatment: Surgical excision.
• Prognosis: Good.

Chondroma

• Location: Maxilla - anterior region, mandible - body & symphysis, coronoid process, and condyle
• Age: Before age 50
• Gender: Equal incidence in genders
• Clinical Feature: Painless, slowly progressive, growing swelling, rarely resulting in mucosal ulceration
• Radiographic Feature: Irregular radiolucent area
• Histopathologic Feature: Consists of well-defined lobules of mature hyaline cartilage.
• Differential Diagnosis: (Need to specify which one you are looking at - different lesions require different differential diagnosis).
• Treatment: Surgical excision
• Prognosis: No recurrence evident