ONCOLOGY Past Paper PDF
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Centro Escolar University
2024
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This document is a past paper from Centro Escolar University, College of Dentistry, for the 2024-2025 academic year, focusing on oncology, specifically on odontogenic tumors and ameloblastoma. The paper details different types of ameloblastoma, their clinical features, radiographic features, differential diagnosis, treatment, and prognosis.
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CENTRO ESCOLAR UNIVERSITY ONCOLOGY COLLEGE OF DENTISTRY DR. FERNANDEZ S.Y. 2024-2025...
CENTRO ESCOLAR UNIVERSITY ONCOLOGY COLLEGE OF DENTISTRY DR. FERNANDEZ S.Y. 2024-2025 Most favored site- Mandibular molar-ramus area Maxilla - molar area is more frequently affected DEFINITION OF ONCOLOGY than the premolar and anterior regions a study of mass of inflammatory growth e.g. cells, neutrophils and lymphocytes deals with disease like tumor/cancer 1. TOPIC: DISEASE 1.1. OTHER TERM/S 1.2. CAUSE/S 1.3. LOCATION 1.4. AGE 1.5. SEX 1.6. CLINICAL FEATURES 1.7. RADIOGRAPHIC FEATURES 1.8. HISTOPATHOLOGIC FEATURES AGE: 1.9. DIFFERENTIAL DIAGNOSIS 1.10. TREATMENT Chiefly a lesion of the adult 1.11. PROGNOSIS Occurs predominantly in the 4th and 5th decades of life Age range is very broad - from childhood to late ODONTOGENIC TUMORS adulthood Mean age: 40 years originated from dental organ or dental lamina Types: SEX: ○ Epithelial Odontogenic Tumor ○ Mesenchymal Odontogenic Tumor no gender predilection for this tumor (Regezi) ○ Mixed Odontogenic Tumor male (Schaffer) A. EPITHELIAL TUMORS CLINICAL FEATURES: usually asymptomatic 1. AMELOBLASTOMA discovered during routine radiographic examinations from the early English word amel, meaning enamel jaw expansion + the Greek word blastos, meaning germ initial presenting signs: tooth movement or most aggressive tumor of the oral cavity malocclusion originates within the mandible or maxilla from epithelium that is involved in the formation of teeth PATHOGENESIS Potential sources of Ameloblastoma 1. enamel organ 2. odontogenic rest (rest of Malassez, rests of Serres) 3. reduced enamel epithelium (REE) 4. epithelial lining of odontogenic cysts, especially BIOLOGICAL SUBTYPES: dentigerous cyst MECHANISM BY WHICH AMELOBLASTOMA GAIN Peripheral or extraosseous ameloblastoma GROWTH AND INVASION ADVANTAGE: may occur in the gingiva and rare in the buccal mucosa 1. overexpression of TNF-a older patients, between 40 and 60 years of age 2. anti-apoptotic proteins (Bcl-2,Bcl-x1) may arise from rest of Serres 3. interface proteins (fibroblast growth factor (FGF) benign, nonaggressive 4. matrix metalloproteinases (MMPs) local excision recurrence is rare LOCATION: May occur anywhere in the mandible and maxilla Rica💓1 CENTRO ESCOLAR UNIVERSITY ONCOLOGY COLLEGE OF DENTISTRY DR. FERNANDEZ S.Y. 2024-2025 A peripheral ameloblastoma.This Photomicrograph displaying tumor arises from rests of Serres features of plexiform or alternately from basal epithelial ameloblastoma cells in the gingiva in a manner analogous to cutaneous basal cell carcinoma. 3. Desmoplastic ameloblastoma ○ the stroma is desmoplastic and the tumor islands become squamoid or elongated Cystic ameloblastoma formerly referred as unicystic ameloblastoma 4. Basal cell or basaloid ameloblastoma multilocular, shows cortical perforation ○ microscopically similar to basal cell high recurrence rate (40%) carcinoma seen in younger age-group (mean age: 35 years) 5. Granular cell ameloblastoma Unicystic ameloblastoma fulfilling the ○ the central neoplastic cells exhibit minimum criteria for this entity, which prominent cytoplasmic granularity should be distinguished from reactive epithelial changes in a radicular cyst. Granular cell ameloblastoma. Most of the tumor cells have an abundant, deeply granular Malignant variants of ameloblastoma cytoplasm. occurs relatively young-age group (30 years) appears in the mandible metastasizes to local lymph nodes or distant The center and left are organs odontogenic epithelium. The fibrous connective tissue stroma 1. Malignant ameloblastoma is right and bottom. Notice the loose ○ the primary and metastatic lesions are stellate reticulum-like appearance in microscopically well-differentiated the middle of epithelial island and tall 2. Ameloblastic carcinoma columnar cells with reverse nucleus ○ the primary and metastatic lesions exhibit at polarity at the outer edge of less microscopic differentiation epithelium. Ameloblastic carcinoma is RADIOGRAPHIC FEATURES: characterized by marked nuclear atypia and numerous mitotic figures. either unilocular or multilocular radiographic margins are usually well defined and sclerotic root resorption occasionally occurs in Sinonasal ameloblastoma association with ameloblastoma additional: soap bubble-like, honeycomb Mean age: 61 years Male predilection Signs: ○ nasal obstruction (difficult in breathing) ○ epistaxis (nose bleeding) ○ opacification HISTOPATHOLOGIC FEATURES: Subtypes: 1. Follicular type DIFFERENTIAL DIAGNOSIS: ○ composed of islands of tumor cells that mimic the normal dental follicle. Most 1. Odontogenic tumors common histological type. ○ CEOT, Odontogenic Myxoma 2. Non-odontogenic tumors 2. Plexiform ameloblastoma ○ Central giant cell granuloma, Ossifying ○ neoplastic cells developed into a network of fibroma, Central hemangioma epithelium. 3. Cyst ○ "Fish Net Pattern" ○ Dentigerous cyst Rica💓2 CENTRO ESCOLAR UNIVERSITY ONCOLOGY COLLEGE OF DENTISTRY DR. FERNANDEZ S.Y. 2024-2025 TREATMENT: maybe unilocular or multilocular well-circumscribed radiographically (radiolucent Surgical excision or may contain opaque foci) Block excision or resection - for large lesions Conservative treatment - for peripheral ameloblastoma Radiotherapy - rarely used (radioresistant) Additional Note: ○ Conservative treatment- only removes AFFECTED part ○ Radicular Treatment Mandibulectomy- removal of ENTIRE jaw Hemimandibulectomy- removal of HALF portion of jaw Ameloblastoma of the maxilla are generally difficult to manage due to anatomic relationship and due to the high content of cancellous bone in the maxilla The resected left half of a mandible containing an ameloblastoma, initiated at the third molar Figure 1: Panoramic radiograph showing a large and well-demarcated lytic lesion involving the PROGNOSIS: right body of the mandible, extending For curettage - 50% to 90% recurrence rate from the second molar to the first premolar (arrows). 2. CALCIFYING EPITHELIAL ODONTOGENIC TUMOR (CEOT) HISTOPATHOLOGIC FEATURES: OTHER TERM: large polygonal epithelial cells, seen in sheets or also known as Pindborg Tumor islands cytoplasm is abundant and eosinophilic LOCATION: focal zones of clear cells (clear cell variant) concentric calcific deposits (Liesegang rings)! Mandible - molar ramus region Calcifications (extreme left) in a CEOT account for the AGE: density noted on radiographs. 2nd to 10th decade Mean Age: 40 years These are thought to be calcified amyloid or SEX: amyloid-like material, some of which can be seen right of NO Gender predilection center as a pale eosinophilic globule (arrow). CLINICAL FEATURES: jaw expansion DIFFERENTIAL DIAGNOSIS: discovered after a routine radiographic examination E.g Cherubism(from doc) dentigerous cyst odontogenic keratocyst RADIOGRAPHIC FEATURES: ameloblastoma odontogenic myхоmа associated with impacted teeth adenomatoid odontogenic tumor Rica💓3 CENTRO ESCOLAR UNIVERSITY ONCOLOGY COLLEGE OF DENTISTRY DR. FERNANDEZ S.Y. 2024-2025 ameloblastic fibroodontoma ossifying fibroma osteoblastoma TREATMENT: surgical excision ranging from enucleation to resection aggressive surgery is contraindicated PROGNOSIS: overall recurrence has been less than 20%. 3. ADENOMATOID ODONTOGENIC TUMOR Adenomatoid odontogenic an odontogenic tumor that contains ductlike or tumor, medium power. Note Adenomatoid odontogenic glandlike structures how the tumor cells form balls tumor. Note the duct-like structures it was thought to be a subtype of ameloblastoma of cells that are called rosettes. OTHER TERM: RADIOGRAPHIC FEATURES: Adenoameloblastoma well circumscribed unilocular lesion usually LOCATION: around the crown of an impacted tooth lesions are typically radiolucent anterior maxilla, generally in association with the crowns of impacted teeth DIFFERENTIAL DIAGNOSIS: AGE: Dentigerous cyst Calcifying odontogenic cyst between 5 and 30 years with most cases CEOT appearing in the second decade SEX: Adenomatoid Odontogenic Tumor resembles a dentigerous cyst and is Female associated with an impacted maxillary anterior tooth. The CLINICAL FEATURES: radiolucency must be differentiated from a normal follicular space and rarely seen in peripheral gingival location from other pericoronal lesions HISTOPATHOLOGIC FEATURES: intracystic epithelial Adenomatoid Odontogenic Tumor proliferation is composed of polyhedral to spindle associated with an impacted first cells premolar. rosettes and duct like structures of columnar epithelial cells characteristic microscopic features TREATMENT: Conservative treatment (Enucleation) PROGNOSIS: Good prognosis (No recurrence - benign and encapsulated) Rica💓4 CENTRO ESCOLAR UNIVERSITY ONCOLOGY COLLEGE OF DENTISTRY DR. FERNANDEZ S.Y. 2024-2025 This is the gross appearance of the enucleated lesion. It is round and fully encapsulated. 4. CLEAR CELL ODONTOGENIC TUMOR DIFFERENTIAL DIAGNOSIS: OTHER TERM: CEOT None Central mucoepidermoid carcinoma metastatic acinic cell carcinoma CAUSE/S: metastatic renal cell carcinoma ameloblastoma etiology is unknown TREATMENT: LOCATION: Surgical excision rare neoplasm of the mandible and maxilla PROGNOSIS: AGE: metastases to lung and regional lymph node have 60 years of age been reported Fair to poor prognosis SEX: usually found in women B. MESENCHYMAL TUMOR 1. ODONTOGENIC MYXOMA a mesenchymal lesion that mimics microscopically the dental pulp or follicular connective tissue. Fibromyxoma- presence of large amounts of collagen CLINICAL FEATURES: OTHER TERM: locally aggressive Fibromyxoma HISTOPATHOLOGIC FEATURES: LOCATION: composed of sheet of cells with relatively clear maxilla and mandible have equal frequency cytoplasm AGE: RADIOGRAPHIC FEATURES: age range is from 10 to 50 years poorly circumscribed neoplasm mean age: 30 years SEX: no gender predilection Clear-cell odontogenic tumor in CLINICAL FEATURES: a nested pattern. benign neoplasm that may be infiltrative and aggressive Rica💓5 CENTRO ESCOLAR UNIVERSITY ONCOLOGY COLLEGE OF DENTISTRY DR. FERNANDEZ S.Y. 2024-2025 HISTOPATHOLOGIC FEATURES: PROGNOSIS: composed of bland, relatively acellular Very good myxomatous connective tissue 2. CENTRAL ODONTOGENIC FIBROMA OTHER TERM: None LOCATION: both mandible and maxilla AGE: seen in all age-group SEX: A, odontogenic myxoma. B, myxoid follicular sac with odontogenic rests. Fragments of reduced enamel None epithelium at far right. CLINICAL FEATURES: RADIOGRAPHIC FEATURES: rare lesion that is regarded as the central counterpart of peripheral odontogenic fibroma always with lucent pattern may appear as a well- circumscribed or a diffuse lesion often multilocular and often has a honeycombed pattern Odontogenic Myxoma of the left HISTOPATHOLOGIC FEATURES: mandible showing a honeycomb 2 patterns: expansible lesion 1. simple type - composed of mass of associated with an mature fibrous tissue containing few impacted tooth. epithelial rests. Odontogenic myxoma exhibiting the characteristic multilocular appearance A photomicrograph of the lesion shows with straight septa forming a dense fibrous connective tissue squares, rectangles and stroma containing a small number of triangles. odontogenic epithelial islands. DIFFERENTIAL DIAGNOSIS: 2. WHO type - mature connective tissue ameloblastoma contains abundant rests and calcific central hemangioma deposits (dentin or cementum) nerve sheath myxoma TREATMENT: A photomicrograph of the lesion shows a calcified cementum-like material. Surgical excision Curettage may result in incomplete removal of the neoplasm because the lesion is often loose and gelatinous in consistency. Rica💓6 CENTRO ESCOLAR UNIVERSITY ONCOLOGY COLLEGE OF DENTISTRY DR. FERNANDEZ S.Y. 2024-2025 RADIOGRAPHIC FEATURES: 1. Osteolytic stage - appears as periapical lucency that is continuous with the periodontal space multilocular often causing cortical expansion 2. Cementoblastic stage - the lucent lesion develops into a mixed or mottled pattern because of bone repair Odontogenic fibroma 3. Mature stage - appears as solid, opaque mass involving the that is often surrounded by a thin, lucent ring; the premolar-molar process may take months to years to reach the final region. stage DIFFERENTIAL DIAGNOSIS: Desmoplastic fibroma TREATMENT: enucleation or excision PROGNOSIS: Good recurrence is very uncommon HISTOPATHOLOGIC FEATURES: 3. PERIAPICAL CEMENTOOSSEOUS DYSPLASIA mixture of benign fibrous tissue, bone and represents a reactive or dysplastic process rather cementum than a neoplastic one unusual response of periapical bone and DIFFERENTIAL DIAGNOSIS: cementum to some undetermined local factor chronic osteomyelitis OTHER TERM: ossifying fibroma periapical granuloma or cyst formerly known as cementoma TREATMENT: LOCATION: no treatment is required mandible - anterior periapical region once the opaque stage (final) is reached, the 2 or more teeth are affected lesion stabilizes and causes no complications AGE: PROGNOSIS: middle age (around 40 years) rarely before the age of 20 Good SEX: 4. CEMENTOAMELOBLASTOMA women - especially black women rare benign neoplasm of cementoblast origin CLINICAL FEATURES: OTHER TERM: occurs at the apex of the vital teeth also known as True Cementoma asymptomatic LOCATION: RADIOGRAPHIC FEATURES: mandible - posterior region discovered on a routine radiographic examination 3 stages: Rica💓7 CENTRO ESCOLAR UNIVERSITY ONCOLOGY COLLEGE OF DENTISTRY DR. FERNANDEZ S.Y. 2024-2025 AGE: 2nd and 3rd decades of life (particularly before 25 years of age) SEX: None HISTOPATHOLOGIC FEATURES: appears as a dense mass of mineralized cementum-like material with numerous reversal lines cementoclast are also evident RADIOGRAPHIC FEATURES: the neoplasm is an opaque lesion that replaces the root of the tooth surrounded by a radiolucent ring Cementoblastoma, typical radiographic appearance of a ball of cementum clinging to the root. DIFFERENTIAL DIAGNOSIS: odontoma osteoblastoma focal sclerosing osteomyelitis hypercementosis TREATMENT: Extraction of the tooth PROGNOSIS: Good No recurrence Rica💓8