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Odontogenic Tumors Sources Epithelial rests of Serres Odontogenic Tumors Epithelial rests of Malassez...

Odontogenic Tumors Sources Epithelial rests of Serres Odontogenic Tumors Epithelial rests of Malassez Reduced enamel epithelium Camille M. Aquino, DDM 22 November 2016 University of Perpetual Help Laguna Odontogenic Tumors Types Epithelial Mesenchymal EPITHELIAL ODONTOGENIC Mixed TUMORS Epithelial Odontogenic Tumors Ameloblastoma Calcifying Epithelial Odontogenic Tumor Adenomatoid Odontogenic Tumor Calcifying Odontogenic Cyst Ameloblastoma Squamous Odontogenic Tumor  Ameloblastoma Ameloblastoma ETIOLOGY adamantinoma or adamantoblastoma unknown/ no single cause polarized ameloblasts Theories locally aggressive o cell rests of enamel organ high recurrence o epithelium of odontogenic origin high tendency to metastasize o disturbances of developing enamel organ o basal cells of the surface epithelium of the jaw o heterotrophic epithelium of other body parts (esp pituitary gland) Ameloblastoma Ameloblastoma CLINICAL FEATURES adults, 4th and 5th decades (35-45 yo) no gender predilection asymptomatic common CC: mobile teeth (severe) slow growing (-) palpation Ameloblastoma Ameloblastoma TYPES RX FEATURES solid soap bubble multicystic osteolytic, multi/unilocular, found in tooth- unicystic bearing areas of the jaw margins not circumscribed tooth resorption, loss of cortical bone  Ameloblastoma Ameloblastoma Ameloblastoma Ameloblastoma HX FEATURES with subtypes due to tissue differences common: polarization of cells cells similar to ameloblasts loosely arranged cells (s. reticulum) Ameloblastoma follicular HX FEATURES Subtypes Follicular Cystic Plexiform Acanthomatous Basal Granular  cystic plexiform basal granular acanthomatous Ameloblastoma TX Solid and multicystic: surgical excision up to resection Unicystic: enucleation up to excision Radiotherapy  Ameloblastoma Ameloblastoma DIFFERENTIAL DIAGNOSIS CEOT, odontogenic myxomas Dentigerous cysts, keratocysts Ameloblastoma Ameloblastoma Ameloblastoma Ameloblastoma  Ameloblastoma Ameloblastoma Other Variants Peripheral Extraosseous Ameloblastoma Peripheral Extraosseous Ameloblastoma surface epithelium/ rests of Serres/ Malignant Variants remnants of dental lamina o Malignant Ameloblastoma gingiva, rarely BM o Ameloblastic Carcinoma benign, non-aggressive, non-invasive, Pituitary Ameloblastoma rare, does not recur Adamantinoma of Long Bones Ameloblastoma Ameloblastoma Malignant Variants Pituitary Ameloblastoma regional lymph nodes, lungs, skull, liver, spleen, craniopharyngioma/ Rathke’s pouch tumor kidney, skin CNS, destroys the pituitary gland relatively younger age (30s) md > mx Adamantinoma of Long Bones Subtypes tibia (90%), ulna, femur, fibula o Malignant Ameloblastoma not related to ameloblastoma of jaw o Ameloblastic Carcinoma CEOT/ Pindborg Tumor ETIOLOGY unknown DL remnants and st intermedium Calicifying Epithelial Odontogenic Tumor  CEOT/ Pindborg Tumor CEOT/ Pindborg Tumor CLINICAL FEATURES RX FEATURES 2nd – 10th decade (mean: 40yo) unilocular/ multilocular no gender predilection honeycomb appearance md >> mx snowflake appearance molar-ramus area usually well-circumscribed IMP more RO than ameloblastoma noted through jaw expansion or routine rx if peripheral: anterior gingiva (rare) CEOT/ Pindborg Tumor CEOT/ Pindborg Tumor CEOT/ Pindborg Tumor CEOT/ Pindborg Tumor HX FEATURES polygonal epithelial cells varying nuclei in size, shape, and number Liesegang rings amyloid/ extracellular products – under Congo red stain, under polarized light with thioflavin (UV) abundant cytoplasm, eosinophilic  CEOT/ Pindborg Tumor CEOT/ Pindborg Tumor CEOT/ Pindborg Tumor CEOT/ Pindborg Tumor DIFFERENTIAL DIAGNOSIS TX RL: dentigerous, keratocysts, ameloblastoma, enucleation or excision myxoma has invasive potential but less than Mixed: COC ameloblastoma recurrence rate = 20% no reported malignancies Adenomatoid Odontogenic Tumor previously called as adenoameloblastoma usually benign Adenomatoid Odontogenic appears duct-like Tumor structure thought to be a hamartoma than a neoplasm Adenomatoid Odontogenic Tumor Adenomatoid Odontogenic Tumor CLINICAL FEATURES RX FEATURES 2nd decade (5-30yo) well-circumscribed lesion around the crown F>M of impacted tooth mx ant (50%) > md ant (35%) > mx post > md enameloid islands post bet anteriors: divergence of roots may be peripheral type: rare, only on gingiva seen lumen of well-encapsulated cyst-like space Adenomatoid Odontogenic Tumor Adenomatoid Odontogenic Tumor Adenomatoid Odontogenic Tumor Adenomatoid Odontogenic Tumor HX FEATURES lobular > reticular pattern polyhedral to spindle-shaped cells rosettes foci of enameloid epithelium with lumen Adenomatoid Odontogenic Tumor Adenomatoid Odontogenic Tumor DIFFERENTIAL DIAGNOSIS dentigerous cyst, lateral cyst RO: CEOT TX enucleation/ excision Calcifying Odontogenic Cyst “ghost cell tumor” rare, benign neoplasm but has a malignant variant Calcifying Odontogenic Cyst Calcifying Odontogenic Cyst Calcifying Odontogenic Cyst CLINICAL FEATURES RX FEATURES occurs at any age usually unilocular cystic 70% mx variation: multilocular with flecks of 2 variants: intraosseous and extraosseous calcification common site: alveolar ridge anterior to 1st occasionally erodes roots of adjacent teeth molar, occlusal in gingiva no pain or tenderness CC: expansion of both alveolar bone and soft tissue (1-8cm , 6 mos)  Calcifying Odontogenic Cyst Calcifying Odontogenic Cyst Calcifying Odontogenic Cyst Calcifying Odontogenic Cyst HX FEATURES Ghost cells Lining of cystic areas: squamous epithelial with cuboidal or ameloblast-like basal cells Calcifying Odontogenic Cyst TX Enucleation Little risk of recurrence Squamous Odontogenic Tumor  Squamous Odontogenic Tumor Squamous Odontogenic Tumor CLINICAL FEATURES HX FEATURES rare tumor affecting mainly young adults islands of sq epith ant mx & post md > post mx & ant md with flattened alveolar process of mx & md peripheral cells set in a fibrous stroma cyst-like or may mimic bone loss in perio foci of approximates roots of erupted teeth keratin/parakeratin behaves similar to a non-neoplastic cyst Squamous Odontogenic Tumor Squamous Odontogenic Tumor RX mimic severe bone loss from periodontitis cyst-like TX curettage & exo of involved teeth Squamous Odontogenic Tumor Squamous Odontogenic Tumor