PL3 - OT - MESENCHYMAL.pdf

ODONTOGENIC TUMORS MERVIN SAM E. ECON DMD, MSCD, FRIDENT, RIDLS UNIVERSITY OF PERPETUAL HELP LAGUNA Odontogenic Tumors TYPES EPITHELIAL MESENCHYMAL MIXED MESENCHYMAL ODONTOGENIC TUMORS Mesenchymal Odontogenic Tumors ODONTOGENIC MYXOMA ODONTOGENIC FIBROMA CEMENTIFYING FIB...

ODONTOGENIC TUMORS MERVIN SAM E. ECON DMD, MSCD, FRIDENT, RIDLS UNIVERSITY OF PERPETUAL HELP LAGUNA Odontogenic Tumors TYPES EPITHELIAL MESENCHYMAL MIXED MESENCHYMAL ODONTOGENIC TUMORS Mesenchymal Odontogenic Tumors ODONTOGENIC MYXOMA ODONTOGENIC FIBROMA CEMENTIFYING FIBROMA CEMENTOBLASTOMA PERIAPICAL CEMENTAL DYSPLASIA DENTINOMA Odontogenic Myxoma Odontogenic Myxoma ALSO KNOWN AS ODONTOGENIC FIBROMYOMA, MYXOFIBROMA, FIBROMYXOMA ORIGIN: ECTOMESENCHYME BENIGN (INFILTRATIVE, AGGRESSIVE, MAY RECUR) RARE VARIANT: MYXOSARCOMA Odontogenic Myxoma CLINICAL FEATURES: YOUNG TO ADULT PATIENTS (MEAN AGE: 30) BONY EXPANSION, CORTICAL DESTRUCTION NO GENDER PREDILECTION MX = MD (SLIGHT PREDILECTION: POST MD) PREMOLAR AND MOLAR AREA SITE: TOOTH-BEARING AREAS OF THE JAWS Odontogenic Myxoma Odontogenic Myxoma RX FEATURES: RADIOLUSCENT, VARIABLE PATTERN MULTILOCULAR, “HONEYCOMB” PATTERN CORTICAL EXPANSION OR PERFORATION, ROOT DISPLACEMENT Odontogenic Myxoma Odontogenic Myxoma HX FEATURES: ACELLULAR MYXOMATOUS CT BENIGN FIBROBLASTS AND MYOFIBROBLASTS, SOME COLLAGEN MUCOPOLYSACCHARIDE MATRIX BONY ISLANDS Odontogenic Myxoma Loosely arrange stellate shaped cells with few collagen fibrils Odontogenic Myxoma Odontogenic Myxoma DIFFERENTIAL DIAGNOSIS CENTRAL HEMANGIOMA CEOT, AMELOBLASTOMA DENTIGEROUS CYST, OKC CENTRAL GIANT CELL GRANULOMA OSSIFYING FIBROMA Odontogenic Myxoma TX SURGICAL EXCISION CURETTAGE: INCOMPLETE REMOVAL CONSERVATIVE TX: RECURRENCE PROGNOSIS VERY GOOD NO METASTASIS Odontogenic Myxoma Odontogenic Fibroma Odontogenic Fibroma CLINICAL FEATURES ALL AGE GROUPS NO GENDER PREDILECTION MD ≥ MX ASYMPTOMATIC, SLOW-GROWING MASS, EXPANDING THE CORTEX Odontogenic Fibroma Odontogenic Fibroma RX FEATURES: RADIOLUSCENT, MULTILOCULAR Odontogenic Fibroma HX FEATURES: FIBROUS TISSUE, SPINDLE-SHAPED FIBROBLASTS CONTAINING RESTS AND STRANDS OF ODONTOGENIC EPITHELIUM 2 TYPES o Simple o WHO type Odontogenic Fibroma This central odontogenic fibroma has a loose stroma with fine collagen fibrils and small odontogenic epithelial rests Odontogenic Fibroma Odontogenic Fibroma TX SIMPLE ENUCLEATION OR EXCISION PROGNOSIS GOOD AGGRESSIVENESS WITH UNCOMMON RECURRENCE RATE Odontogenic Fibroma Odontogenic Fibroma Cementifying Fibroma Cementifying Fibroma CLINICAL FEATURES CENTRAL FIBROUS LESION SIMILAR TO ODONTOGENIC FIBROMA ADULTS (MEAN AGE: 40YO) M MX Cementifying Fibroma RX FEATURES RL WITH MORE OPAQUE FOCI ISLANDS OF CALCIFICATIONS WELL-CIRCUMSCRIBED SURROUNDED BY A SCLEROTIC MARGIN Cementifying Fibroma Cementifying Fibroma HX FEATURES CELLULAR FIBROUS MATRIX COLLAGEN FIBERS ARRANGED HAPHAZARDLY ISLANDS OR TRABECULAE OF NEW BONE OSTEOBLASTS Cementifying Fibroma Cementifying Fibroma DIFFERENTIAL DIAGNOSIS CEMENTOBLASTOMA OSSIFYING FIBROMA CHRONIC OSTEOMYELITIS TX CONSERVATIVE ENUCLEATION/ EXCISION RARE RECURRENCE Cementoblastoma Cementoblastoma TRUE CEMENTOMA RARE, BENIGN NEOPLASM OF CEMENTOBLAST ORIGIN Cementoblastoma CLINICAL FEATURES 2ND- 3RD DECADE, >> MX MD 1ST MOLAR – 50% SLOW GROWING CAUSES CORTICAL EXPANSION LOW-GRADE INTERMITTENT PAIN ASSOCIATED WITH A VITAL TOOTH Cementoblastoma HX FEATURES DENSE MASS OF MINERALIZED CEMENTUM-LIKE MATERIAL WITH NUMEROUS REVERSAL LINES INTERVENING WELL-VASULARIZED SOFT TISSUE CONTAINS CEMENTOBLASTS (NUMEROUS, LARGE, AND HYPERCHROMATIC) SIMILAR TO OSTEOBLASTOMA Cementoblastoma Cementoblastoma RX FEATURES WELL-CIRCUMSCRIBED RO MASS SURROUNDED BY A THIN UNIFORM RL RING Cementoblastoma DIFFERENTIAL DIAGNOSIS SEVERE HYPERCEMENTOSIS BONY ISLAND CHRONIC FOCAL SCLEROSING OSTEOMYELITIS ODONTOMAS OSTEOBLASTOMA Cementoblastoma TX SURGICAL REMOVAL BONE RELIEF NO RECURRENCE Periapical Cemental Dysplasia Periapical Cemental Dysplasia CEMENTOMA FOCAL CEMENTOOSSEOUS DYSPLASIA ETIOLOGY UNKNOWN JUST A REACTIVE PROCESS TO INFECTION/ TRAUMA Periapical Cemental Dysplasia CLINICAL FEATURES COMMON MIDDLE AGE (40 YO) M MX MD ANTERIORS, APEX OF VITAL TEETH ASYMPTOMATIC, USUALLY MULTIPLE LESIONS, VITAL TEETH Periapical Cemental Dysplasia RX FEATURES OSTEOLYTIC STAGE – RL CEMENTOBLASTIC STAGE – RL WITH RO MATURE STAGE - RO Periapical Cemental Dysplasia Periapical Cemental Dysplasia HX FEATURES BONE, CEMENTUM, FIBROUS TISSUE OSTEOLYTIC: PREDOMINANT FIBROSTROMA CEMENTOID: MIXED MATURE: ISLANDS, CALCIFIED Periapical Cemental Dysplasia DIFFERENTIAL DIAGNOSIS CAP ODONTOMA, ENDOSTOSIS HYPERCEMENTOSIS CHRONIC OSTEOMYELITIS OSSIFYING FIBROMA, GRANULOMA, OR CYST FOCAL SCLEROSING OSTEOMYELITIS OSTEOBLASTOMA Periapical Cemental Dysplasia TX NONE PERIODIC OBSERVATION Periapical Cemental Dysplasia FLORID OSSEOUS DYSPLASIA INVOLVES ALL QUADRANTS ASYMPTOMATIC RX: DIFFUSE RO MASSES THROUGHOUT THE JAW, “GROUND- GLASS” OR “CYST-LIKE” APPEARANCE DD: DIFFUSE SCLEROSING OSTEOMYELITIS TX: NONE Dentinoma Dentinoma CLINICAL FEATURES MD MOLAR AREA, ASSOCIATED WITH IMP YOUNG PATIENTS (+) SWELLING SOMETIMES WITH PAIN, MUCOSAL PERFORATION, SUBSEQUENT INFECTION EXTREMELY RARE, BENIGN Dentinoma RX FEATURES NOT SPECIFIC HX FEATURES “DENTINOID” OR OSTEODENTIN TX SURGICAL EXCISION AND CURETTAGE NO METS