Neoplasia: Salivary Gland and Odontogenic Tumors

Name the types of salivary gland tumors

Pleomorphic adenoma, monomorphic adenoma, adenoid cystic carcinoma, mucoepidermoid carcinoma

Where can salivary gland tumors arise

In major or minor salivary glands

Where are minor salivary gland tumors most often located

At the junction of the hard and soft palate

What are adenomas

Benign tumors of the salivary glands

Is pleomorphic adenoma benign or malignant

Benign

What proportion of salivary gland tumors does pleomorphic adenoma represent

about 90%

What is the most common extraoral location for pleomorphic adenoma

The parotid gland

What is the most common intraoral location for pleomorphic adenoma

The palate

How does pleomorphic adenoma appear clinically

Slowly enlarging, nonulcerated, painless, dome-shaped mass

What is the primary treatment for pleomorphic adenoma

Surgical excision

What determines recurrence of pleomorphic adenoma

Success of the initial surgical removal

Can pleomorphic adenoma become malignant

Yes, in 2% to 4% of cases

What is a monomorphic adenoma

a benign encapsulated salivary gland tumor

Is monomorphic adenoma benign or malignant

Benign

What is the histologic pattern of monomorphic adenom

Uniform pattern of epithelial cells

Which demographic is most commonly affected

Adult females

Where does monomorphic adenoma most often occur

Upper lip and buccal mucosa

What is the treatment for monomorphic adenoma

Surgical excision

Is adenoid cystic carcinoma benign or malignant

Malignant

How does adenoid cystic carcinoma usually present clinically

May be ulcerated and painful

What is an adenoid cystic carcinoma (cylindroma)

A slow-growing malignant tumor of either major or minor salivary gland tissue

Where is the most common site of adenoid cystic carcinoma

Parotid gland

Is adenoid cystic carcinoma encapsulated

No, it is unencapsulated and infiltrates surrounding tissue

What do the tumor cells look like microscopically

Small, deeply staining, uniform epithelial cells forming a Swiss cheese pattern

What is the primary treatment for adenoid cystic carcinoma

Surgical excision

What is a mucoepidermoid carcinoma

A malignant salivary gland tumor

Is mucoepidermoid carcinoma encapsulated

No, it is unencapsulated and infiltrating

Where are major gland mucoepidermoid carcinomas most often found

Parotid gland

Where are minor gland mucoepidermoid carcinomas most often found

Palate

How do mucoepidermoid carcinomas typically present clinically

As slowly enlarging masses

What cell types make up mucoepidermoid carcinoma

Mucus cells and squamous-like epithelial cells called epidermoid cells

How may mucoepidermoid carcinoma appear in bone

As a unilocular or multilocular radiolucency

Can mucoepidermoid carcinoma occur in children

Yes, it is the most common malignant salivary gland tumor in children

Which sex is more commonly affected by mucoepidermoid carcinoma

Females

What is the primary treatment for mucoepidermoid carcinoma

Surgical excision

What are the main categories of odontogenic tumors?

Epithelial, mesenchymal, mixed, and peripheral odontogenic tumors

From what tissues are odontogenic tumors derived?

Tooth-forming tissues

What tissues can odontogenic tumors be composed of

Epithelium, mesenchyme, or a combination of both

Are most odontogenic tumors benign or malignant

Most are benign, but rare malignant forms exist

What is an ameloblastoma

A benign, slow-growing but locally aggressive epithelial odontogenic tumor

Is ameloblastoma benign or malignant

Benign, but locally aggressive

Is ameloblastoma encapsulated

No, it is unencapsulated and infiltrates surrounding tissue, including the brain

Where does ameloblastoma most commonly occur

Mandibular molar or ramus area

How does ameloblastoma appear radiographically

Multilocular soap bubble–like or honeycombed radiolucency

Can ameloblastoma be associated with a cyst

Yes with a dentigerous cyst

What clinical effect may ameloblastoma have on bone

Bone expansion

What is the treatment for ameloblastoma

Surgical removal

recurrence is common

What is a Calcifying Epithelial Odontogenic Tumor

A benign epithelial odontogenic tumor

What cell type composes Calcifying Epithelial Odontogenic Tumor

Polyhedral epithelial cells arranged in islands and sheets

What unusual material is found in Calcifying Epithelial Odontogenic Tumor

Amyloid-like material with calcifications

Which age group is most commonly affected by Calcifying Epithelial Odontogenic Tumor

Adults, no sex predilection

How does Calcifying Epithelial Odontogenic Tumor appear on X-ray

As a unilocular or multilocular radiolucency, sometimes with small calcifications

Where does Calcifying Epithelial Odontogenic Tumor most commonly occur

Mandible, usually around bicuspids and molars

How is Calcifying Epithelial Odontogenic Tumor treated

Surgical excision

What type of tumor is an adenomatoid odontogenic tumor

Encapsulated, benign epithelial odontogenic tumor

Who is most commonly affected in adenomatoid odontogenic tumor

Females under age 20

Which part of the jaw is usually involved in adenomatoid odontogenic tumor

Anterior portion of the jaws

Is it more common in the maxilla or mandible in adenomatoid odontogenic tumor

Maxilla

What teeth are often associated with adenomatoid odontogenic tumor

Impacted or unerupted teeth

What surrounds an adenomatoid odontogenic tumor

A dense, fibrous connective tissue capsule

What types of cells are found in the tumor

Cuboidal epithelial cells and spindle-shaped epithelial cells

What distinctive structures are in the tumor?

Ductlike structures

How does an Adenomatoid Odontogenic Tumor appear radiographically

A well-circumscribed radiolucency; may have radiopaque areas

What is the treatment for an adenomatoid odontogenic tumor

Enucleation

Name three common mesenchymal odontogenic tumors

Odontogenic myxoma, central cementifying and ossifying fibromas, benign cementoblastoma

What is an Odontogenic Myxoma

A benign nonencapsulated infiltrating tumor

Who is most commonly affected by Odontogenic Myxoma

Young people aged 10 to 29, both sexes equally

How does it appear on X-ray Odontogenic Myxoma

Multilocular, honeycombed radiolucency with poorly defined margins

Which jaw is most commonly affected in Odontogenic Myxoma

Mandible

What clinical effect can Odontogenic Myxoma have on teeth

It can displace teeth due to jaw expansion

What is the microscopic composition of odontogenic myxoma

Pale-staining mucopolysaccharide ground substance with dispersed cells having long cytoplasmic processes

How is odontogenic myxoma treated?

Surgical excision

may recur

What is a Central Cementifying and Central Ossifying Fibromas

A benign well-circumscribed tumor

Who is most commonly affected by Central Cementifying and Central Ossifying Fibromas

females in their 30s and 40s

Which jaw is most often affected by Central Cementifying and Central Ossifying Fibromas

Mandible

How does the radiographic appearance vary in Central Cementifying and Central Ossifying Fibromas

From radiolucent to radiopaque depending on the amount of calcified tissue

What is the microscopic composition of Central Cementifying and Central Ossifying Fibromas

Fibrous connective tissue with calcifications resembling cementum or bone

How are Central Cementifying and Central Ossifying Fibromas treated

Surgical excision, recurrence is rare

What is a benign cementoblastoma

A cementum-producing lesion

How do Benign Cementoblastoma appear on X-ray

Well-defined radiopaque mass with a surrounding radiolucent halo (the PDL)

How is a Benign Cementoblastoma treated

Surgical enucleation of the tumor and removal of the involved tooth

does not recur

Name three common mixed odontogenic tumors

Ameloblastic fibroma, ameloblastic fibro-odontoma, odontoma

What is an ameloblastic fibroma

A benign, nonencapsulated odontogenic tumor

Who is most commonly affected by ameloblastic fibroma

males under 20

Which part of the jaw is most commonly affected by ameloblastic fibroma

Mandibular bicuspid and molar region

What type of tissue is in ameloblastic fibroma

Both epithelial and mesenchymal odontogenic tissue

What tissues compose ameloblastic fibroma

Strands and islands of odontogenic epithelium + mesenchymal tissue resembling dental papilla

How does ameloblastic fibroma appear on X-ray

Well-defined or poorly defined radiolucency; can be unilocular or multilocular

What is the treatment for ameloblastic fibroma

Surgical excision

recurrence is low

What is a ameloblastic fibro-odontoma

A benign odontogenic tumor that has features of an ameloblastic fibroma and an odontoma

What age group is most affected by ameloblastic fibro-odontoma

Young patients, average age around 10 years

Where in the jaws does Ameloblastic Fibro-Odontoma usually occur

Posterior jaws

What clinical sign may be present in ameloblastic fibro-odontoma

Swelling of the affected area

How does ameloblastic fibro-odontoma appear on X-ray

Well-delineated radiolucency, may be unilocular or multilocular, with calcifications inside

How is ameloblastic fibro-odontoma treated

Conservative surgical excision

recurrence is unusual

What is a compound odontoma

A mass that resembles teeth

Usually located in anterior maxilla

What is a complex odontoma

A mass that does not resemble teeth

Usually located in posterior mandible

What is an odontoma is composed of

mature enamel, dentin, cementum and pulp tissue

Is an odontoma considered a true tumor

No, it is usually considered a developmental malformation (hamartoma)

In what age group are odontomas most commonly found

Adolescents and young adults