Lesson 3 - 5: Odontogenic Tumors

Odontogenic Myxoma, Cementoblastoma, Central Odontogenic Fibroma, Periapical Cemento-Osseous Dysplasia

4 Mesenchymal Odontogenic Tumors (Om, C, Cof, Pcod) (OCCP)

Odontogenic Fibromyxoma, Odontogenic Myxofibroma

Odontogenic Myxoma is aka __________/______

Odontogenic Myxoma

• Most common mesenchymal odontogenic tumor

Odontogenic Myxoma

• Benign, Aggressive tumor that is infiltrative and may recur

Ectomesenchyme

Etiology of Odontogenic Myxoma

Dermis, Heart, Genitourinary Tract, Gastrointestinal Tract, Liver, Spleen

6 Various sites for Odontogenic Myxoma (DH GG LS)

Myxosarcoma

rare variant of Odontogenic Myxoma

Odontogenic Myxoma

CF of _______ includes:

• NO GENDER predilection

• Adults, 10 - 50 y.o. (30 y.o.)

• Affected Site: Md = Mx

• Tooth bearing areas of the jaw

• Asymptomatic (early stages)

• Rare Variant: Myxosarcoma

Honeycomb Appearance

Radiographic appearance of Odontogenic Myxoma

Odontogenic Myxoma

_______ in a radiograph, presents a HONEYCOMB APPEARANCE

• Radiolucent (black), variable pattern

• Multilocular

• Soap bubble, Tennis Racket

• Cortical expansion or perforation and root displacement or resorption

Mucopolysaccharide matrix, Benign Fibroblasts and Myofibroblasts, Variable amounts of Collagen, Bony Islands

Histopathology of Odontogenic Myxoma (M BfaM, Vaoc, B) (4) (M B V B)

Odontogenic fibromyxoma

large amounts of collagen

Calcifying Epithelial Odontogenic Tumor, Odontogenic Keratocyst, Central Giant Cell Granuloma, Ameloblastoma, Central Hemangioma, Ossifying Fibroma

Differential Diagnosis for Odontogenic Myxoma (6)(C O C A C O)(Ceot, Okc, Cgcg, A, Ch, Of)

Surgical Excision

Treatment for Odontogenic Myxoma

Cementoblastoma

True Cementoma

Cementoblastoma

• rare, benign neoplasm

Osteoblastoma

Cementoblastoma resembles an ________

Cementoblast

etiology of Cementoblastoma

Cementoblastoma

Clinical Features of _________:

• NO GENDER predilection

• Young adults (2nd to 3rd decades)

• Affected site: Molar Area: 1st M (Md > Mx)

• Slow growing

• (+) pain, swelling

• Often associated with root of tooth (vital)

Radiopaque lesion surrounded by a thick uniform radiolucent ring

Radiographic appearance of Cementoblastoma

Dense mass of Mineralized Cementum-like material with numerous reversal lines

Histopathology of Cementoblastoma

Osteoblastoma

Histopathology of Cementoblastoma is similar to ____

Odontoma, Osteoblastoma, Focal Sclerosing Osteomyelitis, Severe Hypercementosis

Differential Diagnosis for Cementoblastoma (OO FS)(4) (OO, Fso, Sh)

Surgical removal of lesion and tooth

Standard Treatment for Cementoblastoma

Enucleation with Curettage, Hemimandibulectomy

Other treatment options for Cementoblastoma includes _________ and _______

true

true or false?

Cementoblastoma has a low recurrence rate

Central Odontogenic Fibroma

• rare, benign, ectomesencymal tumor

Peripheral Odontogenic Fibroma

Central Odontogenic Fibroma is the counterpart of _____ _____ _____

Central Odontogenic Fibroma

• proliferation of fibrous connective tissue with varying amounts of inactive odontogenic epithelium

Unknown

etiology of Central Odontogenic Fibroma

Central Odontogenic Fibroma

Clinical Features of ________:

• FEMALE predilection

• ALL age groups

• Affected site: Md = Mx, Anterior Mx, Posterior Md

• often asymptomatic

• Slow Growing mass

Typically radiolucent, Multilocular, Tooth displacement or resorption, Cortical Expansion

Central Odontogenic Fibroma in a radiograph (4) (Tr M Tdor Ce) (TMTC)

Fibrous tissue, spindle-shaped fibroblasts containing rests and strands of odontogenic epithelium

Histopathology of Central Odontogenic Fibroma

SIMPLE type, WHO type

2 Types for Histopathology of Central Odontogenic Epithelium

Dentigerous cyst, Odontogenic Keratocyst, Ameloblastic fibroma, Odontogenic myxoma, Ameloblastoma, Central Giant Cell Granuloma, Desmoplastic fibroma, Fibromyxoma

Differential Diagnosis for Central Odontogenic Fibroma (8)(D OA OA CDF) (Dc Okc Af Om A Cgcg Df F)

enucleation, excision

Treatment for Central Odontogenic Fibroma (2)(E E)

true

true or false?

Central Odontogenic Fibroma has an uncommon recurrence rate

Periapical Cemento-Osseous Dysplasia

• represents a reactive or dysplastic process

Cementoma

Periapical Cemento-Osseous Dysplasia is formerly known as ______

Focal Cemento-Osseous Dysolasia

a Cemento-Osseous Dysplasia that is NOT ASSOCIATED WITH TOOTH APEX

Unknown

Etiology of Periapical Cemento-Osseous Dysplasia

Periapical Cemento-Osseous Dysplasia

Clinical features of _________:

• Racial predilections (Black women)

• Middle Age (40 y.o.)

• Affected Site: Md (Anterior Periapical Region)

• Often Asymptomatic

• Usually multiple lesions (2 or more teeth)

progresses from Lucent to Mixed or Mottled pattern to Opaque lesion

Radiographic Appearance of Periapical Cemento-Osseous Dysplasia (pf Lt M/M tOl)

Osteolytic, Osteoblastic, Mature Stage

3 Stages of Periapical Cemento-Osseous Dysplasia (OOM) in terms of Radiograph

Osteolytic

• stage of periapical cemento-osseous dysplasia that presents a replacement of normal bone with fibrous CT

• radiolucent

Osteoblastic

• stage of Periapical Cemento-Osseous dysplasia presents a radiolucency and radiopacity

• aka Cementoblastic

Mature Stage

• stage of Periapical Cemento-Osseous Dysplasia wherein it has a solid opaque mass with well defined border / outline

• has a radiolucent halo

benign fibrous tissue, bone, cementum

Histopathology of Periapical Cemento-Osseous Dysplasia is a mixture of _____, _____, and ______

Early, Intermediate, Late

In histopathology of Periapical Cemento-Osseous Dysplasia, there are 3 Stages which are _______ (EIL)

Early

stage of Periapical Cemento-Osseous Dysplasia’s histopathology wherein there is high cellularity and vascularity but low mineralized tissue

Intermediate

stage of Periapical Cemento-Osseous Dysplasia’s histopathology wherein there is decreased cells and vascularity, there is also increased tissue

Late

stage of Periapical Cemento-Osseous Dysplasia’s histopathology where we expect high concentration of mineralized tissue // (nawawala cells)

Chronic Osteomyelitis, Ossifying Fibroma, Dentigerous Cyst, Odontogenic Keratocyst, Opaque Stage: Odontoma, Osteoblastoma, Focal Sclerosing Osteomyelitis

Differential Diagnosis for Periapical Cemento-Osseous Dysplasia (CODO , OOF)

none

treatment for Periapical Cemento-Osseous Dysplasia

Opaque stage

In Periapical Cemento-Osseous Dysplasia once the _______ is reached, the lesion stabilizes and causes no complications

Ameloblastic Fibroma, Ameloblastic Fibro-Odontoma, Odontoma

3 Mixed Odontogenic Tumors

Fibroodontoma

Ameloblastic Fibroma is aka _________

Ameloblastic Fibroma

• Slight variation of the same benign neoplastic process

• Rare, Benign Tumor

Ameloblastic Fibrosarcoma

________ (mesenchymal) is rare and it is also the malignant variant of ameloblastic fibroma

Ameloblastic Fibroma

Clinical Features of ________:

• No gender predilection

• Children and Young adults (12 to 40 yo)

• Affected site: Md (Molar-Ramus)

• Often associated with impacted tooth

• Slow growing, asymptomatic

• May cause jaw expansion

Unilocular, Multilocular

2 Types of Ameloblastic Fibroma (Accdg to Radiograph)

well-defined radiolucency with sclerotic margins, completely lucent

Radiographic appearance of Ameloblastic Fibroma (wdrwsm, cl)

radiolucent with opaque foci, combined lucent and opaque lesion

Radiographic appearance of Ameloblastic Fibro-odontoma (rwof, claol)

Lobular-Circumscribed pattern, Predominantly immature myxoid connective tissue, General absence of collagen, Ribbons or strands of odontogenic epithelium

Histopathology of Ameloblastic fibroma (4) (L-cp Pimct, Gaoc, Rosooe)

Areas resembling Ameloblastic Fibroma, One or more foci contain enamel and dentin, sometimes cementum

Histopathology of Ameloblastic Fibro-Odontoma (Araf, Oomfceadsc)

Ameloblastoma, Odontogenic myxoma, Dentigerous Cyst, Odontogenic Keratocyst, Central Giant Cell Granuloma

Differential Diagnosis of Ameloblastic Fibroma (5)(A Om Dc Okc Cgcg)

Calcifying Epithelial Odontogenic Tumor, Calcifying Odontogenic Cyst, Developing odontoma, Adenomatoid Odontogenic Tumor

Differential Diagnosis of Ameloblastic Fibro-odontoma (CCDA)

Curettage or Conservative Excision

Treatment of Ameloblastic Fibroma

true

true or false?

Ameloblastic fibroma has an uncommon recurrence rate

Odontoma

most common odontogenic tumor

Odontoma

Hamartoma rather than neoplasm

odontoameloblastoma

rare variant of odontoma (compound/complex)

Odontogenic

Etiology of Odontoma

Odontoma

Clinical Features of ______

• No gender predilection

• Children, Adults (2nd decade)

• Affected site: Mx > Md, Anterior Maxilla Posterior Mandible

• Compound: Anterior Jaws

• Complex: Posterior Jaws

• Often Asymptomatic

retained deciduous tooth, impacted tooth, alveolar swelling

3 Clinical Signs Suggestive of an Odontoma (RIA)

bag of marbles

Radiographic appearance of Compound Odontoma

Cauliflower Like

Radiographic appearance of Complex Odontoma

Compound Odontoma

• bag of marbles

• numerous tiny teeth in a single focus

• typically found in tooth-bearing area, between roots or over the crown of an impacted tooth

Complex Odontoma

• cauliflower like

• irregular radioopaque mass containing densely radio-opaque enamel

Compound Odontoma

• DENTICLES within Connective Tissue Capsule

• Normal arrangement of Enamel, Dentin, Cementum, and Pulp Tissues
  is a characteristic histopathology of ___________

Complex Odontoma

• Disorganized mass of mature dental tissues, including dentin, enamel, cementum, and pulp

Focal Sclerosing Osteitis, Osteoma, Periapical Cemental Dysplasia, Ossifying Fibroma, Cementoblastoma

Differential Diagnosis of Odontoma (5)(FOPOC) (Fso, O, Pcd, Of, C)

Surgical removal with respect to adjacent teeth or structures, Enucleation

Treatment for Compound Odontoma (Srwrtatas, E)

Surgical removal with respect to adjacent teeth or structures, Enucleation

Treatment for Complex Odontoma (Srwrtatas, E)

True

True or False?

Odontoma has a Low Recurrence Rate

Malignant Ameloblastoma, Ameloblastic Carcinoma, Ameloblastic Fibrosarcoma

3 Malignant Odontogenic Tumors (MAA)

Malignant Ameloblastoma

Clinical Features of _________

• No gender predilection

• Rarely encountered

• young age groups (30 yo)

• Affected site: Md > Mx

• Symptomatic (Pain)

• Swelling in the jaw

• Loose Teeth

• Difficulty with chewing or speaking

• Metastasize to local lymph nodes or distant organs (Lungs)

Benign appearing cells (conventional ameloblastoma)

Histopathology of Malignant Ameloblastoma (1) [Bac (CA)]

Lungs

When Malignant Ameloblastoma undergo metastasis _______ is usually the 1st distant organ to be affected

Unilocular/multilocular but less well-defined/irregular borders, Rapid bone destruction, Cortical perforation, Soft tissue involvement, Tooth Resorption

Radiographic Appearance of Malignant Ameloblastoma (5) (U/mblw-d/ib, Rbd, Cp, Sti, Tr) (URCST)

Ameloblastic Carcinoma

Clinical features of ________:

• rare, malignant tumor

• Older age groups (40 yo)

• Affected Site: Md

• Symptomatic (Pain)

• Facial asymmetry

• Tooth displacement

• Nerve paralysis

Cellular atypia with mitotic figures

Histopathology of Ameloblastic Carcinoma (1) (Cawmf)

Unilocular/multilocular but less well-defined/irregular borders, Rapid bone destruction, Cortical perforation, Soft tissue involvement, Tooth Resorption

Radiographic Appearance of Ameloblastic Carcinoma (5) (U/mblw-d/ib, Rbd, Cp, Sti, Tr) (URCST)

Ameloblastic Fibrosarcoma

• rare, MIXED malignant tumor

• Male Predilection

• 3rd decade (30’s)

• Affected site: Posterior Mandible

• Symptomatic (Pain)

• Occasionally painless facial mass with accompanying paresthesia (numbness)

Surgical resection with a wide margin, Resection, Adjuvant Radiotherapy and Chemotherapy, Immediate Reconstruction

treatment for Ameloblastic Fibrosarcoma (4) (Srwawm, R, Arac, Ir) (SRAI)

true

true or false?

Malignant tumors are not for conservative treatment