Odontogenic Tumors of Oral Cavity: Dr. Deepak K. Gupta

Odontogenic Tumors Of
Oral Cavity
Dr. Deepak K. Gupta
WHO Classification
Benign
• Odontogenic epithelium without odontogenic ectomesenchyme
– Ameloblastoma
– Squamous odontogenic tumor
– Pindborg’s tumor
– Clear cell odontogenic tumor
• Odontogenic epithelium with odontogenic ectomesenchyme
with or without dental hard tissue formation
– Ameloblastic fibroma
– Ameloblastic fibro-odontoma
– Ameloblastic fibro-dentinoma
– Odontoameloblastoma
– Adenomatoid odontogenic tumor
– Complex and compound odontoma
• Odontogenic ectomesenchyme with or without including
odontogenic epithelium
– Odontogenic fibroma
– Odontogenic myxoma
– Benign cementoblastoma www.facebook.com/notesdental
WHO Classification
Malignant tumor
• Odontogenic carcinoma
– Malignant ameloblastoma
– Primary intraosseous carcinoma
– Malignant variant of other odontogenic epithelial
tumors
– Malignant changes in odontogenic cyst
• Odontogenic sarcoma
– Ameloblastic fibrosarcoma
– Ameloblastic fibrodentinosarcoma
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AMELOBLASTOMA
Calcifying Epithelial Odontogenic
Tumor (CEOT)
Calcifying Epithelial Odontogenic
Tumor (CEOT)
• Pindborg’s tumor or
calcifying
ameloblastoma
• Arises from the
Reduced enamel
epithelium (REE) or
dental epithelium
• 1% of all
odontogenic tumors
Clinical Features
• Age and sex: common in men, 8 to 92 years with
a mean age of 42 years
• Site: mandible is more commonly affected (2:1),
developed in premolar & molar area
• Symptoms
– Asymptomatic - painless swelling
– rare cases, there is associated mild paresthesia
• Signs
• cortical expansion occurs
• hard tumor with well defined or diffuse border
• locally invasive with a high recurrence rate.
Radiographic Features
• Driven snow appearance: Combined pattern of
radiolucency and radiopacities
– Radiopacity due to mineralization of amorphous
proteinaceous material generated by the tumor cells
– Multilocular or honeycomb pattern
• Scalloped margin
• May displace the developing tooth or prevent its
eruption
• Expansion of cortical plate
Histopathological Features
• Consist of sheets or strands of epithelial cells in a
connective tissue stroma
• epithelial cells are polyhedral and typically have
distinct outlines
• Nuclei - Gross variation in size, including giant nuclei,
hyperchromatic
• Unlike most carcinomas, a stromal inflammatory
reaction is typically absent.
• Typically homogeneous hyaline areas, similar to
the staining characteristics of amyloid
• These may calcify and form concentric rings in and
around degenerating epithelial cells
Differential Diagnosis
• Mixed radiolucent and radiopaque
– Calcifying odontogenic cyst,
– Adenomatoid odontogenic tumor,
– Fibro-osseous lesion
– Osteoblastoma
• Radiolucency predominates
• Dentigerous cyst,
• Odontogenic keratocyst
• Ameloblastoma
• Odontogenic myxoma
Treatment
• Local, conservative excision including a thin
rim of normal bone
• Peripheral lesions with a narrow periphery of
normal – appearing mucosa
• Prognosis
– Very good
– Recurrence rate is low, from 10 to 15%
– Long-term follow-up recommended
Odontoma
Odontoma
• Nonaggressive lesions that are more likely to
be hamartomatous (development) than
neoplastic
• Once fully calcified they do not develop
further.
• They may be further classified
– Complex Odontoma
– Compound Odontoma
Odontoma
• Compound odontome
– enamel and dentin are laid down in such a fashion
that the structure bears a considerable
anatomical resemblance to that of normal teeth
– Except they are often smaller than the typical teeth
• Complex odontome
– Dental structure are simply arranged in an irregular
mass
– bearing no morphological similarity even to
rudimentary tooth
Etiology
• Unknown origin
• Trauma: local trauma or infection
• Genetic:they are either inherited or are due to a
mutant gene
Mechanism
• Both the epithelial and mesenchymal cells exhibit
complete differentiation
• Results in formation of functional ameloblasts and
odontoblasts form enamel and dentin.
• These are laid down in an abnormal pattern
– failure of cells to reach the morphodifferentiation stage
Clinical Features
• Age: first and second decade of life.
• Sex: Slight males predilection
• Site
– Compound odontome : incisor, canine area of maxilla
– Complex odontome: mandibular 1st and 2nd molar area.
– Unusual situation includes the maxillary sinus, inferior border of
the mandible, ramus and condylar region.
• Frequency: compound odontome is twice as common
as complex odontome
• Size
– Compound odontoma : 1 to 3 cm in diameter. It usually remains
small , occasionally increases than that of the tooth.
– Complex odontoma: varies in size
Clinical Features
• Symptom
– Alveolar swelling in the jaw - facial asymmetry
– In some cases, signs of infection may be present.
• Signs
– it is common for a tooth or teeth to be absent
from the arch in the presence of an odontome.
– On palpation expansion of the jaw may be
noticed.
Clinical Features
• Teeth
– impaction malpositioning, diastema, aplasia,
malformation and deviation of adjacent teeth
– 70% of odontoma.
• Development of cyst
– sometime, cyst develops in relation with a
complex odontome and compound odontome,
– but it is very rare.
Compound odontome
Complex Odontome
• intermediate stage of mixed radiolucency, finally densely
radiopaque
• Internal structure
– cluster of small shapeless dense masses of solid tissue
– having equal or more density, depending on the size of the
mass.
– In some cases, there may be presence of two or more teeth-like
masses
• Margin
– borders are well defined in both the cases
– But vary from smooth to irregular and may have hyperostotic
borders.
Complex
Odontoma
Compound
Odontoma
• Presence of ghost cells (20%)
• Compound Odotome
– Normal appearing enamel or enamel matrix, dentin, pulp
tissues and cementum
– denticles are embedded in fibrous connective tissue, and
have a fibrous capsule
• Complex Odontome
– Mass consists of all the dental tissues in a
disordered arrangement,
– But frequently with a radial pattern.
– Pulp is usually finely branched so that the mass is
perforated
Histopathological Features :
Compound
Histopathological Features: Complex
• Cementifying or ossifying fibroma
• Adenomatoid odontogenic tumor
• Periapical cemental dysplasia
• Calcifying epithelial odontogenic tumor
• Fibrous dysplasia
Treatment
• Simple local surgical excision is the treatment
of choice.
• These lesions are not expected to recur
Adenomatoid Odontogenic Tumor
Adenomatoid Odontogenic Tumor
• Adenoameloblastoma
• Ameloblastic adenomatoid tumor
• Uncommon nonaggressive tumors of
odontogenic epithelium in variety of patterns
mixed with mature connective tissue stroma.
• Some consider it benign neoplasm and others,
Hamartomatous malformation – limited size and
lack of recurrence
• Odontogenic epithelium origin - enamel organ
epithelium
• 3% of all oral tumors
Clinical Features
• Age: range of 5 to 50 years; 70% occur in the
second decade
• Sex: 2 : 1 female predilection
• Classified in 2 types
– Central tumors
• Follicular type : associated with the crown of an
embedded tooth, 73% of all central type
• Extrafollicular type: those with no embedded tooth
– Peripheral tumors
Clinical Features
Clinical Features
• Site: commonly in the maxilla, in the anterior
region and especially in the cuspid area
• Signs & symptom
– often associated with a missing tooth – maxillary
canine
– Slow growing
– Presents as a gradually enlarging, painless swelling
or asymmetry
• Often appears radiographically as a unilocular dentigerous
cyst
• Periphery: well-defined corticated or sclerotic border
• Internal Structure
– its presented as mixed radio-opacity and radio-lucency
– radiopacities in about two thirds of cases
– some may show dense clusters of ill-defined radiopacities -
cluster of small pebbles
– radiolucent circumferential halo which envelops a dense,
central and round radiodense mass.
• Effect on surrounding structure
• separation of roots or displacement of a adjacent tooth occurs frequently
• cortical expansion and root resorption
Histological Features
• Macroscopic features
– Roughly spherical mass with a distinct fibrous capsule
– Cross section: white to tan solid with yellowish brown fluid
or fine gritty material
– Sometimes embedded with tooth or walls of cyst
• Microscopic features
– Multinodular proliferation of spindle, cuboidal and
columnar cells
– Comprises of duct like structures, eosiniphillic material –
hyaline ring: distinctive features of most of AOT
– Ducts are lined by columnar cells similar to ameloblasts
– Microcysts - tumours being called adenomatoid
Low Power
High Power
• Radiolucent
– Dentigerous cyst
• Radiopacities
– Ameloblastoma
– Ameloblastic fibroma
– Calcifying odontogenic cyst
– Odontogenic fibroma or myxoma
Treatment
• Conservative surgical excision is adequate
• Because the tumor is
– Not locally invasive,
– Well encapsulated,
– Separated easily from the bone
• Recurrence rate is 0.2%.
THANKS……
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