Odontogenic tumors

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emm64
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199306
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Odontogenic tumors
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2013-02-10 00:58:46
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osd5 odontogentic tumors
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odontogenic tumors osd5
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  1. What is the most common odontogenic and benign tumor of jaw?
    • ameloblastoma: posterior mandible, 30-40s, m>f
    • painless swelling covered by normal mucosa
  2. What is radiographic appearance of ameloblastoma?
    • variable: unilocular early w remnants of normal bone -> mixed density & septa, multilocular later-> soap bubble
    • growth: locally aggressive, expansive, displace tooth, may resorb roots
    • recurrence: high, dangerous max
    • treatment: aggressive surgery
    • variant: mural on cyst walls
  3. What is the difference in radiographic presentations of septa in ameloblastoma ,central giant cell granuloma and odontogenic myxoma?
    • CGCG: multilocular wispy thin septa
    • ameloblastoma: course septations
    • odontogenic myxoma: linear
    • ameloblastoma: curved
  4. What are the histo findings of ameloblastoma?
    • follicular, adnexal derived similar to basal cell carcinoma
    • odd shaped islands with peripheral cells palisaded
    • may have bone reminants
    • Islands of cells with palisaded nuclei that have reverse polarization.
    • Reverse polarization of nuclei: nuclei distant from the basement membrane/nuclei at pole opposite of basement membrane.
    • Palisaded nuclei = picket fence appearance; columnar-shaped nuclei with long axis perpendicular to the basement membrane.
    • Subnuclear vacuolization in palisading cell - vacuoles at the basement membrane aspect.
    • Loose stroma around the islands of cells.
    • Star-like cells at the centre of the islands of cells (stellate reticulum).
  5. What is stellate reticulum?
    The stellate reticulum is a group of cells located in the center of the enamel organ of a developing tooth. These cells are star shaped and synthesize glycosaminoglycans. As glycosamingoglycans are produced, water is drawn in between the cells and stretch them apart. As they are moved further away from one another, the stellate reticulum maintain contact with one another through desmosomes, resulting in their unique appearance. stellate reticulum is lost after the first layer of enamel is laid down. This brings cells in inner enamel epithelium closer to blood vessels at the periphery
  6. The cervical loop area: (1) dental follicle cells, (2) dental mesenchyme, (3) Odontoblasts, (4) Dentin, (5) stellate reticulum, (6) outer enamel epithelium, (7)inner enamel epithelium, (8) ameloblasts, (9) enamel.
    • Ameloblastoma
    • Islands of cells with palisaded nuclei that have reverse polarization.
    • Reverse polarization of nuclei = nuclei distant from the basement membrane/nuclei at pole opposite of basement membrane.
    • Palisaded nuclei = picket fence appearance; columnar-shaped nuclei with long axis perpendicular to the basement membrane.
    • Subnuclear vacuolization in palisading cell - vacuoles at the basement membrane aspect.
    • Loose stroma around the islands of cells.
    • Star-like cells at the centre of the islands of cells (stellate reticulum).
    • islands -> cystic after outgrowing blood supply
  7. What are ameloblastoma variants?
    • granular: ameloblasts w/ pebbly granular cytoplasm
    • plexiform: no palisading, can appear as invasive cancer, arise in dentigerous cyst
    • desmoplastic: flattened basal, thin layer of ameloblasts, densely collagenized stroma
  8. What often arises from lining of dentigerous cysts?
    (plexiform) ameloblastoma
  9. What are the features of adenomatoid odontogenic tumor?
    • 20s, 2F:1M, 75% maxilla, incisor, canine encircles tooth
    • growth: slow, painless w tooth displacement
    • radio: well def, unicystic, sclerotic borders w or w/o dense radioopacities (calcifications)
    • tx: conservative surgical excision
    • push CEJ apically so usually involves root
  10. What advanced imaging is preferred for AOT?
    • multi-slice CT within soft tissue window to see calcifications within lesion.
    • (adenomatoid odontogenic tumor)
    • (adenomatoid odontogenic tumor)
    • fibrous capsule
    • low columnar cells surrounding duct-like structures-> adenomatoid
    • scattered small calcifications
  11. What is the histo features of AOT?
    • (adenomatoid odontogenic tumor)
    • fibrous capsule
    • low columnar cells surrounding duct-like structures-> adenomatoid
    • scattered small calcifications
  12. What is a calcifying epithelial odontogenic tumor?
    • pindborg tumor
    • rare ameloblastoma-like
    • m>f, mandible, premolar-molar
    • expansile, painlss swelling
    • well or ill defined, uni- or multi locular around impacted tooth
    • radiopaque foci later 
    • tx: aggressive
  13. What are histo presentations of calcifying epithelial odontogenic tumor?
    • prominent/layered calcifications
    • large, hyperchromatic nuclei in epithelial
    • similar to metastases or primary SCC
    • amyloid accumulationk
    • A: SHEET OF ATYPICAL EPITHELIAL CELLS,
    • B: AMYLOID DROPLETS WITH CALCIFIC DYSTROPHICATIONS
  14. Can ameloblastoma metastasize?
    sometimes (rarely) to lung/lymph nodes
  15. What is odontogenic fibroma?
    • rare benign ondontogenic neoplasm
    • 11-40, female, mandible
    • may displace teeth, resorb roots
    • radio: well definied, corticated, unilocular if small then large multilocuar
    • totally radiolucent or w/ small internal opacities
    • tx: simple excision, low recurrence
  16. what are the histo findings of odontogenic fibroma?
    • fibrous tissue may have odontogenic islands
    • fibrous ectomesenchymal tissue
    • could be arrested development of odontoma
  17. What are the features of odontogenic myxoma?
    • locally aggressive only in jaws (md3:mx1)
    • young 10-20
    • pre-molar-molar, missing tooth, expansion displacement
    • high recurrence, no capsule jellylike
    • radio: uni-multi (with small honeycomb, tennis racket locules), well defined, scallops or displaces but rarely resorb roots
    • course linear septations especially in periphery
    • tx: aggressive
    • often appears as a lesion and leads to missing follicle
  18. What is histo presentation of odontogenic myxoma?
    • jelly like material in trabecular bone
    • difficult margins
    • thinly collagenized w/ lots of ground substance
  19. What is a benign cementoblastoma?
    • cementoblast origin
    • male young
    • 2nd premolar, 1st molar
    • slow growing, might displace, exapand, sometimes painful
    • radio: well defined rapiopacity (cementum less dense than dentin) surrounded by halo (PDL like space) attached to root of affected tooth which is resorbed
    • tx: conservative
  20. What distinguished benign cementoblastoma from hypercementosis?
    cementoblastoma resorbs root must be removed
  21. What are the histo features of cementoblastoma?
    • similar to osteoblastoma but localized to root of tooth
    • pink osteoid, osteoblasts
  22. What are the features of ameloblastic fibroma?
    • young, mandible, pre-molar-molar
    • expansile, painless swelling
    • radio: uni or multi well defined lucency
    • associated w/ unerupted tooth (extending from follicle)
    • tx: benign, conservative
    • doesn't respect CEJ
  23. What are the histo features of ameloblastic fibroma?
    • circumscribed densely-collagenized fibrous tissue with a lot of ameloblastic(epithelial)
    • ameloblastic islands w palisading, surrounded by fibro-myxomatous CT
  24. Whats main difference between ameloblastoma and ameloblastic fibroma?
    • fibroma have abundant uniform stroma, not just epithelial
    • ameloblastoma: epithelial islands are more extensive and have more stellate reticulum
  25. What is an odontoma?
    • hamartomatous odontogenic malformation, not true neoplasm
    • complex: nondescript masses of dental tissue, posterior jaws
    • compound: multiple well formed teeth, anterior maxilla
    • M=F, normal dentition, may cause impaction, compound2:complex1
    • tx: conservative
  26. What is radio features of odontoma?
    • usually well-defined corticated mixed-density lesion that affects eruption
    • may have microdonts inside (dissolved enamel but dentin and pulp remnants remain)
  27. What are typical radiographic signs of malignancy?
    scalloped borders, displaced or floating teeth(alveolar resorption)
  28. What are the malignant types of odontogenic tumors?
    • MALIGNANT AMELOBLASTOMA:Jaw analog of basal cell carcinomai.Rarely metastasizes but can be destructive
    • AMELOBLASTIC CARCINOMA: Pallisaded cells with nuclear hyperchromatism.Vaguely resembles ameloblastoma
    • ODONTOGENIC CARCINOMA: Occurrence in the jaw. Relation to developmental tooth structures
    • PRIMARY INTRAOSSEOUS CARCINOMA: histologic features of tooth development tissuei.
    • Looks like poorly differentiated squamous cell carcinoma
  29. What are the categories of odontogenic cysts?
    developmental and inflammatory

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