Odontogenic Tumors

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Odontogenic Tumors
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Classification of Odontogenic Tumors

• I. Tumors of odontogenic epithelium
• A. Ameloblastoma
• 1. Malignant ameloblastoma
• 2. Ameloblastic carcinoma
• B. Clear cell odontogenic carcinoma
• C. Adenomatoid odontogenic tumor
• D. Calcifying epithelial odontogenic tumor
• E. Squamous odontogenic tumor
• II. Mixed odontogenic tumors
• A. Ameloblastic fibroma
• B. Ameloblastic fibro-odontoma
• C. Ameloblastic fibrosarcoma
• D. Odontoameloblastoma
• E. Compound odontoma
• F. Complex odontoma
• III. Tumors of odontogenic ectomesenchyme
• A. Odontogenic fibroma
• B. Granular cell odontogenic tumor
• C. Odontogenic myxoma

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• BENIGN NO RECURRENCE POTENTIAL
• Adenomatoid odontogenic tumor
• Squamous odontogenic tumor
• Cementoblastoma
• Periapical cementoosseous dysplasia
• Odontoma
• BENIGN SOME RECURRENCE POTENTIAL
• Cystic ameloblastoma (unicystic)
• Calcifying epithelial odontogenic tumor
• Central odontogenic fibroma
• Florid cementoosseous dysplasia
• Ameloblastic fibroma and fibroodontoma
• From Regezi et al.

• BENIGN AGGRESSIVE
• Ameloblastoma
• Clear cell odontogenic tumor (some consider this
  a carcinoma)
• Odontogenic ghost cell tumor (COC solid type)
• Odontogenic myxoma
• Odontoameloblastoma
• MALIGNANT
• Malignant ameloblastoma
• Ameloblastic carcinoma
• Primary intraosseous carcinoma
• Odontogenic ghost cell carcinoma
• Ameloblastic fibrosarcoma

Biologic Classification of Odontogenic Tumors
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Tumors of Odontogenic Epithelium
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Ameloblastoma

• The ameloblastoma is the most common clinically
  significant (not the most common) odontogenic
  tumor.
• It may develop from cell rests of the enamel
  organ from the developing enamel organ from the
  lining of odontogenic cysts or from the basal
  cells of the oral mucosa.

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Ameloblastoma

• It is typically slow-growing locally invasive
  and runs a benign course.
• H.G.B. Robinson described it as being a benign
  tumor that is usually unicentric
  non-functional intermittent in growth
  anatomically benign and clinically persistent.

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Ameloblastoma

• Ameloblastomas occur in 3 different
  clinico-radiographic situations requiring
  different therapeutic considerations and having
  different prognoses.
• Conventional Solid/Multicystic (86 of all
  cases)
• Unicystic (13 of all cases)
• Peripheral or Extraosseous (1 of all cases)

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Solid or Multicystic Ameloblastoma Clinical
Features

• Patient Age Approximately equal frequency from
  the third through the seventh decades.
• Sex Predilection Approximately equal.
• Location 80 in mandible 70 in posterior
  regions.
• Radiographic Appearance Radiolucent lesion
  which is usually well-circumscribed it may be
  unilocular or multilocular (soap-bubble
  honeycomb) occasionally an ameloblastoma will be
  ill-defined with a ragged border.

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Solid or Multicystic Ameloblastoma Histologic
Features

• There are several microscopic subtypes but these
  generally have little bearing on the behavior of
  the tumor.
• The follicular and plexiform types are the most
  common.
• The follicular type is composed of islands of
  epithelium which resemble the enamel organ in a
  mature fibrous connective tissue stoma.

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Solid or Multicystic Ameloblastoma Histologic
Features

• The plexiform type is composed of long
  anastomosing cords or larger sheets of
  odontogenic epithelium. Its stroma tends to be
  loose and more vascular.
• The acanthomatous type shows evidence of
  extensive squamous metaplasia with keratin
  formation in the island of odontogenic epithelium.

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Solid or Multicystic Ameloblastoma Histologic
Features

• In the granular cell type there is transformation
  of groups of epithelial cells to granular cells
  the nature of the granular change is unknown.
  This type is more common in young patients and
  has been shown to be clinically aggressive.

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Solid or Multicystic Ameloblastoma Histologic
Features

• The desmoplastic form is composed of
  islands/cords of odontogenic epithelium in a very
  dense collagenous stroma. It has a predilection
  for the anterior maxilla and because of the dense
  connective tissue may appear as a
  radiolucent-radiopaque lesion.
• The basaloid type is the least common and is
  composed of uniform basaloid cells with no
  stellate reticulum.

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Solid or Multicystic Ameloblastoma Additional
Features

• In some studies solid/multicystic ameloblastomas
  are reported to be more common in Blacks.
• While lesions are generally asymptomatic
  ameloblastomas may cause paresthesia pain
  particularly if infected and they can erode the
  cortical palates.

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Solid or Multicystic Ameloblastoma Treatment

• Treatments have ranged from simple enucleation
  and curettage to en bloc resection.
• Marginal resection is the most widely used method
  of treatment with the least recurrences reported
  (up to 15 ).
• Most surgeons advocate a margin of at least 1.0
  cm beyond the radiographic limits of the tumor as
  the tumor often extends beyond the apparent
  radiologic/clinical margins.

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Solid or Multicystic Ameloblastoma Prognosis

• Treatment with curettage has resulted in
  recurrence rates ranging from 55-90 .
• Treatment with marginal resection has resulted in
  approximately a 15 recurrence rate.
• Ameloblastomas of this type arising in the
  maxilla are particularly dangerous as it is often
  difficult in getting adequate margins.
• Rarely is an ameloblastoma life threatening.

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Unicystic Ameloblastoma Clinical Features

• Patient Age The patients are younger than those
  with the solid/multicystic form. 50 are
  diagnosed during the second decade of life.
• Sex Predilection Same as for the solid
• Location 90 occur in the mandible usually in
  the posterior region.
• Radiographic Appearance Typically appears as a
  RL around the crown of an unerupted tooth (most
  commonly a mandibular third molar).

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Unicystic Ameloblastoma Histologic Features

• Three histopathologic variants are recognized
• Luminal the tumor is confined to the luminal
  surface of the cyst.
• Intraluminal/plexiform the tumor projects from
  the cystic lining sometimes resembles the
  plexiform type of solid/multicystic
  ameloblastoma.
• Mural the tumor infiltrates the fibrous cystic
  wall.

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Unicystic Ameloblastoma Treatment and Prognosis

• Enucleation of the cyst is probably adequate for
  the luminal and intraluminal/plexiform types.
• Treatment of the mural type is controversial with
  some surgeons believing that local resection is
  best.
• 10-20 recurrence after enucleation and
  curettage with all unicystic ameloblastomas.

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Peripheral Ameloblastoma

• These tumors are extraosseous and therefore
  occupy the lamina propria underneath the surface
  epithelium but outside of the bone.
• Histologically these lesions have the same
  features as the intraosseous forms of the tumor.

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Peripheral Ameloblastoma Clinical Features

• Patient Age Wide age range but most occur
  during middle-age.
• Gender Predilection This is not known.
• Location Posterior gingival/alveolar mucosa is
  involved most frequently. There is a slight
  predilection for the mandible. The buccal mucosa
  has been the site in a few reported cases.

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Peripheral Ameloblastoma Radiographic
Histologic Features

• Radiographic Appearance Although not in bone a
  few cases have shown superficial erosion of the
  alvelolar bone.
• Histologic Appearance Islands of ameloblastic
  epithelium are observed in the lamina propria
  plexiform and follicular patterns are the most
  common in 50 of the cases the tumor connects
  with the basal cell layer of the surface
  epithelium.

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Peripheral Ameloblastoma Treatment and Prognosis

• Unlike its intraosseous counterpart this tumor
  has an innocuous clinical behavior.
• Patients respond well to local surgical excision.
• Some reports indicate a 25 recurrence rate but
  in these cases as second surgical procedure
  results in cure.
• There has been a rare malignant change reported.

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Malignant Ameloblastoma and Ameloblastic Carcinoma

• Less than 1 of the ameloblastomas show
  malignant behavior with the development of
  metastases.
• Malignant ameloblastoma is a tumor that shows
  histologic features of the typical (benign)
  ameloblastoma in both the primary and secondary
  deposits.
• Ameloblastic carcinoma is a tumor that shows
  cytologic features of malignancy in the primary
  tumor in recurrence and any metastases.

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Malignant Ameloblastoma Ameloblastic Carcinoma
Clinical

• Patients range in age from 4-75 with a mean of 30
  years.
• Metastasis has occurred from 1-30 years after the
  initial treatment.
• Metastases most often occur in the lungs and in
  the case of malignant ameloblastoma raises the
  question of aspiration during surgery. Spread
  has also occurred to the cervical lymph nodes and
  to vertebrae and viscera.

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Malignant Ameloblastoma Ameloblastic Carcinoma
X-Ray

• With the malignant ameloblastoma the appearance
  is similar to the typical solid/multicystic
  ameloblastoma.
• The ameloblastic carcinoma is often more
  aggressive with the lesion appearing as an
  ill-defined radiolucency with cortical
  destruction.

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Malignant Ameloblastoma Ameloblastic Carcinoma
Histology

• With the malignant ameloblastoma both the
  primary and metastases show no microscopic
  features that differ from those of the typical
  solid/multicystic ameloblastoma.
• The ameloblastic carcinoma shows cytological
  features of malignancy in addition to a pattern
  of an ameloblastoma.

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Malignant Ameloblastoma Ameloblastic Carcinoma
Treatment Prognosis

• Long-term follow-up does not permit accurate
  assumptions to be made but prognosis appears to
  be poor.
• Approximately 50 of the patients with
  documented metastases and long-term follow-up
  have died as the result of their disease.

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Clear Cell Odontogenic Carcinoma

• Clear Cell Odontogenic Tumor

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Clear Cell Odontogenic Carcinoma

• First reported in 1985 with few cases thus far.
• Tumor appears to be of odontogenic origin but its
  histogenesis is uncertain.
• The term carcinoma is used because most cases
  have demonstrated aggressive behavior with
  invasion of contiguous structures.

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Clear Cell Odontogenic Carcinoma Clinical and
Radiographic Features

• Patient Age Patients are usually over 50 year
  old.
• Gender Predilection Most cases have occurred in
  females but because of the small number of
  reports thus far the question validity is raised.
• Location Lesions have occurred in both jaws.
• Radiographic Features Usually a unilocular or
  multilocular radiolucency with the margins being
  poorly defined or irregular.

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Clear Cell Odontogenic Carcinoma Histologic
Features

• Several patterns have occurred with the
  predominant pattern consisting of nests of
  epithelial cells with a clear or faintly
  eosinophilic cytoplasm separated by strands of
  hyalinized connective tissue.

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Clear Cell Odontogenic Carcinoma Histologic
Features

• The clear cells contain small amounts of
  glycogen.
• The pathologist must rule out the other clear
  cell tumors such as a clear cell mucoepidermoid
  carcinoma clear cell CEOT and metastatic renal
  cell carcinoma.

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Clear Cell Odontogenic CarcinomaTreatment and
Prognosis

• Most patients require fairly radical surgery as
  most authorities consider the tumor to be
  malignant.
• Metastases to the regional lymph nodes and lungs
  have been reported.
• There are too few cases to draw any conclusions
  about the prognosis of this tumor.

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Adenomatoid Odontogenic Tumor (AOT)

• Formerly called an adenoameloblastoma a somewhat
  deceptive term that should be discarded the AOT
  represents about 3-7 of all odontogenic tumors.
• This epithelial tumor has an inductive effect on
  the odontogenic ectomesenchyme with dentinoid
  frequently being produced.

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AOT Clinical Features

• Patient Age The peak age is in the second
  decade with a mean around 17 years.
• Gender Predilection Females 21.
• Location Sixty-five percent of the AOTs occur
  in the maxilla with 65 occurring in the canine
  region. Seventy-five percent of the cases are
  associated with the crown of an unerupted tooth.
  On rare occasion the lesion is extraosseous.

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AOT Radiographic and Additional Features

• AOTs typically appear as pericoronal
  radiolucencies which may have radiopaque
  material (snowflake calcifications) within the
  lucency.
• These lesions are frequently asymptomatic and
  therefore are discovered upon routine
  radiographic examination. AOTs may also block
  the eruption of a permanent tooth and be
  discovered when radiographs are taken to search
  for the unerupted tooth.

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AOT Histologic Features

• The lesion is usually surrounded by a thick
  fibrous capsule.
• The tumor is composed of spindle-shaped
  epithelial cells that form sheets strands or
  whorled masses with little connective tissue.
• The epithelial cells may form rosette-like
  structures tubular or duct-like structures may
  be prominent or absent.
• Calcifications may be observed in the tumor mass.

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AOT Treatment and Prognosis

• Enucleation is the treatment of choice as the
  tumor is easily removed from the bone.
• AOTs seldom recur.

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Calcifying Epithelial Odontogenic Tumor (CEOT
Pindborg Tumor)

• Pindborg tumor accounts for lt 1 of all
  odontogenic tumors.
• It is clearly of odontogenic origin but its
  histogenesis is uncertain.
• The tumor cells are said to resemble cells of the
  stratum intermedium.

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CEOT Clinical Features

• Patient Age Patients ages range from the second
  to the tenth decades with a mean around 40 years.
• Gender Predilection There is no reported sex
  predilection.
• Location 75 of the CEOTs occur in the
  mandible with most occurring in the posterior
  region. A rare peripheral CEOT does occur.

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CEOT Radiographic Features

• CEOTs occur as radiolucent lesions with/without
  opaque foci.
• They are usually well-circumscribed and may be
  unilocular or multilocular.
• Slightly over 50 of the CEOTs are associated
  with an unerupted tooth.

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CEOT Histologic Features

• This lesion is typically composed of islands
  sheets or strands of polyhedral epithelial cells
  in a fibrous stroma.
• Areas of amorphous eosinophilic hyalinized
  extracellular material may be scattered
  throughout.
• Cells outlines are distinct and intercellular
  bridges may be seen.
• Nuclei show considerable variation with giant
  nuclei and pleomorphism observed.
• Calcifications may be noted as well as
  amyloid-like material. Liesegang rings also may
  be present.

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CEOT Additional Features Treatment and
Prognosis

• Bony lesions most commonly present as painless
  slow-growing swellings.
• Peripheral lesions typically appear as
  non-specific sessile gingival masses.
• Conservative local resection is the treatment of
  choice as these lesions are typically less
  aggressive than the ameloblastoma.
• With this treatment the recurrence rate is
  approximately 15 and the overall prognosis is
  good.

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Squamous Odontogenic Tumor (SOT) Clinical
Features

• Patient Age Second through the seventh decades
  (mean 40 years).
• Gender Predilection None
• Location SOTs occur with about equal frequency
  in maxilla and mandible. They are more common in
  the anterior regions of the jaws than in the
  posterior. The lesions occur in the alveolar
  process.

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SOT Radiographic and Histologic Features

• SOTs appear as non-specific radiolucent lesions.
  They may be well-circumscribed or ill-defined.
  They often appear triangular in shape and lateral
  to the tooth root.
• Histologically they appear as islands of
  bland-appearing squamous epithelium in a mature
  fibrous connective tissue stroma. The peripheral
  cells do not show the characteristic polarization
  seen in the ameloblastoma.

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SOT Additional Features Treatment and Prognosis

• SOTs often present as painless gingival swellings
  associated with tooth mobility. Approximately 25
  are asymptomatic.
• Conservative local excision or curettage appears
  to be effective treatment and there have only be
  a few recurrences reported.

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Mixed Odontogenic Tumors

• This group of tumors is composed of proliferating
  odontogenic epithelium in a cellular
  ectomesenchyme resembling the dental papilla.

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Ameloblastic Fibroma Clinical Features

• This true mixed odontogenic tumor is more common
  in patients in the first and second decades of
  life with a mean of 14 years.
• It is slightly more common in males than females.
• Approximately 70 of the ameloblastic fibromas
  occur in the posterior mandible.

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Ameloblastic Fibroma Radiographic Features

• Generally these lesions appear as either a
  unilocular or multilocular radiolucency.
• They tend to be well-defined and may have a
  sclerotic border.
• Approximately 50 are associated with an
  unerupted tooth.

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Ameloblastic Fibroma Histologic Features

• The tumor is composed of a cell-rich mesenchymal
  tissue resembling the primitive dental papilla
  admixed with proliferating odontogenic epithelium.

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Ameloblastic Fibroma Additional Features
Treatment and Prognosis

• The tumor is often encapsulated with small tumors
  usually being asymptomatic. Larger tumors
  produce swelling which can expand the cortex and
  be quite pronounced.
• Most ameloblastic fibromas are treated by
  conservative surgical excision however a 20
  recurrence rate has led some surgeons to
  recommend a more aggressive approach.

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Ameloblastic Fibro-odontoma

• This lesion is defined as a tumor with general
  features of an ameloblastic fibroma but
  containing enamel and dentin.
• Some investigators believe that this entity is
  but a stage in the development of an odontoma
  however most agree that progressive destructive
  tumors are true neoplasms.

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Ameloblastic Fibro-odontoma Clinical and
Radiographic Features

• Patient Age Most common in the 5-12 year age
  range with a mean of 10 years.
• Gender Predilection None.
• Location It is more common in the
  premolar/molar regions of both jaws.
• Radiographic Features Usually appears as a
  well-defined unilocular or rarely multilocular
  radiolucency with variable amounts of calcified
  material which is radiopaque. Therefore it may
  appear as a mixed radiolucent-radiopaque lesion.

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Ameloblastic Fibro-odontoma Histologic Features

• The soft tissue component is identical to the
  ameloblastic fibroma. The calcified portion
  consists of foci of enamel and dentin matrix
  formation in close relationship to the epithelial
  structures.

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Ameloblastic Fibro-odontoma Treatment and
Prognosis

• The ameloblastic fibro-odontoma is usually
  treated by conservative curettage with the lesion
  separating easily from the surrounding bone.
• Prognosis is excellent and recurrence is unusual.

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Ameloblastic Fibrosarcoma

• This lesion is considered the malignant
  counterpart of the ameloblastic fibroma in which
  the mesenchymal portion shows features of
  malignancy.
• The ameloblastic fibrosarcoma may arise de novo
  or there may be a malignant transformation of an
  ameloblastic fibroma.

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Ameloblastic Fibrosarcoma Clinical and
Radiographic Features

• Patient Age The mean age for patients with
  ameloblastic fibrosarcoma is 26 years.
• Gender Predilection Males 21.
• Location 75 have occurred in the mandible.
• Radiographic Features Appear as an ill-defined
  destructive radiolucent lesion.

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Ameloblastic Fibrosarcoma Histologic Features

• The epithelial component of this tumor appears
  histologically benign.
• The mesenchymal portion is highly cellular. The
  cells are hyperchromatic and quite pleomorphic.
  Mitoses are usually prominent.

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Ameloblastic Fibrosarcoma Additional Features
Treatment Prognosis

• Pain and swelling are typically associated with
  this tumor. Rapid clinical growth is another
  common feature.
• Radical surgical excision is the treatment of
  choice.
• The long-term prognosis is difficult to ascertain
  because of the small number of reported cases.

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Odontoameloblastoma (Ameloblastic Odontoma)
Clinical Features

• Extremely rare tumor thus there is little
  reliable information.
• Patient Age Has been seen in younger patients.
• Gender Predilection Unknown.
• Location Most cases have been in mandible.
• Radiographic Appearance Lesion is a mixed
  radiolucent-radiopaque ill-defined one.

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Odontoameloblastoma Histologic Features

• The epithelial portion of the tumor has the
  features of an ameloblastoma most often with a
  plexiform or follicular pattern.
• The odontoma portion of the lesion is composed of
  enamel dentin and cementum with either a
  compound or complex pattern.

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Odontoameloblastoma Treatment and Prognosis

• Since multiple recurrences have been reported
  following local curettage the lesion should be
  treated as an ameloblastoma with marginal
  resection.
• No valid data on long-term prognosis is available
  due to the small number of cases.

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Odontoma

• The odontoma is the most common odontogenic
  tumor.
• It is not a true neoplasm but rather is
  considered to be a developmental anomaly
  (hamartoma).
• Two types of odontomas are recognized
• Compound this type of odontoma is composed of
  multiple small tooth-like structures.
• Complex this lesion is composed of a
  conglomerate mass of enamel and dentin which
  bears no anatomic resemblance to a tooth.

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Odontoma Clinical Features

• Patient Age Most cases are recognized during
  the second decade of life with a mean of 14
  years.
• Gender Predilection Approximately equal.
• Location Somewhat more common in the maxilla.
  The compound type is more often in the anterior
  maxilla while the complex type occurs more often
  in the posterior regions of either jaw.

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Odontoma Radiographic Features

• Early lesions are radiolucent with smooth
  well-defined contours.
• Later a well-defined radiopaque appearance
  develops.
• The compound type shows apparent tooth shapes
  while the complex type appears as a uniform
  opaque mass with no apparent tooth shapes present.

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Odontoma Additional Features

• Most odontomas are small and do not exceed the
  size of a normal tooth in the region.
• However large ones do occur and these may cause
  expansion of the jaw.
• Most odontomas are asymptomatic and as a result
  are discovered upon routine radiographic
  examination.
• Odontomas may block the eruption of a permanent
  tooth and in these cases are often discovered
  when searching for the missing tooth
  radiographically.

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Odontoma Histologic Features

• The compound odontoma is composed of enamel
  dentin and cementum arrange in recognizable tooth
  forms some enamel matrix may be retained in
  immature and hypomineralized specimens.
• The complex odontoma is composed of enamel
  dentin and cementum but these tissues are
  arranged in a random manner that bears no
  morphological resemblance to a tooth.

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Odontoma Treatment and Prognosis

• Odontomas are treated by simple local excision
  and the prognosis is excellent.

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Tumors of Odontogenic Ectomesenchyme
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(Central) Odontogenic Fibroma Clinical Features

• Fewer than 70 cases have been reported in the
  English literature. (VS hyperplastic follicle
  when associated with unerupted tooth)
• Patient Age Patients have ranged in age from
  9-80 years old with a mean of 40 years.
• Gender Predilection Females 7.41 in one
  study.
• Location Sixty percent occur in the maxilla
  where most are located anterior to the first
  molar. When in the mandible approximately 50
  occur in the posterior jaw.

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Odontogenic Fibroma Radiographic Appearance

• The odontogenic fibroma usually appears as a
  well-defined unilocular radiolucency. It is
  often associated with the apical area of an
  erupted tooth.
• Larger lesions are often multilocular.
• Many odontogenic fibromas have sclerotic borders.
• Root resorption is common.

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Odontogenic Fibroma Additional Features

• Small odontogenic fibromas are usually
  asymptomatic.
• The larger lesions may be associated with
  localized bony expansion of the jaw or with the
  loosening of adjacent teeth.

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Odontogenic Fibroma Histologic Features

• Some authors have described two separate types of
  odontogenic fibromas.
• The simple odontogenic fibroma is composed of
  stellate fibroblasts arranged in a whorled
  pattern with fine collagen fibrils and a lot of
  ground substance.
• Foci of odontogenic epithelium may or may not be
  present.
• Occasionally foci of dystrophic calcification
  may be present.

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Odontogenic Fibroma Histologic Features

• The WHO type odontogenic fibroma appears as a
  fairly cellular fibrous connective tissue with
  collagen fibers arranged in interlacing bundles.
  
• Odontogenic epithelium in the form of long
  strands or isolated nests is present throughout
  the lesion.
• Calcifications composed of cementoid and/or
  dentinoid may be present.

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Odontogenic Fibroma Treatment and Prognosis

• The odontogenic fibroma is usually treated by
  enucleation and curettage.
• There have been few recurrences this the
  prognosis is good.

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Peripheral Odontogenic Fibroma (POF) Clinical
Radiographic

• Patient Age POFs are seen over a wide age
  range.
• Gender Predilection This is unknown.
• Location Most POFs occur on the facial gingiva
  of the mandible.
• Radiographic Appearance The lesion does not
  involve the underlying bone but areas of
  calcification may be seen in the soft tissues in
  some cases.

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POF Histologic Additional Features

• The POF is histologically similar to the central
  odontogenic fibroma WHO type.
• POFs generally present as firm slow-growing
  usually sessile masses covered by
  normal-appearing oral mucosa.
• They may cause tooth displacement.

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POF Treatment and Prognosis

• Local surgical excision is the treatment of
  choice and the prognosis is excellent.
• There is little to no tendency for recurrence.

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Granular Cell Odontogenic Tumor

• Granular Cell Odontogenic Fibroma
• Less than 25 cases have been reported

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Granular Cell Odontogenic Tumor Clinical and
Radiographic Features

• Patient Age Almost all the patients have been
  over the age of 40 years.
• Gender Predilection This is unknown.
• Location The lesion has been seen in both the
  maxilla and mandible most often in in molar
  regions.
• Radiographic Appearance Typically appears as a
  well-demarcated radiolucency which may have some
  areas of opacity.

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Granular Cell Odontogenic Tumor Histologic
Features

• The tumor is composed of large eosinophilic
  granular cells.
• Narrow cords or small islands of odontogenic
  epithelium are scattered among the granular
  cells.
• The nature of the granular cells is controversial
  ( lysosomal structures).

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Granular Cell Odontogenic Tumor Treatment and
Prognosis

• Curettage has been the method of treatment and no
  recurrences have been reported.

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Odontogenic Myxoma Clinical and Radiographic
Features

• Patient Age 10-50 years with a mean around 30
  years.
• Gender Predilection Reported to be about equal.
• Location May occur in any area of the jaws but
  more common in the mandible.
• Radiographic Appearance Radiolucent lesion
  often with a multilocular appearance. The
  borders may be indistinct.

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Odontogenic Myxoma Histologic Features

• The tumor is composed of loosely arranged
  stellate spindle-shaped and round cells in an
  abundant loose myxoid stroma with few collagen
  bundles.
• Epithelial cells are not required for diagnosis.
• The odontogenic myxoma may be confused with a
  chrondromyxoid fibroma or with myxoid change in
  an enlarged dental follicle or papilla.

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Odontogenic Myxoma Treatment and Prognosis

• Small odontogenic myxomas are treated by
  curettage while larger lesions may require
  surgical resection.
• Odontogenic myxomas are not encapsulated and tend
  to infiltrate adjacent tissues.
• Recurrence rates of up to 25 are reported.
• Overall the prognosis is good for most
  odontogenic myxomas.

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Cementoblastoma (True Cementoma) Clinical
Features

• Patient Age This lesion is most commonly occurs
  in the second and third decades.
• Gender Predilection Approximately equal.
• Location The cementoblastoma is associated with
  the roots of posterior teeth and is more common
  in the mandible than the maxilla.

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Cementoblastoma Radiographic and Histologic
Features

• Radiographically the lesion appears as an opaque
  lesion attached to and replacing the root of the
  involved tooth.
• Opaque spicules radiate from the central mass.
• The lesion is composed of sheets or thick
  trabeculae of mineralized material with
  irregularly placed lacunae and prominent
  basophilic reversal lines. Multinucleated giant
  cells are often present.
• This lesion closely resembles the osteoblastoma.

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Cementoblastoma Additional Features Treatment
and Prognosis

• The cementoblastoma is a slow-growing lesion that
  may cause local expansion of the jaw.
• Pain may or may not be associated with the lesion
  but the cementoblastoma is usually asymptomatic.
• The usual treatment consists of surgical
  extraction of the tooth together with the
  attached mass occasionally there are attempts to
  save the tooth.
• The prognosis is excellent as the lesion does not
  recur.

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