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Odontogenic Tumors

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Title: 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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