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BENIGN%20NEOPLASMS

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Title: BENIGN%20NEOPLASMS


1
BENIGN NEOPLASMS
OF ORAL TISSUES
Neo new Plasia formation. A neoplasm is
defined as an uncoordinated proliferation of
tissue, the growth of which persists in a
potentially unlimited fashion, even after
cessation of the stimulus which evoked the change.
2
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
  • Hyperplastic lesions
  • 1. Polyp
  • 2. Epulis
  • 3. Giant cell granuloma
  • Epithelial origin
  • 1. Papilloma
  • 2. Adenoma
  • 3. Pigmented nevus
  • 4. Keratoacanthoma
  • Mesenchymal
  • 1. Connective tissue origin
  • a. Fibroma
  • b. Lipoma / Fibrolipoma
  • c. Haemangioma
  • d. Lymphangioma
  • e. Chondroma
  • f. Osteoma
  • Mesenchymal
  • 2. Muscle tissue origin
  • a. Leiomyoma
  • b. Rhabdomyoma
  • c. Granular cell myoblastoma
  • 3. Nerve tissue origin
  • a. Neurofibroma
  • b. Neurilemmoma
  • c. Melanotic progonoma
  • Epithelial origin
  • 1. Ameloblastoma
  • 2. Adenomatoid odontogenic tumor
  • 3. Calcifying epithelial odontogenic tumor
  • 4. Squamous odontogenic tumor
  • B Mixed origin
  • 1. Ameloblastic fibroma
  • 2. Odontomes
  • C Mesodermal origin
  • 1. Myxoma Myxofibroma
  • 2. Odontogenic fibroma
  • 3. Cementifying fibroma
  • 4. Periapical cemental dysplasia
  • 5. Benign cementoblastoma
  • 6. Familial multiple cementoma

3
ODONTOGENIC TUMORS
Common Clinical Features
Age of occurrence Varies with each tumor
Sex predilection Varies with each tumor
Symptoms Most of the tumors present as a
painless, gradually / rapidly enlarging swelling.
If infected, pain may be present. Other symptoms
include facial deformity, mobility in teeth,
numbness.
4
ODONTOGENIC TUMORS
Common Clinical Features
Signs The swelling has the following
features Inspection usually single, round or
oval, well-defined boundaries, smooth or nodular
surface, normal overlying skin or mucosa,
expansion of jaw bone, obliteration of
vestibule Palpation Normal temperature of the
overlying skin or mucosa, non-tender, consistency
is bony hard (if entirely within bone)
egg-shell crackling (if overlying bone is
thin) firm (if no bone coverage), teeth
mobility, paraesthesia Additional features
missing tooth or normal dentition, displacement
of teeth, pathological jaw fracture, signs of
inflammation if tumor is infected
5
ODONTOGENIC TUMORS
Common Radiographic Features
Type of lesion radiolucent Site body of jaw
bone Size usually more than 1.5 cms Shape round
or oval, unilocular or multi-locular Number
mostly single Outline regular if unilocular,
scalloped if multi-locular Border well-defined
hyperostotic (partially hyperostotic) Contents
homogenous radiolucency (radiopaque
foci) Additional features expansion of jaw
bone, displacement/resorption of roots,
displacement of inferior alveolar canal,
obliteration of maxillary antrum, thinning of
both cortical plates, thinning of inferior border
of mandible, cyst-in-cyst appearance,
pathological jaw fracture
6
ODONTOGENIC TUMORS
Common Radiographic Features
7
ODONTOGENIC TUMORS
Common Radiographic Features
8
ODONTOGENIC TUMORS
Common Radiographic Features
9
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
  • Epithelial origin
  • 1. Ameloblastoma
  • 2. Adenomatoid odontogenic tumor
  • 3. Calcifying epithelial odontogenic tumor
  • 4. Squamous odontogenic tumor
  • 5. Ameloblastic fibroma
  • 6. Odontomes
  • Mesodermal origin
  • 1. Myxoma Myxofibroma
  • 2. Odontogenic fibroma
  • 3. Cementifying fibroma
  • 4. Periapical cemental dysplasia
  • 5. Benign cementoblastoma
  • 6. Familial multiple cementoma

Pathogenesis Proliferation of tissues
differentiated from dental lamina. Stimulus for
this proliferation not known.
10
ODONTOGENIC TUMORS
Ameloblastoma (locally malignant)
Clinical Features
Age of occurrence mostly between 20 to 50 years
of age, peak frequency at 33 years of age
Sex predilection males slightly more commonly
affected than females
Site 80 of tumors in mandible, in mandible 3rd
molar-ramus region more affected
Symptoms Most of the tumors present as a
painless, gradually / rapidly enlarging swelling.
If infected, pain may be present. Other symptoms
include facial deformity, mobility in teeth,
numbness
11
ODONTOGENIC TUMORS
Ameloblastoma (locally malignant)
Clinical Features
Signs The swelling has the following
features Inspection single, round or oval,
well-defined boundaries, smooth or lobulated,
normal overlying skin or mucosa (ulcerated if
large), expansion of jaw bone in all the 3
planes, obliteration of vestibule Palpation
normal temperature of the overlying skin or
mucosa, non-tender, consistency is bony hard (if
entirely within bone) egg-shell crackling (if
overlying bone is thin) firm (if no bone
coverage) or soft (if unicystic), teeth mobility,
paraesthesia Additional features missing tooth
or normal dentition, displacement of teeth,
pathological jaw fracture, thin straw colored
fluid on aspiration (unicystic variety) signs of
inflammation if tumor is infecte
Image Lucass Pathology of Tumors of the Oral
Tissues, 5th edition
12
ODONTOGENIC TUMORS
Ameloblastoma (locally malignant)
Radiographic Features
Type of lesion radiolucent Site usually
mandibular 3rd molar-ramus region Size large
lesion Shape unilocular (round or oval),
multilocular (soap bubble, honeycomb) with
locules separated by bony septae Number
single Outline regular or scalloped Border
well-defined hyperostotic (partially
hyperostotic) Contents homogenous
radiolucency Additional features impaction of
tooth with displacement deep in the jaw,
expansion of jaw bone bucco-lingually,
antero-posteriorly and vertically, displacement
resorption of roots, displacement of inferior
alveolar canal, obliteration of maxillary antrum,
thinning of cortical plates, thinning of inferior
border of mandible, cyst-in-cyst appearance,
pathological jaw fracture
13
ODONTOGENIC TUMORS
Ameloblastoma (locally malignant)
Images Atlas of Oral Diagnostic Imaging by
Higashi
14
ODONTOGENIC TUMORS
Ameloblastoma (locally malignant)
Differential Diagnosis Unilocular - other
odontogenic tumors (except radiopaque) and
cysts Multilocular - ameloblastic fibroma,
myxoma, haemangioma, central giant cell
granuloma, early stages of fibro-osseous lesions,
odontogenic keratocyst
Management wide surgical excision to avoid
recurrence, bone grafts
15
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
  • Epithelial origin
  • 1. Ameloblastoma
  • 2. Adenomatoid odontogenic tumor
  • 3. Calcifying epithelial odontogenic tumor
  • 4. Squamous odontogenic tumor
  • 5. Ameloblastic fibroma
  • 6. Odontomes
  • Mesodermal origin
  • 1. Myxoma Myxofibroma
  • 2. Odontogenic fibroma
  • 3. Cementifying fibroma
  • 4. Periapical cemental dysplasia
  • 5. Benign cementoblastoma
  • 6. Familial multiple cementoma

16
ODONTOGENIC TUMORS
Adenomatoid Odontogenic Tumor (AOT)
Clinical Features
Signs The swelling has the following
features Inspection single, round or oval,
well-defined boundaries, smooth, normal overlying
skin or mucosa, little expansion of jaw bone,
obliteration of vestibule Palpation normal
temperature of the overlying skin or mucosa,
non-tender, consistency is bony hard (if entirely
within bone) egg-shell crackling (if overlying
bone is thin) firm (if no bone
coverage) Additional features normal dentition,
displacement of teeth
17
ODONTOGENIC TUMORS
Adenomatoid Odontogenic Tumor (AOT)
Radiographic Features
Type of lesion predominantly radiolucent
(mixed) Site maxillary anterior region Size
about 3 cms in diameter Shape unilocular (round
or oval) Number single Outline regular Border
well-defined hyperostotic Contents homogenous
radiolucency interspersed with radiopaque foci
(driven snow appearance) Additional features
sometimes impaction of tooth, little expansion of
jaw bone, displacement resorption of roots,
thinning of cortical plates
18
ODONTOGENIC TUMORS
Adenomatoid Odontogenic Tumor (AOT)
Differential Diagnosis No radiopaque foci
ameloblastoma, ameloblastic fibroma, odontogenic
fibroma, primordial cyst, lateral periodontal
cyst Radiopaque foci CEOC, CEOT
Management surgical enucleation
Image Atlas of Oral Diagnostic Imaging by Higashi
19
ODONTOGENIC TUMORS
Calcifying Epithelial Odontogenic Tumor (CEOT,
Pindborg tumor)
Clinical Features
Signs The swelling has the following
features Inspection single, round or oval,
well-defined boundaries, smooth, normal overlying
skin or mucosa, little expansion of jaw bone,
obliteration of vestibule Palpation normal
temperature of the overlying skin or mucosa,
non-tender, consistency is bony hard (if entirely
within bone) egg-shell crackling (if overlying
bone is thin) firm (if no bone
coverage) Additional features missing tooth,
displacement of teeth
20
ODONTOGENIC TUMORS
Calcifying Epithelial Odontogenic Tumor (CEOT,
Pindborg tumor)
Radiographic Features
Type of lesion predominantly radiolucent
(mixed) Site mandibular premolar-molar
region Size about 3 cms in diameter Shape
somewhat irregular Number single Outline
somewhat irregular Border well-defined, at times
diffuse Contents homogenous radiolucency
interspersed with diffuse radiopacities Additional
features impaction of tooth is common, little
expansion of jaw bone, displacement resorption
of roots, thinning of cortical plates
21
ODONTOGENIC TUMORS
Calcifying Epithelial Odontogenic Tumor (CEOT,
Pindborg tumor)
Differential Diagnosis CEOC, AOT, intermediate
stages of fibro-osseous lesions
Management wide surgical excision to avoid
recurrence
Image Lucass Pathology of Tumors of the Oral
Tissues, 5th edition
22
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
  • Epithelial origin
  • 1. Ameloblastoma
  • 2. Adenomatoid odontogenic tumor
  • 3. Calcifying epithelial odontogenic tumor
  • 4. Squamous odontogenic tumor
  • 5. Ameloblastic fibroma
  • 6. Odontomes
  • Mesodermal origin
  • 1. Myxoma Myxofibroma
  • 2. Odontogenic fibroma
  • 3. Cementifying fibroma
  • 4. Periapical cemental dysplasia
  • 5. Benign cementoblastoma
  • 6. Familial multiple cementoma

23
ODONTOGENIC TUMORS
Odontome (complex/compound composite odontome,
Odontoma)
Clinical Features
Signs If present, the swelling has the following
features Inspection single, round or oval,
well-defined boundaries, smooth, normal overlying
skin or mucosa, little expansion of jaw
bone, Palpation normal temperature of the
overlying skin or mucosa, non-tender, consistency
is bony hard (if entirely within bone) firm or
hard (if no bone coverage) Additional features
missing tooth
24
ODONTOGENIC TUMORS
Odontome (complex/compound composite odontome,
Odontoma)
Radiographic Features
Type of lesion radiopaque mass surrounded by a
radiolucent line and further by a radiopaque
line, mixed in early stages Site mandibular
premolar-molar region / maxillary anterior
region Size complex can be large, compound
usually small Shape round or oval Number
single Outline regular Border well-defined
hyperostotic Contents radiopacities of varying
densities interspersed with tiny radiolucencies,
radiopacities arranged in haphazard manner
(complex) or in anatomical relation forming
several small teeth denticles
(compound) Additional features associated
with supernumerary tooth, impaction of tooth,
little expansion of jaw bone, displacement
resorption of roots, thinning of cortical plates
25
ODONTOGENIC TUMORS
Odontome (complex/compound composite odontome,
Odontoma)
Images Atlas of Oral Diagnostic Imaging by
Higashi
26
ODONTOGENIC TUMORS
Odontome (complex/compound composite odontome,
Odontoma)
Differential Diagnosis in the early stage CEOC,
AOT, intermediate stage of fibro-osseous
lesions in the mature stage mature stage of
fibro-osseous lesions, osteoma
Management surgical removal to allow eruption of
impacted tooth and avoid cystic changes
27
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
  • Epithelial origin
  • 1. Ameloblastoma
  • 2. Adenomatoid odontogenic tumor
  • 3. Calcifying epithelial odontogenic tumor
  • 4. Squamous odontogenic tumor
  • 5. Ameloblastic fibroma
  • 6. Odontomes
  • Mesodermal origin
  • 1. Myxoma Myxofibroma
  • 2. Odontogenic fibroma
  • 3. Cementifying fibroma
  • 4. Periapical cemental dysplasia
  • 5. Benign cementoblastoma
  • 6. Familial multiple cementoma

Fibro-osseous lesions
28
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
  • Hyperplastic lesions
  • 1. Polyp
  • 2. Epulis
  • 3. Giant cell granuloma
  • Epithelial origin
  • 1. Papilloma
  • 2. Adenoma
  • 3. Pigmented nevus
  • 4. Keratoacanthoma
  • Mesenchymal
  • 1. Connective tissue origin
  • a. Fibroma
  • b. Lipoma / Fibrolipoma
  • c. Haemangioma
  • d. Lymphangioma
  • e. Chondroma
  • f. Osteoma

29
NON-ODONTOGENIC TUMORS
Giant Cell Granuloma (central/peripheral,
reparative/hyperplastic giant cell lesion )
Pathogenesis excessive reparative response to an
irritant (trauma, infection)
Clinical Features Age of occurrence central
variety occurs in young adults especially below
30 years of age, peripheral variety usually in
adults
Sex predilection both varieties more common in
females
Site the region of the jaws anterior to molars
involved by the central variety , the peripheral
variety involves only gingiva / alveolar mucosa
30
NON-ODONTOGENIC TUMORS
Giant Cell Granuloma (central/peripheral,
reparative/hyperplastic giant cell lesion )
Radiographic Features Type of lesion
radiolucent Site usually anterior to mandibular
1st molar Size medium sized lesion Shape
unilocular (round or oval), multilocular (soap
bubble) with locules separated by thin bony
septae Number single Outline regular or
scalloped Border well-defined hyperostotic Conten
ts homogenous radiolucency Additional features
expansion of jaw bone bucco-lingually and
vertically, displacement of developing teeth,
thinning of cortical plates, thinning of inferior
border of mandible
31
NON-ODONTOGENIC TUMORS
Giant Cell Granuloma (central/peripheral,
reparative/hyperplastic giant cell lesion )
Radiographic Features
Differential Diagnosis from other multilocular
lesions like ameloblastoma, hemangioma, myxoma
and early fibro-osseous lesions
Management surgical removal with adequate
margins to avoid recurrence, screening for
hyperparathyroidism
Image Lucass Pathology of Tumors of the Oral
Tissues, 5th edition
32
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
  • Hyperplastic lesions
  • 1. Polyp
  • 2. Epulis
  • 3. Giant cell granuloma
  • Epithelial origin
  • 1. Papilloma
  • 2. Adenoma
  • 3. Pigmented nevus
  • 4. Keratoacanthoma
  • Mesenchymal
  • 1. Connective tissue origin
  • a. Fibroma
  • b. Lipoma / Fibrolipoma
  • c. Haemangioma
  • d. Lymphangioma
  • e. Chondroma
  • f. Osteoma

33
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
  • Hyperplastic lesions
  • 1. Polyp
  • 2. Epulis
  • 3. Giant cell granuloma
  • Epithelial origin
  • 1. Papilloma
  • 2. Adenoma
  • 3. Pigmented nevus
  • 4. Keratoacanthoma
  • Mesenchymal
  • 1. Connective tissue origin
  • a. Fibroma
  • b. Lipoma / Fibrolipoma
  • c. Haemangioma
  • d. Lymphangioma
  • e. Chondroma
  • f. Osteoma

34
NON-ODONTOGENIC TUMORS
Osteomas
35
NON-ODONTOGENIC TUMORS
Osteomas
36
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
  • Mesenchymal
  • 2. Muscle tissue origin
  • a. Leiomyoma
  • b. Rhabdomyoma
  • c. Granular cell myoblastoma
  • 3. Nerve tissue origin
  • a. Neurofibroma
  • b. Neurilemmoma
  • c. Melanotic progonoma

37
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