Dent 356-11 Laboratory Session 5 Odontomes & Odontogenic Tumors

Dr. Rima Safadi

Modified from Dr. Huda Hammad

Complex Odontome: Radiographic Features

Compound Odontome: Radiographic Features

Compound Odontome: Radiographic Features

Compound odontome
Prof. JH, U of Iowa/USA

pulp

Complex & Compound Odontomes: Histopathological Features

Complex odontome: Mass of irregularly arranged, well-formed enamel, dentin, pulp & cementum surrounded by a fibrous capsule.

Compound odontome: a number of separate denticles embedded in fibrous tissue.

Complex & Compound Odontomes: Histopathological Features

Both developing complex and compound odontomes contain varying amounts of odontogenic epithelium and structures resembling enamel organs.
They show all stages of odontogenesis and may be difficult to differentiate from ameloblastic fibroma and ameloblastic fibroodontoma.

Ameloblastoma: Radiographic Features

Most commonly appears as a multilocular radiolucency. Root resorption of involved teeth.

Ameloblastoma: Radiographic Features

May be associated with an unerupted tooth, particularly an impacted 3rd molar. The appearance then may mimic a dentigerous cyst. Less frequently, it may present as a unilocular radiolucency.

Ameloblastoma
Prof. JH, U of Iowa/USA

Ameloblastoma
ameloblasts

Prof. JH, U of Iowa/USA

ate reticulum like cells

Squamo metapla

Ameloblastoma
Prof. JH, U of Iowa/USA

Odontogen

stroma

Ameloblastoma
Prof. JH, U of Iowa/USA

Could be arising from cyst wall

Ameloblastoma: Histopathological Features

Variable patterns depending on arrangement of neoplastic epithelium. Follicular pattern: Discrete, rounded islands or follicles, each resembling the enamel organ. Stellate reticulum like cells at center, surrounded by cuboidal or columnar cells resembling ameloblasts. Nuclei of peripheral cells are polarized away from the basement membrane. Islands are separated by varying amounts of fibrocollagenous stroma.

Ameloblastoma: Histopathological Features

2. squamous metaplasia

Follicular pattern: several changes can occur within the stellate area, including: 1. cystic breakdown.

3. granular cell change.

Ameloblastoma: Histopathological Features

Plexiform pattern: epithelium arranged as a tangled network of strands and irregular masses, each showing the same cell layers seen in the follicular pattern.

Ameloblastoma: Behavior

Typical ameloblastoma is locally invasive and tumor islands infiltrate cancellous marrow spaces without initially causing bone destruction. This requires wide surgical excision with normal margins to avoid recurrence.

Unicystic Ameloblastoma

Typically presents in a younger age group than other variants 2nd-3rd decade). Radiographically, it appears as a well-defined, unilocular radiolucency, usually associated with an unerupted tooth, i.e. similar to dentigerous cyst. The diagnosis is made only after histopathological examination. Treatment is conservative, since epithelium in most cases is limited to cyst lumen. If epithelium infiltrates the cyst wall, it should be treated like typical ameloblastoma.

Ameloblastoma, Unicystic
Prof. JH, U of Iowa/USA

Ameloblastoma unicystic
Prof. JH, U of Iowa/USA

Peripheral (Extraosseous) Ameloblastoma

Rare variant which arises in gingival or alveolar soft tissues without involving bone. May arise from basal cell layer of oral epithelium, or from extraosseous dental lamina remnants.

Ameloblastoma
Prof. JH, U of Iowa/USA

Ameloblastic fibroma

Young fibrous tissue, part of the tumor

Ameloblastic fibroma

Ameloblastic fibro odontoma

Squamous Odontogenic Tumor

Rare tumor presenting with tooth mobility. Radiographically presents as a wellcircumscribed, semilunar or triangular radiolucency associated with roots of teeth. Histologically consists of islands of benign, well-differentiated squamous epithelium.

Ameloblastic Fibroma

Important to differentiate from ameloblastoma since it is not invasive and does not require aggressive therapy. Radiographically, welldefined unilocular radiolucency.

Ameloblastic Fibroma

Proliferating strands of odontogenic epithelium lying in highly cellular fibroblastic tissue resembling dental papilla. Epithelium resembles that of ameloblastoma but stellate cells are much less abundant.

Adenomatoid Odontogenic Tumor

Well-defined radiolucency, may have radiopacities. often associated with unerupted tooth, simulating dentigerous cyst.

Adenomatoid Odontogenic Tumor

Well-encapsulated, solid or cystic. Sheets, strands, masses of epithelium which in some places forms duct-like structures lined by columnar epithelium. Small foci of calcification and occasional dentin and enamel matrix may be seen.

AOT, odontogenic epithelial tumor

AOT

AOT

Odontogenic Fibroma

Odont. Epith remenants

COC
Prof. JH, U of Iowa/USA

COC

Dr. John Hellstein, UIOWA

COC
Prof. JH, U of Iowa/USA

Ghost cells COC Prof. JH, U of Iowa/USA

CEOT
Prof. JH, U of Iowa/USA

CEOT Prof. JH, U of Iowa/USA

CEOT
Prof. JH, U of Iowa/USA

calcifications

Odont. Epith. Cells prominent intercell

CEOT
Prof. JH, U of Iowa/USA

CEOT
Prof. JH, U of Iowa/USA

CEOT Prof. JH, U of Iowa/USA

CEOT Prof. JH, U of Iowa/USA

calcification

Odontogenic Amyloid like material

Odontogenic Myxoma: Clinical & Radiographic Features

Multilocualr radiolucency, soap-bubble, or tennis-racket appearance, often with well-defined margins. Root resorption.

Odontogenic Myxoma: Histopathological Features

Nonencapsulated immature odontogenic connective tissue (not very fibrous) rich in ground substance. Inactive rests of odontogenic epithelial cells surrounded by mature fibroblasts with delicate cytoplasmic processes. May contain variable amounts of collagen, hence the term myxofibroma.

Odontogenic Myxoma

Cementoblastoma

A rare, benign, wellcircumscribed neoplasm of cementum-like tissue growing in continuity with the apical cemental layer of a molar or premolar that produces expansion of cortical plates and pain. Identical to osteoblastoma except for association with tooth roots.

Cementoblastoma Prof. JH, U of Iowa/USA

Cementoblastoma
Prof. JH, U of Iowa/USA

Tumors of Debatable Origin: Congenital Epulis

Congenital epulis

Granular cells

MNETI