ODONTOGENIC TUMORS

derived from od. epith.

Odontogemic tissue and its
remnants
 NORMAL TOOTH GERM

Classification of odontogenic tumors

Epithelial ……...oral epithelium
d lamina
enamel organ
epith root sheath of Hertwig
Mesenchymal …………..d papilla
tooth follicle
Mixed ……. Both epithelium and connective
tissue
 Classification

Epith C.T Mixed

Ameloblastoma Od fibroma AB fibroma
AOT Od myxoma Odontomes
Pindborg cementoblastoma
Squamous od t cemento-ossifying fibroma
ODONTOGENIC TUMORS OF
EPITHELIAL ORIGIN
1. AMELOBLASTOMA

Definition: a benign
but locally invasive
neoplasm.
It is epithelial in origin
3 Types of ameloblastoma:

•Solid or muliticystic (conventional)

•Unicystic
•Peripheral (extraosseous)
1.Solid (multicystic)
•Clinical features
•4th – 5th decades
•80% mandible (70%
molar region)

•Early: asymptomatic
•Later:
•painless swelling;
•expansion; can
become large.
Radiological features
Multilocular,
radiolucent
“soap bubble” or
“honeycombed”
appearance
Cortical expansion
Root resorption
Unerupted tooth
commonly
associated.
1. Solid (multicystic)
Ameloblastoma

•Histological features
•2 main patterns:
Follicular and Plexiform
It consists of proliferating odontogenic
epithelium with a follicular or plexiform
pattern, in a fibrous stroma
 Follicular ameloblastoma
Follicular:
Islands of
epithelium with
ameloblasts on
the periphery
and central
stellate
reticulum
Stellate
reticulum
Ameloblast like cells
like cells
•Variants within follicular patterns:
•Solid
•Micro and macrocystic
•Acanthomatous (squamous metaplasia in
stellate reticulum with keratin formation)
•Keratoameloblastoma.
Granular cell type (lysosomes inside
stellate reticulum like cells)
•Basaloid type
•Desmoplastic type
•Hyalinized C.T stroma
1-Solid 2- Microcystic

Cystic
area
Microcystic
3-Macrocystic
4- Acanthomatous
5 granular
Granular cell
6-Basaloid
•7-Desmoplastic
•You say
macrocystic
Squamous
metaplasia
•Plexiform

Plexiform: network of
epithelial cords with
peripheral ameloblasts
and central stellate
reticulum; cysts are in
the fibrous stroma.
Types
Solid and Hemangio
Solid
Plexiform solid
Variant of Plexiform
Haemangio plexiform
Treatment
1. Solid (multicystic)
•Enucleation and curettage –
recurrence high

•Block resection (recurrence 15%)

•Prognosis good (benign tumour)

EXCEPT for maxillary tumour with
invasion of skull base.
Ameloblastoma

2. Unicystic ameloblastoma
•Clinical features
•10 – 15% of all ameloblastomas
•Younger patients; 2nd decade
•90% mandible, posterior
painless swelling
•Radiological features
•well circumscribed, radiolucent, unilocular
•associated with crown of unerupted 3rd molar
•Histological features 3 variants:
•Luminal Intraluminal Mural
•Luminal
•intraluminal
•mural
2. Unicystic ameloblastoma
Ameloblastoma

•Histological features
•Luminal type
•Cystic cavity lined by stellate reticulum
and ameloblast lining
•. fibrous cyst wall

•Intraluminal type
•1 or more nodules of ameloblastoma (follicular or
plexiform) project into cyst lumen.
•Mural type
•fibrous cyst wall becomes infiltrated by follicular or
plexiform ameloblastoma.
Ameloblastoma – Unicystic
•Treatment
•Luminal or intraluminal Enucleation
•Mural Resection

•recurrence 10 – 20%; but prognosis

good.
 Ameloblastoma

•3. Peripheral ameloblastoma

•Clinical
•Rare, 1% of all ameloblastomas
•Gingiva or alveolar mucosa swelling
•Middle-aged patients

•Histological features
•patterns as seen for solid
ameloblastoma

•Treatment
•excision
•recurrence rare.
Ameloblastoma – Peripheral

Gingiva

Alveolar bone
•Histiogenesis

Basal layer of oral epith

D. lamina or remnants
E.Organ or remnants
Lining of dentig. cyst
•Behavior and local spread
1-Spreads in cancellous
space(radiolucent in x ray)so remains
unnoticed

2-No
resorption
of cortical bone

2-No capsule
Invasive
•Diagnosis
•Biopsy
•X ray
•Mri
•Ttt
•Safety margin (desmoplastic , peripheral,
unicystic types 1 &2)
•Resection (mural unicystic and solid &muticystic
AB)
•Radioresistant
•Prog
Solid and multicystic are poor in prog
Maxillary AB are poor
 MALIGNANT TUMOURS OF
ODONTOGENIC EPITHELIUM
 1. MALIGNANT AMELOBLASTOMA

Rare
It means AB giving metastasis(mainly to
pulmonary area)
Malignant ameloblastoma: shows histopathologic
characteristics of ameloblastoma in primary
tumour as well as in metastases

It must send metastasis

 2-Ameloblastic carcinoma

•Primary tumor shows AB + signs of malignancy

•Secondary tumor shows AB +signs of
malignancy

•It may or may not cause metastasis

Ameloblastic carcinoma
Ameloblastic carcinoma:
•Rare malignant neoplasm
initially it resembles AB,
but later it loses its
differentiation and
behaves as malignant
and histological changes
into sq. cell carcinoma.
 3. PRIMARY INTRAOSSEOUS
(INTRA-ALVEOLAR) CARCINOMA
A squamous carcinoma that develops in the
jaws, with no obvious connection with the oral
mucosa, and that develops from odontogenic
epithelial rests undergoing sq. metaplasia.
4. ADENOMATOID ODONTOGENIC TUMOUR
3 – 7% all odontogenic tumours.
Produces hard dental structure (dentine or enamel
matrix). It is considered hamartoma.
•Clinical features:
•10 –19 years, F:M = 2:1
•Maxilla:mandible = 2:1
• Expansion.
Maxilla >mandible ant >post
Female >male
Associated with impacted canine
Radiological features
Radiolucent area, sometimes small opacities

calcifications
Adenomatoid odontogenic tumour

•Treatment
•Enucleate easily
•Good prognosis, no recurrence.
1-Fibrous capsule
Adenomatoid Odontogenic tumour
 Convoluted
tubules

Ducts
Convoluted
tubules

ducts
Adenomatoid Odontogenic tumour

Dysplastic
dentine
3. CALCIFYING ODONTOGENIC TUMOUR
(PINDBORG TUMOUR)
Definition: a locally invasive epithelial neoplasm characterised
by the development of intraepithelial structures, probably
amyloid-like, that become released as the cells break down.

Clinical features
•rare, 3rd to 7th decades
•75% mandible, posterior
•painless slow growing
swelling
 Calcifying odontogenic tumour

Radiological features
Uni- or multilocular radiolucent
•Histological features
•islands, sheets or cords epithelial cells in fibrous
stroma
•outlines of epithelial cells clear, intercellular
bridges
•nuclear pleomorphism
•amorphic, eosinophilic, hyalinised extracellular
material
•hyaline amyloid-like material sometimes
surrounded by epithelial cells, with concentric
calcifications (Liesegang rings).
•Treatment
• excision
•recurrence 15%, prognosis good.
Calcifying odontogenic tumour

Epithelium
Calcifying odontogenic tumour

Prominent
Desmosomes
Calcifying odontogenic tumour

Amyloid-like
Leisgang ring
 Melanotic Neuroectodermal tumor
of infancy=
Melanoameloblastoma
•Def: Rare neoplasm which originates from neural
crest.
•Age: Congenital (at birth) or in the first few months of
life.
•Site: Anterior part of maxilla
•It is usually painless.
•Have very rapid initial growth giving an impression
of malignancy.
•The rate of growth slows down and may stop after
the tumor reaches certain size.
Radiographic appearance:
Bone distraction + displacement of the developing
tooth + expansion of the cortex.
Histological picture:
- The tumor is none encapsulated.
- Abundant fibrous CT stroma dividing the lesion
into an alveolar like structure
•Alveolar spaces lined by large polygonal cells
that contain melanin and contain small rounded
cells (lymphocyte like)
 6. Squamous odontogenic tumor:

Rare Odontogenic tumor.

Site: Maxilla and mandible close to the roots

erupted teeth.

Radiographic picture:
Resemble severe bone loss from
periodontitis or resemble cyst like area.
Histopathology:
•Rounded or irregular: Islands of odontogenic squamous.
•Have flatted peripheral cells,
•Foci of Keratin or parakeratine may form in the epithelium.
•May contain laminated calcifications.
 MESENCHYME
ODONTOGENICTUMOURS
WITH OR WITHOUT INCLUDED
ODONTOGENIC EPITHELIUM
 1) Odontogenic fibroma:

It is a benign neoplasm of odontogenic

mesenchyme origin.
Clinically:
•Affects the mandible.
•Slowly growing and asymptomatic and may be
discovered during routine X-ray examination.
X-ray:
Well defined unilocular radiolucent area.
Histological picture:
•Formed of cellular fibroblastic tissue.
•Collagen fibers are variable in amount, most cases
the lesion is cellular except in older tumors.
•Stands or nests of odontogenic epith.
•Islands of osteoid and cementum like tissue may be
present scattered through out the lesion
 Epithelial rests

Treatment: Simple enculation

 2- Odontogenic Myxoma

It is locally invasive neoplasm.

Clinical picture:
•Age: Young age
•Site: Post of mandible.
•Origin: Primitive odontogenic mesenchyma
•The tumor produces a fusiform hard swelling.
X-ray: Multilocular radiolucent area with fine or coarse
internal trabeculae soap bubble appearance.
Histological picture:
•Scanty spindle or star shaped cells with long processes
that anastomose one to another.
•The cells are distributed in loose mucoid material.
•Few collagens may be seen.
•Scatted epithelial rests.
 Epithelial
rests

Star shaped
cell
Spindle
shaped
N.B:
1. The tumor is benign but has a tendency for
recurrence.
2. Treatment is by resection .
3. CEMENTOBLASTOMA
•Clinical features:
•No gender predilection, <25
years
•Mandible, molar region
•Grows slowly, late
expansion; Sometimes pain.

•Radiological features
•Radioopaque mass
associated with root of vital
tooth
•Mandibular first permanent
molar
•Fused with root , root
resorbtion
•Radiographically:
•Radio opaque mass attached to the roots of 6>6 and surrounded by
thin radiolucent margin.
•The mass may be irregular or rounded.
•There is resorption of the roots of the teeth 6>6 but the related tooth
is vital.
 •Sheets or thick trabeculae calcified material
Cementoblastoma
•Lacunae, basophilic reversal lines
•Cellular fibrovascular tissue between trabeculae
•Multinucleate giant cells
•Trabeculae lined with cementoblast-like cells
•Peripheral: unmineralised matrix.

Treatment
•Surgical extraction of tooth and mass.
Resorbed
roots
 Cementoblastoma

Trabeculae
of calcified
material
2. Periapical cemental dysplasia:

It is non neoplastic proliferation.

Clinical picture:
Age and sex: Middle aged women.
Site: lower incisors (multiple) 21>12.
Asymptomatic and discovered during routine x-ray
examination.
Radiographical picture:

• Early lesions are rounded

radiolucent areas related
to the apices of the teeth.
• In this stage it resembles
the periapical granuloma,
but here related teeth are
vital.
• As the lesion matures
central calcification which
increase progressively
makes the radiolucent
areas appears as dense
radiopaque masses.
Microscopic picture
• Cellular fibrous tissue is containing fossi of
calcifications in the early stage.
• As the lesion matures progressive calcification
leads to formation of dense, solid bone like or
cementum like mass.

N.B:
The condition
is self limited
and no need
for treatment.
Cementicles or bone like tissue in a
fibrous tissue
 3. Gigantiform cementoma
•It is the formation of sclerotic masses
(cementum like tissue)
• These masses are large,
symmetrically distributed and may
involve the 4 quadrants.
•These are asymptomatic unless it is
infected it expand bone
•Radiographically and histological the
same as the periapical cemental dysplasia
 4. Cemento ossifying fibroma
Clinical picture:
Age: Young adults from 20 to 40 years.
Site: Mandible premolar molar area.
Sex: Female more frequent than males.
Slowly expanding in the bone and produce bonny
swelling. And it Causes displacement of the teeth.
•Radiographic appearance:
•Well defined radiolucent area with varying degree of
calcification.
•Calcification tends to be concentrated centrally.
•Some lesions appear as a large radiopaque with thin
radiolucent margin.
•Roots of the teeth can be displaced.
Microscopic picture:
•Varies widely and ranges form:
•Highly fibrous and cellular stroma + scanty
calcification fossi. To Scanty CT stroma +
extensive calcification.
•The calcification may be( Woven bone or
dystrophic calcification or rounded
cementicles)
•These types of calcification grow, fuse and
ultimately form a dense Mass.
N.B:
1. D.D of cementifying fibroma and fibrous
dysplasia: is cementifying fibroma x-ray is well
defined where in Fibroma dysplasia is ill defined
Radiolucent.

2. D.D of benign cemntoblastoma with focal

sclaerosing.
•Histologic picture:
 Mixed TUMOURS OF
ODONTOGENIC EPITHELIUM AND
MESENCHYME
 1. Ameloblastic fibroma
Rare; True mixed tumour: epithelium and
mesenchymal tissue is neoplastic
Some may be early odontomas

•Clinical Features:
•1st 2 decades; more commonly in females
•Asymptomatic; Later swelling
•Posterior mandible (70%).

•Radiological features
•Uni- or multilocular radiolucent
•Unerupted tooth (50%)
Ameloblastic fibroma
•Histological features

•Stroma=primitive
mesenchymal tissue
like dental papilla

•Odontogenic epithelium
; compressed of
follicles(same cells as
AB) nests or rosettes or
long thin cords
•sometimes with
adjacent hyalinisation
around all follicles
 Compressed
Primitive follicles
mesenchyme
tissue
Ameloblastic fibroma
 2. AMELOBLASTIC FIBRODENTINOMA
AND FIBRO-ODONTOMA
Has the characteristics of ameloblastic fibroma but
contains also dentine, or dentine and enamel.

•Recently : First stage of odontoma

•Clinical Features:
•Children, average 10 years
•Mandible = maxilla
•No gender predilection
•Asymptomatic, later swelling.
Ameloblastic fibrodentinoma and fibro-odontoma
•Radiological features
•Unilocular radiolucent
• radiopacities
•Unerupted tooth (most cases).

•Histological features
•Soft tissue component identical to ameloblastic fibroma

•Ameloblastic fibrodentinoma:
•Dentine matrix and dentinoid material

•Ameloblastic fibro-odontoma:
•Enamel and dentine matrix in close relationship with
epithelium
•Complex masses or sometimes small teeth.
Ameloblastic fibro-odontoma
Ameloblastic fibrodentinoma and fibro-odontoma

•Treatment
•Conservative curettage
•Good prognosis, recurrence rare.
 6. ODONTOMA
•Common
•Hamartoma
•Consists of enamel, dentine, pulp and cementum
•2 types:
•Compound type: small tooth-like structures in anterior maxilla
•Complex type: mass of mixed enamel and dentine.in
posterior mandible

•Clinical features:
•Average age 14 years
•Asymptomatic,
Odontoma
•Radiological features
•Compound: tooth-like structures, surrounded by radiolucent
zone
•Complex: radiopaque mass, surrounded by radiolucent zone
•Sometimes associated with unerupted tooth

•Histological features
•Compound: small teeth in fibrous stroma
•Complex:
•Dentine, enamel, sometimes ghost cells; Cementum.

•Treatment
•Excision
Odontoma - compound
Histological:
- The denticles (E, D, C, pulp) are embedded in fibrous CT
stroma and have a fibrous capsule.

N.B: Should be enucleated to avoid cysts or

prevention of tooth eruption.
Odontoma - complex
Odontoma - complex
Histological:
All the dental tissue which are irregularly arranged.
Odontoma - complex