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Mesenchymal Tumors

Group II DFD Celso, Chalaki, Concepcion, Derakshanfard

Odontogenic Myxoma
Paul Concepcion

Odontogenic Myxoma
 an uncommon benign odontogenic tumor arising from embryonic connective tissue associated with tooth formation  This is a benign neoplasm that may be infiltrative and aggressive

Odontogenic Myxoma
Clinical Features
 Mean age of occurrence is 30 years old  With no gender predilection  Lesions may be seen in either jaws
 Mandible 63%  Maxilla 37%

Odontogenic Myxoma
 In the maxilla: it can be found anywhere in the maxilla and constantly involve the maxillary sinus

Odontogenic Myxoma
 In the mandible: lesions are generally found in the molar and premolar region. Which may extend to the ascending ramus and the condylar region

Odontogenic Myxoma
Clinical Features
 These are painless, slow growing which cause root dilaceration and in some cases root resorption  Generally associated with retained or missing teeth  Causes cortical expansion and eventual perforation, and results to tumefaction and facial deformity

Odontogenic Myxoma
Radiographic Features
 It may appear as a well-circumscribed or a diffuse radiolucent lesion  Often, it is multiloculated and has a honeycomb pattern

Odontogenic Myxoma

Odontogenic Myxoma

Odontogenic Myxoma
Histopathology
 This tumor is composed of bland, relatively acellular myxomatous connective tissue  Benign fibroblasts and myofibroblasts with variable amounts of collagen are found in a mucopolysaccharide matrix  Odontogenic rests are absent

Odontogenic Myxoma

Odontogenic Myxoma

Odontogenic Myxoma
Differential Diagnosis
 Ameloblastoma  Central Hemangioma  Giant Cell Granuloma

Odontogenic Myxoma
Treatment and Prognosis
 Surgical excision  For small unilocular lesions enucleation and curettage followed by chemical bone cautery can be done
 Prognosis is very good.

CENTRAL ODONTOGENIC FIBROMA


Anne Celso

CENTRAL ODONTOGENIC FIBROMA


CLINICAL FEATURES -benign odontogenic neoplasm occurring within the jaws -the lesion is central in bone and has persistent progressive growth

CENTRAL ODONTOGENIC FIBROMA

CENTRAL ODONTOGENIC FIBROMA


CLINICAL FEATURES -more common in adults, with the average age being 40. -twice as likely to affect women than men -usually found either in the anterior maxilla or the posterior mandible

CENTRAL ODONTOGENIC FIBROMA


RADIOGRAPHIC APPEARANCE -appear as a loculated radiolucent area that may be associated with unerupted or displaced teeth -uni or multilocular radiolucency involving periodontal and crestal bone adjacent to dental roots

CENTRAL ODONTOGENIC FIBROMA

CENTRAL ODONTOGENIC FIBROMA


MICROSCOPIC APPEARANCE -In the simple type, the lesion is composed of a mass of mature fibrous tissue containing few epithelial rests. -In the World Health Organization type, mature connective tissue contains abundant rests and calcific deposits of what is regarded as dentin or cementum.

CENTRAL ODONTOGENIC FIBROMA

CENTRAL ODONTOGENIC FIBROMA

CENTRAL ODONTOGENIC FIBROMA


DIFFERENTIAL DIAGNOSIS -Desmoplastic fibroma -Fibromyxoma -Hyperplastic follicular sac

CENTRAL ODONTOGENIC FIBROMA


TREATMENT -enucleation or excision PROGNOSIS -recurrence is very uncommon

Benign Cementoblastoma
Anne Celso

BENIGN CEMENTOBLASTOMA
CLINICAL FEATURES

-aka true cementoma -benign neoplasm and forms a mass of cementum-like tissue as an irregular or round mass attached to the roots of a tooth -often involving the mandibular molars or premolars -involved tooth usually has a vital pulp -usually occurs in people under the age of 25 -asymptomatic

BENIGN CEMENTOBLASTOMA

BENIGN CEMENTOBLASTOMA
CLINICAL FEATURES -have unlimited growth potential -behave in a locally aggressive manner resulting in bony expansion, root resorption, displacement of adjacent teeth, and jaw deformity -higher predilection for males

BENIGN CEMENTOBLASTOMA

BENIGN CEMENTOBLASTOMA
RADIOGRAPHIC APPEARANCE -appears as a well-defined, markedly radiopaque mass, with a radiolucent peripheral "line", which overlies and obliterates the tooth root -there is usually apparent external resorption of the root where the tumor and the root join.

BENIGN CEMENTOBLASTOMA
RADIOGRAPHIC APPEARANCE

BENIGN CEMENTOBLASTOMA
MICROSCOPIC APPEARANCE -presents cementum-like tissue with numerous reversal lines -prominent basophilic reversal lines may give a pagetoid appearance to the lesion

BENIGN CEMENTOBLASTOMA

BENIGN CEMENTOBLASTOMA
DIFFERENTIAL DIAGNOSIS - Severe hypercementosis -Chronic focal sclerosing osteomyelitis -Cementoblasts -Osteoblastoma

BENIGN CEMENTOBLASTOMA
TREATMENT -removal of the tumor, along with the affected tooth and curettage or peripheral ostectomy -enucleation of the tumor through apicoectomy following root canal treatment

BENIGN CEMENTOBLASTOMA
PROGNOSIS -an excellent prognosis is usually achieved after complete removal of the tumor. -recurrence and continued growth are possible if lesional tissues are left behind after initial surgery

CENTRAL ODONTOGENIC FIBROMA


Zivar Chalaki

Cementifying fibroma
 Is a benign neoplasm of bone that has the potential for excessive growth, bone destruction, and recurrence.it is clinically and microscopically similar to ossifying fibroma.  Composed of a fibrous connective tissue stroma in which new bone is formed, it is classified as one of the benign fibroosseous lesion of the jaws.

Etiology and pathogenesis


Is of undetermined cause. Although chromosome translocations have been identified in a few cases of cementifying fibroma , genetic studies have been insufficient to determine the molecular mechanisms that underlie the development of this tumor.

Clinical feature
 Uncommon lesion that tends to occur during 3rd and 4th decades of life  In women more than men  Is a slow-growing, asymptomatic, and expansile lesion.  Maybe seen in the jaws and craniofacial bones  Lesion of the jaws characteristically arise in the tooth bearing regions

Clinical feature
 Most often in the mandibular premolar ,molar area  The slow but persistent growth of the tumor may ultimately produce expansion and thinning of the buccal and lingual cortical plates, although perforation and mucosal ulceration are rare.  The most important radiographic feature of this lesion is the well_circumscribed, sharply defined border.

Clinical feature
 Cementifying fibroma, cementoossifying fibroma, and psammomatoid ossifying fibroma are terms occasionally used when the bony islands in these lesions are round or spheroidal.  These tumors occur in similar age groups and locations, exhibit comparable clinical characteristics, and have the same biologic behavior.

Histopathology
 Is composed of fibrous connective tissue with well differentiated spindled fibroblast.  Cellularity is uniform but may vary from one lesion to the next.  Collagen fibers are arranged haphazardly , although a whorled, storiform pattern may be evident.

Histo pathology
 Bony spheroids , trabeculae, or islands are evenly distributed throughout the fibrous stroma.  Bone is immature and often surrounded by osteoblasts; osteoclasts are infrequently seen.

Treatment and prognosis


 Surgical removal using curettage or enucleation .  The lesion can typically be separated easily from the surrounding normal bone.  Recurrence is described only rarely after removal.

Treatment and prognosis

Cemento-Osseous Dysplasias
Mohsen Derakshanfard

Cemento-Osseous Dysplasias
Includes Periapical Cemental Dysplasia (PCD) Florid cemento-osseous dysplasia (aka Florid Osseous Dysplasia, FCOD, FOD) Focal Cemento-osseous dysplasia (aka Focal osseous dysplasia, FCOD, FOD)  This lesion appears to arise from the periodontal ligament and contains various amounts of fibrous tissue, cementum, and bone. All of these lesions represent the same histopathological process, but are distinguished by the location and extent of lesions in the jaws.

Radiographic features
PCD is a localized change in bone metabolism. It occurs at the apices of lower anterior teeth This lesion passes through three stages in its maturation.  The osteolytic stage occurs first and is characterized by localized dental periapical radiolucencies similar in appearance to those that occur with a dental abscess.  The next period is termed the cementoblastic stage. During this time cementoblasts become more active and produce spicules of cementum, which produce a mixed radiolucent/radiopaque appearance.  The final or mature stage consists of an abnormally large amount of calcification that appears as a dense periapical radiopacity surrounded by a thin radiolucent border.

Radiographic Features
Location Apices of mandibular anterior teeth Multiple or solitary Shape and Borders Well defined Round, oval or irregular shape May have a sclerotic border

Periapical cemental dysplasia (early stage)


Multiple radiolucencies at the apices of the mandibular anterior teeth. In periapical cemental dysplasia, the teeth are vital unless otherwise involved with caries or trauma. The radiolucencies should not be misdiagnosed as inflammatory apical lesions (granulomas, cysts, abscess) in which the teeth are nonvital and maybe symptomatic.

Periapical cemental dysplasia (early stage)

Periapical cementaldysplasia (early stage).

Periapical cemental dysplasia (calcified stage).


Each radiopacity is surrounded by a radiolucent border at the apices of mandibular incisor teeth.

Effects on adjacent structures May efface the lamina dura of adjacent teeth Root resorption is rare Surrounding bone may become sclerotic Occasionally, large lesions may cause expansion of the jaws

Periapical cemental dysplasia (MATURE stage)

Periapical Cemental Dysplasia


Clinical Features Teeth are vital Usually an incidental radiographic finding F:M 9:1 3:1 African: Caucasian Frequent in Asians Mean age = 39 yrs In most cases, multiple lesions are present that are asymptomatic.

Dentinoma
Mohsen Derakshanfard

Histologic description This lesion contains varying amounts of fibrous connective tissue, cementoblasts, and cemental tissue depending on the stage of the lesion. Treatment Periodic radiographic observation is appropriate. The teeth are vital and should not be treated by extraction or endodontic therapy. Electrical, thermal, and mechanical stimulation of the teeth can aid the clinician who is attempting to rule out dental infection during the osteolytic or cementoblastic stages.

dentinoma
 This type is quite rare, is composed of connective tissue, odontogenic epithelium, and abnormal dentin associated with coronary portions of unerupted permanent teeth. Its radiographic appearance is radiopaque mass in close proximity to the crown of an unerupted tooth.

Age and sex it seen in px younger than 36 years with an average of age 26 years with no sex predilection for occurrence It is often associated with an impacted tooth; however, extraosseous cases can occur. Pain, swelling, and mucosal perforation have been reported. Site it is predominately seen in mandible. especially in molar area and frequently is associated with an impacted tooth. The tumor is located, usually in intraosseous structures, although there are reports that say they have found in the soft tissues. Causes increased bone volume expansion. May or may not be pain. Symptomes patient notices a swelling over a variable period of time with pain. Sign perforation of mucosa and subsequent infection may be present. There may be redness of overlying mucosa with discharge.

Clinical feature

Radiographic features
The radiographic picture may be extremely variable. It may appear as a radiolucency, a radiolucency with small radiopaque flecks, or a solitary radiopaque mass. Internal structure the lesion offers a radiolucency, specific limits,within which are irregular radiopaque mass that may vary in size and extension. it contain either a large, solitary, opaque mass or numerous smaller irregular radiopaque masses of calcified material which may vary considerably in size Bone It may cause local destruction of bone.

Histopathological features
The connective tissue stroma resembles dental papilla. Masses of irregular Dentin(which has been termed as dentinoid or osteodentine) with demonstrable dentinal tubules are present. Undifferentiated odontogenic epitheliumis present and enamel is absent. If enamel were present the lesion would be called a complex composite odontoma.
Dentinoma. Histological section showing a tumor composed mostlyof dentin dysplasia ,poorly calcified.

Microscopically, the dentinoma may resemble ameloblastic fibroma.Epithelial tissue that composes Pathology it often takes the form of fine strands, consisting of round or cuboidal cells are arranged in one or two layers. The connective tissue resembles that of the dental papilla by the type and degree of cellularity.

Among the connective tissue and odontogenic epithelium shows a poorly organized dentin deposition which gives sometimes an aspect of osteodentin or interglobular dentin. Some cells, like odontoblasts-often present around the islets of dentine. In the dentin frequently poorly mineralized mesenchymal cells can be seen inside.

management
 Surgical incision with through curettage of area and enucleation . A careful excision with removal of all tumor formation, is sufficient for control. It should be detailed in the eventual removal of fibrous capsule, since at the expense of it, when left remains, recurrence occurs, although this is unusual.