Lec.10 Oral Pathology ‫مصطفى السعدي‬.

‫د‬

2- Mesenchymal origin tumors

a- Odontogenic fibroma
It is benign neoplasm derived from connective tissue of odontogenic origin, it could arise
intraosseously without odontogenic epithelium (desmoplastic fibroma) which is rare or
extraosseously (peripheral odontogenic fibroma) which is relatively common.
Desmoplastic fibroma:-
Mostly affect the mandible of young adult. Painless swelling lead to extensive bone
expansion of affected area.
Radiograph:- similar to ameloblastoma.
Histopathology:- acellular hyalinized connective tissue in scar like pattern.
Treatment:- enucleation with high recurrence rate.

Peripheral odontogenic fibroma:-

Derived from overlying gingival epithelium or rest of dental lamina that remain in
peripheral location (extraosseous).
Clinically:- focal growth of gingiva like peripheral fibroma may be indistinguishable from
a fibrous epulis.
Histopathology:- the lesion is composed of a mixture of dense connective tissue,
(collagenized fibrous tissue) that separate localized zones of myxomatous, & loose
connective tissue. Small islands of odontogenic epithelium present in varying amounts.
Treatment:- enucleation or localized excision

b- Odontogenic myxoma
It is a special tumor for the jaws locally aggressive arise from dental mesenchymal tissue. It
is infiltrative (not capsulated) benign tumor.
Clinically
It occurs in young age group, most commonly involve the mandible, appear as a painless
swelling or asymptomatic. The maxillary lesion will arise into the sinus while the mandibular
lesion found in molar, premolar area & often extend into ramus.
Radiograph
Multilocular radiolucency with scalloped margin, soap-bubble appearance or honey comb
appearance (resemble ameloblastoma).

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Histopathology
- Grossly it is a gelatinous tissue, microscopically consist of a scanty spindle shape
irregular cells with fine long anastomosing processes, and a mucoid material & few collagen
fibers & epithelial rest. The margins of the lesion are ill defined & the bone trabeculae show
resorption. They will give difficulty in removal of the lesion . Some cases contain an
odontogenic epithelium.
Treatment & prognosis
- It is a benign tumor with infiltrative properties & not capsulated, therefore, bone
resection & curettage is the treatment, it is associated with recurrence.
- It is important to remove all gelatinous tissue to reach an intact area in order to reduce
ratio of recurrence.
c- Benign cementoblastoma
It is benign neoplasm of cementum like tissue growing in continuity with apical cemental
layer of molar & premolar, that produce expansion of cortical plate & pain (which is
diagnostic feature of this tumor) which become more intense if the area is palpated, but the
teeth are vital.
Radiograph
Radiopaque mass attached to the root, and surrounded by a thin radiolucent rim. It should be
differentiated from focal sclerotic osteomyelitis.
Histopathology
Cementum material surrounded by a fibrous tissue, at the periphery cementoid structures,
bone trabeculae surrounded by osteoblast &osteoclast cells that show formation & resorption
of bone.
Treatment: - Since the lesion is well encapsulated, the enucleation is done with no
recurrence.

3- Mixed epithelial & mesenchymal origin

a- Calcifying odontogenic cyst
This lesion is unusual in that it has some features of a cyst but also has many features of
solid neoplasm.
It occurs at any age in both jaws, most commonly in anterior region (anteriorl to the 1 st
molar). Usually extraosseous lesion appear as focal localized swelling in gingival, whereas
intraosseous lesion produce generalized expansion of buccal & lingual cortical plates.
Radiograph
Unilocular well defined radiolucency, occasionally multilocular containing flecks of
calcification which either irregular or tooth like density. The lesion is associated with
unerupted tooth mostly upper canine. Root resorption or divergence of adjacent teeth is seen.

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Histopathology
Well defined cystic lesion within fibrous capsule. The lumen is lined by 4-10 cells depth
epithelium with basal cells (cuboidal or columnar), a solid variant may show epithelial
thickening and contain stellate reticulum like cells. The important features is the presence of
ghost cells within the epithelium (they are swelled eosinophilic cells appear as altered
epithelial cells that lost their nuclei & reserve their outline).
Calcification like (dentinoid- like material) may be seen under epithelium in the connective
tissue (called : Dysplastic Calcification), and 10% of cases associated with odontoma &
other odontogenic tumors.
Treatment: few recurrence may be reported after simple enucleation. The aggressive type
is of unknown prognosis.

b- Ameloblastic fibroma
This tumor originates from epithelial & mesenchymal components slowly growing,
asymptomatic lead to bone expansion. It affects young patient, the lesion is located mainly
in mandibular molars area often on unerupted tooth. (common in mandible).
Radiograph
Unilocular or multilocular radiolucency associated with impacted tooth.
Histopathology
Thin strands & part of dentogingival epithelium that resemble dental lamina of cup & bell
stages of early odontogenesis. The stroma is composed of randomly oriented widely spread
fibroblast, hyalinization & focal area of calcification often surround the epithelial
component.
Treatment:- Enucleation & recurrence is high.
c-Adenomatoid odontogenic tumor
It is a rare benign tumor occurs between (10-19 years) at early adolescence more frequent in
female at anterior maxilla. It is derived from enamel organ epithelium it is believed to be
odontogenic ectomesenchymal in origin. They are frequently asymptomatic discovered by
radiograph, large lesion may produce painless swelling. (common in maxilla).
Radiograph
Its well circumscribed (defined) radiolucent area, involve the crown of unerupted tooth,
sometime may contain radiopaque calcification on the lesion similar to dentigerous cyst but
differs by:-
1- radiolucent area extend beyond C.E.Junction
2- sometime presence of flecks of radiopacities in a radiolucent area.
Histopathology
It surrounded by thick capsule, the cutting surface either cystic or solid. A well defined
capsule enclose either mass or strand of epithelium among which microcystic & duct like

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structure, these microcystic structures may contain homogenous eosinophilic material.
Fragments of amorphous cementoid or dentinoid calcification may be seen between the
epithelium.
Treatment: Enucleation, no recurrence.
d- Odontoma
Odontomes are dental hamartomas containing the calcified dental tissue.
- Odontoma is a hamartomatous lesion found over unerupted teeth containing enamel,
dentine, pulp and cementum in either normal tooth shape (compound) or abnormal tooth
shape (complex).
- It represents nearly 70% of whole odontogenic tumors, complex odontoma is more
commonly occurred in posterior mandible than maxilla, as asymptomatic swelling.
- Compound odontoma more commonly occurs in anterior maxilla than in mandible and
as a symptomatic swelling either over the crowns of unerupted teeth or between the roots of
erupted one.
Radiograph
- Unilocular radiolucency containing multiple radiopaque structures that resemble small
teeth , compound odontoma may contain as few as 2-3 tooth like structures or as many as
20-30 tooth like structures.
- Complex odontoma in posterior part of mandible on impacted tooth and may reach
several (cm) in size ,appear as solid radiopaque mass, lesions are unilocular & separated
from normal bone by distinct radiolucent line. Individual tooth like structure is absent.
Histopathology
- Enamel, dentine, pulpal tissue or tooth like structure of compound odontoma are arranged
in an ordinary pattern in a fibrous capsule. Complex odontoma differs by being composed of
single disorganized mass of enamel, dentine & pulp within abnormal tooth shape.
Treatment: Enucleation from surrounding bone.

B- Malignant tumors
Malignant ameloblastoma
It is similar to histological features of ameloblastoma, may give pulmonary metastasis &
retain microscopic appearance of primary tumor result either from aspiration or
implantation.
Treatment: local excision.
Ameloblastic carcinoma
Histologically resembles ameloblastoma but loss the differentiation & behave in malignant
way, it spreads by lymph node & distant to other regions later on.
Microscopically resemble squamous cell carcinoma & is treated as intraosseous carcinoma
(malignant tumor in jaw). The prognosis is poor when lymph node is involved.