AMELOBLASTOMA

Dr. DEVI CHARAN SHETTY

Director-Principal and Head
29.08.23
 LEARNING OBJECTIVES
• To learn about the clinical and
radiological features of
Ameloblastoma.

• To learn about the histological

features and variants of
Ameloblastoma.
 CONTENTS
• Introduction
• Classification of Odontogenic tumours
• Definition
• Pathogenesis
• Clinical features, Radiographic & Histopathological
features of Ameloblastoma
• Histopathological Variants of Ameloblastoma
• Summary and Conclusion
• References and Suggested Reading
 INTRODUCTION
• The Ameloblastoma is a true neoplasm of
enamel organ type tissue which does not
undergo differentiation to the point of enamel
formation.
Category I
ODONTOGENIC EPITHELIUM WITHOUT ODONTOGENIC ECTOMESENCHYME:

•AMELOBLASTOMA

•Squamous odontogenic tumor

•Calcifying epithelial odontogenic tumor( Pindborg’s Tumor)

•Adenomatoid odontogenic Tumor

 Definition:
• By ROBINSON:

“ A benign odontogenic tumor that is

usually unicentric, non functional, intermittent
in growth anatomically, benign and clinically
persistent.”

1885: Malassez used the term “Adamantinoma”.

1934: Churchill coined the term “ Ameloblastoma”.

 PATHOGENESIS:
 Varied origin:
1. Cell rests of enamel organ i.e.
A) Remnants of dental lamina.
B) Epithelial rests of Malassez

2. Epithelium of odontogenic cysts

a) Dentigerous cyst

3. Disturbance in the developing dental organ

4. Basal cells of surface epithelium.

5. Heterotopic epithelium in other parts of the body( Pituitary

gland).
 EPIDEMIOLOGY:
• Most common benign odontogenic tumor after
odontome
• Equal in both sexes.

 Any age , but usually in the 4th- 5th decade. Mandible:

Maxilla-80:20.

 Mandible:

 66% Molar and Ramus region.

 11% premolar region.
 10% incisor region.
 SIGNS AND SYMPTOMS:

• Slow growing, when small,

seldom symptomatic.

• Initial diagnosis by routine

radiographs.

• When undiagnosed in the

early stage, there is
enlargement of the affected
side.
 Mobility of the affected teeth.

 Expansion of both cortical plates with the lingual

cortical plate expanding first.

 No pain, unless secondarily infected.

 If neglected, gross disfigurement , pathologic

fractures, extension into soft tissues may be seen.
 Radiographic features:

• Most commonly
multilocular
radiolucency

• May be associated with

resorption of roots.
• Ameloblastoma in an edentulous anterior mandible. Occlusal view shows a destructive multilocular
lesion

Multilocular
Radiolucency
in ramus area
 HISTOPATHOLOGY:
• Occurs in 2 main patterns: Other Variants
– Follicular Acanthomatous
– Plexiform Clear cell
Desmoplastic
Basal cell
• Not infrequently, both present in
the same tumor. Granular
Keratoameloblastoma
• In follicular areas, islands of
epithelium tumor tissue are
surrounded by a network of
connective tissue stroma.
• Where as in plexiform areas, the
pattern is reversed.
 The classical features of
Ameloblastoma originally were
described by Vickers and Gorlin in 1970
(criteria)

The darkly staining periphery of the

tumour islands is composed of :
•Peripheral layer of tall columnar cells
with hyperchromasia
• Reverse polarity of the nuclei,
• sub nuclear vacuole formation
Stroma - A moderately to densely
collagenized connective tissue
 Follicular type

FOLLICULAR VARIETY
Plexiform variant of Ameloblastoma
 Histologic variants:
• Granular cell ameloblastoma.

• Acanthomatous ameloblastoma.

• Basal cell ameloblastoma.

• Desmoplastic ameloblastoma.

• Unicystic ameloblastoma.

• Peripheral ameloblastoma.
 Follicular Ameloblastoma

• Discrete islands or follicles of

epithelial cells seperated by a
variable amount of connective
tissue stroma
• Islands resemble the enamel organ
of the developing tooth germ.

well defined The may be separated

oval nuclei cytoplasm from the
situated at may be finely peripheral cells by
the end of granular or a layer or two of
the cell homogenous flattened cells
nearest to and vacuoles similar to stratum
the centre of are often intermedium
the follicle present.
 Follicular Ameloblastoma

Solld/ rnulticystic ameloblastoma Solid/multicystic ameloblastoma with extensive

showing a follicular pattern with cystic degeneration of follicular tumor islands
central cystic degeneration and some (multicystic ameloblastoma) (H&E, x25).
squamous cell metaplasia
 Plexiform type

• Epithelium proliferates in a “cord-

like fashion anastomosing each
other,” hence the name
“plexiform.”

• Strands of epithelium are bordered

by a single layer of cuboidal or
columnar cells with an internal
area of stellate cells

• Cyst formation occurs very

frequently in the stroma as well as
within epithelium
 Acanthomatous Ameloblastoma
• When extensive squamous metaplasia, often
associated with keratin formation, occurs in
the central portions of the epithelial islands
Acanthomatous Ameloblastoma
 Granular cell Ameloblastoma:

• A type of solid ameloblastoma in which the

central neoplastic cells exhibit prominent
cytoplasmic granularity.

• Abundant cytoplasm filled with eosinophilic

granules that resemble lysosomes
ultrastructurally and histochemically
 Granular cell
changes in Ameloblastoma
 Basal cell ameloblastoma
• Composed of nests of uniform basaloid cells,
and they histopathologically are very similar
to basal cell carcinoma of the skin.

• No stellate reticulum is present in the central

portions.
BASAL CELL AMELOBLASTOMA
 Desmoplastic ameloblastoma
• Small islands and cords of odontogenic
epithelium in a densely collagenized stroma.

• Peripheral columnar ameloblast-like cells are

inconspicuous about the epithelial islands
KITE TAIL PATTERN
 UNICYSTIC AMELOBLASTOMA
• Cystic neoplasm with unilocular presentation.

• Unicystic Ameloblastoma are most often seen in younger

patients, with about 50% of all such tumors diagnosed during
the second decade of life.
• Mandible> Maxilla
• Posterior> Anterior

• The lesion is often asymptomatic, although large lesions may

cause a painless swelling of the jaws.
• Appear as sharply defined radiolucent areas

• Also seen as a circumscribed radiolucency that

surrounds the crown of an unerupted mandibular
third molar, clinically resembling a dentigerous cyst.
• Unicystic ameloblastoma (UA) refers to those
cystic lesions that show clinical, radiographic,
or gross features of a mandibular cyst, but on
histologic examination show a typical
ameloblastomatous epithelium lining part of
the cyst cavity, with or without luminal and/or
mural tumor growth
 PATHOGENESIS
• Three pathogenic mechanisms for the evolution
of Unicystic ameloblastoma are: reduced enamel
epithelium, from dentigerous cyst and due to
cystic degeneration of solid ameloblastoma.

• It often involves an impacted tooth and the focal

area of the cystic tumor lining is often composed
of a nonspecific, thin epithelium that mimics the
dentigerous cyst lining.
 TYPES of UA

Intraluminal UA Intramural UA
Intraluminal UA Intramural UA
 UNICYSTIC AMELOBLASTOMA
(LUMINAL TYPE)

Cystic lining showing intramural proliferation

PATHOLOGY OF UA-HISTOLOGIC UA
SUBGROUPING(By Ackermann)

SUBGROUP INTERPRETATION

1 Luminal UA

1.2 Luminal & Intraluminal UA

1.2.3 Luminal, Intraluminal & Intramural UA

1.3 Luminal & Intramural UA

 Peripheral Ameloblastoma
• Uncommon

• Arises from rests of dental lamina

beneath the oral mucosa or from
the basal epithelial cells of the
surface epithelium.
• Painless, nonulcerated sessile or
pedunculated gingival or alveolar
mucosal lesion.

• Posterior gingival and alveolar

mucosa commonly involved.
• Peripheral ameloblastomas have islands of
ameloblastic epithelium that occupy the
lamina propria underneath the surface
epithelium.

• The proliferating epithelium may show any of

the features described for the intraosseous
ameloblastoma; plexiform or follicular
patterns are the most common.
Peripheral Ameloblastoma
 TREATMENT
• Surgical intervention range from enucleation
to en bloc resection.

• Marginal resection is the most widely used

treatment.

• Recurrence rates of up to 15% have been

reported after marginal or block resection.
 SUMMARY and CONCLUSION
• Ameloblastoma are benign odontogenic tumor of enamel organ
type which arise from remnants of enamel organ.

• Show wide histopathologic and clinical variation.

• May have significant effect on prognosis and biological behaviour.

• Histopathology: Tall columnar cells with peripheral palisading and

hyperchromatic nuclei.

• Central stellate reticulum like cells

• Microcystic degeneration.
 MCQs
1. Unicystic Ameloblastoma can arise from:
• Reduced enamel epithelium
• Dentigerous cyst
• Cystic degeneration in Ameloblastic islands
• All of the above

2. Which is not a criteria for Vickers and Gorlin criteria:

• Tall columnar cells
• Sub nuclear vacuolization
• Inclusion bodies in the cell
• Hyperchromatic nucleus
 Questions
• Discuss Variants of Ameloblastoma.(University
2013,17)

• Short note on Unicystic Ameloblastoma.

 LINK TO VIDEO
• https://www.youtube.com/watch?
v=uujIdEq12AI

• https://www.youtube.com/watch?
v=MUOr8qK4XN4
 REFERENCES

• Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and
Maxillofacial Pathology (Fourth edition).

• Rajendran and Sivapathasundharam. Shafer’s Textbook of

Oral Pathology (Ninth edition).

SUGGESTED READING
Reichert and Phillipsen. Odontogenic Tumors and
allied lesions. Quintessence Publishing. 2004.