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Odontomes & Odontogenic Tumors (Lab 6)
Odontomes & Odontogenic Tumors (Lab 6)
Compound odontome
Prof. JH, U of Iowa/USA
pulp
Complex odontome: Mass of irregularly arranged, well-formed enamel, dentin, pulp & cementum surrounded by a fibrous capsule.
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.
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
Squamo metapla
Ameloblastoma
Prof. JH, U of Iowa/USA
Odontogen
stroma
Ameloblastoma
Prof. JH, U of Iowa/USA
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.
Follicular pattern: several changes can occur within the stellate area, including: 1. cystic breakdown.
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
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
Ameloblastic fibroma
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.
Well-defined radiolucency, may have radiopacities. often associated with unerupted tooth, simulating dentigerous cyst.
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
AOT
Odontogenic Fibroma
COC
Prof. JH, U of Iowa/USA
COC
COC
Prof. JH, U of Iowa/USA
CEOT
Prof. JH, U of Iowa/USA
CEOT
Prof. JH, U of Iowa/USA
calcifications
CEOT
Prof. JH, U of Iowa/USA
CEOT
Prof. JH, U of Iowa/USA
calcification
Multilocualr radiolucency, soap-bubble, or tennis-racket appearance, often with well-defined margins. Root resorption.
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
Congenital epulis
Granular cells
MNETI