MELOBLASTOMA

dontogenic tumors

complex group of lesions

diverse histopathologic types and clinical behavior

true neoplasms
Rarely exhibit malignant
behavior

Tumorlike
malformations
(hamartomas)

,Odontogenic tumors, like normal odontogenesis

demonstrate varying inductive interactions
between
odontogenic epithelium and odontogenic
.ectomesenchyme
Oral epithelium
Epithelial
invagination

ectomesenchyme

Dental lamina

Classification of Odontogenic Tumors

A. Tumors of odontogenic epithelium
Ameloblastoma. 1
a. Malignant ameloblastoma
b. Ameloblastic carcinoma
Clear cell odontogenic carcinoma. 2
*Adenomatoid odontogenic tumor. 3
Calcifying epithelial odontogenic tumor . 4
Squamous odontogenic tumor. 5

B. Mixed odontogenic tumors

Ameloblastic fibroma. 1
Ameloblastic fibro-odontoma. 2
Ameloblastic fibrosarcoma. 3
Odontoameloblastoma. 4
Compound odontoma. 5
Complex odontoma. 6

C. Tumors of odontogenic ectomesenchyme

Odontogenic fibroma. 1
Granular cell odontogenic tumor. 2
Odontogenic myxoma. 3
Cementoblastoma. 4

Tumors of Odontogenic
Epithelium
are composed of odontogenic epithelium
without participation of odontogenic
.ectomesenchyme

AMELOBLASTOMA

clinically significant
odontogenic tumor
the most common

Its relative frequency equals the combined frequency of all. other

odontogenic tumors, excluding odontomas
Tends to infiltrate between intact cancellous bone trabeculae at the periphery of
the lesion before bone resorption becomes radiographically evident.
Recurrence often takes many years to become clinically manifest.

rests of dental lamina

a developing enamel organ

they ma yarise from

the epithelial lining of an odontogenic
cyst

the basal cells of the oral mucosa

the epithelial cell rests of Malessez

slow-growing, locally invasive

tumors that run a benign course in most cases.
Ameloblastomas are

Three different clinicoradiographic situations

Conventional solid or multicystic (86%)(1
Unicystic (13%)(2
Peripheral (Extraosseous) (1%)(3
differing therapeutic considerations and
prognosis.

Conventional solid

a wide age range

or

multicystic

Relatively uncommon in the 10- to 19-year-old

groupequal prevalence in the third to seventh
decades of life
rare in children younger than age 10
no significant gender
predilection

Pain and paresthesia are

uncommon, even with large
tumors.

Most often in the molar-ascending ramus area

painless swelling expansion

clinical presentation
A

of the jaw is the

usual

If untreated, the lesion may grow slowly to massive or

grotesque proportions

Radiographic feature
Multilocular radiolucent lesion, soap
Buccal & lingual cortical expansion
resorption of the roots of teeth
In many cases an unerupted teeth
defect

.soap

bubble" appearance"

bubble / honey combed

specially

3rd molar is associated with

.honeycombed" appearance"

Solid ameloblastomas may radiographically appear as

radiolucent

unilocular

defects, which may resemble almost any type of cystic

lesion
resorption of the roots of teeth

irregular scalloping margins.

This small unilocular radiolucency

lesion be mistaken for a lateral periodontal
cyst

Although the radiographic features, particularly of the typical

multilocular

defect, may be

highly suggestive of

ameloblastoma
a variety of odontogenic and nonodontogenic lesions may show
similar radiographic features

Odontogenic keratocyst
Central giant cell granuloma
Ameloblastic fibroma
Odontogenic myxoma

Histopathologic Features
Follicular
II. plexiform
I.

III. Acanthomatuos
IV. granular cell

desmoplastic

V.
VI.

The

No correlation
between
clinical
behavior and
these
microscopic
patterns

basal cell

follicular and plexiform patterns are the most common

Follicular pattern
Islands of epithelium resemble enamel organ epithelium in a mature fibrous
connective tissue stroma
a core of loosely arranged angular cells resembling the stellate reticulum
of an enamel organ.
A single layer of tall columnar ameloblast-like cells or cuboidal that resemble
basal cells surrounds this central core.

The nuclei of these cells are

located at the opposite pole to the
basement membrane (reversed

polarity)

Cyst formation
is common and may vary from microcysts, which form within the epithelial islands, to
large macroscopic cysts, which may be several centimeters in diameter

Plexiform pattern
consists of long, anastomosing cords or larger sheets of odontogenic epithelium
columnar or cuboidal ameloblast-like cells surrounding more loosely arranged
epithelial cells.
. The supporting stroma tends to be loosely arranged and vascular

Cyst formation is relatively

uncommon .

When Cyst formation occurs, it is

more often associated with stromal
degeneration rather than cystic
change within the epithelium

Acanthomatous pattern
When extensive squamous metaplasia, often associated with keratin

formation, occurs in the central portions of the epithelial islands of a follicular

ameloblastoma
This change does
not indicate a more
aggressive course
for the lesion.

Islands of ameloblastoma demonstrating central squamous differentiation.

unicystic
ameloblastom
a

separate consideration
clinical features
Radiographic features
pathologic features
its response to treatment

10% to 15% of all intraosseous ameloblastomas

Whether the unicystic ameloblastoma originates de nova as a neoplasm

or whether it is the result of neoplastic transformation of nonneoplastic cyst
.epithelium has been long debate

Clinical and Radiographic Features

of all such tumors,diagnosed during the second decade of life 50%
More than 90%........

in the mandible,( usually in the posterior regions)

Often asymptomatic
A circumscribed
radiolucency that surrounds
the crown of an unerupted
mandibular third molar

Other tumors simply appear as sharply defined radiolucent areas and are usually
considered to be a primordial ,radicular, or residual cyst.
The surgical findings may also suggest that the lesion in question is a cyst.

Histopathologic Features
luminal

a fibrous cyst wall

l
a basal layer of columnar or cuboidal cells with hyperchromatic nuclei
reverse polarity and basilar cytoplasmic vacuolization
The overlying epithelial cells are loosely cohesive and resemble stellate reticulum

.plexiform unicystic ameloblastomas

one or more
nodules
of ameloblastoma
project from the
cystic lining into
the lumen of the
cyst

Because the secondary inflammation,

The intraluminal cellular proliferation does
not always meet the strict histopathologic
criteria for ameloblastoma

intralumina

Typical ameloblastoma, however, may be

found in other, less inflamed parts of the
specimen
.

the fibrous wall of the cyst is

infiltrated
by typical follicular or
.plexiform ameloblastoma

multiple sections
through many
levels of the
specimen
are necessary to
rule out the
possibility of mural
invasion of tumor
cells

Mural UAB

Radiographic diff.diagnosis
residual cyst.1
okc.2
ameloblastoma. 3

gross features

Subepithelial hyalinization

Squamous differentiation

Mural invasion of tumor cells

Ameloblastomatous invasion into the underlying mature collagenous connective
tissue wall

The End