ODONTOGENIC

TUMORS
Learning objectives
 Define and classify Odontogenic cysts & tumours.
 Explain pathogenesis of common odontogenic cysts.
 Describe clinical, radiographical and histopathological
features of common Jaw cysts and tumours.
 Identify and draw histopathological features of common
cysts and tumours through microsopy.
 Generate differential diagnosis of various jaw cysts and
tumors.
 Relate and apply knowledge in clinical practice.
DEFINITION
 Tumors arising either from odontogenic
epithelium , ectomesenchyme or mixture
of both.
ODONTOGENESIS and ODONTOGENIC CYSTS AND
TUMORS
Dental Lamina Inner and Outer Enamel Epithelium
(Rests of Serres)** (Reduced Enamel Epithelium)**

Dental Lamina
Stratum Intermedium
Enamel Organ

Stelate Reticulum
Hertwig’s Root Sheath
(Rests of Malassez)**

Dental Papillae
Dental Papillae

Ameloblasts
**Give Rise to
Odontogenic Cysts and
Odontoblasts Epithelial Tumors
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Odontogenic tumors classification
EPITHELIAL TUMORS

Benign- Ameloblastoma,
Calcifying epithelial Odontogenic tumor
Squamous Odontogenic tumor
Adenomatoid odontogenic tumor

Malignant-
Malignant Ameloblastoma
Ameloblastic Carcinoma
2. Mesenchymal tumors
– Odontogenic Myxoma
– Odontogenic Fibroma
– Cemento Blastoma
– Multiple Cementoma
– Cementifying Fibroma

3. Mixed tumors
Benign – Ameloblastic Fibroma
– Ameloblastic Fibroodontoma
– Odontoma
– Dentinoma
– Odonto Ameloblastoma
Malignant
– Ameloblastic Fibrosarcoma
 ODONTOGENIC TUMORS
General Considerations

 Jaw Swelling - Usually Asymptomatic

 Well-Defined Radiolucent or Mixed

◦ Some Odontomas Opaque Only
 Uni- or Multilocular
◦
 Often Expand Bone
◦ May Resorb and/or Displace Teeth

10
 ameloblastoma
Radiolucent,
Most
common, Adults, May be
associated
Painless jaw Posterior
with
bone mandible
impacted
expansion
tooth
 Unilocular Radiolucency

Ameloblastoma

Clinical
Expansion

Multilocular Radiolucency
Multilocular Radiolucency
Soap bubble / honey comb
Pericoronal

Desmoplastic Variant may be “Mixed” Radiographically 17

 Ameloblastoma
- Histology -

Follicular Histology
Epithelial Islands Ameloblasts

Stellate Reticulum

Fibrous
Stroma

22
 Ameloblastoma
 Histologic Resemblance to Enamel Organ

Ameloblastoma Enamel Organ

• Other Histologic Patterns of Ameloblastoma

• Plexiform
• Basal Cell
• Spindle Cell
• Acanthomatous
• Granular Cell
• Desmoplastic 23
 UNICYSTIC (“CYSTOGENIC”)
AMELOBLASTOMA
 Younger Patients as
Pericoronal Unilocular
Radiolucency around
Mandibular Third Molar
 ~10-15% of All
Ameloblastomas
 Lower Recurrence with
Enucleation !!

36
types
 Luminal
 Intraluminal
 mural
PERIPHERAL AMELOBLASTOMA
 Usually Nodule on Mandibular Posterior
Gingiva
 ~1% of All Ameloblastomas
 Same “Follicular” Histology
 Conservative Excision with Low
Recurrence

42
 Malignant Ameloblastoma and
Ameloblastic Carcinoma

 Malignant Ameloblastoma
◦ Typical Histology with Clinical Metastasis
 Ameloblastic Carcinoma
◦ Histologic Malignancy with or without
Metastasis

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AOT
Adenomatoid Odontogenic Tumor
 Teenagers and Female AOT

 Associated with impacted

Maxillary Cuspid
◦ Unilocular Radiolucency
◦ May be “Mixed”
◦ Thick Capsule -

AOT
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Variants of AOT: E1-E4, extrafollicular
sites; F, follicular; P, peripheral.
Adenomatoid Odontogenic Tumor
- Histology -
CEOT
Calcifying Epithelial Odontogenic Tumor
CEOT / Pindborg Tumor
 Patients Similar to Ameloblastoma
◦ Adult
◦ Posterior Mandible
◦ Uni- or Multilocular
◦ Often with Impacted Tooth
 Frequently Partially Radiopaque

55
CEOT with -Opacity

56
 CEOT / Pindborg Tumor
Polyhedral epithelial Cells

Amyloid Material with “Liesegang” Calcifications

58
MIXED TUMORS
 Odontomas
Mixed odontogenic tumors
Enamel & dentine

Compound Complex
Tooth like Posterior mandible
Anterior maxilla Association with
impacted tooth
Compound odontoma

Tooth like
structures
Complex odontoma

Radiopaque
mass of
enamel and
dentine
Compound odontoma
Complex odontoma
Complex odontoma
Ameloblastic fibroma
 Mixed tumor
 Younger age group
 Male predominence
 Posterior mandible
 Association with unerupted tooth
 Radiographically radiolucent, unilocular or
multilocular
Odontogenic
epithelium

Mesenchymal cells
resembles dental
papilla
Plump to ovoid
mesenchymal
cells
Ameloblastic fibro- odontoma
 Resembles Ameloblastic fibroma
 General features of ameloblastic fibroma
but also contains enamel and dentine
 Radiographically, radiolucent with
variabled amount of radiodensity
MESENCHYMAL
TUMORS
 Odontogenic Myxoma
 Mesenchymal tumor
 Originates from dental papilla or follicular
mesenchyme
 Slow growing, aggressively invasive
 Multilocular, expansile; impacted teeth?
 Radiology – radiolucency
 Histology – spindle/stellate fibroblasts with
basophilic ground substance
 Odontogenic fibromyxoma
 Cementoblastoma
 True neoplasm of cementoblasts
 First mandibular molars
 Cortex expanded
 Involved tooth ankylosed
 Radiology – apical mass; radio-opaque
 Histology – calcified mass with cementoblasts
lying within the lacunae
Learning Outcomes
 By the end of this topic students will be
able to
1. Define and classify odontogenic cysts and
tumours.
2. Explain the origin and pathogenesis of
common odontogenic cysts.
3. Describe and analyse clinical, histopathological
and radiographical features of cysts and
tumours
4. Generate and discuss differential diagnosis of
cysts and tumours.