Odontogenic tumours part 2

Dr. Ali Tahir. M.Phil Oral Pathology

Calcifying Epithelial Odontogenic TumourCEOT

Dr. Ali Tahir. M.Phil Oral Pathology

CEOTAlso called ‘Pindborg’ tumourRare, < 1% of all tumoursLocally aggressive like ameloblastomaArises from rests of dental lamina or reduced

enamel epitheliumCentral & peripheral types

Dr. Ali Tahir. M.Phil Oral Pathology

Clinical features20-60yrs of ageMore common in

mandibleMolar premolar areaSlow growing painless

massMaxillary lesions can

cause nasal, sinus & eye sypmtoms

Peripheral appears as a small, sessile mass, often without calcification

Dr. Ali Tahir. M.Phil Oral Pathology

Radiographical FeaturesRadiolucent with flecks of radio-opacitiesLess commonly appears as a mixture of radio-

opaque & radiolucent areasUnilocular/MultilocularMay appear as mixed areasMostly associated with an impacted toothIndistinct line of demarcation

Dr. Ali Tahir. M.Phil Oral Pathology

RadiographCalcifications are prominent around the crown of impacted tooth

Dr. Ali Tahir. M.Phil Oral Pathology

CEOTD.D:

Dentigerous cystAOTAmeloblastic fibro-odontoma

Dr. Ali Tahir. M.Phil Oral Pathology

Histological FeaturesSheets of polyhedral cellsProminent intercellular bridgesNuclie vary in size, pleomorphism may be seen

but it doesn’t indicate malignancyUnlike ameloblastoma, it has calcifications

which may be spherical or diffusePools of amorphous, eosinophilic, hyalinized

materialA clear cell variant also existsNature of Eosinophilic material is controversial

Dr. Ali Tahir. M.Phil Oral Pathology

HistopathologySheets of Polyhedral cellsProminent intercellular bridgesPools of Eosinophilic material

Dr. Ali Tahir. M.Phil Oral Pathology

HistopathologySpherical calcifications can be seen

Dr. Ali Tahir. M.Phil Oral Pathology

Clear cell variant

Dr. Ali Tahir. M.Phil Oral Pathology

Congo red stain in polarized light

Dr. Ali Tahir. M.Phil Oral Pathology

Adenomatoid Odontogenic TumourAOT

Dr. Ali Tahir. M.Phil Oral Pathology

Adenomatoid Odontogenic tumourAn odontogenic tumour arising from

odontogenic epithelium, around the crowns of un-erupted anterior teeth in young patients

Biologically non-aggressive

Dr. Ali Tahir. M.Phil Oral Pathology

Clinical Features3-7% of all odontogenic

tumoursCommon in anterior jawsMore common in maxillaFrequently associated with

an impacted toothCommon in younger

patients (14-15yrs)Female predilectionPresents as swelling

around un-erupted toothUsually asymptomaticPeripheral appears as

small, sessile mass on gingiva

Dr. Ali Tahir. M.Phil Oral Pathology

Clinical FeaturesPresents as swelling

around un-erupted tooth

Usually asymptomatic

Large lesions cause painless expansion of bone, although seldom exceeds 3cm

Peripheral appears as small, sessile mass on gingiva

Dr. Ali Tahir. M.Phil Oral Pathology

Radiographic featuresWell corticated,

unilocular radiolucency around an impacted tooth

Flecks of radio-opacity (snow-flake calcifications)

Extends apically beyond CE junction

Dr. Ali Tahir. M.Phil Oral Pathology

Extra-follicular type

Dr. Ali Tahir. M.Phil Oral Pathology

Histological FeaturesOuter capsule of thick

fibrous CTSurrounds a

nodular,/ductal/whorled pattern of epithelium (spindled or columnar) surrounding pools of PAS positive material (type of basement membrane)

Spherical calcifications

Dr. Ali Tahir. M.Phil Oral Pathology

Histological Features• Columnar epithelium

arranged in duct-like tubular structures

• These are not true ducts or glands

• Foci of calcifications may be seen

Dr. Ali Tahir. M.Phil Oral Pathology

Calcifying Odontogenic CystGorlin cystOdontogenic Ghost Cell Tumour

Dr. Ali Tahir. M.Phil Oral Pathology

COCA rare, well circumscribed solid or cystic

lesion with a wide spectrum of histological features & contains ghost cells & spherical calcifications

Associated with odontomasMostly occurs as solid, non-cystic lesion

called odontogenic ghost cell tumour

Dr. Ali Tahir. M.Phil Oral Pathology

Clinical FeaturesCommon in areas

anterior to molars2nd decadeIntraosseous/

extraosseousIntraosseous causes

expansion of cortical plates

Usually painless

Dr. Ali Tahir. M.Phil Oral Pathology

Radiographical FeaturesWell defined

unilocular radiolucency

Flecks of radio-opacities which may be irregular calcifications or tooth-like structures

1/3rd cases associated with unerupted canine

Root resorption & divergence

Dr. Ali Tahir. M.Phil Oral Pathology

R/F

Dr. Ali Tahir. M.Phil Oral Pathology

HistologyVariableCystic/SolidEpithelium

resembles that of ameloblastoma

Outer layer of palisaded columnar cells

Inner layer ressembels stellate reticulum

Dr. Ali Tahir. M.Phil Oral Pathology

HistopathologyEosinophilic epithelial

cells without nuclie referred to as ‘ghost cells’

Spherical calcificationsHyalinized material

Dr. Ali Tahir. M.Phil Oral Pathology

Squamous Odontogenic TumourRare benign odontogenic neoplasm that may

be clinically aggressiveClinical Features:Anterior to molarsPeak incidence in 3rd decadePresents as painless swelling with loosening

of teethSlow growing

Dr. Ali Tahir. M.Phil Oral Pathology

Radiographical featuresSmall lesions have

Unilocular radiolucency

Large are multilocular

Indistinct bordersDisplaces teeth

Dr. Ali Tahir. M.Phil Oral Pathology

HistologyIslands of normal appearing stratified

squamous epitheliumIslands may have microcyst formation in the

centreSpherical or irregular shaped calcifications

Dr. Ali Tahir. M.Phil Oral Pathology

Histopathology