Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc. Presented by Dr. Binaya Subedi

2. Binaya Subedi
BDS Intern
School Of Dental Sciences, CMC

3. 
 Definition
 Classification of tumors of oral cavity
 Tumors of Epithelial origin
 Benign
 Malignant
 Tumors of Connective Tissue Origin
 Odontogenic Tumors
Contents

4. 
Tumor:
“a swelling of the tissue.”
Neoplasia:
“An abnormal mass of tissue, the growth of which
exceeds and is uncoordinated with that of the normal
tissues and persists in the same excessive manner after
cessation of the stimuli, which evoked that change.”
-Robin’s Basic Pathology (10th etd.)
Introduction

5. 
 According to GLOBOCAN 2012, lip and oral cavity
cancer is the 12th most common cancer in Asia and
ranks 8th among all the cancers in men.
 Second most common cancer in men in south east
asia.
Introduction

6. 
Classification
Based on Tissue of origin;
 Non-Odontogenic Tumors
 Tumors of Epithelial tissue origin
 Tumors of Connective tissue origin
 Tumors of Salivary gland origin
 Tumors of Muscle tissue origin
 Tumors of Nerve tissue origin
 Metastatic tumors of jaws
 Odontogenic Tumors
Based on differentiations
 Benign tumors
 Malignant tumors

7. WHO Histologic Classification of Tumors of Oral cavity, 2017

8. 
Benign Tumors of
Epithelial Origin

9. 
Squamous Papilloma
 Associated with papilloma virus HPV 6 & 11, non-
contagious.
 Virus-induced focal papillary hyperplasia of the mucosa,
similar to verruca vulgaris.
 An exophytic, pedunculated, painless growth made up of
numerous, small finger-like projections, which result in a
lesion with a roughened, verrucous or ‘cauliflower’ surface.
 Found most commonly on the tongue, lips, buccal mucosa,
gingiva & palate, esp. that area adjacent to the uvula.

11. Treatment:
 Excision, including the base of the mucosa into
which the pedicle inserts.
 If properly excised, recurrence is very rare.
 Other methods;
 conservative surgical excision
 curettage
 liquid nitrogen cryotherapy
 topical keratolytic agents (usually containing salicylic
acid and lactic acid)

12. 
 Low-grade malignancy that originates in the
pilosebaceous glands which is considered to be a
variant of invasive squamous cell carcinoma.
 Sunlight, trauma, HPV, Chemical Carcinogens are
common etiological factors in genetically susceptible
and immuno-compromised host.
 More common in fair-skinned people and in sun-
exposed areas
Keratoacanthoma
(self healing carcinoma, molluscum sebaceum,
verrucoma)

14.  Occurs in all age groups but incidence increases with
age.
 Men: women =2:1
 Face, neck and dorsum of upper extremities are the
most common sites.
 Intraoral lesions are quite uncommon. May be seen
on lips.
 Lesions are typically solitary elevated, umbilicated or
crateriform with a depressed central core or plug. Its
often painful and regional lymphadenopathy may be
present.
Treatment:
 Surgical excision

15. 
 Hamartomas, i.e. benign proliferations of nevus cells
in either epithelium or CT
 Can be congenital or acquired
 Histologically,
 Intradermal
 Junctional
 Mucosal
 Most common mucosal type is the intramucosal
nevus, followed by the common Blue nevus.
Oral Nevi
Oral melanocytic nevus, nevocellular nevus, mole

16. 
 Usually occurs in White patients over 40 years, mostly
female on hard palate and buccal mucosa.
 Asymptomatic, pigmented, brown black or blue colored,
well circumscribed, raised lesions.
 Sometimes amelanotic, sessile growths which resemble
fibromas or papillomas.
 Compound nevus; involving mucosal epithelium and CT

18. White sponge nevus
• a condition characterized by
the formation of white patches
that appear as thickened,
velvety, sponge-like tissue.
• most commonly found on the
buccal mucosa
Treatment of oral nevus:
• Surgical excision
Congenital nevi have a greater risk for malignant transformation.

19. 
Malignant Tumors of
Epithelial Origin

20. 
 Slow growing, rarely metastasizes but has ability to
produce significant local destruction.
 Most frequently develops on the exposed surfaces of
the skin, face and scalp in middle aged or elderly fair
skinned persons.
 It is thought to arise from pluripotent stem cells of
the basal cell layer as well as follicular structures.
Basal Cell Carcinoma
Rodent Ulcer

21. 
Etiology:
 UV light (chronic sun ray exposure)– most important
and common cause
 Radiation like X-rays
 Chemicals like arsenic
 Immunosuppression
 Syndromes like Xeroderma Pigmentosum and
Nevoid BCC syndrome

22. Clinical features :
• Most frequently in the fourth decade of life
• Male :female =2:1
• Most frequently seen on the middle third of face
• Does not arise from the oral mucosa so is not seen
intraorally except for invasion from an adjacent skin surface.
Subtypes of BCC;
• Nodular BCC
• Pigmented BCC
• Cystic BCC
• Superficial BCC
• Morpheaform and infiltrating BCC

23. A. Nodular BCC:
• Most common variety.
• It begins as a slightly elevated papule with a central
depression which ulcerates, heals over and then breaks
down again. Very mild trauma may cause bleeding.
• Eventually, the crusting ulcer which appears superficial
develops a smooth, rolled border representing tumor cells
spreading laterally beneath the skin.
B. Pigmented BCC
• In addition to the features seen in the nodular type, this
type contains black or brown pigmentation and are seen
more commonly in dark skinned people.
C. Cystic BCC
• May contain translucent blue-gray cystic nodules that may
mimic benign cystic lesions.

24. D. Superficial BCC
• presents as scaly patches or papules, commonly on the
trunk,
E. Micronodular BCC
• An aggressive variety, less prone to ulceration
• May have a seemingly well-defined border.
F. Morpheaform and infiltrating BCC
• aggressive types with sclerotic (scar-like) plaques or
papules, which may be mistaken for scar tissue.
• Border is usually not well defined and often extends well
beyond clinical margins.
• Ulceration, bleeding and crusting are common.

26. 
Treatment:
 Small lesions (<1 cm)– surgical excision, laser
ablation or electrodissection and curettage, with 5
mm margins of normal appearing skin.
 Large lesions – radical surgery or radiation therapy.
 For sclerosing type or recurrent lesions, Mohs
Micrographic surgery should be used.
Prognosis is usually good as the tumor doesn’t
metastasize and recurrence is rare.

27. 
 Malignant neoplasm of squamous differentiation as
characterized by the formation of keratin pearsls
and/or the presence of intercellular bridges.
 The most common malignant neoplasm of the oral
cavity.
Squamous cell carcinoma
(Epidermoid Carcinoma)
Note:
Unless specified oral carcinoma
always means Squamous cell
carcinoma

28. Etiology:
• Tobacco in its various forms, sespecially when coupled
with excess alcohol.
• High exposure to UV radiation
• Premalignant lesions and conditions (Leukoplakia)
• Poor oral hygeine
• Vitamin A and C deficiency
• Immunosuppressed
• Rare conditions like xeroderma pigmentosum
• HPV infection
Besides all the causes, tobacco and UV radiation is only
established causes of SCC. All other causes are supposed to
have synergistic effects on former two causes.

29. Clinical Features:
• Male: female = 2:1
• Mainly found in the elderly, after the fourth decade of life.
• Commonly affects vermilion border of lower lip, tongue,
floor of mouth, palate, gingiva, buccal mucosa in descending
order.
• The mortality rate is the lowest for lip cancer and highest for
the tongue.
• Clinically, two very characteristic features are ulceration
and an indurated margin.
• Any swellings, papules, discolorations that shows abrupt
increase in size, with change in surface texture with surface
ulcerations, change in surface colors any chronic non-
healing ulcers are all indicative of squamous cell carcinoma.
• Regional lymph nodes are enlarged and tender, simulating
metastatic tumor.
• Pain and difficulty in mastication are the common
complaints

31. Carcinoma of Lips
• Chiefly occurs in the elderly men , in the lower lip.
Clinical features :
• Usually begins on the vermilion border of the lip to one side
of the midline.
• Often starts as a small area of thickening, induration, and
ulceration or irregularity of the surface. Later, it may create a
small crater-like defect or produce an exophytic, proliferative
growth.
• Generally, slow to metastasize when does, usually ipsilateral
and involves the submental or submandibular nodes. Contra
lateral metastasis may occur only if the lesion is near or
crosses the midline.
Treatment and Prognosis:
• Surgical excision with or without radiation
• Prognosis is good.

33. Carcinoma of Tongue
• A relationship has been suggested between syphilis and tongue
carcinoma but nothing has been proved as yet.
Clinical features :
• Develops on the lateral border or ventral surface of the tongue.
• It presents as a painless mass or ulcer, which might become
painful if secondarily infected.
• May begin as a superficially indurated ulcer with slightly raised
borders and may develop into a fungating exophytic mass or
infiltrate the deep layers of the tongue, producing fixation and
induration.
• Lesions on the posterior portion are usually of a higher grade of
malignancy.
Treatment and Prognosis
• Surgical Excision with radiation (difficult to treat)
• Poor prognosis

35. Carcinoma of floor of mouth
Clinical Features:
• An indurated ulcer of varying size, situated on one side of
the midline.
• More frequently in the anterior portion of the floor.
• Sometimes it may produce limitation of motion of the tongue
or slurring of speech.
• Contra lateral metastasis is common as the primary lesion
occurs most commonly near the midline, where lymphatic
cross-drainage occurs.
Treatment and Prognosis:
• Radiation better than surgery
• Smaller lesions recur, larger don’t.
• Fair prognosis

37. Carcinoma of Buccal Mucosa
• It has a strong predilection of occurrence in men, almost ten
times more.
Etiology :
• Habitual quid of chewing tobacco for years.
Clinical features :
• Usually develops along or inferior to a line opposite the
plane of occlusion.
• Lesion is often a painful ulcerative one where induration
and infiltration of deeper tissues is common. Some lesions
may even be exophytic.
• Metastasis is very frequent.
Treatment :
• Combined use of surgery or x-ray radiation.

39. Carcinoma of Gingiva
Clinical features :
• More commonly found in the mandibular gingiva.
• Initially presents as an area of ulceration, which may be
purely erosive or may exhibit an exophytic growth usually
arises more commonly in edentulous areas.
• Attached gingiva is more commonly involved than the
free gingiva.
• Erosion of the underlying bone is frequent.
• Metastasis is more common from the mandibular gingiva.
Treatment :
• Treatment is generally difficult
• Bad prognosis

41. Carcinoma of Palate
• Not a common lesion of the oral cavity.
Clinical features :
• Poorly defined, ulcerated, painful lesion on one side of the
midline. It frequently crosses the midline and may extend
laterally to include the lingual gingiva or posteriorly to
involve the tonsilar pillar or even the uvula.
• It may invade the bone or occasionally the nasal cavity,
while infiltrating lesions of the soft palate may extend into
the nasopharynx.
• Metastasis occurs quite commonly.
Treatment :
• Both surgery and x-ray radiation are used.
• Prognosis is not very good.

43. TNM Grading
Of SCC
Proposed by Pierre
Denoix 1940s
Adopted by
International
Union Against Cancer
(UICC) in 1968

44. Treatment of Oral SCC
a) Surgery
a) Excisional surgery
b) Cryosurgery
c) Curettage and electrodesiccation (electrosurgery)
d) Laser surgery
b) Chemotherapy
a) Radiation therapy
• Teletherapy
• Brachytherapy
As a thumb rule,
• Stage I and Stage II cancers  surgery with or without
radiotherapy.
• Stage III  Radiation therapy and surgery with or without
chemotherapy
• Stage IV cancers  Supportive care

45. Radiation dose:
• A dose between 50 and 70 Gy, usually given over a 5- to 7-week period,
once a day, 5 days a week, 2 Gy per fraction.
Radioactive elements used:
192Ir, 137Cs ,125I, and 198Au.
Drugs Used in Chemotherapy:
• Bleomycin
• Cisplatin
• Methotrexate
• 5-flourouracil

46. 
Verrucous Carcinoms
 A warty, high grade variant of SCC.
 It is a predominantly exophytic overgrowth of well
differentiated keratinizing epithelium having
minimal atypia, locally destructive margins.
 Usually in elderly, on an average between 60-70
years.
 Most commonly on buccal mucosa and gingiva.

47. Clinical features:
• Appears papillary, with a pebbly surface, which is sometimes
covered by a white leukoplakic film.
• Lesions on the gingiva may grow into the soft tissue and
invade and destroy the underlying bone.
• Regional lymph nodes are enlarged and tender, simulating
metastatic tumor.
• Pain and difficulty in mastication are the common complaints.
• Growth is usually slow and metastasis occurs late, if at all. It
may become more aggressive if irradiated.
Treatment and Prognosis:
• Conservative excision
• Risk of anaplastic transformation if irradiated.

49. 
Malignant Melanoma
 A neoplasm of epidermal melanocytes.
 One of the most biologically unpredictable and deadly of
all human neoplasias.
 The third most common cancer of skin (after BCC and
SCC).
 Previously believed to be developed from junctional
nevus, which is premalignant melanocytic dysplasia of
some kind.
 It can arise de novo or from premalignant melanocytic
dysplasia.

50. Etiological factors :
A. Environmental factors :
• Sun exposure
• Artificial UV sources
• Socioeconomic status
• Fair skin, red hair
• No. of melanocytic nevi
B. Genetic factors :
• Familial melanoma
• Xeroderma pigmentosum
Risk factors for oral melanomas are unknown. Most of these
are thought to arise de novo.
Two growth phases:
• Radial Growth phase
• Vertical Growth phase

51. Cutaneous melanomas have been classified into :
• Superficial spreading melanoma
• Nodular melanoma
• Lentigo malignant melanoma
• Acral lentiginous melanoma
Oral manifestations :
• Twice as common in men than in women.
• Most cases occur between 40 and 70 years.
• Predilection for the palate and maxillary gingiva.
• Usually appears as a deeply pigmented area, at times
ulcerated and hemorrhagic, which tends to increase
progressively in size.
• Oral melanomas exist in superficial spreading, acral
lentiginous and nodular types.

52. ABCDE Rule in clinical diagnosis of Malignant Melanoma
 ASYMMETRY
 BORDER IRREGULARITY – with blurred, notched or
ragged edges.
 COLOR IRREGULARITY – pigmentation is not uniform
black, brown, red, tan, white and blue can all appear
together.
 DIAMETER – greater than 6 mm growth in itself is a sign.
 ELEVATION

53. 
Treatment and Prognosis
 Surgical excision for oral melanomas, jaw resection
and lymph node dissection.
 Women have a much better survival rates upto 50
years and then the rate declines.
 Nodular and superficial spreading melanomas have
a much poorer prognosis than the LMM.
 Oral melanomas have a much poorer prognosis than
the cutaneous ones.

54. 
Benign Tumors of
Connective Tissue
Origin

55. 
 Most common benign soft tissue neoplasm of the
oral cavity.
 Females: Males = 2:1
 Most commonly on the buccal mucosa along the
plane of occlusion.
 A well defined, slow growing lesion, most common
in the third, fourth, and fifth decades
 Appears as an elevated nodule of normal color with
a smooth surface, and a sessile or pedunculated base.
Fibroma
(Irritational fibroma, focal fibrous hyperplasia)

56. Treatment:
• Surgical Excision

57. 
Giant Cell Fibroma
Clinical Features
 The giant cell fibroma is typically an asymptomatic sessile
or pedunculated nodule, usually less than 1 cm in size
with papillary surface.
 Mandibular gingiva is affected twice as often as the
maxillary gingiva.
 The tongue and palate also are common sites.
Treatment and prognosis:
 Surgical Excision
 Fair prognosis, recurrence is rare.

59. 
Peripheral Ossifying
Fibroma
 Reactive rather than neoplastic in nature.
 Some peripheral ossifying fibromas are thought to
develop initially as pyogenic granulomas that
undergo fibrous maturation and subsequent
calcification.
 Occurs exclusively on the gingiva in maxillary arch
incisor- cuspid region
 Appears as a nodular mass, either pedunculated or
sessile, usually arises from the interdental papilla,
red to pink , and frequently ulcerated surface.
Peripheral clacifying fibroblastic granuloma, ossifying
fibroid epulis

61. 
Treatment and Prognosis:
 Elimination of possible irritants
 Local surgical excision
 The mass should be excised down to periosteum
because recurrence is more likely if the base of the
lesion is allowed to remain.

62. 
 Neoplasm of bone with remarkable similarities with
central cementifying fibroma
 3rd-5th decades of life, female predilection.
 Typically asymptomatic with displacement of teeth
Radiographic Features:
 well defined and unilocular with a sclerotic border.
 depending upon calcification, completely
radiolucent to radio-opaque.
Central Ossifying Fibroma

63. Treatment:
• Conservative surgical excision

64. Differences between POF and COF

65. 
Pyogenic Granuloma
 Misnomer
 Non-neoplastic, painless, nodular growth arising
from the interdental papilla specially in anterior
region of maxilla.
 Most commonly occurs in females, found to
associated with female sex hormones. Aggravates in
pregnancy thus called, pregnancy tumor.
Causes:
Gingival hyper-responsiveness to
local traumas or irritations.

66. Clinical Features:
• Buccal interdental papilla > lingual IP
• Maxilla > Mandible
• Anterior region > posterior region
• Red-to-purple, Smooth or lobulated, Pedunculated or
sessile, nodular lesion with increased vascularity & usually
ulcerated surface, ranging from few mm to centimeters.
• Soft to palpation, mature lesions are firm to touch and
reduced bleeding tendency.

67. 
Treament:
 Regress on its own after removal of local irritating
factors
 Long standing fibrotic cases can be treated with
conservative surgical excision

68. 
 Relatively common tumor like growth of the oral cavity,
reactive lesion caused by local irritation or trauma eg:
tooth extraction, denture irritation or chronic infection
Clinical Features:
 5th and 6th decades of life, mostly females, mandible is
affected more than maxilla, anterior and posterior region.
 Occurs exclusively on gingiva or edentulous alveolar
ridge, presenting as red or reddish blue nodular mass,
pedunculated or sessile, with or without surface
ulceration, mostly less than 2 cm in size.
Peripheral Giant Cell
Granuloma

70. 
TREATMENT:
 local surgical excision down to the underlying bone
with removal of source of irritation.

71. 
 Aka Giant Cell Tumor, Giant cell lesion, non-neoplastic
but aggressive lesion mimics neoplasm.
 Mostly females, mandible more than maxilla, majority in
anterior region which frequently crosses midline.
 Asymptomatic, however, may be associated with pain,
paresthesia, or perforation of the cortical bone plate
 Radiographically, unilocular or multilocular radiolucent
lesion, well delinated but non-corticated borders.
Central Giant Cell
Granuloma

72. Treatment:
• Surgical Excision

73. Differences between CGCG & PGCG

74. 
Hemangioma
 Benign neoplasm of vascular tissue origin, with
distinctive phases of proliferation and involution,
which is present at birth and regresses later.
 Hemangioma of oral cavity isn’t that common, but
head & neck is most common site.

75.  According to Watson and McCarthy,
• Capillary hemangioma.
• Cavernous hemangioma.
• Angioblastic or hypertrophic hemangioma.
• Racemose hemangioma.
• Diffuse systemic hemangioma.
• Metastasizing hemangioma.
• Nevus vinous, or port-wine stain
• Hereditary hemorrhagic telangiectasis

77. Clinical Features:
• Occur in infants or children.
• Usually affects whites but rarely occurs in blacks.
• Female: male = 3:1.
• Most common site of occurrence is lip, tongue, buccal
mucosa, and palate.
• Most commonly affected facial bones are mandible,
maxilla, and nasal bones.
• Intramuscular hemangiomas in the oral region are most
commonly seen in the masseter.
• Oral lesions appears as a flat or raised, deep red or
bluish red lesion which is seldom well circumscribed.
• They are readily compressible and fill slowly when
relieved
• Two third of the central hemangiomas were located in
the mandible. They are bone destructive lesions, often
resembling cyst and causing root resorption, but vitality
of teeth is not affected.

78. Treatment and Prognosis:
Many congenital hemangiomas have been found to
undergo spontaneous regression at a relatively early age.
Cases which do not show such remission have been
treated by :
• Surgery
• Radiation therapy
• Sclerosing agents, such as sodium morrhuate or
psylliate, injected into the lesion
• Cryotherapy
• Prognosis is excellent since it does not become
malignant or recur.

79. 
 A benign hamartomatous hyperplasia of lymphatic
vessels, with three-fourths of all cases occurring in
the head and neck region.
 Classification suggested by Watson and McCarthy;
 simple lymphangioma
 cavernous lymphangioma
 cellular or hypertrophic lymphangioma
 diffuse systemic lymphangioma
 cystic lymphangioma or hygroma
Lymphangioma

80. Clinical Features:
• The intraoral form most commonly occurs on the tongue.
• Superficial lesions are manifested as papillary lesions
which may be of the same color or of a slightly redder hue.
• Deeper lesions appear as diffuse nodules or masses without
any significant change in surface texture or color.
• “The irregular nodularity of the surface of the tongue with gray
and pink projections, and when associated with macroglossia, is
pathognomonic of lymphangioma.”
• Lip involvement referred to as macrocheilia.
• An unusual form of lymphangioma occurs in the alveolar
ridge in neonates which exhibits small blue-domed fluid-
filled lesions on the alveolar ridges of black newborns.

82. 
Treatment and Prognosis :
 Surgical excision is the treatment of choice, since the
lymphangioma is more radioresistant and insensitive
to sclerosing agents.
 Spontaneous regression is rare.
 Because of the nonencapsulated and ‘infiltrating’
nature of the lymphangioma, complete removal is
often impossible without excessive removal of
surrounding normal structures.

83. 
Odontogenic Tumors

84. Classification of Odontogenic Tumors

86. 
Ameloblastoma
(Adamantinoma, adamantoblastoma, multilocular cyst)
Coined by Churchill in 1934 to replace ‘adamantinoma’ given by
Malassez in 1884.
“The ameloblastoma is a true neoplasm of enamel organ type
tissue which does not undergo differentiation to the point of
enamel formation.”
- WHO Definition
“A tumor that is ‘usually unicentric, nonfunctional, intermittent
in growth, anatomically benign and clinically persistent’.”
- Robinson
 Second most common odontogenic neoplasm

87. Origin of Ameloblastoma:
 Cell rests of the enamel organ, either remnants of the dental lamina or
remnants of Hertwig’s sheath, the epithelial rests of Malassez.
 Epithelium of odontogenic cysts, particularly the dentigerous cyst, and
odontomas.
 Disturbances of the developing enamel organ.
 Basal cells of the surface epithelium of the jaws.
 Heterotopic epithelium in other parts of the body, especially the
pituitary gland.
Presently, it is thought that it is likely the result of alterations or mutations
in the genetic material of cells that embryologically preprogrammed for
tooth development.
Genetics:
 Overexpression of TNF-α, antiapoptotic proteins (Bcl-2, BclxL), and
interface proteins (fibroblast growth factor [FGF], matrix
metalloproteinases [MMPs]

88. Variants of Ameloblastoma
• Central (intraosseous) ameloblastoma – most common,
2nd common odontogenic tumor
• Peripheral (extraosseous) ameloblastoma – soft tissue
• Pituitary ameloblastoma (cranio pharyngioma, Rathke’s
pouch tumor)
WHO types of Ameloblastoma
 Solid / multicystic
 Extraosseous or peripheral
 Desmoplastic
 Unicystic

89. Clinical Features: Central Type
• 10 years through 90 years with peak at 33-39 years. Only
10% in below 10 years.
• No significant sex predilection
• Occurs in all areas of the jaws - mandible is the most
commonly affected area (more than 80%)
• Molar angle ramus area > 3 times more commonly than the
premolar and anterior regions combined.
• It may be either solid or unicystic type
• Usually asymptomatic and are discovered either during
routine radiographic examination or because of
asymptomatic jaw expansion

91. Peripheral (extraosseous) Ameloblastoma
Occurs in the soft tissue outside and overlying the
alveolar bone.
Originate from either surface epithelium or remnants of
dental lamina
Slight predilection for males, 2 : 1 ratio of mandible over
the maxilla
Found as nodules on the gingiva, varied in size from 3
mm- 2 cm in diameter, resembles basal cell carcinoma of
gingiva.
Relatively innocuous, lacks the persistent invasiveness
of the intraosseous lesion
Very limited tendency for recurrence

93. 
Pitutary Ameloblastoma
 Usually found in suprasellar area, grows as a
pseudoencapsulated mass
 Patient may have endocrine disturbance, drowsiness
or even toxic symptoms.
Adamantinoma of long bones
 True nature of the lesion is still unknown.
 Occurred in the tibia in approximately 90%,
sometimes in ulna, femur and fibula

94. Radiographic Features:
 Unilocular or multilocular radiolucency, with usually
smooth but in advanced lesions scalloped, sclerotic
margins.
 tumor exhibits a compartmented appearance with septa of
bone extending into the radiolucent tumor mass which
gives it a Honey Comb or soap bubble.

95. Jaw expansion or thinning of
the cortical plate

97. Histological Features:
Six histopathologic subtypes
• Follicular
• Acanthomatous
• Plexiform
• Granular cell
• Basal cell
• Desmoplastic
• Disconnected islands, strands, and cords within the
collagenized fibrous CT stroma
• Consist of tall columnar cells with hyperchromatic nuclei,
reverse polarity of the nuclei, and subnuclear vacuole -
characteristic palisading pattern

98. 
Treatment and Prognosis:
 Include both radical and conservative surgical excision,
curettage, chemical and electrocautery, radiation.
 Or a combination of surgery and radiation.
 Curettage is least desirable - highest incidence of
recurrence
 Radiation - highly radioresistant, so not preferred now
Surgical excision with 1mm of safety margins with chemical
cauterization with carnoy’s solution is treatment of choice.
carnoy’s solution:
60% ethanol, 30% chloroform and 10% glacial acetic
acid,1gm of ferric chloride

99. 
 Aka Pindborg tumor
 Uncommon benign odontogenic tumor which is
exclusively epithelial in origin
 Locally aggressive tumor, comprises 1% of all
odontogenic tumor.
Histogenesis:
 Stratum intermedium and Strands of remnants of dental
lamina, as suggested by Pindborg
Amyloid depositions are believed to be immunological
response to the startum intermedium cells
Calcifying Epithelial
Odontogenic Tumor

100. Clinical Features:
• Affects populations over wide range of age group of 8-92
years with predilection for 4th to 6th decades.
• No specific gender predilection
• Mandible is affected twice more than maxilla
• Molar-ramus-angle region is most common sites, thrice
common than in premolars region.
• Asymptomatic, expansile, hard bony swellings, may be
associated with unerupted or impacted tooth.
• Tumor shows bucco-lingual extension with thining of cortical
plate, and egg-shell cracking
• Tipping of tooth, rotations, root resorption, mobility of tooth
in affected area is a common finding.

101. Radiographic features:
• Mixed radiolucent lesion
• Unilocular or multilocular radiolucency, with ill-
defined margins and flecks of calcifications giving
wind-driven snow appearance,
• Sometimes unerupted teeth is present inside lesion
mimicking dentigerous cyst.

102. Histology:
 Proliferation of polyhedral epithelial cells in islands, strands,
cords or sheets which sometimes show cribiform
appearance.
 Homogenous, amyloid depositions among the cells, and
calcifications in forms of “liesegang ring pattern”.
 Apple green birefringence in polarized light
Treatment and prognosis:
 Small lesions: excision or curettage
 Larger, recurrent lesions: segmental resection
 Atypical CEOT or Malignant ex CEOT radial resection+
radiotherapy+ chemotherapy
 Recurrance rate: 10-20%

103. 
Adenomatoid Odontogenic
Tumors
 Uncommon tumor, mostly associated with
unerupted maxillary canine
Histogenesis
 Unknown
 Odontogenic; because arises in tooth areas, and
histologically resembles cells of dental lamina

104. Clinical Features:
• Younger patients with 69% occurring in second decade of life.
• Female : Male = 2: 1 (over 30 years, F:M = 1:2)
(Gingival lesions F:M= 14:1)
• Maxilla > mandible, anterior to canine
2/3rd tumor:
2/3rd occurs in maxilla
2/3rd in young patients
2/3rd in association with unerupted teeth
2/3rd of affected teeth are canines
• Asymptomatic, bony swelling, in maxillary anterior regions
mostly resulting into facial asymmetry and most commonly
missing canines or delayed eruption.
• When occurs in mandible, bucco-lingual extension can lead to
fractures of mandible.

106. Radiographic Features:
• Unilocular to multilocular radiolucency with some foci
of calcification, smooth sclerotic or corticated borders.
• Erosions of cortical plates and displacement of tooth
more than resorption.

107. 
Treatment and Prognosis:
 Conservative Surgical excision
 Recurrence is rare.

108. 
 Odontomas are hamartomas or malformations of dental tissues
and not neoplasms
 Similar to teeth:
 do not develop further once calcified
 may erupt into the mouth
 form during the period of odontogenesis
 can become carious (if exposed to saliva)
 Both epithelium and mesenchymal cells exibit complete
differentiation resulting in functional ameloblast and odontoblast
 Organisation of odontogenic apparatus fails to reach normal state
of morphodifferentiation
Odontomas

109. 
Two types:
a) Compound Odontoma : Moderately developed and
well arranged all tooth structures
b) Complex Odontomas: tooth like materials (enamel,
dentin) haphazardly arranged which don’t show
any resemblance to tooth.

110. Clinical Features:
 Age: 10 and 19 years
 Sex: No predilection
 Site: Maxilla > Mandible
Anterior region ( maxilla)- Compound
Posterior Jaw- Complex
 Hard painless masses, usually accidently recorded on
routine radiographic examination.
Associated problems:
 Caries
 Abscess formation
 Prevent eruption
 Displace teeth
 Cyst formation

111. A. Compound Odontoma
Radiographic Features:
• Many separate, small denticles
• Structure of normal teeth; small and simpler gross morphology

112.  Dense opacity
 Radiolucent rimming (develop within a dental follicle)
 If infected, the calcified tissues may be mistaken for a sequestrum
Radiographic Features:
B. Complex odontoma

113. Treatment:
A. Compound Odontoma
 Enucleated surgically
Complications:
 Dentigerous cyst
 Gardner's syndrome of intestinal polyposis: multiple odontomas
 Odontoameloblastoma
B. Complex Odontoma
 Enucleated surgically
Complications:
 potential obstructions to the eruption
 focus of infection
 cosmetic lesions

114. 
References:
 Robbin’s Basic Pathology, 10th etd.
 Shafer’s Textbook of Oral Pathology, 5th etd.
 Oral and Maxillofacial Pathology, Neville, 4th etd.
 Burket’s Oral Medicine, 12th etd.