a presentation from subject of oral pathology.

1. S A R A N G S U R E S H H OTC H A N D A N I

2. TUMOR LIKE SWELLINGS OF JAWS
• In olden time, tumor meant Lump or swelling due to any cause.
• In contemporary science, tumor means neoplasm
that has formed lump/swelling in
any part of body.

3. NEOPLASM….?
Abnormal Growth of
Tissues.

4. Cyst
• Odontogenic & Non Odontogenic
Tumor/Neoplasm
• Odontogenic & Non Odontogenic
• Metastatic
Giant Cell Lesion Fibro osseous Lesion
Swellings of Jaws

5. INTRODUCTION…
•As the name indicates, odontogenic tumors
are derived from odontogenic tissues.
–Odontogenic tissues are those which take part in
tooth development.
•Odontogenic Tumors are most common types
of neoplasm of jaws.

6. CLASSIFICATION
OdontogenicTumors
Benign
Epithelium
Ameloblastoma
Squamous Odontogenic
Tumor
Calcifying epithelial
odontogenic tumor
Adenomatoid
odontogenic tumor
Calcifying cystic tumor
Mesenchymal
Odontogenic fibroma
Odontogenic myxoma
cementoblastoma
Mixed of Both Ameloblastic Fibroma
Malignant
Epithelium
Odontogenic carcinoma
Clear cell odontogenic
tumor
Mesenchymal Odontogenic sarcoma

7. INTRODUCTION
• Benign but locally invasive
neoplasm derived from one of the
following odontogenic epithelium;
– Surface epithelium
– Reduced enamel
– Remnants of dental lamina
– Rest cells of Malessez
– Lining of dentigerous cyst
• It is rare & accounts for 1% of all
tumors of oral cavity.
• BUT, Ameloblastoma
is common in our
Society.
(PAKISTAN)

8. TYPES OF AMELOBLASTOMA
Ameloblastoma On the basis of Clinical & Radiological
Features.
Central / Intra Osseous
Multicystic Ameloblastoma
Solid Ameloblastoma
Conventional Ameloblastoma
Follicular Ameloblastoma
True Ameloblastoma
Unicystic
Peripheral / Extra
Osseous

9. GENERAL FEATURES
OF AMELOBLASTOMA
• Most common neoplasm of
odontogenic origin.
• Usually in 3rd – 5th decade.
– Rare in children & elderly
– Mostly in posterior region of
mandible.
• No specific gender
prediction.
• Locally invasive but does
not metastasize
– That’s why called benign.
• About 80% of
Ameloblastoma occur in
Mandible.

10. CLINICAL PRESENTATION
OF AMELOBLASTOMA
• Usually asymptomatic & slow growing.
• Results in facial deformity & jaw
expansion.
• In maxilla even large lesion of
Ameloblastoma produce very little
expansion because lesion can extend
into sinuses & beyond.
• Characteristics of Jaw Expansion by
Ameloblastoma
–Bony hard, non tender, ovoid
or fusiform outline.
–in advanced cases egg shell
crackling due to thinning of
bone.

11. A CLINICAL
PHOTOGRAPH OF
GRANULAR CELL
AMELOBLASTOMA IN
THE ORAL CAVITY
SHOWS AN
ENORMOUS MASS ON
THE RIGHT MANDIBLE.
http://www.nature.com/ijos/journal/v4/n1/full/ijos20129a.html

12. CLINICAL PRESENTATION
(LATE FEATURES) OF AMELOBLASTOMA
•Pain
•Paresthesia
•Perforation of bone
•Extension of
neoplasm into soft
tissue.

13. R A D I O G R A P H I C
F E A T U R E S O F
A M E L O B L A S T O M A
Typically form
Rounded & Cyst like
Radiolucency with
moderately well
defined margins and
appear as multilocular
– SOAP BUBBLE or
HONEY COMB
APPEARANCE.

14. A panoramic radiograph displays a well defined multilocular
radiolucency with scalloped border (arrowheads) extending from the
right second mandibular premolar to the mandibular ramus. Extensive
root resorption of the right second mandibular premolar and thinning of
the cortical plate is detected. Note that the inferior alveolar nerve canal
has been displaced inferiorly to the inferior cortex of the mandible
(arrows).
http://www.nature.com/ijos/journal/v4/n1/full/ijos20129a.html

15. HISTOPATHOLOGY
OF AMELOBLASTOMA
• Conventional ameloblastoma are usually made of mixture of
solid neoplasm & cysts.
• They have variety of patterns histologically but there are some features
which are common to all histological variety of ameloblastoma;
–Presence of neoplastic ameloblasts
with Palisaded appearance & reverse
polarization (presence of nuclei away from
basement membrane)

16. FollicularAmeloblastoma
PlexiformAmeloblastoma
BasalAmeloblastoma
GranularAmeloblastoma
AcanthomatousAmeloblastoma
DesmoplasticAmeloblastoma

17. FOLLICULAR AMELOBLASTOMA
• Most common type of ameloblastoma.
• Characterized by; islands of follicles of epithelial
cells in a connective tissue stroma.
– Outer layer of these islands have well organized, tall
columnar ameloblasts like cells with reverse polarity
which are surrounding core of polyhedral or angular
cells.
– small cysts may be present within follicle or stoma
– Here islands of epithelium are not interconnected.

18. FOLLICULAR AMELOBLASTOMA

19. PLEXIFORM AMELOBLASTOMA
• Here epithelium forms cords or strands and
trabeculae of small, darkly stained epithelial
cells which may lack reverse polarization and
does not resemble any stage of ameloblasts
present in less cellular stroma.
• This variant give Fish – net appearance.

20. ACANTHOMATOUS
AMELOBLASTOMA
• It has similar histological appearance to follicular
ameloblastoma, except difference in;
– Squamous metaplasia of core cells (stellate &
angular cells) occurs producing prickle cells &
keratin in core.
• this variant is sometimes confused with
squamous cell carcinoma.

21. BASAL
AMELOBLASTOMA
• Rare type
• Arranged as trabecular pattern
with peripheral cells cuboidal
rather than columnar.
• Mistaken with basal cell carcinoma.

22. GRANULAR
AMELOBLASTOMA
• In this appearance of epithelium & stroma is also
similar to follicular ameloblastoma but difference in
it is; central / core cells & some ameloblasts at
peripheral cells undergo degenerative changes &
form sheets of large PINK / eosinophilic granular
cells in the center of island.

23. DESMOPLASTIC
AMELOBLASTOMA
• In this epithelium,
odontogenic
epithelium is
arranged in small
islands or cords
in dense & highly
collagenised
stroma.

24. BEHAVIOR OF AMELOBLASTOMA
• Although ameloblastoma is benign, but some cells of this
ameloblastoma may infiltrate the narrow spaces without
causing swelling and destruction of bone.
• So that’s why simple curettage or enucleation of lesion cannot
be done due to high recurrence.
• So surgical resection with small normal tissue is best
treatment option. (wide excision)

25. MANAGEMENT OF MULTICYSTIC
AMELOBLASTOMA
• Diagnosis is confirmed by biopsy.
• Treatment of choice is wide excision – taking upto 2 cm of
normal bone around margin of lesion.
– Simple enucleation can cause Recurrence because of probability of
invasion in surrounding space.
• Regular radiographic follow up for detecting any recurrence.

26. MANAGEMENT OF MULTICYSTIC
AMELOBLASTOMA
• Maxillary Ameloblastoma are dangerous because;
–Bone is thinner in mandible.
–Neoplasm spread easily to following areas in maxilla.
• Maxillary sinus
• Pterygomaxillary fossa
• Orbit
• Cranium
• Brain

27. UNICYSTIC
AMELOBLASTOMA

28. INTRODUCTION
UNICYSTIC AMELOBLASTOMA
• It is defined as ameloblastoma having single cyst or appear as single cyst.
• However, ameloblastoma radiographically appearing as single cyst can be Multicystic
like mural ameloblastoma
Explanations for a Unicystic presentation of
ameloblastoma radiologically.
The two patterns on the left are true
Unicystic
ameloblastoma while that on the right is a
conventional ameloblastoma with one very
large cyst.

29. FEATURES OF UNICYSTIC
AMELOBLASTOMA
• Mostly b/w 10 – 20 years of age.
• Mostly in posterior mandible.
• Sometimes arises with
dentigerous cysts.
• Radiological Features
– Appear as unilocular radiolucency
• Histology
– Tumor cells forming cyst wall
are flattened & can be
mistaken for those or non –
neoplastic cyst.
• Treatment
– Enucleation

30. PERIPHERAL AMELOBLASTOMA
• In this type, ameloblastoma is present in gingival or alveolar soft tissues and does not
involve bone.
• These lesion may arise from;
– Basal cells of oral epithelium
– Extra osseous rests of dental lamina.
• Histologically similar to intra osseous ameloblastoma.

31. MALIGNANT OR METASTASIZING
AMELOBLASTOMA
• It is distant or metastasized ameloblastoma.
• Metastasis usually occur to lung.
• Although it is benign and truly speaking does not metastasize
but in some conditions as described under they may move
from oral cavity to other places;
– Aspiration of some cells of ameloblastoma into lungs during surgery.
– Surgically disrupting primary site
– Incomplete removal

32. AMELOBLASTIC CARCINOMA
• It arises when dysplastic changes occur in the primary
benign ameloblastoma.
• Rare
• Histologically poorly differentiated and shows
dysplasia .
• Metastasize to lymph nodes.
• If metastasis is present, prognosis is poor.

33. AMELOBLASTIC CARCINOMA
MALIGNANT AMELOBLASTOMA
• Clinically primary &
secondary ameloblastoma
have same all clinical
histological & other
features.
• Usually lungs.
AMELOBLASTIC CARCINOMA
• Primary has features of
normal benign
ameloblastoma, while
secondary show dysplasia
& malignant .
• Metastasize to lymph
nodes.