Calcifying Epithelial Odontogenic Tumor

Pindborg tumor.

Mandibular bicuspid region, often associated with unerupted / impacted tooth

Non encapsulated and locally invasive

Enucleation with margin of bone

Radiography

Trabecular pattern of bone lost

Circumscribed unilocular radiolucency with honey-comb pattern along with scattered flecks of calcifications, Driven snow appearance

Calcifying Epithelial Odontogenic Tumor

Histology

• Islands of eosinophilic epithelial cells

• Cells infiltrate bony trabeculae

• Psammoma-like calcifications (Liesegang rings)

• Nuclear hyperchromatism and pleomorphism

CEOT- histopathology

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Clear cells

Calcifying odontogenic cyst

Stratified squamous epithelial liningPolarized basal layer, lumen contains ghost cells

Adenomatoid Odontogenic Tumor

Pathognomic histo picture of duct like structure of epithelium: nests, whorls, strands, cords, sworls and has distinct capsule

Often in maxillary canine region in association with impacted canine. F:M 2:1

Radiologic: destructive lesion, unilocular radiolucency.

Enucleation

Adenomatoid odontogenic tumour

Thick fibrous capsule, clusters of spindle cells, columnar cells (rosettes, ductal) throughout

Squamous odontogenic tumour

oval nest of squamous epithelium

in mature collagen stroma

Mixed odontogenic tumorsEpithelial and Mesenchymal

Ameloblastic Fibroma

Uncommon odontogenic neoplasm producing considerable inductive change in connective tissue.

Except for pathologic / Histologic features, clinical and radiological picture mimics Ameloblastoma.

Enucleation

Ameloblastic fibroma

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Ameloblastic Fibro- odontoma

Fibrous c/t along with enamel and dentin matrix

Altered occlusion, delayed eruption of teeth.

Swelling and mild pain.

Aggressive and invades adjacent tissues

Wide radical excision

Odontomas

Composite: Enamel, dentin, cementum, pulp.

Compound: Calcified structures bear some degree of resemblance to teeth.

Complex: disorderly, disoriented fashion of alignment of tissues.

Complex odontoma

•one of the most commonest odontogenic lesion/malformation

•It is commonly found in the posterior mandible

OSTEODENTIN

•Compound odontoma

•Anterior maxilla.

Mesenchymal tumors

Odontogenic Myxoma Spindle shaped cells and

scattered collagen fibers distributed through a loose, mucoid material.

 Painless, slowly enlarging expansion of the jaw with possible tooth loosening or displacement

Mandible>maxilla, posterior>anterior "soap bubble" or "honeycomb"

appearance Because of the gelatinous nature of the

tumor, it is crucial for the surgeon to remove the lesion intact so as to further reduce the risk of recurrence.

The odontogenic Myxoma is made up of loosely arranged spindle and stellate cells with a mucoid intercellular substance. Nests of odontogenic epithelium are found infrequency

Cementoma

an intraosseous lesion composed of fibrous connective tissue enclosing foci of calcified material resembling cementum.

a. Periapical Cemental

Dysplasia

b. Cementifying Fibroma

c. Benign Cementoblastoma

Cementoma

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Radial oriented trabeculae from cementum

The radiographic picture varies from a radiolucent (fibrous) to a radiopaque (calcified) lesion.

Cementoblastoma in the third stage consisting of a radiopaque mass with a radiolucent border and attached to the apices of the mandibular second premolar and first molar. The teeth are vital.

Periapical Cemental

Dysplasia Etiology: mild

trauma from occlusion.

Asymptomatic

Radiolucencies at root apices of lower anteriors often mature to calcify. When pulp tested, the teeth were found to be vital

Central Cementifying Fibroma

Mimics central ossifying fibroma of bone.

Displacement of teeth common.

Impingement on structures- nerve paraesthesia.

Taking into account the fact that the demographics, radiographic appearances and location are identical. 

Cemento-ossifying fibroma should not be confused with peripheral ossifying fibroma which is a reactive non- neoplastic lesion.

sub-classification of cemental tumors warranted???

The management in case of the Cementoblastoma and the Cementifying fibroma is the same, surgical excision, which is in contrast to the Periapical Cemental dysplasia where no treatment should be done

Learning objectives Definition, clinical features,

Radiographic features and histopathological features of CEOT. Know the cystic variant.

Clinical features, Radiographic features and histopathological features of ameloblastic fibroma

Clinical features, Radiographic features and histopathological features of ameloblastic fibro-odontoma

Definition, clinical features, Radiographic features and histopathological features of AOT, SOT, Odontoma

Definition, clinical features, Radiographic features and histopathological features of Cementoma and its sub types.

Be familiar with the histological terms used for description