SUBMITTED BY: Lekshmy Jayan
I MDS
Department of Oral Pathology
GUIDED BY: Dr. Jayant
ODONTOGENIC TUMOR
Group of neoplasm and tumor- like malformations arising from cells of odontogenic apparatus and their remnants.
In simple terms, odontogenic tumors arise from odontogenic or tooth forming apparatus.
Origin of Odontogenic Tumors
Ectodermal
Dental lamina( Cell
rests of Serre)
Enamel organ
REEHERS( Cell
rests of Malassez)
Mesenchymal
Dental papilla
Dental sac
• Malignant Odontogenic Tumors
Ameloblastic carcinoma
Primary intraosseous carcinoma
Clear cell odontogenic carcinoma
Sclerosing odontogenic carcinoma
Ghost cell odontogenic carcinoma
Odontogenic carcinosarcoma
Odontogenic sarcoma
Benign Odontogenic Tumors
Ameloblastoma
Squamous odontogenic tumor
Calcifying epithelial odontogenic tumor
Adenamatoid odontogenic tumor
Ameloblastic fibroma
Primordial odontogenic tumor
Dentinogenic ghost cell tumor
Odontoma
Odontogenic fibroma
Odontogenic myoma
Cementoblastoma
Cemento-ossifying fibroma
Odontogenic
carcinoma with
dentinoid
Odontogenic Cysts
Dentigerous cyst
Odontogenic keratocyst
Lateral periodontal and botryoid odontogenic cyst
Gingival cyst
Glandular odontogenic cyst
Calcifying odontogenic cyst
Nasopalatine cyst
Orthokeratinized odontogenic cyst
(Wright et al : Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Odontogenic and Maxillofacial Bone Tumors, 2017)
First described by Mosqueda et al, 2014
Found 6 cases of tumors that did not fulfil the criteria of any described odontogenic tumor
Primordial odontogenic tumor is an intraoral mixed odontogenic tumor consisting of dental papilla like tissue covered with cuboidal to columnar epithelium that resembles inner enamel epithelium of enamel organ
(Mikami et al : Primordial odontogenic tumor: A
case report with histopathological analysis. 2017)
Soft tissue odontoma with massively enlarged dental papilla
Soft tissue odontoma with monstrous papillomegaly
(Slater et al: Primordial Odontogenic Tumor: Report of a Case:2015)
Still not clear
But may possibly originated from mesenchyme of an abortive tooth germ that failed to produce a dental organ
The mesenchymal tissue may have stimulated the epithelium to proliferate around it
Mimics early/ primordial stages of tooth development
(Ronell Bologna- Molina et al: Primordial odontogenic tumor: an immunohistochemical profile: 2017)
Novel lesion
Only 9 cases reported so far
Age= 3-19years
Sex =
Mandible : Maxilla = 6:1
Posterior molar region
All cases except one has been reported in left side
Asymptomatic expansile lesion
Average size= 56mm (25-90 mm)
Seen in association with unerupted teeth
Aggressive lesion
( Toshinori Ando et al: A case report of priomordialodontogenic tumor: A new entity in WHO classification 2017: 2017)
Age/
Gender
Location Clinical findings Radiographic findings Treatment Follow
up
1.
18yr/M
Left posterior mandible from
the first molar to the angle of
the mandible
Asymptomatic buccal
swelling clinically
evident for 6 months
RL, UL, well defined,
45 9 40 mm, enclosing
the crown of the third
molar
Enucleation together
with embedded third
molar
20
years,
NED
2.16yr/M Left posterior mandible from
the first molar to the angle of
the mandible
Asymptomatic, buccal
and inferior mandibular
cortical bone expansion.
Clinically evident for 4
months
RL, UL, well defined,
55 9 50 mm, enclosing
the crown of the third
molar
Enucleation together
with embedded third
molar
LFU
3.
16yr/M
Left posterior mandible from
the first molar to the angle of
the mandible
Asymptomatic buccal
swelling. Clinically
evident for 1 year
RL, UL, well defined,
65 9 50 mm, enclosing
the crown of the third
molar
Enucleation together
with embedded third
molar
10
years,
NED
4. 3yr/F Left posterior mandible from
the first molar to the angle of
the mandible
Asymptomatic buccal
and lingual bony
expansion. Clinically
evident for 22 months
RL, biloculated, well
defined, 90 9 70 mm,
enclosing the crowns of
the second deciduous
and first permanent
molars. Root resorption
of the first deciduous
molar
Enucleation together
with first and second
deciduous molars
and tooth 19
9 years,
NED
Age/
Gender
Location Clinical features Radiographic features Treatment Follow
up
5. 13yr/F Left posterior mandible
from the second premolar
to the upper third of the
ascending ramus
Asymptomatic
buccal swelling.
Clinically evident
for 4 months
RL, biloculated, well defined,
80 9 50 mm, enclosing the
third molar
Enucleation with the
third molar and
extraction of the first
and second molars
3 years,
NED
6.
3yr/F
Left posterior maxilla from
the first deciduous molar
up to the floor of the
maxillary sinus and
tuberosity
Asymptomatic
buccal and palatal
bony swelling.
Clinically evident
for 3 months
RL, UL, well defined, 35 9 30
mm, displacing the second
deciduous and first permanent
molars
Enucleation together
with the second
deciduous and first
permanent molars
6
months,
NED
7.
8yr/F Left posterior maxilla from
second premolar upto the
floor of the maxillary sinus
and tuberosity
Asymptomatic left
maxillary buccal
and palatal
swelling
well-defined RL associated
with an unerupted first
deciduous molar, which
induced buccal cortical plate
expansion and elevation of the
floor of left maxillary sinus,
and also slightly displaced the
first premolar toward palatal
side
Enucleation together
with the deciduous
first molar
16
months,
NED
8. 5yr/M Right posterior mandible
from deciduous first molar
to permanent first molar
Asymptomatic
buccal swelling
Well-defined homogenous
radiolucency pushing the
unerupted tooth to the base of
the mandible.
Enucleation together
with second deciduous
molar
7
months,
NED
White, solid spherical mass
Glossy and multilobulated
If enucleated along with the involved tooth then it is also seen
Loose and myxoid fibrous tissue
Scattered stellate and fusiform fibroblast- forms central area of tumor
Cell-rich ectomesenchymatous tissue or myxoid tissue
Periphery of lesion is covered by columnar or cuboidal epithelium
Resemble INNER ENAMEL EPITHELIUM of developing tooth
No odontoblastic differentiation
REE overlying enamel surface of embedded teeth- no direct continuity
Independent ectomesenchymal proliferation??
Induce proliferation of adjacent dental lamina to surround it !!
(Mosqueda- Taylor et al ; Primordial odontogenic tumor: Clinicopathological analysis of 6 cases of previously undescribed entity: 2014)
CK 14- positive in all epithelial layers
CK 19 positive in columnar epithelium
Vimentin strongly positive in mesenchymal tumor cells
Moderately positive in all epithelial layers
Amelogenin -positive in cuboidal and columnar epithelium
MOC-31- found in localised areas in epithelium
SYNDECAN-1( CD138)- vary from entirely negative zones to focally positive areas in epithelium
Strong stromal expression
PITX2- Weak immunostaining in mesenchymal cells
Weak to moderate positivity in endothelial cells
Focal moderate positivity in epithelium
CD34- strong positivity in mesenchymal tumor cells in contact or closer to epithelial layers and blood vessels
Indicate presence of embryonic fibroblast
(Ronell Bologna et al: Primordial odontogenic tumor: A immuohistochemical profile, 2017)
Dentigerous cyst
Ameloblasticfibroma
Cemento-ossifying fibroma
Odontogenic myxoma
Hyperplastic dental follicle
Loose collagenous fibrous connective tissue with myxoid areas
Small odontogenic epithelial nests
Lined on inner surface by epithelium derived from Enamel Organ
Epithelium never covers external surface
Doesn’t show expansile growth as big as lesions reported with POT
Highly cellular mesenchymal tissue
Surface has single layer of odontoblasts adjacent to enamel organ
Represent primordial ectomesenchymal odontogenic proliferation with features closely resembling dental papilla
(Mosqueda- Taylor et al ; Primordial odontogenic tumor: Clinicopathological analysis of 6 cases of previously undescribed entity: 2014)
Only
difference
Enucleation of lesion by separating it from the adjacent bone along with the impacted tooth
No recurrence has been reported so far
Primordial odontogenic tumor (POT) was first reported by Mosqueda-Taylor et al in 2014.
Classified into benign mixed epithelial and mesenchymal odontogenic tumour in the 4th edition of the World Health Organization (WHO) classification of Head and Neck tumours in 2017.
Radiographic appearance and histopathological features
However, there are only eight reported cases so far, therefore, pathogenesis and the biological properties of this tumor are not well understood.
Reported case of 5 year old patient with POT
5-year-old Japanese boy
Chief complaint of delayed eruption of the second deciduous molar in the right mandible
No relevant medical or family history
Intraoral examination revealed mobility of the adjacent first deciduous molar, and buccal swelling in the affected area of the mandible with no pain
Normal overlying mucosa
Surgical excision of the lesion was performed under general anesthesia
The tumor was detached from adjacent bone, and surgically enucleated in one piece
Vimentin
CK 18
Mitotic activity of tooth germ
CD 34
All these support that the mesenchymal
component of POT is derived from
dental papilla of primordial tooth germ
10-20th week- cap to late bell stage
FOR CASE REPORT
TOPIC ITEM CHECKLIST ITEM DESCRIPTION REPORTED
ON PAGE
TITLE 1 The area of focus and “case report” should appear in the title
KEYWORDS 2 Two to five key words that identify topics in this case report
ABSTRACT 3a Introduction – What is unique and why is it important?
(UNSTRUCTURED) 3b The patient’s main concerns and important clinical findings
3c The main diagnoses, interventions, and outcomes
3d Conclusion—What are one or more “take-away” lessons?
INTRODUCTION 4 Briefly summarize why this case is unique with medical literature
references.
PATIENT INFORMATION 5a Demographic information
5b Main concerns and symptoms
5c Medical, family, and psychosocial history including genetic information
5d Relevant past interventions and their outcomes
CLINICAL FINDINGS 6 Relevant physical examination (PE) and other clinical findings
TIMELINE 7 Relevant data from this episode of care organized as a timeline (figure or table) X
DIAGNOSTIC
ASSESSMENT
8a Diagnostic methods (PE, laboratory testing, imaging, surveys)
8b Diagnostic challenges
8c Diagnostic reasoning including differential diagnosis
8d Prognostic characteristics when applicable
THERAPEUTIC
INTERVENTION
9a Types of intervention (pharmacologic, surgical, preventive)
FOLLOW UPS AND
OUTCOMES
10a Clinician and patient-assessed outcomes when appropriate -
10b Important follow-up diagnostic and other test results X
DISCUSSION 11a Strengths and limitations in the approach to this case X
11b Discussion of the relevant medical literature
Top Related