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Odontomes & Odontogenic Tumors I
Odontomes & Odontogenic Tumors I
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Odontomes & Odontogenic Tumors I Dr. Tahani Abualteen
Odontomes & Odontogenic Tumors I Dr. Tahani Abualteen
Odontomes & Odontogenic Tumors I Dr. Tahani Abualteen
Odontomes & Odontogenic Tumors I Dr. Tahani Abualteen
Odontomes
Odontomes
 Odontome (or odontoma): non-neoplastic, developmental anomaly or malformation that contains fully formed enamel and
 Odontome (or odontoma): non-neoplastic,
developmental anomaly or malformation that
contains fully formed enamel and dentin.
 They can be considered as dental hamartomas
containing dental calcified tissues.
 hamartoma is normal tissues in normal location
but are abnormal in amount or shape , and have
limited growth potential.
 Classifications may vary, and some include
odontomes with odontogenic tumors.
growth potential.  Classifications may vary, and some include odontomes with odontogenic tumors. Dr. Tahani Abualteen
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Odontomes
Odontomes
Invaginated odontome These are better considered as structural anomalies of teeth rather than odontomes.
Invaginated odontome
These are better
considered as
structural anomalies
of teeth rather than
odontomes.

Evaginated odontome Enamel pearl

 (dens invaginatus, dens-in-dente)
(dens invaginatus,
dens-in-dente)
  (enameloma)
(enameloma)
 Geminated odontome  Complex odontome  Compound odontome
Geminated odontome
 Complex odontome
 Compound odontome
  (enameloma)  Geminated odontome  Complex odontome  Compound odontome Dr. Tahani Abualteen
  (enameloma)  Geminated odontome  Complex odontome  Compound odontome Dr. Tahani Abualteen
  (enameloma)  Geminated odontome  Complex odontome  Compound odontome Dr. Tahani Abualteen
  (enameloma)  Geminated odontome  Complex odontome  Compound odontome Dr. Tahani Abualteen
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Complex Odontomes
Complex Odontomes
 Complex odontome is a developmental tumor-like mass consisting of disorderly arranged dental tissues. 
 Complex odontome is a developmental tumor-like mass
consisting of disorderly arranged dental tissues.
 They have limited growth potential and can be considered
as dental hamartomas.
 Complex odontome occurs mostly in premolar-molar
regions, especially in mandible.
 Radiographically, initially present as radiolucent area with
progressive deposition of hard tissue; the fully developed
odontome present as a radiopaque mass surrounded by a
radiolucent zone.
 Histologically present as a mass of irregularly arranged,
well-formed enamel, dentin, pulp & cementum surrounded
by a fibrous capsule. Dentin forms the bulk of the lesion.
dentin, pulp & cementum surrounded by a fibrous capsule. Dentin forms the bulk of the lesion.
Dr. Tahani Abualteen
Dr. Tahani Abualteen
dentin, pulp & cementum surrounded by a fibrous capsule. Dentin forms the bulk of the lesion.
dentin, pulp & cementum surrounded by a fibrous capsule. Dentin forms the bulk of the lesion.
dentin, pulp & cementum surrounded by a fibrous capsule. Dentin forms the bulk of the lesion.
Compound Odontomes
Compound Odontomes
 Compound odontome is a developmental tumor- like mass consisting of numerous small, discrete, tooth-like
 Compound odontome is a developmental tumor-
like mass consisting of numerous small,
discrete, tooth-like structures. So it shows a
much more morphodifferentiation.
 Compound odontome mostly occurs in the
anterior maxilla.
 Radiographically, tooth-like structures
surrounding the crown of unerupted tooth.
 Histologically, a number of separate
denticles embedded in fibrous tissue.
(with dental tissues arranged similar to a
normal tooth)
denticles embedded in fibrous tissue. (with dental tissues arranged similar to a normal tooth) Dr. Tahani
Dr. Tahani Abualteen
Dr. Tahani Abualteen
denticles embedded in fibrous tissue. (with dental tissues arranged similar to a normal tooth) Dr. Tahani
Complex & Compound Odontomes  The majority of odontomes are associated with the crowns of
Complex & Compound Odontomes
 The majority of odontomes are associated with the crowns
of unerupted teeth. Occasionally, they take the place of a
missing tooth.
 Odontomes of long duration may appear to erupt following
resorption of overlying bone, sometimes leading to
secondary infection.
 Both are often diagnosed in 2 nd decade of life.
 Majority of odontomes are small and arise in association
with permanent dentition.
Often discovered as incidental radiographic findings.
Occasionally, they cause painless expansion.
In some cases, this is associated with dentigerous cyst
formation around the odontome.  Gradations between the 2 types exist.  Multiple odontomes are
formation around the odontome.
 Gradations between the 2 types exist.
Multiple odontomes are rare.
Dr. Tahani Abualteen
around the odontome.  Gradations between the 2 types exist.  Multiple odontomes are rare. Dr.
around the odontome.  Gradations between the 2 types exist.  Multiple odontomes are rare. Dr.
around the odontome.  Gradations between the 2 types exist.  Multiple odontomes are rare. Dr.
Complex Odontome: Radiographic Features
Complex Odontome: Radiographic Features
Complex Odontome: Radiographic Features A radiopaque mass similar in density to the adjacent dental tissue surrounded
Complex Odontome: Radiographic Features A radiopaque mass similar in density to the adjacent dental tissue surrounded
Complex Odontome: Radiographic Features A radiopaque mass similar in density to the adjacent dental tissue surrounded
Complex Odontome: Radiographic Features A radiopaque mass similar in density to the adjacent dental tissue surrounded
Complex Odontome: Radiographic Features A radiopaque mass similar in density to the adjacent dental tissue surrounded

A radiopaque mass similar in density to the adjacent dental tissue surrounded by a radiolucent rim which represents the dental

follicle

to the adjacent dental tissue surrounded by a radiolucent rim which represents the dental follicle Dr.
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Compound Odontome: Radiographic Features
Compound Odontome: Radiographic Features
Compound Odontome: Radiographic Features Dr. Tahani Abualteen
Compound Odontome: Radiographic Features Dr. Tahani Abualteen
Compound Odontome: Radiographic Features Dr. Tahani Abualteen
Compound Odontome: Radiographic Features Dr. Tahani Abualteen
Compound Odontome: Radiographic Features Dr. Tahani Abualteen
Compound Odontome: Radiographic Features Dr. Tahani Abualteen
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Complex & Compound Odontomes: Histopathological Features
Complex & Compound Odontomes:
Histopathological Features
 Both developing complex and compound odontomes contain varying amounts of odontogenic epithelium and structures
 Both developing complex
and compound odontomes
contain varying amounts of
odontogenic epithelium
and structures resembling
enamel organs.
 They show all stages of
odontogenesis and may be
difficult to differentiate
from ameloblastic fibroma
and ameloblastic fibro-
odontoma.
and may be difficult to differentiate from ameloblastic fibroma and ameloblastic fibro- odontoma. Dr. Tahani Abualteen
and may be difficult to differentiate from ameloblastic fibroma and ameloblastic fibro- odontoma. Dr. Tahani Abualteen
and may be difficult to differentiate from ameloblastic fibroma and ameloblastic fibro- odontoma. Dr. Tahani Abualteen
and may be difficult to differentiate from ameloblastic fibroma and ameloblastic fibro- odontoma. Dr. Tahani Abualteen
and may be difficult to differentiate from ameloblastic fibroma and ameloblastic fibro- odontoma. Dr. Tahani Abualteen
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Odontogenic Tumors
Odontogenic Tumors
 Odontogenic tumors are uncommon lesions, some of them are rare.  The nomenclature and
 Odontogenic tumors are uncommon lesions,
some of them are rare.
 The nomenclature and classification used is based
on those recommended by the WHO (1992) and
its Consensus Conference (2003).
 The latter redesignated the OKC as the
keratinizing cystic odontogenic tumor,
although in this textbook and others it is still
referred to as a cyst.
 Likewise, the calcifying odontogenic cyst has
been redesignated as the calcifying cystic
odontogenic tumor.
Dr. Tahani Abualteen

Classification of Odontogenic Tumors

Benign Odontogenic Tumors
Benign Odontogenic Tumors
Epithelial lesions: (1) Without odontogenic mesenchyme 
Epithelial lesions:
(1) Without odontogenic mesenchyme

Ameloblastoma Squamous odontogenic tumor*

mesenchyme  Ameloblastoma Squamous odontogenic tumor*    Calcifying epithelial odontogenic tumor

 Ameloblastoma Squamous odontogenic tumor*    Calcifying epithelial odontogenic tumor Adenomatoid

 Ameloblastoma Squamous odontogenic tumor*    Calcifying epithelial odontogenic tumor Adenomatoid

Calcifying epithelial odontogenic tumor

Adenomatoid odontogenic tumor
Adenomatoid odontogenic tumor
epithelial odontogenic tumor Adenomatoid odontogenic tumor  Keratinizing cystic odontogenic tumor * (omitted, not

Keratinizing cystic odontogenic tumor

Adenomatoid odontogenic tumor  Keratinizing cystic odontogenic tumor * (omitted, not required) Dr. Tahani Abualteen
Adenomatoid odontogenic tumor  Keratinizing cystic odontogenic tumor * (omitted, not required) Dr. Tahani Abualteen
* (omitted, not required) Dr. Tahani Abualteen
* (omitted, not required)
Dr. Tahani Abualteen
Adenomatoid odontogenic tumor  Keratinizing cystic odontogenic tumor * (omitted, not required) Dr. Tahani Abualteen
Adenomatoid odontogenic tumor  Keratinizing cystic odontogenic tumor * (omitted, not required) Dr. Tahani Abualteen
Adenomatoid odontogenic tumor  Keratinizing cystic odontogenic tumor * (omitted, not required) Dr. Tahani Abualteen

Classification of Odontogenic Tumors

Benign Odontogenic Tumors
Benign Odontogenic Tumors
Epithelial lesions: (2) With odontogenic mesenchyme (mixed)  Ameloblastic fibroma and fibrodentinoma 
Epithelial lesions:
(2) With odontogenic mesenchyme (mixed)
Ameloblastic fibroma and fibrodentinoma
Ameloblastic fibro-odontoma
Odontoamaloblastoma
Calcifying odontogenic cyst and dentinogenic
ghost cell tumor

Calcifying cystic odontogenic tumor (calcifying odontogenic cyst) and dentinogenic ghost cell tumor Complex odontome

  Compound odontome
Compound odontome
odontogenic cyst) and dentinogenic ghost cell tumor Complex odontome   Compound odontome Dr. Tahani Abualteen
odontogenic cyst) and dentinogenic ghost cell tumor Complex odontome   Compound odontome Dr. Tahani Abualteen
Dr. Tahani Abualteen
Dr. Tahani Abualteen
odontogenic cyst) and dentinogenic ghost cell tumor Complex odontome   Compound odontome Dr. Tahani Abualteen
odontogenic cyst) and dentinogenic ghost cell tumor Complex odontome   Compound odontome Dr. Tahani Abualteen

Classification of Odontogenic Tumors

Benign Odontogenic Tumors
Benign Odontogenic Tumors
Mesenchymal lesions:
Mesenchymal lesions:
Tumors Benign Odontogenic Tumors Mesenchymal lesions:  Odontogenic fibroma Myxoma   Cementoblastoma

Odontogenic fibroma

Myxoma
Myxoma
Odontogenic Tumors Mesenchymal lesions:  Odontogenic fibroma Myxoma   Cementoblastoma Dr. Tahani Abualteen
  Cementoblastoma
Cementoblastoma
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Odontogenic Tumors Mesenchymal lesions:  Odontogenic fibroma Myxoma   Cementoblastoma Dr. Tahani Abualteen
Odontogenic Tumors Mesenchymal lesions:  Odontogenic fibroma Myxoma   Cementoblastoma Dr. Tahani Abualteen
Odontogenic Tumors Mesenchymal lesions:  Odontogenic fibroma Myxoma   Cementoblastoma Dr. Tahani Abualteen
Odontogenic Tumors Mesenchymal lesions:  Odontogenic fibroma Myxoma   Cementoblastoma Dr. Tahani Abualteen
Classification of Odontogenic Tumors Malignant Odontogenic Tumors Odontogenic carcinomas:  Malignant
Classification of Odontogenic Tumors
Malignant Odontogenic Tumors
Odontogenic carcinomas:
Malignant ameloblastoma/ameloblastic carcinoma
 

Primary intra-osseous carcinoma Clear cell odontogenic carcinoma Malignant variants of other epithelial tumors

carcinoma Malignant variants of other epithelial tumors   Malignant change in odontogenic cysts Odontogenic
carcinoma Malignant variants of other epithelial tumors   Malignant change in odontogenic cysts Odontogenic

carcinoma Malignant variants of other epithelial tumors   Malignant change in odontogenic cysts Odontogenic

Malignant change in odontogenic cysts

Odontogenic sarcomas:  Ameloblastic fibrosarcoma  Ameloblastic fibro-odontosarcoma
Odontogenic sarcomas:
 Ameloblastic fibrosarcoma
 Ameloblastic fibro-odontosarcoma
Dr. Tahani Abualteen
Dr. Tahani Abualteen
cysts Odontogenic sarcomas:  Ameloblastic fibrosarcoma  Ameloblastic fibro-odontosarcoma Dr. Tahani Abualteen
cysts Odontogenic sarcomas:  Ameloblastic fibrosarcoma  Ameloblastic fibro-odontosarcoma Dr. Tahani Abualteen
cysts Odontogenic sarcomas:  Ameloblastic fibrosarcoma  Ameloblastic fibro-odontosarcoma Dr. Tahani Abualteen
cysts Odontogenic sarcomas:  Ameloblastic fibrosarcoma  Ameloblastic fibro-odontosarcoma Dr. Tahani Abualteen
Classification of Odontogenic Tumors Tumors of Debatable Origin
Classification of Odontogenic Tumors
Tumors of Debatable Origin
 Melanotic neuroectodermal tumor of infancy  Congenital gingival granular cell tumor (congenital epulis)
 Melanotic neuroectodermal tumor of
infancy
 Congenital gingival granular cell
tumor (congenital epulis)
Dr. Tahani Abualteen
Dr. Tahani Abualteen
neuroectodermal tumor of infancy  Congenital gingival granular cell tumor (congenital epulis) Dr. Tahani Abualteen
neuroectodermal tumor of infancy  Congenital gingival granular cell tumor (congenital epulis) Dr. Tahani Abualteen
neuroectodermal tumor of infancy  Congenital gingival granular cell tumor (congenital epulis) Dr. Tahani Abualteen
neuroectodermal tumor of infancy  Congenital gingival granular cell tumor (congenital epulis) Dr. Tahani Abualteen
Ameloblastoma
Ameloblastoma
 Benign BUT locally invasive neoplasm derived from odontogenic epithelium.  Rare but commonest of
 Benign BUT locally invasive neoplasm derived
from odontogenic epithelium.
 Rare but commonest of odontogenic tumors
(without odontomes considered).
~1% of all oral tumors.
 More common in black Americans and West
Africans.
 2 more variants, unicystic and peripheral that
worth separate discussion.
Dr. Tahani Abualteen
Dr. Tahani Abualteen
and West Africans.  2 more variants, unicystic and peripheral that worth separate discussion. Dr. Tahani
Ameloblastoma: Clinical Features
Ameloblastoma: Clinical Features
 Wide age range.  80% occur in the mandible.  The majority of mandibular
Wide age range.
80% occur in the mandible.
 The majority of mandibular lesions
(~90%) occur in posterior areas and
ramus.
 The majority of maxillary lesions also
occur in posterior areas, ~15% involve
the antrum.
Dr. Tahani Abualteen
Dr. Tahani Abualteen
 The majority of maxillary lesions also occur in posterior areas, ~15% involve the antrum. Dr.
 The majority of maxillary lesions also occur in posterior areas, ~15% involve the antrum. Dr.
Ameloblastoma: Clinical Features
Ameloblastoma: Clinical Features
 Slow growing & asymptomatic in early stages.  As it gets larger, there may
 Slow growing &
asymptomatic in early
stages.
 As it gets larger, there
may be gradual facial
deformity and bone
expansion.
 Enlargement is usually
bony-hard, non-tender,
and ovoid to fusiform.
 In advanced cases, egg-
shell crackling may be
felt due to thinning of
cortex.
 Perforation of bone and
extension into soft tissue
are late findings.
Dr. Tahani Abualteen
to thinning of cortex.  Perforation of bone and extension into soft tissue are late findings.
to thinning of cortex.  Perforation of bone and extension into soft tissue are late findings.
to thinning of cortex.  Perforation of bone and extension into soft tissue are late findings.
to thinning of cortex.  Perforation of bone and extension into soft tissue are late findings.
to thinning of cortex.  Perforation of bone and extension into soft tissue are late findings.
Ameloblastoma: Clinical Features
Ameloblastoma: Clinical Features
 In the maxilla, even large tumors may cause little expansion since the lesion can
 In the maxilla, even large tumors
may cause little expansion since the
lesion can expand into the sinus.
expansion since the lesion can expand into the sinus.  Teeth may become loose , but
expansion since the lesion can expand into the sinus.  Teeth may become loose , but

Teeth may become loose, but pain is seldom a feature.

the lesion can expand into the sinus.  Teeth may become loose , but pain is
Dr. Tahani Abualteen
Dr. Tahani Abualteen
the lesion can expand into the sinus.  Teeth may become loose , but pain is
the lesion can expand into the sinus.  Teeth may become loose , but pain is
the lesion can expand into the sinus.  Teeth may become loose , but pain is
the lesion can expand into the sinus.  Teeth may become loose , but pain is
Ameloblastoma: Radiographic Features
Ameloblastoma: Radiographic Features
Ameloblastoma: Radiographic Features  Most commonly appears as a multilocular radiolucency.  Root resorption
Ameloblastoma: Radiographic Features  Most commonly appears as a multilocular radiolucency.  Root resorption
Ameloblastoma: Radiographic Features  Most commonly appears as a multilocular radiolucency.  Root resorption
Ameloblastoma: Radiographic Features  Most commonly appears as a multilocular radiolucency.  Root resorption

Most commonly appears as a multilocular radiolucency. Root resorption of involved teeth.

Most commonly appears as a multilocular radiolucency.  Root resorption of involved teeth. Dr. Tahani Abualteen
Most commonly appears as a multilocular radiolucency.  Root resorption of involved teeth. Dr. Tahani Abualteen
Most commonly appears as a multilocular radiolucency.  Root resorption of involved teeth. Dr. Tahani Abualteen
Most commonly appears as a multilocular radiolucency.  Root resorption of involved teeth. Dr. Tahani Abualteen
Most commonly appears as a multilocular radiolucency.  Root resorption of involved teeth. Dr. Tahani Abualteen
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Ameloblastoma: Radiographic Features
Ameloblastoma: Radiographic Features


May be associated with an unerupted

Features  May be associated with an unerupted tooth, particularly an impacted 3 rd molar.The appearance
Features  May be associated with an unerupted tooth, particularly an impacted 3 rd molar.The appearance
tooth, particularly an impacted 3 rd molar.The appearance then may mimic a dentigerous cyst. 
tooth, particularly an
impacted 3 rd
molar.The appearance
then may mimic a
dentigerous cyst.

Less frequently, it may present as a unilocular radiolucency.

may mimic a dentigerous cyst.  Less frequently, it may present as a unilocular radiolucency. Dr.
may mimic a dentigerous cyst.  Less frequently, it may present as a unilocular radiolucency. Dr.
may mimic a dentigerous cyst.  Less frequently, it may present as a unilocular radiolucency. Dr.
may mimic a dentigerous cyst.  Less frequently, it may present as a unilocular radiolucency. Dr.
may mimic a dentigerous cyst.  Less frequently, it may present as a unilocular radiolucency. Dr.
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Ameloblastoma: Histopathological Features
Ameloblastoma: Histopathological Features
 Variable patterns depending on arrangement of neoplastic epithelium; follicular and plexiform patterns 
 Variable patterns depending on
arrangement of neoplastic epithelium;
follicular and plexiform patterns
 Follicular pattern:
- Discrete, rounded islands or open-
up follicles, each resembling
the enamel organ.
- Stellate reticulum –like cells at
center, surrounded by cuboidal or
columnar cells resembling
ameloblasts.
- Nuclei of peripheral cells are
polarized away from the basement
membrane “reversed polarity”
- Islands are separated by varying
amounts of fibrocollagenous
stroma (non-neoplastic
component).
- Islands are separated by varying amounts of fibrocollagenous stroma (non-neoplastic component). Dr. Tahani Abualteen
- Islands are separated by varying amounts of fibrocollagenous stroma (non-neoplastic component). Dr. Tahani Abualteen
- Islands are separated by varying amounts of fibrocollagenous stroma (non-neoplastic component). Dr. Tahani Abualteen
- Islands are separated by varying amounts of fibrocollagenous stroma (non-neoplastic component). Dr. Tahani Abualteen
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Ameloblastoma: Histopathological Features
Ameloblastoma: Histopathological Features
 Follicular pattern: - Several changes can occur within the stellate area, including cystic breakdown,
 Follicular pattern:
- Several changes can occur
within the stellate area,
including cystic breakdown,
squamous metaplasia, and
granular cell change.
- Acanthomatous types secrete
keratin.
breakdown, squamous metaplasia, and granular cell change. - Acanthomatous types secrete keratin. Dr. Tahani Abualteen
breakdown, squamous metaplasia, and granular cell change. - Acanthomatous types secrete keratin. Dr. Tahani Abualteen
breakdown, squamous metaplasia, and granular cell change. - Acanthomatous types secrete keratin. Dr. Tahani Abualteen
breakdown, squamous metaplasia, and granular cell change. - Acanthomatous types secrete keratin. Dr. Tahani Abualteen
breakdown, squamous metaplasia, and granular cell change. - Acanthomatous types secrete keratin. Dr. Tahani Abualteen
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Ameloblastoma: Histopathological Features
Ameloblastoma: Histopathological Features
 Plexiform pattern: epithelium arranged as a network of strands (thinner than follicles) and irregular
 Plexiform pattern:
epithelium arranged
as a network of
strands (thinner
than follicles) and
irregular masses, each
showing the same cell
layers seen in the
follicular pattern.
 Cyst formation in this
pattern occurs within
the stroma rather
than the epithelium.
Dr. Tahani Abualteen
Dr. Tahani Abualteen
pattern.  Cyst formation in this pattern occurs within the stroma rather than the epithelium. Dr.
pattern.  Cyst formation in this pattern occurs within the stroma rather than the epithelium. Dr.
Ameloblastoma: Pathogenesis
Ameloblastoma: Pathogenesis
Ameloblastoma: Pathogenesis General opinion supports origin from dental lamina or its residues .   Other

General opinion supports origin from dental lamina or its residues.

supports origin from dental lamina or its residues .   Other sources include the epithelial

 Other sources include the epithelial lining of odontogenic cysts (unicystic ameloblastoma) and the basal
 Other sources include the epithelial lining of
odontogenic cysts (unicystic ameloblastoma) and
the basal layer of oral epithelium (peripheral
ameloblastoma).
 Enamel and dentin are NOT formed in this
tumor, and the columnar or cuboidal cellls at the
periphery of epithelial islands are thought to
represent pre-ameloblasts.
or cuboidal cellls at the periphery of epithelial islands are thought to represent pre-ameloblasts. Dr. Tahani
Dr. Tahani Abualteen
Dr. Tahani Abualteen
or cuboidal cellls at the periphery of epithelial islands are thought to represent pre-ameloblasts. Dr. Tahani
Ameloblastoma: Behavior
Ameloblastoma: Behavior
 Typical ameloblastoma is aggressive and locally invasive , tumor islands infiltrate cancellous marrow spaces
 Typical ameloblastoma is aggressive
and locally invasive , tumor islands
infiltrate cancellous marrow spaces
without initially causing bone
destruction.
 High recurrence rate (50-90%). so
needs to be treated with wide surgical
excision with margins of normal bone.
 Rare reports of pulmonary metastasis
of ameloblastoma are probably the
result of aspiration of tumor cells
associated with surgery or may be
due to implantation of tumor cells into
blood or lymphatic vessels.
 Pulmonary metastasis is rarely due to
truly malignant ameloblastomas.
 Ameloblastic carcinoma when features
of malignancy are noticed in the
epithelium.
Dr. Tahani Abualteen
Unicystic Ameloblastoma
Unicystic Ameloblastoma
 Typically presents in a younger age group (2 nd -3 rd decade) than other
Typically presents in a younger age group (2 nd -3 rd decade)
than other variants
Mostly in the mandibular third molar area.
Radiographically, it appears as a well-defined, unilocular
radiolucency, usually associated with an unerupted tooth,
i.e. similar to dentigerous cyst.
Histologically, present as a cyst lined by
amelobastomatous epithelium:
– sometimes the epithelial lining shows nodular proliferation into
the lumen “luminal growth”
– The lining is invadig or infiltrating the cyst wall “mural
growth”.
Dr. Tahani Abualteen
“luminal growth” – The lining is invadig or infiltrating the cyst wall “mural growth”. Dr. Tahani
Unicystic Ameloblastoma
Unicystic Ameloblastoma
 The diagnosis is made only after histopathological examination.  Treatment is conservative, since epithelium
 The diagnosis is made only after histopathological
examination.
 Treatment is conservative, since epithelium in
most cases is limited to cyst lumen.
 If epithelium infiltrates the cyst wall, it should be
treated like typical ameloblastoma.
Dr. Tahani Abualteen
Dr. Tahani Abualteen
 If epithelium infiltrates the cyst wall, it should be treated like typical ameloblastoma. Dr. Tahani
 If epithelium infiltrates the cyst wall, it should be treated like typical ameloblastoma. Dr. Tahani
Peripheral (Extraosseous) Ameloblastoma
Peripheral (Extraosseous) Ameloblastoma
 Rare variant which arises in gingival or alveolar soft tissues without involving bone. 
 Rare variant which arises
in gingival or alveolar
soft tissues without
involving bone.
 May arise from basal cell
layer of oral epithelium, or
from extraosseous dental
lamina remnants.
 Much less invasive, and
treatment is
conservative.
from extraosseous dental lamina remnants.  Much less invasive, and treatment is conservative. Dr. Tahani Abualteen
from extraosseous dental lamina remnants.  Much less invasive, and treatment is conservative. Dr. Tahani Abualteen
Dr. Tahani Abualteen
Dr. Tahani Abualteen
from extraosseous dental lamina remnants.  Much less invasive, and treatment is conservative. Dr. Tahani Abualteen
Squamous Odontogenic Tumor
Squamous Odontogenic Tumor
 Rare tumor presenting with tooth mobility.  Radiographically presents as a well-circumscribed, semilunar or
 Rare tumor presenting with tooth
mobility.
 Radiographically presents as a
well-circumscribed, semilunar or
triangular radiolucency associated
with roots of teeth.
 Histologically consists of islands of
benign, well-differentiated
squamous epithelium.
 Thought to b e derived from
epithelial rests of Malassez.
 Although some lesions may be
aggressive, curettage is the
treatment of
choice.
Dr. Tahani Abualteen
of Malassez.  Although some lesions may be aggressive, curettage is the treatment of choice. Dr.
Calcifying Epithelial Odontogenic Tumor (Pindborg Tumor)  Rare, benign, but locally invasive epithelial neoplasm.
Calcifying Epithelial Odontogenic Tumor
(Pindborg Tumor)
Rare, benign, but locally invasive epithelial neoplasm.
 Rare, benign, but locally invasive epithelial neoplasm.  Wide age range.  Mandible > maxilla.
 Rare, benign, but locally invasive epithelial neoplasm.  Wide age range.  Mandible > maxilla.

Wide age range.

 Mandible > maxilla.  Most arise in molar and premolar areas.  ~50% associated
Mandible > maxilla.
Most arise in molar and premolar areas.
~50% associated with crown of unerupted tooth.
Extraosseous examples reported.
Locally invasive but less aggressive than ameloblastoma.
Dr. Tahani Abualteen
Dr. Tahani Abualteen
 Extraosseous examples reported.  Locally invasive but less aggressive than ameloblastoma. Dr. Tahani Abualteen
 Extraosseous examples reported.  Locally invasive but less aggressive than ameloblastoma. Dr. Tahani Abualteen
Calcifying Epithelial Odontogenic Tumor (Pindborg Tumor): Radiographic Features
Calcifying Epithelial Odontogenic Tumor
(Pindborg Tumor): Radiographic Features
 Irregular radiolucent area,
 Irregular
radiolucent area,

may or may not be clearly demarcated.

radiolucent area, may or may not be clearly demarcated.  May contain varying amounts of radiopaque
 May contain varying amounts of radiopaque bodies due to calcification.
May contain
varying amounts of
radiopaque bodies
due to calcification.
be clearly demarcated.  May contain varying amounts of radiopaque bodies due to calcification. Dr. Tahani
Dr. Tahani Abualteen
Dr. Tahani Abualteen
be clearly demarcated.  May contain varying amounts of radiopaque bodies due to calcification. Dr. Tahani
Calcifying Epithelial Odontogenic Tumor (Pindborg Tumor): Histopathologic Features
Calcifying Epithelial Odontogenic Tumor
(Pindborg Tumor): Histopathologic Features


Sheets and strands of polyhedral epithelial cells with abundant eosinophilic cytoplasm in fibrous stroma.

with abundant eosinophilic cytoplasm in fibrous stroma.  Cells show hyperchromatism, pleomorphism , prominent
with abundant eosinophilic cytoplasm in fibrous stroma.  Cells show hyperchromatism, pleomorphism , prominent
with abundant eosinophilic cytoplasm in fibrous stroma.  Cells show hyperchromatism, pleomorphism , prominent
with abundant eosinophilic cytoplasm in fibrous stroma.  Cells show hyperchromatism, pleomorphism , prominent
 Cells show hyperchromatism, pleomorphism , prominent intercellular bridges (notice spaces between cells) and
 Cells show
hyperchromatism,
pleomorphism , prominent
intercellular bridges (notice
spaces between cells) and
nevertheless it is not
malignant.
 Amyloid-like material may
be present, it may become
calcified.
it is not malignant.  Amyloid-like material may be present, it may become calcified. Dr. Tahani
it is not malignant.  Amyloid-like material may be present, it may become calcified. Dr. Tahani
it is not malignant.  Amyloid-like material may be present, it may become calcified. Dr. Tahani
it is not malignant.  Amyloid-like material may be present, it may become calcified. Dr. Tahani
Dr. Tahani Abualteen
Dr. Tahani Abualteen
Adenomatoid Odontogenic Tumor: Clinical & Radiographic Features  2 nd and 3 rd decades. 
Adenomatoid Odontogenic Tumor:
Clinical & Radiographic Features
2 nd and 3 rd decades.
Majority in anterior
maxilla, especially canine
area.
Slowly enlarging swelling.
may be considered
hamartoma.
Well-defined radiolucency,
may have radiopacities. often
associated with unerupted
tooth, simulating dentigerous
cyst.
Rare extraosseous variant.
Dr. Tahani Abualteen
Dr. Tahani Abualteen
associated with unerupted tooth, simulating dentigerous cyst.  Rare extraosseous variant. Dr. Tahani Abualteen
Adenomatoid Odontogenic Tumor: Histopathologic Features
Adenomatoid Odontogenic Tumor:
Histopathologic Features
 Well-encapsulated, solid or cystic.  Sheets, strands, masses of epithelium which in some places
 Well-encapsulated, solid or
cystic.
 Sheets, strands, masses of
epithelium which in some
places forms duct-like
structures lined by columnar
epithelium.
 Small foci of calcification and
occasional dentin and enamel
matrix may be seen.
 Treatment is conservative
enucleation.
Dr. Tahani Abualteen
Dr. Tahani Abualteen
and occasional dentin and enamel matrix may be seen.  Treatment is conservative enucleation. Dr. Tahani
and occasional dentin and enamel matrix may be seen.  Treatment is conservative enucleation. Dr. Tahani
and occasional dentin and enamel matrix may be seen.  Treatment is conservative enucleation. Dr. Tahani