**Oral Pathology module**
<br>**Odontogenic tumours**
<br>DENT4217
<br>A/Prof Omar Kujan
<br>BDS DipOPath MDSc MFDS RCPS FHEA FRCPath PhD
**Acknowledgement**
of country
The University of Western Australia acknowledges that its
campus is situated on Noongar land, and that Noongar
people remain the spiritual and cultural custodians of their
land, and continue to practise their values, languages, beliefs
and knowledge.
**Artist: Dr Richard Barry Walley OAM**
THE UNIVERSITY OF
WESTERN
AUSTRALIA
**Learning outcomes**
1. Outline the classification of odontogenic tumours
2. Describe the different entities of odontogenic tumours
WHO Classification of Odontogenic Tumours
(Kramer et al 1991)
**- based on the similarity between tumours**
**and various stages of tooth development**
**Classification of Benign Odontogenic**
**Tumours**
1. Odontogenic epithelium without
odontogenic ectomesenchyme
2. Odontogenic epithelium with odontogenic
ectomesenchyme, with or without dental
hard tissue formation
3. Odontogenic ectomesenchyme with or
without included odontogenic epithelium
**E8** cranial
neural
crest
**E9**
**JAW**
**ORAL**
**ECTODERM**
**MESENCHYME**
**heterotopic**
**E10** **mesenchyme**
**heterotopic**
**ectoderm**
**E11**
**dental**
**mesenchyme**
**1**
**X**
**2**
**dental**
**lamina**
**E12**
**E13**
**dental**
**papilla**
**3**
**E14**
**X**
**enamel**
**4**
**organ**
**dermis**
**E15**
**preodontoblasts**
**E16**
**preameloblasts**
**E17**
**odontoblasts**
**5**
**E18**
**predentine**
**6**
**epidermis**
**ameloblasts**
**E19**
**dentine**
**enamel**
Tissue interactions in tooth formation
Tooth germ - bell stage
Histological image showing cellular layers of the enamel organ.
**Figure 1. 2a and b. Neural Crest in tooth formation.**
**a. Early stage. The epithelial wall surrounding the dental mesenchyme is shown on the right. The neural crest cells on the left are differentiating into odontoblasts.**
**b. More advanced stage. Odontoblasts are aligned in a layer on the right, and the dentin matrix they formed is shown on the extreme right.**
**1. Odontogenic epithelium without**
**odontogenic ectomesenchyme**
*Ameloblastoma
*Squamous odontogenic tumour
*Adenomatoid odontogenic tumour
*Calcifying epithelial odontogenic
tumour (Pindborg Tumour)
**2. Odontogenic epithelium with**
**odontogenic ectomesenchyme with**
**or without dental hard tissue**
•Ameloblastic fibroma
•Ameloblastic fibro-dentinoma
•Ameloblastic fibro-odontome
•Calcifying odontogenic cyst
•Complex odontome
•Compound odontome
**3. Odontogenic ectomesenchyme**
**with or without included odontogenic**
**epithelium**
- **Odontogenic fibroma**
- **Myxoma [myxofibroma]**
- **Benign cementoblastoma ('true'**
**cementoma)**
**Malignant Odontogenic Tumours**
1. Clear cell odontogenic carcinoma
2. Malignant ameloblastoma
3. Primary intra-osseous carcinoma
4. Malignant variants of other odontogenic
epithelial tumours
5. Malignant changes in odontogenic cysts
**Ameloblastoma**
Clinical image showing oral cavity and dentition.
Panoramic radiograph showing a multilocular radiolucency in the posterior mandible.
The image shows an X-ray of what appears to be the jaw and surrounding structures. The overall view presents a horseshoe-shaped bone (mandible) at the bottom, with a dark, empty space above it. To the right side of the image, higher up, there's a complex, textured area, likely representing facial bones or sinuses.
Here's an analysis of the specific cropped areas:
**Crop 1 (Top Left):**
This crop shows a smooth, curved bony structure on the left side, which is likely part of the mandible. The area to its right is dark and featureless, consistent with empty space. The texture is generally smooth, indicating bone.
**Crop 2 (Top Right):**
This crop highlights the intricate structures superior and posterior to the mandible on the right side. It reveals a highly textured area with various radiolucent (darker) and radiopaque (lighter) regions, suggesting air-filled cavities (like maxillary sinus) and overlying bone. The patterns are irregular, typical of complex anatomical structures in the facial region.
**Crop 3 (Bottom Left):**
This crop focuses on the lower left portion of the image, showing the curved body of the mandible. There are some indistinct, slightly more radiopaque areas within the bone, which could represent normal bone trabeculation or possibly some subtle anatomy. The border of the bone is smooth and well-defined.
**Crop 4 (Bottom Right):**
This crop draws attention to the lower right side, again showing the curved body of the mandible. There's a prominent, very radiopaque (bright white), rounded or oval structure embedded within or overlying the bone. This distinct, dense lesion could represent a salivary gland stone (sialolith), a calcified lymph node, or some other calcification. Below this primary bright structure, there appears to be another, less distinct, round opacity. These bright areas stand out significantly against the surrounding bone.
- **769/95**
-------------------------------------
0 1 2 3 4 5 6 7 8 9 10
cms
**Ameloblastoma** - **follicular pattern**
**Ameloblastoma** - follicular pattern
I am sorry, but there is no descriptive text provided for me to extract or enhance from the PDF in relation to the images. The request asks me to "Extract all of the text from this image, use the pdf text for context to enhance the ocr ," but no such text is available in the prompt. I can only describe what is visible in the images.
The images displayed are microscopic views of biological tissue, stained predominantly in pink and purple hues. The pattern suggests a mix of glandular structures and a more dense, possibly bone-like or connective tissue.
More specifically:
* The main image and the first and third cropped images show numerous rounded or elongated structures with a lumen (open space) and an outer border of darker-stained cells. These could be ducts or glands. Surrounding these structures is a lighter pink, fibrous-looking tissue. In some areas, there are also clusters of darker, granular-looking cells.
* The second and fourth cropped images show a prominent area of very dense, bright pink, somewhat irregularly shaped material with lacunae (small cavities) and what appears to be canaliculi (tiny channels). This is highly suggestive of bone tissue (osseous tissue), possibly trabecular bone due to its irregular, branching appearance. This bone-like material is intermingled with the same glandular/ductal structures and fibrous tissue seen in the other images.
Overall, the images depict a histological section containing a mixture of epithelial (glandular/ductal), connective, and possibly osseous (bone) tissues.
<br>
**<font color="#000080">Ameloblastoma - plexiform pattern</font>**
**Unicystic**
**ameloblastoma**
Panoramic dental X-ray showing impacted tooth.
789 / 95
0
1
2
3
4
5
6
7
8
9
10
cms
Unicystic ameloblastoma
Unicystic ameloblastoma
Unicystic ameloblastoma
<p style="margin-top:0pt; margin-bottom:10pt; text-align: left; font-size: 27.99pt; font-family: Montserrat; color: #0000FF; line-height: 1.2294117647058823;"><b><span style="font-family: Montserrat; font-size: 27.99pt; color: #0000FF;">Differential diagnosis</span></b></p>
<p style="margin-top:0pt; margin-bottom:10pt; text-align: left; font-size: 19.99pt; font-family: Montserrat; color: #000000; line-height: 1.2294117647058823;"><b><span style="font-family: Montserrat; font-size: 19.99pt; color: #000000;"></span></b><span style="font-family: Montserrat; font-size: 19.99pt; color: #000000;">• Dentigerous cyst<br />• Squamous odontogenic tumour<br />• Ameloblastic carcinoma</span></p>
<p style="text-align: right; font-size: 11.00pt; font-family: Montserrat; color: #000000;">29</p>
**Ameloblastic fibroma**
Panoramic dental X-ray showing mixed dentition.
and here are the different crops of this image to help you see better, use these only as hints:
Ameloblastic fibroma
Odontoma
Here is the original image:
and here are the different crops of this image to help you see better, use these only as hints:
Compound odontome
Complex odontome
Compound odontome
**Ameloblastic fibro odontome**
**and ameloblastic**
**fibrodentinoma**
Radiographic image showing impacted teeth.
This is an image of a biological specimen under a microscope, likely stained with hematoxylin and eosin (H&E) given the pink and purple hues. The image shows a roughly oval-shaped structure in the center, which appears to be a developing tooth germ.
Key features observable:
* **Central structure:** This is the dental papilla, composed of mesenchymal cells (fibroblasts) which will form the dental pulp and dentin. The cells appear loosely arranged at the center and more condensed towards the periphery.
* **Layer surrounding the central structure:** This is the inner enamel epithelium, characterized by a single layer of columnar cells that will differentiate into ameloblasts responsible for enamel formation.
* **Outer layer:** Enclosing the inner enamel epithelium is a broader band of pink-stained material, likely representing the developing enamel matrix or pre-enamel, possibly with the remnants of the stellate reticulum and stratum intermedium layers of the enamel organ (not distinctly visible in this magnification).
* **Surrounding tissue:** The tissue outside the main structure is likely the dental follicle or sac, composed of connective tissue (fibroblasts and collagen fibers) which will form the cementum and periodontal ligament. Scattered nuclei (small, dark dots) are visible within this pink extracellular matrix.
The overall appearance suggests a bell stage or early cap stage of tooth development.
Odontogenic fibroma
Panoramic dental radiograph showing a large radiolucent lesion in the mandible.
Histological image of odontogenic fibroma.
**Odontogenic myxoma**
here are the **different crops of this image to help you see better, use these only as hints:**
The image shows a microscopic view of tissue, likely stained with hematoxylin and eosin (H&E), given the pink and purple hues. This type of staining is common in histology and pathology.
**Key features visible in the image include:**
* **Elongated, Spindle-Shaped Cells:** A prominent feature is the presence of numerous elongated cells with fusiform (spindle-like) shapes. Their nuclei appear dark purple, consistent with hematoxylin staining, and their cytoplasm is pink, consistent with eosin staining. These could be fibroblasts, smooth muscle cells, or cells from a mesenchymal neoplasm.
* **Collagenous or Fibrous Background:** There is an abundant pink, somewhat fibrillar background material. This is characteristic of collagen, which is the main component of connective tissue, providing structural support. The arrangement of these fibers appears somewhat haphazard but also shows areas of more parallel orientation.
* **Red Blood Cells/Hemorrhage:** Scattered throughout the tissue, particularly in some areas, are clusters or individual small, round, red structures with a distinct reddish-pink color. These are consistent with red blood cells, indicating either small vessels or areas of hemorrhage within the tissue. In some regions, they appear more concentrated.
* **Scattered Nuclei/Cells:** In addition to the dominant spindle cells, there are some smaller, rounder dark purple dots that could represent nuclei of other scattered cells, such as inflammatory cells, or cross-sections of the elongated cells.
* **Vascularity:** The presence of red blood cells suggests vascularity within the tissue, although distinct large vessel lumens are not clearly delineated in all areas. Some areas show a higher concentration of these red structures, possibly indicative of engorged capillaries or small venules.
* **Overall Texture:** The tissue has a relatively loose to moderately dense appearance, with the spindle cells embedded within the fibrous matrix.
**Potential interpretations based on morphology (without clinical context):**
* **Reactive Fibrosis/Scar Tissue:** The combination of spindle cells (fibroblasts/myofibroblasts) and abundant collagen with scattered red blood cells could be seen in areas of healing or chronic inflammation leading to fibrosis and scar formation.
* **Benign Mesenchymal Proliferation/Neoplasm:** Conditions like a fibroma, schwannoma (spindle cell variant), or leiomyoma (smooth muscle tumor) could present with spindle cells and collagen. The degree of cellularity and atypia would be critical for further differentiation, which is difficult from a single static image without higher magnification or clinical history.
* **Granulation Tissue:** In an early healing phase, granulation tissue is characterized by proliferating fibroblasts, new blood vessels, and inflammatory cells, which aligns with some features observed.
* **Angiofibroma or Fibrous Histiocytoma:** The presence of both fibrous elements and apparent vascular components (red blood cells) might suggest entities with a significant vascular component.
In summary, the image displays a histology section characterized by spindle-shaped cells embedded in a collagenous matrix, with evidence of red blood cells, indicative of connective tissue with vascular elements, possibly in a reactive or proliferative state. Further diagnostic interpretation would require clinical information and possibly additional staining or higher magnification.
Cementoblastoma
No specific text content was provided in the PDF for contextualization. Therefore, the OCR extraction is based solely on the image.
The image contains a dental radiograph showing a section of the jaw with multiple teeth. There appears to be a large, irregular, radiolucent (dark) lesion in the bone between the roots of some teeth. Some teeth show evidence of restorative work (fillings). The overall image is black and white, with varying shades of gray representing bone density and other structures.
Dental X-ray image showing multiple teeth and surrounding alveolar bone.
Image OCR: Extract text using both sources. Prioritize image text but use PDF text for context.
Below are the images with the extracted text where available:
(No text in image)
Journal of Oral and
Maxillofacial Surgery
**Submit AAOMS Members L**
**CASE REPORT | VOLUME 65, ISSUE 10, P2080-2082, OCTOBER 2007**
**Download Full Issue**
**Purchase Subscr**
An Unusual Recurrent Cementoblastoma Associated With a
Developing Lower Second Molar Tooth: A Case Report
**Halla Zaitoun, BDS, MFDS** • **Omar Kujan, DDS, MSc • Philip Sloan, BDS, PhD, FDSRCS, FRCPath**
**DOI: https://doi.org/10.1016/j.joms.2006.06.288**
References
Article info
Related
Articles
Cementoblastoma is a benign ectomesenchymal odontogenic neoplasm that forms a mass of cementum or cementum-like
tissue continuous with the tooth root, usually a mandibular premolar or first molar. ¹ It has been considered analogous to
osteoblastoma and can be very destructive of tissue. ² This lesion clinically presents as a tender, sometimes painful swelling
at the buccal and lingual/palatal aspect of the alveolus. ¹ It generally affects persons under age 30 years and has a higher
prevalence in males (1.2:1). Radiographically, it appears as a radiopaque mass with a thin radiolucent rim attached to the
roots of a tooth. The mass may be rounded or irregular in shape and mottled in texture. ³ Several cases of tooth resorption,
loss of root outline, and obliteration of the periodontal ligament space have been reported. ¹ Histologically, the lesion is
composed predominantly of sheets or trabeculae of cementum-like calcified tissue with variably prominent reversal lines,
sometimes with a pagetoid appearance. ¹ Cells including cementoblasts and cementoclasts are enclosed within the hard
53
**Malignant odontogenic**
**tumours (carcinomas)**
Odontogenic carcinoma - pathol. fracture
X-ray image showing multiple developing permanent teeth in the maxillary arch.
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Ameloblastic carcinoma
Ameloblastic
carcinoma
**Frequent mitoses**
CCOC
Keratin 19, a marker
for odontogenic
epithelium
Illustration of students facing red, angry-looking cell-like creatures, possibly representing a biological or medical challenge. A "ENTER HERE!" sign is in the top corner, suggesting the start of an activity or challenge.
