BENIGN NEOPLASMS OF ORAL TISSUES Neo: new; Plasia: formation. A neoplasm is defined as an uncoordinated proliferation of tissue, the growth of which persists in a potentially unlimited fashion, even after cessation of the stimulus which evoked the change.

OF ORAL TISSUES BENIGN NEOPLASMS CLASSIFICATION BENIGN NEOPLASMS Odontogenic tumors Non-odontogenic tumors Hyperplastic lesions 1. Polyp 2. Epulis 3. Giant cell granuloma Epithelial origin 1. Papilloma 2. Adenoma 3. Pigmented nevus 4. Keratoacanthoma Mesenchymal 1. Connective tissue origin a. Fibroma b. Lipoma / Fibrolipoma c. Haemangioma d. Lymphangioma e. Chondroma f. Osteoma Mesenchymal 2. Muscle tissue origin a. Leiomyoma b. Rhabdomyoma c. Granular cell myoblastoma 3. Nerve tissue origin a. Neurofibroma b. Neurilemmoma c. Melanotic progonoma Epithelial origin 1. Ameloblastoma 2. Adenomatoid odontogenic tumor 3. Calcifying epithelial odontogenic tumor 4. Squamous odontogenic tumor B Mixed origin 1. Ameloblastic fibroma 2. Odontomes C Mesodermal origin 1. Myxoma & Myxofibroma 2. Odontogenic fibroma 3. Cementifying fibroma 4. Periapical cemental dysplasia 5. Benign cementoblastoma 6. Familial multiple cementoma

Common Clinical Features OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Common Clinical Features Age of occurrence: Varies with each tumor Sex predilection: Varies with each tumor Symptoms: Most of the tumors present as a painless, gradually / rapidly enlarging swelling. If infected, pain may be present. Other symptoms include facial deformity, mobility in teeth, numbness.

Common Clinical Features OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Common Clinical Features Signs: The swelling has the following features: Inspection: usually single, round or oval, well-defined boundaries, smooth or nodular surface, normal overlying skin or mucosa, expansion of jaw bone, obliteration of vestibule Palpation: Normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage), teeth mobility, paraesthesia Additional features: missing tooth or normal dentition, displacement of teeth, pathological jaw fracture, signs of inflammation if tumor is infected

Common Radiographic Features OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Common Radiographic Features Type of lesion: radiolucent Site: body of jaw bone Size: usually more than 1.5 cms Shape: round or oval, unilocular or multi-locular Number: mostly single Outline: regular if unilocular, scalloped if multi-locular Border: well-defined hyperostotic (‘partially hyperostotic’) Contents: homogenous radiolucency (‘radiopaque foci’) Additional features: expansion of jaw bone, displacement/resorption of roots, displacement of inferior alveolar canal, obliteration of maxillary antrum, thinning of both cortical plates, thinning of inferior border of mandible, ‘cyst-in-cyst’ appearance, pathological jaw fracture

Common Radiographic Features OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Common Radiographic Features

Common Radiographic Features OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Common Radiographic Features

Common Radiographic Features OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Common Radiographic Features

OF ORAL TISSUES BENIGN NEOPLASMS CLASSIFICATION BENIGN NEOPLASMS Odontogenic tumors Non-odontogenic tumors Epithelial origin 1. Ameloblastoma 2. Adenomatoid odontogenic tumor 3. Calcifying epithelial odontogenic tumor 4. Squamous odontogenic tumor 5. Ameloblastic fibroma 6. Odontomes Mesodermal origin 1. Myxoma & Myxofibroma 2. Odontogenic fibroma 3. Cementifying fibroma 4. Periapical cemental dysplasia 5. Benign cementoblastoma 6. Familial multiple cementoma Pathogenesis: Proliferation of tissues differentiated from dental lamina. Stimulus for this proliferation not known.

(‘locally malignant’) OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Ameloblastoma (‘locally malignant’) Clinical Features Age of occurrence: mostly between 20 to 50 years of age, peak frequency at 33 years of age Sex predilection: males slightly more commonly affected than females Site: 80% of tumors in mandible, in mandible 3rd molar-ramus region more affected Symptoms: Most of the tumors present as a painless, gradually / rapidly enlarging swelling. If infected, pain may be present. Other symptoms include facial deformity, mobility in teeth, numbness

(‘locally malignant’) OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Ameloblastoma (‘locally malignant’) Clinical Features Signs: The swelling has the following features: Inspection: single, round or oval, well-defined boundaries, smooth or lobulated, normal overlying skin or mucosa (ulcerated if large), expansion of jaw bone in all the 3 planes, obliteration of vestibule Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage) or soft (if unicystic), teeth mobility, paraesthesia Additional features: missing tooth or normal dentition, displacement of teeth, pathological jaw fracture, thin straw colored fluid on aspiration (unicystic variety) signs of inflammation if tumor is infecte Image: Lucas’s Pathology of Tumors of the Oral Tissues, 5th edition

OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Ameloblastoma (‘locally malignant’) Radiographic Features Type of lesion: radiolucent Site: usually mandibular 3rd molar-ramus region Size: large lesion Shape: unilocular (round or oval), multilocular (‘soap bubble’, ‘honeycomb’) with locules separated by bony septae Number: single Outline: regular or scalloped Border: well-defined hyperostotic (‘partially hyperostotic’) Contents: homogenous radiolucency Additional features: impaction of tooth with displacement deep in the jaw, expansion of jaw bone bucco-lingually, antero-posteriorly and vertically, displacement & resorption of roots, displacement of inferior alveolar canal, obliteration of maxillary antrum, thinning of cortical plates, thinning of inferior border of mandible, ‘cyst-in-cyst’ appearance, pathological jaw fracture

(‘locally malignant’) OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Ameloblastoma (‘locally malignant’) Images: Atlas of Oral Diagnostic Imaging by Higashi

(‘locally malignant’) OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Ameloblastoma (‘locally malignant’) Differential Diagnosis: Unilocular - other odontogenic tumors (except radiopaque) and cysts Multilocular - ameloblastic fibroma, myxoma, haemangioma, central giant cell granuloma, early stages of fibro-osseous lesions, odontogenic keratocyst Management: wide surgical excision to avoid recurrence, bone grafts

OF ORAL TISSUES BENIGN NEOPLASMS CLASSIFICATION BENIGN NEOPLASMS Odontogenic tumors Non-odontogenic tumors Epithelial origin 1. Ameloblastoma 2. Adenomatoid odontogenic tumor 3. Calcifying epithelial odontogenic tumor 4. Squamous odontogenic tumor 5. Ameloblastic fibroma 6. Odontomes Mesodermal origin 1. Myxoma & Myxofibroma 2. Odontogenic fibroma 3. Cementifying fibroma 4. Periapical cemental dysplasia 5. Benign cementoblastoma 6. Familial multiple cementoma

Adenomatoid Odontogenic Tumor OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Adenomatoid Odontogenic Tumor (‘AOT’) Clinical Features Age of occurrence: mostly in 2nd & 3rd decades of life Sex predilection: females slightly more commonly affected than males Symptoms: Most of the tumors present as a painless, gradually enlarging swelling. Sometimes asymptomatic, being discovered radiographically. Site: almost all cases involve maxillary anterior teeth Signs: The swelling has the following features: Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying skin or mucosa, little expansion of jaw bone, obliteration of vestibule Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage) Additional features: normal dentition, displacement of teeth

OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Adenomatoid Odontogenic Tumor (‘AOT’) Radiographic Features Type of lesion: predominantly radiolucent (‘mixed’) Site: maxillary anterior region Size: about 3 cms in diameter Shape: unilocular (round or oval) Number: single Outline: regular Border: well-defined hyperostotic Contents: homogenous radiolucency interspersed with radiopaque foci (‘driven snow’ appearance) Additional features: sometimes impaction of tooth, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates

Adenomatoid Odontogenic Tumor OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Adenomatoid Odontogenic Tumor (‘AOT’) Differential Diagnosis: No radiopaque foci – ameloblastoma, ameloblastic fibroma, odontogenic fibroma, primordial cyst, lateral periodontal cyst Radiopaque foci – CEOC, CEOT Management: surgical enucleation Image: Atlas of Oral Diagnostic Imaging by Higashi

OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Calcifying Epithelial Odontogenic Tumor (‘CEOT’, Pindborg tumor) Clinical Features Signs: The swelling has the following features: Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying skin or mucosa, little expansion of jaw bone, obliteration of vestibule Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage) Additional features: missing tooth, displacement of teeth Age of occurrence: mostly in middle aged patients Sex predilection: females equally affected as males Symptoms: Most of the tumors present as a painless, gradually enlarging swelling. Sometimes non-eruption of tooth / asymptomatic, being discovered radiographically. Site: majority in mandibular premolar-molar region

OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Calcifying Epithelial Odontogenic Tumor (‘CEOT’, Pindborg tumor) Radiographic Features Type of lesion: predominantly radiolucent (‘mixed’) Site: mandibular premolar-molar region Size: about 3 cms in diameter Shape: somewhat irregular Number: single Outline: somewhat irregular Border: well-defined, at times diffuse Contents: homogenous radiolucency interspersed with diffuse radiopacities Additional features: impaction of tooth is common, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates

OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Calcifying Epithelial Odontogenic Tumor (‘CEOT’, Pindborg tumor) Differential Diagnosis: CEOC, AOT, intermediate stages of fibro-osseous lesions Management: wide surgical excision to avoid recurrence Image: Lucas’s Pathology of Tumors of the Oral Tissues, 5th edition

OF ORAL TISSUES BENIGN NEOPLASMS CLASSIFICATION BENIGN NEOPLASMS Odontogenic tumors Non-odontogenic tumors Epithelial origin 1. Ameloblastoma 2. Adenomatoid odontogenic tumor 3. Calcifying epithelial odontogenic tumor 4. Squamous odontogenic tumor 5. Ameloblastic fibroma 6. Odontomes Mesodermal origin 1. Myxoma & Myxofibroma 2. Odontogenic fibroma 3. Cementifying fibroma 4. Periapical cemental dysplasia 5. Benign cementoblastoma 6. Familial multiple cementoma

(‘complex/compound composite odontome’, Odontoma) OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Odontome (‘complex/compound composite odontome’, Odontoma) Clinical Features Signs: If present, the swelling has the following features: Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying skin or mucosa, little expansion of jaw bone, Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); firm or hard (if no bone coverage) Additional features: missing tooth Age of occurrence: mostly in young adults Sex predilection: males more frequently affected Symptoms: mostly asymptomatic, being discovered radiographically for non-eruption of tooth, sometimes slowly enlarging swelling Site: complex more common in mandibular premolar-molar region, compound more common in maxillary anterior region

OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Odontome (‘complex/compound composite odontome’, Odontoma) Radiographic Features Type of lesion: radiopaque mass surrounded by a radiolucent line and further by a radiopaque line, ‘mixed’ in early stages Site: mandibular premolar-molar region / maxillary anterior region Size: complex can be large, compound usually small Shape: round or oval Number: single Outline: regular Border: well-defined hyperostotic Contents: radiopacities of varying densities interspersed with tiny radiolucencies, radiopacities arranged in haphazard manner (‘complex’) or in anatomical relation forming several small teeth ‘denticles’ (‘compound’) Additional features: associated with supernumerary tooth, impaction of tooth, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates

(‘complex/compound composite odontome’, Odontoma) OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Odontome (‘complex/compound composite odontome’, Odontoma) Images: Atlas of Oral Diagnostic Imaging by Higashi

(‘complex/compound composite odontome’, Odontoma) OF ORAL TISSUES BENIGN NEOPLASMS ODONTOGENIC TUMORS Odontome (‘complex/compound composite odontome’, Odontoma) Differential Diagnosis: in the early stage: CEOC, AOT, intermediate stage of fibro-osseous lesions in the mature stage: mature stage of fibro-osseous lesions, osteoma Management: surgical removal to allow eruption of impacted tooth and avoid cystic changes

Fibro-osseous lesions OF ORAL TISSUES BENIGN NEOPLASMS CLASSIFICATION BENIGN NEOPLASMS Odontogenic tumors Non-odontogenic tumors Epithelial origin 1. Ameloblastoma 2. Adenomatoid odontogenic tumor 3. Calcifying epithelial odontogenic tumor 4. Squamous odontogenic tumor 5. Ameloblastic fibroma 6. Odontomes Mesodermal origin 1. Myxoma & Myxofibroma 2. Odontogenic fibroma 3. Cementifying fibroma 4. Periapical cemental dysplasia 5. Benign cementoblastoma 6. Familial multiple cementoma Fibro-osseous lesions

OF ORAL TISSUES BENIGN NEOPLASMS CLASSIFICATION BENIGN NEOPLASMS Odontogenic tumors Non-odontogenic tumors Hyperplastic lesions 1. Polyp 2. Epulis 3. Giant cell granuloma Epithelial origin 1. Papilloma 2. Adenoma 3. Pigmented nevus 4. Keratoacanthoma Mesenchymal 1. Connective tissue origin a. Fibroma b. Lipoma / Fibrolipoma c. Haemangioma d. Lymphangioma e. Chondroma f. Osteoma

(‘central/peripheral’, reparative/hyperplastic giant cell lesion’ ) OF ORAL TISSUES BENIGN NEOPLASMS NON-ODONTOGENIC TUMORS Giant Cell Granuloma (‘central/peripheral’, reparative/hyperplastic giant cell lesion’ ) Pathogenesis: excessive reparative response to an irritant (trauma, infection) Clinical Features Age of occurrence: central variety occurs in young adults especially below 30 years of age, peripheral variety usually in adults Sex predilection: both varieties more common in females Site: the region of the jaws anterior to molars involved by the central variety , the peripheral variety involves only gingiva / alveolar mucosa

(‘central/peripheral’, reparative/hyperplastic giant cell lesion’ ) OF ORAL TISSUES BENIGN NEOPLASMS NON-ODONTOGENIC TUMORS Giant Cell Granuloma (‘central/peripheral’, reparative/hyperplastic giant cell lesion’ ) Symptoms: mostly slowly enlarging swelling, sometimes mobility in teeth Clinical Features Signs: the swelling has the following features: Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying mucosa, bluish discoloration of mucosa if cortex is perforated, expansion of jaw bone, Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); soft (if no bone coverage) Additional features: displacement / mobility in teeth Radiographic Features Type of lesion: radiolucent Site: usually anterior to mandibular 1st molar Size: medium sized lesion Shape: unilocular (round or oval), multilocular (‘soap bubble’) with locules separated by thin bony septae Number: single Outline: regular or scalloped Border: well-defined hyperostotic Contents: homogenous radiolucency Additional features: expansion of jaw bone bucco-lingually and vertically, displacement of developing teeth, thinning of cortical plates, thinning of inferior border of mandible

(‘central/peripheral’, reparative/hyperplastic giant cell lesion’ ) OF ORAL TISSUES BENIGN NEOPLASMS NON-ODONTOGENIC TUMORS Giant Cell Granuloma (‘central/peripheral’, reparative/hyperplastic giant cell lesion’ ) Radiographic Features Differential Diagnosis: from other multilocular lesions like ameloblastoma, hemangioma, myxoma and early fibro-osseous lesions Management: surgical removal with adequate margins to avoid recurrence, screening for hyperparathyroidism Image: Lucas’s Pathology of Tumors of the Oral Tissues, 5th edition

OF ORAL TISSUES BENIGN NEOPLASMS CLASSIFICATION BENIGN NEOPLASMS Odontogenic tumors Non-odontogenic tumors Hyperplastic lesions 1. Polyp 2. Epulis 3. Giant cell granuloma Epithelial origin 1. Papilloma 2. Adenoma 3. Pigmented nevus 4. Keratoacanthoma Mesenchymal 1. Connective tissue origin a. Fibroma b. Lipoma / Fibrolipoma c. Haemangioma d. Lymphangioma e. Chondroma f. Osteoma

OF ORAL TISSUES BENIGN NEOPLASMS CLASSIFICATION BENIGN NEOPLASMS Odontogenic tumors Non-odontogenic tumors Hyperplastic lesions 1. Polyp 2. Epulis 3. Giant cell granuloma Epithelial origin 1. Papilloma 2. Adenoma 3. Pigmented nevus 4. Keratoacanthoma Mesenchymal 1. Connective tissue origin a. Fibroma b. Lipoma / Fibrolipoma c. Haemangioma d. Lymphangioma e. Chondroma f. Osteoma

OF ORAL TISSUES BENIGN NEOPLASMS NON-ODONTOGENIC TUMORS Osteomas

OF ORAL TISSUES BENIGN NEOPLASMS NON-ODONTOGENIC TUMORS Osteomas

OF ORAL TISSUES BENIGN NEOPLASMS CLASSIFICATION BENIGN NEOPLASMS Odontogenic tumors Non-odontogenic tumors Mesenchymal 2. Muscle tissue origin a. Leiomyoma b. Rhabdomyoma c. Granular cell myoblastoma 3. Nerve tissue origin a. Neurofibroma b. Neurilemmoma c. Melanotic progonoma

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