Ameloblastoma

Dr.Ansar Uddin Ahmed

Asst. prof and Head
Periodontology, Oral pathology and Oral medicine
 Contents
1. Introduction
2. Source of origin
3. Subtype
4. Clinical features
5. Radiological features
6. Differential diagnosis
7. Histological feature
8. Investigations
9. Treatment
10. Prognosis
11. Key features
12. Variety of ameloblastoma
Introduction

Several types of ameloblastoma are recognised.

All are benign epithelial neoplasms in which
the
epithelium contains ameloblast-like cells and
stellate reticulum-like cells, indicating its
odontogenic nature
Source of origin-

1. Enamel organ
2. Remnants of dental lamina
3. Epithelial rest of malassez
4. Linning of odontogenic cyst
5. Basal layer of oral epithelium
 AMELOBLASTOMA: BIOLOGICAL
SUBTYPES

Solid ameloblastoma
Cystic (unicystic) ameloblastoma
Peripheral ameloblastoma
Malignant ameloblastoma
Ameloblastic carcinoma
Clinical features
1. Age: 20-50 years
2. Sex: no significant sex predilection
3. Site: mandible > maxilla(more than 80%
mandible)
4. With in mandible molar-ramus area is
affected three times more commonly than
premolars & anteriors
5. It starts as a slow growing , painless,
hard, non tender, ovoid swelling
which often enlarges in size as it
causes little discomfort in early stage.
6. Facial assymetry
7. Mobilty of teeth and exfoliation
8. Expansion of jaw.
9. Pain or paresthesia if impinges on
nerve
In the absence of treatment,
 It may be extremely
disfiguring fungating and
ulcerative like carcinoma
 Keeps on enlarging and
cause “egg shell crackling’’&
fluctuation
 Invades surrounding tissues

 Bone destruction is a common

finding by invasion to bone
marrow
Radiological features
1. Ameloblastoma is osteolytic lesion with
Unilocular or multilocul radiolucency.
Multilocular lesion may be :
Honey combed (small loculation)
Soap bubble (large loculation)
2. Cortical bone may be expanded or destroyed.
3. Unerupted tooth may be present (resembling
dentigerous cyst)
4. Root resorption of associated teeth.
Differential diagnosis

A. Odontogenic tumors-
 Calcifying epithelial odontogenic tumor
 Odontogenic myxoma
B. Cystic lesions-
 Dentigerous cyst
 Odontogenic keratocyst
 C. Non-odontogenic lesions-
 Central giant cell granuloma
 Central hemangioma
Histological Feature:
Microscopically 5 types
1. Follicular
2. Plexiform
3. Granular cell
4. Basaloid
5. Desmoplastic
Follicular ameloblastoma-
The most common and most readily recognisable
type. There are islands with an outer layer of tall,
columnar, ameloblast-like cells with reversed
polarity surrounding a core of loosely arranged
polyhedral or angular cells, resembling stellate
reticulum
Ameloblastoma. Islands of follicular ameloblastoma
comprising ‘stellate reticulum’ and a peripheral layer of
elongate ameloblast-like cells
Plexiform ameloblastoma-
The epithelium forms strands and
interconnected sheets and the ameloblast
cells are often less prominent
.
Ameloblastoma, plexiform type. There are thin,
interlacing strands of epithelium, but typical
ameloblasts are often not seen in this pattern
Acanhomatous ameloblastoma-
This usually occurs in the follicular type of
ameloblastoma in which prickle cells replace
the stellate reticulum and sometimes form
keratin
Acanthomatous change in an ameloblastoma.
Stellate reticulum-like cells have undergone
squamous metaplasia to form keratin. This is called
acanthomatous because it looks like prickle cells in
keratinising epithelium
Granular cell ameloblastoma-
The epithelium in the central areas of the tumour
islands degenerates into sheets of large
eosinophilic granular cells.
Ameloblastoma. Granular cell change in an ameloblastoma.
Ameloblastoma and stellate reticulum-like cells have undergone
degenerative change to form large pink granular cells. In some
tumours this change is extensive, and the term granular cell
ameloblastoma’ is applied
Basal cell ameloblastoma-
Rare variety and consists of more darkly stainning
Basal cells with little evidence of ameloblasts
 Investigations

• Radiograph
• Biopsy
• CT scan
• MRI
Treatment

1. Wide surgical excision, preferably removing 10

mm of apparently normal bone around the
margin to ensure that any extension into the
medullary bone is removed.
2. Reconstruction should be done after resection
3. Conservative treatment like enucleation can
sometimes be done incase of small tumor, but
has a greater chance of recurrence.
Prognosis
Ameloblastomas treated by resection seldom recur
(98% cure rate). Enucleation and curettage
procedures are associated with a high incidence of
recurrence (70% to 85%).
Key features

• Benign neoplasm of odontogenic epithelium

• The most common odontogenic neoplasm
• Usually presents between ages 30 and 50 years
• Locally infiltrative into surrounding bone
• Typically asymptomatic and appears as a multilocular cyst
radiographically
• Most commonly forms in posterior mandible
• Treated by excision with a margin of normal tissue
• Maxillary ameloblastomas can invade the cranial base
and be lethal
Unicystic ameloblastoma
The unicystic ameloblastoma is an ameloblastoma that
has a single cyst cavity.
 Such ameloblastomas present at a younger age than
conventional ameloblastoma, in the second and third
decades
 May account for 10% of all ameloblastomas
Unicystic ameloblastomas may be enucleated without
recurrence
 Desmoplastic ameloblastoma
 The desmoplastic ameloblastoma is a distinctive variant of
conventional ameloblastoma.
 These ameloblastomas arise with equal frequency in
both jaws
 Its unique radiographic appearance is that of a mixed
radiolucent‐radiopaque lesion
 The islands of epithelium are sparse, do not show
obvious ameloblasts and the lesion is dominated by
densely collagenous (‘desmoplastic’) tissue.
 Behaviour and treatment are the same as for the
conventional ameloblastoma.
PERIPHERAL AMELOBLASTOMA
Ameloblastoma developing in gingival soft tissue
May originate from gingival epithelium
Typically does not invade underlying bone
Older adults most commonly affected
Presents as a painless gingival mass
Mandibular gingiva > maxillary gingival
Treated with local excision; rarely recurs
 Malignant variety

These lesions occur in a relatively young age group

(thirties) and appear in the mandible more
commonly than in the maxilla.
By definition, these are lesions that metastasize to
local lymph nodes or distant organs
Malignant lesions have been divided into two
subtypes: malignant ameloblastoma in which
primary and metastatic lesions are
microscopically well differentiated with the
characteristic histologic features of
ameloblastoma, and ameloblastic carcinoma in
which the lesions (primary and/or metastatic)
exhibit less microscopic differentiation, showing
cytologic atypia and mitotic figures