Odontogenic Tumors

Most common odontogenic tumor (besides odontomas)
Seen in the posterior mandible between age 20-30
70% of mandibular ones have BRAFV600E mutations

Well-circumscribed, multilocular RL (soap-bubble or honeycomb)
May arise in association with dentigerous cyst or unerupted tooth 
Histo: piano keys appearance due to polarization of nuclei away from basement membrane

Found in younger patients (23 years average)
Mostly in the posterior mandible and presents as a painless swelling 
Circumscribed, unolocular RL
Resembles a dentigerous, primordial, or residual cyst radiographically and is often surrounding the crown of an unerupted third molar

Histo: luminal, intraluminal, mural (pictures in notes)

Usually painless, non-ulcerated, sessile or broadly pedunculated swelling of gingiva or alveolar mucosa
Most in middle-aged patients
More common in mandible, posterior
May erode superficial bone—cupping erosion
should NOT infiltrate into bone by definition

Ameloblastoma that metastasizes, but who's primary tumor and metastasis look like normal ameloblastoma microscopically
Mets to lungs, cervical lymph nodes

May be locally aggressive, but does not usually metastasize
Cytologic features of malignancy in the primary tumor, recurrence, or metastasis, characterized by: Increased nuclear/cytoplasmic ratio, hyperchromatism, mitoses

Benign tumor that is seen 2/3 in the second decade, 2/3s of the time in females, 2/3rds in the anterior maxilla, 2/3 associated with an impacted tooth which is the canine 
Well-circumscribed, unilocular lesion, associated with the crown but extending below the CEJ 
May contain fine "snowflake" mineralization

Benign tumor that is found in the posterior mandible, painless, slow-growing swelling 
Usually multilocular, RL, with scalloped margins 
Histo: large areas of hyalinized, eosinophilic material 
Aka Pindborg Tumor

Benign neoplasm that is most common in posterior mandible 
May present as a local bony swelling
well-circumscribed, UL or ML RL lesion 
may associated with the crown of an impacted tooth

Benign neoplasm that may represent a developing complex odontoma
 May represent a progression from ameloblastic fibroma
Clinical and radiographic features –  Same clinical presentation as ameloblastic fibroma (age, location)
unlike odontoma, may continue to grow–  Large cases show swelling
Usually unilocular–  Mixed radiolucent/radiopaque

Most common odontogenic “tumor”, more than all others combined
May be a developmental anatomy, not a neoplasm 
Often first noted after radiographic evaluation for an unerupted tooth
Usually detected at age 14 
Usually radiopaque and surrounded by a radiolucent line. This is usually diagnostic.

Tooth-like structures in the lesion
Mainly in the incisor-canine area (sometimes look like supernumerary teeth)

Lesion does not resemble tooth, mainly posterior of jaws
Disorganized arrangment of tubular dentin, enamel, thin layers of cementum

Usually seen in young adults 
May have "honey comb" appearance 
May be multilocular)—locularity is different than that seen in ameloblastoma because the septae are more whispy
Often poorly-defined, unilocular or scalloped margins