Mesenchymal OT

MESODERMAL
TUMORS OF
ODONTOGENIC
ORIGIN
CLASSIFICATION
Mesenchymal &/0r odontogenic ectomesenchyme
with or without included odontogenic epithelium
1.1.3.1 Odontogenic Fibroma (Simple type)

1.1.3.2 Odontogenic Fibroma (WHO type)
1.1.3.3 Odontogenic myxoma/myxofibroma
1.1.3.4 Benign Cementoblastoma
ODONTOGENIC FIBROMA
◼ Elusive & controversial tumor
◼ Topographically two varients:
- an intraosseous or central type
- an extraosseous or peripheral type
CENTRAL ODONTOGENIC TUMOR
◼ 1992 WHO classification defines COF as, “a fibroblastic

neoplasm containing varying amount of apparently
inactive odontogenic epithelium”
◼ Occurs predominantly in the mandible (1:6.5) in young
individuals (mean age 27 years with a range of 11-67
years)
◼ Premolar molar area in mandible & anterior region in
maxilla
◼ Female predilection ( 1:2.8)
◼ The tumor is silent when small
◼ Painless swelling
◼ Three basic concepts have existed concerning this
tumor :
1. Lesion around the crown of a unerupted tooth
resembling a small dentigerous cyst
2. Lesion of fibrous connective tissue with scattered
islands of odontogenic epithelium
3. Lesion described WHO as a fibroblastic neoplasm
containing varying amounts of odontogenic
epithelium
PATHOGENESIS
◼ Ectomesenchymal tissue of PDL, dental
follicle or dental papilla
◼ Not occur in an extragnathic location
◼ According to Gardener-
Simple type- dental follicle
WHO-type – PDL
◼ Presence of odontogenic epithelium embeded
in the tumor tissue
◼ The growth is slow but progressive
◼ Cortical expansion
◼ Radiologically shows unilocular radiolucent area
with well-defined borders
◼ Large lesions show scalloping of the margins or
multiloculation
◼ Shows displaced teeth & root resorption of
adjacent teeth, mobility of teeth
◼ Lesion may be associated with the crown of an
unerrupted molar, premolar & incisor
Intraosseous lesion in the righ maxilla
exhibiting a circumscribed radiolucency
HISTOPATHOLOGY
Simple type –
◼ An expansile, noninfiltrating connective tissue lesion
resembling a dental follicle. papilla
◼ It is relatively acellular, the fibers being quite
delicate
◼
fibrous
There is a considerable amount of ground substance
yielding a fibromyxoid quality. C T in more offibromymaidity
◼ It may exhibit inactive-looking rests of odontogenic
epithelium but they are seldom numerous.Tiative
◼ Occasionally, nondiscript calcification are found.
age
WHO type –
◼ A benign neoplasm composed of cellular connective
tissue.
◼ Fibroblastic strands interwoven with less cellular areas
Jen
in which numerous small blood vessels are present.
◼ Foci of calcified collagenous matrix, resembling
dysplastic dentin often occur. more fibre but less ground
substance
◼ Islands or strands of inactive-looking odontogenic
epithelium are an integral component of this type of
COF. here epithelium is the tumor
part of
◼ A clearly defined capsule is not encountered. dysplastic
dentin present
PERIPHERAL ODONTOGENIC
FIBROMA
◼ Represents soft tissue counterpart of COF
◼ Also called as ‘odontogenic hamartomas’ &
‘peripheral fibroameloblastic dentinoma’
◼ Firm, slow-growing, & usually sessile gingival
mass covered by normal-appearing mucosa
◼ Age: second to seventh decades of life
◼ Commonly affected site facial gingiva of the
mandible.
◼ Radiographically there is no involvement of underlying bone
and soft tissue mass shows area of calcification.
Histopathologic features
◼ Intervowen fascicles of cellular fibrous

connective tissue intermixed with areas of less
cellular, myxoid connective tissue
◼ Islands or strands of odontogenic epithelium
◼ Epithelial cells may show vacuolisation
◼ Dysplastic dentin, amorphous ovoid
cementum-like calcifications and trabaculae of
osteoid may be present
ODONTOGENIC MYXOMA
worst tggressivelision
◼ In 1947, Thoma & Goldman first described
myxoma of jaws
◼ Slowly increasing swelling or asymmetry of
the affected jaw
◼ Painless swelling
◼ Growth may be rapid & infiltration of
neighbouring soft tissue structure may occur
◼ Mostly intraosseous but peripheral variant can
occur
corticate plate proliferat
pathologic fracture
Pathogenesis
perforation
◼ Possible germ centres are:
dental papilla,
dental follicle &
periodontal tissues
◼ Can cause expansion of the buccal & lingual
cortical plates expansion lead toperforation
◼ Displacement of tooth roots is seen in 74% of
patients, root resorption in 9.5% & can be
associated with impacted teeth in 5% of cases
◼ Relative incidence is 3.7% of all odontogenic
tumors
◼ Mean age of occurrence 30 years (1-73 years)
◼ Female predilection (1:1.6) mainly 30 40years
◼ Mandible is commonly involved, premolar
molar area
appears
bluish due
GAG
in
shiny
appearance
fibers are
slattered
gel like
like
jelly
dential follicle is myxomatous
even
umbilital
lard in
mynamatory
Histopathology
◼ A locally aggressive neoplasm consisting of rounded &
angular cells lying in an abundant mucoid stroma. (WHO
definition)
aggressivelesion hence
◼ Non-encapsulated, non-metastasing neoplasm infiltrating bone
marrow spaces
◼ Loose mucoid stroma with rounded or spindle shaped cells
◼ Stroma relatively avascular lessblood
◼
supply
Fibrils stains with silver impregnation are reticulin
◼
skin
Odontogenic epithelium is sometimes surrounded by zone of
hyalinization
BENIGN CEMENTOBLASTOMA
◼ First described by Norberg in 1930
◼ Only true neoplasm of cemental origin
◼ Characterized by proliferation of cellular
cementum
◼ Intimately associated with tooth root
Pathogenesis
◼ Ectomesenchymal cells of the periodontium,
including cementoblasts
◼ Evolve in three stages:
1. Periapical osteolysis
2. Cementoblastic stage
3. Inactive stage of maturation & calcification
◼ Slow growing, unilateral swelling with
expansion of the affected bone
◼ Associated with pain & occasionally with
paresthesia
◼ 0.2%-6.2% of odontogenic tumors
◼ Wide age range first to seventh decade of life
◼ Male: female ratio 1:1.2
◼ Mandible commonly involved, premolar molar
region
◼ Vitality test of teeth is positive
◼ Cause resorption of root & invade the pulp
◼ Radiographically – radiopaque mass fused with
one or several roots of the associated tooth,
surrounded by the radiolucent border
◼ Size of the lesion varies from 0.5-5cm ( average
1.36 cm)
◼ ‘ A neoplasm characterized by the formation of sheets of
cementum-like tissue which contains a large number of
reversal lines & is unmineralized at the periphery of the mass
in the more active growth area’ (WHO definition)
Histopathological Features
◼ Numerous basophilic reversal lines
◼ Cemental trabeculae rimmed with plump active

cementoblasts
◼ Fibrous tissue with dilated vessels & multinucleated
giant cells
◼ At the periphery proliferation of ocementoblast &
cementoclasts is evident

Mesenchymal OT

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MESODERMAL

1.1.3.1 Odontogenic Fibroma (Simple type)

◼ 1992 WHO classification defines COF as, “a fibroblastic

◼ Intervowen fascicles of cellular fibrous

◼ Cemental trabeculae rimmed with plump active

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