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									    Radiology of Benign Tumors I

           Ghaida AlJamal, BDS, MS, Dip. ABOMR
                  Assistant Professor of
            Oral and Maxillofacial Radiology

Mar 20th, 2007                                   1
Radiology of Benign Tumors


•   Well defined
•   Corticated
•   Space occupying
•   Displacement of teeth
•   Directional resorption of teeth
•   Displacement of anatomical structures


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Radiology of Benign Tumors


           Well Defined      Poorly Defined




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Radiology of Benign Tumors

                  Corticated




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Radiology of Benign Tumors

   Space Occupying vs. Non-Space Occupying




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Radiology of Benign Tumors

                 Space Occupying




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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors



Displacement of periosteum
Internal structure: trabeculae & calcification
Unilocular / multilocular




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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors




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                        The
                   Radiology
                        of
                 Benign Tumors
                   I. Odontogenic

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        Radiology of Benign Tumors
             . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
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                . .. .. .. . . . . . . . . . .. .. .. .. . . . . . . . . . . .. .. .. .. .. .. . . . .. ..
                    . . . . . . . . . . . . . . . . . . . . . . . .
                     . . . . . . . . .                         . . . . . . . . . . . . .. .
                       . . .                . . .                . . . . . . . . ..
                        ..                     ..                  ..               ..
                                                                   ..
     Dental Lamina Ameloblastoma                                   ..
                                                                    ..
                                                                    ..
                                                                   ..
                                                                    ..
                                                                    ..
                                                                    ..
                                                                    ..
                                                              . . . .. . .. . .
                                                   .....
       Enamel organ
         Adenomatoid
                                                                                          ..
                                                . . . . . . . . .. . .. .                   .
                  Odontogenic                         Dental Lamina                ... .
                   Tumor
                                                 .           Odontoma                   .
                                                  .                                     .
Root sheath of Hertwig
     Ameloblastic fibroma                           .                                 .
                                                                                    .
        Mar 20th, 2007                                                                                          21
Radiology of Benign Tumors



       Odontogenic
           • Epithelial
               Ameloblastoma
               Squamous odontogenic tumor
               Adenomatoid odontogenic tumor
               Calcifying epithelial odontogenic tumor
               Clear cell odontogenic tumor
Mar 20th, 2007 [Melanotic neuroectodermal tumor of infancy]
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Radiology of Benign Tumors



Ameloblastoma

                 • Age: 20 - 50 years (predominantly
                   30s and 40s)
                 • Mandible:Maxilla = 85:15
                 • 60% mandibular molar-ramus area

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Radiology of Benign Tumors



Ameloblastoma

                 • Unilocular
                 • Multilocular (coarse septa)
                   Soap bubble
                   Honeycomb

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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors



Ameloblastoma

                 • Displacement or resorption of teeth
                 • Extends beyond radiographic limits
                 • Superior aspect often lost


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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors




      Keratocyst -> Ameloblastoma



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Radiology of Benign Tumors




                 Simple Bone Cyst ->
                   Ameloblastoma


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Radiology of Benign Tumors




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                 February 5, 1966
Radiology of Benign Tumors




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                 December 29, 1967
Radiology of Benign Tumors




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                 July 19, 1968
Radiology of Benign Tumors




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                 July 14, 1969
Radiology of Benign Tumors




            Recurrent Ameloblastoma



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Radiology of Benign Tumors



Recurrent Ameloblastoma

                 • radiolucent areas
                 • circular pattern




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Radiology of Benign Tumors




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Radiology of Benign Tumors



       Odontogenic
           • Epithelial
               Ameloblastoma
               Squamous odontogenic tumor
               Adenomatoid odontogenic tumor
               Calcifying epithelial odontogenic tumor
               Clear cell odontogenic tumor
Mar 20th, 2007 [Melanotic neuroectodermal tumor of infancy]
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Radiology of Benign Tumors




     Squamous odontogenic tumor
               (SOT)



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Radiology of Benign Tumors


         Squamous odontogenic tumor
                   (SOT)
                 •   Age: 10s - 60s years (mean of 40)
                 •   Mandible:Maxilla = 1:1
                 •   alveolar process area
                 •   from rests of Malassez?

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Radiology of Benign Tumors


         Squamous odontogenic tumor
                   (SOT)
                 •   radiolucent
                 •   well-circumscribed
                 •   semilunar
                 •   associated with roots of teeth

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Radiology of Benign Tumors


         Squamous odontogenic tumor
                   (SOT)

                 • locally invasive
                 • recur with conservative treatment
                 • excision is treatment of choice

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Radiology of Benign Tumors



       Odontogenic
           • Epithelial
               Ameloblastoma
               Squamous odontogenic tumor
               Adenomatoid odontogenic tumor
               Calcifying epithelial odontogenic tumor
               Clear cell odontogenic tumor
Mar 20th, 2007 [Melanotic neuroectodermal tumor of infancy]
                                                        44
Radiology of Benign Tumors




 Adenomatoid odontogenic tumor
            (AOT)



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Radiology of Benign Tumors


     Adenomatoid odontogenic tumor
                (AOT)
                 •   10-20 (18 years of age)
                 •   anterior maxilla or mandible
                 •   radiolucent or with radiopaque foci
                 •   may mimic dentigerous cyst

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Radiology of Benign Tumors




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Radiology of Benign Tumors



       Odontogenic
           • Epithelial
               Ameloblastoma
               Squamous odontogenic tumor
               Adenomatoid odontogenic tumor
               Calcifying epithelial odontogenic tumor
               Clear cell odontogenic tumor
Mar 20th, 2007 [Melanotic neuroectodermal tumor of infancy]
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Radiology of Benign Tumors




 Calcifying epithelial odontogenic
           tumor (CEOT)


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Radiology of Benign Tumors


    Calcifying epithelial odontogenic
     tumor (CEOT, Pindborg tumor)
                 • 10-90 (mean 40)
                 • maxilla:mandible = 1:2
                 • ramus-molar region


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Radiology of Benign Tumors


    Calcifying epithelial odontogenic
     tumor (CEOT, Pindborg tumor)
                 • usually associated with impacted teeth
                 • unilocular or multilocular
                 • radiolucent or with radiopaque foci


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Radiology of Benign Tumors




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Radiology of Benign Tumors



       Odontogenic
           • Epithelial
               Ameloblastoma
               Squamous odontogenic tumor
               Adenomatoid odontogenic tumor
               Calcifying epithelial odontogenic tumor
               Clear cell odontogenic tumor
Mar 20th, 2007 [Melanotic neuroectodermal tumor of infancy]
                                                        53
Radiology of Benign Tumors




      Clear cell odontogenic tumor



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Radiology of Benign Tumors



          Clear cell odontogenic tumor

                 •   rare
                 •   60 years of age
                 •   females
                 •   maxilla or mandible

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Radiology of Benign Tumors



          Clear cell odontogenic tumor

                 • radiolucent
                 • poorly circumscribed
                 • locally aggressive


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Radiology of Benign Tumors



       Odontogenic
           • Epithelial
               Ameloblastoma
               Squamous odontogenic tumor
               Adenomatoid odontogenic tumor
               Calcifying epithelial odontogenic tumor
               Clear cell odontogenic tumor
Mar 20th, 2007 [Melanotic neuroectodermal tumor of infancy]
                                                        57
Radiology of Benign Tumors




Melanotic neuroectodermal tumor
            of infancy


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Radiology of Benign Tumors


   Melanotic neuroectodermal tumor
         of infancy (MNTI)
                 •   rare
                 •   young, usually first year of life
                 •   anterior maxilla
                 •   moderately well circumscribed,
                     around apical area of roots
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Radiology of Benign Tumors




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Radiology of Benign Tumors



            Odontogenic

                 • Epithelial
                 • Epithelial with induction/Mixed
                   (epithelial and mesenchymal)
                 • Mesenchymal

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Radiology of Benign Tumors



            Odontogenic

                 • Epithelial with induction
                    Ameloblastic fibroma
                    Ameloblastic fibro-odontoma
                    Odonto-ameloblastoma

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Radiology of Benign Tumors



            Odontogenic

                 • Epithelial with induction
                    Ameloblastic fibroma
                    Ameloblastic fibro-odontoma
                    Odonto-ameloblastoma

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Radiology of Benign Tumors




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Radiology of Benign Tumors



            Odontogenic

                 • Epithelial with induction
                    Ameloblastic fibroma
                    Ameloblastic fibro-odontoma
                    Odonto-ameloblastoma

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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors



            Odontogenic

                 • Epithelial with induction
                    Ameloblastic fibroma
                    Ameloblastic fibro-odontoma
                    Compound odontoma
                    Complex odontoma
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   Radiology of Benign Tumors




                                                    –>Compound Odontoma
Ameloblastic Fibroma–>Ameloblastic Fibro-odontoma
                                                    –>Complex Odontoma




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     Radiology of Benign Tumors

• Ameloblastic Fibroma         • Ameloblastic Fibro-
                                 odontoma
l   resemblance to dental pulp l resemblance to dental pulp
l   primitive myxoid           l primitive myxoid
    connective tissue            connective tissue
l   strands of odontogenic     l strands of odontogenic
    epithelium 2 cells wide      epithelium 2 cells wide
                               l cells differentiate to
l                                produce enamel and dentin
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    Radiology of Benign Tumors
• Ameloblastic Fibro-       • Compound Odontoma
  odontoma                    Complex odontoma
l prominent enamel matrix l prominent enamel matrix
  often seen before final     often seen before final
  maturation of hard tissue   maturation of hard tissue
  enamel and dentin in the    enamel and dentin in the
  form of compound or         form of compound or
  complex odontoma            complex odontoma



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Radiology of Benign Tumors



            Odontogenic

                 • Epithelial with induction
                    Ameloblastic fibroma
                    Ameloblastic fibro-odontoma
                    Odonto-ameloblastoma

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Radiology of Benign Tumors




                 Odonto-ameloblastoma



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Radiology of Benign Tumors



                 Odonto-ameloblastoma

                 • rare
                 • young, first decade
                 • ameloblastoma component
                 • odontoma component

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Radiology of Benign Tumors



             Odontogenic

                 • Epithelial
                 • Epithelial with induction/Mixed
                   (epithelial and mesenchymal)
                 • Mesenchymal

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Radiology of Benign Tumors



            Odontogenic
                 • Mesenchymal
                    Odontogenic fibroma
                    Odontogenic myxoma
                    Benign cementoblastoma
                    Cementifying fibroma

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Radiology of Benign Tumors




                 Odontogenic fibroma
                 • Central odontogenic fibroma
                 • Peripheral odontogenic fibroma


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Radiology of Benign Tumors




       Central odontogenic fibroma



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Radiology of Benign Tumors



Central odontogenic fibroma

                 • rare
                 • all age groups
                 • radiolucent
                 • usually unilocular

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Radiology of Benign Tumors




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Radiology of Benign Tumors




   Peripheral odontogenic fibroma



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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors



            Odontogenic

                 • Mesenchymal
                    Central odontogenic fibroma
                    Odontogenic myxoma
                    Benign cementoblastoma
                    Cementifying fibroma
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Radiology of Benign Tumors




                 Odontogenic myxoma



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Radiology of Benign Tumors



Odontogenic myxoma

                 • 10-50 years (15-35, mean 30)
                 • maxilla:mandible 1:1
                 • may be infiltrative and aggressive


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Radiology of Benign Tumors



Odontogenic myxoma

                 •“tennis racket” appearance
                   (neither coarse nor fine septa)
                 • cortical expansion
                 • root displacement rather than resorption

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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors



            Odontogenic

                 • Mesenchymal
                    Central odontogenic fibroma
                    Odontogenic myxoma
                    Benign cementoblastoma
                    Cementifying fibroma
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Radiology of Benign Tumors




            Benign cementoblastoma



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Radiology of Benign Tumors



Benign cementoblastoma

                 • second or third decade, usually before 25
                 • continuous with root , which is resorbed
                 • pulp vitality unrelated


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Radiology of Benign Tumors



Benign cementoblastoma

                 • radiopaque mass
                 • surrounded by radiolucent line
                 • surrounded by radiopaque line


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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors



            Odontogenic

                 • Mesenchymal
                    Central odontogenic fibroma
                    Odontogenic myxoma
                    Benign cementoblastoma
                    Cementifying fibroma
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Radiology of Benign Tumors




         Cementifying fibroma
          Ossifying fibroma
       Cemento-ossifying fibroma


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Radiology of Benign Tumors


Cementifying fibroma

            • all age groups, mainly around 40
            • radiolucent, mixed, radiopaque
            • usually unilocular


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Radiology of Benign Tumors




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Radiology of Benign Tumors




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Radiology of Benign Tumors




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