Hello friends, this is Dr. Sangeeta and welcome back to another lecture of Dental Partiala where we help you understand and learn dentistry better and easy way and today's topic we are going to talk about the odontogenic tumor. So without further ado, let's get started. Welcome back to another 10 in 10 series where we cover each topic under 10 heading in 10 minutes and today's topic is the amyloblastoma.
Now this is a true neoplasm of the enamel organ tissue wherein there is no enamel formation happening. So this is a process, this is a neoplasm of enamel organ wherein there is no enamel formation. So before that point there is a differentiation and this leads to the tumor formation. So this is a neoplasm of the enamel organ type.
type tissue. So basically the ameloblast hence the name ameloblastoma. As we know that ameloblast are the cells which forms the enamel. So there is going to be differentiation of ameloblast proliferation of ameloblast to form a tumor true tumor true neoplasm this is the most common neoplasm.
So this is the ameloblastoma. So Robinson described this tumor as unicentric non-functional intermittent growth. Now, see what happens before initially it was called as edementinoma.
So, this was given by Malasis in 1885. But since there is no heart tissue which is formed, right? There is no enamel which is forming. So, the term is replaced to ameloblastoma by Churchill in 1934. Now, the origin is from the, of course, ameloblast originate from what? Originate from the dental organ. these ameloblasts ameloblastoma the tumor cells of ameloblastoma they are arising from cell rest of dental organ either the remnant of dental lamina or the remnant of hertwig epithelial root sheath so either they are the cell rest of dental their remnants of the dental lamina or they are remnants of the herdwig epithelial root sheath.
So this is how these ameloblastoclastic cells are proliferating in n numbers giving rise to the neoplasm which is the ameloblastoma. So how are we going to classify it? See there are many classification based on the clinical type as you can see we have made multilocular radiolucency. So all this is the multilocular type.
Then we have the unicystic type wherein there is going to be single cystic sac in the intraosseous. Then the third one we have is the peripheral or external. extraosseous which is outside the bone which occurs only one person. So most of the lesions 80% of the lesion approximately more than 80 I must say are the conventional solid or the multicystic type wherein we will see the multicystic spaces and in that also we have the histological variants. The histological variants these are the follicular pattern, the plexiform pattern, acanthameters granular or we have the desmoplastic type so all these types are the variants we can write in histological types there these are the desmoplastic plus plexiform follicular again the matters granular and clinically we have the multilocular unicystic or the peripheral third one is the peripheral or the other can be malignant amyloblastoma or amyloblastic carcinoma so talking about amyloblastoma multicystic type right conventional solid or multisystic intraosseous that means within the bone this ameloblastoma.
So, ameloblastoma as such is the most common odontogenic neoplasm of the oral cavity and it is benign locally aggressive lesion arising from the odontogenic epithelium which we have covered. Now, it involves the second, third, fourth and fifth decay of life and most common are affected are the males mandibular region and the molar and ramus region. See, always remember this that the mandible occurrence of ameloblastoma is more and And specifically the molar ramus region.
So if you take close to the angle of the mandible. So molar ramus region is most commonly affected. Molar angle ramus area.
Three times more affected than the premolar or the anterior region. So mandible M. Remember M molar, M mandible and M is males. Are more affected. Now racial black people are more affected with amyloblastoma compared to others.
So this is a slow growing pain. less bony hard swelling because amiloblastitis definitely going to be the hard swelling and patient will have facial asymmetry because of this large swelling. These large lesion can even displace the teeth, there can be pain, paresthesia, teeth can be mobile, the involved teeth can be mobile, it can be locally invasive and there can be infiltration of intermedullary spaces causing the erosion of the cortical bone. So if we see radiographically we see two appearances soap bubble or honeycomb appearance as you can see these big bubbles are the soap bubbles so in case when the lesion is large when the radiolucent loculations are large then the appearance looks something like the soap bubble when this multilocular radiolucent lesions or the loculations are small then they appears like the comb honeycomb appearance so they look like the honeycomb so that is why the honeycomb appearance and these appearances they have in between they have this septa which radio in which this masses are there so in between if you see in between there are these septa which is present so radiolucency is there radiolucent tumor mass is there and also there is buccal and lingual cortical expansion there is resorption of the root adjacent to the adjacent teeth the margins of the lesion are irregular and scaloping these large lesion will cause the expansion disturb distortion destruction of the cortical plates so there will be thin very thin cortical plates so if you see outside this mass there is going to be very thin cortical plate which is left because the lesion is expanding so expansion of the bony cortex occurs and because the tumor grows from time and with time and And therefore only thin shelf of bone is left. left which is ahead of the bone as you can see when the grows when it grows so there is only thin bone which is left so if we do the palpation if we put the digital pressure then these this thin shell of the bone it cracks on digital palpation we call it the egg shell crackling so this is because we because of very thin shell of bone which is left and when we palpate it when we put the digital pressure then this thin bone cracks on putting the digital pressure.
So the sound which appears is the eggshell crackling sound. So that is why eggshell crackling. Also we can see the pathologic fractures, the tooth involved is vital.
So all these things, even if suppose in desmoplastic type, this desmoplastic aminoblastoma is seen in the maxilla. So also it can be seen in the maxilla also. So sometimes when the lesion is too big, then it can invade into the ethmoidal air sinus. it can even go up to the cranial base so all these variants are there in the aminoblastoma then we have the desmoplastic type which is seen in the maxillary so if we look at histological section we have histological variations so histological types are the granular desmoplastic follicular acanthomaters plexiform so all these types but what is the common feature in in all of these histological types is that there is reverse polarization.
away from the basement membrane as you can see this is the basement membrane and the nucleus is away from the basement membrane so this is the common feature we can see the hyperchromatism of the basal cell nuclei as well as the pelliciding of these basal cell with the polarization of nucleus away from the basement membrane we call it the reverse polarity so reverse polarity seen in all of the variations so also there is cytoplasmic veculization of the basal cell as As you can see, See there is a vacuole towards the basement membrane. So we have many patterns like follicular pattern. If you can see in the follicular pattern what happens. There is a cystic degeneration. So in between these.
See there are these peripheral cells. Which have the reverse polarization. As you can see this is away from the basement membrane.
Right and in between there is a central mass of cells. Now these cells are more like a stellate reticulum cells. Star shaped cells. cells and there is a connective tissue matrix and there is a cystic regeneration.
So what do we see in the follicular pattern that the pattern is more like a follicular. These odontogenic epithelial cells they are in form of multiple follicles or islands right and there is reverse polarization of these basal epithelial cells we can see these tall columnar cells or ameloblast like cell I can And same there is a central mass of cells in between. which is a star in shape.
Then we have the plexiform pattern. So as you can see in the plexiform pattern, the epithelial cells, they proliferate, they anastomose with each other in a fish, fish like pattern. So as you can see fish net, like a net of the fish.
So these are overlapping each other like this. So there is a fish net appearance we see in case of a plexiform pattern. So in the plexiform pattern, these neoplastic odontogenic cells, they proliferate in form of a long continuous strand scords.
So, there are strands, anastomosing strands, which are, these strands are anastomosing each other. As you can see, they are overlapping each other. And there is telate reticular-like cells in between. And if you look at the peripheral cells or the basal cells, these are cuboidal to pulmonary in shape. Now, the another variant we have is the acanthomatous type.
as you can see in the egg and tomato type in between we have the squamous metaplasia which is taking place in the echinthomatous pattern. If you look at the granular pattern, now you see that there are granular cells, cuboidal or rounded cells which are present. So, these resemble like the granules. So, lysosomes like structures.
So, these are the granular pattern, cell pattern because these are placed in a granular like manner. Then we have the desmoplastic type. As you can see in the Desmo plastic type we have lot of a lot of the densely fiber as you can see green color stroma is more compared to the other so desmoplastic type we have the dense very dense fibrous stroma and these there are also central cells which are present right and also there are thin cords of epithelial cells as you can see there are thin cords of epithelial cells which are present in the desmoplastic like pattern so this is about the multi-locular or variant, right? So how are we going to treat it? There can be, we can treat treated via the simple enucleation or we can do the curatage to the end block resection to complete we can remove it because reoccurrence rate is high 50 to 90 percent reoccurrence rate is there also we have another variants like unicystic amyloblastoma wherein the usually there is only one cystic sac so in that also we have histological variants we have luminal so if you look at luminal is when in the lumen space there is neoplastic cells growth which is happening Then we have the intraluminal.
So intraluminal, if you see, they will be like this. From the lumen, they are coming. And then we have the mural type.
So mural type will be present in between here. So like this, we have the unicistic variations, histological variations. then we have the peripheral or extra osseous amyloblastoma now this amyloblastoma is usually present in the gingival surface posterior gingival and alveolar mucosa commonly in the mandible compared to the maxillary again this is also painless non ulcerated we will see the swelling in the middle age person and then we have the malignant ameloblastoma or ameloblastic carcinoma now malignant ameloblastoma is a tumor that shows histopathological features of ameloblastoma only both in the primary tumor as well as it shows the same features in the metastatic deposition ameloblastic carcinoma is again an ameloblastoma that has cytological variations of malignant seen the primary tumor and in a reoccurrence or in a metastatic deposit so this is about the ameloblastoma i hope that you have enjoyed the video so if you have enjoyed the video give it a thumbs up also you can comment in the comment section below and there is a link in the description box below to support me on patreon as well as on paypal to make free videos for you guys and to make free notes and the reference of this is the sheffers edition as well as the naval third edition so guys still then keep reading keep learning stay motivated i will see you soon in the next video