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ODONTOGENIC TUMORS: WHERE ARE WE in 2017? Odontojen Tümörler

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ODONTOGENIC TUMORS: WHERE ARE WE in 2017? Odontojen Tümörler S10 J Istanbul Univ Fac Dent 2017;51(3 Suppl 1):S10-S30. http://dx.doi.org/10.17096/jiufd.52886 INVITED REVIEW ODONTOGENIC TUMORS: WHERE ARE WE IN 2017? Odontojen Tümörler: 2017 Yılında Neredeyiz? John M WRIGHT 1, Merva SOLUK-TEKKEŞIN 2 Received: 05/07/2017 Accepted:04/08/2017 ABSTRACT ÖZ Odontogenic tumors are a heterogeneous group of Odontojen tümörler, klinik davranışlarına ve lesions of diverse clinical behavior and histopathologic histopatolojik özelliklerine göre hamartomdan maligniteye types, ranging from hamartomatous lesions to malignancy. kadar değişen heterojen bir grup lezyondur. Bu tümörler, Because odontogenic tumors arise from the tissues which dişleri oluşturan dokulardan köken aldığı için çenelere make our teeth, they are unique to the jaws, and by extension özgüdür ve genellikle diş hekimliğini ilgilendirir. Odontojen almost unique to dentistry. Odontogenic tumors, as in normal tümörler normal odontogenezis sürecinde olduğu gibi odontogenesis, are capable of inductive interactions between odontojen ektomezenkim ve epitel arasındaki karşılıklı odontogenic ectomesenchyme and epithelium, and the indüksiyon mekanizmasıyla ortaya çıkar ve bu tümörlerin classification of odontogenic tumors is essentially based sınıflamasında bu indüksiyon mekanizması baz alınır. on this interaction. The last update of these tumors was Odontojen tümörlerle ilgili en son güncelleme 2017 published in early 2017. According to this classification, yılının başında yapılmıştır. Bu sınıflamaya göre; iyi huylu benign odontogenic tumors are classified as follows: tümörler köken aldıkları diş germi yapısına bağlı olarak Epithelial, mesenchymal (ectomesenchymal), or mixed epitelyal, mezenkimal (ektomezenkimal) veya mikst olarak depending on which component of the tooth germ gives sınıflanmıştır. Kötü huylu tümörler ise oldukça enderdir rise to the neoplasm. Malignant odontogenic tumors are ve iyi huylu tümör sınıflamasına benzer şekilde epitelyal, quite rare and named similarly according to whether the mezenkimal veya her iki komponentinde malign olmasına epithelial or mesenchymal or both components is malignant. göre adlandırılırlar. Bu derlemenin amacı odontojen The goal of this review is to discuss the updated changes to tümörleri son güncellemeler eşliğinde tartışmak ve en sık odontogenic tumors and to review the more common types görülen tipleri klinik ve radyolojik resimleri ile gözden with clinical and radiological illustrations. geçirmektir. Keywords: Odontogenic tumors; odontogenesis; Anahtar kelimeler: Odontojen tümörler; odontogenezis; update; ameloblastoma; odontomas güncelleme; ameloblastom; odontom 1 Department of Diagnostic Sciences, School of Dentistry, Texas A&M University, Dallas, TX, USA 2 Department of Tumor Pathology, Institute of Oncology, Istanbul University, Istanbul, Turkey How to cite: Wright JM, Soluk Tekkesin M. Odontogenic tumors. Where are we in 2017?. J Istanb Univ Fac Dent 2017;51(3 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Suppl 1):S10-S30. S11 Wright JM & Soluk Tekkeşin M Introduction benign odontogenic tumors seem to arise de novo, whereas the malignant odontogenic tumors may Odontogenic tumors (OT) are a heterogeneous arise de novo but more often arise from their benign group of lesions of diverse clinical behavior and precursor. The classification of odontogenic tumors is histopathologic types, ranging from hamartomatous essentially based on interactions between odontogenic lesions to malignancy. OT are derived from ectomesenchyme and epithelium. This dynamic ectomesenchymal and/or epithelial tissues that classification is constantly renewed with the addition constitute the tooth-forming apparatus. Like normal of new entities, and the removal of some older entities. odontogenesis, the odontogenic tumors represent The last update of these tumors was published in early inductive interactions between odontogenic 2017 (3). Table 1 and 2 summarize the changes of ectomesenchyme and epithelium (1, 2). Therefore odontogenic tumors from the first WHO classification OT are found within the jaw bones (central types) to date (3-5). In this review, we discuss odontogenic or in the mucosal tissue overlying tooth-bearing tumors relative to the latest updates and focus on the areas (peripheral types). OT are basically divided more common tumors with clinical and radiological into two primary categories; malignant and benign illustrations. but the etiology is unknown. The majority of Table 1. Historically WHO benign odontogenic tumor classification from 1971 to 2017. Please note that origin based sub-classification (epithelial, mixed and mesenchymal), which is still in use in 2017, was first defined in 1992. 1971 WHO classification 1992 WHO classification 2005 WHO classification 2017 WHO classification Ameloblastoma Epithelial origin Epithelial origin Epithelial origin Calcifying epithelial odontogenic Ameloblastoma Ameloblastoma, solid / multicystic Ameloblastoma tumor type Ameloblastic fibroma Squamous odontogenic tumor Ameloblastoma, extraosseous / Ameloblastoma, unicystic peripheral type type Adenomatoid odontogenic tumor Calcifying epithelial odontogenic Ameloblastoma, desmoplastic type Ameloblastoma, extraosseous/ (adeno-ameloblastoma) tumor (Pindborg tumor) peripheral type Calcifying odontogenic cyst Clear cell odontogenic tumor Ameloblastoma, unicystic type Metastasizing (malignant) ameloblastoma Dentinoma Squamous odontogenic tumor Squamous odontogenic tumor Ameloblastic fibro-odontoma Calcifying epithelial odontogenic Calcifying epithelial tumor odontogenic tumor Odonto-ameloblastoma Adenomatoid odontogenic tumor Adenomatoid odontogenic tumor Complex odontoma Keratocystic odontogenic tumor Compound odontoma Mixed origin Mixed origin Mixed origin Fibroma (odontogenic fibroma) Ameloblastic fibroma Ameloblastic fibroma Ameloblastic fibroma Myxoma (myxofibroma) Ameloblastic fibrodentinoma (dentinoma) Ameloblastic fibrodentinoma Primordial odontogenic and ameloblastic fibro-odontoma tumor Cementomas Odontoameloblastoma Ameloblastic fibro-odontoma Odontoma, Complex type a. Benign cementoblastoma (true Adenomatoid odontogenic tumor Odontoma, Complex type Odontoma, Compound type cementoma) b.Cementifying fibroma Calcifying odontogenic cyst Odontoma, Compound type Dentinogenic ghost cell tumor c. Periapical cemental ysplasia Complex odontoma Odontoameloblastoma (periapical fibrous dysplasia) d. Giganti form cementoma (familial Compound odontoma Calcifying cystic odontogenic tumor multiple cementomas) Melanotic neuro-ectodermal tumor of infancy Dentinogenic ghost cell tumor Mesenchymal origin Mesenchymal origin Mesenchymal origin Odontogenic fibroma Odontogenic fibroma Odontogenic fibroma Myxoma (odontogenic myxoma, Odontogenic myxoma / Odontogenic myxoma/ myxofibroma) myxofibroma myxofibroma Benign cementoblastoma Cementoblastoma Cementoblastoma Cemento-ossifying fibroma S12 Clinicopathologic review of OT Table 2. Historically WHO malign odontogenic tumor classification from 1971 to 2017. 1971 WHO 1992 WHO 2017 WHO 2005 WHO classification classification classification classification Odontogenic Odontogenic Odontogenic Odontogenic carcinomas carcinomas carcinomas carcinomas Malignant Malignant Metastasizing (malignant) Ameloblastic ameloblastoma ameloblastoma ameloblastoma carcinoma Primary intra-osseous Primary intraosseous Ameloblastic carcinoma – Primary intraosseous carcinoma carcinoma primary type carcinoma, NOS Other carcinomas arising from odontogenic Malignant variants Ameloblastic carcinoma– Sclerosing epithelium, including of other odontogenic secondary type, odontogenic those arising from epithelial tumors intraosseous carcinoma odontogenic cysts Malignant changes in Ameloblastic carcinoma– Clear cell odontogenic Odontogenic sarcomas odontogenic cysts secondary type, peripheral carcinoma Ameloblastic Primary intraosseous Odontogenic Ghost cell odontogenic fibrosarcoma squamous cell carcinoma sarcomas carcinoma (ameloblastic sarcoma) – solid type Ameloblastic Primary intraosseous Ameloblastic fibrosarcoma squamous cell carcinoma Odontogenic odontosarcoma (ameloblastic derived from keratocystic carcinosarcoma sarcoma) odontogenic tumor Primary intraosseous Ameloblastic squamous cell carcinoma Odontogenic fibrodentino–and derived from odontogenic sarcomas fibro-odontosarcoma cysts Clear cell odontogenic carcinoma Ghost cell odontogenic carcinoma Odontogenic sarcomas Ameloblastic fibrosarcoma Ameloblastic fibrodentino–and fibro- odontosarcoma Odontogenic benign tumors, epithelial common mutation (6). WHO 2017 classification divided ameloblastoma into four categories; Ameloblastoma conventional, extraosseous / peripheral, unicystic, and metastasizing ameloblastoma. Ameloblastoma is a benign but locally aggressive epithelial neoplasm that is one of the most common Clinical features odontogenic tumors. Current genetic studies show mutations in genes that belong to MAPK pathway Conventional ameloblastoma usually shows slow, in many ameloblastomas. BRAFV600E is the most painless expansion (Figure 1). The posterior area of S13 Wright JM & Soluk Tekkeşin M mandible is the most common location. They tend different clinical features, including a radiolucent- to grow in a buccolingual direction, resulting in radiopaque appearance, and predilection for the significant expansion. The signs and symptoms are anterior jaws, especially maxilla (8). variable; including malocclusion, facial deformity, Unicystic ameloblastoma is a subtype of soft tissue invasion
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