Squamous odontogenic tumor

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Squamous odontogenic tumors (SOTs) are very rare benign locally infiltrative odontogenic neoplasms of epithelial origin. Only some 50 cases have been documented. They occur mostly from 20-40 and are more common in males. Treatment is by simple enucleation and local curettage, and recurrence is rare. [1]

Neoplasm abnormal mass of tissue as a result of abnormal growth or division of cells

A neoplasm is a type of abnormal and excessive growth, called neoplasia, of tissue. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and it persists growing abnormally, even if the original trigger is removed. This abnormal growth usually forms a mass. When it forms a mass, it may be called a tumor.

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Clinical appearance

Clinically, they are initially slow growing and asymptomatic but may cause mobility or displacement of teeth. They may occur anywhere in the jaws but are more common in the posterior mandible and anterior maxilla. They are usually intrabony, but some peripheral cases have been observed. Radiographically, they are small unilocular or larger multilocular well defined non-corticated radiolucencies, triangular or crescent in shape, with the base apically between adjacent roots of vital teeth. They are often misdiagnosed as periodontitis. SOT should be suspected where isolated periodontal defects occur without obvious risk factors. [2]

Radiodensity is opacity to the radio wave and X-ray portion of the electromagnetic spectrum: that is, the relative inability of those kinds of electromagnetic radiation to pass through a particular material. Radiolucency or hypodensity indicates greater passage to X-ray photons and is the analogue of transparency and translucency with visible light. Materials that inhibit the passage of electromagnetic radiation are called radiodense or radiopaque, while those that allow radiation to pass more freely are referred to as radiolucent. Radiopaque volumes of material have white appearance on radiographs, compared with the relatively darker appearance of radiolucent volumes. For example, on typical radiographs, bones look white or light gray (radiopaque), whereas muscle and skin look black or dark gray, being mostly invisible (radiolucent).

Histology

Lesions are non-encapsulated with islands of well differentiated squamous epithelium that commonly contain microcysts and calcifications in a dense fibrous connective tissue stroma. The pathogenesis is unclear but they appear to arise from the gingival epithelium or cell rests of Malassez or Serres. This presentation is similar to that of squamous cell carcinomas; however, the epithelium of SOT is highly differentiated. [3]

Epithelial cell rests of Malassez

In dentistry, the epithelial cell rests of Malassez (ERM) or epithelial rests of Malassez are part of the periodontal ligament cells around a tooth. They are discrete clusters of residual cells from Hertwig's epithelial root sheath (HERS) that didn't completely disappear. It is considered that these cell rests proliferate to form epithelial lining of various odontogenic cysts such as radicular cyst under the influence of various stimuli. They are named after Louis-Charles Malassez (1842–1909) who described them. Some rests become calcified in the periodontal ligament (cementicles).

Squamous cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that result from squamous cells. These cells form the surface of the skin and lining of hollow organs in the body and line the respiratory and digestive tracts.

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Esophageal cancer gastrointestinal system cancer that is located in the esophagus

Esophageal cancer is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach. Symptoms often include difficulty in swallowing and weight loss. Other symptoms may include pain when swallowing, a hoarse voice, enlarged lymph nodes ("glands") around the collarbone, a dry cough, and possibly coughing up or vomiting blood.

Carcinoma A category of types of cancer that develops from epithelial cells

Carcinoma is a category of types of cancer that develop from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesodermal or ectodermal germ layer during embryogenesis.

Head and neck cancer organ system cancer that arises in the head or neck region (including the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx)

Head and neck cancer is a group of cancers that starts in the mouth, nose, throat, larynx, sinuses, or salivary glands. Symptoms for head and neck cancer may include a lump or sore that does not heal, a sore throat that does not go away, trouble swallowing, or a change in the voice. There may also be unusual bleeding, facial swelling, or trouble breathing.

Leukoplakia condition of the mucous membranes

Leukoplakia generally refers to a firmly attached white patch on a mucous membrane which is associated with an increased risk of cancer. The edges of the lesion are typically abrupt and the lesion changes with time. Advanced forms may develop red patches. There are generally no other symptoms. It usually occurs within the mouth, although sometimes mucosa in other parts of the gastrointestinal tract, urinary tract, or genitals may be affected.

Ameloblastoma cell type benign neoplasm that has material basis in odontogenic epithelium

Ameloblastoma is a rare, benign or cancerous tumor of odontogenic epithelium much more commonly appearing in the lower jaw than the upper jaw. It was recognized in 1827 by Cusack. This type of odontogenic neoplasm was designated as an adamantinoma in 1885 by the French physician Louis-Charles Malassez. It was finally renamed to the modern name ameloblastoma in 1930 by Ivey and Churchill.

Papilloma cell type benign neoplam that is composed of epithelial tissue on papillae of vascularized connective tissue

A papilloma is a benign epithelial tumor growing exophytically in nipple-like and often finger-like fronds. In this context papilla refers to the projection created by the tumor, not a tumor on an already existing papilla.

Dental follicle

The dental follicle, also known as dental sac, is made up of mesenchymal cells and fibres surrounding the enamel organ and dental papilla of a developing teeth. It is a vascular fibrous sac containing the developing tooth and its odontogenic organ. The dental follicle (DF) differentiates into the periodontal ligament. In addition, it may be the precursor of other cells of the periodontium, including osteoblasts, cementoblasts and fibroblasts. They develop into the alveolar bone, the cementum with Sharpey's fibers and the periodontal ligament fibers respectively. Similar to dental papilla, the dental follicle provides nutrition to the enamel organ and dental papilla and also have an extremely rich blood supply.

The oral mucosa is the mucous membrane lining the inside of the mouth and consists of stratified squamous epithelium termed oral epithelium and an underlying connective tissue termed lamina propria. The oral cavity has sometimes been described as a mirror that reflects the health of the individual. Changes indicative of disease are seen as alterations in the oral mucosa lining the mouth, which can reveal systemic conditions, such as diabetes or vitamin deficiency, or the local effects of chronic tobacco or alcohol use. The oral mucosa tends to heal faster and with less scar formation compared to the skin. The underlying mechanism remains unknown but research suggest that extracellular vesicles might be involved.

Craniopharyngioma is a rare type of brain tumor derived from pituitary gland embryonic tissue that occurs most commonly in children, but also affects adults. It may present at any age, even in the prenatal and neonatal periods, but peak incidence rates are childhood-onset at 5–14 years and adult-onset at 50–74 years. People may present with bitemporal inferior quadrantanopia leading to bitemporal hemianopsia, as the tumor may compress the optic chiasm. It has a point prevalence around two per 1,000,000. Craniopharyngiomas are distinct from Rathke's cleft tumours and intrasellar arachnoid cysts.

A dentigerous cyst is an odontogenic cyst – thought to be of developmental origin – associated with the crown of an unerupted tooth. The cyst cavity is lined by epithelial cells derived from the reduced enamel epithelium of the tooth forming organ. Regarding its pathogenesis, it has been suggested that the pressure exerted by an erupting tooth on the follicle may obstruct venous flow inducing accumulation of exudate between the reduced enamel epithelium and the tooth crown.

Periapical cyst

The periapical cyst is the most common odontogenic cyst. Periapical is defined as "the tissues surrounding the apex of the root of a tooth" and a cyst is "a pathological cavity lined by epithelium, having fluid or gaseous content that is not created by the accumulation of pus." Most frequently located in the maxillary anterior region, it is caused by pulpal necrosis secondary to dental caries or trauma. The cyst has lining that is derived from the epithelial cell rests of Malassez which proliferate to form the cyst. Highly common in the oral cavity, the periapical cyst is asymptomatic, but highly significant because a secondary infection can cause pain and damage. In radiographs, it appears a radiolucency around the apex of a tooth's root.

An eruption cyst, or eruption hematoma, is a bluish swelling that occurs on the soft tissue over an erupting tooth. It is usually found in children. The fluid in the cyst is sometimes clear creating a pale-coloured cyst although often they are blue. An eruption cyst is a developmental soft-tissue cyst of odontogenic origin that forms over an erupting tooth.

Odontogenic keratocyst

An odontogenic keratocyst is a rare and benign but locally aggressive developmental cyst. It most often affects the posterior mandible and most commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of jaw cysts.

Calcifying odontogenic cyst

Calcifying odotogenic cyst is a benign odontogenic tumor of cystic type most likely to affect the anterior areas of the jaws. It is most common in people in their second to third decades but can be seen at almost any age. On radiographs, the calcifying odontogenic cyst appears as a unilocular radiolucency. In one-third of cases, an impacted tooth is involved. Microscopically, there are many cells that are described as "ghost cells", enlarged eosinophilic epithelial cells without nuclei.

The calcifying epithelial odontogenic tumor (CEOT), also known as a Pindborg tumor, is an odontogenic tumor first recognized by the Danish pathologist Jens Jørgen Pindborg in 1955. It was previously described as an adenoid adamantoblastoma, unusual ameloblastoma and a cystic odontoma. Like other odontogenic neoplasms, it is thought to arise from the epithelial element of the enamel origin.It is a typically benign and slow growing, but invasive neoplasm.

Vaginal cancer is a malignant tumor that forms in the tissues of the vagina. Primary tumors are most usually squamous cell carcinomas. Primary tumors are rare, and more usually vaginal cancer occurs as a secondary tumor. Vaginal cancer occurs more often in women over age 50, but can occur at any age, even in infancy. It often can be cured if found and treated in early stages. Surgery alone or surgery combined with pelvic radiation is typically used to treat vaginal cancer. Children can be diagnosed with advanced vaginal cancer. They are treated by surgery, radiation therapy, and chemotherapy. Vaginal cancer in children may recur. Gene therapy to treat vaginal cancer is currently in clinical trials.

Pilomatricoma Human disease

Pilomatricoma, also known as a calcifying epithelioma of Malherbe, Malherbe calcifying epithelioma, and Pilomatrixoma, is a benign skin tumor derived from the hair matrix. These neoplasms are relatively uncommon and typically occur on the scalp, face, and upper extremities. Clinically, pilomatricomas present as a subcutaneous nodule or cyst with unremarkable overlying epidermis that can range in size from 0.5-3.0 cm, but the largest reported case was 24 cm.

Odontogenic cyst are a group of jaw cysts that are formed from tissues involved in odontogenesis. Odontogenic cysts are closed sacs, and have a distinct membrane derived from rests of odontogenic epithelium. It may contain air, fluids, or semi-solid material. Intra-bony cysts are most common in the jaws, because the mandible and maxilla are the only bones with epithelial components. That odontogenic epithelium is critical in normal tooth development. However, epithelial rests may be the origin for the cyst lining later. Not all oral cysts are odontogenic cyst. For example, mucous cyst of the oral mucosa and nasolabial duct cyst are not of odontogenic origin.
In addition, there are several conditions with so-called (radiographic) 'pseudocystic appearance' in jaws; ranging from anatomic variants such as Stafne static bone cyst, to the aggressive aneurysmal bone cyst.

A cyst is a pathological epithelial lined cavity that fills with fluid or soft material and usually grows from internal pressure generated by fluid being drawn into the cavity from osmosis. The bones of the jaws, the mandible and maxilla, are the bones with the highest prevalence of cysts in the human body. This is due to the abundant amount of epithelial remnants that can be left in the bones of the jaws. The enamel of teeth is formed from ectoderm, and so remnants of epithelium can be left in the bone during odontogenesis. The bones of the jaws develop from embryologic processes which fuse together, and ectodermal tissue may be trapped along the lines of this fusion. This "resting" epithelium is usually dormant or undergoes atrophy, but, when stimulated, may form a cyst. The reasons why resting epithelium may proliferate and undergo cystic transformation are generally unknown, but inflammation is thought to be a major factor. The high prevalence of tooth impactions and dental infections that occur in the bones of the jaws is also significant to explain why cysts are more common at these sites.

Vaginal melanoma is a rare malignancy that originates from melanocytes in the vaginal epithelium. It is also known as a melanocytic tumor or as a malignant melanoma. It is aggressive and infrequently cured. The five year survival rate is approximately 21%. It was first described in 1887 and only 500 cases are found in current literature. Vaginal melanoma is 3% of all vaginal cancers and only 0.3% of all melanomas. When the neoplasm is discovered it has already become invasive and prognosis is poor. The average age of those diagnosed is sixty-years-old.

References

  1. Badni M, Nagaraja A, Kamath V. Squamous odontogenic tumor: A case report and review of literature. J Oral Maxillofac Pathol. 2012;16(1):113-7.
  2. Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.
  3. Mardones Ndo R, Gamba Tde O, Flores IL, de Almeida SM, Lopes SL. Squamous Odontogenic Tumor: Literature Review Focusing on the Radiographic Features and Differential Diagnosis. Open Dent J. 2015;9:154-8. Published 2015 May 15. doi:10.2174/1874210601509010154