 Hello everyone, welcome back to a new session on dentistry and more. Today's topic is amyloblastoma or adamantinoma. It is the most important topic in oral pathology that is coming under odendogenic tumors. So in odendogenic tumors we have seen AOT that is adenomatoid odendogenic tumor and the next one was C.E.O.T calcifying epithelial odendogenic tumor and the most important one is amyloblastoma. So all our odendogenic tumors is dental related tissues are the cause or the origin. It is originated from dental related tissues. Now let's move on to amyloblastoma or adamantinoma. From the name itself we get an idea about the tumor that is amyloblastoma. So amyloblastoma means venomeloblast so it is related to enamel and blastro means germ. So it is originating from enamel tissues that is why it got amyloblastoma. And another name is adamantinoma because it is adamantinoma another tumor which is seen in the longer bones. The histological similarity with that type of tumors with the amyloblastoma gave this name to amyloblastoma that is adamantinoma. So the histological similarities between the adamantinoma of longer bones. So it got two names amyloblastoma or adamantinoma. So Robinson defined this amyloblastoma as unicentric, non-functional, intermittent in growth, anatomically benign and clinically persistent. So it is a unicentric, non-functional, intermittent in growth, anatomically benign and clinically persistent tumor. So we can classify it under two headings. One is clinical classification another one is histological classification. In clinical classification the most common is central variant that is intra-ocious type. So in intra-ocious type we have two types that is the most common one that is multi-cystic variant that is conventional or multi-cystic or solid type tumors and the second one is unicistic that is in central or intra-ocious variant. The next one is extra-ocious or peripheral and another type is pituitary amyloblastoma and the last one is malignant amyloblastoma. This is clinical classification central peripheral pituitary malignant in central we have multi-cystic and unicistic and multi-cystic is the most common type. In histological type it is based on the histological appearance follicular plexiform acanthomatous granular basal cell and dysmoplastic. So it is follicular plexiform acanthomatous granular basal cell and dysmoplastic. Now let's see what are the etiological factors for amyloblastoma. The common etiologies are traumatic episodes. So the trauma happening to these structures and extraction, cystectomy and various type of fractures, infection and dietary deficiency especially vitamin D and lack of protein intake and viral infections. So all these could be etiological factors for amyloblastoma so it could be a trauma, extraction, cystectomy, fractures, infection, vitamin D, deficiency, lack of protein intake and viral infection. So in pathogenesis it is believed that it is derived either from cell rest of enamel organ, remnants of dental lamina, heart wicks sheath, epithelial rest of malasis. So all these could be the originating factor because it is originating from enamel tissues and also could be epithelium of odendogenic cyst. Most commonly the dentiture assist and odentoma and also it could be from basal cell of surface epithelium of jaw and it could be due to the disturbance of developing enamel organ and also from heterotopic epithelium of pituitary gland. So that is about pathogenesis. So we discussed the classification that is clinical and histological type, etiology and pathogenesis. So the clinical features include that most commonly seen between 20 to 50 years of age group and there is no gender predilection it is both the genders are equally affected. There is no predilection for a particular gender but the black race people are more affected than the white race and the mandible is almost affected by 80 percentage cases than maxilla only 20 percentage are restricted to maxilla and mandibular molars areas are more prone for ameloblastoma compared to the anterior or premolar areas. While moving on to the science and symptoms it is a slow growing painless, hard and non-tender avoid swelling it is a very slowly growing painless, hard non-tender avoid swelling which enlarges in size as it causes little discomfort in early stage. So at the early stage it is very asymptomatic it does not cause any pain so any other symptoms so it slowly slow rate enlarges to become a avoid swelling and large mass. So facial asymmetry will be a problem there will be mobility of teeth and exfoliation and the dentures will be ill-fitting because of this enlarged size of the maxilla or the mandible and pain or parasitia if any nerve is impinged we have various nerves in these areas we have inferior alveolar nerve we have mandibular nerve we have facial nerve so parasitia will be there affected there will be parasitia pain and there will be inability to occlude and there will be ulcerations. So it is a slowly growing painless mass because there will be very little discomfort in the early stages so it continuously grows unless it shows any very clinical evidence symptoms. In absence of treatment if it is left untreated what happens it will become extremely disfiguring fungating and ulcerative mass with axial cracking and fluctuation so it keep on increasing if it is not treated so there will be disfiguring and fungating and it will become very ulcerative and there will be axial cracking and there will be fluctuation. So the palpitation elicit heart sensation on and her crepitus also will be there. So crepitus or heart sensation on palpitation also will be seen if it is not treated. So it is not an encapsulated tumor and it invades the surrounding tissue and the bone destruction as a very common feature in amylablastoma also root resorption because it is continuously growing and it invades the surrounding tissues surrounding bones will be destroyed the root resorption will be there. So what happens if it is in case of maxilla so it is commonly affecting tuberosity it causes nasal obstruction proptosis of eye damage to the vital structure and it involves cranial base so there will be gross facial distortion if it is in the maxilla maxillary bone. So amyloblastoma is nothing but amyloblastoma from a dentigerus cyst. So the histological features it has tall columnar cell hyperchromatic nucleus palisade nucleus reverse polarity of nuclei and sub-nuclear vesicle formation. So this is histological features. So amyloblastoma it is a lengthier topic. So we have seen the basic features and clinical features science and symptoms what happens if it is not treated and in case of maxilla and about histology parts. Now we have various histological types of amyloblastoma. Now let us see the histological classification of amyloblastoma. So in histological type so it is divided into 6 types follicular plexiform acanthameters granular basal cell and decimal plastic. So it is based on the histological picture or histological detailing of amyloblastoma. So we had seen based on the clinical features also. So now let us see one by one. So in follicular pattern it is all explaining the histological pictures. So it is not very easy to draw and explain it. Anyway let me explain it without picture. So when you are writing for exam always keep pictures for any syndrome the histological explaining requires pictures. So let us see the details. Follicular type the small discreet islands of tumour cells with peripheral cuboidal or columna cells. Nuclear will be polarized and it resembles a amyloblast. Amyloblast we know the enamel forming cells and cyst formation is relatively common. Great reticulum like cells prominently enclosed by columnar or cuboidal cells. So it has nuclei polarized with peripheral columna cells and the cyst formation is common in follicular type of amyloblastoma. The second one is plexiform. The cells that is amyloblast like cells arranged in irregular masses. So here we have small discreet islands of tumour cells here it is irregular masses and network of interconnecting strands of cells and each strand is bounded by a columnar cell. The columnar cell is common in all type of amyloblastoma. So between this teletreticulum we have less prominent tissues compared to the follicular amyloblastoma. So the teletreticulum like tissues is less prominent and here it is more prominent whereas plexiform it is less prominent and areas of cystic degeneration is also common. A canthamata type the cells occupying the position of teletreticulum undergo squamous metaplasia. So teletreticulum like cells are present all the types. So acanthomatous it is the name itself saying acanthomatous we know what is acantholysis we have seen in Pemphigus. So acanthomatous is a cell to cell adhesion. So here we are getting a squamous metaplasia and keratin formation or keratin pulse is seen. Whereas granular cells it is marked transformation of teletreticula cells it becomes a coarse granular esophilic appearance type with peripheral columnar and also hyperchromatism and also reverse polarity is also seen. The basal cell type is why it is known as basal cell type basal cell amyloblastoma because it resembles basal cell carcinoma of skin that is BCC and it is the rarest form of amyloblastoma that is histological type and we can see hyperchromatic less columnar which is arranged in sheets without peripheral palisading nature. So that is about basal cell. The desmo plastic is we have dense collagen stroma which is hypocellular and hyalinized which is grow in thin strands and cords of epithelium which proliferation seems to be compressed and fragmented by hyalinized stroma. So in desmo plastic we have a collagen stroma which is hypocellular and hyalinized and this proliferation compress and fragments the hyalinized stroma. So this proliferation will compress and it make the stroma fragmented appearance in desmo plastic. So it is more of a content in amyloblastoma if it is asked for every longer question that is 14 mile question you can build up the content by writing this histological type that is follicular plexiform acanthomatous granular basal cell and desmo plastic. So every type you need to have a key point. So follicular type it is like nuclei is polarized and it resembles amyloblast plexiform. It is less prominent follicular amyloblast that is stellate reticulum type tissues less prominent here. In acanthomatous there is squamous metaplasia in granular cells this stellate reticulum becomes coarse granule granular isonophilic appearance in basal cell it looks like basal cell casinoma desmo plastic this compression and fragmentation of hyalinized stroma will be there. So most of the features are same for all but it differs that is why it got this name. So from the name itself we get an idea how it differs. So that is about histology type of amyloblastoma. The next variety is unicistic amyloblastoma. This we had seen in clinical classification where we had multisistic that is very common unicistic is not very common type. So unicistic amyloblastoma which is nothing but a single cystic cavity unlike the multisistic amyloblastoma it is seen in very younger group that is around 20 years and the gender prediction is same as multisistic. The male and female has equal chances of getting this unicistic and it is most commonly seen in 90 percentage of in mandible and that also in posterior part. And it is typically surrounds the crown of unearrupted third molar. So third molar associated amyloblastoma is unicistic one and it has basically three types that is luminal, intraluminal and murals. So luminal is nothing but the tumor is confined to the luminal surface of the cyst by fibrous connective tissue partially or totally. So this is luminal type it is confined to the luminal surface of the cyst by fibrous connective tissue. Intraluminal the tumor nodules projects from the cystic lining the tumor nodules projects from cystic lining and the mural one is the tumor infiltrates the fibrous cystic wall. So these are the three types of unicistic amyloblastoma in mural type the tumor infiltrates the fibrous cystic wall and coming to the radiographic features. So radiographic features unilocular or multi-locular radiolucency can be seen and there is a striking radiographic appearance in unicistic amyloblastoma that is honeycomb or soap bubble appearance. So honeycomb or soap bubble appearance. So it will be like compartments, compartments, soap bubble we know how soap bubble appears all will be clubbed together a bunch of soap bubbles. So the multi-locular radiolucency with compartmentalized appearance due to the bony septa. So there will be radiolucency a big radiolucency but there will be compartmentalization due to the bone septum in between. So it gives a honeycomb appearance or a soap bubble appearance that is a characteristic radiographic feature of unicistic amyloblastoma. Now we have investigation that is mostly the radiographs will be taken and we can go for biopsy and also CT MRI or ultrasound. So apart from unicistic amyloblastoma we have malignant amyloblastoma, pituitary amyloblastoma and peripheral amyloblastoma which are not very much important. So peripheral amyloblastoma is like very rare type which develops in soft tissues of ginger and mucosa and it is non-invasive whereas pituitary amyloblastoma is like it is also known as ratkis pouch tumor which involves neoplasma of CNS whereas malignant amyloblastoma it is a malignant transformation of normal amyloblastoma which is a very very rare relation. So those are the three types which we have seen in classification malignant pituitary and peripheral amyloblastoma. Now how do we go with the treatment? So what are the treatment options? We have many treatment options that is radical and conservative surgical excision, in-block resection, segmental resection, cure-attach, chemical and electrocorty, chemotherapy and radiation. So simple excision or nucleation is also there. So if we have the peripheral amyloblastoma we can do a simple excision. Enucleation or cure-attach is in peripheral amyloblastoma it is a removal of tumor by scraping it from the surrounding normal tissue. So that is enucleation or cure-attach. End-block resection is removal of tumor with a rim of uninvolved bone but maintaining the continuity of jaw. So in end-block resection we are removing a rim of uninvolved bone but we will continue or maintain the jaw, it will not be completely or it will not be segmented. Next one is segmental resection. It is removal of a segment of maxilla or mandible up to the including hemi-section or more. So end-block resection it will not be segmented only a part of normal bone will be removed. In segmental resection the segment of maxilla or mandible it may include hemi-maxillectomy or hemi-mantiblectomy and this is most commonly used treatment because it has very less chance of recurrence, segmental resections. So it is noted that the lesion most likely to recur after segmental resection are those over 5 cm. So more than 5 cm will have a chance of recurrence even after the segmental resection. So chemotherapy we know, we do chemotherapy using platinum agents, we can use cyclophosphamide cisplatin, windblastin and electrocortree is another method and we have also radiation therapy. So we finished ameloblastoma it was a very lengthy session because it has various classification based on clinical nature and the histological type then we had seen the pathogenesis, the clinical features, the radiative features and the histological type, unisistic and it is detailed and various treatment options, investigation. So ameloblastoma is an odendogenic tumor and one of the most common odendogenic tumor it is along with C.E.O.T. and A.O.T. calcifying epithelial or pinboc tumor and adenomatoid odendogenic tumor ameloblastoma. So these are very commonly asked question C.E.O.T., A.O.T. and ameloblastoma. So I will come up with a new session on dentistry and more, thank you.