 Hello everyone, welcome back to another session on dentistry and more. So today we have a new section in oral pathology that is calcifying epithelial odendogenic tumor or CEOT which is widely known as Pinburg tumor. So we have N number of tumors to cover up. So last sessions we covered various syndromes. We have covered around 9 to 10 syndromes. Now we are moving on to tumor section. And the first one is CEOT or Pinburg tumor. So let's see the details of CEOT. Calcifying epithelial odendogenic tumor CEOT or Pinburg tumor which is benign in nature epithelial in origin and odendogenic one. So odendogenic means it is nothing but which is derived from a specialized dental tissue. So Pinburg tumors are locally invasive epithelial odendogenic neoplasm which is characterized by presence of amylod material that may become calcified. So it has a peculiar amylod material which may become calcified over a period of time and it was first described by Dr. Jens J. Pinburg. Now let's move on to the pathogenesis. So according to various authors the Pinburg himself said it is originated from odendogenic epithelium some others said it is from reduced enamel epithelium of closely related an uninterrupted tooth or some are saying the possibility that it arises from rest of dental lamina or from basal cells of oral epithelium. So the origin has various theories or various concepts. It could be odendogenic epithelium, reduced enamel epithelium of an uninterrupted tooth and rest of dental lamina or basal cell of oral epithelium and it is associated with mutation of PTCH gene. While moving on to the epidemiology it is most commonly seen among 20 to 60 year old and the main age is 40 years and the male to female ratio is almost same but a little higher predilection male that is 6 to 5 ratio. And it is just one percentage of all odendogenic tumors and it has basically two types that is intraocious or central type and extraocious or peripheral type intraocious is a most common that is 94 percentage which is seen in mandible region compared to maxilla it is a posterior part of the bone mandible or maxilla. So it has mandible have twice more occurrence compared to maxilla and the peripheral type which is seen in anterior part that is extraocious type this is intraocious that is a central one peripheral one is extraocious. Supremolar molar region is a most affected one and while moving on to the clinical features which is a painless mass with slow growth and it is associated with an impacted or unirrupted tooth there will be nasal congestion epistaxis or headache and this peripheral soft tissue or extraocious type the CEOT appears most commonly as a painless firm gingival mass that is this type anterior gingival mass as it appears in peripheral or extraocious type and it shows little bit of ulceration on overlying mucosa and sometimes if we go for surgical removal and underlying bony depression or sorcerization has been seen in some cases. So these are the clinical features so we covered pathogenesis epidemiology and clinical features now let's move on to the radiographic features. So radiographic features we can see mixed radiolucent and radiopic areas and can be unilocular or multi-locular type and the most striking feature of CEOT is honeycomb or soap bubble appearance because of the scattered radiopacities can be wind-driven or snow-falling type so never forget these two honeycomb or soap bubble or snow-falling or wind-driven appearance it coming in radiographic features because of its specular radiolucent or radiopic areas. Now we have histopathology what are the cells seen in the staining process that is it is epithelial cells are present so these epithelial cells which are like polyhedral in the form of sheets, strands or nests and these cells usually closely packed with few areas showing intracellular bridges and they may have indistinct outline or isnophilic and homogenous cytoplasm and the cells resembles the cells of stratum inter-medium of enamel organ so it has epithelial cells and the next one is isnophilic material which is seen between the epithelial cells and the stroma and it is thought to be synthesized by the epithelial cells and next thing is calcified deposit that is the unique feature of this tumour that is why its name came calcifying epithelial odendogenic tumours which are seen to be associated with amylod deposits and can either be calcified amylod or calcified collision so this calcification it can be in the form of lamellae formed by the fusion of small calcific deposits at different foci and they are referred to as lisegang rings so this is another unique feature of ceot lisegang rings and how it forms the calcified deposits the lamellae formed by the fusion of small calcified deposits at different foci so different foci this calcified deposits will form and it becomes a lisegang ring and also symptom like deposition is seen only after the amylod is fully calcified so the next is it can also have a nuclear pliomorphism with intercellular bridge and amylod like material will be there cement and like components and also clear cells and it could be langer han cells so langer han cells we had seen we had discussed in our cells that is pathognomic cells we had discussed it already so clear cells and langer han cells are seen not in every cases but it is reported now we have differential diagnosis so what are the differential diagnosis so it could be amyloblastoma, regional odendodysplasia, dentiturus cyst, odendogenic keratocyst, odendogenic myxoma these all could be the differential diagnosis of ceot and treatment part treatment part is basically surgical inoculation and also in severe widespread cases should go for hemimantablectomy or hemimaxylectomy and prognosis is overall prognosis good and there is recurrence rate around 15 percentage so that is summary of calcifying epithelial odendogenic tumour the take away points is it is radiographic features that is honeycomb or soap bubble appearance and wind driven or falling snow appearance and also the lisagang rings lisagang rings it is very peculiar because it is a calcified ring so calcification happens that is a unique feature of ceot from the name itself you should understand that there is calcification and it is associated with lisagang rings so when you are writing about tumour so you should go for these subreddings like pathogenesis little bit about introduction epidemiology clinical features radiographic features histopathology and differential diagnosis treatment and prognosis and always make sure that you highlight all these striking features like honeycomb wind driven or snow falling and lisagang rings so I will come up with a new tumour in my next session in the industry and more thank you