PDF(Pubmed)
Abstract：
BACKGROUND: The World Health Organization\'s (WHO) chapter on odontogenic and maxillofacial bone tumors provides a global reference for diagnosis of these tumors. In the fifth edition, the inclusion of consensus definitions and development of essential and desirable diagnostic criteria help improve recognition of distinct entities. These are key enhancements since the diagnosis of odontogenic tumors is largely based on histomorphology which is taken in combination with clinical and radiographic appearances.
METHODS: Review.
RESULTS: Despite delineation of diagnostic criteria for ameloblastoma, adenoid ameloblastoma, and dentinogenic ghost cell tumor, a subset of these tumors continues to show overlapping histological features that can potentially lead to misdiagnosis. Accurate classification may be challenging on small biopsies, but potentially enhanced by refining existing diagnostic criteria and utilization of immunohistochemistry and/or molecular techniques in a specific cases. It has become clear that the clinical and histologic features of the non-calcifying Langerhans cell-rich subtype of calcifying epithelial odontogenic tumor and the amyloid-rich variant of odontogenic fibroma converge into a single tumor description. In addition, this tumor shows remarkable clinical, histological overlap with a subset of sclerosing odontogenic carcinoma located in the maxilla. Benign perineural involvement vs perineural invasion is an underexplored concept in odontogenic neoplasia and warrants clarification to reduce diagnostic confusion with sclerosing odontogenic carcinoma.
CONCLUSIONS: While controversial issues surrounding classification and discrete tumor entities are addressed in the WHO chapter, ambiguities inevitably remain. This review will examine several groups of odontogenic tumors to highlight persistent knowledge gaps, unmet needs and unresolved controversies.
METHODS: Review.
RESULTS: Despite delineation of diagnostic criteria for ameloblastoma, adenoid ameloblastoma, and dentinogenic ghost cell tumor, a subset of these tumors continues to show overlapping histological features that can potentially lead to misdiagnosis. Accurate classification may be challenging on small biopsies, but potentially enhanced by refining existing diagnostic criteria and utilization of immunohistochemistry and/or molecular techniques in a specific cases. It has become clear that the clinical and histologic features of the non-calcifying Langerhans cell-rich subtype of calcifying epithelial odontogenic tumor and the amyloid-rich variant of odontogenic fibroma converge into a single tumor description. In addition, this tumor shows remarkable clinical, histological overlap with a subset of sclerosing odontogenic carcinoma located in the maxilla. Benign perineural involvement vs perineural invasion is an underexplored concept in odontogenic neoplasia and warrants clarification to reduce diagnostic confusion with sclerosing odontogenic carcinoma.
CONCLUSIONS: While controversial issues surrounding classification and discrete tumor entities are addressed in the WHO chapter, ambiguities inevitably remain. This review will examine several groups of odontogenic tumors to highlight persistent knowledge gaps, unmet needs and unresolved controversies.
摘要：
背景：世界卫生组织（WHO）关于牙源性和颌面骨肿瘤的章节为这些肿瘤的诊断提供了全球参考。在第五版中,纳入共识定义和制定必要和理想的诊断标准有助于提高对不同实体的认识.这些是关键的增强，因为牙源性肿瘤的诊断主要基于组织形态学，并结合临床和影像学表现。
方法：审查。
结果：尽管有成釉细胞瘤的诊断标准，腺样成釉细胞瘤，和牙本质鬼细胞瘤，这些肿瘤的一部分继续显示重叠的组织学特征,这可能导致误诊.准确的分类可能是具有挑战性的小活检，但可能通过完善现有的诊断标准和在特定病例中使用免疫组织化学和/或分子技术来增强。很明显，钙化上皮牙源性肿瘤的非钙化朗格汉斯细胞丰富亚型和牙源性纤维瘤的淀粉样蛋白丰富变体的临床和组织学特征融合为单个肿瘤描述。此外,这个肿瘤显示出显著的临床，组织学上与位于上颌骨的硬化性牙源性癌的子集重叠。良性神经周受累与神经周受累是牙源性肿瘤中一个未充分开发的概念，需要澄清以减少与硬化性牙源性癌的诊断混淆。
结论：虽然在WHO章节中讨论了围绕分类和离散肿瘤实体的有争议的问题，歧义不可避免地仍然存在。这篇综述将研究几组牙源性肿瘤，以突出持续的知识差距，未满足的需求和未解决的争议。
方法：审查。
结果：尽管有成釉细胞瘤的诊断标准，腺样成釉细胞瘤，和牙本质鬼细胞瘤，这些肿瘤的一部分继续显示重叠的组织学特征,这可能导致误诊.准确的分类可能是具有挑战性的小活检，但可能通过完善现有的诊断标准和在特定病例中使用免疫组织化学和/或分子技术来增强。很明显，钙化上皮牙源性肿瘤的非钙化朗格汉斯细胞丰富亚型和牙源性纤维瘤的淀粉样蛋白丰富变体的临床和组织学特征融合为单个肿瘤描述。此外,这个肿瘤显示出显著的临床，组织学上与位于上颌骨的硬化性牙源性癌的子集重叠。良性神经周受累与神经周受累是牙源性肿瘤中一个未充分开发的概念，需要澄清以减少与硬化性牙源性癌的诊断混淆。
结论：虽然在WHO章节中讨论了围绕分类和离散肿瘤实体的有争议的问题，歧义不可避免地仍然存在。这篇综述将研究几组牙源性肿瘤，以突出持续的知识差距，未满足的需求和未解决的争议。
