Zusammenfassung
Die Gruppe der odontogenen ektomesenchymalen Tumoren wird von 3 Läsionen gebildet, dem odontogenen Fibrom (epithelarm und epithelreich), dem odontogenen Myxom und dem Zementoblastom. Während odontogene Fibrome und Zementoblastome sehr selten sind, ist das odontogene Myxom nach dem keratozystischen odontogenen Tumor, den Odontomen und dem Ameloblastom der vierthäufigste odontogene Tumor. Die Diagnose des Zementoblastoms ergibt sich aus seiner engen Assoziation mit einer Zahnwurzel. Die Abgrenzung odontogener Fibrome und Myxome kann jedoch schwierig werden, da sie histologisch große Ähnlichkeiten mit normalen Zahnstrukturen (Zahnpapille, Zahnfollikel) besitzen, wobei die letzteren häufig als odontogene Tumoren, besonders Myxome, fehlinterpretiert werden, wenn das Röntgenbild (umschriebene Osteolyse mit einem retinierten Zahn) nicht beachtet wird und andere Hinweise (oberflächliche Reste des Schmelzepithels, Dentinfragmente) nicht gesucht werden. Während odontogene Fibrome kaum rezidivieren und lokal exzidiert werden können, zeigen das Zementoblastom und insbesondere das odontogene Myxom eine ausgeprägte Rezidivneigung, sodass besonders bei Myxomen im Oberkiefer primäre Resektionen erforderlich werden, um ein Übergreifen auf Orbita oder Schädelbasis zu verhindern.
Abstract
The group of odontogenic ectomesenchymal tumors consists of odontogenic fibroma (epithelium-rich and epithelium-poor types), odontogenic myxoma, and cementoblastoma. Whereas odontogenic fibromas and cementoblastomas are very rare lesions, odontogenic myxoma is the fourth common odontogenic tumor, preceded only by keratocystic odontogenic tumor, the odontomas, and ameloblastoma. The diagnosis of cementoblastoma rests on its connection to the root of a tooth. The differentiation of odontogenic fibroma and myxoma from other lesions, especially from normal structures such as dental follicles and papillae, may be challenging if the X-ray appearance (localized osteolysis containing a tooth) is not appreciated and subtle histological clues (remainders of inner enamel epithelium at the surface of the lesion, dentin fragments) are not properly recognized. While odontogenic fibromas have almost no tendency for recurrence and are treated by enucleation or local excision, cementoblastomas and especially odontogenic myxomas have a high percentage of recurrence if intralesional procedures are applied. Hence, complete resection with free margins is recommended—at least for larger odontogenic myxomas and, especially, lesions in the maxilla—to prevent further extension to the orbita or base of the skull.
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Herrn Professor Dr. med. Wolfgang Remagen zu seinem 80. Geburtstag gewidmet
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Jundt, G., Reichart, P. Benigne odontogene ektomesenchymale Tumoren. Pathologe 29, 199–204 (2008). https://doi.org/10.1007/s00292-008-0997-z
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DOI: https://doi.org/10.1007/s00292-008-0997-z